Serial hemodynamic measurement in normal pregnancy, preeclampsia, and intrauterine growth restriction
Received 26 July 2007; received in revised form 11 September 2007; accepted 6 November 2007. published online 18 February 2008.
Objective
The study hypothesis was that hemodynamic measurements in conjunction with uterine artery Doppler could enable selection of women at risk for the development of preeclampsia or fetal growth restriction.
Study Design
Systolic (SBP) and diastolic blood pressure, heart rate (RR), cardiac output (CO), total peripheral resistance (TPR), phase difference of SBP and RR interval were measured serially before, during, and after pregnancy. At 20 weeks, uterine artery Doppler measurement was performed. Outcome was classified as preeclampsia (PE) or gestational hypertension (GH) with or without fetal growth restriction (FGR), FGR without PE or GH, and normal pregnancy (NP). Differences between these groups were assessed by 1-way analysis of variance and discriminant analysis.
Results
In early pregnancy, in comparison with NP (n = 28), PE/GH had a higher SBP and phase difference of SBP–RR interval. CO was higher in PE/GH without FGR (n = 5) but not PE/GH with FGR (n = 5). FGR, either with or without PE/GH (n = 4), was associated with higher TPR. Conjunction with uterine Doppler allowed selection of 93% of women with an abnormal outcome with a specificity of 100%.
Conclusion
The study supports our hypothesis that in early pregnancy, hemodynamic parameters differ from normal in women predisposed to develop preeclampsia or fetal growth restriction.
aDepartment of Obstetrics and Gynecology, the Academic Medical Center, Amsterdam, The Netherlands
bDepartment of Internal Medicine, the Academic Medical Center, Amsterdam, The Netherlands.
Reprints: Hans Wolf, PhD, Academic Medical Center, Department of Obstetrics and Gynecology, Rm H4-137, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Cite this article as: Rang S, van Montfrans GA, Wolf H. Serial hemodynamic measurement in normal pregnancy, preeclampsia, and intrauterine growth restriction. Am J Obstet Gynecol 2008;198:519.e1-519.e9.
ABSTRACT
Serial hemodynamic measurement in normal pregnancy, preeclampsia, and intrauterine growth restriction