The maternal cerebral circulation in pre-eclampsia: investigations using Laplace transform analysis of Doppler waveforms

Change in pulse wave velocity throughout normal pregnancy and its value in predicting pregnancy-induced hypertension: a longitudinal study

OBJECTIVE

We longitudinally examined the changes of brachial to ankle distensibility using pulse wave velocity (PWV) throughout pregnancy and its difference between normal pregnancy and pregnancy-induced hypertension (PIH) groups.

STUDY DESIGN

One hundred and eighty-three pregnant women were included in this study. The PWV examinations were performed in a longitudinal way during the first, second, and third trimesters of pregnancy, and immediately and 1 month after delivery.

RESULTS

In normal pregnancies, the PWV significantly decreased at the second trimester, increased from the third trimester through immediately after delivery, and decreased again at 1 month after delivery. In PIH patients, it increased in proportion to the progression of gestation.

CONCLUSION

We monitored the longitudinal changes in PWV and constructed a PWV normogram during pregnancy. The predictive value of PWV and blood pressure for PIH was higher than that of blood pressure alone, suggesting the usefulness of measuring PWV to predict PIH.

Cerebral edema on MRI in severe preeclamptic women developing eclampsia

OBJECTIVE

The aim of this study is to identify suitable applications for cerebral MR (magnetic resonance) scanning in cases of severe preeclampsia and eclampsia through comparison of clinical course and easily accessible parameters.

METHODS

From January 2001 to December 2003, cerebral MR scans were performed on 43 women with severe preeclampsia; of those 41 were enrolled in data analyses. Twenty clinical parameters, including age, body mass index, blood pressure, liver and renal function, and coagulation status, were compared for each patient. Data were analyzed using the SPSS program on a VAX main frame.

RESULTS

Among 41 severe preeclamptic women, abnormal MR images were observed in 11 cases including six with systemic seizures. Predictive accuracy of eclampsia with abnormal cerebral MR imaging was 84.9% (P=0.00001), while only 14.3% of severe preeclampsia cases had been diagnosed radiologically. Statistical analysis suggests diastolic BP and serum AST as predictive parameters for abnormal MR images with 82.9% predictive accuracy (P=0.0007).

CONCLUSIONS

Cerebral edema can be observed in preeclamptic patients developing eclampsia. Rapid delivery is indicated when diastolic BP and AST are elevated. MR scanning is useful when delivery is delayed due to fetal immaturityin cases of severe preeclampsia.

Neuroimaging of delayed eclampsia. Report of 3 cases and review of the literature

Computed tomography and magnetic resonance imaging findings consistent with eclampsia were recently encountered in 3 patients who developed severe headache days to weeks after uncomplicated delivery. The neurologic presentation was nonspecific, and pre-eclamptic symptoms were not present, including significant hypertension. Variable expression of pre-eclampsia occurred during the course of their observation. Conventional angiography obtained in 2 patients because of a concern for aneurysm demonstrated central and peripheral vasospasm. Magnetic resonance angiography demonstrated central vasospasm in the third patient.