The effect of acute volume expansion and vasodilatation with verapamil on uterine and umbilical artery Doppler indices in severe preeclampsia.
Preeclampsia is associated with increased peripheral, uterine, and umbilical artery resistance. Acute blood pressure reduction may result in shunting of blood and sudden fetal distress. We therefore investigated the effects of volume expansion and verapamil therapy on uteroplacental and umbilical resistance during treatment of preeclampsia.


METHODS
Five severe preeclamptics underwent volume expansion and subsequent vasodilatation with an infusion of verapamil. Invasive hemodynamic monitoring and Doppler ultrasonography were used to study changes in maternal, uterine, and umbilical hemodynamics.


RESULTS
Volume expansion and subsequent verapamil therapy was associated with significant changes in maternal hemodynamics without significant change in uteroplacental or umbilical resistance. Uterine artery waveform changes were noted, with disappearance of notching in some cases.


CONCLUSIONS
Volume expansion and verapamil therapy effectively reduces maternal blood pressure in preeclampsia, without adversely affecting uteroplacental or umbilical artery resistance. Uterine artery waveform changes may be associated with improved fetal outcome.
Belfort
M
M
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
Akovic
K
K
Anthony
J
J
Saade
G
G
Kirshon
B
B
Moise
K
K
D000328:Adult; D001158:Arteries; D001783:Blood Flow Velocity / Q000187:drug effects / Q000502:physiology; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D001810:Blood Volume / Q000187:drug effects* / Q000502:physiology; D002302:Cardiac Output / Q000187:drug effects / Q000502:physiology; D003911:Dextrans / Q000627:therapeutic use*; D005260:Female; D005333:Fetus / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D010101:Oxygen Consumption / Q000187:drug effects / Q000502:physiology; D010920:Placenta / Q000098:blood supply*; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging / Q000628:therapy*; D011247:Pregnancy; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure / Q000187:drug effects / Q000502:physiology; D012039:Regional Blood Flow / Q000187:drug effects / Q000502:physiology; D014463:Ultrasonography; D014469:Umbilical Arteries / Q000000981:diagnostic imaging / Q000187:drug effects / Q000502:physiology*; D014599:Uterus / Q000098:blood supply*; D014655:Vascular Resistance / Q000187:drug effects / Q000502:physiology; D014664:Vasodilation / Q000502:physiology*; D014700:Verapamil / Q000627:therapeutic use*
D003911:Dextrans; D010952:Plasma Substitutes; D014700:Verapamil