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Published on: June 29, 2013
Pulse Pressure as a Hemodynamic Parameter in Preeclampsia with Severe Features Accompanied by Fetal Growth
Rachael Sampson1, Sidney Davis1, Roger Wong2,3
1Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, State University of New York Upstate Medical University, Syracuse, NY 13210, USA.
Insights
Severe preeclampsia with fetal growth restriction (FGR) shows lower pulse pressure on admission. Assessing pulse pressure may help differentiate preeclampsia subtypes, optimizing hypertension management.
Area of Science:
- Obstetrics and Gynecology
- Cardiovascular Physiology in Pregnancy
- Perinatal Medicine
Background:
- Preeclampsia management can be improved by tailoring hypertension treatment to individual hemodynamic profiles.
- Distinct preeclampsia phenotypes exist, including hyperdynamic profiles and those with uteroplacental insufficiency.
- Fetal growth restriction (FGR) is linked to uteroplacental insufficiency, yet research on hemodynamic differences in severe preeclampsia with and without FGR is limited.
Purpose of the Study:
- To identify differing hemodynamic parameters between severe preeclampsia patients who develop FGR and those who do not.
- To investigate the role of hemodynamic profiling in understanding preeclampsia heterogeneity.
Main Methods:
- Retrospective analysis of severe preeclampsia patients admitted to a referral center.
- Inclusion criteria: live birth ≥23 weeks gestation; exclusion: multiple gestations, fetal anomalies, HELLP syndrome.
- FGR definition: sonographic EFW < 10th percentile or AC < 10th percentile.
Main Results:
- Patients with severe preeclampsia and FGR had significantly lower odds of elevated pulse pressure on admission (aOR = 0.24).
- Advanced gestational age correlated with reduced odds of severely abnormal labs and elevated diastolic blood pressure in FGR cases.
- Pulse pressure emerged as a key differentiating hemodynamic parameter.
Conclusions:
- Hemodynamic evaluation, specifically assessing pulse pressure upon admission, may help distinguish between preeclampsia subtypes with and without FGR.
- This finding could inform more personalized hypertension management strategies in severe preeclampsia.
Abstract:
Background: Modern management of preeclampsia can be optimized by tailoring the targeted treatment of hypertension to an individual's hemodynamic profile. Growing evidence suggests different phenotypes of preeclampsia, including those with a hyperdynamic profile and those complicated by uteroplacental insufficiency. Fetal growth restriction (FGR) is believed to be a result of uteroplacental insufficiency. There is a paucity of research examining the characteristics of patients with severe preeclampsia who do and who do not develop FGR. We aimed to elucidate which hemodynamic parameters differed between these two groups. Methods: All patients admitted to a single referral center with severe preeclampsia were identified. Patients were included if they had a live birth at 23 weeks of gestation or higher. Multiple gestations and pregnancies complicated by fetal congenital anomalies and/or HELLP syndrome were excluded. FGR was defined as a sonographic estimation of fetal weight (EFW) < 10th percentile or abdominal circumference (AC) < 10th percentile. Results: There were 76% significantly lower odds of overall pulse pressure upon admission for those with severe preeclampsia comorbid with FGR (aOR = 0.24, 95% CI = 0.07-0.83). Advanced gestational age on admission was associated with lower odds of severely abnormal labs and severely elevated diastolic blood pressure in preeclampsia also complicated by FGR. Conclusions: Subtypes of preeclampsia with and without FGR may be hemodynamically evaluated by assessing pulse pressure on admission.
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