O111. The association between maternal haemodynamics and pre-eclampsia: Systematic review and meta-analysis

Abstract

Objective Pre-eclampsia (PE) is associated with marked maternal cardiovascular changes before its clinical onset, at the time of clinical diagnosis, and in the postpartum period. These changes vary according to the timing of onset (early vs late) or the severity (mild vs severe) of PE.The aim of this study was to perform a systematic review and meta-analysis to quantify these cardiovascular changes associated with PE. Methods MEDLINE, EMBASE, CINAHL and The Cochrane Library were searched, using combinations of the terms pre-eclampsia, cardiac, vascular resistance, stroke volume (SV) and pregnancy hypertension. Reference lists within relevant articles and reviews were hand-searched for additional reports. Randomised controlled trials, cohort and case-control studies were included. Studies reporting data on cardiac output (CO), cardiac index (CI), SV, systemic vascular resistance (SVR) and its index (SVRI) were included. Between-study heterogeneity was assessed using the I 2 test. Results The search yielded 1943 citations, of which 56 studies were included in the review. A significant increase in SVR (weighted mean difference [WMD] 446.42, p p p p p p p =0.002) and SVR (WMD 317.33, p =0.004) were significantly lower, while the SV (WMD −9.00, p =0.002) was significantly higher after the incident pregnancy (postpartum), when complicated by PE. Conclusion Women who develop PE have significantly elevated SVR, both at the time of the clinical diagnosis and postpartum. SV may also be useful in first trimester screening for PE. However, changes in CO were not significantly different in PE before its clinical onset, at the time of diagnosis, or postpartum.