Title: Mid-term maternal cardiovascular profile in preterm and term pre-eclampsia: a prospective analysis
Authors: Dr Rabi Narayan Satapathy, Dr Khyamanidhi Sethy, Dr Jyoti Narayan Puhan, Dr Sagar Mohapatra
DOI: https://dx.doi.org/10.18535/jmscr/v6i9.111
Abstract
Aims and Objectives: Maternal cardiovascular system is largely affected in the pathogenesis of preeclampsia. In other words, those women who are destined to develop preeclampsia, severe cardio vascular remodeling with ventricular dysfunction starts during the mid gestational age which differs those who develop preterm preeclampsia than those of term eclampsia. The aim of this study to differentiate what cardiovascular changes occur between these two high risk pregnancy groups during mid gestation who were normotensive during then .
Materials & Methods: This is a prospective analysis taking totally 115 women, including 56 high risk women tend to develop PE as determined by mid-gestational uterine artery Doppler assessment. All women underwent blood pressure monitoring, echocardiography and Doppler assessment between 20-23 weeks of gestation and there cardio vascular profile in women with normal pregnancy and those that subsequently developed preterm preeclampsia and term preeclampsia were compared.
Results: Out of 56 high risk women, 13 women developed PE and 8 developed preterm PE. Irrespective of gestation, 23% preeclamptic women had evidence of concentric left ventricular remodeling which was not found in control women group. 1 out of 8 preterm PE women (12.5%) developed concentric hypertrophy which was not seen in term preeclamptic group also. Only women who developed preterm PE exhibited a high resistance low volume haemodynamic state at mid gestation .They also have evidence of left ventricular diastolic and systolic dysfunction.
Conclusion: Asymptomatic cardiac diastolic dysfunction is evident at mid gestation in women who subsequently develop preterm PE but not in those who develop term PE. Also concentric hypertrophy of LV is mainly associated with preterm PE than term PE group. These cardio vascular changes support preeclampsia is not a single disorder, but a cluster of symptoms that have several different etiologies.
Keywords: PE – preeclampsia, LV – left ventricle,
References
- Karen Melchiorre, George Ross Sutherland, Aigul Baltabaeva, Marco Liberati, Basky Thilaganathan. Maternal Cardiac Dysfunction and Remodeling in Women With Preeclampsia at Term. Hypertension. 2011;57:85-93.
- Esther F. Davis, MBBS; Adam J. Lewandowski, BSc; Paul Leeson, PhD, FRCP. Cardiac Dysfunction and Preeclampsia Can Imaging Give Clues to Mechanism? Circ Cardiovasc Imaging. 2012;5:691-692.
- E. A. K. BAMFO, N. A. KAMETAS, J. B. CHAMBERS and K. H. NICOLAIDES. Maternal cardiac function in normotensive and pre-eclamptic intrauterine growth restriction. Ultrasound Obstet Gynecol 2008; 32: 682–686.
- Simmons LA, Gillin AG, Jeremy RW. Structural and functional changes in left ventricle during normotensive and preeclamptic pregnancy. Am J Physiol Heart Circ Physiol. 2002;283:H1627–H1633.
- Tihtonen KM, Kööbi T, Vuolteenaho O, Huhtala HS, Uotila JT. Natriureticpeptides and hemodynamics in preeclampsia. Am J Obstet Gynecol. 2007;196:328.e1–328.e7.
- Valensise H, Vasapollo B, Gagliardi G, Novelli GP. Early and late preeclampsia: two different maternal hemodynamic states in the latent phase of the disease. Hypertension. 2008;52:873–880 .
- Rafik Hamad R, Larsson A, Pernow J, Bremme K, Eriksson MJ. Assessment of left ventricular structure and function in preeclampsia by echocardiography and cardiovascular biomarkers. J Hypertens 2009;27:2257–64.
- Lykke JA, Langhoff-Roos J, Sibai BM, Funai EF, Triche EW, Paidas MJ. Hypertensive pregnancy disorders and subsequent cardiovascularmorbidity and type 2 diabetes mellitus in the mother. Hypertension 2009;53:944–51.
- Mongraw-Chaffin ML, Cirillo PM, Cohn BA. Preeclampsia and cardiovascular disease death: prospective evidence from the child health and development studies cohort. Hypertension 2010;56:166–71.
- Valensise H, Vasapollo B, Gagliardi G, Novelli GP. Early and late preeclampsia: two Different maternal hemodynamic states in the latent phase of the Hypertension 2008;52:873–80
- Valensise H, Vasapollo B, Novelli GP, Larciprete G, Romanini ME, Arduini D, et al. Maternal diastolic function in asymptomatic pregnant women with bilateral notching of the uterine artery waveform at 24 weeks’ gestation: a pilot study. Ultrasound Obstet Gynecol 2001;18:450–5.