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Farsetti D, Pometti F, Tiralongo GM, Lo Presti D, Pisani I, Gagliardi G, Vasapollo B, Novelli GP, Valensise H. Distinction between SGA and FGR by means of fetal umbilical vein flow and maternal hemodynamics. J Matern Fetal Neonatal Med 2021; 35:6593-6599. [PMID: 33938366 DOI: 10.1080/14767058.2021.1918091] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To improve identification of fetal growth restriction (FGR) by means of umbilical venous flow (QUV) and maternal hemodynamics, including systemic vascular resistance (SVR) and cardiac output (CO), in order to distinguish between FGR and SGA. METHODS We enrolled 68 pregnancies (36 SGA, 8 early FGR and 24 late FGR) who underwent a complete fetal hemodynamic examination including QUV and a noninvasive maternal hemodynamics assessment by means of USCOM. RESULTS In comparison with SGA, QUV and corrected for estimated fetal weight QUV (cQUV) were significantly lower in early and late-FGR. In addition, maternal CO was lower in early and late-FGR, while SVR was lower only in early-onset FGR. According to ROC analysis, cQUV centile (AUC 0.92, 0.72) was the best parameter for the prediction of SGA before and after 32 weeks, followed by SVR and CO. For all parameters, the prediction was always better in the case of early-onset FGR <32 weeks. CONCLUSIONS UV flow and maternal hemodynamics examination are useful tools to accurately discern between SGA and FGR.
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Affiliation(s)
- Daniele Farsetti
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy.,Department of Obstetrics and Gynecology, Policlinico Casilino Hospital, Rome, Italy
| | - Francesca Pometti
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy.,Department of Obstetrics and Gynecology, Policlinico Casilino Hospital, Rome, Italy
| | | | - Damiano Lo Presti
- Department of Obstetrics and Gynecology, Policlinico Casilino Hospital, Rome, Italy
| | - Ilaria Pisani
- Department of Obstetrics and Gynecology, Policlinico Casilino Hospital, Rome, Italy
| | - Giulia Gagliardi
- Department of Obstetrics and Gynecology, Policlinico Casilino Hospital, Rome, Italy
| | - Barbara Vasapollo
- Department of Obstetrics and Gynecology, Policlinico Casilino Hospital, Rome, Italy
| | - Gian Paolo Novelli
- Department of Integrated Care Processes, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
| | - Herbert Valensise
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy.,Department of Obstetrics and Gynecology, Policlinico Casilino Hospital, Rome, Italy
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Valensise H, Farsetti D, Pisani I, Tiralongo GM, Gagliardi G, Lo Presti D, Novelli GP, Vasapollo B. Hemodynamic maladaptation and left ventricular dysfunction in chronic hypertensive patients at the beginning of gestation and pregnancy complications: a case control study. J Matern Fetal Neonatal Med 2020; 35:3290-3296. [PMID: 32933343 DOI: 10.1080/14767058.2020.1818206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate early pregnancy differences in maternal hemodynamics, cardiac geometry and function, between chronic hypertensive (CH) patients with and without the development of feto-maternal complications later in pregnancy. METHODS We performed a case-control study on nulliparous CH treated patients. From a group of CH patients referred to our outpatient clinic at 4-6 weeks for a clinical evaluation the first consecutive 30 patients with subsequent complications (superimposed PE, abruptio placentae, uncontrolled severe hypertension with delivery <34 weeks, HELLP syndrome, FGR, perinatal death) were enrolled; the first 2 CH women with uneventful pregnancy referred after the case were enrolled as controls for a total of 60 patients. All patients were shifted to alpha-methyl dopa at the beginning of pregnancy and were submitted to an echocardiographic evaluation to assess the maternal hemodynamics, cardiac geometry, diastolic and systolic function. RESULTS Patients developing complications had a lower early pregnancy heart rate (73 ± 11 vs. 82 ± 11 bpm), cardiac output (5.23 ± 1.2 vs. 6.5 ± 1.3 L/min, p<.01) and cardiac index (3.0 ± 0.7 vs. 3.6 ± 0.7 L/min/m2, p<.01); higher total vascular resistance (1554 ± 305 vs. 1248 ± 243 d.s.cm-5, p<.01) and total vascular resistance index (2666 ± 519 vs. 2335 ± 431, d.s.cm-5/m2, p<.01); higher left ventricular mass index (42.1 ± 8.6 vs. 36.9 ± 8.3 g/m2, p<.01) and relative wall thickness (0.40 ± 0.05 vs. 0.36 ± 0.05, p<.01) of the left ventricle, resulting in a higher prevalence of altered cardiac geometry vs. uneventful CH controls. Diastolic and systolic dysfunction were also present with a higher E/e' ratio (10.50 ± 3.56 vs. 7.22 ± 1.91, p<.01) and a lower stress corrected midwall mechanics (89 ± 21 vs. 100 ± 22, p=.02) of the left ventricle. CONCLUSION CH treated patients developing maternal and/or fetal complications show early pregnancy altered cardiac geometry, diastolic and systolic dysfunction, and impaired hemodynamics with a high resistance circulation.
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Affiliation(s)
- Herbert Valensise
- Division of Obstetrics and Gynecology, Policlinico Casilino Hospital, Rome, Italy.,Department of Surgery, Tor Vergata University, Rome, Italy
| | - Daniele Farsetti
- Division of Obstetrics and Gynecology, Policlinico Casilino Hospital, Rome, Italy.,Department of Surgery, Tor Vergata University, Rome, Italy
| | - Ilaria Pisani
- Division of Obstetrics and Gynecology, Policlinico Casilino Hospital, Rome, Italy
| | | | - Giulia Gagliardi
- Division of Obstetrics and Gynecology, Policlinico Casilino Hospital, Rome, Italy
| | - Damiano Lo Presti
- Division of Obstetrics and Gynecology, Policlinico Casilino Hospital, Rome, Italy
| | | | - Barbara Vasapollo
- Division of Obstetrics and Gynecology, Policlinico Casilino Hospital, Rome, Italy
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Valensise H, Farsetti D, Pisani I, Tiralongo GM, Lo Presti D, Gagliardi G, Vasapollo B, Novelli GP. Friendly help for clinical use of maternal hemodynamics. J Matern Fetal Neonatal Med 2019; 34:3075-3079. [PMID: 31619097 DOI: 10.1080/14767058.2019.1678136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Maternal hemodynamics plays a major role during pregnancy and its evaluation is fundamental to understand obstetric conditions. The modern opinion about maternal hemodynamics assessment is to shift focus from single hemodynamic parameters to the whole hemodynamic profile. Our aim is to create a simple, intuitive, and easily understandable graphing technique to evaluate the main hemodynamic parameters. METHODS We enrolled 531 pregnant women without maternal or fetal disease. One hundred and forty five in the first trimester of pregnancy, 258 in the second one and 128 in the third one. We performed hemodynamic assessment with ultrasonic cardiac output monitor method. We selected the six main parameters: cardiac output, systemic vascular resistance, heart rate, potential-to-kinetic energy ratio, inotropy index, and stroke volume variation. We chose the radar chart to display the multivariate data of the hemodynamic measurement of the patient in evaluation. RESULTS We have obtained mean and deviation standard values for the six main hemodynamic parameters in every trimester. They deeply change during the pregnancy, so it is correct to compare a new hemodynamic measurement with the mean values for the specific trimester in order to evaluate any possible alterations. In fact, once a new hemodynamic assessment is performed, we calculate the Z-score in order to fix the positions of the six measured parameters in their specific axis of radar chart. CONCLUSIONS At the end of a hemodynamic exam, the physician can input the data in the program obtaining a graphic representation. Using this technique, which simultaneously evaluates six hemodynamic parameters, it is possible to easily understand the patient's hemodynamic status. By converting the parameters values in Z-score, it is easier to understand when hemodynamics is altered, even if the physician does not have any experience in maternal hemodynamics.
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Affiliation(s)
- Herbert Valensise
- Obstetrics and Gynecology Unit, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy.,Department of Obstetrics and Gynecology, Casilino General Hospital, Rome, Italy
| | - Daniele Farsetti
- Obstetrics and Gynecology Unit, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Ilaria Pisani
- Department of Obstetrics and Gynecology, Casilino General Hospital, Rome, Italy
| | | | - Damiano Lo Presti
- Department of Obstetrics and Gynecology, Casilino General Hospital, Rome, Italy
| | - Giulia Gagliardi
- Department of Obstetrics and Gynecology, Casilino General Hospital, Rome, Italy
| | - Barbara Vasapollo
- Department of Obstetrics and Gynecology, Casilino General Hospital, Rome, Italy
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Valensise H, Lo Presti D, Gagliardi G, Tiralongo GM, Pisani I, Novelli GP, Vasapollo B. Persistent Maternal Cardiac Dysfunction After Preeclampsia Identifies Patients at Risk for Recurrent Preeclampsia. Hypertension 2016; 67:748-53. [PMID: 26902488 DOI: 10.1161/hypertensionaha.115.06674] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 12/17/2015] [Indexed: 11/16/2022]
Abstract
The purpose of our study was to assess cardiac function in nonpregnant women with previous early preeclampsia before a second pregnancy to highlight the cardiovascular pattern, which may take a risk for recurrent preeclampsia. Seventy-five normotensive patients with previous preeclampsia and 147 controls with a previous uneventful pregnancy were enrolled in a case-control study and submitted to echocardiographic examination in the nonpregnant state 12 to 18 months after the first delivery. All patients included in the study had pregnancy within 24 months from the echocardiographic examination and were followed until term. Twenty-two (29%) of the 75 patients developed recurrent preeclampsia. In the nonpregnant state, patients with recurrent preeclampsia compared with controls and nonrecurrent preeclampsia had lower stroke volume (63 ± 14 mL versus 73 ± 12 mL and 70 ± 11 mL, P<0.05), cardiac output (4.6 ± 1.2 L versus 5.3 ± 0.9 L and 5.2 ± 1.0 L, P<0.05), higher E/E' ratio (11.02 ± 3.43 versus 7.34 ± 2.11 versus 9.03 ± 3.43, P<0.05), and higher total vascular resistance (1638 ± 261 dyne · s(-1) · cm(-5) versus 1341 ± 270 dyne · s(-1) · cm(-5) and 1383 ± 261 dyne · s(-1) · cm(-5), P<0.05). Left ventricular mass index was higher in both recurrent and nonrecurrent preeclampsia compared with controls (30.0 ± 6.3 g/m(2.7) and 30.4 ± 6.8 g/m(2.7) versus 24.8 ± 5.0 g/m(2.7), P<0.05). Signs of diastolic dysfunction and different left ventricular characteristics are present in the nonpregnant state before a second pregnancy with recurrent preeclampsia. Previous preeclamptic patients with nonrecurrent preeclampsia show left ventricular structural and functional features intermediate with respect to controls and recurrent preeclampsia.
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Affiliation(s)
- Herbert Valensise
- From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.).
| | - Damiano Lo Presti
- From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.)
| | - Giulia Gagliardi
- From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.)
| | - Grazia Maria Tiralongo
- From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.)
| | - Ilaria Pisani
- From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.)
| | - Gian Paolo Novelli
- From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.)
| | - Barbara Vasapollo
- From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.)
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Valensise H, Lo Presti D, Tiralongo GM, Pisani I, Gagliardi G, Vasapollo B, Frigo MG. Foetal heart rate deceleration with combined spinal–epidural analgesia during labour: a maternal haemodynamic cardiac study. J Matern Fetal Neonatal Med 2015; 29:1980-6. [DOI: 10.3109/14767058.2015.1072156] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tiralongo GM, Pisani I, Gagliardi G, Presti DL, Scala RL, Vasapollo B, Novelli G, Andreoli A, Valensise H. P51. Screening for preeclampsia in the first trimester: A reduced fat mass increases the risk in normo BMI patients. Pregnancy Hypertens 2015. [DOI: 10.1016/j.preghy.2015.07.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lo Presti D, Scala RL, Tiralongo GM, Pisani I, Gagliardi G, Novelli GP, Vasapollo B, Andreoli A, Valensise H. PP065. Assessment of total vascular resistance and total body water in normotensive women during the first trimester of pregnancy in order to predict hypertensive complications. Pregnancy Hypertens 2013; 3:90-1. [PMID: 26105918 DOI: 10.1016/j.preghy.2013.04.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In pregnancy there is an increase in maternal cardiac output (CO) and a reduction in total vascular resistance (TVR). Abnormalities of this adaptive mechanisms lead to numerous disorders of pregnancy. Moreover the mother's body water composition undergoes important modifications in total body water (TBW), extracellular and intracellular body water (EBW, IBW). OBJECTIVES Aim of the study is to identify a group of patients at high risk of developing hypertensive complications of pregnancy in frist trimester. METHOD To investigate hemodynamic changes and distribution of body water during the frist trimester of pregnancy, we conducted an observational study. We evaluated CO, TVR and Time Flow Corrected (TFc) with the USCOM system, a non invasive method. Patients were, also, subjected to BIA (Body Impedance Assessment). RESULTS We enrolled 120 healthy pregnant women. 20 patients, were excluded for bad signal. Absolute values of haemodynamic and body impedance measures are shown in Fig. 1. Patients were divided in two groups:Group A with TVR>1200 dyne and Group B with TVR<1200 dyne. CO values were higher in group B. There wasn't significant differences in TBW, haematocrit, TFc and WBI (water balance index: TBW/Hct) between the two groups. CONCLUSION Our results show that at costant values of TBW, Hct and WBI,we can find difference in term of TVR and CO in the first trimester of pregnancy. These parameters may improve the accuracy of screening in clinical practice.
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Lo Presti D, Scala RL, Tiralongo GM, Pisani I, Gagliardi G, Novelli GP, Vasapollo B, Valensise H. PP064. Total vascular resistances in early pregnancy: A key to understand abnormal cardiovascular adaptation associated with spontaneous abortion. Pregnancy Hypertens 2013; 3:90. [PMID: 26105919 DOI: 10.1016/j.preghy.2013.04.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION From early pregnancy, maternal hemodynamic profile begins to change. The absence of these changes leads to increased risk of complication during the gestation. OBJECTIVES Aim of this study is to understand in early pregnancy the behaviour of total vascular resistances (TVR) as a sign of maternal cardiovascular adaptation to pregnancy. METHOD A cross section study was conducted. We followed 160 healthy women with singleton pregnancy during the first trimester of gestation. We evaluated cardiac output (CO) and TVR at 7, 9 and 11 weeks of gestation. We obtained the following haemodynamic measurements with the USCOM system, a non invasive method: heart rate (HR), systolic and diastolic blood pressure (SBP, DBP), CO and TVR. RESULTS 160 healthy pregnant women were selected, 8 patients, were excluded for a bad signal. Absolute values of the haemodynamic measures are shown in Fig. 1. 41 patients underwent spontaneous embryonic demise. This last group of patients showed in 54% (group A) TVR values within the normal limits (TVR<1200), while 46% patients (group B) showed TVR values well above the normal limits (TVR>1200) and CO values below the normal adaptation to pregnancy. Table 1 shows hemodynamic measures for the group A and group B; we found differences in term of CO, TVR and PAS between the two groups. CONCLUSION Elevated TVR might indicate an abnormal vascular adaptation already in first weeks of pregnancy. Moreover, in women who undergo to abortion, elevated TVR could be use to distinguish genetic or environmental causes of miscarriage.
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