A combined technique for predicting pre-eclampsia: concurrent measurement of uterine perfusion and analysis of heart rate and blood pressure variability.
OBJECTIVE
Pre-eclampsia is a serious complication of pregnancy with high morbidity and mortality and an incidence of 3-5% in all pregnancies. Early prediction is still insufficient in clinical practice. Although most pre-eclamptic patients have pathological uterine perfusion in the second trimester, perfusion disturbance has a positive predictive accuracy (PPA) only of approximately 30%.


METHODS
Non-invasive continuous blood pressure recordings were taken simultaneously via a finger cuff for 30 min. Time series of systolic as well as diastolic beat-to-beat pressure values were extracted to analyse heart rate and blood pressure variability and baroreflex sensitivity in 102 second-trimester pregnancies, to assess predictability for pre-eclampsia (n = 16). All women underwent Doppler investigations of the uterine arteries.


RESULTS
We identified a combination of three variability and baroreflex parameters to best predict pre-eclampsia several weeks before clinical manifestation. The discriminant function of these three parameters classified patients with later pre-eclampsia with a sensitivity of 87.5%, a specificity of 83.7%, and a PPA of 50.0%. Combined with Doppler investigations of uterine arteries, PPA increased to 71.4%.


CONCLUSIONS
This technique of incorporating one-stop clinical assessment of uterine perfusion and variability parameters in the second trimester produces the most effective prediction of pre-eclampsia to date.
Department of Cardiology, Charité, Campus Benjamin Franklin (CBF), Berlin, Germany.
Thomas
T
Walther
Niels
N
Wessel
Hagen
H
Malberg
Andreas
A
Voss
Holger
H
Stepan
Renaldo
R
Faber
D000328:Adult; D001158:Arteries / Q000503:physiopathology; D017704:Baroreflex / Q000502:physiology*; D001724:Birth Weight; D001783:Blood Flow Velocity; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000503:physiopathology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011379:Prognosis; D014599:Uterus / Q000098:blood supply*