Static and Functional Hemodynamic Profiles of Women with Abnormal Uterine Artery Doppler at 22-24 Weeks of Gestation.
OBJECTIVE
To compare cardiac function, systemic hemodynamics and preload reserve of women with increased (cases) and normal (controls) uterine artery (UtA) pulsatility index (PI) at 22-24 weeks of gestation.


METHODS
A prospective cross-sectional study of 620 pregnant women. UtA blood flow velocities were measured using Doppler ultrasonography, and PI was calculated. Mean UtA PI ≥ 1.16 (90th percentile) was considered abnormal. Maternal hemodynamics was investigated at baseline and during passive leg raising (PLR) using impedance cardiography (ICG). Preload reserve was defined as percent increase in stroke volume (SV) 90 seconds after passive leg raising compared to baseline.


RESULTS
Mean UtA PI was 1.49 among cases (n = 63) and 0.76 among controls (n = 557) (p < 0.0001). Eighteen (28.6%) cases and 53 (9.5%) controls developed pregnancy complications (p <0.0001). The mean arterial pressure and systemic vascular resistance were 83 mmHg and 1098.89±293.87 dyne s/cm5 among cases and 79 mmHg and 1023.95±213.83 dyne s/cm5 among controls (p = 0.007 and p = 0.012, respectively). Heart rate, SV and cardiac output were not different between the groups. Both cases and controls responded with a small (4-5%) increase in SV in response to PLR, but the cardiac output remained unchanged. The preload reserve was not significantly different between two groups.


CONCLUSIONS
Pregnant women with abnormal UtA PI had higher blood pressure and systemic vascular resistance, but similar functional hemodynamic profile at 22-24 weeks compared to controls. Further studies are needed to clarify whether functional hemodynamic assessment using ICG can be useful in predicting pregnancy complications.
Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT- The Arctic University of Norway and Department of Obstetrics and Gynaecology University Hospital of Northern Norway, Tromsø, Norway.
Åse
Å
Vårtun
Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT- The Arctic University of Norway and Department of Obstetrics and Gynaecology University Hospital of Northern Norway, Tromsø, Norway.
Kari
K
Flo
Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT- The Arctic University of Norway and Department of Obstetrics and Gynaecology University Hospital of Northern Norway, Tromsø, Norway.
Christian
C
Widnes
Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT- The Arctic University of Norway and Department of Obstetrics and Gynaecology University Hospital of Northern Norway, Tromsø, Norway.|Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
Ganesh
G
Acharya
D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity; D002302:Cardiac Output; D002307:Cardiography, Impedance; D003430:Cross-Sectional Studies; D005260:Female; D005865:Gestational Age; D006339:Heart Rate; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies; D011673:Pulsatile Flow; D013318:Stroke Volume; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D055988:Uterine Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014599:Uterus / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014655:Vascular Resistance