The effect of acute volume expansion and vasodilatation with verapamil on uterine and umbilical artery Doppler indices in severe preeclampsia

Belfort, Michael A.; Akovic, K.; Anthony, John; Saade, George R.; Kirshon, Brian; Moise, K. J.

doi:10.1002/jcu.1870220506

Cited by 17 publications

(10 citation statements)

References 34 publications

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“…We could not observe any change in the UtA resistance index after hemodilution. This is in agreement with another report25 and could be explained by the assumption that the uteroplacental circulation is a low‐impedance vascular system and therefore the degree of pulsatility does not reflect downstream impedance26, 27.…”

Section: Discussionsupporting

confidence: 93%

The impact of maternal plasma volume expansion and antihypertensive treatment with intravenous dihydralazine on fetal and maternal hemodynamics during pre‐eclampsia: a clinical, echo‐Doppler and viscometric study

Boito

Struijk

Pop

et al. 2004

Ultrasound in Obstet & Gyne

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Section: Discussionsupporting

confidence: 93%

The impact of maternal plasma volume expansion and antihypertensive treatment with intravenous dihydralazine on fetal and maternal hemodynamics during pre‐eclampsia: a clinical, echo‐Doppler and viscometric study

Boito

Struijk

Pop

et al. 2004

Ultrasound in Obstet & Gyne

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“…[ 30 ] Rapid fluid infusion may improve maternal and fetal organ perfusion, but it also results in a significant increase in alveolar-arterial oxygen difference and shunt fraction, indicating maternal interstitial pulmonary edema. [ 31 ] In addition, the risk of pulmonary edema is elevated in HDP parturient due to the increased capillary permeability, reduced colloid oncotic pressure gradient and impaired left ventricular function. [ 6 32 ] Consequently, adequate volume expansion may benefit HDP parturient while excessive volume expansion will increase risks of developing pulmonary edema.…”

Section: Discussionmentioning

confidence: 99%

Goal-directed Fluid Therapy May Improve Hemodynamic Stability of Parturient with Hypertensive Disorders of Pregnancy Under Combined Spinal Epidural Anesthesia for Cesarean Delivery and the Well-being of Newborns

Xiao

Duan

et al. 2015

Chinese Medical Journal

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Background:Hypotension induced by combined spinal epidural anesthesia in parturient with hypertensive disorders of pregnancy (HDP) can easily compromise blood supply to vital organs including uteroplacental perfusion and result in fetal distress. The aim of this study was to investigate whether the goal-directed fluid therapy (GDFT) with LiDCOrapid system can improve well-being of both HDP parturient and their babies.Methods:Fifty-two stable HDP parturient scheduled for elective cesarean delivery were recruited. After loading with 10 ml/kg lactated Ringer's solution (LR), parturient were randomized to the GDFT and control group. In the GDFT group, individualized fluid therapy was guided by increase in stroke volume (ΔSV) provided via LiDCOrapid system. The control group received the routine fluid therapy. The primary endpoints included maternal hypotension and the doses of vasopressors administered prior to fetal delivery. The secondary endpoints included umbilical blood gas abnormalities and neonatal adverse events.Results:The severity of HDP was similar between two groups. The total LR infusion (P < 0.01) and urine output (P < 0.05) were higher in the GDFT group than in the control group. Following twice fluid challenge tests, the systolic blood pressure, mean blood pressure, cardiac output and SV in the GDFT group were significantly higher, and the heart rate was lower than in the control group. The incidence of maternal hypotension and doses of phenylephrine used prior to fetal delivery were significantly higher in the control group than in the GDFT group (P < 0.01). There were no differences in the Apgar scores between two groups. In the control group, the mean values of pH in umbilical artery/vein were remarkably decreased (P < 0.05), and the incidences of neonatal hypercapnia and hypoxemia were statistically increased (P < 0.05) than in the GDFT group.Conclusions:Dynamic responsiveness guided fluid therapy with the LiDCOrapid system may provide potential benefits to stable HDP parturient and their babies.

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“…20 The later evolution of the disease is due to defective vasoregulation and vasoconstriction associated with loss of intravascular volume through leaky capillaries and the onset of multi-organ ischaemia. 21 - 25 …”

Section: Pathology and Pathophysiologymentioning

confidence: 99%

Hypertensive disorders of pregnancy: what the physician needs to know

Anthony¹,

Damasceno²,

Ojjii³

2016

CVJA

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Hypertension developing during pregnancy may be caused by a variety of different pathophysiological mechanisms. The occurrence of proteinuric hypertension during the second half of pregnancy identifies a group of women whose hypertensive disorder is most likely to be caused by the pregnancy itself and for whom the risk of complications, including maternal mortality, is highest. Physicians identifying patients with hypertension in pregnancy need to discriminate between pre-eclampsia and other forms of hypertensive disease. Pre-eclamptic disease requires obstetric intervention before it will resolve and it must be managed in a multidisciplinary environment. The principles of diagnosis and management of these different entities are outlined in this review.

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The effect of acute volume expansion and vasodilatation with verapamil on uterine and umbilical artery Doppler indices in severe preeclampsia

Abstract: Volume expansion and verapamil therapy effectively reduces maternal blood pressure in preeclampsia, without adversely affecting uteroplacental or umbilical artery resistance. Uterine artery waveform changes may be associated with improved fetal outcome.

Cited by 17 publications

References 34 publications

The impact of maternal plasma volume expansion and antihypertensive treatment with intravenous dihydralazine on fetal and maternal hemodynamics during pre‐eclampsia: a clinical, echo‐Doppler and viscometric study

The impact of maternal plasma volume expansion and antihypertensive treatment with intravenous dihydralazine on fetal and maternal hemodynamics during pre‐eclampsia: a clinical, echo‐Doppler and viscometric study

Goal-directed Fluid Therapy May Improve Hemodynamic Stability of Parturient with Hypertensive Disorders of Pregnancy Under Combined Spinal Epidural Anesthesia for Cesarean Delivery and the Well-being of Newborns

Hypertensive disorders of pregnancy: what the physician needs to know

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