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Maternal cardiovascular hemodynamics in pre‐eclampsia allows identification of patients with a more severe clinical phenotype

Abstract

Objectives The limitation of the current assertion of preeclampsia (PE) is that blood pressure is used to stratify the severity of illness, even when the hemodynamic of the phenotypes may differ. We sought to describe the clinical characteristics of patients with late‐onset PE classified according to their hemodynamic profile. Methods Prospective observational study in an obstetric referral centre in Cartagena, Colombia. Thirty pregnant women presenting with PE were recruited consecutively and maternal cardiovascular parameters were obtained through bioreactance using a noninvasive continuous cardiac output monitor. Patients were classified as follows: 1) PE with normal total peripheral resistance (TPR) (n=12) and 2) Hypodinamic profile, for those PE with high TPR (> 1180 dyn*sec/cm5) (n=17). Results There were no significant differences in clinical characteristics between the study groups. Clinical and laboratory parameters such as blood pressure, platelets count, creatinine, LDH, AST, and ALT were also similar between groups (p>0.05). However, PE with high RPT had worse hemodynamic parameters than those with normal RPT: Significantly lower cardiac output, and stroke volume compared to controls (all p values <0.05). Furthermore, PE with high RPT had a trend towards higher BNP and longer length of hospital stay, but also their newborns have significantly lower birthweight centile. Conclusions Non-invasive cardiovascular hemodynamic monitoring in PE is an informative technique that would be potentially useful in the identification of patients with a more severe clinical phenotype regardless of values of blood pressure.

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