Maternal cardiac function at 35-37 weeks' gestation: prediction of pre-eclampsia and gestational hypertension.
OBJECTIVE
To investigate the potential value of combining maternal factors with multiples of the normal median values of maternal cardiovascular parameters at 35-37 weeks' gestation in the prediction of pre-eclampsia (PE) and gestational hypertension (GH).


METHODS
In 2764 singleton pregnancies maternal characteristics and medical history were recorded; uterine artery pulsatility index (UtA-PI), mean arterial pressure (MAP) and maternal cardiovascular parameters were measured. Multivariable logistic regression analysis was then used to determine if the maternal factors and maternal cardiovascular parameters made a significant contribution to predicting PE and GH. The performance of screening was determined by the area under receiver-operating characteristics curves.


RESULTS
In pregnancies that subsequently delivered with PE or GH, total peripheral resistance and MAP were higher and maternal cardiac output was lower, mainly owing to a decrease in heart rate in PE and a decrease in stroke volume in GH. The increases in total peripheral resistance and MAP were inversely related to gestational age at delivery. The performance of screening for PE and GH achieved by maternal characteristics and medical history was improved by the inclusion of MAP, but not by UtA-PI or maternal cardiovascular parameters.


CONCLUSIONS
In women developing term PE total peripheral resistance and MAP are increased and maternal cardiac output is reduced. However, assessment of maternal cardiac function at 35-37 weeks' gestation is unlikely to improve the performance of screening for PE provided by maternal factors and MAP alone. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
G P
GP
Guy
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
H Z
HZ
Ling
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
P
P
Garcia
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.|Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong.
L C
LC
Poon
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
K H
KH
Nicolaides
D019540:Area Under Curve; D062186:Arterial Pressure; D001724:Birth Weight; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000000981:diagnostic imaging* / Q000503:physiopathology; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal
cardiac output; gestational hypertension; maternal cardiovascular function; pre-eclampsia; third-trimester screening; total peripheral resistance