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Cerebrovascular Hemodynamics in Chronic Hypertensive Pregnant Women Who Later Develop Superimposed Preeclampsia

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Abstract

Objective

We have previously shown that normotensive pregnant women who later develop preeclampsia demonstrate lower baseline pulsatility index (PI) and resistance index (RI) but normal vasodilatory responses to stimulation tests. In the current study, we tested the hypothesis that women with chronic hypertension who later developed superimposed preeclampsia behave similarly.

Methods

Transcranial Doppler ultrasound was performed on 17 women with chronic hypertension during the second trimester of pregnancy to measure middle cerebral artery (MCA) velocities. Superimposed preeclampsia developed in seven patients (SUPER group) while the rest did not develop preeclampsia (CHT group). Measurements were performed in the left lateral position at baseline on room air, during 5% CO2 inhalation, and during a 2-minute isometric handgrip test. Blood pressure, heart rate, O2 saturation, and end-tidal Pco2 were recorded with each Doppler measurement. Mean PI, RI, and cerebral perfusion pressure (CPP) at each time were compared using two-way repeated measures analysis of variance. Statistical significance was set at P <. 05.

Results

The women who developed superimposed preeclampsia did this an average of 8.7 ± 1.3 weeks after the study. MCA PI and Rlwere lower, and CPP higher, in the SUPER group compared to the CHT group (0.64, 0.46, and 80.7 vs 0.74, 0.51, and 63.6, respectively; P <.05). Both maneuvers caused reduction in MCA PI and RI in both groups, whereas CPP increased only in the SUPER group.

Conclusions

These findings suggest that women destined to develop preeclampsia have cerebral hemodynamic changes that predate the development of overt preeclampsia.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA

    Shlomit Riskin-Mashiah MD & Michael A. Belfort MD

  2. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, USA

    Michael A. Belfort MD

  3. 18 Freud Street, Haifa, 34753, Israel

    Shlomit Riskin-Mashiah MD

Authors
  1. Shlomit Riskin-Mashiah MD
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  2. Michael A. Belfort MD
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Corresponding author

Correspondence to Shlomit Riskin-Mashiah MD.

Additional information

Supported by a grant from the National Institute of Health (MO1-00188), General Clinical Research Center.

The authors deeply appreciate Dr Alan J. Herd and Dr George R. Saade for their thoughtful insight and helpful discussions regarding this project.

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Riskin-Mashiah, S., Belfort, M.A. Cerebrovascular Hemodynamics in Chronic Hypertensive Pregnant Women Who Later Develop Superimposed Preeclampsia. Reprod. Sci. 12, 28–32 (2005). https://doi.org/10.1016/j.jsgi.2004.08.002

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