Maternal venous hemodynamics in gestational hypertension and preeclampsia

Abstract

BackgroundTo evaluate characteristics of venous hemodynamics, together with cardiac and arterial function, in uncomplicated pregnancies (UP), non-proteinuric gestational hypertension (GH) and preeclampsia (PE).MethodsIn this observational cross-sectional study, venous hemodynamics was assessed using a standardised protocol for combined electrocardiogram (ECG)-Doppler ultrasonography, together with a non-invasive standardised cardiovascular assessment using impedance cardiography (ICG) in 13 women with UP, 21 with GH, 34 with late onset PE ≥ 34 w (LPE) and 22 with early onset PE < 34 w (EPE). ECG-Doppler parameters were impedance index at the level of hepatic veins (HVI) and renal interlobar veins (RIVI) together with venous pulse transit times (VPTT), as well as resistive and pulsatility index, and arterial pulse transit time (APTT) at the level of uterine arcuate arteries. ICG parameters were aortic flow velocity index (VI), acceleration index (ACI) and thoracic fluid content. Mann Whitney U-test, Kruskall-Wallis test and linear regression analysis with heteroskedastic variance was used for statistical analysis.ResultsRIVI in both kidneys was >15% higher (P ≤ .010) in LPE and EPE, as compared to GH and UP. Next to this, >30% lower values for VI and ACI (P ≤ .029), and > 15% lower values for APTT (P ≤ .012) were found in GH, LPE and EPE, as compared to GH.ConclusionIn comparison to UP, similar abnormalities of central arterial function and APTT were found in GH, EPE and LPE. Proteinuria of LPE and EPE was associated with increased RIVI, this was not observed in GH.

Assessment of venous hemodynamics and volume homeostasis during pregnancy: recommendations of the International Working Group on Maternal Hemodynamics

“…Contrary to observations in PE, in non‐proteinuric gestational hypertension, venous Doppler wave measurements do not differ from those in uncomplicated pregnancies. This suggests that venous hemodynamic dysfunction may be a pathophysiological feature of PE but not of gestational hypertension.…”

“…VPTT is shorter in PE than in normal pregnancy, and this is more pronounced in early‐ than in late‐onset PE. PE‐related shortening of VPTT occurs simultaneously at the arterial and venous sites, reflecting stiffening of the vascular wall, probably owing to increased vascular tone.…”

“…This represents backflow of venous blood during atrial contraction up to the level of the kidneys, which might relate to cardiac diastolic dysfunction or reduced venous distensibility. This indicates that during PE, the venous backflow of blood during atrial contraction travels faster and further upstream than in uncomplicated pregnancies. In late‐onset PE, however, RIVI values are often within the normal range.…”

The role of cardiac output monitoring in obstetric anesthesia

“…There is sparse information about the venous circulation in preeclampsia, but Gyselaers et al [37] have reported venous haemodynamic dysfunction in preeclampsia, presenting weeks before clinical onset of disease.…”

Preeclampsia: a gestational cardiorenal syndrome

“…More recently, ECG‐guided Doppler assessment of maternal venous haemodynamics in preeclampsia demonstrated that renal interlobar venous impedance index is increased several weeks before the onset of early preeclampsia, is raised much higher, has an parallel left‐right undulating pattern and is associated with a shorter venous pulse transit time compared to late preeclampsia (Gyselaers et al . , , ; Mesens et al . ).…”