A randomized trial of plasma volume expansion in hypertensive disorders of pregnancy: influence on the pulsatility indices of the fetal umbilical artery and middle cerebral artery.
OBJECTIVE
The purpose of this study was to investigate the effect of plasma volume expansion on the pulsatility indices of the fetal umbilical and middle cerebral arteries.


METHODS
Two hundred sixteen patients with severe preeclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, eclampsia, hypertension-related fetal growth restriction, and gestational ages between 24 and 34 completed weeks of gestation were assigned randomly for temporizing treatment with plasma volume expansion (n = 111 patients; 250 mL hydroxyethyl starch 6% twice daily in 4 hours, and NaCl 0.9% between doses of hydroxyethyl starch and with intravenous medication) or without plasma volume expansion (n = 105; only NaCl 0.9% when necessary with medication). Measurements of the pulsatility index of the umbilical and middle cerebral arteries were performed at admission, after 16 to 48 hours, 60 to 120 hours, and 7 to 11 days.


RESULTS
Median gestational age was 30 weeks in both groups. Infused volumes of plasma volume expansion in the treatment group (total median, 813 mL/d) were associated with a significant decrease of hemoglobin concentration. Changes from baseline measurements of the umbilical and middle cerebral arteries were not different between the groups nor within subgroups during the first 7 to 11 days.


CONCLUSIONS
Plasma volume expansion did not influence the pulsatility indices of the umbilical and middle cerebral arteries.
Ganzevoort
Wessel
W
Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands. j.w.ganzevoort@amc.uva.nl
Rep
Annelies
A
Bonsel
Gouke J
GJ
De Vries
Johanna I P
JI
Wolf
Hans
H
D000293:Adolescent; D000328:Adult; D001810:Blood Volume / Q000187:drug effects / Q000502:physiology; D005260:Female; D005333:Fetus / Q000098:blood supply*; D017359:HELLP Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D020768:Middle Cerebral Artery / Q000187:drug effects / Q000502:physiology; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000627:therapeutic use*; D011247:Pregnancy; D011673:Pulsatile Flow / Q000187:drug effects; D012039:Regional Blood Flow / Q000187:drug effects; D012965:Sodium Chloride / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000187:drug effects / Q000502:physiology
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D012965:Sodium Chloride