Non-invasive assessment of gestational hemodynamics: benefits and limitations of impedance cardiography versus other techniques

Staelens, Anneleen; Tomsin, Kathleen; Grieten, Lars; Oben, Jolien; Mesens, Tinne; Spaanderman, Marc E. A.; Jacquemyn, Yves; Gyselaers, Wilfried

doi:10.1586/17434440.2013.853466

Cited by 26 publications

(27 citation statements)

References 101 publications

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“…The use of noninvasive technologies with a standardized protocol and known inter‐ and intra‐observer correlations is an advantage. Bio‐impedance may be criticized as being less valid than maternal echocardiography or dye dilution plasma volume measurements; however, our results are in line with these gold‐standard methods . We acknowledge that the number of pregnancies with longitudinal measurements in each trimester is low and no correction for multiple testing was performed, due to which some of the significant results can still relate to chance.…”

Section: Discussionmentioning

confidence: 99%

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Obesity in pregnancy causes a volume overload in third trimester

Vonck

Lanssens

Staelens

et al. 2019

Eur J Clin Investigation

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Background Obesity is a major risk factor for cardiovascular diseases. In this study, we aimed to investigate the maternal circulatory differences during pregnancy between obese and normal weight women. Materials and methods The functioning of the maternal circulation (arteries, veins, heart and body fluid) was assessed by ECG‐Doppler ultrasound, impedance cardiography (ICG) and bio‐impedance during pregnancy in obese women (BMI ≥30 kg/m2) and normal weight, nonobese women (BMI 20‐25 kg/m2). In this observational study, 232 assessments were performed in the obese group, whereas 919 assessments were performed in the nonobese group. Results Relative to nonobese women, the overall cardiovascular function in obese women during first and second trimester is consistent with a high volume/low‐resistance circulation. In third trimester, cardiac output of obese women decreases from 9.2 (8.2‐10.7) L/min to 8.5 (7.6‐9.6) L/min (P = .037) whereas this is not true in the nonobese women (from 7.8 (7‐8.5) L/min to 7.8 (6.8‐8.9) L/min, P = .536). Simultaneously, the persistently lower peripheral vascular resistance in obese vs nonobese women disappears (880 (761‐1060) dyn.sec/cm5 vs 928 (780‐1067). Conclusions The circulatory gestational adaptations between nonobese and obese women were generally similar. The findings in the third trimester suggest that a pregnancy in obese women start as a state of high volume/low resistance, gradually shifting to a volume overload with decrease of cardiac output and disappearance of low vascular resistance. This evolution makes obese women vulnerable for gestational hypertensive diseases.

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Section: Discussionmentioning

confidence: 99%

“…Total body water (L) 33 (31)(32)(33)(34)(35) 37 (35)(36)(37)(38)(39)(40) .0001 34 (32-36) 39 (36)(37)(38)(39)(40)(41) .0001 36 (34-38) 40 (37)(38)(39)(40)(41)(42)(43)(44) .0001…”

Section: Fluidmentioning

confidence: 99%

Obesity in pregnancy causes a volume overload in third trimester

Vonck

Lanssens

Staelens

et al. 2019

Eur J Clin Investigation

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“…The accuracy of measuring hemodynamics using ICG has been questioned, but this technique has been validated in pregnant populations and significantly correlates with echocardiography, also during PLR . Moreover, a new generation of ICG devices and recent updates in the ICG signal analysis software have improved ICG measurement accuracy . However, measurements performed using different ICG devices might not be comparable.…”

Section: Discussionmentioning

confidence: 99%

“…Although its accuracy has been questioned, ICG has been validated in pregnant populations with modest agreement with echocardiography . Moreover, a new generation of devices together with recent updates in ICG signal analysis software have improved its measurement accuracy . Until now, maternal hemodynamics in twin pregnancies has been assessed by means of echocardiography while ICG measurements are lacking.…”

Section: Introductionmentioning

confidence: 99%

Maternal functional hemodynamics in uncomplicated twin pregnancies: A longitudinal study using impedance cardiography

Orabona

Prefumo

Zanardini

et al. 2018

Acta Obstet Gynecol Scand

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Introduction Longitudinal studies of maternal hemodynamics in twin pregnancy are scarce and preload reserve in twin pregnancies has not been studied. Thus, we aimed to investigate serial changes in maternal systemic hemodynamics from the first to third trimester, and cardiovascular response to passive leg raising to evaluate preload reserve using impedance cardiography in a cohort of uncomplicated twin pregnancies. Material and methods This was a prospective longitudinal study of 50 twin pregnancies. Maternal hemodynamics was assessed at baseline and 120 seconds after passive leg raising using impedance cardiography, at five time points during gestation. Women were excluded from the analysis if there were pregnancy complications or fewer than three of five planned assessments were available. Results Data from 37 uncomplicated twin pregnancies were available for analysis. Mean arterial pressure slightly decreased until 17 weeks’ gestation, then increased. Systemic vascular resistance was constant in the first half of pregnancy before rising steadily thereafter, whereas the cardiac output increased from the first trimester, peaked by the end of the second trimester and then decreased in the third trimester. The change in stroke volume and cardiac output following passive leg raising during pregnancy ranged from −2.2% to 1.6% and from −3.7% to 3.2%, respectively. Although passive leg raising caused no significant changes in systemic vascular resistance, cardiac output or heart rate, mean arterial pressure decreased in the first and second trimesters. Conclusions In uncomplicated twin pregnancies, maternal cardiovascular adaptation is evident from the first trimester. Twin pregnancies show a reduced preload reserve in the second half of gestation.

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“…A new generation of noninvasive methods for hemodynamic assessment is emerging now, which have outgrown their childhood diseases: impedance cardiography, bioreactance, bioconductance, etc. [16]. Several research groups are currently exploring the possibilities and limitations of these technologies and mostly conclude that reliabilities are high enough for application into research programs and clinical practice [17].…”

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confidence: 99%