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Am J Perinatol
DOI: 10.1055/a-2267-3994
Clinical Opinion

Maternal Hemodynamics from Preconception to Delivery: Research and Potential Diagnostic and Therapeutic Implications: Position Statement by Italian Association of Pre-Eclampsia and Italian Society of Perinatal Medicine

Barbara Vasapollo 
1   Department of Surgical Sciences, Tor Vergata University, Rome, Italy
2   Division of Obstetrics and Gynecology, Policlinico Casilino, Rome, Italy
,
Sara Zullino
3   Department of Obstetrics and Gynecology, Biomedical, Experimental and Clinical Sciences, University Hospital Careggi, Florence, Italy
,
Gian Paolo Novelli 
4   Department of Integrated Care Services, Prehospitalization Unit, Policlinico di Tor Vergata, Rome, Italy
,
Daniele Farsetti
1   Department of Surgical Sciences, Tor Vergata University, Rome, Italy
2   Division of Obstetrics and Gynecology, Policlinico Casilino, Rome, Italy
,
Serena Ottanelli
3   Department of Obstetrics and Gynecology, Biomedical, Experimental and Clinical Sciences, University Hospital Careggi, Florence, Italy
,
Sara Clemenza
3   Department of Obstetrics and Gynecology, Biomedical, Experimental and Clinical Sciences, University Hospital Careggi, Florence, Italy
,
Massimo Micaglio 
5   Department of Anesthesia and Intensive Care, Unit of Obstetric and Gynecologic Anesthesia, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
,
Enrico Ferrazzi
6   Department of Obstetrics and Gynecology, Unit of Obstetrics, Department of Woman, Child, and Newborn, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
7   Department of Clinical and Community Sciences, University of Milan, Milan, Italy
,
Daniela Denis Di Martino
6   Department of Obstetrics and Gynecology, Unit of Obstetrics, Department of Woman, Child, and Newborn, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
,
Tullio Ghi
8   Obstetrics and Gynecology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
,
Elvira Di Pasquo 
8   Obstetrics and Gynecology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
,
Rossana Orabona
9   Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
,
Paola Corbella
10   Maternal Infant Department SC, Obstetrics and Gynecology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
,
Maria Grazia Frigo
11   Department of Anesthesia and Resuscitation in Obstetrics, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
,
Federico Prefumo
12   Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
,
Tamara Stampalija
13   Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
14   Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
,
Stefano Raffaele Giannubilo
15   Department of Obstetrics and Gynecology, Marche Polytechnic University, Ancona, Italy
16   Department of Clinical Sciences, Polytechnic University of Marche Salesi Hospital, Ancona, Italy
,
Herbert Valensise
1   Department of Surgical Sciences, Tor Vergata University, Rome, Italy
2   Division of Obstetrics and Gynecology, Policlinico Casilino, Rome, Italy
,
Federico Mecacci
3   Department of Obstetrics and Gynecology, Biomedical, Experimental and Clinical Sciences, University Hospital Careggi, Florence, Italy
› Author Affiliations Funding None.
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Abstract

Objective The Italian Association of Preeclampsia (AIPE) and the Italian Society of Perinatal Medicine (SIMP) developed clinical questions on maternal hemodynamics state of the art.

Study Design AIPE and SIMP experts were divided in small groups and were invited to propose an overview of the existing literature on specific topics related to the clinical questions proposed, developing, wherever possible, clinical and/or research recommendations based on available evidence, expert opinion, and clinical importance. Draft recommendations with a clinical rationale were submitted to 8th AIPE and SIMP Consensus Expert Panel for consideration and approval, with at least 75% agreement required for individual recommendations to be included in the final version.

Results More and more evidence in literature underlines the relationship between maternal and fetal hemodynamics, as well as the relationship between maternal cardiovascular profile and fetal-maternal adverse outcomes such as fetal growth restriction and hypertensive disorders of pregnancy. Experts agreed on proposing a classification of pregnancy hypertension, complications, and cardiovascular states based on three different hemodynamic profiles depending on total peripheral vascular resistance values: hypodynamic (>1,300 dynes·s·cm−5), normo-dynamic, and hyperdynamic (<800 dynes·s·cm−5) circulation. This differentiation implies different therapeutical strategies, based drugs' characteristics, and maternal cardiovascular profile. Finally, the cardiovascular characteristics of the women may be useful for a rational approach to an appropriate follow-up, due to the increased cardiovascular risk later in life.

Conclusion Although the evidence might not be conclusive, given the lack of large randomized trials, maternal hemodynamics might have great importance in helping clinicians in understanding the pathophysiology and chose a rational treatment of patients with or at risk for pregnancy complications.

Key Points

  • Altered maternal hemodynamics is associated to fetal growth restriction.

  • Altered maternal hemodynamics is associated to complicated hypertensive disorders of pregnancy.

  • Maternal hemodynamics might help choosing a rational treatment during hypertensive disorders.

Keywords

maternal hemodynamics - pregnancy - total peripheral vascular resistance - fetal growth restriction - hypertensive disorders of pregnancy - twin pregnancy - diabetes - preterm delivery


Publication History

Accepted Manuscript online:
13 February 2024

Article published online:
28 February 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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