Serial hemodynamic measurement in normal pregnancy, preeclampsia, and intrauterine growth restriction

Rang, Saskia; Montfrans, Gert A. van; Wolf, Hans

doi:10.1016/j.ajog.2007.11.014

Cited by 62 publications

(60 citation statements)

References 37 publications

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“…31 The pattern of change in peripheral vascular resistance in the period preceding a gestational hypertensive disorder is still unclear. [32][33][34] Our explorative study supports the findings of Rang et al 32 who at 18 + 2 weeks gestation, the peripheral vascular resistance is probably already raised in the recurrent subgroup relative to that in the uncomplicated subgroup. We were unable to discern a difference in MAP in early pregnancy.…”

Section: Discussionsupporting

confidence: 93%

Early Pregnancy Circulatory Adaptation and Recurrent Hypertensive Disease: An Explorative Study

et al. 2013

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Section: Discussionsupporting

confidence: 93%

Early Pregnancy Circulatory Adaptation and Recurrent Hypertensive Disease: An Explorative Study

et al. 2013

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“…There is growing evidence that dysfunction of maternal venous hemodynamics is part of the pathophysiology of preeclampsia. The effects of abnormal cardiovascular adaptation to pregnancy including decreased venous capacitance (39) and distensibility (40) and a decreased cardiac output (41) may be blunted by OMT during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Acute improvement in hemodynamic control after osteopathic manipulative treatment in the third trimester of pregnancy

Hensel¹,

Pacchia²,

Smith³

2013

Complementary Therapies in Medicine

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Objectives The physiological changes that occur during pregnancy, including increased blood volume and cardiac output, can affect hemodynamic control, most profoundly with positional changes that affect venous return to the heart. By using Osteopathic Manipulative Treatment (OMT), a body-based modality theorized to affect somatic structures related to nervous and circulatory systems, we hypothesized that OMT acutely improves both autonomic and hemodynamic control during head-up tilt and heel raise in women at 30 weeks gestation. Design One hundred subjects were recruited at 30 weeks gestation. Setting The obstetric clinics of UNTHealth in Fort Worth, Texas. Intervention Subjects were randomized into one of three treatment groups: OMT, placebo ultrasound, or time control. Ninety subjects had complete data (N=25, 31 and 34 in each group respectively). Main outcome measures Blood pressure and heart rate were recorded during 5 min of head-up tilt followed by 4 min of intermittent heel raising. Results No significant differences in blood pressure, heart rate or heart rate variability were observed between groups with tilt before or after treatment (p>0.36), and heart rate variability was not different between treatment groups (p>0.55). However, blood pressure increased significantly (p=0.02) and heart rate decreased (p<0.01) during heel raise after OMT compared to placebo or time control. Conclusions These data suggest that OMT can acutely improve hemodynamic control during engagement of the skeletal muscle pump and this was most likely due to improvement of structural restrictions to venous return.

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“…Normotensive pregnancies with fetal growth restriction have, compared with those without fetal growth restriction, a higher total peripheral resistance and reduced cardiac output already in early pregnancy. 24 Similar but even more severe insufficient maternal physiological adaptation has been shown in pregnancies complicated with preeclampsia. 17,25 Intrauterine growth restriction and preeclampsia are closely linked with abnormal placentation.…”

Section: Potential Explanations For the Associations Between Prehypermentioning

confidence: 92%

Prehypertension in Pregnancy and Risks of Small for Gestational Age Infant and Stillbirth

et al. 2016

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Abstract-It is not fully known whether maternal prehypertension is associated with increased risk of adverse fetal outcomes, and it is debated whether increases in blood pressure during pregnancy influence adverse fetal outcomes. We performed a population-based cohort study in nonhypertensive women with term (≥37 weeks) singleton births (n=157 446). Using normotensive (diastolic blood pressure [DBP] <80 mm Hg) women as reference, we calculated adjusted odds ratios with 95% confidence intervals between prehypertension (DBP 80-89 mm Hg) at 36 gestational weeks (late pregnancy) and risks of a small-for-gestational-age (SGA) birth or stillbirth. We further estimated whether an increase in DBP from early to late pregnancy affected these risks. We found that 11% of the study population had prehypertension in late pregnancy. Prehypertension was associated with increased risks of both SGA birth and stillbirth; adjusted odds ratios (95% confidence intervals) were 1.69 (1.51-1.90) and 1.70 (1.16-2.49), respectively. Risks of SGA birth in term pregnancy increased by 2.0% (95% confidence intervals 1.5-2.8) per each mm Hg rise in DBP from early to late pregnancy, whereas risk of stillbirth was not affected by rise in DBP during pregnancy. We conclude that prehypertension in late pregnancy is associated with increased risks of SGA birth and stillbirth. Risk of SGA birth was also affected by rise in DBT during pregnancy. Our findings provide new insight to the relationship between maternal blood pressure and fetal well-being and suggest that impaired maternal perfusion of the placenta contribute to SGA birth and stillbirth. (Hypertension.

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Serial hemodynamic measurement in normal pregnancy, preeclampsia, and intrauterine growth restriction

Cited by 62 publications

References 37 publications

Early Pregnancy Circulatory Adaptation and Recurrent Hypertensive Disease: An Explorative Study

Early Pregnancy Circulatory Adaptation and Recurrent Hypertensive Disease: An Explorative Study

Acute improvement in hemodynamic control after osteopathic manipulative treatment in the third trimester of pregnancy

Prehypertension in Pregnancy and Risks of Small for Gestational Age Infant and Stillbirth

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