Prediction Of Hypertensive Disorders Research Articles

Prediction of hypertensive disorders after screening at 35–36 weeks’ gestation – Comparison of angiogenic markers with the competing risks model

Prediction of hypertensive disorders after screening at 35–36 weeks’ gestation – Comparison of angiogenic markers with the competing risks model

Prediction of hypertensive disorders in pregnant women in the «gray» risk zone following combined first-trimester screening

Introduction. In obstetrics, hypertensive disorders of pregnancy (HDP) including preeclampsia (РЕ) are one of the primary causes resulting in critical cases and maternal mortality. HDP prediction is a milestone that allows preventing complications as well as reducing the number of most common relevant complications of pregnancy. Existing algorithms that predict PE risk distribute the risks in such a way that a considerable number of patients fall into the category of false negative results, and, consequently, receive no timely prevention and proper follow-up. In particular, this cohort usually consists of patients with borderline high risks, who may be designated as a medium risk group or located in a “gray” zone. Aim: to develop a prognostic model for risk stratification in female patients with borderline to high developing PE risk based on combined first-trimester screening. Materials and Methods. A prospective comparative study included 1089 female patients who underwent a combined screening at 11–14 weeks of gestation. Group 1 consisted of female patients at high РЕ risk (1:100 and greater), while female patients at moderate risk (1:101–1:250) and low risk (below 1:250) were included into Group 2 and Group 3, respectively. All pregnant women underwent examination including assessed anamnestic, general clinical and laboratory data, mean blood pressure (BP), uterine artery pulsatility index, serum level of human chorionic gonadotropin beta-subunits (β-hCG), placental growth factor (PlGF), pregnancy-associated plasma protein-A (PAPP-A). Results. An impact of various factors on risk of developing hypertensive disorders in pregnancy was assessed by binary logistic regression by identifying most significant among them and generating a statistical prediction model – the prognostic index of hypertensive disorders in pregnancy. The latter included: obstetric history, body mass index, PlGF, mean ВР, and alanine aminotransferase level. The sensitivity and specificity comprised 91.2 and 53.6 %, respectively, and the method effectivenesswas 81.8 %. Conclusion. The method proposed for HDP prediction is a second-line approach that may be used in clinical practice to stratify patients with borderline high risk of developing PE.

The prediction of hypertensive disorders by maternal hemodynamic assessment in the first trimester of pregnancy

Background Hypertensive disorders of pregnancy and fetal growth restriction share common etiopathological origins and could be caused by maternal hemodynamic maladaptation to pregnancy. Objective The aim of our study is to evaluate if there is a correlation between maternal hemodynamic detected by UltraSonic Cardiac Output Monitor (USCOM®) during the first trimester and the pregnancy outcome. Study design We recruited a nonconsecutive series of women in the first trimester of pregnancy with no previous history of hypertensive disorders. We measured the pulsatility index uterine arteries and performed a hemodynamic evaluation by USCOM® device. After delivery, we reported the development of hypertensive disorders or intrauterine fetal growth restriction later during gestation. Results A total of 187 women were enrolled during the first trimester; 17 (9%) developed gestational hypertension or preeclampsia while 11 (6%) delivered a restricted growth fetus. Mean uterine artery pulsatility index above the 95th percentile was significantly more frequent in both women who developed hypertension and those with fetal growth restriction compared to controls. Hemodynamic parameters (reduced cardiac output and increased total vascular resistance) were significantly different in the group that developed hypertensive disorders, compared to uncomplicated pregnancy. ROC curves demonstrated the usefulness of uterine artery pulsatility index in the prediction of fetal growth restriction, while hemodynamic parameters were significantly associated to the development of hypertensive disorders. Conclusions Hemodynamic maladaptation to pregnancy may predispose to the development of hypertension, while we demonstrated a significative relationship between growth restriction and mean uterine pulsatility index. Further studies are needed to assess the value of hemodynamics evaluation in screening protocols of preeclampsia.

Y-010. Prediction of hypertensive disorders of pregnancy based on home blood pressure monitoring

Y-010. Prediction of hypertensive disorders of pregnancy based on home blood pressure monitoring

Prediction of hypertensive disorders in pregnancy based on placental growth factor.

BACKGROUND: The prediction of hypertensive disorders in pregnancy (HDP) mainly involves various aspects such as maternal characteristics and biomarkers.OBJECTIVE: We aimed to study the effect of the HDP prediction model with or without placental growth factor (PlGF).METHODS: This study used maternal factors and PlGF, and standardized the data uniformly. At 12–20 weeks, the comprehensive comparison of model quality with or without PlGF was conducted by logistic regression.RESULTS: The area under curve and the model accuracy of the model with PlGF were higher than those of the model without PlGF. The accuracy of the model with PlGF was above 90%.CONCLUSIONS: Adding PlGF to the model for predicting HDP improved the accuracy and effectiveness of the model. This study confirmed the predictive performance of PlGF.

EP03.07: Early pregnancy biomarkers and prediction of hypertensive disorders of pregnancy

EP03.07: Early pregnancy biomarkers and prediction of hypertensive disorders of pregnancy

Neutrophil to lymphocyte ratio and monocyte to lymphocyte ratio in early pregnant women with hypertensive disorders

Objective To investigate the correlation of systemic inflammation parameters including neutrophil to lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR) with the pregnancy outcome of hypertension disorders of pregnancy. Methods Two hundred and twelve pregnant women in first-trimester with hypertensive disorders and 212 matched healthy subjects (control group) were enrolled in the study. The differences in white blood cell count (WBC), neutrophil (N), lymphocyte (L), monocyte (M), NLR and MLR were compared between groups. Results The WBC, N, M, NLR and MLR values were significantly higher in pregnant women with hypertensive disorders than those in healthy controls (9.1×109/L vs.8.5×109/L,Z=4.89, P 0.05). Multivariate logistic regression analysis showed that NLR was a predictive factor of hypertensive disorders of pregnancy (OR=1.68, 95%CI: 1.07-2.62, P<0.05). Conclusions NLR might be a useful systemic inflammation marker for the prediction of hypertensive disorders in women with early pregnancy. Key words: Hypertension, pregnancy-induced; Neutrophil to lymphocyte ratio; Monocyte to lymphocyte ratio

Prediction of Hypertensive Disorders of Pregnancy by Measuring Cardiac Output in Early Pregnancy

Hypertensive disorders of pregnancy continue to be unresolved dilemma even today, with dangerous repercussions on maternal, perinatal morbidity mortality. The prediction becomes imperative for prevention. During pregnancy, normally there is increase in blood volume, heart rate, stroke volume, and cardiac output, however, there may be variations and their implications. The present study was done to know the predictive value of measurement of cardiac output in early pregnancy for knowing the occurrence of hypertensive disorders. The cardiac output (CO) was measured at 10 + 2 weeks, 14 + 2 weeks, 18 + 2 weeks, 22 + 2 weeks, 26 + 2 weeks, 30 + 2 weeks of pregnancy and 7 days post partum. Of 500 cases studied, in those with high cardiac output, 7.4% developed hypertensive disorders, of cases who had normal cardiac output , 0.5% developed hypertensive disorders and cases in whom cardiac output was less, no one developed hypertensive disorders . The CO at 10+2 weeks had high positive and high correlation with CO at increasing gestation. Those with high CO at 10±2 weeks had a risk of developing hypertensive disorders with significant co relation between high maternal CO and occurrence of hypertensive disorders. Synopsis: Women with high cardiac output at 10±2 weeks of pregnancy are at high risk of developing hypertensive disorders .

D1. Renal interlobar vein impedance index (RIVI) as a first trimester marker for prediction of hypertensive disorders of pregnancy

Objective: To examine whether the maternal renal interlobar vein impedance index (RIVI) as assessed by first trimester ultrasonography is able to predict the later development of hypertensive disorders of pregnancy.Methods: Venous Doppler parameters of both maternal kidneys were studied in 214 pregnant women at 11 + 0 to 13 + 6 weeks’ gestation. Subjects were classified according to the outcomes related to hypertensive disorders. Detection rates and areas under receiver operating characteristic (ROC) curves were determined for the maternal RIVI impedance as a first trimester predictor for preeclampsia (PE) and gestational hypertension (GH).Results: Among the 214 patients, 22 developed PE (10.3%), 10 developed GH (4.7%), and 182 were unaffected by hypertensive disorders (controls) (85%). In the overall study population, there was no difference in the RIVI between the right (0.44; 0.35–0.50) and left side (0.43; 0.35–0.53), p¼0.86. The average RIVI did not differ among women destined to develop PE (0.46; 0.38–0.57), GH (0.39; 0.33–0.46), or pregnancies uncomplicated by hypertensive disease (0.42; 0.37–0.50), p¼0.16. Area under ROC curve analysis demonstrated that RIVI was not predictive of hypertensive disorders of pregnancy. Conclusion: Maternal RIVI should not be considered a first-trimester marker of hypertensive disorders of pregnancy.

Risk Prediction Models for Hypertensive Disorders of Pregnancy: Role of 12-Lead Electrocardiography

Summary Hypertensive disorders represent the most common medical complications of pregnancy, affecting 6 to 8 percent of gestations. They may lead to severe maternal and fetal complications. Several observational studies have highlighted that weight, systolic and diastolic blood pressure, obtained at antenatal visit prior to 16 weeks, may be suitable to stratify the risk of developing hypertensive disorders during pregnancy. Recently, however, other markers have been proposed as potential predictors of hypertensive disorders during pregnancy. In this context, some electrocardiographic changes have shown significant power in refining risk stratification. Specifically, changes during pregnancy in QT interval and P wave morphology improved the accuracy of multivariable models for the prediction of hypertensive disorders. In particular, the presence of left atrial abnormalities at ECG seems to be associated with a marked increase in the risk of developing hypertensive disorders, and when included in a multivariable model taking into account some maternal features, it may discriminate between women who will develop hypertensive disorders during pregnancy and women who will remain normotensive. This prediction model was also able to identify pregnant women at increased risk for the occurrence of fetal/neonatal complications. The aim of the present overview is to discuss the available data supporting the evidence that specific ECG patterns occurring early in pregnancy may have clinical relevance for risk prediction of hypertensive disorders.

296-POS

Objectives To assess the Doppler data finding in predicting adverse pregnancy outcomes like developed pre-eclampsia and fetal growth restriction (FGR). Methods Doppler study was done on 1222 high risk patients. These patients were followed and abnormal pregnancy outcomes were noted. Uterine artery flow velocity forms were studied. Results Resistance Index as a single parameter is the best indicator with highest sensitivity and negative predictive value. However, combination of parameters is the best indicator. There was a high incidence of developed pre-eclampsia and FGR when there were abnormalities in uterine artery indices, sensitivity ranging from 30% to 90% while specificity from 63% to 90%. When multiple indices were abnormal, 55–63% of patients developed pre-eclampsia and FGR. When both normal only 2.4% patients developed hypertensive disorders of pregnancy and 2.1% patients developed FGR. Conclusions The combination of uterine artery indices is the best indicator for prediction of hypertensive disorders of pregnancy and FGR. Bilateral diastolic notch in the uterine artery as a single parameter is more specific than the individual Doppler indices in uterine artery. Women with normal Doppler flow in uterine artery constitute a group of low risk of developing obstetric complications compare to abnormal flows. Uterine artery Doppler may be included in hospitals to identify a group of patients at risk of developing hypertensive disorders of pregnancy and poor fetal outcome. Disclosures S. Agrawal: None. T. Nagar: None. S. Khoiwal: None. S. Arora: None. S. Agrawal: None. K. Jayant: None.

A cohort evaluation on arterial stiffness and hypertensive disorders in pregnancy.

BackgroundHypertensive disorders in pregnancy are associated with systemic endothelial dysfunction leading to impaired physiological vasodilation. Recent evidence has shown central aortic pressures obtained through pulse wave analysis, at less than 14 weeks of gestation, to be predictive of pre-eclampsia. In light of this, we aimed to evaluate the role of central aortic stiffness in the prediction and discrimination of hypertensive disorders in pregnancy.MethodsA cohort study of women with viable, singleton pregnancies at less than 14 weeks of amenorrhoea, and without multiple pregnancies, autoimmune or renal disease, diagnosed with aneuploidy or fetal anomaly will be recruited from a single maternity hospital and followed up till delivery and puerperium. A targeted sample size of 1000 eligible pregnant women will be enrolled into the study from antenatal clinics. Main exposure under study is central aortic pulse pressure using radial pulse wave recording, and the outcomes under follow-up are gestational hypertension and pre-eclampsia. Other measures include lifestyle factors such as smoking, physical exercise, psychometric evaluations, vasoactive factors, uterine artery pulsatility index, height and weight measurements. These measures will be repeated over 4 antenatal visits at 11-14, 18-22, 28-32 and above 34 weeks of gestation. Double data entry will be performed on Microsoft Access, and analysis of data will include the use of random effect models and receiver operating characteristic curves on Stata 11.2.DiscussionThe proposed study design will enable a longitudinal evaluation of the central aortic pressure changes as a marker for vascular compliance during pregnancy. As measures are repeated over time, the timing and severity of changes are detectable, and findings may yield important information on how aberrant vascular responses occur and its role in the early detection and prediction of hypertensive disorders.

Bilateral notching of uterine arteries at 12-14 weeks of gestation for prediction of hypertensive disorders of pregnancy

Bilateral notching of uterine arteries at 12-14 weeks of gestation for prediction of hypertensive disorders of pregnancy

Doppler assessment of the uterine circulation in the second trimester in twin pregnancies: prediction of hypertensive disorders, small‐for‐gestational age and weight discordance

Objective: To compare singleton nomograms of the uterine circulation with previously established twin nomograms in the prediction of hypertensive disorders, small‐for‐gestational age (SGA) and birth weight discordance &gt;20%.Methods: This was an analysis of maternal and perinatal data obtained from 256 diamniotic–dichorionic twin pregnancies. The uterine artery resistance and pulsatility index were calculated as a mean from both sides and the presence and absence of notching was recorded. Cut‐off levels for abnormal flow parameters were the 95th centile of reference ranges using singleton and twin nomograms.Results: As mean uterine artery indices are lower in twin gestation, a higher number of patients (n = 73; 28.5%) was screen positive according to twin reference values when compared to those of singletons (n = 51; 19.9%). However, singleton reference ranges or recording of notches only proved to be more efficient than twin reference ranges to correctly predict SGA (17.6, 19, 13.7%), birth weight discordance &gt;20% (30.6, 37.5, 23.9%), and hypertensive disorders (23.5, 21.4, 16.4%), respectively. Compared to singleton nomograms of uterine artery Doppler, twin nomograms had higher sensitivities, lower specific and positive predictive values, but equal negative predictive value to comprise adverse pregnancy outcomes.Conclusion: For routine clinical practice, it seems justified to use singleton nomograms to assess uterine circulation in twin gestation. However, as the negative predictive value of uterine Doppler studies is slightly lower when compared to singletons, maternal and fetal complications might occur despite normal uterine waveforms.