Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands.
Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands.
BJOG. 2022 Apr;129(5):696-707. doi: 10.1111/1471-0528.16678. Epub 2021 Apr 6.
In-depth insight into haemodynamic changes during normotensive pregnancy may help identify women at risk for gestational hypertensive complications.
To determine the magnitude of changes in cardiac output and its determinants stroke volume and heart rate, and total peripheral vascular resistance during singleton normotensive and hypertensive pregnancies.
PubMed (NCBI) and Embase (Ovid) databases were searched from their inception up to November 2019.
Studies reporting original measurements of haemodynamic parameters during pregnancy together with a non-pregnant reference measurement. Studies including women using antihypertensive medication were excluded.
Pooled mean differences between pregnant and non-pregnant women, and absolute values of haemodynamic parameters were calculated for predefined gestational intervals using a random-effects model in normotensive and hypertensive pregnancy. Meta-regression analysis was used to analyse group differences in adjustments and absolute values during pregnancy.
In normotensive pregnancies, cardiac output increased from the first weeks on, reaching its highest level early in the third trimester (mean difference, 1.41 l·min ; 95% CI 1.18-1.63 l·min). In parallel, vascular resistance decreased progressively until its nadir in the early third trimester (mean difference, -331 dyn·sec ·cm ; 95% CI -384 to -277 dyn·sec ·cm ) and then increased slightly at term. In hypertensive pregnancies, the initial cardiac output increase was higher and vascular resistance did not change throughout gestation compared with reference values.
Hemodynamic changes in women who eventually develop hypertensive complications are substantially different. Serial monitoring and plotting against developed normograms can identify women at risk and may allow timely intervention.
Monitoring haemodynamic changes in pregnancy helps identify women at risk for hypertensive complications.
深入了解正常妊娠期间的血液动力学变化可能有助于识别发生妊娠高血压并发症的高危女性。
确定在单胎正常妊娠和高血压妊娠期间心输出量及其决定因素（每搏量和心率）和总外周血管阻力的变化幅度。
从建库开始到 2019 年 11 月，在 PubMed（NCBI）和 Embase（Ovid）数据库中进行检索。
报告妊娠期间血液动力学参数原始测量值并与非妊娠参考值的研究。排除使用抗高血压药物的女性的研究。
使用随机效应模型在正常妊娠和高血压妊娠中计算预定妊娠间隔内孕妇和非孕妇之间的血液动力学参数的汇总平均差异和绝对值。使用元回归分析来分析妊娠期间调整和绝对值的组间差异。
在正常妊娠中，心输出量从第一周开始增加，在孕早期达到最高水平（平均差异，1.41l·min；95%CI 1.18-1.63l·min）。同时，血管阻力逐渐降低，直到孕早期达到最低点（平均差异，-331dyn·sec·cm；95%CI-384 至-277dyn·sec·cm），然后在足月时略有增加。在高血压妊娠中，与参考值相比，初始心输出量增加较高，血管阻力在整个妊娠期间没有变化。
最终发生高血压并发症的女性的血液动力学变化明显不同。连续监测并与已建立的正常图表进行比较可以识别高危女性，并可能允许及时干预。
监测妊娠期间的血液动力学变化有助于识别发生高血压并发症的高危女性。
