Department of Biomedicine - Obstetrics and Gynecology Policlinico Casilino, Tor Vergata University, Rome, Italy.
Department of Cardiology, San Sebastiano Martire Hospital, Frascati, Rome, Italy.
Ultrasound Obstet Gynecol. 2018 Apr;51(4):509-513. doi: 10.1002/uog.17447.
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.
This was a prospective observational study of 77 women with low-risk term pregnancy and AGA fetus, in the early stages of labor. Hemodynamic indices were obtained using the UltraSonic Cardiac Output Monitor (USCOM ) system. Patients were followed until the end of labor to identify fetal/neonatal and maternal outcomes, and those which developed complications of labor were compared with those delivering without complications.
Eleven (14.3%) patients had a complication during labor: in seven there was fetal distress and in four there were maternal complications (postpartum hemorrhage and/or uterine atony). Patients who developed complications during labor had lower cardiac output (5.6 ± 1.0 vs 6.7 ± 1.3 L/min, P = 0.01) and cardiac index (3.1 ± 0.6 vs 3.5 ± 0.7 L/min/m , P = 0.04), and higher total vascular resistance (1195.3 ± 205.3 vs 1017.8 ± 225.6 dynes × s/cm , P = 0.017) early in labor, compared with those who did not develop complications. Receiver-operating characteristics curve analysis to determine cut-offs showed cardiac output ≤ 5.8 L/min (sensitivity, 81.8%; specificity, 69.7%), cardiac index ≤ 2.9 L/min/m (sensitivity, 63.6%; specificity, 76.9%) and total vascular resistance > 1069 dynes × s/cm (sensitivity, 81.8%; specificity, 63.6%) to best predict maternal or fetal/neonatal complications.
The study of maternal cardiovascular adaptation at the end of pregnancy could help to identify low-risk patients who may develop complications during labor. In particular, low cardiac output and high total vascular resistance are apparently associated with higher risk of fetal distress or maternal complications. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
确定对足月且胎儿大小与胎龄相符（AGA）的低危孕妇进行血液动力学评估是否可以改善对分娩期间发生母婴或胎儿/新生儿并发症的患者的识别。
这是一项前瞻性观察性研究，共纳入 77 例低危足月妊娠且胎儿大小与胎龄相符的孕妇，处于分娩早期。使用超声心输出量监测仪（USCOM）系统获得血液动力学指数。患者一直随访至分娩结束，以识别胎儿/新生儿和母婴结局，并将出现分娩并发症的患者与无并发症分娩的患者进行比较。
11 例（14.3%）患者在分娩过程中出现并发症：7 例胎儿窘迫，4 例产妇并发症（产后出血和/或子宫收缩乏力）。在分娩过程中出现并发症的患者心输出量（5.6±1.0 比 6.7±1.3 L/min，P=0.01）和心指数（3.1±0.6 比 3.5±0.7 L/min/m，P=0.04）较低，总血管阻力（1195.3±205.3 比 1017.8±225.6 dynes×s/cm，P=0.017）在分娩早期较高，与未发生并发症的患者相比。使用受试者工作特征曲线分析确定截断值，结果显示心输出量≤5.8 L/min（敏感性 81.8%，特异性 69.7%）、心指数≤2.9 L/min/m（敏感性 63.6%，特异性 76.9%）和总血管阻力>1069 dynes×s/cm（敏感性 81.8%，特异性 63.6%）可以更好地预测母婴或胎儿/新生儿并发症。
对妊娠末期产妇心血管适应性的研究有助于识别可能在分娩过程中发生并发症的低危患者。特别是，心输出量低和总血管阻力高与胎儿窘迫或产妇并发症的风险增加明显相关。版权所有©2017 ISUOG。由 John Wiley & Sons Ltd 出版。
