Maternal total vascular resistance and concentric geometry: A key to identify uncomplicated gestational hypertension

H. Valensise, B. Vasapollo, G. P. Novelli, P. Pasqualetti, A. Galante, D. Arduini

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To evaluate the prognostic impact of elevated total vascular resistance (TVR) on the outcome of pregnancy in early mild gestational hypertension (EMGH). Design: Prospective observational study. Setting: Data collected from women with EMGH referred to the obstetrics outpatient clinic of Tor Vergata University from June 2003 to June 2005. Population: A total of 268 women with EMGH (systolic and diastolic blood pressure [BP] 140-150 mmHg and 90-99 mmHg, respectively, without significant proteinuria). Methods: Women had a maternal echocardiographic examination and BP examination within 24 hours of diagnosis. From this, the TVR was calculated and the geometric pattern of the left ventricle assessed. Main outcome measures: Fetal/maternal adverse outcomes (pre-eclampsia, preterm delivery, placental abruption, other maternal medical problems, fetal distress, neonatal low birthweight, admittance to neonatal intensive care unit and perinatal death). Results: Ninety-two out of the 268 pregnancies showed adverse outcomes (34.3%). The best independent predictor for the composite of maternal and fetal complications was TVR (OR 64.4, 95% CI 25.9-160.1). The cutoff value was 1340 dyn seconds/cm5 with a sensitivity and a specificity of 90 and 91%, respectively. Concentric geometry of the left ventricle was also an independent predictor (OR 4.72, 95% CI 1.85-12.04). Conclusions: Echocardiography could help in identifying women with EMGH who subsequently develop maternal and fetal complications, allowing a classification in high-risk (TVR > 1340 dyn seconds/cm5, concentric geometry of the left ventricle) and low-risk women (TVR <1340 dyn seconds/cm5, nonconcentric geometry of the left ventricle) for adverse outcomes of pregnancy.

Original languageEnglish
Pages (from-to)1044-1052
Number of pages9
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume113
Issue number9
DOIs
Publication statusPublished - Sep 2006

Keywords

  • Fetal growth restriction
  • Haemodynamics
  • Hypertension
  • Pre-eclampsia
  • Pregnancy

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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