G. P. Novelli

Abnormal maternal cardiac function precedes the clinical manifestation of fetal growth restriction

To compare maternal hemodynamics in women whose fetuses are small‐for‐gestational age (SGA) with those in women with fetal growth restriction (FGR) before manifestation of the clinical disease.

Maternal and fetal hemodynamic effects induced by nitric oxide donors and plasma volume expansion in pregnancies with gestational hypertension complicated by intrauterine growth restriction with absent end-diastolic flow in the umbilical artery

To evaluate the effect of plasma volume expansion (PVE) and nitric oxide (NO) donors, in addition to antihypertensive therapy for gestational hypertensive pregnancies complicated by intrauterine growth restriction (IUGR) with absent end‐diastolic flow (AEDF) in the umbilical artery (UA).

Medical treatment of early-onset mild gestational hypertension reduces total peripheral vascular resistance and influences maternal and fetal complications

Complications in early‐onset mild gestational hypertension (GH) are better predicted by total peripheral vascular resistance (TPVR) > 1350 dyne than by blood pressure. We therefore aimed to assess the possible reduction of severe complications by lowering TPVR with nitric oxide (NO) donors, oral fluids and standard antihypertensive therapy in women with early‐onset mild GH.

Screening for pre‐eclampsia in the first trimester: role of maternal hemodynamics and bioimpedance in non‐obese patients

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).

H1. Persistent maternal cardiac dysfunction after preeclampsia identifies patients at risk for recurrent pre-eclampsia.

Abstract Objective: The purpose of our study was to assess cardiac function in non-pregnant women with previous early preeclampsia before a second pregnancy to highlight the cardiovascular pattern, which may take a risk for recurrent preeclampsia. Methods: 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 non-pregnant state 12–18 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. Results: Twenty-two (29%) of the 75 patients developed recurrent preeclampsia. In the non-pregnant state, patients with recurrent preeclampsia compared to controls and non-recurrent 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·cm−5 versus 1341 ± 270 dyne·s·cm−5 and 1383 ± 261 dyne·s·cm−5, p < 0.05). Left ventricular mass index was higher in both recurrent and non-recurrent preeclampsia compared to controls (30.0 ± 6.3 g/m2.7 and 30.4 ± 6.8 g/m2.7 versus 24.8 ± 5.0 g/m2.7, p < 0.05). Conclusions: Signs of diastolic dysfunction and different left ventricular characteristics are present in the non-pregnant state before a second pregnancy with recurrent preeclampsia. Previous preeclamptic patients with non-recurrent preeclampsia show left ventricular structural and functional features intermediate with respect to controls and recurrent preeclampsia.

OC215: Elevated total vascular resistance more than persisting bilateral notches of uterine artery Doppler waveforms identifies patients at risk of pregnancy complications

Objectives: To explore the value of uterine artery (UA) Doppler waveform analysis in the prediction of superimposed pre-eclampsia (SPE) in gestations complicated by mild chronic arterial hypertension (MCAH) Methods: UAs were recorded using Doppler ultrasonography in 40 women at 24–26 weeks of gestation with a diagnosis of MCAH developed before the current pregnancy. Mean pulsatility index (PI) and presence/absence of a notch in both UAs were registered. The onset of SPE was divided into: early (before 34 weeks of gestation) or late (after 34 weeks). An abnormal UA-PI was considered when the mean value was above or equal to 1.4. ROC curves and likelihood ratios were calculated to evaluate the predictive capacity of the test for both modalities of SPE. Results: The prevalence of SPE in the studied group was 30% (12/40), three early and nine late onset. Mean UA-PI values of MCAH cases without SPE were significantly lower than in those developing SPE (0.88 vs. 1.29; P = 0.005). A UA-PI value above or equal to 1.4 showed a predictive capacity for SPE with specificity 93.7%, sensitivity 33.3%, positive predictive value (PPV) 80%, negative predictive value (NPV) 65.2%, positive likelihood ratio (LR+) 5.3 and negative likelihood ratio (LR−) 0.7; adding the presence of unilateral or bilateral notch gave values of 93.7%, 58.3%, 87.5%, 75%, 9.3 and 0.4 respectively. For early-onset SPE a UA-PI value above or equal to 1.4 had a specificity of 92%, sensitivity 100%, PPV 60%, NPV 100%, LR+ 12.5 and LR− 0. Conclusions: Mean UA-PI seems to be a useful tool for predicting mainly early-onset SPE in gestations complicated with MCAH. The test showed a low sensitivity for late SPE, which was apparently improved by analysis of the notch.

OC216: Treatment with NO donor patches in asymptomatic women with bilateral notch and elevated total vascular resistance

Objectives: To explore the value of uterine artery (UA) Doppler waveform analysis in the prediction of superimposed pre-eclampsia (SPE) in gestations complicated by mild chronic arterial hypertension (MCAH) Methods: UAs were recorded using Doppler ultrasonography in 40 women at 24–26 weeks of gestation with a diagnosis of MCAH developed before the current pregnancy. Mean pulsatility index (PI) and presence/absence of a notch in both UAs were registered. The onset of SPE was divided into: early (before 34 weeks of gestation) or late (after 34 weeks). An abnormal UA-PI was considered when the mean value was above or equal to 1.4. ROC curves and likelihood ratios were calculated to evaluate the predictive capacity of the test for both modalities of SPE. Results: The prevalence of SPE in the studied group was 30% (12/40), three early and nine late onset. Mean UA-PI values of MCAH cases without SPE were significantly lower than in those developing SPE (0.88 vs. 1.29; P = 0.005). A UA-PI value above or equal to 1.4 showed a predictive capacity for SPE with specificity 93.7%, sensitivity 33.3%, positive predictive value (PPV) 80%, negative predictive value (NPV) 65.2%, positive likelihood ratio (LR+) 5.3 and negative likelihood ratio (LR−) 0.7; adding the presence of unilateral or bilateral notch gave values of 93.7%, 58.3%, 87.5%, 75%, 9.3 and 0.4 respectively. For early-onset SPE a UA-PI value above or equal to 1.4 had a specificity of 92%, sensitivity 100%, PPV 60%, NPV 100%, LR+ 12.5 and LR− 0. Conclusions: Mean UA-PI seems to be a useful tool for predicting mainly early-onset SPE in gestations complicated with MCAH. The test showed a low sensitivity for late SPE, which was apparently improved by analysis of the notch.

P10.05: Nitric oxide donors and fluid therapy increase fetal growth in gestational hypertension

Objective: Adding NO donors to the antihypertensive treatment in gestational hypertensive patients complicated by fetal growth restriction. Methods: Fifty moderate to severe gestational hypertensive patients (27–30 weeks of gestation) with fetal abdominal circumference < 10th percentile for gestational age and normal fetal Doppler parameters, were submitted to maternal echocardiographic exam before and 14 days after treatment was started. Patients were randomised in two treatment groups: (1) 25 patients underwent Calcium antagonists and Bed Rest; (2) 25 patients underwent Calcium antagonists and Bed Rest + Transdermal glyceryl trinitrate (5–10 mg released in 24 hours administrated for 12–14 hours) + intravenous fluid infusion with 2000 mL over 24 hours. Results: Are shown in the table. Conclusions: Nitrates and fluid therapy added to standard antihypertensive treatment improve maternal hemodinamics and fetal growth more than standard antihypertensive treatment alone.

Restricted physical activity in pregnancy reduces maternal vascular resistance and improves fetal growth

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.

Maternal hemodynamics early in labor: a possible link with obstetric risk?

To determine if hemodynamic assessment in ‘low‐risk’ pregnant women at term with an appropriate‐for‐gestational age (AGA) fetus can improve the identification of patients who will suffer maternal or fetal/neonatal complications during labor.