title: Maternal cardiac function, uteroplacental Doppler flow parameters and pregnancy outcome: a systematic review.
abstract: OBJECTIVE
  To investigate the existing evidence for a link between maternal cardiac function, abnormal uteroplacental flow and poor perinatal outcome in women with and without known cardiac disease.
  
  
  METHODS
  PubMed and EMBASE databases were searched systematically for studies relating cardiac functional parameters and uteroplacental Doppler flow with pregnancy outcome in women with pre-existing congenital cardiac disease and women without known cardiac disease. Only studies based on echocardiography were included.
  
  
  RESULTS
  From 1732 citations, 10 articles were included. In women with known congenital heart disease, a relationship was found between abnormal uteroplacental Doppler flow patterns and cardiac function before and during pregnancy. Conversely, women without a history of congenital heart disease, but with abnormal uterine artery resistance and pregnancy complications, more often showed global left ventricular diastolic dysfunction (33%; P = 0.0001), impaired myocardial relaxation (72%; P < 0.0001) and left ventricular systolic dysfunction (17%; P = 0.006), even up to 1 year postpartum.
  
  
  CONCLUSIONS
  There is increasing evidence for an association between pre-existing subclinical cardiac dysfunction, poor placentation (reflected by uteroplacental Doppler flow abnormalities) and poor pregnancy outcome. It may be postulated that pre-existing suboptimal cardiac performance, as a result of either congenital heart disease or a subclinical latent condition, is one of the common denominators of poor placentation, leading to poor pregnancy outcome.
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.|The Netherlands Heart Institute (ICIN), Utrecht, The Netherlands.
authors.forename: M A M
authors.initials: MA
authors.lastname: Kampman
authors.affiliation: Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: C M
authors.initials: CM
authors.lastname: Bilardo
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: B J M
authors.initials: BJ
authors.lastname: Mulder
authors.affiliation: Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: J G
authors.initials: JG
authors.lastname: Aarnoudse
authors.affiliation: Women's and Children's Clinic, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.|Reproductive Biology Laboratory, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Ris-Stalpers
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: D J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: P G
authors.initials: PG
authors.lastname: Pieper
mesh_terms: D005260:Female; D006321:Heart / Q000503:physiopathology; D006331:Heart Diseases / Q000151:congenital / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D010920:Placenta / Q000000981:diagnostic imaging; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging*; D011256:Pregnancy Outcome; D016216:Ultrasonography, Prenatal / Q000379:methods*; D055988:Uterine Artery / Q000000981:diagnostic imaging*; D014599:Uterus / Q000000981:diagnostic imaging
keywords: congenital heart disease; maternal cardiac function; pregnancy; uteroplacental Doppler flow