Because early and late preeclampsia (PE) are thought to be different disease entities, we compared maternal cardiac function at 24 weeks gestation in a group of normotensive asymptomatic patients with subsequent development of early (140/90+proteinuria >300 mg/dL) to detect possible early differences in the hemodynamic state. A group of 1345 nulliparous normotensive asymptomatic women underwent at 24 weeks gestation uterine artery Doppler evaluation and maternal echocardiography calculating total vascular resistance. In the subsequent follow-up 107 patients showed PE: 32 patients had late and 75 had early PE. Five of 32 patients with late PE and 45 of 75 patients with early PE had bilateral notching of the uterine artery at 24 weeks (15.6% versus 60.0%; P <0.05). Total vascular resistance was 1605±248 versus 739±244 dyn · s · cm ⁻⁵ , and cardiac output was 4.49±1.09 versus 8.96±1.83 L in early versus late PE ( P <0.001). Prepregnancy body mass index was higher in late versus early PE (28±6 versus 24±2 kg/m ² ; P <0.001). Early and late PE appear to develop from different hemodynamic states. Late PE appears to be more frequent in patients with high body mass index and low total vascular resistance; earlier forms of PE appear to be more frequent in patients with lower BMI and with bilateral notching of the uterine artery. These findings support the hypothesis of different hemodynamics and origins for early PE (placental mediated, linked to defective trophoblast invasion with high percentage of altered uterine artery Doppler) and late PE (linked to constitutional factors such as high body mass index).

We evaluated the predictive value of elevated total vascular resistance on the outcome of pregnancy in normotensive high-risk primigravidas with bilateral notching of the uterine artery Doppler. A total of 526 high-risk primigravidas referred to the obstetrics outpatient clinic of Tor Vergata University with bilateral notching of the uterine artery at 20 to 22 weeks’ gestation were submitted to a maternal echocardiographic examination and uterine artery Doppler evaluation at 24 weeks’ gestation. Blood pressure was recorded at the time of the examination, total vascular resistance was calculated, and the geometric pattern of the left ventricle was assessed. Patients were followed until the end of pregnancy to detect fetal/maternal adverse outcomes (gestational hypertension, preeclampsia, abruptio placentae, fetal growth restriction, perinatal death, etc). A total of 111 of the 526 pregnancies showed a bilateral notch at 24 weeks’ gestation, and 97 had an adverse outcome (18.44%). The best independent predictor for maternal and fetal complications was total vascular resistance (odds ratio: 91.25; 95% CI: 39.64 to 210.05; P 0.37; odds ratio: 2.47; 95% CI: 1.12 to 5.44) and a hypertrophized ventricle (left ventricular mass >130 g; odds ratio: 2.52; 95% CI: 1.12 to 5.64) were also independent predictors ( P <0.05). Echocardiography might identify at 24 weeks’ gestation patients who subsequently develop maternal and fetal complications through the assessment of maternal hemodynamics and left ventricular geometry.

Objective: To determine reference values of fetal subcutaneous tissue thickness (SCTT) throughout gestation in a healthy population and to compare them with those from a population of pregnant women with gestational diabetes under standard therapy.Methods: Three hundred and three women recruited from a high‐risk pregnancy clinic were classified as being healthy (n = 218) or as having gestational diabetes (n = 85) on the basis of a negative or positive oral glucose tolerance test, respectively. They were enrolled into the cross‐sectional study at 20 weeks' gestation. Ultrasound examinations were performed approximately every 3 weeks until delivery at term. The mid‐arm fat mass and lean mass (MAFM, MALM), the mid‐thigh fat mass and lean mass (MTFM, MTLM), the abdominal fat mass (AFM) and the subscapular fat mass (SSFM) were evaluated. Time‐specific reference ranges were constructed from the 218 healthy women and a conventional Student's t‐test was performed to compare SCTT values between the two study groups throughout gestation.Results: Normal ranges, including 5^th, 50^th and 95^th centiles of the distribution, were generated for each SCTT parameter obtained in each of the two groups of women. Significant differences were found between the two study groups at 37–40 weeks' gestation for MTFM, at 20–22 and 26–28 weeks for MTLM, at 31–34 and 35–37 weeks for MAFM, at 26–28 and 38–40 weeks for SSFM, and at 39–40 weeks for AFM, the mean residual values always being greater in gestational diabetic women than they were in the group of healthy pregnant women.Conclusions: We provide gestational age‐specific reference values for fetal SCTT. Fetal fat mass values, particularly in late gestation, are greater in women with gestational diabetes compared with healthy women. The reference values may have a role in assessing the influence of maternal metabolic control on fetal state. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.

Objective: To test the hypothesis of the existence of a relationship between central and peripheral hemodynamic parameters by the longitudinal evaluation of maternal echocardiographic and uteroplacental resistance modifications during normal pregnancy.Methods: Forty‐three healthy normotensive primigravidae were evaluated at 12 ± 1, 21 ± 1, and 33 ± 1 weeks of gestation with uterine artery color Doppler and maternal echocardiographic examinations to identify morphologic, systolic, and diastolic variables.Results: Cardiac output and stroke volume significantly increased during pregnancy. Uterine resistance index (RI) decreased from the first to the second trimesters (0.72 ± 0.10 versus 0.54 ± 0.09, P < 0.001). Left atrial dimensions increased during pregnancy (33.8 ± 1.9 cm, 38.1 ± 1.8 cm, 39.3 ± 2.1 cm, P < 0.001). Left atrial function also increased. Left ventricular mass increased (132 ± 18 g, 162 ± 16 g, 174 ± 27 g, P < 0.001). Diastolic function parameters showed significant modifications: E wave velocity and E/A ratio decreased; A wave velocity and deceleration time of the E wave (DtE) increased; the left ventricular isovolumetric relaxation time (IVRT) decreased significantly (88.7 ± 6.7 ms, 75.6 ± 7.7 ms, 71.1 ± 5.0 ms, P < 0.001) showing a correlation with left atrial dimensions and RI (r = −0.38, r = 0.47, respectively; P < 0.001).Conclusions: Diastolic cardiac function varies during pregnancy. A relationship between preload (left atrial enlargement), afterload (RI reduction), morphologic, and diastolic function modifications (IVRT reduction, DtE prolongation) appears to exist as a consequence of the hemodynamic modifications which occur during physiologic pregnancy. Diastolic function analysis maybe useful to identify women who fully adapt to pregnancy, and to understand the mechanisms that might be involved in women who show abnormal uterine artery Doppler waveforms. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology

Objective: To evaluate the effect of plasma volume expansion (PVE) and nitric oxide (NO) donors, in addition to antihypertensive therapy for gestational hypertensive pregnancies complicated by intrauterine growth restriction (IUGR) with absent end‐diastolic flow (AEDF) in the umbilical artery (UA).Methods: This was a case–control study into which 32 gestational hypertensive pregnancies with IUGR and AEDF were enrolled. Sixteen of these were treated with antihypertensive drugs, NO donors and PVE (Group A), and 16, matched for maternal age, gestational age and fetal conditions, were treated with antihypertensive drugs only (Group B). All patients underwent fetal and uteroplacental assessment and maternal echocardiography to evaluate total vascular resistance (TVR) and cardiac output before and 5–14 days after initiation of treatment.Results: After 5–14 days of treatment, the maternal TVR in Group A fell from 2170 ± 248 to 1377 ± 110 dynes·s·cm⁻⁵ (P < 0.01), and that in Group B fell from 2090 ± 260 to 1824 ± 126 dynes·s·cm⁻⁵ (P < 0.01), with the reduction being greater in Group A than in Group B (P < 0.01). There was a significant increase in cardiac output in Group A after 5–14 days of treatment vs. baseline (6.19 ± 0.77 vs. 4.32 ± 0.66, P < 0.001), and, after treatment, cardiac output was significantly greater in Group A than it was in Group B (6.19 ± 0.77 vs. 4.70 ± 0.44, P < 0.001). Reappearance of end‐diastolic flow in the UA occurred in 14/16 patients in Group A but in no patients in Group B (87.5% vs. 0%, P < 0.05). The interval between detection of UA‐AEDF and delivery was 28 ± 16 days in Group A and 11 ± 6 days in Group B (P < 0.05).Conclusion: Administration of NO donors and PVE in gestational hypertensive pregnancies affected by IUGR and UA‐AEDF appears to improve both maternal and fetal hemodynamics, inducing prolongation of gestation. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.

Objective: To explore maternal cardiac function through an echocardiographic evaluation, in a group of nulliparous patients with intrauterine fetal growth restriction during the third trimester of pregnancy.Methods: Twenty‐one consecutive nulliparous pregnant women who had fetuses with intrauterine growth restriction (IUGR) and abnormal umbilical artery Doppler pulsatility index (PI) underwent maternal echocardiographic examination during the third trimester of gestation. The data were then compared with those obtained from 21 normal nulliparous women who had fetuses with an estimated fetal weight > 10th percentile and a normal umbilical artery Doppler PI who were considered as the control group.Results: Heart rate was slightly lower in the IUGR group, whereas blood pressure and total vascular resistance were higher compared with the control subjects. End‐diastolic volume, stroke volume and cardiac output were lower in the IUGR patients compared with normal patients. The IUGR group had smaller left atrial maximal dimensions and greater left atrial minimal areas compared with the control subjects. Left atrial function was depressed in the IUGR group. A smaller left ventricular mass was present in the IUGR patients compared with the control subjects. Isovolumetric relaxation time (IVRT) was prolonged in the IUGR patients compared with the controls.Conclusions: The absence of a ‘correct’ maternal cardiovascular compensatory response to abnormal trophoblastic invasion, might be one of the factors that slowly determine the conditions of reduced placental perfusion and eventually of the development of fetal growth restriction. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology