Tinne Mesens

Role of dysfunctional maternal venous hemodynamics in the pathophysiology of pre-eclampsia: a review

The venous compartment has an important function in regulation and control of cardiac output. Abnormalities of cardiac output have been found in early gestational stages of both early‐ and late‐onset pre‐eclampsia. The venous compartment also maintains the balance between circulating and non‐circulating blood volumes and regulates the amount of reserve blood stored in the splanchnic venous bed. It is well known that adaptive regulation of maternal blood volume is disturbed in pre‐eclampsia. Abnormal venous hemodynamics and venous congestion are responsible for secondary dysfunction of several organs, such as the kidneys in cardiorenal syndrome and the liver in cardiac cirrhosis. Renal and liver dysfunctions are among the most relevant clinical features of pre‐eclampsia.

Ultrasound methods to distinguish between malignant and benign adnexal masses in the hands of examiners with different levels of experience

To determine the effect of an ultrasound training course on the performance of pattern recognition when used by less experienced examiners and to compare the performance of pattern recognition, a logistic regression model and a scoring system to estimate the risk of malignancy between examiners with different levels of experience.

MATERNAL HEPATIC VEIN DOPPLER VELOCIMETRY DURING UNCOMPLICATED PREGNANCY AND PRE-ECLAMPSIA

Changes of Doppler velocity measurements of distinct hepatic vein (HV) Doppler wave components were evaluated during uncomplicated pregnancy (UP) as a reference to measurements in pre-eclampsia (PE). Women with UP (n = 13) were submitted to standardised duplex scanning of HV at 11 stages of pregnancy between 10 and 38 weeks. For each stage, mean +/- SD was calculated for HV A-, X-, V- and Y-peaks. Women with PE (n = 30) were evaluated once, and mean +/- SD was calculated for pregnancies <32 weeks, 32-34(+6) weeks and > or =35 weeks. PE and UP values at corresponding gestational age were compared statistically using t-test. HV A-velocity measurements changed markedly from negative values in early uncomplicated pregnancy, converting around 22-24 weeks to positive values until term. Changes throughout gestation were less prominent for HV X-, V- and Y-velocities. HV A-velocity measurements were significantly lower in PE than in UP, the difference being more pronounced at 30 weeks (-3.59 +/- 3.41 vs. 6.12 +/- 3.43, p = 0.0001) than at 37 weeks (2.35 +/- 4.54 vs. 5.32 +/- 1.92, p = 0.04). From our results, we conclude that HV Doppler velocimetry shows a gradual shift from central venous reversed flow during atrial contraction in uncomplicated early pregnancy to constantly forward moving flow until term. HV A-velocities are significantly lower in PE than in UP, the differences being more pronounced in late second trimester than near term.

Impedance cardiography in uncomplicated pregnancy and pre-eclampsia: A reliability study

It has been reported that cardiac contractility is altered in pre-eclampsia compared with normal pregnancy. Because of the non-invasive nature of impedance cardiography (ICG), this method is gaining popularity in the obstetric field. We assessed the reliability of ICG measurements in uncomplicated 3rd trimester pregnancies (UP) and pre-eclamptic pregnancies (PE). ICG measurements were recorded before and after three position changes, and this examination was done twice (session 1 and 2) per subject. For each of the 22 haemodynamic parameters, inter- and intrasession Pearsons correlation coefficients (PCC) were calculated for mean values of 30 measurements per position per subject. PCC was consistently ≥ 0.80 for contractility parameters ‘acceleration-’, ‘velocity-’ and ‘heather-index’ in both UP and PE. These data illustrate that correlation between repeated ICG measurements of cardiac contractility is high under standardised conditions, and that ICG may be useful to study changes of cardiac contractility in pregnancy.

Maternal renal interlobar vein impedance index is higher in early- than in late-onset pre-eclampsia

To test the hypothesis that Doppler characteristics of maternal renal interlobar veins (RIV) are different between pregnancies affected by early‐onset pre‐eclampsia (EP) and those affected by late‐onset pre‐eclampsia (LP).

Diurnal and position-induced variability of impedance cardiography measurements in healthy subjects

Cardiovascular (CV) parameters and their measurements are subject to variation. In this study, we evaluated the reproducibility of impedance cardiography (ICG) measurements following orthostatic and diurnal challenges for a set of 22 CV parameters in ten randomly selected healthy nonpregnant women. A standard protocol was used to record a consecutive series of measurements for each parameter before and after three position changes. This series of measurements was performed twice (AM and PM sessions). For each parameter, measurement‐shift following position change was evaluated at 5% cutoff and compared between sessions. Intra‐ and intersession intraclass correlation (ICC) was calculated for individual measurements per position using repeated‐measures analysis of variance. Intra‐ and intersession Pearson’s correlation coefficient (PCC) was calculated for mean values per position. Intersession correlation for measurement‐shift following position change was 0·42 (5/12) for pressure parameters, whereas this was 0·96 (52/54) for other parameters. Inter‐ and intrasession ICC for individual measurements varied between 0·02 and 1 for all parameters, however inter‐ and intrasession PCC for mean values was consistently >0·80 for stroke volume (SV), stroke index (SI), cardiac output (CO), acceleration and velocity index (ACI and VI), thoracic fluid content (TFC), TFC index (TFCI) and heart period duration (HPD). We conclude that in healthy subjects under standardised conditions, reproducibility of means of multiple ICG measurements is high for SV, SI, CO, ACI, VI, TFC, TFCI and HPD. From our data, we cannot draw conclusions on trends in diseased subjects.

Venous Pulse Transit Time in Normal Pregnancy and Preeclampsia

Uncomplicated pregnancies (n = 16) were evaluated longitudinally and compared to early- (n = 12) and late-onset (n = 14) preeclampsia patients, assessed once at diagnosis. Pulse transit time (PTT), equivalent to pulse wave velocity, was measured as the time interval between corresponding characteristics of electrocardiography and Doppler waves, corrected for heart rate, at the level of renal interlobar veins, hepatic veins, and arcuate branches of uterine arteries. Impedance cardiography was used to measure PTT at the level of the thoracic aorta. In normal pregnancy, all PTT increased gradually (P ≤ .01). Pulse transit time was shorter in late-onset preeclampsia (P < .05) and also in early-onset preeclampsia, with exception for hepatic veins and thoracic aorta (P > .05). Our results indicate that PTT is an easy and highly accessible measure for vascular reactivity at both arterial and venous sites of the circulation. Our observations correlate well with known gestational cardiovascular adaptation mechanisms. This suggests that PTT could be used as a new parameter in the evaluation and prediction of preeclampsia.

Colonoscopy-assisted reposition of the incarcerated uterus in mid-pregnancy: a report of four cases and a literature review

The treatment of mid-gestational uterine incarceration remains a challenge. The success rate of manual reduction decreases with gestational age, and an operative procedure may carry important fetal, next to possible maternal morbidities. We will present four cases of uterine incarceration between the 15th and 25th week of pregnancy of which three colonoscopy-assisted manual repositions proved successful. It illustrates that conservative treatment of uterine incarceration is feasible, even during the late second trimester. That is why a review of the conservative approach of this rare condition is also presented.

Non-invasive assessment of gestational hemodynamics: benefits and limitations of impedance cardiography versus other techniques

To obtain data for maternal stroke volume and cardiac output during pregnancy, it is preferable to use a non-invasive, accurate and reproducible method. In this aspect, impedance cardiography is an excellent technique which is also highly accessible and easy to perform. This paper is a comprehensive review on the published literature about impedance cardiography and highlights the strengths and limitations of its applications in obstetrics.

Recurrent incarceration and/or sacculation of the gravid uterus: A review

Retroverted uterine incarceration with sacculation of the anterior wall is reported to occur approximately in 1/3000 pregnancies. A literature search identified only one case report of incarceration of an anteflexed gravid uterus and six reported cases of recurrent incarceration and/or sacculation. We present a case of an incarceration of an anteflexed uterus in the first pregnancy, followed by a retroflexed incarceration in the second pregnancy. From this, a review is presented on recurrent uterine incarceration and/or sacculation.