Maternal cardiac function and uterine artery Doppler at 11-14 weeks in the prediction of pre-eclampsia in nulliparous women.
OBJECTIVE
To assess maternal cardiac function in nulliparous women in the first trimester of pregnancy and evaluate its potential role for predicting pre-eclampsia and small for gestational age (SGA).


METHODS
Prospective, observational, cross-sectional study.


METHODS
Maternity unit of a teaching hospital.


METHODS
Nulliparous women with singleton pregnancies presenting consecutively for routine antenatal care (n= 534).


METHODS
Two-dimensional and M-mode echocardiography and uterine artery Dopplers were carried out at 11-14 weeks.


METHODS
Cardiac output (CO), stroke volume (SV), mean arterial pressure (MAP), total vascular resistance and uterine artery pulsatility index (UAPI) were compared in four outcome groups according to the development of pre-eclampsia and/or SGA.


RESULTS
Compared with the normal outcome group (n= 457), in those with pre-eclampsia but not SGA (n = 8), CO and MAP were increased; in the group with pre-eclampsia and SGA (n= 19) MAP, TRP and UAPI were increased and in the group with SGA but no pre-eclampsia (n= 50) total peripheral resistance and UAPI were increased. Independent predictors of pre-eclampsia were MAP, SV and UAPI and of SGA SV and UAPI.


CONCLUSIONS
Alterations in maternal cardiac function and UAPI are observed in the first trimester of pregnancy in nulliparous women that subsequently develop pre-eclampsia and/or SGA.
Khaw
A
A
Harris Birthright Research Centre for Fetal Medicine, Golden Jubilee Wing - Suite 9, King's College Hospital, London, UK.
Kametas
N A
NA
Turan
O M
OM
Bamfo
J E A K
JE
Nicolaides
K H
KH
D000328:Adult; D001158:Arteries / Q000000981:diagnostic imaging / Q000502:physiology; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D010298:Parity; D011225:Pre-Eclampsia / Q000175:diagnosis* / Q000503:physiopathology; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D013318:Stroke Volume / Q000502:physiology; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014599:Uterus / Q000098:blood supply*; D014655:Vascular Resistance / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology