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Ravid D, Ovadia M, Asali A, Nisim S, Gershnabel SF, Biron-Shental T, Weitzner O. Changes in maternal heart rate in delayed post-partum preeclampsia. BMC Womens Health 2023; 23:99. [PMID: 36894928 PMCID: PMC9999508 DOI: 10.1186/s12905-023-02233-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/17/2023] [Indexed: 03/11/2023] Open
Abstract
AIM Delayed-onset postpartum preeclampsia (PET) is defined as a new diagnosis of preeclampsia presenting 48 h to 6 weeks postpartum. This disorder is infrequent and associated with a higher incidence of complications as compared to antepartum PET. There seems to be a need to further characterize this disorder. The aim of the study was to investigate the difference of maternal heart rate in women with delayed onset postpartum preeclampsia as compared to healthy controls. METHODS The medical files of all women who were readmitted with delayed onset postpartum preeclampsia during 2014-2020 were reviewed. Data on maternal physiological characteristics were compared to healthy control group of women at the same post-partum day, with uncomplicated pregnancies. RESULTS Included 45 women with the diagnosis of delayed onset of preeclampsia at 6.3 ± 2.86 post-partum day. As compared to controls (n = 49), women with delayed post-partum were older, 34.6 ± 5.4 vs. 32.3 ± 4.7 years, p = 0.003. There were no differences between groups regarding maternal gravidity, parity, BMI (kg/m2) or Hb level at delivery day. Women with delayed post-partum preeclampsia had lower mean pulse rate as compared to controls, 58 ± 15 bpm vs. 83 ± 11.6 bpm, respectively, P < 0.0001. Only 17% of the women in the delayed onset group had pulse rate above 70 bpm as compared to 83% in the control group. CONCLUSIONS Maternal low heart rate in cases with delayed onset of post-partum preeclampsia is an important clinical characteristic that may reflect baroreceptors response to maternal hypertension.
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Affiliation(s)
- Dorit Ravid
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 4428164, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Ovadia
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 4428164, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aula Asali
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 4428164, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Nisim
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 4428164, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sivan Farladansky Gershnabel
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 4428164, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 4428164, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omer Weitzner
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 4428164, Kfar Saba, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Morton A. Possible additional criteria for the diagnosis of preeclampsia with severe features. Obstet Med 2023; 16:9-11. [PMID: 37139506 PMCID: PMC10150306 DOI: 10.1177/1753495x221103981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 03/09/2022] [Indexed: 11/17/2022] Open
Abstract
Preeclampsia is a disorder affecting multiple organ systems. Preeclampsia with severe features may prompt consideration of delivery. The diagnostic criteria for preeclampsia with severe features, while focusing upon maternal cardiopulmonary, neurological, hepatic, renal and haematological systems, vary considerably in international practice guidelines. In the absence of alternative causes, severe hyponatraemia, pleural effusions and ascites, and abrupt severe maternal bradycardia are proposed as possible additional criteria for the diagnosis of preeclampsia.
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Affiliation(s)
- Adam Morton
- Obstetric Medicine, Mater Health,
Raymond Terrace, South Brisbane, Australia
- University of Queensland, Brisbane,
Australia
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Li L, Wilson C, Morton A. Maternal bradycardia heralding deteriorating HELLP syndrome (pregnancy hypertension). Pregnancy Hypertens 2021; 27:115-116. [PMID: 34999312 DOI: 10.1016/j.preghy.2021.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 12/09/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Ling Li
- Department of Endocrinology, Mater Misericordiae Hospital, South Brisbane, QLD 4101, Australia.
| | - Caroline Wilson
- Department of Endocrinology, Mater Misericordiae Hospital, South Brisbane, QLD 4101, Australia
| | - Adam Morton
- Department of Endocrinology, Mater Misericordiae Hospital, South Brisbane, QLD 4101, Australia
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Habib YH, Gowayed MA, Abdelhady SA, El-Deeb NM, Darwish IE, El-Mas MM. Modulation by antenatal therapies of cardiovascular and renal programming in male and female offspring of preeclamptic rats. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2021; 394:2273-2287. [PMID: 34468816 DOI: 10.1007/s00210-021-02146-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/26/2021] [Indexed: 11/28/2022]
Abstract
Morbidity and mortality risks are enhanced in preeclamptic (PE) mothers and their offspring. Here, we asked if sexual dimorphism exists in (i) cardiovascular and renal damage evolved in offspring of PE mothers, and (ii) offspring responsiveness to antenatal therapies. PE was induced by administering NG-nitro-L-arginine methyl ester (L-NAME, 50 mg/kg/day, oral gavage) to pregnant rats for 7 days starting from gestational day 14. Three therapies were co-administered orally with L-NAME, atrasentan (endothelin ETA receptor antagonist), terutroban (thromboxane A2 receptor antagonist, TXA2), or α-methyldopa (α-MD, central sympatholytic drug). Cardiovascular and renal profiles were assessed in 3-month-old offspring. Compared with offspring of non-PE rats, PE offspring exhibited elevated systolic blood pressure and proteinuria and reduced heart rate and creatinine clearance (CrCl). Apart from a greater bradycardia in male offspring, similar PE effects were noted in male and female offspring. While terutroban, atrasentan, or α-MD partially and similarly blunted the PE-evoked changes in CrCl and proteinuria, terutroban was the only drug that virtually abolished PE hypertension. Rises in cardiorenal inflammatory (tumor necrosis factor alpha, TNFα) and oxidative (isoprostane) markers were mostly and equally eliminated by all therapies in the two sexes, except for a greater dampening action of atrasentan, compared with α-MD, on tissue TNFα in female offspring only. Histopathologically, antenatal terutroban or atrasentan was more effective than α-MD in rectifying cardiac structural damage, myofiber separation, and cytoplasmic alterations, in PE offspring. The repair by antenatal terutroban or atrasentan of cardiovascular and renal anomalies in PE offspring is mostly sex-independent and surpasses the protection offered by α-MD, the conventional PE therapy.
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Affiliation(s)
- Yasser H Habib
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt
| | - Mennatallah A Gowayed
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt
| | - Sherien A Abdelhady
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt
| | - Nevine M El-Deeb
- Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Inas E Darwish
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt
- Department of Clinical Pharmacology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mahmoud M El-Mas
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt.
- Department of Pharmacology and Toxicology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
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Angsubhakorn N, Benditt D. Relative Sinus Bradycardia: An Unexpected Finding in Preeclampsia With Acute Pulmonary Edema. Cureus 2021; 13:e13262. [PMID: 33728199 PMCID: PMC7948310 DOI: 10.7759/cureus.13262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Preeclampsia is a multifactorial pregnancy-specific syndrome, which can result in significant alterations in cardiovascular hemodynamics. We report an observation of unexpected relative bradycardia in a previously healthy woman who presented with postpartum preeclampsia and acute pulmonary edema. We observed an increase in heart rate following normalization of blood pressure, which suggested that the initial slower than expected heart rate may reflect a baroreceptor response to hypertension. Whether this finding should be regarded as a severe aspect of the disease spectrum needs further study.
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Affiliation(s)
| | - David Benditt
- Cardiac Arrhythmia Center, Cardiovascular Division, University of Minnesota, Minneapolis, USA
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Umazume T, Yamada S, Yamada T, Ishikawa S, Furuta I, Iwano H, Murai D, Hayashi T, Okada K, Morikawa M, Tsutsui H, Minakami H. Association of peripartum troponin I levels with left ventricular relaxation in women with hypertensive disorders of pregnancy. Open Heart 2018; 5:e000829. [PMID: 30245837 PMCID: PMC6144895 DOI: 10.1136/openhrt-2018-000829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/01/2018] [Accepted: 07/24/2018] [Indexed: 01/08/2023] Open
Abstract
Objective Women with hypertensive disorders of pregnancy (HDP) show elevated risk of heart failure despite decreased circulating plasma volume compared with those with normotensive control pregnancies (NCP). This study was performed to better characterise the heart in women with HDP and determine whether high-sensitivity troponin I (hs-TnI) around childbirth predicts reduced left ventricular (LV) relaxation at 1 month postpartum. Methods Echocardiography was performed longitudinally during the first, second and third trimesters and immediately postpartum within 1 week and 1 month postpartum in 24 women with HDP, with simultaneous determination of blood variables in comparison with 51 women with NCP. Results Compared with NCP, HDP showed greater antepartum left atrial (LA) volume, LV mass and inferior vena cava (IVC) diameter, higher peripartum brain natriuretic peptide/N-terminal pro-B-type natriuretic peptide and hs-TnI with the highest value immediately postpartum, and lower early diastolic mitral annular velocity (e') during pregnancy/postpartum. In analyses of data on HDP and NCP, hs-TnI at the third trimester as well as that immediately postpartum was negatively correlated with later e' at 1 month postpartum. The areas under the receiver operating characteristic curves were 0.82 and 0.81 for hs-TnI at the third trimester and immediately postpartum, respectively, in the prediction of reduced LV relaxation at 1 month postpartum. Conclusion Reduced LV diastolic function and decreased splanchnic blood reservoir may contribute to the increased third trimester IVC diameter and LA volume in women with HDP. The rise in hs-TnI around childbirth was associated with poor LV relaxation ability at 1 month postpartum.
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Affiliation(s)
- Takeshi Umazume
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Yamada
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takahiro Yamada
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Ishikawa
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Itsuko Furuta
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroyuki Iwano
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Daisuke Murai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Taichi Hayashi
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazunori Okada
- Faculty of Health Sciences, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Mamoru Morikawa
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hisanori Minakami
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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