Maternal cardiovascular health represents the key point for developing an uneventful pregnancy, and its proper function is important for a normal evolution of pregnancy. Serious pregnancy-related hypertensive disorders such as preeclampsia might entail severe future effects on women's health even after delivery and influence the long-term quality of life as well as the following pregnancy outcomes. A proper maternal cardiovascular adaptation to the pregnancy plays a key role for preventing gestational hypertensive complications, such as preeclampsia. [1][2][3][4][5] Preeclampsia affects the 3% to 8% of pregnancies and represents a cause of increased maternal and perinatal morbidity and mortality. 6,7 According to the different onset time, the origin and hemodynamics, preeclampsia is classified as early (placental mediated, linked to defective trophoblast invasion with high incidence of altered uterine artery Doppler, and lower body mass index [BMI]) and late (related to higher BMI and no alteration of uterine artery Doppler) 8 recurring in 15% of the following pregnancies.9-11 Former preeclamptics have a 7× higher risk of disease recurrence compared with women who have had a normal pregnancy. 12,13Patients with a previous preeclampsia show maternal cardiac dysfunction, and they are more likely to develop systemic hypertension and to die at an early age from cardiovascular disease. [14][15][16][17] In particular, postpartum follow-up of women with a previous preeclampsia showed persistence of altered cardiac geometry and left ventricular dysfunction. 18,19 The latest studies in literature highlight the importance of assessing maternal cardiac function and structure evaluating hemodynamics in terms of total vascular resistance (TVR), left ventricular geometric pattern with regard to the presence of concentric geometry, and diastolic dysfunction. [20][21][22] It is of primary importance to understand how to select and identify those women at increased risk for recurrent preeclampsia. In a recent study, Scholten et al 23 concluded that the risk of recurrent preeclampsia and fetal growth restriction in a subsequent pregnancy is inversely and linearly related to pregnancy plasma volume, and this condition might predispose to abnormal hemodynamic adaptation to pregnancy. In previously early preeclamptic women, given the high incidence of postpartum asymptomatic left ventricular abnormalities, the high See Editorial Commentary, pp 690-692Abstract-The purpose of our study was to assess cardiac function in nonpregnant women with previous early preeclampsia before a second pregnancy to highlight the cardiovascular pattern, which may take a risk for recurrent preeclampsia. Seventy-five normotensive patients with previous preeclampsia and 147 controls with a previous uneventful pregnancy were enrolled in a case-control study and submitted to echocardiographic examination in the nonpregnant state 12 to 18 months after the first delivery. All patients included in the study had pregnancy within 24 months from the echocardiograp...

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The study of maternal cardiovascular adaptation at the end of pregnancy could help to identify low-risk patients who may develop complications during labor. In particular, low cardiac output and high total vascular resistance are apparently associated with higher risk of fetal distress or maternal complications. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Women with a diagnosis of TPD showing TVR values of > 1000 dynes × s/cm and elevated levels of CRP are at high risk of preterm delivery. An impaired maternal cardiovascular adaptation during pregnancy in these patients might suggest a possible higher risk for subsequent future cardiovascular disease. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.