The effects of cardiovascular dynamics monitoring in the outpatient management of pregnancy hypertension.
OBJECTIVE
Our purpose was to assess the effects of the adjunctive use of cardiovascular dynamics monitoring in the ambulatory management of 199 pregnant patients with severe hypertension.


METHODS
A prospective, observational study was performed. Determinants of mean arterial pressure were computed by using the Hon monitor. Indicators of arterial compliance and effective blood volume were developed. All patients were monitored in the outpatient clinic; additionally, 19 patients self-tested at home. No rigid medication protocol was followed, but furosemide was used in most cases when cardiovascular dynamics monitoring patterns were consistent with volume loading. Otherwise, vasodilators were prescribed. The t test for independent samples was used to compare the home-monitored subgroup with the outpatient-only group.


RESULTS
Pregnancy was prolonged by 74 +/- 63.9 days (mean +/- SD). Mean gestation was 37.6 +/- 2.9 weeks, and mean birth weight was 2882.4 +/- 837 g. The primary cesarean delivery rate was 23.7%, but only 15 (7.5%) cesarean deliveries were performed because of failed therapy. The 19 home-monitored patients gained 108 +/- 75 days (83.1 +/- 42.2 days beyond 20 weeks).


CONCLUSIONS
Adjunctive cardiovascular dynamics monitoring may have a role in the evaluation and management of hypertension during pregnancy.
Fukushima
Teiichiro
T
Division of Maternal-Fetal Medicine and Reproductive Sciences, Department of Obstetrics and Gynecology, King/Drew Medical Center, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA.
Berumen
Maria
M
Vargas
Noemi
N
Zadeh
Neda
N
Hon
Edward H
EH
D000328:Adult; D000553:Ambulatory Care; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001724:Birth Weight; D001795:Blood Pressure Determination / Q000379:methods; D002319:Cardiovascular System / Q000503:physiopathology*; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000503:physiopathology* / Q000628:therapy*; D011159:Population Surveillance / Q000379:methods; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000503:physiopathology* / Q000628:therapy*; D011273:Pregnancy, Prolonged / Q000502:physiology; D011446:Prospective Studies; D012648:Self Care; D017211:Treatment Failure
D000959:Antihypertensive Agents