Pulse wave analysis in the first trimester of pregnancy: a possible predictive test to identify women at risk of placental or maternal preeclampsia and IUGR
Tesi di Dottorato
Data di Pubblicazione:
2012
Citazione:
Pulse wave analysis in the first trimester of pregnancy: a possible predictive test to identify women at risk of placental or maternal preeclampsia and IUGR / D.d. Di Martino ; tutor: E. Ferrazzi ; coordinatore: R. Weinstein. Universita' degli Studi di Milano, 2012 May 30. 24. ciclo, Anno Accademico 2011. [10.13130/di-martino-daniela-denis_phd2012-05-30].
Abstract:
Pulse Wave Analysis in the first trimester of pregnancy: a possible predictive test to identify women at risk of placental or maternal preeclampsia and IUGR
Background:
Preeclampsia and intrauterine growth restriction are major contributors to maternal and/or perinatal mortality and morbidity worldwide. At present preeclampsia is classified based on time domain. Just few Authors proposed classification based on different origin of the diseases: placental and maternal. The former involves inadequate placentation and consequently placental insufficiency and IUGR; the latter is thought to be caused by maternal "metabolic syndrome" characterized by low grade chronic inflammation and android obesity, but associated with normal placental function and appropriate fetal growth (AGA).
Independently on the classification of the disease, it is well known that women with a history of preeclampsia are at increased risk of cardiovascular events later on in life.
Recent developments in cardiological technology provided useful non-invasive tool capable to assess peripheral and central vascular resistance: applanation tonometry. By assessing the radial pulse wave it is possible to derive indices of arterial stiffness (Augmentation Index) and compliance (Pulse Way Analysis and Pulse Way Velocity). In the literature there are few studies that investigated arterial stiffness in preeclamptic women, but limited mostly by low study population. Just one report investigated applanation tonometry in the first trimester of pregnancy. None of Authors explored the role of pulse wave analysis considering the above proposed classification of preeclampsia.
Aim: to investigate maternal indices of central and peripheral vascular resistance (arterial stiffness) and indices of central pressure in aorta, in the first trimester of pregnancy, in preeclampsia of maternal and placental origin and fetal growth restriction.
Methods: applanation radial tonometry together with uterine artery Doppler have been performed between 11-13+6 wg in general population attending to our hospital for Down syndrome screening. Augmentation index corrected for heart rate (AIX75) and Aortic systolic peak have been calculated. PE was defined as placental when associated with IUGR and of maternal origin in cases with clinical manifestation of hypertension/PE but with appropriate fetal growth, independently of time of onset.
Results: 308 pregnancies were recruited: four (1%) developed PE/IUGR; four (1%) PE/AGA; seven (2,3%) GH; 16 (5,2%) IUGR, and eight (2,6%) SGA. None of the seven women with gestational hypertension had associated fetal growth restriction, so they were included in maternal preeclampsia group (PE+AGA).
Patients with maternal PE showed a statistically higher BMI and higher rate of IVF pregnancy when compared to controls (p=0,011), while placental PE showed a higher incidence of previous pregnancy affected by preeclampsia (p=0,004). There were no statistical differences for other demographic data.
Both maternal and placental PE group delivered at an earlier GA, but only placental PE had smaller babies and major incidence of admittance to NICU (p< 0,001). There were no significant differences in heart rate and Augmentation index at 75 bpm between the two groups of PE compared with controls. Mean arterial pressure was significantly higher in both placental and maternal preeclampsia when compared to the control group, while central systolic pressure was significantly higher only in placental PE group (p< 0,001).
The mean uterine artery PI was significantly higher in placental PE group (p< 0,001) and maternal serum PAPP-A resulted significantly lower only in maternal PE group (p=0,024).
Conclusions:
Although, the classification of preeclampsia based on time doma
Tipologia IRIS:
Tesi di dottorato
Keywords:
PWA ; arterial stifness ; preeclampsia ; first trimester
Elenco autori:
D.D. DI MARTINO
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