Maternal venous hemodynamics in gestational hypertension and preeclampsia.

Wilfried Gyselaers,Anneleen Staelens,Jolien Oben,Kathleen Tomsin,Geert Molenberghs,Tinne Mesens

doi:10.1186/1471-2393-14-212

Wilfried Gyselaers, Anneleen Staelens + Show 4 more

Open Access

https://doi.org/10.1186/1471-2393-14-212

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Abstract

BackgroundTo evaluate characteristics of venous hemodynamics, together with cardiac and arterial function, in uncomplicated pregnancies (UP), non-proteinuric gestational hypertension (GH) and preeclampsia (PE).MethodsIn this observational cross-sectional study, venous hemodynamics was assessed using a standardised protocol for combined electrocardiogram (ECG)-Doppler ultrasonography, together with a non-invasive standardised cardiovascular assessment using impedance cardiography (ICG) in 13 women with UP, 21 with GH, 34 with late onset PE ≥ 34 w (LPE) and 22 with early onset PE < 34 w (EPE). ECG-Doppler parameters were impedance index at the level of hepatic veins (HVI) and renal interlobar veins (RIVI) together with venous pulse transit times (VPTT), as well as resistive and pulsatility index, and arterial pulse transit time (APTT) at the level of uterine arcuate arteries. ICG parameters were aortic flow velocity index (VI), acceleration index (ACI) and thoracic fluid content. Mann Whitney U-test, Kruskall-Wallis test and linear regression analysis with heteroskedastic variance was used for statistical analysis.ResultsRIVI in both kidneys was >15% higher (P ≤ .010) in LPE and EPE, as compared to GH and UP. Next to this, >30% lower values for VI and ACI (P ≤ .029), and > 15% lower values for APTT (P ≤ .012) were found in GH, LPE and EPE, as compared to GH.ConclusionIn comparison to UP, similar abnormalities of central arterial function and APTT were found in GH, EPE and LPE. Proteinuria of LPE and EPE was associated with increased RIVI, this was not observed in GH.

Highlights

To evaluate characteristics of venous hemodynamics, together with cardiac and arterial function, in uncomplicated pregnancies (UP), non-proteinuric gestational hypertension (GH) and preeclampsia (PE)
It has been reported that the maternal heart is subject to morphological and functional changes during uncomplicated pregnancy [5] and that this cardiac adaptation is different in women with preeclampsia [6,7] or destined to develop preeclampsia [8]
In former publications, we have reported that renal interlobar veins (RIVI) is higher in early onset PE < w (EPE) than in late onset PE ≥ w (LPE) [9] and that hepatic veins (HVI) is increased in PE, as compared to uncomplicated pregnancy (UP) [26]

Summary

Introduction

To evaluate characteristics of venous hemodynamics, together with cardiac and arterial function, in uncomplicated pregnancies (UP), non-proteinuric gestational hypertension (GH) and preeclampsia (PE). Abnormal arterial tone and increased arterial stiffness are well known features of preeclampsia [1,2] This is reflected in abnormal notching and increased pulsatility index in duplex ultrasound assessment of the uterine arteries [3] and in abnormal serum analytes in a subpopulation of pregnant women destined to develop preeclampsia [4]. It has been reported that the maternal heart is subject to morphological and functional changes during uncomplicated pregnancy [5] and that this cardiac adaptation is different in women with preeclampsia [6,7] or destined to develop preeclampsia [8]. Combined electrocardiogram - Doppler ultrasonography (ECG-D) [13,14,15] and impedance cardiography (ICG) are non-invasive methods to study maternal hemodynamics, with acceptable reproducibility and repeatability when applied according to standardized protocols [16,17,18,19,20]

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