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Longitudinal maternal hemodynamic evaluation in uncomplicated twin pregnancies according to chorionicity: physiological cardiovascular dysfunction in monochorionic twin pregnancy
Farsetti, D.; Pometti, F.; Novelli, G. P. ...
Ultrasound in obstetrics & gynecology,
February 2024, 2024-02-00, 20240201, Letnik:
63, Številka:
2
Journal Article
Recenzirano
ABSTRACT
Objective
Maternal cardiac function plays a crucial role in placental function and development. The maternal hemodynamic changes in twin pregnancy are more pronounced than those in singleton ...
pregnancy, presumably due to a greater plasma volume expansion. In view of the correlation between maternal cardiac and placental function, it is plausible that chorionicity could influence maternal cardiac function. The aim of this study was to compare the longitudinal maternal hemodynamic changes between uncomplicated dichorionic (DC) and monochorionic (MC) twin pregnancies and in comparison to singleton pregnancies.
Methods
Included in the study were 40 MC diamniotic and 35 DC diamniotic uncomplicated twin pregnancies. These were compared with a group of 294 healthy singleton pregnancies from a previous cross‐sectional study. All participants underwent a hemodynamic evaluation using an Ultrasound Cardiac Output Monitor (USCOM®), at three different stages in pregnancy (11–15 weeks, 20–24 weeks and 29–33 weeks). The following parameters were recorded: mean arterial pressure (MAP), stroke volume (SV), stroke volume index (SVI), heart rate, cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR), systemic vascular resistance index (SVRI), stroke volume variation, Smith–Madigan inotropy index (INO) and potential‐to‐kinetic‐energy ratio (PKR).
Results
In the first trimester, DC and MC twin pregnancies showed lower MAP, SVR and PKR and higher CO and SV in comparison to singleton pregnancy. In the second trimester, maternal CO (8.33 vs 7.30 L/min, P = 0.03) and CI (4.52 vs 4.00 L/min/m2, P = 0.02) were significantly higher in MC compared with DC twin pregnancy. In the third trimester, compared with in singleton pregnancy, women with MC twin pregnancy showed significantly higher PKR (24.06 vs 20.13, P = 0.03) and SVRI (1837.20 vs 1698.48 dynes × s/cm5/m2, P = 0.03), and significantly lower SV (78.80 vs 88.80 mL, P = 0.01), SVI (42.79 vs 50.31 mL/m2, P < 0.01) and INO (1.70 vs 1.87 W/m2, P = 0.03); these differences were not observed between DC twin and singleton pregnancies.
Conclusions
Maternal cardiovascular function undergoes significant change during uncomplicated twin pregnancy and chorionicity influences maternal hemodynamics. In both MC and DC twin pregnancy, hemodynamic changes are detectable as early as the first trimester, showing higher maternal CO and lower SVR compared with singleton pregnancy. In DC twin pregnancy, the maternal hemodynamics remain stable during the rest of pregnancy. In contrast, in MC twin pregnancy, the rise in maternal CO continues in the second trimester in order to sustain the greater placental growth. There is a subsequent crossover, with a reduction in cardiovascular performance during the third trimester. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Effect of a nitric oxide donor on maternal hemodynamics in fetal growth restriction
Tiralongo, G. M.; Pisani, I.; Vasapollo, B. ...
Ultrasound in obstetrics & gynecology,
April 2018, 2018-Apr, 2018-04-00, 20180401, Letnik:
51, Številka:
4
Journal Article
Recenzirano
Odprti dostop
ABSTRACT
Objective
To evaluate the effect on maternal cardiovascular parameters of treatment with a nitric oxide (NO) donor and plasma volume expansion in pregnancies complicated by fetal growth ...
restriction (FGR).
Methods
Twenty‐six pregnant women with a diagnosis of FGR were treated with transdermal patches of a NO donor and plasma volume expansion by co‐administration of oral fluids. We compared the treated group to a historical control group of untreated FGR patients. Hemodynamic indices were obtained using the UltraSonic Cardiac Output Monitor system.
Results
At diagnosis, the two groups were similar in terms of maternal and hemodynamic characteristics. In the treated group, we found a significant increase in maternal cardiac output and stroke volume and a decrease in systemic vascular resistance after 2 weeks of therapy. No significant differences were found 2 weeks after diagnosis in the untreated group. The treated group delivered infants with higher birth‐weight centile than did the untreated control group.
Conclusions
The combined therapeutic approach of NO donor administration and plasma volume expansion in FGR apparently improves significantly maternal hemodynamic indices. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Fetal cerebral Doppler changes and outcome in late preterm fetal growth restriction: prospective cohort study
Stampalija, T.; Thornton, J.; Marlow, N. ...
Ultrasound in obstetrics & gynecology,
August 2020, Letnik:
56, Številka:
2
Journal Article
Recenzirano
Odprti dostop
ABSTRACT
Objectives
To explore the association between fetal umbilical and middle cerebral artery (MCA) Doppler abnormalities and outcome in late preterm pregnancies at risk of fetal growth ...
restriction.
Methods
This was a prospective cohort study of singleton pregnancies at risk of fetal growth restriction at 32 + 0 to 36 + 6 weeks of gestation, enrolled in 33 European centers between 2017 and 2018, in which umbilical and fetal MCA Doppler velocimetry was performed. Pregnancies were considered at risk of fetal growth restriction if they had estimated fetal weight and/or abdominal circumference (AC) < 10th percentile, abnormal arterial Doppler and/or a fall in AC growth velocity of more than 40 percentile points from the 20‐week scan. Composite adverse outcome comprised both immediate adverse birth outcome and major neonatal morbidity. Using a range of cut‐off values, the association of MCA pulsatility index and umbilicocerebral ratio (UCR) with composite adverse outcome was explored.
Results
The study population comprised 856 women. There were two (0.2%) intrauterine deaths. Median gestational age at delivery was 38 (interquartile range (IQR), 37–39) weeks and birth weight was 2478 (IQR, 2140–2790) g. Compared with infants with normal outcome, those with composite adverse outcome (n = 93; 11%) were delivered at an earlier gestational age (36 vs 38 weeks) and had a lower birth weight (1900 vs 2540 g). The first Doppler observation of MCA pulsatility index < 5th percentile and UCR Z‐score above gestational‐age‐specific thresholds (1.5 at 32–33 weeks and 1.0 at 34–36 weeks) had the highest relative risks (RR) for composite adverse outcome (RR 2.2 (95% CI, 1.5–3.2) and RR 2.0 (95% CI, 1.4–3.0), respectively). After adjustment for confounders, the association between UCR Z‐score and composite adverse outcome remained significant, although gestational age at delivery and birth‐weight Z‐score had a stronger association.
Conclusion
In this prospective multicenter study, signs of cerebral blood flow redistribution were found to be associated with adverse outcome in late preterm singleton pregnancies at risk of fetal growth restriction. Whether cerebral redistribution is a marker describing the severity of fetal growth restriction or an independent risk factor for adverse outcome remains unclear, and whether it is useful for clinical management can be answered only in a randomized trial. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Screening for pre‐eclampsia in the first trimester: role of maternal hemodynamics and bioimpedance in non‐obese patients
Gagliardi, G.; Tiralongo, G. M.; LoPresti, D. ...
Ultrasound in obstetrics & gynecology,
November 2017, 2017-Nov, 2017-11-00, 20171101, Letnik:
50, Številka:
5
Journal Article
Recenzirano
Odprti dostop
ABSTRACT
Objective
To test if maternal hemodynamics and bioimpedance, assessed at the time of combined screening for PE, are able to identify in the first trimester of gestation normotensive ...
non‐obese patients at risk for pre‐eclampsia (PE) and/or intrauterine growth restriction (IUGR).
Methods
One hundred and fifty healthy nulliparous non‐obese women (body mass index < 30 kg/m2) in the first trimester of pregnancy underwent assessment by UltraSonic Cardiac Output Monitor (USCOM) to detect hemodynamic parameters, bioimpedance analysis to characterize body composition, and combined screening for PE (assessment of maternal history, biophysical and maternal biochemical markers). Patients were followed until term, noting the appearance of PE and/or IUGR.
Results
One hundred and thirty‐eight patients had an uneventful pregnancy (controls), while 12 (8%) developed complications (cases). USCOM showed, in cases compared with controls, lower cardiac output (5.6 ± 0.3 vs 6.7 ± 1.1 L/min, P < 0.001), lower inotropy index (1.54 ± 0.38 vs 1.91 ± 0.32 W/m2, P < 0.001) and higher total vascular resistance (1279.8 ± 166.4 vs 1061.4 ± 179.5 dynes × s/cm5, P < 0.001). Bioimpedance analysis showed, in cases compared with controls, lower total body water (53.7 ± 3.3% vs 57.2 ± 5.6%, P = 0.037). Combined screening was positive for PE in 8% of the controls and in 50% of the cases (P < 0.001). After identification of cut‐off values for USCOM and bioimpedance parameters, forward multivariate logistic regression analysis identified as independent predictors of complications in pregnancy the inotropy index (derived by USCOM), fat mass (derived from bioimpedance analysis) and combined screening.
Conclusions
Combined screening for PE and assessment of bioimpedance and maternal hemodynamics can be used to identify early markers of impaired cardiovascular adaptation and body composition that may lead to complications in the third trimester of pregnancy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Methods and considerations concerning cardiac output measurement in pregnant women: recommendations of the International Working Group on Maternal Hemodynamics
Bijl, R. C.; Valensise, H.; Novelli, G. P. ...
Ultrasound in obstetrics & gynecology,
July 2019, 2019-Jul, 2019-07-00, 20190701, Letnik:
54, Številka:
1
Journal Article
Recenzirano
Odprti dostop
ABSTRACT
Cardiac output (CO), along with blood pressure and vascular resistance, is one of the most important parameters of maternal hemodynamic function. Substantial changes in CO occur in normal ...
pregnancy and in most obstetric complications. With the development of several non‐invasive techniques for the measurement of CO, there is a growing interest in the determination of this parameter in pregnancy. These techniques were initially developed for use in critical‐care settings and were subsequently adopted in obstetrics, often without appropriate validation for use in pregnancy. In this article, methods and devices for the measurement of CO are described and compared, and recommendations are formulated for their use in pregnancy, with the aim of standardizing the assessment of CO and peripheral vascular resistance in clinical practice and research studies on maternal hemodynamics. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Restricted physical activity in pregnancy reduces maternal vascular resistance and improves fetal growth
Vasapollo, B.; Lo Presti, D.; Gagliardi, G. ...
Ultrasound in obstetrics & gynecology,
20/May , Letnik:
51, Številka:
5
Journal Article
Recenzirano
Odprti dostop
ABSTRACT
Objectives
To test the efficacy of maternal activity restriction for reducing peripheral vascular resistance in normotensive pregnant women with raised total vascular resistance (TVR) and to ...
evaluate its effect on fetal growth.
Methods
This was a prospective case–control study of 30 women enrolled between 27 and 29 weeks' gestation. All patients met the following criteria: normal blood pressure before and during pregnancy, TVR between 1300 and 1400 dynes × s/cm5 at enrolment, normal fetal Doppler parameters at enrolment and abdominal circumference between the 10th and 25th centiles. Patients were assigned to activity restriction (activity‐restriction group; n = 15) or no treatment (control group; n = 15) and were assessed after 4 weeks for TVR and fetal growth.
Results
TVR at enrolment and estimated fetal weight centile were similar in the activity‐restriction group vs controls (1358 ± 26 vs 1353 ± 30 dynes × s/cm5; 18th ± 4 vs 19th ± 4 centile; P = NS). After 4 weeks, the activity‐restriction group compared with controls showed significantly lower TVR (1165 ± 159 vs 1314 ± 190 dynes × s/cm5; P < 0.05), which was associated with higher estimated fetal weight centile (25th ± 5 vs 20th ± 5 centile; P < 0.05). TVR was lower and estimated fetal weight centile higher for the activity‐restriction group after 4 weeks compared with at enrolment.
Conclusions
In normotensive pregnant women with raised TVR, maternal activity restriction appears to be effective in reducing TVR and therefore enhancing fetal growth. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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