Maternal Cardiac Output Between 11 and 13 Weeks of Gestation in the Prediction of Preeclampsia and Small for Gestational Age

Paco, Catalina De; Kametas, Nikos; Rencoret, G.; Strobl, I; Nicolaides, Kypros H.

doi:10.1097/01.aoa.0000344709.41667.b9

Cited by 31 publications

(45 citation statements)

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“…In addition, our previous work that showed a positive correlation between maternal peripheral resistance and uterine artery PI 38 explains why uterine artery PI would not perform as well in a group of patients who are more likely to have a low-peripheral resistance hemodynamic profile. 33,34,39 First-trimester screening can identify a high proportion of pregnancies destined to develop hypertensive disorders, and it was estimated that 1 in 5 pregnancies classified as being screen-positive would develop such disorders. Such high detection rates and positive predictive values cannot be achieved by the traditional approach of screening, which relies entirely on maternal history.…”

Section: Discussionmentioning

confidence: 99%

First-Trimester Prediction of Hypertensive Disorders in Pregnancy

et al. 2009

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Abstract-This study aimed to establish a method of screening for pregnancy hypertension by a combination of maternal variables, including mean arterial pressure, uterine artery pulsatility index, pregnancy-associated plasma protein-A, and placental growth factor in early pregnancy. The base-cohort population constituted of 7797 singleton pregnancies, including 34 case subjects who developed preeclampsia (PE) requiring delivery before 34 weeks (early PE) and 123 with late PE, 136 with gestational hypertension, and 7504 cases subjects (96.3%) who were unaffected by PE or gestational hypertension. Maternal history, uterine artery pulsatility index, mean arterial pressure, and pregnancy-associated plasma protein-A were recorded in all of the cases in the base cohort, but placental growth factor was measured only in the case-control population of 209 cases who developed hypertensive disorders and 418 controls. In each case the measured mean arterial pressure, uterine artery pulsatility index, pregnancy-associated plasma protein-A, and placental growth factor were converted to a multiple of the expected median (MoM) after correction for maternal characteristics found to affect the measurements in the unaffected group. Early PE and late PE were associated with increased mean arterial pressure (1. Key Words: first-trimester screening Ⅲ mean arterial pressure Ⅲ uterine artery Doppler Ⅲ PAPP-A Ⅲ placental growth factor Ⅲ preeclampsia P reeclampsia (PE), which affects Ϸ2% of pregnancies, is a major cause of maternal and perinatal morbidity and mortality. [1][2][3][4] In the United Kingdom, the National Institute for Clinical Excellence has issued guidelines on routine prenatal care recommending that at the first prenatal visit a woman's level of risk for PE should be evaluated so that a plan for her schedule of prenatal visits can be formulated. 5 There is no proven effective method for the prevention of PE. Nevertheless, routine prenatal care in the last 50 years has evolved with the aim of early identification of women at high-risk for PE, which could potentially improve pregnancy outcome. Intensive maternal and fetal monitoring in such patients would lead to an earlier diagnosis of the clinical signs of the disease and the associated fetal growth restriction and avoid the development of serious complications through such interventions as the administration of antihypertensive medication and early delivery. Early identification of the high-risk group for the development of PE is also important for future studies investigating the potential role of pharmacological interventions starting from the first trimester to improve placentation and reduce the prevalence of the disease.The traditional method of screening for PE is maternal history. The likelihood of developing PE is increased in black compared with white women, in nulliparous compared with parous women, in those with a high body mass index (BMI), and in those with a previous or family history of PE. 6 However, screening on the basis of such history would identify Ϸ3...

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Section: Discussionmentioning

confidence: 99%

First-Trimester Prediction of Hypertensive Disorders in Pregnancy

et al. 2009

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“…32,33 A few previous studies have investigated a limited range of risk factors for SGA infants born to hypertensive mothers. [34][35][36] A small number of risk factors for SGA infants born to hypertensive mothers were identified, including small fetal measurements at the 20-week scan, which were common to all groups of SGA. Amongst hypertensive women, a previous early pregnancy loss (two-thirds of which occurred with the same partner as in the current pregnancy) was associated with an approximate two-fold increase in risk of an SGA infant.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for small‐for‐gestational‐age infants by customised birthweight centiles: data from an international prospective cohort study

McCowan

Roberts

Dekker

et al. 2010

BJOG

126

112

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Objective To identify clinical and ultrasound variables associated with the birth of small-for-gestational-age (SGA) infants by customised centiles, subclassified according to whether their mothers were normotensive or developed hypertensive complications.Design Prospective, multicentre cohort study.Setting Participating centres of the Screening for Pregnancy Endpoints (SCOPE) study in Auckland, New Zealand, Adelaide, Australia, Manchester and London, UK, and Cork, Ireland.Population The 3513 nulliparous participants of the SCOPE study.Methods Women were interviewed at 15 ± 1 weeks, and had ultrasound growth measurements and umbilical and uterine Doppler studies at 20 ± 1 weeks. Variables associated with SGA infants were identifed using logistic regression.Main outcome measures Small for gestational age (i.e. a birthweight of less than the tenth customised centile), normotensive-SGA and hypertensive-SGA. Comparison groups for statistical analyses were non-SGA, normotensive non-SGA and hypertensive non-SGA.Results Among 376 (10.7%) SGA infants, 281 (74.7%) were normotensive-SGA and 95 (25.3%) were hypertensive-SGA. Independent risk factors for normotensive-SGA were low maternal birthweight, low fruit intake pre-pregnancy, cigarette smoking, increasing maternal age, daily vigorous exercise, being a tertiary student, head and abdominal circumference of less than the tenth centile and increasing uterine artery Doppler indices at the 20-week scan. Protective factors were: high green leafy vegetable intake pre-pregnancy, and rhesus-negative blood group. Risk factors for hypertensive-SGA were conception by in vitro fertilisation, previous early pregnancy loss and femur length of less than tenth centile at the 20-week scan.Conclusions Risk factors for infants who are SGA by customised centiles have been identified in a cohort of healthy nulliparous women. A number of these factors are modifiable; however, further studies are needed to replicate these findings.

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“…[16][17][18][19][20][21][22][23][24][25][26] At midgestation, there is a shift toward a low cardiac index associated with a high total vascular resistance index, increased mean arterial pressure, contracted intravascular volume, and reduced venous reserve capacity (Level 2). [16][17][18][19][20][21][22][23][24][25][26] In contrast, the hemodynamic profile of women destined to develop late-onset preeclampsia is not well delineated, with some authors reporting a normal cardiac index and increased total vascular resistance index at midgestation, 22 and others reporting a high cardiac output/ low TVR status. 17,18,23 However, the latter authors did not normalize hemodynamic measures for body surface area or body mass index, notwithstanding the significant differences in the anthropometric parameters in the analyzed study groups.…”

Section: Preeclampsia and The Cardiovascular System The Cardiovasculamentioning

confidence: 99%