Abstract
Dynamic cerebral autoregulation and cerebral perfusion pressure are altered in pregnancies complicated by preeclampsia compared with normotensive pregnancies, but the connections of dynamic cerebral autoregulation, cerebral perfusion pressure, and cerebral complications in preeclampsia remain unclear. This study aimed to assess dynamic cerebral autoregulation and cerebral perfusion pressure after delivery in women with eclampsia, in women with preeclampsia both with and without severe features, and in normotensive women. This was a prospective case control study at a large referral hospital in Cape Town, South Africa. The recruitment of participants was done at diagnosis (cases) or at admission for delivery (controls). Transcranial Doppler examinations with continuous noninvasive blood pressure measurements and end-tidal CO2 monitoring were conducted for cases and controls after delivery. Cerebral perfusion pressure and dynamic cerebral autoregulation index were calculated, and values were compared among groups. We included 16 women with eclampsia, 18 women with preeclampsia with severe features, 32 women with preeclampsia without severe features, and 21 normotensive women with uncomplicated pregnancies. Dynamic cerebral autoregulation was depressed in pregnant women with eclampsia; (autoregulation index, 3.9; interquartile range, 3.1-5.2) compared with all other groups (those with preeclampsia with severe features, autoregulation index, 5.6 [interquartile range, 4.4-6.8]; those with preeclampsia without severe features, autoregulation index, 6.8 [interquartile range, 5.1-7.4]; and normotensive controls, autoregulation index, 7.1 [interquartile range, 6.1-7.9]). Pregnant women with eclampsia had increased cerebral perfusion pressure (109.5 mm Hg; interquartile range, 91.2-130.9) compared with those with preeclampsia without severe features and those with normal blood pressure (84 mm Hg [interquartile range, 73.0-122.0] and 80.0 mm Hg [interquartile range, 67.5-92.0], respectively); furthermore, there was no difference in cerebral perfusion pressure between pregnant women with eclampsia and pregnant women with preeclampsia with severe features (109.5 mm Hg [interquartile range, 91.2-130.9] vs 96.5 mm Hg [interquartile range, 75.8-110.5]). Cerebral perfusion pressure and dynamic cerebral autoregulation are altered in eclampsia and may be important in the pathophysiological pathway and constitute a therapeutic target in the prevention of cerebral complications in preeclampsia.
Highlights
Preeclampsia (PE), defined as hypertension with end-organ dysfunction after 20 weeks of gestation, is a multisystem disorder that complicates 4% to 6% of all pregnancies.[1,2] Cerebral complications, which include convulsions, cerebral edema, and hemorrhage, often result in severe maternal morbidity and mortality.[3]
This study showed that depressed Dynamic cerebral autoregulation (DCA) may be an important pathophysiological mechanism in the pathophysiology of cerebral edema and eclampsia in pregnancies complicated by PE
This study was conducted from April 2018 to March 2020 during which time 316 women were included in the Preeclampsia Obstetric Adverse Events (PROVE) biobank
Summary
Preeclampsia (PE), defined as hypertension with end-organ dysfunction after 20 weeks of gestation, is a multisystem disorder that complicates 4% to 6% of all pregnancies.[1,2] Cerebral complications, which include convulsions, cerebral edema, and hemorrhage, often result in severe maternal morbidity and mortality.[3]. OBJECTIVE: This study aimed to assess dynamic cerebral autoregulation and cerebral perfusion pressure after delivery in women with eclampsia, in women with preeclampsia both with and without severe features, and in normotensive women. Dynamic cerebral autoregulation was depressed in pregnant women with eclampsia; (autoregulation index, 3.9; interquartile range, 3.1e5.2) compared with all other groups (those with preeclampsia with severe features, autoregulation index, 5.6 [interquartile range, 4.4e6.8]; those with preeclampsia without severe features, autoregulation index, 6.8 [interquartile range, 5.1e7.4]; and normotensive controls, autoregulation index, 7.1 [interquartile range, 6.1e7.9]). Pregnant women with eclampsia had increased cerebral perfusion pressure (109.5 mm Hg; interquartile range, 91.2e130.9) compared with those with preeclampsia without severe features and those with normal blood pressure (84 mm Hg [interquartile range, 73.0e122.0] and 80.0 mm Hg [interquartile range, 67.5e92.0], respectively); there was no difference in cerebral perfusion pressure between pregnant women with eclampsia and pregnant women with preeclampsia with severe features (109.5 mm Hg [interquartile range, 91.2e130.9] vs 96.5 mm Hg [interquartile range, 75.8e110.5]). 94% of women with eclampsia or PE were on antihypertensive medications at the time of examination
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