This study aimed to establish a method of screening for pregnancy hypertension by a combination of maternal variables, including mean arterial pressure, uterine artery pulsatility index, pregnancy-associated plasma protein-A, and placental growth factor in early pregnancy. The base-cohort population constituted of 7797 singleton pregnancies, including 34 case subjects who developed preeclampsia (PE) requiring delivery before 34 weeks (early PE) and 123 with late PE, 136 with gestational hypertension, and 7504 cases subjects (96.3%) who were unaffected by PE or gestational hypertension. Maternal history, uterine artery pulsatility index, mean arterial pressure, and pregnancy-associated plasma protein-A were recorded in all of the cases in the base cohort, but placental growth factor was measured only in the case-control population of 209 cases who developed hypertensive disorders and 418 controls. In each case the measured mean arterial pressure, uterine artery pulsatility index, pregnancy-associated plasma protein-A, and placental growth factor were converted to a multiple of the expected median (MoM) after correction for maternal characteristics found to affect the measurements in the unaffected group. Early PE and late PE were associated with increased mean arterial pressure (1.15 MoM and 1.08 MoM) and uterine artery pulsatility index (1.53 MoM and 1.23 MoM) and decreased pregnancy-associated plasma protein-A (0.53 MoM and 0.93 MoM) and placental growth factor (0.61 MoM and 0.83 MoM). Logistic regression analysis was used to derive algorithms for the prediction of hypertensive disorders. It was estimated that, with the algorithm for early PE, 93.1%, 35.7%, and 18.3% of early PE, late PE, and gestational hypertension, respectively, could be detected with a 5% false-positive rate and that 1 in 5 pregnancies classified as being screen positive would develop pregnancy hypertension. This method of screening is far superior to the traditional approach, which relies entirely on maternal history.

This study aimed to determine the performance of screening for preeclampsia (PE) by maternal medical history and mean arterial pressure (MAP) at 11 ⁺⁰ to 13 ⁺⁶ weeks. In 5590 women with singleton pregnancies attending for routine care at 11 ⁺⁰ to 13 ⁺⁶ week’s gestation we recorded maternal variables and measured the MAP. We excluded 397 because they had missing outcome data or the pregnancies resulted in miscarriage or termination. In 104 patients there was subsequent development of PE, 97 developed gestational hypertension, 574 delivered small-for-gestational-age newborns, and 4418 were unaffected by PE, gestational hypertension, or small for gestational age. A multivariate Gaussian model was fitted to the distribution of log multiple of the median MAP in the PE and unaffected groups. Likelihood ratios for log multiple of the median MAP were computed and used together with maternal variables to produce patient-specific risks for each case. Detection rates and false-positive rates were calculated by taking the proportions with risks above a given risk threshold. In the unaffected group, log MAP was influenced by maternal age, ethnic origin, smoking, family and personal history of PE, and fetal crown-rump length. In the prediction of PE, significant contributions were provided by log multiple of the median MAP, ethnic origin, body mass index, and personal history of PE. The detection rate of PE by log multiple of the median MAP and maternal variables was 62.5% for a false-positive rate of 10%. Maternal variables, together with MAP, at 11 ⁺⁰ to 13 ⁺⁶ weeks identify a group at high risk for development of PE.

Objective Singleton pregnancy causes important changes in respiratory function. The incidence of twin pregnancies is increasing, but it is not known whether affected women suffer greater respiratory compromise. The aim of this study was to determine if changes in respiratory function during pregnancy in healthy women were greater in those with a twin pregnancy compared with those with a singleton pregnancy.Design Cross sectional study.Setting London teaching hospital.Population Healthy pregnant women attending the antenatal clinic and ultrasound department.Methods A cross sectional study of respiratory function was performed in 68 women with twin pregnancies (17 examined in the first trimester, 35 second trimester, 16 third trimester) and 140 women with singleton pregnancies (28, 80, 40, respectively) and 22 non‐pregnant women. Women were examined once between 7 and 40 weeks of gestation. Forced vital capacity, relaxed vital capacity, forced expiratory volume in 1 second (FEV1), peak flow, inspiratory capacity, functional residual capacity (FRC), expiratory reserve volume, pulmonary diffusing capacity and minute ventilation were measured.Results Both in twin and singleton pregnancies, the mean FRC and expiratory reserve volume of women studied in the third trimester and minute ventilation of women studied in each trimester differed significantly from that of the non‐pregnant women. There were, however, no significant differences demonstrated in respiratory function between healthy women with twin as compared with singleton pregnancies.Conclusion In healthy women, the extra demands of a twin compared with a singleton pregnancy do not compromise further the respiratory system.

Objective: To evaluate changes in left ventricular mass and diastolic function during normal pregnancy.Methods: This was a cross‐sectional study of 125 pregnant women at 9–42 weeks of gestation and 19 non‐pregnant female controls. Two‐dimensional and M‐mode echocardiography of the maternal left ventricle and left atrium was performed.Results: During pregnancy left ventricular mass increased by 52%. There was an increase in left ventricular end‐diastolic and end‐systolic diameters (12% and 20%, respectively), left ventricular posterior wall diameter during diastole and systole (22% and 13%, respectively) and left intraventricular septum during diastole and systole (15% and 19%, respectively). Mitral valve A‐wave maximum velocity increased during pregnancy by 19%, while mitral valve E‐wave maximum velocity and the ratio of E‐wave/A‐wave velocities increased early in pregnancy by about 14% and 6%, respectively, with a subsequent decline to 4% and 10%, respectively, below non‐pregnant levels.Conclusion: Left ventricular mass increases during pregnancy, while left ventricular diastolic function, as demonstrated by the changes in mitral valve flow velocities, increases in the first two trimesters but declines in the third trimester. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology