OP 30 Maternal hemodynamics in hypertensive disorders and different feto-placental growth patterns, in pregnancy and post-partum

Abstract

Maternal hemodynamics varies in different clinical phenotypes of preeclampsia: early placental damage associated with fetal growth restriction; maternal cardiovascular risk factors most frequently associated with appropriate feto-placental growth. We compared maternal hemodynamic profile during pregnancy and at 6–12 months postpartum in women affected by Hypertensive Disorder of Pregnancy (HDP), associated with two different feto-placental growth patterns. 89 patients from 24 weeks to term were enrolled in this prospective observational study: 24 HDP with appropriate for gestational age fetus (HDP-AGAf), 27 HDP with intrauterine growth restriction (HDP-IUGR), 16 normotensive women with severe IUGR (s-IUGR), 22 controls. Diagnosis of HDP was made according to the ISSHP criteria, with the exclusion of chronic hypertension. s-IUGR was defined as abdominal circumference 2SD. Maternal echocardiography was performed by a cardiologist blinded to clinical diagnosis, at recruitment and at 6–12 months postpartum. During pregnancy, HDP-IUGR showed significantly lower heart rate (HR), lower cardiac output (CO) and increased total vascular resistances (TVR), compared to controls. s-IUGR presented significantly lower CO and increased TVR, compared to controls. These profiles remained relatively unchanged at 6–12 months postpartum. HDP-AGAf showed increased CO as in control pregnancies, but significantly higher TVR; this group also presented significantly increased left ventricular mass (LVM) and relative wall thickness (RWT), and a reduced E/A ratio, indicating an impaired myocardial relaxation. In post-partum we observed persistently increased MAP values, due to high TVR, in spite of a return to normal HR and CO values. Our hypothesis, that prioritizes the feto-placental phenotype, allowed us to observe a significantly poor cardiovascular adaptation to pregnancy metabolic demands in HDP-IUGR and s-IUGR. This was profoundly different from uneventful pregnancies, characterized by increased HR and CO and low TVR. HDP-AGAf presented similar increase in HR and CO as in controls, but at the cost of diastolic function impairment and of left ventricle remodeling. In postpartum, HR and CO returned to normal, but TVR and MAP remained higher.