Montaguti Elisa, Di Donna Gaetana, Youssef Aly, Pilu Gianluigi
Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 13, 40138, Bologna, Italy.
J Med Ultrason (2001). 2022 Jul;49(3):405-413. doi: 10.1007/s10396-022-01225-3. Epub 2022 Jun 15.
Hypertensive disorders are quite common, complicating about 10% of pregnancies, while preeclampsia occurs in 2-8% of cases. The most recognized etiopathogenetic factor for the development of preeclampsia is deficient remodeling of the spiral arteries during trophoblastic invasion. Recently, some authors speculated about the "cardiovascular origin of preeclampsia"; in particular, they postulate that placental dysfunction is not the primum movens of preeclampsia, but it could be caused by a failure of the maternal cardiovascular system to adapt to the pregnancy itself. Moreover, several studies have also shown that developing preeclampsia in pregnancy is associated with an increased risk of cardiovascular disease later in life. Due to the importance of this pathology, it would be crucial to have an effective screening in order to implement a prophylaxis; for this purpose, it could be useful to have an accurate and noninvasive device for the assessment of maternal hemodynamic variables. USCOM (Ultrasonic Cardiac Output Monitor) is a noninvasive Doppler ultrasonic technology which combines accuracy, reproducibility, noninvasiveness, and a fast learning curve. Maternal hemodynamic evaluation is important in order to monitor the changes that the maternal organism encounters, in particular a reduction in blood pressure, a decrease in total peripheral resistances, and an increase in cardiac output, resulting in a hyperdynamic circle. These hemodynamic modifications are lacking in pregnancies complicated by preeclampsia. For these reasons, it is crucial to have a tool that allows these parameters to be easily evaluated in order to identify those women at higher risk of hypertensive complications and more severe outcomes.
高血压疾病相当常见，约10%的妊娠会并发该疾病，而子痫前期的发生率为2%-8%。子痫前期发生发展最公认的病因学因素是滋养细胞侵入时螺旋动脉重塑不足。最近，一些作者推测了“子痫前期的心血管起源”；特别是，他们假设胎盘功能障碍不是子痫前期的首要动因，而是可能由母体心血管系统无法适应妊娠本身所致。此外，多项研究还表明，孕期发生子痫前期与日后患心血管疾病的风险增加有关。鉴于这种疾病的重要性，进行有效的筛查以实施预防措施至关重要；为此，拥有一种准确且无创的设备来评估母体血流动力学变量可能会很有用。USCOM（超声心输出量监测仪）是一种无创多普勒超声技术，兼具准确性、可重复性、无创性以及快速的学习曲线。进行母体血流动力学评估很重要，以便监测母体机体所经历的变化，特别是血压降低、总外周阻力下降以及心输出量增加，从而导致高动力循环。子痫前期合并的妊娠缺乏这些血流动力学改变。出于这些原因，拥有一种能够轻松评估这些参数的工具至关重要，以便识别那些发生高血压并发症和更严重后果风险较高的女性。
