Development of a biophysical screening model for gestational hypertensive diseases

Abstract

Background To investigate the possibility of using maternal biophysical parameters only in screening for the different types of gestational hypertensive diseases. Methods A total of 969 pregnant women were randomly screened in first and second trimester, of which 8 developed Early-onset Preeclampsia, 29 Late-onset Preeclampsia, 35 Gestational Hypertension and 897 women had a normal outcome. An observational maternal hemodynamics assessment was done via standardized electrocardiogram-Doppler ultrasonography, Impedance Cardiography and bio-impedance, acquiring functional information on heart, arteries, veins and body fluid. Preliminary prediction models were developed to test the screening potential for early preeclampsia, late preeclampsia and gestational hypertension using a Partial Least Square Discriminant Analysis. Results A combined model using maternal characteristics with cardiovascular parameters in first and second trimester offers high screening performance with Area Under the Curve of 99,9% for Early-onset Preeclampsia, 95,3% for Late-onset Preeclampsia and 94% for Gestational Hypertension. Conclusions Using biophysical parameters as fundament for a new prediction model, without the need of biochemical parameters, seems feasible. However, validation in a large prospective study will reveal its true potential.

Maternal Hemodynamics from Preconception to Delivery: Research and Potential Diagnostic and Therapeutic Implications: Position Statement by Italian Association of Preeclampsia and Italian Society of Perinatal Medicine

“…Other techniques for maternal hemodynamic detection have shown promising results for the prediction of HDP such as bioimpedance, impedance cardiography and ECG-Doppler ultrasound. 79,80 This article is protected by copyright. All rights reserved.…”

“…Moreover, alongside these widely studied areas, interesting data are emerging regarding other pregnancy diseases such as diabetes and preterm delivery (PTD), as well as a potential role of hemodynamics before pregnancy, in FGR, during tween pregnancy, labor, and delivery with the anesthesiologic implications of hemodynamic profile of the mothers. 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106…”

Fatores de risco e elementos primitivos no desenvolvimento de síndromes hipertensivas no pré-natal: revisão integrativa

“…43 O cálcio é um elemento com potencial efeito protetor. [24][25] Pode-se supor que o aumento da variabilidade da PAD no sono noturno confere um certo efeito protetor para o desenvolvimento de HG, enquanto uma maior PAD máxima no sono noturno representaria um maior fator de risco para o desenvolvimento de HG. 22 Todos os fatores de risco e os elementos primitivos levaram ao aumento da hipertensão gestacional e/ou Pré-eclâmpsia, e/ou eclâmpsia e/ou síndrome HELLP.…”

Hemodynamic pathways of gestational hypertension and preeclampsia

“…ajog.org peripheral resistance, and TBW volumes allows discriminating early-onset PE from other hypertensive disorders already in the first half of pregnancy, with detection rates of >80% at falsepositive rates of <15% for all types of gestational hypertensive disorders. 96 Likewise, hypertension can be categorized as volume-dominant, resistancedominant, or both. Normal blood pressure can be classified as true or false normotension, the latter presenting as high volume antagonized by a low resistance, or vice versa (Figure 6).…”