Gutierrez Henares J, Gutierrez Henares R, Perry H, Khalil A, Thilaganathan B
Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK.
Electronic Engineering, Malaga University, Campus de Teatinos, Málaga, Spain.
Ultrasound Obstet Gynecol. 2022 May;59(5):613-618. doi: 10.1002/uog.24768.
Non-invasive assessment of maternal cardiovascular potential and kinetic energy can be used to derive potential-to-kinetic-energy ratio (PKR) and Smith-Madigan inotropic index (SMII), which reflect the balance between blood pressure and blood flow. The aim of this study was to evaluate PKR and SMII in pregnancies complicated by hypertensive disorders of pregnancy (HDP) and/or small-for-gestational-age (SGA) birth.
This was a prospective study that enrolled women with a singleton pregnancy between 5 and 41 weeks' gestation. Women who developed HDP and/or SGA underwent cardiovascular profiling from 20 weeks. To establish reference ranges for PKR and SMII, women without any pre-existing medical problems at the time of booking who did not develop HDP, SGA or other complications during pregnancy were also recruited for cardiovascular profiling. Measurements of cardiovascular parameters were obtained using a non-imaging ultrasound cardiac output monitor.
A total of 688 women completed the study, including 626 controls, 21 cases with HDP, 19 cases with SGA and 22 cases with HDP and SGA. PKR was significantly elevated in pregnancies with placental dysfunction compared with controls (HDP only, 29.81 ± 9.5; HDP and SGA, 44.33 ± 24.27; SGA only, 31.05 ± 13.14; vs controls, 22.30 ± 7.93; all P < 0.05). SMII values were significantly lower only in cases affected by SGA alone when compared with controls (1.47 ± 0.23 W/m vs 1.75 ± 0.40 W/m ; P < 0.005). These differences remained statistically significant when the analysis was undertaken using multiples of the median values corrected for gestational age.
The findings of this study suggest that point-of-care non-invasive cardiovascular profiling using PKR and SMII may help distinguish between pregnancies affected by specific placental disorders and those exhibiting healthy cardiovascular adaptation to pregnancy. Women with HDP and/or SGA appear to have distinctive PKR and SMII profiles that reflect low kinetic energy in pregnancies with SGA and high potential energy in pregnancies affected by HDP. Finally, non-invasive assessment of potential and kinetic cardiovascular energy demonstrates physiological high-flow and low-resistance adaptation in uncomplicated pregnancies. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
对母体心血管潜能和动能进行无创评估，可用于得出潜能-动能比（PKR）和史密斯-马迪根变力指数（SMII），这两者反映了血压与血流之间的平衡。本研究的目的是评估妊娠合并妊娠期高血压疾病（HDP）和/或小于胎龄儿（SGA）出生的孕妇的PKR和SMII。
这是一项前瞻性研究，纳入了妊娠5至41周的单胎妊娠女性。发生HDP和/或SGA的女性从孕20周开始进行心血管评估。为了确定PKR和SMII的参考范围，还招募了在登记时没有任何既往病史且在孕期未发生HDP、SGA或其他并发症的女性进行心血管评估。使用非成像超声心输出量监测仪获取心血管参数测量值。
共有688名女性完成了研究，包括626名对照者、21例HDP患者、19例SGA患者和22例HDP合并SGA患者。与对照组相比，胎盘功能障碍的孕妇PKR显著升高（仅HDP组，29.81±9.5；HDP合并SGA组，44.33±24.27；仅SGA组，31.05±13.14；对照组，22.30±7.93；所有P<0.05）。与对照组相比，仅受SGA影响的病例中SMII值显著降低（1.47±0.23W/m对1.75±0.40W/m；P<0.005）。当使用校正胎龄后的中位数倍数进行分析时，这些差异仍具有统计学意义。
本研究结果表明，使用PKR和SMII进行即时无创心血管评估可能有助于区分受特定胎盘疾病影响的妊娠和那些对妊娠表现出健康心血管适应的妊娠。HDP和/或SGA女性似乎具有独特的PKR和SMII特征，反映了SGA妊娠中的低动能和HDP影响的妊娠中的高潜能。最后，对心血管潜能和动能的无创评估证明了正常妊娠中的生理性高血流和低阻力适应。©2022国际妇产科超声学会。
