Maternal total vascular resistance and concentric geometry: a key to identify uncomplicated gestational hypertension.
OBJECTIVE
To evaluate the prognostic impact of elevated total vascular resistance (TVR) on the outcome of pregnancy in early mild gestational hypertension (EMGH).


METHODS
Prospective observational study.


METHODS
Data collected from women with EMGH referred to the obstetrics outpatient clinic of Tor Vergata University from June 2003 to June 2005.


METHODS
A total of 268 women with EMGH (systolic and diastolic blood pressure [BP] 140-150 mmHg and 90-99 mmHg, respectively, without significant proteinuria).


METHODS
Women had a maternal echocardiographic examination and BP examination within 24 hours of diagnosis. From this, the TVR was calculated and the geometric pattern of the left ventricle assessed.


METHODS
Fetal/maternal adverse outcomes (pre-eclampsia, preterm delivery, placental abruption, other maternal medical problems, fetal distress, neonatal low birthweight, admittance to neonatal intensive care unit and perinatal death).


RESULTS
Ninety-two out of the 268 pregnancies showed adverse outcomes (34.3%). The best independent predictor for the composite of maternal and fetal complications was TVR (OR 64.4, 95% CI 25.9-160.1). The cutoff value was 1340 dyn seconds/cm(5) with a sensitivity and a specificity of 90 and 91%, respectively. Concentric geometry of the left ventricle was also an independent predictor (OR 4.72, 95% CI 1.85-12.04).


CONCLUSIONS
Echocardiography could help in identifying women with EMGH who subsequently develop maternal and fetal complications, allowing a classification in high-risk (TVR > 1340 dyn seconds/cm(5), concentric geometry of the left ventricle) and low-risk women (TVR < 1340 dyn seconds/cm(5), nonconcentric geometry of the left ventricle) for adverse outcomes of pregnancy.
Valensise
H
H
Department of Obstetric and Gynecology, Tor Vergata University, Rome, Italy. valensise@med.uniroma2.it
Vasapollo
B
B
Novelli
G P
GP
Pasqualetti
P
P
Galante
A
A
Arduini
D
D
D000037:Abruptio Placentae / Q000517:prevention & control; D000328:Adult; D009202:Cardiomyopathies / Q000473:pathology; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D005260:Female; D005317:Fetal Growth Retardation / Q000517:prevention & control; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000175:diagnosis* / Q000503:physiopathology; D015588:Observer Variation; D007752:Obstetric Labor, Premature / Q000517:prevention & control; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000473:pathology; D011256:Pregnancy Outcome; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal / Q000379:methods; D014655:Vascular Resistance / Q000502:physiology*