Maternal Hemodynamics Research Articles

The Effect of Position on Maternal Haemodynamics in Late Pregnancy

The Effect of Position on Maternal Haemodynamics in Late Pregnancy

Influence of estrous cycle and gestation on cardiovascular system of bitches

The purpose of this study was to evaluate the consequences of the estrous cycle and gestation on the cardiovascular system of bitches evaluated through echocardiographic assessment. Fifteen healthy pregnant bitches aged 2 to 6 years and weighing 8.8 ± 2.5 kg were included in the study. Heart rate and blood pressure were clinically evaluated. M-mode, spectral, and tissue Doppler-echocardiography assessments were performed during the anestrous and estrous stages, every 15 days during pregnancy (15, 30, 45, and 60 days), and 45 days postpartum. The data for evaluated variables were submitted for statistical analysis. Heart rate (P = 0.286) and systolic blood pressure (P = 0.686) were not changed as a result of pregnancy or estrus, while ejection fraction (P = 0.0016) and fractional shortening (P = 0.00004) changed. The variables transmitral flow, isovolumetric relaxation time, aortic and pulmonary flow, and some variables related to myocardium movement obtained via tissue Doppler assessment varied (P < 0.05) among the reproductive periods studied. In conclusion, gestation resulted in changes in echocardiography variables, and consequently, on maternal hemodynamics, with myocardial contractility increasing during pregnancy, resulting in greater systolic efficiency and ventricular compliance.

To study the changes in maternal hemodynamics with intravenous labetalol or nifedipine in acute severe hypertension.

To study the maternal hemodynamic changes in acute severe hypertension after treatment with intravenous labetalol or oral nifedipine using color doppler ultrasound. We evaluated thirty pregnant women with gestational age between 28 and 40weeks in acute severe hypertension (more than or equal to 160/105mmHg) which were randomly allocated to receive either intravenous labetalol or oral nifedipine until blood pressure was lowered to less than or equal to 140/90mmHg. Doppler vascular indices namely pulsatility index, resistance index, S/D ratio of bilateral uterine arteries and maternal renal artery were measured baseline at the time of acute severe hypertension and repeated after control of blood pressure, to assess the changes in maternal hemodynamics if any with labetalol or nifedipine. When evaluating right uterine artery Doppler parameters, a trend to increase in PI and RI was observed in those who received labetalol and nifedipine however the difference was not statistically significant. Whereas, while evaluating left uterine artery indices a trend to decrease PI was seen in nifedipine group but the difference was not statistically significant. On intergroup comparison there was no any significant change in any of uterine artery as well as renal artery indices in either group. The use of labetalol and nifedipine were not related to any significant changes in maternal Doppler, which is reassuring about the safety of these drugs when treating acute severe hypertension in pregnancy.

Functional hemodynamic testing in pregnancy: recommendations of the International Working Group on Maternal Hemodynamics.

In the general population, functional hemodynamic testing, such as that during submaximal aerobic exercise and isometric handgrip, and the cold pressor test, has long been utilized to unmask abnormalities in cardiovascular function. During pregnancy, functional hemodynamic testing places additional demands on an already stressed maternal cardiovascular system. Dysfunctional responses to such tests in early pregnancy may predict the development of hypertensive disorders that develop later in gestation. For each of the above functional hemodynamic tests, these recommendations provide a description of the test, test protocol and equipment required, and an overview of the current understanding of clinical application during pregnancy. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Hemodynamic effects of lateral tilt before and after spinal anesthesia during cesarean delivery: an observational study.

BackgroundPost-spinal hypotension is a common maternal complication during cesarean delivery. Aortocaval compression by the gravid uterus has been assumed as a precipitating factor for post-spinal hypotension. The role of left lateral tilting position in improving maternal cardiac output after subarachnoid block (SAB) is unclear. The aim of this work is to investigate the effect of left lateral tilting on maternal hemodynamics after SAB.MethodsA prospective observational study was conducted including 105 full term pregnant women scheduled for cesarean delivery. Mean arterial pressure, heart rate, cardiac output (measured by electrical cardiometry), stroke volume, and systemic vascular resistance were recorded in three positions (supine, 150, and 300 left lateral positions) before SAB, after SAB, and after delivery of the fetus.ResultsBefore SAB, no significant hemodynamic changes were reported with left lateral tilting. A significant decrease was reported in mean arterial pressure, cardiac output, stroke volume, and systemic vascular resistance after SAB (in supine position). When performing left lateral tilting, there was an increase in cardiac output, heart rate, and mean arterial pressure. No difference was reported between the two tilt angles (150 and 300).ConclusionsChanging position of full term pregnant woman after SAB from supine to left lateral tilted position results increased cardiac output and mean arterial pressure. There is no difference between the two tilt angles (150 and 300).Trial registrationclinicaltrials.gov (NCT02828176) retrospectively registered.

Postdural puncture headache and maternal hemodynamics after single-shot and continuous spinal anesthesia using epidural kit for cesarean section

Background The aim of this study was to compare the incidence of postdural puncture headache and maternal hemodynamics after single-dose spinal anesthesia and continuous spinal anesthesia using epidural kit with prophylactic intrathecal saline injection for a cesarean section. Patients and methods Ninety patients scheduled for elective cesarean section were randomly allocated to one of the three groups. Group A (30 patients) received single-dose spinal anesthesia using a 25-G Quincke type point spinal needle. Groups B and C (30 patients each) received continuous spinal anesthesia using 18-G epidural needles and intrathecal 20-G epidural catheters. In group C, the patients received 5 ml normal saline intrathecally before local anesthetic injection and 10 ml just before catheter removal 24 h after insertion. Incidence and severity of postdural puncture headache, block characteristics, patient satisfaction, hemodynamic parameters, and incidence of complications were recorded. Results Significantly longer sensory and motor regression times with higher total bupivacaine dose in group A compared with groups B and C. The hypotension and ephedrine dose needed were significantly more in group A compared with the other two groups. Nausea and vomiting were significantly more in group A compared with the other two groups. Incidence of postdural puncture headache was 16.7% in group B and 10% in both groups A and C. Patient satisfaction was significantly more in group C compared with the other two groups. Mean arterial pressure and heart rate were significantly lower in group A compared with the other two groups at 10, 15, 20, and 25 min Conclusion Incidence of postdural puncture headache with continuous spinal anesthesia with keeping of the intrathecal catheter for 24 h and prophylactic intrathecal saline is comparable to single-dose spinal anesthesia for a cesarean section. It allows using lower doses of local anesthetic with better hemodynamic stability, fewer complications, and better patient satisfaction.

Hemodynamic and Electrocardiographic Aspects of Uncomplicated Singleton Pregnancy.

Pregnancy is associated with significant changes in maternal hemodynamics, which are triggered by profound systemic vasodilation and mediated through the autonomic nervous system as well as the renin-angiotensin-aldosterone system. Vascular function changes to help accommodate an increase in intravascular volume due to blood volume expansion associated with pregnancy while maintaining the efficiency of ventricular-arterial coupling and diastolic perfusion pressure. The heart undergoes physiological (eccentric) hypertrophy due to increased volume load and cardiac stroke work, whereas the functional change of the left ventricle remains controversial. There are changes in cardiac electrical activity during pregnancy which can be detected in the electrocardiogram that are not related to disease. Sympathetic activation is a common phenomenon during uncomplicated pregnancy and may be a compensatory mechanism induced by profound systemic vasodilation and a decrease in mean arterial pressure. Despite marked sympathetic activation, vasoconstrictor responsiveness is blunted during uncomplicated pregnancy. There are race and ethnic differences in maternal hemodynamic adaptations to uncomplicated pregnancy, which may be attributed to differences in socioeconomic status or in prevalence rates of cardiovascular risk factors.

Assessment of the effect of two doses of prophylactic onandsetron on maternal hemodynamics, neonatal outcome and spinal blockade specifications, in parturients scheduled for cesarean delivery

Objective To compare between two doses of ondansetron (2 mg, 4 mg) and ephedrine in prevention of maternal hypotension and bradycardia induced by spinal anesthesia, their effects on specifications of spinal blockade, neonatal outcome, and their side effects. Patients and methods One hundred twenty parturients ASA І or ІІ aged between 18 and 40 years, scheduled for elective cesarean section under spinal anesthesia. They were randomly divided into four equal groups. First group received intravenous I.V. 2 mg ondansetron, second group received I.V. 4 mg ondansetron, third group received 10 mg ephedrine, and the fourth group received normal saline. All the test drugs were administered as bolus dose five minutes before intrathecal injection. Mean blood pressure, heart rate, vasopressor use, spinal anesthesia specifications, neonatal outcome, and side effects were assessed. Results The fall in mean blood pressure after spinal anesthesia in ondansetron 4 mg group was the least and the greatest was in the control group. There was dropping in heart rate values after spinal anesthesia started from 5 minutes value with significance to the control group only. No significant difference between the four groups in the spinal anesthesia characters. Slight acidosis was noticed in the ephedrine group which doesn’t affect the clinical neonatal outcome. Conclusion Prophylactic bolus intravenous ondansetron 4 mg and to less extent 2 mg could decrease the fall in mean blood pressure of parturients following spinal anesthesia as well as intravenous ephedrine 10 mg with added advantage that it could decrease neonatal acidosis associated with ephedrine use.

Maternal Thyroid Function and Placental Hemodynamics

Maternal Thyroid Function and Placental Hemodynamics

Cardiovascular Sequels During and After Preeclampsia.

Preeclampsia is a pregnancy-specific disorder complicating 2%-8% of pregnancies worldwide and characterized by de novo development of hypertension and proteinuria. Current understanding of the pathophysiology of preeclampsia is limited. A main feature is disrupted spiral artery remodeling in the placenta, which restricts the blood flow to the placenta, which in turn leads to decreased uteroplacental perfusion. Impaired blood flow through the placenta might result in fetal growth restriction and secretion of several factors by the placenta-mainly pro-inflammatory cytokines and anti-angiogenic factors-which spread into the maternal circulation, leading to endothelial dysfunction, which subsequently results in disrupted maternal hemodynamics. To date, no treatment options are available apart from termination of pregnancy. Despite normalization of the maternal vascular disturbances after birth, it has become apparent that formerly preeclamptic women experience an increased risk to develop cardiovascular and kidney disease later in life. One well-accepted concept is that the development of preeclampsia is an indicator of maternal susceptibility to develop future cardiovascular conditions, although the increased risk might also be the result of organ damage caused during preeclampsia. Given the associations between preeclampsia and long-term complications, preeclampsia is acknowledged as woman-specific risk factor for cardiovascular disease. Current research focuses on finding effective screening and prevention strategies for the reduction of cardiovascular disease in women with a history of preeclampsia.

Pregnancy, prescription medicines and the potential risk of herb-drug interactions: a cross-sectional survey

BackgroundPregnant women are routinely prescribed medicines while self-medicating with herbal natural products to treat predominantly pregnancy related conditions. The aim of this study was to assess the potential for herb-drug interactions (HDIs) in pregnant women and to explore possible herb-drug interactions and their potential clinical significance.MethodsA cross-sectional survey of women during early pregnancy or immediately postpartum in North-East Scotland. Outcome measures included; Prescription medicines use excluding vitamins and potential HDIs assessed using Natural Medicines Comprehensive Database.ResultsThe survey was completed by 889 respondents (73% response rate). 45.3% (403) reported the use of at least one prescription medicine, excluding vitamins. Of those taking prescription medicines, 44.9% (181) also reported concurrent use of at least one HNP (Range 1–12). A total of 91 different prescription medicines were reported by respondents using HNPs. Of those taking prescription medicines, 44.9% (181) also reported concurrent use of at least one HNP (Range 1–12). Thirty-four herb-drug interactions were identified in 23 (12.7%) women with the potential to increase the risk of postpartum haemorrhage, alter maternal haemodynamics, and enhance maternal/fetal CNS depression.Almost all were rated as moderate (93.9%), one as a potentially major (ginger and nifedipine) and only one minor (ondansetron and chamomile).ConclusionAlmost half of pregnant women in this study were prescribed medicines excluding vitamins and minerals and almost half of these used HNPs. Potential moderate to severe HDIs were identified in an eighth of the study cohort. Healthcare professionals should be aware that the concurrent use of HNPs and prescription medicines during pregnancy is common and carries potential risks.

Maternal hemodynamics in late gestation and immediate postpartum in singletons vs. twin pregnancies.

Differences in hemodynamic changes during a cesarean section (CS) between twin and singleton pregnancies are poorly defined. The Non-Invasive Cardiac System (NICaS) is an impedance device that measures cardiac output (CO) and its derivatives. We compared maternal cardiac parameters using NICaS™ in singleton and twins before and during delivery, as well at the early puerperium in healthy women undergoing CS at term. This prospective longitudinal study included women with twin (n=27) or singleton pregnancies (n=62) whose hemodynamic parameters were assessed by NICaS before an elective CS, after spinal anesthesia, immediately after delivery, after fascia closure, and within 24-36 and 48-72h postpartum. By 24-36h postpartum, the mean arterial pressure and the total peripheral resistance equaled preoperative values in both groups. The CO increased throughout the CS and peaked immediately after delivery in the singleton group (P<0.0001), after which it abruptly began to decline until reaching a nadir 24-36h after delivery (P<0.0001), while it remained steady throughout the CS and then dropped until 24-36h after delivery in the twin group (P<0.05). None of the studied parameters differed significantly between the groups for the 24-36 and 48-72h postpartum measurements. Hemodynamic parameters immediately before, during and shortly after CS in singleton and twin pregnancies are equivalent. Further evaluations of the value of NICaS™ in assessing cardiovascular-related pregnancy complications are warranted.

Zinc is a critical regulator of placental morphogenesis and maternal hemodynamics during pregnancy in mice

Zinc is an essential micronutrient in pregnancy and zinc deficiency impairs fetal growth. We used a mouse model of moderate zinc deficiency to investigate the physiological mechanisms by which zinc is important to placental morphogenesis and the maternal blood pressure changes during pregnancy. A 26% reduction in circulating zinc (P = 0.005) was exhibited in mice fed a moderately zinc-deficient diet. Zinc deficiency in pregnancy resulted in an 8% reduction in both near term fetal and placental weights (both P < 0.0001) indicative of disrupted placental development and function. Detailed morphological analysis confirmed changes to the placental labyrinth microstructure. Continuous monitoring of maternal mean arterial pressure (MAP) revealed a late gestation decrease in the zinc-deficient dams. Differential expression of a number of regulatory genes within maternal kidneys supported observations on MAP changes in gestation. Increased MAP late in gestation is required to maintain perfusion of multiple placentas within rodent pregnancies. Decreased MAP within the zinc-deficient dams implies reduced blood flow and nutrient delivery to the placenta. These findings show that adequate zinc status is required for correct placental morphogenesis and appropriate maternal blood pressure adaptations to pregnancy. We conclude that insufficient maternal zinc intake from before and during pregnancy is likely to impact in utero programming of offspring growth and development largely through effects to the placenta and maternal cardiovascular system.

Impaired maternal hemodynamics in morbidly obese women: a case-control study.

Maternal obesity is associated with significant pregnancy complications and is a risk factor for the development of hypertensive disorders of pregnancy as well as other adverse outcomes. There are few data regarding the hemodynamic aberrations observed in maternal obesity. The aim of this study was to investigate maternal hemodynamics in morbidly obese women. This was a prospective, case-control study of morbidly obese women (body mass index (BMI) ≥ 40 kg/m2 ) and controls (BMI 20-29.9 kg/m2 ). The control population was matched for maternal age and gestational age. BMI was calculated based on maternal height and weight at the time of recruitment to the study, which occurred on the same day as the hemodynamic assessment. Pregnant women in the second or third trimester of pregnancy were included. Women who were found to be hypertensive at any time were excluded from the study. A USCOM-1A® device was used to assess hemodynamic parameters (heart rate, stroke volume (SV), cardiac output and systemic vascular resistance (SVR)). The parameters were corrected for body surface area (BSA) to provide the SV index (SVI), cardiac index (CI) and SVR index (SVRI). Mann-Whitney U-test was used to compare the medians of the hemodynamic variables between the two groups. In total, 23 morbidly obese women and 327 controls were included in the analysis. There was no difference in maternal (P = 0.506) or gestational (P = 0.693) age at recruitment between the groups. Mean arterial pressure was higher both at pregnancy booking (90 vs 80 mmHg, P < 0.001) and study recruitment (91 vs 85 mmHg, P < 0.001) in the obese group compared with the controls. Heart rate was higher in the obese group (P = 0.003), but there was no difference in SV (P = 0.271), cardiac output (P = 0.238) or SVR (P = 0.635). Following correction of these parameters for BSA, compared with the control group, SVI (34 vs 45 mL/m2 , P < 0.001) and CI (2.96 vs 3.64 L/min/m2 , P < 0.001) were significantly reduced in the obese group, whereas SVRI was significantly higher (2354 vs 1840 dynes × s/cm5 , P < 0.001). The findings of our study suggest that cardiac function is significantly altered in morbidly obese pregnant women. In order to make appropriate comparisons between individuals, it is imperative that hemodynamic parameters are indexed for BSA, as is standard practice in pediatric cardiology. The novel finding of reduced CI in morbidly obese pregnant women may explain the predisposition to pre-eclampsia and other adverse outcomes in this population and warrants further investigation. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Maternal hemodynamics: a method to classify hypertensive disorders of pregnancy

The classification of hypertensive disorders of pregnancy is based on the time at the onset of hypertension, proteinuria, and other associated complications. Maternal hemodynamic interrogation in hypertensive disorders of pregnancy considers not only the peripheral blood pressure but also the entire cardiovascular system, and it might help to classify the different clinical phenotypes of this syndrome. This study aimed to examine cardiovascular parameters in a cohort of patients affected by hypertensive disorders of pregnancy according to the clinical phenotypes that prioritize fetoplacental characteristics and not the time at onset of hypertensive disorders of pregnancy. At the fetal-maternal medicine unit of Ziekenhuis Oost-Limburg (Genk, Belgium), maternal cardiovascular parameters were obtained through impedance cardiography using a noninvasive continuous cardiac output monitor with the patients placed in a standing position. The patients were classified as pregnant women with hypertensive disorders of pregnancy who delivered appropriate- and small-for-gestational-age fetuses. Normotensive pregnant women with an appropriate-for-gestational-age fetus at delivery were enrolled as the control group. The possible impact of obesity (body mass index ≥30 kg/m2) on maternal hemodynamics was reassessed in the same groups. Maternal age, parity, body mass index, and blood pressure were not significantly different between the hypertensive disorders of pregnancy/appropriate-for-gestational-age and hypertensive disorders of pregnancy/small-for-gestational-age groups. The mean uterine artery pulsatility index was significantly higher in the hypertensive disorders of pregnancy/small-for-gestational-age group. The cardiac output and cardiac index were significantly lower in the hypertensive disorders of pregnancy/small-for-gestational-age group (cardiac output 6.5 L/min, cardiac index 3.6) than in the hypertensive disorders of pregnancy/appropriate-for-gestational-age group (cardiac output 7.6 L/min, cardiac index 3.9) but not between the hypertensive disorders of pregnancy/appropriate-for-gestational-age and control groups (cardiac output 7.6 L/min, cardiac index 4.0). Total vascular resistance was significantly higherin the hypertensive disorders of pregnancy/small-for-gestational-age group than in the hypertensive disorders of pregnancy/appropriate-for-gestational-age group and the control group. All women with hypertensive disorders of pregnancy showed signs of central arterial dysfunction. The cardiovascular parameters were not influenced by gestational age at the onset of hypertensive disorders of pregnancy, and no difference was observed between the women with appropriate-for-gestational-age fetuses affected by preeclampsia or by gestational hypertension with appropriate-for-gestational-age fetuses. Women in the obese/hypertensive disorders of pregnancy/appropriate-for-gestational-age and obese/hypertensive disorders of pregnancy/small-for-gestational-age groups showed a significant increase in cardiac output, as well as significant changes in other parameters, compared with the nonobese/hypertensive disorders of pregnancy/appropriate-for-gestational-age and nonobese/hypertensive disorders of pregnancy/small-for-gestational-age groups. Significantly low cardiac output and high total vascular resistance characterized the women with hypertensive disorders of pregnancy associated with small for gestational age due to placental insufficiency, independent of the gestational age at the onset of hypertension. The cardiovascular parameters were not significantly different in the women with appropriate-for-gestational-age or small-for-gestational-age fetuses affected by preeclampsia or gestational hypertension. These findings support the view that maternal hemodynamics may be a candidate diagnostic tool to identify hypertensive disorders in pregnancies associated with small-for-gestational-age fetuses. This additional tool matches other reported evidence provided by uterine Doppler velocimetry, low vascular growth factors in the first trimester, and placental pathology. Obesity is associated with a significantly higher cardiac output and outweighs other determinants of hemodynamics in pregnancy; therefore, in future studies on hypertensive disorders, obesity should be studied as an additional disease and not simply as a demographic characteristic.

Screening for pre-eclampsia in the first trimester: role of maternal hemodynamics and bioimpedance in non-obese patients.

To test if maternal hemodynamics and bioimpedance, assessed at the time of combined screening for PE, are able to identify in the first trimester of gestation normotensive non-obese patients at risk for pre-eclampsia (PE) and/or intrauterine growth restriction (IUGR). One hundred and fifty healthy nulliparous non-obese women (body mass index < 30 kg/m2 ) in the first trimester of pregnancy underwent assessment by UltraSonic Cardiac Output Monitor (USCOM) to detect hemodynamic parameters, bioimpedance analysis to characterize body composition, and combined screening for PE (assessment of maternal history, biophysical and maternal biochemical markers). Patients were followed until term, noting the appearance of PE and/or IUGR. One hundred and thirty-eight patients had an uneventful pregnancy (controls), while 12 (8%) developed complications (cases). USCOM showed, in cases compared with controls, lower cardiac output (5.6 ± 0.3 vs 6.7 ± 1.1 L/min, P < 0.001), lower inotropy index (1.54 ± 0.38 vs 1.91 ± 0.32 W/m2 , P < 0.001) and higher total vascular resistance (1279.8 ± 166.4 vs 1061.4 ± 179.5 dynes × s/cm5 , P < 0.001). Bioimpedance analysis showed, in cases compared with controls, lower total body water (53.7 ± 3.3% vs 57.2 ± 5.6%, P = 0.037). Combined screening was positive for PE in 8% of the controls and in 50% of the cases (P < 0.001). After identification of cut-off values for USCOM and bioimpedance parameters, forward multivariate logistic regression analysis identified as independent predictors of complications in pregnancy the inotropy index (derived by USCOM), fat mass (derived from bioimpedance analysis) and combined screening. Combined screening for PE and assessment of bioimpedance and maternal hemodynamics can be used to identify early markers of impaired cardiovascular adaptation and body composition that may lead to complications in the third trimester of pregnancy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Comparing Intravenous Phenylephrine and Ephedrine for Hypotension During Spinal Anesthesia for Elective Cesarean Section: A Randomized Double-Blind Clinical Trial

Background: Neuraxial anesthesia is an acceptable technique in pregnant females for cesarean section and up to 71% of pregnant patients have hemodynamic complications, especially hypotension. Objectives: This study aimed at comparing the effectiveness of phenylephrine versus ephedrine in treatment of maternal hypotension due to spinal anesthesia for elective cesarean section to determine drug efficacy and fewer side effects. Methods: In this randomized double blind clinical study, 124 pregnant females, who were admitted to Ali ibn Abi Talib hospital in Zahedan, Iran, between 2015 and 2016, for elective cesarean section, were selected by the Block randomization sampling method. The samples were divided to 4 groups: Group I received 5 mg ephedrine bolus, Group II was administered 10 mg bolus ephedrine, Group III were delivered phenylephrine bolus of 50 mcg, and Group IV 100 mcg phenylephrine bolus in case of hypotension. Neonatal outcome and maternal side effects, hemodynamics changes, and Apgar score were controlled and recorded. Results: In terms of hemodynamic parameters (systolic blood pressure, diastolic blood pressure, and pulse rate), there was a significant difference between the groups (P < 0.0001). The umbilical arterial pH value and base excess between ephedrine and phenylephrine groups were significantly different (P < 0.0001), and fetal acidosis in the ephedrine group was found. Nausea and vomiting was significant between the 2 groups (P = 0.03), while the incidence of nausea and vomiting in the ephedrine group was higher than the other groups. There was no difference between the 2 groups in the first- and fifth-minute Apgar (P = 1). Conclusions: Control of blood pressure during spinal 50-mcg phenylephrine is recommended.

P25.10: Maternal hemodynamics in pregnancies complicated by hypertensive disorders

P25.10: Maternal hemodynamics in pregnancies complicated by hypertensive disorders

OC07.01: Pre‐conception maternal hemodynamics is associated with subsequent development of pre‐eclampsia (PE) or intrauterine growth restriction (IUGR)

OC07.01: Pre‐conception maternal hemodynamics is associated with subsequent development of pre‐eclampsia (PE) or intrauterine growth restriction (IUGR)

OC09.02: Maternal hemodynamics in SGA fetuses that turn to IUGR and the potential efficacy of treatment

OC09.02: Maternal hemodynamics in SGA fetuses that turn to IUGR and the potential efficacy of treatment