Maternal Hypertension, Advanced Doppler Haemodynamics and Therapeutic Precision: Principles and Illustrative Cases

Abstract

Purpose of Review Maternal hypertension is a common and serious condition associated with increased maternal and foetal morbidity and mortality, with early detection and management improving outcomes. Recent Findings Blood pressure (BP) changes of pre-eclampsia are defined after 20 gestational weeks, while haemodynamic changes can be detected at 5-11 weeks using a specialised non-invasive Doppler stroke volume (SV) monitor. Thus, advanced haemodynamic monitoring allows for physiologically precise identification of circulatory abnormalities, and implementation of appropriate therapy within the first trimester. We measured the oscillometric BP and advanced haemodynamics (USCOM 1A) of 3 unselected women with singleton pregnancies, consecutively listed for therapeutic induction for maternal hypertension at 32-41 weeks gestational age. While the BP's of the patients varied, it was the haemodynamics, particularly SV, cardiac output, systemic vascular resistance, Smith Madigan Inotropy Index, and oxygen deliver, that identified differing patterns of circulatory dysfunction, therapeutic objectives, and predicted post-partum complications of the mother and child. Summary First trimester screening of maternal haemodynamics may allow for earlier detection of circulatory derangements, selection of patient precise interventions, and improved maternal-foetal outcomes.

Global Hypertension Guidelines; Are Central Haemodynamics Critical and Neglected?

“…However BP changes of HTN are not detected until 20-25 weeks [50], thus providing a therapeutic window for early and physiologically precise therapy during the period of ANS compensated normotension. Importantly the concept of cardiogenic and vasogenic aetiology has been established allowing for a simpli ed approach to treatment [51] using vasodilators, negative inotropes and diuretics implemented before the decompensated phase of frank HTN is established by the re-set of baroreceptor set-points. Precision management according to objective measures of SV, CO and SVR is consistent with circulatory physiology and pathophysiology and is improving the understanding of HDP [52][53][54][55], with an SVR value greater than 1069 dynes.s.cm -5 signi cantly associated with increased maternal-foetal complications [52].…”

“…Consequently, management of HTN should target the reduction of the appropriate pathological central haemodynamic parameter with the appropriate class of therapy as summarised in gure 2 [10].…”

The Relationship between Age, Parity, Early Detection, K1-K4 Visits, Integrated ANC, Three Times Obgyn’s Ultrasound Examination, and Maternal Mortality

“…Through early detection, it is possible to anticipate the incidence of hypertension in pregnant women. Early detection is done by hemodynamic screening for circulatory disorders, to improve maternal-fetal outcomes, it can be done by selecting the right intervention (Phillips et al, 2020).In addition, early detection is very important for pregnant women who are at risk of preeclampsia in the first trimester (Mönckeberg et al, 2020).…”

Ligustrazine-induced microRNA-16-5p inhibition alleviates preeclampsia through IGF-2

“…According to the World Health Organization, 10% of pregnant women are diagnosed as having PE, and PE accounts for one-seventh of maternal deaths in China, which is equivalent to a incidence rate of 5% (Say et al 2014, Liang et al 2019, Yang et al 2020. PE is a pregnancy complication mainly occurring after 20 weeks of gestation, which is characterized by maternal hypertension and proteinuria (Phillips et al 2020, Rozas-Villanueva et al 2020. PE usually first manifests with hypertension followed by proteinuria in the third trimester, and the pathogenesis and impact on both mother and fetus make it a tremendously challenging condition (Rana et al 2019).…”