Monteith Cathy, McSweeney Lisa, Breatnach Colm R, Doherty Anne, Shirren Lucy, Tully Elizabeth C, Dicker Patrick, Malone Fergal D, El-Khuffash Afif, Kent Etaoin
Department of Obstetrics & Gynaecology, Royal College of Surgeons, Ireland.
Department of Obstetrics & Gynaecology, Royal College of Surgeons, Ireland.
Eur J Obstet Gynecol Reprod Biol. 2017 Sep;216:116-124. doi: 10.1016/j.ejogrb.2017.07.018. Epub 2017 Jul 20.
We aimed to firstly identify the different haemodynamic profiles amongst nulliparous women who develop either gestational hypertension (GH), pre-eclampsia (PE), normotensive fetal growth restriction (FGR) versus unaffected pregnancies using non-invasive cardiac output monitoring (NICOM). Our second primary objective was to assess the ability of NICOM derived variables to predict the evolution of PE, GH and FGR.
Low risk nulliparous women were enrolled in a single center prospective observational study. NICOM assessments were performed at 14, 20 and 28 weeks' gestation and data was obtained on cardiac output (CO), total peripheral resistance (TPR), indexed TPR (adjusted for maternal body surface area; TPRi), stroke volume (SV), indexed SV (adjusted for maternal body surface area; SVi) and heart rate (HR). Logistic regression was used to model GH, PE and FGR with NICOM measurements as predictors. Linear, non-linear and interaction terms were assessed using the Akaike Information Criterion.
The haemodynamic profile of pregnancies complicated by uteroplacental disease- GH (n=18), PE (n=6) and FGR (n=24) were compared to 318 healthy unaffected pregnant controls. Women with evolving PE have a different haemodynamic profile to those developing either GH or FGR. The best independent predictors for the evolution of uteroplacental disease at 14 weeks' gestation were CO in the prediction of FGR (AUC=0.61; p 0.002), TPR in the prediction of GH (AUC=0.63; p<0.02) and SVi in the prediction of PE (AUC=0.62; p<0.05). The performance of haemodynamic variables was enhanced when combined in a multivariate logistic model. We demonstrated that TPR, CO and SV when combined with BP were significant predictors of pregnancies complicated by FGR (AUC=0.64, p=0.004; AUC=0.65, p=0.004; and AUC=0.65, p=0.007 respectively). Whereas in pregnancies complicated by PE, HR and SVi in combination with BP were also statistically significant predictors (AUC=0.75, p=0.017 and AUC=0.77, p=0.007 respectively).
NICOM derived maternal haemodynamic profile at 14 weeks' gestation has the novel potential to identify pregnancies which will ultimately develop uteroplacental disease.
我们旨在首先使用无创心输出量监测（NICOM），确定未孕女性中发生妊娠期高血压（GH）、先兆子痫（PE）、正常血压胎儿生长受限（FGR）与未受影响妊娠之间不同的血流动力学特征。我们的第二个主要目标是评估NICOM得出的变量预测PE、GH和FGR进展的能力。
低风险未孕女性被纳入一项单中心前瞻性观察性研究。在妊娠14、20和28周时进行NICOM评估，并获取心输出量（CO）、总外周阻力（TPR）、校正后TPR（根据母体体表面积校正；TPRi）、每搏输出量（SV）、校正后SV（根据母体体表面积校正；SVi）和心率（HR）的数据。使用逻辑回归以NICOM测量值作为预测指标对GH、PE和FGR进行建模。使用赤池信息准则评估线性、非线性和交互项。
将并发子宫胎盘疾病的妊娠——GH（n = 18）、PE（n = 6）和FGR（n = 24）的血流动力学特征与318名健康未受影响的妊娠对照组进行比较。PE进展期女性的血流动力学特征与发生GH或FGR的女性不同。妊娠14周时子宫胎盘疾病进展的最佳独立预测指标为：预测FGR时为CO（AUC = 0.61；p = 0.002），预测GH时为TPR（AUC = 0.63；p < 0.02），预测PE时为SVi（AUC = 0.62；p < 0.05）。当组合在多变量逻辑模型中时，血流动力学变量的性能得到增强。我们证明，TPR、CO和SV与血压组合时分别是并发FGR妊娠的显著预测指标（AUC = 0.64，p = 0.004；AUC = 0.65，p = 0.004；AUC = 0.65，p = 0.007）。而在并发PE的妊娠中，HR和SVi与血压组合时也是具有统计学意义的预测指标（分别为AUC = 0.75，p = 0.017和AUC = 0.77，p = 0.007）。
妊娠14周时NICOM得出的母体血流动力学特征具有识别最终会发生子宫胎盘疾病妊娠的新潜力。
