Abstract
Hypertensive disorders of pregnancy are a major cause of poor outcome, including placental abruption, organ failure, cerebrovascular accident and disseminated intravascular coagulation. These disorders are associated with increased fetal risk of intrauterine growth restriction, intrauterine death and prematurity. Electrocardiography (ECG) recently emerged as a useful tool to evaluate cardiovascular complications during pregnancy. Specifically, left atrial abnormalities detected by standard ECG are associated with a fourfold increased risk of developing hypertensive disorders during pregnancy. The mechanisms linking left atrial abnormality on ECG with hypertensive disorders are still elusive. Several mechanisms, possibly reflected by abnormal left atrial activation on ECG, has been suggested. These include increased reactivity to angiotensin II and up-regulation of angiotensin type 1 receptors, with activation of autoantibodies targeting these receptors.
Highlights
Hypertension disorders complicate approximately 6%–11% of all pregnancies and remain leading causes of maternal and perinatal morbidity and mortality, when elevated blood pressure (BP) is due to preeclampsia, either alone or superimposed on chronic vascular disease [1,2,3].they rank among the leading causes of maternal adverse outcome, along with embolism, hemorrhage and non-obstetric injuries, accounting for almost 15% of such deaths [2].They contribute significantly to stillbirths and fetal complications including abruptio placentae, intrauterine growth restriction, premature delivery, and intrauterine fetal death [4].Hypertension in pregnancy is defined by office systolic BP ≥ 140 mmHg and/or diastolicBP ≥ 90 mmHg
According to current guidelines [5], hypertensive disorders during pregnancy are classified into four categories: (i) Pre-existing or chronic hypertension; (ii) Gestational hypertension
Epidemiological evidences supporting the worse prognosis associated with hypertension in pregnancy provide a strong basis for developing risk prediction models to identify women whose gestations may be considered at high risk for hypertensive disorders
Summary
Hypertension disorders complicate approximately 6%–11% of all pregnancies and remain leading causes of maternal and perinatal morbidity and mortality, when elevated blood pressure (BP) is due to preeclampsia, either alone or superimposed on chronic vascular disease [1,2,3]. Epidemiological evidences supporting the worse prognosis associated with hypertension in pregnancy provide a strong basis for developing risk prediction models to identify women whose gestations may be considered at high risk for hypertensive disorders. These women may require a closer surveillance and preventive treatments [4]. We critically discussed the available data supporting the concept that specific ECG patterns occurring in the first trimester of pregnancy may have clinical relevance for the risk prediction of hypertensive disorders For this purpose, we searched for clinical studies using research Methodology Filters [22,23]. We checked the reference list of identified articles and previous systematic reviews to find other relevant studies
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