Assessment of venous hemodynamics and volume homeostasis during pregnancy: recommendations of the International Working Group on Maternal Hemodynamics

Gyselaers, Wilfried; Spaanderman, M.E.A.

doi:10.1002/uog.18952

Cited by 14 publications

(7 citation statements)

References 107 publications

(162 reference statements)

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“…Changes in the cardiovascular system during pregnancy and delivery lead to PH worsening in women with PH since their compensatory mechanisms for the changes may be disabled [17]. Plasma volume and cardiac output (CO) will start to increase early in pregnancy and reach the peak around 32 gestational weeks at values 40-50% above pre-pregnancy values [18,19]. Moreover, the second trimester has been generally confirmed as the earliest period of deterioration of heart function for pregnant women with PH [20].…”

Section: Therapeutic Abortion and Postpartum Carementioning

confidence: 99%

Effect of multidisciplinary team (MDT) centred on pregnant women with pulmonary hypertension on treatment and outcomes of pregnancy

et al. 2023

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Background The importance of multidisciplinary team (MDT) centred on pregnant women with pulmonary hypertension (PH) has been highlighted. However, rare studies have explored its effects on pregnancy outcomes. This study seeks to investigate whether and how the MDT has an effect on the treatment and outcomes of PH pregnant women. Methods A pre- and post-intervention study was conducted based on an interrupted time series design to compare the treatment and outcomes of patients with PH before (pre-MDT) and after (post-MDT) implementation of the MDT. PH was defined as pulmonary artery systolic pressure (sPAP) ≥ 35 mmHg measured by echocardiography or right heart catheterization and sPAP at 35–60 mmHg and over 60 mmHg was defined as mild and severe PH, respectively. All results were analyzed by T-tests, Chi square tests or Fisher exact test and two-sided p value < 0.05 was set to be statistically significant. Results 149 pregnancies were found in 143 women with PH. Overall, 46 pregnancies were elective abortions, remaining 49 and 54 pregnancies completing delivery in the pre-MDT group and post-MDT group, respectively. Five (10.2%) mother and seven (8.6%) neonatal died in the former, while no maternal deaths but 1.9% neonatal death occurred in the latter. In subgroup analysis, maternal and fetal/neonatal complications were higher in patients with severe PH and World Health Organization functional class (WHO FC) III/IV and all maternal deaths occurred in class III/IV women. In pre-MDT and post-MDT groups, there were 8 and 22 pregnant women receiving the pulmonary-specific therapy and completing delivery, respectively. The percentage of heart failure and urgent cesarean of pre-MDT group was higher than the post-MDT group (30.6% vs. 12.9%, p = 0.02; 40.8% vs. 14.8%, p = 0.01, respectively). Conclusion Implementing the MDT decreased the rate of urgent caesarean section and heart failure in patients with PH and no maternal deaths occurred in the post-MDT group. Pregnant women with severe PH and WHO FC III/IV might have a poor prognosis, whereas the use of pulmonary-specific therapy might improve outcomes of pregnancy.

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Section: Therapeutic Abortion and Postpartum Carementioning

confidence: 99%

Effect of multidisciplinary team (MDT) centred on pregnant women with pulmonary hypertension on treatment and outcomes of pregnancy

et al. 2023

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“…30 A bioimpedance spectrum analysis does not allow to obtain information of the circulatory volume or intravascular filling, for which other technologies exist. 35,36 The measurements are performed in the supine position immediately after the Doppler sonography assessment (Figure 2). Four electrodes are placed, 2 on the right hand and 2 on the right bare foot: the receiving electrodes are attached at the dorsal side of the right wrist and the ankle, and the sending electrodes are placed at the distal end of the metacarpal and metatarsal bones (Figure 2).…”

Section: Change Of Maternal Venous Doppler Flow In the Liver During N...mentioning

confidence: 99%

Hemodynamic pathways of gestational hypertension and preeclampsia

Gyselaers

2022

American Journal of Obstetrics and Gynecology

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“…Predetermined alarm signals were set: based on international guidelines, was decided to generate an alarm signal when the diastolic blood pressure was greater than or equal to 90 mmHg and/or the systolic blood pressure was greater than or equal to 140 mmHg. 16,17 When appropriate, individual alarm signals were set (e.g., when they started with an antihypertensive therapy and on demand of the obstetrician). All alarm events were communicated to the obstetrician in charge to discuss management options before the patient was contacted and instructed at home.…”

Section: Datamentioning

confidence: 99%

A Prenatal Remote Monitoring Program in Pregnancies Complicated with Gestational Hypertensive Disorders: What Are the Contributors to the Cost Savings?

Lanssens

Vonck

Vandenberk

et al. 2019

Telemedicine and e-Health

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Background: In 2015, we performed a cost analysis of a prenatal remote monitoring (RM) program compared with conventional care (CC) for women diagnosed with gestational hypertensive disorders (GHD). Introduction: We investigated where the cost savings were distributed by dividing our patient population into three subgroups, according to the gestational age (GA) at the time of delivery: (1) <34 weeks; (2) 34-37 weeks; and (3) >37 weeks of GA. Materials and Methods: Healthcare costs were calculated from patient-specific hospital bills at Ziekenhuis Oost Limburg (Genk, Belgium) in 2015-2016. Cost comparisons were made from the perspectives of the Belgium national healthcare system (HCS), the National Institution for Insurance of Disease and Disability (RIZIV), and the costs to individual patients. Results: A total of 256 pregnant women were included, 80 (31.25%) of whom received RM and 176 (68.75%) of whom received CC. The greatest difference in costs between RM and CC was in the group that delivered before 34 weeks of GA, followed by the group who delivered after 37 weeks of GA, and then the group of women who delivered at 34-37 weeks of GA. Most of the cost savings were in neonatal care, for both the three separate study subgroups and the total study group. Discussion and Conclusion: Our data showed that RM is more cost-effective than CC for pregnant women with GHD. Further investigation of the effects of RM on the long-term economic and social costs is recommended, together with an analysis of the price that should be asked for RM services.

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Assessment of venous hemodynamics and volume homeostasis during pregnancy: recommendations of the International Working Group on Maternal Hemodynamics

Cited by 14 publications

References 107 publications

Effect of multidisciplinary team (MDT) centred on pregnant women with pulmonary hypertension on treatment and outcomes of pregnancy

Effect of multidisciplinary team (MDT) centred on pregnant women with pulmonary hypertension on treatment and outcomes of pregnancy

Hemodynamic pathways of gestational hypertension and preeclampsia

A Prenatal Remote Monitoring Program in Pregnancies Complicated with Gestational Hypertensive Disorders: What Are the Contributors to the Cost Savings?

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