Maternal hemodynamics early in labor: a possible link with obstetric risk?

Objective To compare maternal hemodynamics and perinatal outcome, in pregnancies that do not develop pre‐eclampsia (PE) or deliver a small‐for‐gestational‐age (SGA) neonate, between those identified at 11–13 weeks' gestation as being screen positive or negative for preterm PE, by a combination of maternal factors, mean arterial pressure, uterine artery pulsatility index, serum placental growth factor and pregnancy associated plasma protein‐A. Methods This was a prospective longitudinal cohort study of maternal cardiovascular function, assessed using a bioreactance method, in women undergoing first‐trimester screening for PE. Maternal hemodynamics and perinatal outcome were compared between screen‐positive and screen‐negative women who did not have a medical comorbidity, did not develop PE or pregnancy‐induced hypertension and delivered at term a live neonate with birth weight between the 5th and 95th percentiles. A multilevel linear mixed‐effects model was used to compare the repeated measures of cardiac variables, controlling for maternal characteristics. Results The screen‐negative group (n = 926) had normal cardiac function changes across gestation, whereas the screen‐positive group (n = 170) demonstrated static or reduced cardiac output and stroke volume and higher mean arterial pressure and peripheral vascular resistance with advancing gestation. In the screen‐positive group, compared with screen‐negative women, birth‐weight Z‐score was shifted toward lower values, with prevalence of delivery of a neonate below the 35th, 30th or 25th percentile being about 70% higher, and the rate of operative delivery for fetal distress in labor also being higher. Conclusion Women who were screen positive for impaired placentation, even though they did not develop PE or deliver a SGA neonate, had pathological cardiac adaptation in pregnancy and increased risk of adverse perinatal outcome. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Section: Discussionsupporting

confidence: 76%

Section: Discussionsupporting

confidence: 53%

Maternal hemodynamics in screen‐positive and screen‐negative women of the ASPRE trial

Ling

Guy

Bisquera

et al. 2019

“…Tiralongo et al 25 demonstrated significantly more complications and poorer outcomes in the group with SVR greater than 1200 dynes × s/cm 5 . In terms of SVR, our findings are in agreement with that of previous studies; with the group that underwent operative delivery due to presumed fetal compromise having a significantly higher median SVR than the group that delivered without fetal compromise 17 . It has been suggested that, under normal circumstances, vascular remodeling of the spiral arteries allows for a decrease in SVR, and thus an improved blood flow, which reduces the chances of the fetus suffering from hypoxia 17 .…”

Section: Discussionsupporting

confidence: 92%

“…A number of studies have identified SVR as a key predictor of intrapartum complications, including fetal distress. Valensise et al 17 demonstrated a raised SVR to be associated significantly with fetal distress and Vasapollo et al 24 determined an elevated SVR to be the best predictor of intrapartum complications. Tiralongo et al 25 demonstrated significantly more complications and poorer outcomes in the group with SVR greater than 1200 dynes × s/cm 5 .…”

Section: Discussionmentioning

confidence: 99%

Maternal cardiovascular function and risk of intrapartum fetal compromise in women undergoing induction of labor: pilot study

Kalafat

Barratt

Nawaz

et al. 2020

Objective Identification of the fetus at risk of intrapartum compromise has many benefits. Impaired maternal cardiovascular function is associated with placental hypoperfusion predisposing to intrapartum fetal distress. The aim of this study was to assess the predictive accuracy of maternal hemodynamics for the risk of operative delivery due to presumed fetal compromise in women undergoing induction of labor (IOL). Methods In this prospective cohort study, patients were recruited between November 2018 and January 2019. Women undergoing IOL were invited to participate in the study. A non‐invasive ultrasonic cardiac output monitor (USCOM‐1A®) was used for cardiovascular assessment. The study outcome was operative delivery due to presumed fetal compromise, which included Cesarean or instrumental delivery for abnormal fetal heart monitoring. Regression analysis was used to test the association between cardiovascular markers, as well as the maternal characteristics, and the risk of operative delivery due to presumed fetal compromise. Receiver‐operating‐characteristics‐curve analysis was used to assess the predictive accuracy of the cardiovascular markers for the risk of operative delivery for presumed fetal compromise. Results A total of 99 women were recruited, however four women were later excluded from the analysis due to semi‐elective Cesarean section (n = 2) and failed IOL (n = 2). The rate of operative delivery due to presumed fetal compromise was 28.4% (27/95). Women who delivered without suspected fetal compromise (controls) were more likely to be parous, compared to those who had operative delivery due to fetal compromise (52.9% vs 18.5%; P = 0.002). Women who underwent operative delivery due to presumed fetal compromise had a significantly lower cardiac index (median, 2.50 vs 2.60 L/min/m2; P = 0.039) and a higher systemic vascular resistance (SVR) (median, 1480 vs 1325 dynes × s/cm5, P = 0.044) compared to controls. The baseline model (being parous only) showed poor predictive accuracy, with an area under the curve of 0.67 (95% CI, 0.58–0.77). The addition of stroke volume index (SVI) < 36 mL/m2, SVR > 7.2 logs or SVR index (SVRI) > 7.7 logs improved significantly the predictive accuracy of the baseline model (P = 0.012, P = 0.026 and P = 0.012, respectively). Conclusion In this pilot study, we demonstrated that prelabor maternal cardiovascular assessment in women undergoing IOL could be useful for assessing the risk of intrapartum fetal compromise necessitating operative delivery. The addition of SVI, SVR or SVRI improved significantly the predictive accuracy of the baseline antenatal model. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

“…Recently a new device has been introduced for the measurement of SV and CO in pregnancy, the UltraSonic Cardiac Output Monitor (USCOM 1A®). This is a non‐invasive hemodynamic monitor that measures cardiovascular values by using a non‐imaging continuous‐wave Doppler transducer placed on the suprasternal notch to determine ascending transaortic blood flow (Figure ).…”

Section: Methods Of Co Measurementmentioning

confidence: 99%

Methods and considerations concerning cardiac output measurement in pregnant women: recommendations of the International Working Group on Maternal Hemodynamics

Bijl

Valensise

Novelli³

et al. 2019

Self Cite

Cardiac output (CO), along with blood pressure and vascular resistance, is one of the most important parameters of maternal hemodynamic function. Substantial changes in CO occur in normal pregnancy and in most obstetric complications. With the development of several non‐invasive techniques for the measurement of CO, there is a growing interest in the determination of this parameter in pregnancy. These techniques were initially developed for use in critical‐care settings and were subsequently adopted in obstetrics, often without appropriate validation for use in pregnancy. In this article, methods and devices for the measurement of CO are described and compared, and recommendations are formulated for their use in pregnancy, with the aim of standardizing the assessment of CO and peripheral vascular resistance in clinical practice and research studies on maternal hemodynamics. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.