Definition, identification, implications and management of hypodynamic hypertension in pregnancy

Abstract

Hypertensive disorders of pregnancy show different maternal hemodynamic and cardiovascular profiles going from a hyperdynamic to a hypodynamic condition. These different maternal cardiovascular situations might evolve towards different outcomes and might require targeted approaches. In particular, a hypodynamic maternal cardiovascular profile might be associated to severe and early complications of pregnancy (in particular fetal growth restriction, either isolated or associated to hypertensive disorders of pregnancy). This condition is characterized by a constriction of the vessels and a low plasma volume with low cardiac output and stroke volume. The assessment of the maternal hemodynamic condition requires an echocardiographic evaluation or the use of other non invasive devices, but in the absence of these instruments there is also a simple clinical method that can give us an idea of the maternal hemodynamic profile of the mother: the measurement of blood pressure and heart rate. In a hypodynamic low cardiac output condition, the choice of drugs that might reduce cardiac output and myocardial contractility to lower blood pressure might be irrational, whereas pharmacological interventions that directly act on the vessels reducing vasoconstriction, such as dihydropyridine calcium channel blockers and nitric oxide donors, might be more appropriate. This hemodynamic guided approach to therapy might have positive effect not only on maternal hemodynamics, but also on the fetal side, probably reducing or mitigating maternal and fetal complications.

Keywords: Echocardiography; Fetal growth restriction; Hypertensive disorders of pregnancy; Hypodynamic circulation; Maternal cardiac performance; Maternal hemodynamics; Total peripheral vascular resistance.