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

Vinayagam, Dimuthu; Thilaganathan, B.; Stirrup, Oliver; Mantovani, E.; Khalil, Asma

doi:10.1002/uog.17504

Cited by 68 publications

(58 citation statements)

References 35 publications

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“…They reported similar findings to ours in terms of the longitudinal changes of CO and SVR, but their study is limited by the lack of measurements in the late third trimester. Our group has previously reported reference ranges for the USCOM non‐invasive device, which demonstrated similar longitudinal changes in hemodynamic indices in pregnancy.…”

Section: Discussionmentioning

confidence: 68%

Influence of maternal characteristics and gestational age on hemodynamic indices: NICOM device‐specific reference ranges

Perry

Stirrup

Gutiérrez

et al. 2019

Ultrasound in Obstet & Gyne

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Objectives To construct reference ranges for stroke volume, cardiac output and systemic vascular resistance (SVR) in normal pregnancy for the NICOM® device, and to explore associations between maternal characteristics and these hemodynamic variables. Methods This was a prospective cohort study of healthy singleton pregnancies between 10 and 40 weeks' gestation attending a tertiary referral hospital between September 2012 and May 2018. Measurements of stroke volume, cardiac output and SVR were obtained throughout pregnancy using NICOM, a non‐invasive device based on bioreactance technology. NICOM device‐specific reference ranges were created with respect to gestational age and maternal characteristics. Once the distribution of the data had been determined with respect to the gestational age, patient characteristics were added to the model to test whether they provided a significant improvement in prediction of the median value. The effect was assessed of maternal weight, height, smoking status, conception using assisted reproductive technology, nulliparity and ethnicity. Results We included 411 women in this study. The relationships between cardiac variables and gestational age observed in the NICOM‐specific reference ranges are consistent with previous findings, with increasing cardiac output values until around 35 weeks and a decrease thereafter until term, and decreasing SVR until around 36 weeks, followed by an increase towards 40 weeks. Stroke volume showed a small linear increase across gestation with lower variability in observations close to term. Maternal weight, height and age were associated with cardiac output (all P < 0.05) and SVR (all P < 0.01), whilst maternal weight and height were associated with stroke volume (both P < 0.001). Ethnicity was significantly associated with stroke volume (P = 0.001) but not with cardiac output or SVR. Conclusions This study presents device‐specific reference ranges for stroke volume, cardiac output and SVR for the NICOM device in healthy pregnancy and describes the maternal characteristics that are associated with the values of these hemodynamic measurements. Studies using NICOM in pregnancy can use these ranges in order to evaluate observations relative to those expected in uncomplicated pregnancy conditional on maternal characteristics. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Discussionmentioning

confidence: 68%

Influence of maternal characteristics and gestational age on hemodynamic indices: NICOM device‐specific reference ranges

Perry

Stirrup

Gutiérrez

et al. 2019

Ultrasound in Obstet & Gyne

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“…Interpretation of maternal cardiac output in the majority of studies has been undertaken without taking into consideration maternal haemodynamic demands, which vary with height, weight, age and gestation (Vinayagam et al . ; Perry et al . ; Bijl et al .…”

Section: Cardiovascular and Renal Characteristics Of Preeclampsiamentioning

confidence: 99%

“…This hypothesis is further undermined by the interpretation of cardiac output indices independently of maternal morphological characteristics. Interpretation of maternal cardiac output in the majority of studies has been undertaken without taking into consideration maternal haemodynamic demands, which vary with height, weight, age and gestation (Vinayagam et al 2018;Perry et al 2018b;Bijl et al 2019). To correctly interpret whether measured cardiac output is 'high' or 'low' , one needs to consider what the appropriate or 'normal' cardiac output would be for maternal characteristics and gestational age -a process called indexing.…”

Section: Cardiovascular Phenotypes Of Early and Late Preeclampsiamentioning

confidence: 99%

Preeclampsia: a gestational cardiorenal syndrome

Gyselaers

Thilaganathan

2019

The Journal of Physiology

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It is generally accepted today that there are two different types of preeclampsia: an early‐onset or placental type and a late‐onset or maternal type. In the latent phase, the first one presents with a low output/high resistance circulation eventually leading in the late second or early third trimester to an intense and acutely aggravating systemic disorder with an important impact on maternal and neonatal mortality and morbidity; the other type presents initially as a high volume/low resistance circulation, gradually evolving to a state of circulatory decompensation usually in the later stages of pregnancy, with a less severe impact on maternal and neonatal outcome. For both processes, numerous dysfunctions of the heart, kidneys, arteries, veins and interconnecting systems are reported, most of them presenting earlier and more severely in early‐ than in late‐onset preeclampsia; however, some very specific dysfunctions exist for either type. Experimental, clinical and epidemiological observations before, during and after pregnancy are consistent with gestation‐induced worsening of subclinical pre‐existing chronic cardiovascular dysfunction in early‐onset preeclampsia, and thus sharing the pathophysiology of cardiorenal syndrome type II, and with acute volume overload decompensation of the maternal circulation in late‐onset preeclampsia, thus sharing the pathophysiology of cardiorenal syndrome type 1. Cardiorenal syndrome type V is consistent with the process of preeclampsia superimposed upon clinical cardiovascular and/or renal disease, alone or as part of a systemic disorder. This review focuses on the specific differences in haemodynamic dysfunctions between the two types of preeclampsia, with special emphasis on the interorgan interactions between heart and kidneys, introducing the theoretical concept that the pathophysiological processes of preeclampsia can be regarded as the gestational manifestations of cardiorenal syndromes.

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“…This allows all measurements to start from the same ‘point’ but does not take into account the change in weight and significant increase in metabolic demands with advancing pregnancy. Normalizing using pregnancy CO reference ranges. Gestational age and, preferably, device‐specific reference ranges for hemodynamic parameters in normal pregnancy constructed from data from women of differing ages and weights, would permit the interpretation of measured CO as a fraction of expected CO. Individual values can then be converted to gestational age‐specific Z ‐scores, multiples of the median or percentiles to allow comparison.…”

Section: Interpreting Co Measurements In Pregnancy: When and How To Imentioning

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

Ultrasound in Obstet & Gyne

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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.

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

Cited by 68 publications

References 35 publications

Influence of maternal characteristics and gestational age on hemodynamic indices: NICOM device‐specific reference ranges

Influence of maternal characteristics and gestational age on hemodynamic indices: NICOM device‐specific reference ranges

Preeclampsia: a gestational cardiorenal syndrome

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

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