- MP <34 P<0.001 UA UA/MCA MCA P<0.05 UA UA/MCA UtA PI RI P<0.05 UtA 24 BP 24 MP III

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1 Changes of maternal and fetal hemodynamics in early-onset severe preeclampsia : : : 98-6 : : : : : OO

2 - MP <34 P<0.001 UA UA/MCA MCA P<0.05 UA UA/MCA UtA PI RI P<0.05 UtA 24 BP 24 MP III

3 ,,,,,, Changes of maternal and fetal hemodynamics in early-onset severe preeclampsia Abstract Objective To compare the changes of maternal and fetal hemodynamics between pregnancies with early-onset severe preeclampsia and normal pregnancies, and to evaluate the role of feto-maternal hemodynamic investigation to predict adverse perinatal outcome in early-onset severe preeclampsia Methods A case-control study was performed. Consecutive women admitted after 20 weeks gestation with the diagnosis of severe preeclampsia were included in the study. Each case was matched to two healthy pregnant women (controls) who had ultrasound at the same gestational age (±3d). The Doppler indices of umbilical artery(ua) and middle cerebral artery(mca) and maternal uterine artery (UtA) and the maternal peripheral hemodynamic parameters by using non-invasive cardiovascular surveyor (MP Inspecting System) were measured and IIII

4 analyzed. Results Forty-six severe preeclamptic women were enrolled, of whom 30 were early-onset and 16 were late. Correspondingly, ninety-two normal pregnancy women were enrolled, 60 of them were <34weeks gestation, 32 were 34 weeks. In the early-onset severe preeclampsia cases, all the mean Doppler indices of fetal UA, UA/MCA and maternal UtA were higher than the <34weeks controls (P<0.05), meanwhile all the fetal MCA indices were lower(p<0.05). The proportion of cases with abnormal peripheral circulation patterns was higher in cases than in controls(p<0.05). In the early-onset group, there were more adverse fetal prognoses in patients with abnormal fetal Doppler indices compared with those with normal indices(p<0.05). Similarly, there were more adverse pregnancy prognoses in patients with abnormal UtA indices and peripheral circulation patterns(p<0.05). Conclusion Both fetal and maternal hemodynamics significantly altered in early-onset severe preeclampsia. Abnormal feto-maternal hemodynamics were more frequently associated with adverse pregnancy outcome in early-onset severe preeclampsia. Key Words preeclampsia, early-onset, hemodynamics, Doppler ultrasound, uterine artery, umbilical artery, middle cerebral artery IVI

5 VI

6 ABBREVIATIONS (preeclampsia) early-onset severe preeclampsia 1

7 <34, ±3 92 < National High Blood Pressure Education Program Working Group (U.S. 2000) 20 BP 160/110mmHg 2.0g 24 >106 mol/ < ( LDH ) ALT AST ; 2

8 10 MP ALOKA S-5500 Imagine Point 5MHz middle cerebral artery MCA S/D (pulsatility index PI) (resistance index RI) umbilical artery UA 3 S/D RI PI 3

9 uterine artery UtA S/D PI RI [1] UA UtA 90 MCA MP MAP CI K (TPR (TM) V 5 10 [2], (CI) L.min -1 /m 2 TPR TPR<0.9PRU TPR>1.2PRU (0.9PRU<TPR<1.2PRU); CI > 4.0L.min -1 /m 2, 4

10 TPR <0.9 PRU, K <0.4 ; CI<2.5 L.min -1 /m 2 TPR>1.2 PRU K> [3] (early-onset severe pre-eclampsia) (late-onset severe pre-eclampsia) 34 n=30 (n=16) <34 n=60 34 (n=32) FGR Apgar 7 5

11 30 30 FGR 3 [4] <35 FGR ± x SD t x 2 P 0.05 SPSS <34 (60 ) 34 6

12 (32 ) 1 (P 0.05) (P 0.05) 1 [x s n(%)] n=46 _(n=92) n=30 n=16 < 34 (n=60) 34 (n=32) (y) (kg/cm 2 ) (kg) (50.0) 12 (75.0) 55 (91.7) 31 (96.9) 15 (50.0) 4 (25.0) 5 (8.3) 1 (3.1) 8 (26.7) 6 (37.5) 6 (10.0) 1 (3.1) 18 (60.0) 12 (75.0) 60 (100) 32 (100) (wk) (wk) (25.0) 4 (6.7) 1 (3.1) <35 21 (70.0) 1(6.3) (70.0) 11 (68.8) 13 (21.7) 9 (28.1) (g) (60.0) 5 (31.3) 9 (15.0) 6 (18.8) 9 (30.0) 2 (12.5) (73.3) 4 (25.0) 4 (6.7) 1 (31.3) 1. 2 (P<0.05) P<0.05 (P<0.01) (P<0.01) 50.0% (15/30) 25.0% 4/

13 6 40.0% 6/ ± ±1.4 P<0.01 ; 93.3% (28/30) 6.7% (4/60), (P<0.001) % % 21.7% P< % 30.0% 73.3% P< % UA MCA UA MCA 2 UA S/D PI RI UA MCA PI RI

14 P<0.05 MCA S/D PI RI P< ( x s) (UA) (MCA) UA/MCA S/D PI RI S/D PI RI PI RI n= (n=46) n= <34W (n=60) (n=92) 34W (n=32) : P<0.05 P<0.01 UA P>0.05 UA/MCA PI RI PI RI MCA PI PI P<0.01 [1], < UA UA/MCA 90 MCA 10 6 P< UtA MP 9

15 2.2.1 UtA 3 3 (UtA) x SD S/D PI RI (n=30) (n=16) <34 (n=60) (n=32) P< UtA S/D PI RI P< P>0.05 UtA UtA UtA P< MP K TPR V, P<0.001 P<0.001 P<0.05 CI (TM) 4 10

16 4 MP (x SD) MAP CI mmhg (L/min/m 2 ) K TPR (PRU) TM (S) V(CP) n= *** ** *** * n=46 n= *** <34 (n=60) ( n=92 ) 34 (n=32) : P<0.05 P<0.01 P<0.001 MP [2] 5 (χ 2 =1.45 P>0.05) % 7 (50%) (48.5%) 17 (51.5%) % 23/ /60 (χ P<0.01) [5] 5 MP (n ) (n=30) 14 (46.7) 9 (30.0) 7 (23.3) (n=16) 7 (43.8) 9 (56.2) 0 <34 (n=60) 33 (55.0) 19 (31.7) 8 (13.3) 34 (n=32) 20 (62.5) 12 (37.5) 0 11

357 P <. 5. TCD findings revealed that the contralateral vertebral artery systolic blood flow velocities in patients with phase Ⅰ Ⅱ and Ⅲ steal groups

357 P <. 5. TCD findings revealed that the contralateral vertebral artery systolic blood flow velocities in patients with phase Ⅰ Ⅱ and Ⅲ steal groups 356 TCD 212 3 215 4 TCD 45 TCD 8 Ⅰ 21 Ⅱ 11 Ⅲ 5 4 45 6 2 Ⅰ 12 9 Ⅱ 3 7 1 Ⅲ 3 2 r =. 78 P