title: Assessment of total vascular resistance and total body water in normotensive women during the first trimester of pregnancy. A key for the prevention of preeclampsia.
abstract: BACKGROUND
  Maternal cardiovascular system adapts to pregnancy, thanks to complex physiological mechanisms that involve cardiac output, total vascular resistance and water body distribution. Abnormalities of these adaptive mechanisms are connected with hypertensive disorders.
  
  
  OBJECTIVE
  To identify patients at a high risk of developing hypertensive complications of pregnancy during the first trimester of pregnancy, through the use of non-invasive methods such as USCOM (Ultrasonic Cardiac Output Monitor) and Bioimpedance.
  
  
  METHODS
  We enrolled 120 healthy normotensive women during the first trimester of pregnancy obtaining all measurements with the USCOM system and Bioimpedance.
  
  
  RESULTS
  20 patients were excluded for a bad USCOM signal. The remaining patients (n = 100) were retrospectively divided into two groups: Group A (n = 75) TVR<1200 dynes s cm(-5), Group B (n = 25) TVR>1200 dynes s cm(-5). No statistically significant difference was identified in terms of water distribution, Fat Free Mass, Systolic/Diastolic Blood Pressure, Heart Rate, Hematocrit, Flow Time Corrected and Water Balance Index between the two groups. In contrast, higher values of the Cardiac Output, Stroke Volume, Fat Mass and Inotropy Index have been highlighted in the Group A. Moreover, in the Group A we found a better maternal-neonatal outcome and a lower incidence of hypertensive complications.
  
  
  CONCLUSIONS
  High TVR during the first weeks of gestation may be an early marker of cardiovascular maladaptation more than the evaluation of water distribution and, in particular, with respect to the single blood pressure assessment. Moreover lower values of Inotropy Index could be an indicative of the worst cardiac performance.
authors.affiliation: Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy; Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy.
authors.forename: G M
authors.initials: GM
authors.lastname: Tiralongo
authors.affiliation: Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy; Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Lo Presti
authors.affiliation: Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy; Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Pisani
authors.affiliation: Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy; Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Gagliardi
authors.affiliation: Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy.
authors.forename: R L
authors.initials: RL
authors.lastname: Scala
authors.affiliation: Department of Cardiology, San Sebastiano Martire Hospital, Frascati, Rome, Italy.
authors.forename: G P
authors.initials: GP
authors.lastname: Novelli
authors.affiliation: AFaR (Fatebenefratelli Association for Research), Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Vasapollo
authors.affiliation: Department of Physiology, Tor Vergata University, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Andreoli
authors.affiliation: Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy; Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy.
authors.forename: H
authors.initials: H
authors.lastname: Valensise
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D001834:Body Water / Q000502:physiology*; D017097:Electric Impedance; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000503:physiopathology; D011225:Pre-Eclampsia / Q000503:physiopathology* / Q000517:prevention & control; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000502:physiology; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D014655:Vascular Resistance / Q000502:physiology*
keywords: Bioimpedance; Early and late preeclampsia; Early pregnancy; Gestational hypertension; Inotropy index; Total vascular resistance