Maternal venous hemodynamics in gestational hypertension and preeclampsia

Abstract

Background: To evaluate characteristics of venous hemodynamics, together with cardiac and arterial function, in uncomplicated pregnancies (UP), non-proteinuric gestational hypertension (GH) and preeclampsia (PE).

Methods: In this observational cross-sectional study, venous hemodynamics was assessed using a standardised protocol for combined electrocardiogram (ECG)-Doppler ultrasonography, together with a non-invasive standardised cardiovascular assessment using impedance cardiography (ICG) in 13 women with UP, 21 with GH, 34 with late onset PE ≥ 34 w (LPE) and 22 with early onset PE < 34 w (EPE). ECG-Doppler parameters were impedance index at the level of hepatic veins (HVI) and renal interlobar veins (RIVI) together with venous pulse transit times (VPTT), as well as resistive and pulsatility index, and arterial pulse transit time (APTT) at the level of uterine arcuate arteries. ICG parameters were aortic flow velocity index (VI), acceleration index (ACI) and thoracic fluid content. Mann Whitney U-test, Kruskall-Wallis test and linear regression analysis with heteroskedastic variance was used for statistical analysis.

Results: RIVI in both kidneys was >15% higher (P ≤ .010) in LPE and EPE, as compared to GH and UP. Next to this, >30% lower values for VI and ACI (P ≤ .029), and > 15% lower values for APTT (P ≤ .012) were found in GH, LPE and EPE, as compared to GH.

Conclusion: In comparison to UP, similar abnormalities of central arterial function and APTT were found in GH, EPE and LPE. Proteinuria of LPE and EPE was associated with increased RIVI, this was not observed in GH.

Figure 1

Correlation between venous pulse transit time and venous impedance index in liver and kidneys. Venous pulse transit time (VPTT), venous impedance index in liver (HVI) and kidneys (RIVI), uncomplicated pregnancies (UP), gestational hypertension (GH), late-onset preeclampsia (LPE) and early-onset preeclampsia (EPE), at the level of the liver (panel A), right kidney (panel B) and left kidney (panel C).

Figure 2

Comparison of cardiac, arterial and venous hemodynamic parameters between uncomplicated and hypertensive pregnancies. Parameters at the level of aorta (panel A), liver (panel B), right kidney (panel C), left kidney (panel D), right uterine arcuate artery (panel E) and left uterine arcuate artery (panel F). Uncomplicated pregnancy (UP), gestational hypertension (GH), late-onset preeclampsia (LPE) and early-onset preeclampsia (EPE), VI = aortic flow velocity index, as measured by impedance cardiography (ICG), ACI = ICG-measured aortic flow acceleration index; HVI = hepatic vein impedance index, RIVI = renal interlobar vein impedance index; VPTT = venous pulse transit time, APTT = arterial pulse transit time. An asterisk indicates a statistically significant difference at nominal level α ≤ 0.05 with Mann–Whitney U test between UP and GH, between GH and LPE or between LPE and EPE.