title: OS095. Impedance cardiography: A straightforward and reliable tool to evaluate differences of cardiac reflex response between normal pregnancy and pre-eclampsia.
abstract: BACKGROUND
  Reflex responses of cardiac cycle time intervals (CCTI) can be measured by echocardiography, and are reported to differ between uneventful pregnancy (UP) and pre-eclampsia (PE). It is unknown whether impedance cardiography (ICG) is a useful method to measure CCTI during pregnancy.
  
  
  OBJECTIVE
  ICG measurements of CCTI before and after orthostatic challenge are evaluated in UP and in the clinical phase of PE.
  
  
  METHODS
  Examinations were performed twice in 16 UP (30-36 weeks), and once in 30 early PE (EPE, <34 weeks) and in 32 late PE (LPE, ⩾34 weeks). A 3rd generation ICG device using a 4 electrode arrangement (NICCOMO, Medis, Germany) was used to measure CCTI in supine position and after moving to upright position. The pre-ejection period (PEP) is the time-interval between ventricular depolarisation and start of aortic flow. The left ventricular ejection time (LVET) is the time-interval between opening and closing of the aortic valve. Diastolic time (DT) is heart period duration - (PEP+LVET). Orthostatic-induced changes from supine to upright position (cardiac reflex response or CRR) were evaluated using One-sample Wilcoxon Signed Rank Tests. All CRRs in EPE and LPE were compared to UP using Mann-Whitney U tests. Data are represented as medians (interquartile ranges).
  
  
  RESULTS
  Maternal age was comparable between all groups [29 (26-32) years; p⩾0.47]. Gestational age was comparable between both early [31 (28-32) vs 31 (27-33) weeks] and late [37 (36-39) vs 38 (36-39) weeks] third trimester UP and PE [p⩾0.38]. Pre-gestational BMI was higher in EPE compared to UP [26 (24-32) vs 23 (21-24); p<0.01]. This was not true for LPE [25 (23-28); p=0.06]. Birth weight percentiles were lower in both EPE and LPE compared to UP [UP: 44 (38-78), EPE: 18 (5-28), LPE: 31 (18-59); p<0.05], and also lower in EPE compared to LPE [p=0.03]. CRRs within each group are shown in Table 1. The CRRs of PEP were significantly different between UP and both EPE and LPE [p⩽0.01], due to orthostatic-induced increase in PE but not in UP .
  
  
  CONCLUSIONS
  Our study confirms that orthostasis does not change PEP in UP but induces a significant increase of PEP in PE. The increased reflex-induced duration of isovolumetric contraction time can be explained by a decreased left ventricular performance in the clinical phase of PE as compared to UP. ICG turns out to be a straightforward and useful method to evaluate these hemodynamic features.
authors.affiliation: Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine, Diepenbeek, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Tomsin
authors.affiliation: Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: T
authors.initials: T
authors.lastname: Mesens
authors.affiliation: Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine, Diepenbeek, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Oben
authors.affiliation: I-BioStat, Hasselt University, Diepenbeek, Belgium.
authors.forename: G
authors.initials: G
authors.lastname: Molenberghs
authors.affiliation: Obstetrics and Gynaecology (GROW), Maastricht University, Maastricht, Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Peeters
authors.affiliation: Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine, Diepenbeek, Belgium.
authors.forename: W
authors.initials: W
authors.lastname: Gyselaers