Assessment of cardiac hemodynamic changes during pregnancy in normal and hypertensive women


Background: The hypertensive disorders of pregnancy (HDP) are the most common complication of pregnancy and are major cause of maternal and perinatal morbidity and mortality. Hypertension in pregnancy complicates about 10 % of all pregnancies worldwide.Objective: This study aims to compare the hemodynamics of healthy pregnant women with hemodynamics of pregnant women with gestational hypertension (GH) or preeclampsia (PE).Methods: A total of (120) women were included in this study; their ages range from (17 to 42) years; classified as follows: (60) normotensive pregnant women and (60) pregnant women with GH or PE. 2nd group is subdivided into: (30) hypertensive pregnant women who take antihypertensive treatment (methyldopa) and (30) those without antihypertensive medications. All women subjected to echocardiographic examination by experience specialist.Results: Compared with healthy pregnant women, untreated pregnant women with GH or PE were associated with increase mean arterial pressure (MAP) (82.81±9.083 mm Hg vs. 113.66±7.327 mm Hg, p ˂ 0.001), increase total peripheral vascular resistance (TPR) (1379.01±425.65 vs. 1733.99 ± 396.97, p˂0.001), increased cardiac output (CO) (5.01 ± 1.100 L / min vs. 5.55 ±1.42 L/min, p = 0.04), increased ejection fraction (EF) (64.9 ± 4.9 % vs. 67.4± 6.561%, p=0.04) and fractional shortening (FS) (34.76±3.492% vs. 37.34±4.21%, p = 0.003), increased left ventricular mass (LVM) (136.41±29.22 gm vs. 174.16±41.04 gm, p˂0.001) and decreased ratio of peak velocity of early transmitral flow to late transmitral flow (E/A ratio) (1.39±0.166 vs. 1.30±0.19, p=0.02). The hypertensive pregnant patients treated with methyldopa; compared to non-treated group; showed a significant decreased in MAP (99.91±13.874 mm Hg vs. 113.66±7.325 mm Hg, p˂ 0.001, decreased TPR (1534.58 ± 349.47 vs. 1733.99 ± 396.97, p= 0.04), decreased EF (63.7±4.621% vs. 67.4±6.561%, p=0.014), decreased LVM (153.087±33.778 gm vs. 174.16±41.04 gm, p=0.03) and significant increase in E/A ratio (1.444±0.262 vs. 1.306±0.190, p=0.02).Conclusion: Pregnant women with PE or GH have evidence of hemodynamic changes that justify routine echocardiographic assessment even in the absence of cardiac symptoms.