Maternal Hemodynamics Research Articles

84. Central and uterine haemodynamics in hypertensive disorders of pregnancy

Background Placental disorders such as hypertensive disorders of pregnancy (HDP) and are associated with de novo changes in uterine artery pulsatility index (PI) and cardiovascular indices. The aim of this study is to explore the relationship between central and uterine haemodynamics in pregnancies complicated by HDP compared to controls. Methods A prospective study involving ongoing third trimester pregnancies complicated by HDP, as well as healthy controls. Maternal central haemodynamics were measured using an USCOM-1A® device and uterine artery Doppler assessments were carried out by a standardised technique. Indices that varied physiologically with gestation or maternal characteristics were corrected for by calculating multiples of the median (MoM). Results The study included 211 HDP and 446 control pregnancies. Compared to controls, HDP pregnancies had significantly (all p Conclusion HDP pregnancies are associated with altered central maternal haemodynamics – namely reduced cardiac output and increased systemic vascular resistance. Maternal haemodynamics is further deranged with more severe phenotypes of HDP. Changes in third trimester uterine artery PI are likely to be a consequence rather than the cause of modified central haemodynamics in HDP.

125. Peripheral maternal haemodynamic adaptation across gestation in hypertensive disorders of pregnancy

Introduction Preeclampsia is characterized by haemodynamic maladaptation but the timing of its onset is controversial. Objective To evaluate maternal haemodynamics across pregnancy in hypertensive disorders of pregnancy (HDP) compared to uncomplicated pregnancies. Study design Prospective cohort study from 2015–2018 of healthy, nulliparous, singleton-bearing women. Maternal haemodynamic adaptation between 11 and 32 weeks’ gestation in pregnancies complicated by HDP: preeclampsia with severe (sPE) and without severe features (nsPE), gestational hypertension (GH) and occasionally hypertensive (OH) were compared uncomplicated pregnancies using mixed-effects linear modelling. Main outcome measures Maternal haemodynamics assessed by Uscom BP+ [peripheral and central blood pressure (BP), augmentation index (AIx)] in uncomplicated pregnancies and those complicated by HDP. Results Maternal haemodynamics at 11 weeks’ were different in all hypertensive groups compared to uncomplicated pregnancies (n = 286). When corrected for initial measurement, women who developed sPE (n = 12) and nsPE (n = 49) had a relative haemodynamic maladaptation by 34 weeks’. Compared to those with uncomplicated pregnancies, preeclamptics showed an additional increase in peripheral systolic BP [SBP; 14.33 mmHg, 8.61–20.05 (sPE)], peripheral diastolic BP [DBP; 7.70 mmHg, 3.31–12.09 (sPE); 2.58 mmHg, 3.31–12.09 (nsPE)], peripheral mean arterial pressure [MAP; 10.60 mmHg, 5.75–15.45 (sPE); 3.39 mmHg, 0.83–5.96 (nsPE)], peripheral pulse pressure [PP; 6.63 mmHg, 2.13–11.13 (sPE)], central SBP [15.83 mmHg, 10.43–21.22 (sPE); 2.94 mmHg, 0.08–5.80 (nsPE)], central DBP [8.26 mmHg, 3.89–12.64 (sPE); 2.46 mmHg, 0.15–4.78 (nsPE), central MAP [10.79 mmHg, 6.39–15.19 (sPE); 2.62 mmHg, 0.29–4.95 (nsPE)], central PP [7.57 mmHg, 3.85–11.28 (sPE)] and AIx decreased less (15.48% 6.32–24.65 (sPE); 9.00% (4.15–13.56 (nsPE)]. Haemodynamic adaptation in women who developed GH (n = 25) and OH (n = 33) was similar to those with uncomplicated pregnancies. Conclusion Haemodynamic adaptation in women who develop preeclampsia was altered, while those who develop GH or OH had comparable haemodynamic changes, to those with uncomplicated pregnancies. These data indicate that women with preeclampsia fail to undergo proper cardiovascular adaptation to pregnancy. This occurs as early as the first trimester.

123. Peripheral maternal haemodynamic gestation across pregnancy in gestational diabetes mellitus

Introduction Haemodynamic maladaptation has been associated with gestational diabetes mellitus (GDM), a risk factor for hypertensive disorders of pregnancy. Recent RCT’s suggested that metformin treatment may reduce the risk for preeclampsia in very obese women. Objectives To evaluate maternal haemodynamics across gestation in uncomplicated pregnancies and those complicated by GDM. Study design Prospective cohort study from 2015 to 2018 of healthy, nulliparous, singleton-bearing women. Maternal haemodynamics assessed at 11 and 32 weeks’ gestation in pregnancies complicated by GDM, grouped by treatment: diet, metformin or insulin, compared to uncomplicated pregnancies using mixed-effects linear modelling. Main outcome measures Maternal haemodynamics assessed by Uscom BP+ [peripheral and central blood pressure (BP), and augmentation index (AIx)] in uncomplicated pregnancies and those complicated by GDM. Results Eighty-five women developed GDM (insulin: 19, metformin: 12, diet: 53) and 294 women had uncomplicated pregnancies. All 379 women showed a mean increase in peripheral systolic BP (SBP; 2.89 mmHg, 1.75–4.02), peripheral diastolic BP (DBP; 2.06 mmHg, 1.20–2.92), peripheral mean arterial pressure (MAP; 1.85, 0.90–2.80), central DBP (2.36 mmHg, 1.49–3.22), central MAP (1.39 mmHg, 0.55–2.24) but not peripheral pulse pressure (PP) nor central SBP across gestation. Central PP decreased across gestation (2.88 mmHg, 2.14–3.63), as did AIx (18.22%, 16.57–19.96). AIx decreased less in women with diet-controlled GDM (9.27%, 4.78–13.77) and metformin-controlled GDM (8.76%, 0.33–17.18), but not in those with insulin-controlled GDM, compared to uncomplicated pregnancies. Changes across gestation for peripheral SBP, DBP, MAP, PP and central SBP, DBP, MAP and PP were not different in women with GDM compared to those with uncomplicated pregnancies. Conclusion Across gestation, AIx decreased less in women with diet-controlled and metformin-controlled GDM, compared to those with uncomplicated pregnancies. Those with insulin-controlled GDM showed comparable haemodynamic adaptation to those with uncomplicated pregnancies. This suggests that women with diet-controlled or metformin-controlled GDM have cardiovascular maladaptation to pregnancy which disappears with insulin treatment.

81. Maternal cardiovascular changes secondary to sildenafil intake in pregnancies complicated by severe fetal growth restriction: STRIDER trial

Background Fetal growth restriction (FGR) is associated with maternal cardiovascular changes. Sildenafil, a phosphodiesterase type 5 inhibitor, potentiates the actions of nitric oxide and could alter maternal haemodynamics. The main aim of this study was to investigate the effect of sildenafil on maternal haemodynamics in pregnancies complicated by severe early-onset FGR. Methods In this multicentre, placebo-controlled trial, we randomly assigned 135 women with singleton pregnancies and severe early-onset FGR (defined as a combination of estimated fetal weight or abdominal circumference below 10th centile and absent/reversed end diastolic flow in the umbilical artery on Doppler velocimetry diagnosed between 22+0 and 29+6 weeks’ gestation) to either sildenafil 25 mg three times daily or placebo until 32+0 weeks’ gestation or delivery. The maternal blood pressure (BP), heart rate (HR), augmentation index, pulse wave velocity (PWV), cardiac output, stroke volume (SV) and total peripheral resistance were recorded before, one hour after, and 48–72 h post-randomisation, and postnatally. Results Sildenafil increased maternal HR by 4 bpm more than placebo did [5 bpm (95%CI:1,12) vs 1 (−5,8); P = 0.004] and reduced systolic BP by 1 mmHg more than placebo [−4 mmHg (−9,1) vs −3 mmHg (−8,5); P = 0.048]. Even after adjusting for maternal BP, sildenafil reduced aortic PWV by 0.6 m/s more than placebo [−0.90 m/s (−1.31,−0.51) vs −0.26 (−0.75,0.59); P = 0.001]. Sildenafil was associated with a non-significant decrease in the SV index [−5.5 m/m[b]/beat (−11,−0.5) vs 0 (−0.5,4); P = 0.056]. Conclusions Sildenafil increases HR, reduces BP and reduces arterial stiffness in pregnancies complicated by FGR. These changes are modest and their clinical impact on mother and baby, both short- and long-term, remains uncertain.

Re: Maternal hemodynamics in normal pregnancy and in pregnancy affected by pre-eclampsia. D. Stott, O. Nzelu, K. H.Nicolaides and N. A. Kametas. Ultrasound Obstet Gynecol 2018; 52: 359-364.

Linked Comment: Ultrasound Obstet Gynecol 2018; 52: 359–364

Maternal hemodynamics in normal pregnancy and in pregnancy affected by pre-eclampsia.

To determine if, in a high-risk group of women in the first half of pregnancy, those who develop pre-eclampsia (PE) with fetal growth restriction (FGR) demonstrate distinct hemodynamics compared with those with PE in the absence of FGR (PE only). Cardiac output (CO), peripheral vascular resistance (PVR) and mean arterial pressure (MAP) were measured at the first hospital visit at 9-24 weeks' gestation in 69 women who had chronic hypertension and 67 who had had a hypertensive disorder in a previous pregnancy. These women were divided into five groups according to pregnancy outcome. In total, 19 subsequently developed PE only, 22 developed PE with FGR, 17 developed pregnancy-induced hypertension, 39 had chronic hypertension without PE or FGR and 39 had had a hypertensive disorder in a previous pregnancy without PE, pregnancy-induced hypertension or FGR in the index pregnancy. The hemodynamic values in each of these groups were compared with those in a cohort of 300 low-risk women with normal pregnancy. In all the high-risk groups, PVR and MAP were higher than in women with a normal pregnancy, but CO was lower in the group of women with PE and FGR, whereas in the other high-risk groups, it was not significantly different from normal. In women who develop PE, there is evidence of high PVR and MAP from the first half of pregnancy, whilst PE and FGR are associated with failure in physiological expansion of CO. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Assessment of venous hemodynamics and volume homeostasis during pregnancy: recommendations of the International Working Group on Maternal Hemodynamics.

Venous hemodynamics and volume homeostasis are important aspects of cardiovascular physiology. However, today their relevance is still very much underappreciated. Their most important role is maintenance and control of venous return and, as such, cardiac output. A high-flow/low-resistance circulation, remaining constant under physiological circumstances, is mandatory for an uncomplicated course of pregnancy. In this article, characteristics of normal and abnormal venous and volume regulating functions are discussed with respect to normal and pathologic outcomes of pregnancy, and current (non-invasive) methods to assess these functions are summarized. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

The effect of supine positioning on maternal hemodynamics during late pregnancy

Introduction: Recent studies have demonstrated an association between maternal supine sleep position and an increased risk of late stillbirth. During late pregnancy, the gravid uterus compresses the inferior vena cava (IVC) when a woman lies in the supine position. The azygos system of veins is the dominant pathway of collateral venous return back to the heart in the event of acute obstruction of the IVC. It is suggested that this pathway provides adequate collateral venous circulation in the event of IVC compression in the supine position during late pregnancy.Objective: Investigate the effect of supine positioning on maternal hemodynamics during late pregnancy and the role of collateral venous circulation.Methods: Ethics approval was obtained and 12 women with singleton pregnancies between 35- and 38-week gestation underwent magnetic resonance imaging in the supine and left lateral decubitus positions using a Skyra 3T system (Siemens). Phase-contrast images were evaluated to measure cardiac output, blood flow through the azygos vein, and blood flow through the abdominal aorta (AA) and IVC at two levels: at the level of aortic bifurcation and immediately above the renal veins.Results: The supine position was associated with a 16.4% reduction in cardiac output when compared to the left lateral position. In addition, blood flow through the IVC decreased at its origin by 85.3% and by 44.4% at the level of the renal veins. Blood flow through the azygos vein increased in the supine position by 220%. Blood flow through the AA at the level of the renal veins did not differ significantly; however, it is reduced by 32.3% at the level of the aortic bifurcation.Conclusions: Women in late pregnancy experience an increase in collateral venous blood flow when lying supine, likely as a response to marked compression of the IVC in this position. However, cardiac output and aortic blood flow were found to decrease while in the supine position.

Managing spinal hypotension during caesarean section: An update

Hypotension is common after spinal local anaesthesia for caesarean section. However, the substandard treatment of spinal hypotension and associated complications are responsible for up to two-thirds of deaths that occur in South Africa (SA) for caesarean section under spinal anaesthesia. In some cases, spinal hypotension may be predicted by simple parameters such as age >25 years, preoperative heart rate >90 bpm and preoperative mean arterial pressure <90 mmHg. Heart rate variability and point-of-care echocardiography also predict hypotension with greater accuracy, but are limited by equipment and training issues. Spinal anaesthesia is absolutely contraindicated if the parturient is hypovolaemic. Left lateral tilt is still advised, despite the absence of strong supporting evidence. The dose of spinal bupivacaine should not be reduced in obese patients. Crystalloid co-loading is an adequate fluid strategy in most cases, but is of limited efficacy in the prevention of hypotension. It is imperative that immediately after the patient is placed supine, close attention is paid to communication with her, heart rate changes and pulse volume. Early intervention with phenylephrine is the first-line approach for hypotension if heart rate is preserved under spinal anaesthesia. Phenylephrine infusions (25 - 50 μg/min) are easy to administer, maintain baseline maternal haemodynamics and are applicable to the SA context. The vigilant use of phenylephrine boluses (50 - 100 μg), targeting maternal heart rate as a surrogate for cardiac output, is also effective. Noradrenaline has been used successfully to prevent spinal hypotension, but evidence does not yet suggest practice change. Local and international guidelines have recently been published.

Re: Maternal hemodynamics in normal pregnancy: reference ranges and role of maternal characteristics. D. Vinayagam, B. Thilaganathan, O. Stirrup, E. Mantovani and A. Khalil. Ultrasound Obstet Gynecol 2018; 51: 665-671.

Linked Comment: Ultrasound Obstet Gynecol 2018; 51: 665–671

Abstract 128: Disruption of Methylarginine Metabolism Impairs Vascular Homeostasis During Pregnancy

Endogenously produced asymmetrically methylated forms of L-arginine (ADMA) competitively inhibit all three isoforms of nitric oxide synthase enzymes and therefore have the potential to exert significant cardiovascular effects. Elevated circulating ADMA concentrations have been reported in a number of cardiovascular disease states, including preeclampsia, suggesting that impaired ADMA metabolism may contribute to pathology. In order to test the causal relationship between ADMA concentrations and hemodynamics in pregnancy we employed radiotelemetric measurement of hemodynamic function in mice with either global or fetal-specific deletion of the predominant ADMA metabolising enzyme dimethylarginine dimethylaminohydrolase 1 (DDAH1). Global deletion of DDAH1 in non-pregnant female mice caused an elevation in circulating ADMA concentrations (2.851±0.289 vs 1.216±0.072 μM p&lt;0.01) and blood pressure (118±2.28 vs 110.36±0.82 mmHg p&lt;0.05). During the first and second trimesters of pregnancy DDAH1 -/- mice showed no further elevation in ADMA and normal pregnancy related changes in blood pressure were observed. However, during the third trimester ADMA levels in DDAH1 -/- mice increased further and this was associated with increased concentrations of sEng and sFlt1 (2288±301.58 vs 1181.35 ± 161.83 pg/ml p&lt;0.01 and 153.31 ± 8.57 vs 114.42 ± 8.79 ng/ml p&lt;0.001) and an exaggerated hypertensive response (115.773 ± 3.7 vs 101.93 ± 3.27 mmHg p&lt;0.05). Fetal-specific deletion of DDAH1 elevated fetal ADMA concentrations (4.97 ± 0.29 μM vs 1.7 ± 0.12 μM p&lt;0.001) but did not impact on maternal ADMA concentrations or blood pressure during early pregnancy. However in the third trimester a significant elevation in maternal ADMA concentrations was detected (2.49 ± 0.17 vs 1.75 ± 0.13 μM p&lt;0.01) and was associated with an elevation in maternal blood pressure. No changes in sEng or sFLt1 were detectable in fetal-specific DDAH1 -/- mice. Our data indicate that elevated ADMA is sufficient to increase levels of sFLlt1 and sEng and disrupt maternal hemodynamics. The fetus is a significant source of ADMA in late pregnancy suggesting that dysfunctional fetal ADMA metabolism is sufficient to impair maternal hemodynamic function.

Effect on neonatal outcome of pharmacological interventions for attenuation of the maternal haemodynamic response to tracheal intubation: a systematic review.

The primary aim of this systematic review was to assess the effect on neonatal outcome of pharmacological interventions used for attenuation of the haemodynamic response to tracheal intubation in patients undergoing caesarean section under general anaesthesia. A systematic search of randomised controlled trials from 1990 to 2015 was conducted. The primary outcome measure was the Apgar score at five minutes and secondary outcomes were umbilical arterial blood gas parameters and neurological adaptive capacity scores. Twenty-seven randomised controlled trials (1,689 patients) were included in the qualitative synthesis. Only five studies using opioids (383 patients) and five studies using non-opioid analgesics (358 patients) were subjected to meta-analysis. The Apgar score at five minutes was significantly lower in neonates of opioid-treated mothers (mean difference: -0.29, 95% confidence interval -0.56 to -0.02, <i>P</i>-value=0.03) compared to mothers in the control group; the umbilical arterial pH was lower and there was a higher requirement for tactile stimulation in neonates. No difference was seen in Apgar scores of neonates of mothers administered non-opioid analgesics compared to placebo. No difference was observed in other parameters between opioid- or non-opioid-treated mothers. This review suggests that opioid interventions for attenuation of the haemodynamic response to tracheal intubation in pregnant patients under general anaesthesia affect neonatal Apgar scores at five minutes in neonates but the difference did not appear to be clinically meaningful. We were unable to demonstrate any difference in safety.

Comparison of barbotage and single injection applied to combined spinal and epidural anesthesia in cesarean section

Objective Comparing the outcome of barbotage(Bbt) and single injection applied to combined spinal and epidural anesthesia(CSEA) in cesarean section, including sensation block effect, motor block effect, changes of maternal hemodynamics, neonatal Apgar scores. Methods One hundred ASA Ⅱ parturients of 20-40 years with full-term pregnancy were scheduled for cesarean delivery under L2-L3 CSEA were included. They were randomly divided into 2 groups with 50 cases each group. 0.5% ropivacaine 2.2 ml(11 mg) were used in all patients. A Bbt technique was carried out in group B: 1st step, inject 1.1 ml of 2.2 ml total solution and withdrawing back to 2.1 ml, 2nd step, inject 1.1 ml of 2.1 ml solution and withdrawing back to 1.6 ml, 3rd step, inject 1.1 ml of 1.6 ml solution and withdrawing back to 1.1 ml, 4th step, inject the rest solution into subarachnoid space. The total injection time of group B is 44 s with an average speed of 0.1 ml/s. Single injection is carried out in group S within 22 s and same average speed. Dopamine and phenylephrine were used to stabilize maternal circlatory system. Record maternal blood pressure, heart rate, level of sensory block, Bromage score, usage of vasoactive drugs and local anesthetics at time of resting(t0) and 4 min(t1), 6 min(t2), 8 min(t3), 10 min(t4) min after injection. Record perioperative adverse reaction and condition of newborns. Results The speeds of block sensory level rising: group B>group S(P group S(P group S(P 0.05). Conclusions In the spinal anesthesia of cesarean section, Bbt provides wider distribution of local anesthetics in subarachnoid space, which leads to faster nerve block and higher block level with more stable blood pressure and HR. Key words: Barbotage; Ropivacaine; Combined spinal and epidural anesthesia; Cesarean section

Maternal hemodynamics in normal pregnancy: reference ranges and role of maternal characteristics.

The main aim of this study was to construct reference ranges of maternal central hemodynamic parameters during pregnancy. The second aim was to determine the maternal and pregnancy characteristics that influence these hemodynamic parameters. This was a prospective cohort study of low-risk pregnant women attending for routine antenatal care at St George's Hospital, London, UK. Exclusion criteria included any medical disorder present at the time of study recruitment, or development of hypertension or intrauterine fetal growth restriction following study recruitment. Stroke volume (SV), cardiac output (CO) and systemic vascular resistance (SVR) were obtained using non-invasive cardiac output monitoring (USCOM-1A®). USCOM-1A utilizes a non-imaging probe in the suprasternal notch to obtain velocity-time integrals of transaortic blood flow at the left ventricular outflow tract. Once the distribution of the data with respect to gestational age had been determined, maternal characteristics were added to the model to test whether they provided a significant improvement in the prediction of the median value. The study included 627 women with a singleton pregnancy. The estimated median CO was constant for a maternal age above 32 years, but was around 0.5 L/min higher for women aged ≤ 25 years (P < 0.001). Maternal weight (P < 0.001) and height (P < 0.001) significantly affected CO values and there was a significant interaction (P = 0.002) between them. In women with a height of less than 1.60 m, there was no association between median CO and weight; however, in those with a height exceeding 1.60 m, an increase in weight was associated with an increase in CO. SV was primarily associated with height (P < 0.001), although some positive association with weight (P < 0.001) could also be observed within the normal body-mass-index range. Greater height (P < 0.001) was associated with lower median values of SVR, with an estimated difference of around 120 dynes × s/cm5 between 1.60 m and 1.80 m. Advancing maternal age was associated with higher median SVR, with an estimated difference of around 50 dynes × s/cm5 between 25 and 35 years. Smokers had a lower SVR by 73.5 (95% CI, 8.6-138.4) dynes × s/cm5 . Maternal hemodynamics are influenced significantly by maternal age, height and weight. We provide USCOM-1A-specific reference ranges and a calculator for SV, CO and SVR in uncomplicated pregnancies that correct for maternal age, height and weight. This should enable clinical application and comparison in both uncomplicated and pathological pregnancies. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Effect of a nitric oxide donor on maternal hemodynamics in fetal growth restriction

To evaluate the effect on maternal cardiovascular parameters of treatment with a nitric oxide (NO) donor and plasma volume expansion in pregnancies complicated by fetal growth restriction (FGR). Twenty-six pregnant women with a diagnosis of FGR were treated with transdermal patches of a NO donor and plasma volume expansion by co-administration of oral fluids. We compared the treated group to a historical control group of untreated FGR patients. Hemodynamic indices were obtained using the UltraSonic Cardiac Output Monitor system. At diagnosis, the two groups were similar in terms of maternal and hemodynamic characteristics. In the treated group, we found a significant increase in maternal cardiac output and stroke volume and a decrease in systemic vascular resistance after 2 weeks of therapy. No significant differences were found 2 weeks after diagnosis in the untreated group. The treated group delivered infants with higher birth-weight centile than did the untreated control group. The combined therapeutic approach of NO donor administration and plasma volume expansion in FGR apparently improves significantly maternal hemodynamic indices. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Neural Network of the gestosis diagnosis system

Introduction. The work is devoted to the increase of the information content of the methods of express diagnostics of the state of the cardiovascular system of pregnant women by developing a diagnostic monitoring system and assessment of the state of hemodynamics of pregnant women due to the use of neural network technologies. Currently, gestosis is one of the most urgent problems of modern obstetrics due to the prevalence and complexity of etiopathogenesis, the absence of early and reliable diagnostic criteria, effective prevention and treatment measures, high maternal and perinatal morbidity and mortality, as well as large economic costs of intensive care for patients. The proposed approach to optimization of the diagnosis of preeclampsia using registration key hemodynamic parameters, which allows to objectively evaluate the hemodynamics in pregnant women with preeclampsia, to determine the type of hemodynamics in pregnant women and to monitor the effectiveness of the therapy. Neural network technologies for the analysis and processing of medical data. The synthetic structure of the artificial neural network has shown the effectiveness of its use for diagnosis of gestation, using real clinical data. The basis of the diagnostic system was the artificial neural network, using the application package Statistica. Hybrid network as an adaptive system of neuro-fuzzy output system. In order to diagnose gestosis, we synthesized a neural network that allowed us to classify the pathologies of pregnant women on the basis of oscillometric data, using neural-fuzzy modeling in the Matlab environment. In the framework of this work, the ANFIS editor was used to build the model that would help create or load a specific model of the adaptive neuro-fuzzy inference system, perform its training, visualize its structure, change and adjust its parameters, and use the configured network to obtain the results of fuzzy inference. The findings of the tests, show that with the introduction of 7 basic parameters characterizing the state of a pregnant woman, the produced result is in the form of a definition of the type of hemodynamics and the degree of gestosis. The determination of the type of hemodynamics and the degree of gestosis allows the diagnostician and the obstetrician-gynecologist to assess the critical state of the pregnant woman at the time of the study and to take the necessary treatment measures. Conclusion. In order to diagnose gestosis, a neural network was synthesized, which allowed classifying the pathology of pregnant women using neuro-fuzzy simulation in a Matlab environment. The application of the proposed system helps choose the tactics of treating a patient diagnosed with gestosis according to individually selected therapy, monitoring its effectiveness, which will have a positive effect on the course and outcome of pregnancy; most importantly, controlling the state of maternal hemodynamics will eliminate the unreasonable use of medications.

Effects of betamethasone on fetoplacental and maternal hemodynamics in preterm pregnancies.

To evaluate the possible effects of prenatal steroid administration onDoppler parameters of the umbilical artery, uterine artery, middle cerebral artery, and ductus venosus, the cerebroplacental ratio, and the amniotic fluid index in pretermfetuses. The present prospective observational study was performed at the Perinatology Department of Trakya University, Edirne, Turkey, between June 1, 2015, and September 1, 2016. It included patients with healthy singleton pregnancies who had received betamethasone at 24-34weeks of pregnancy. Doppler parameters were measured before (0hours) and 24, 48, and 72hours after the administration of betamethasone (two intramuscular doses of 12mg each, administered 24hours apart). There were 68 patients included. Pairwise comparisons demonstrated that, at 72hours after betamethasone administration, the umbilical artery resistance index (P=0.038), the middle cerebral artery systolic/diastolic velocity ratio (P=0.007), and the amniotic fluid index (P=0.017) were reduced, whereas the end-diastolic velocity of the middle cerebral artery was increased (P=0.012), compared with baseline values. Betamethasone had favorable effects on fetal cerebral circulation, with increased end-diastolic velocity in the middle cerebral artery; this could represent a positive effect on cerebral blood circulation and decreased flow resistance in the umbilical artery.

The effects of metformin on maternal haemodynamics in gestational diabetes mellitus: A pilot study

BackgroundGestational diabetes mellitus (GDM) is a major clinical challenge and is likely to remain so as the incidence of GDM continues to increase. AimTo assess longitudinal changes in maternal haemodynamics amongst women diagnosed with GDM requiring either metformin or dietary intervention in comparison to low-risk healthy controls. MethodologyFifty-six pregnant women attending their first appointment at the GDM clinic and 60 low-risk healthy pregnant controls attending their routine antenatal clinics were recruited and assigned to three groups: GDM Metformin (GDM-M), GDM Diet (GDM-D) and Control. Non-invasive assessment of maternal haemodynamics, using recognised measures of arterial stiffness and central blood pressure (Arteriograph®), were undertaken under controlled conditions within four gestational windows: antenatal; AN1 (26–28 weeks), AN2 (32–34 weeks) and AN3 (37–40 weeks), and postnatal (PN) (6–8 weeks after delivery). Data were analysed using a linear mixed model incorporating gestational age and other relevant predictors, including age, blood pressure (BP), baseline bodyweight and pulse as fixed effects, and patient as a random effect. ResultsFitted linear mixed models showed evidence of a two-way interaction effect between groups (GDM-D, GDM-M and Control) and stages of gestation (AN1, AN2, AN3 and PN) for maternal haemodynamic parameters: brachial artery augmentation index (AIx) (p = 0.004), aortic AIx (p = 0.008), and central systolic BP (p = 0.001). However, differences in respect of aortic pulse wave velocity (p = 0.001) and heart rate (p < 0.001) were only significant for gestational stage. At AN2, we did not observe any evidence that the mean brachial Aix in the GDM-M was different from the control group (p = 0.158). ConclusionAIx and central systolic BP measures of arterial stiffness are adversely affected by GDM in comparison to controls during pregnancy. The possible beneficial effects of metformin therapy seen at 32 to 34 weeks of gestation require further exploration.

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.