Cardiac output; obstetrics

PURPOSE: This study aimed to investigate fetal cardiac output and myocardial performance index in pregnant women with idiopathic polyhydramnios and compare them to healthy pregnant women. METHODS: Thirty patients admitted to Ankara City Hospital at 24-39 weeks of gestation with idiopathic polyhydramnios were included as the study group. Clinical characteristics, fetal cardiac output, and fetal modified myocardial performance index (Mod-MPI) were compared between the groups...

OBJECTIVE: There is a paucity in the literature regarding evidence-based guidelines for the management of large placental chorioangiomas (≥ 4cm diameter). The objective of this study is to describe different thermal techniques that may improve the efficiency of in utero intervention for chorioangiomas. METHODS: This is a retrospective cohort study of 34 patients referred for the management of large placental chorioangiomas in a single center from January 2011 to December 2022, who were managed expectantly or with intervention...

OBJECTIVE: Maternal cardiac function plays a crucial role in normal placental function and development. The maternal hemodynamic changes in twin pregnancy are more pronounced than in singleton, presumably due to an increased plasma volume expansion. In view of the correlation between cardiac and placental function, it is plausible that chorionicity could influence maternal cardiac function. The aim of this study was to compare the longitudinal maternal hemodynamic changes in dichorionic and monochorionic twin pregnancies...

OBJECTIVES: To evaluate the clinical effectiveness of integrated management during the perinatal period for fetuses diagnosed with total anomalous pulmonary venous connection (TAPVC) by prenatal echocardiography. METHODS: Clinical data of 64 cases of TAPVC fetuses diagnosed by prenatal echocardiography and managed with integrated perinatal care in Qingdao Women and Children's Hospital from January 2017 to December 2021 were retrospectively analyzed. Integrated perinatal care included multidisciplinary collaboration among obstetrics, fetal medicine, ultrasound, pediatric cardiology, pediatric anesthesia, and neonatology...

Any acute and profound reduction in fetal oxygenation increases the risk of anaerobic metabolism in the fetal myocardium and, hence, the risk of lactic acidosis. On the contrary, in a gradually evolving hypoxic stress, there is sufficient time to mount a catecholamine-mediated increase in the fetal heart rate to increase the cardiac output and redistribute oxygenated blood to maintain an aerobic metabolism in the fetal central organs. When the hypoxic stress is sudden, profound, and sustained, it is not possible to continue to maintain central organ perfusion by peripheral vasoconstriction and centralization...

Optimal perioperative fluid management is crucial, with over- or under-replacement associated with complications. There are many strategies for fluid therapy, including liberal fluid therapy (LFT), restrictive fluid therapy (RFT) and goal-directed fluid therapy (GDT), without a clear consensus as to which is better. We aimed to find out which is the more effective fluid therapy option in adult surgical patients undergoing non-vascular abdominal surgery in the perioperative period. This study is a systematic review and network meta-analysis (NMA) with node-splitting analysis of inconsistency, sensitivity analysis and meta-regression...

Eisenmenger syndrome (ES) is the end stage of pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD), which can occur in patients with large, unrepaired cardiac shunts (ventricular septal defects (VSD), atrial septal defects (ASD), and patent ductus arteriosus (PDA)). Pregnancy in Eisenmenger syndrome is uncommon and is poorly tolerated due to physiological changes that may lead to a risk of rapidly progressive cardiopulmonary decompensation, thrombotic complications, and sudden death...

OBJECTIVE: To perform a longitudinal assessment of B-type natriuretic peptide (BNP) and its association with cardiac function in low-risk pregnant women and in pregnant women with congenital heart disease (CHD). METHODS: Longitudinal study in low-risk pregnancy and pregnancy in women with CHD seen at 10-14, 18-22, and 30-34 weeks of pregnancy for BNP quantification and exercise studies using impedance cardiography (ICG). RESULTS: Forty-three low-risk women with longitudinal samples (129 samples, 43 in each trimester) and 30 pregnant women with CHD with convenience samples (first trimester, five samples; second trimester, 20 samples; third trimester, 21 samples) were included...

BACKGROUND: Monochorionic (MC) twin pregnancies may be complicated by placental pathologies that impact fetal cardiac function, such as twin-twin transfusion syndrome (TTTS) and selective intrauterine growth-restriction (sIUGR). In the TTTS, the unbalanced blood flow through placental anastomoses lead a recipient volume overload, hypertension and hypertrophic cardiomyopathy and the donor twin experiences hypovolemia and hypertension due to increased placental resistance and poor renal perfusion...

BACKGROUND: With the COVID-19 pandemic, there was an increase and scaling up of provider-to-provider telemedicine programs that connect frontline health providers such as nurses and community health workers at primary care clinics with remote doctors at tertiary facilities to facilitate consultations for rural patients. Considering this new trend of increasing use of telemedicine, this study was conducted to generate evidence for patients, health providers, and policymakers to compare if provider-to-provider telemedicine-based care is equivalent to in-person care and is safe and acceptable in terms of diagnostic and treatment standards...

OBJECTIVE: Amniotic fluid embolism (AFE) is a rare life-threatening complication in obstetrics, but the diagnosis lacks a consensual definition. The objective of this study was to compare two different AFE classification systems by analysing the AFE cases from two university hospitals. MATERIAL AND METHODS: In this retrospective study, all patients with a strong suspicion of AFE between 2014 and 2021 at two university hospitals, LMU Women's University Hospital Munich, and Women's University Hospital Basel, were included...

Safe and thoughtful medication management of pregnant patients requiring intensive care unit (ICU) level of care is key to optimizing outcomes for both mother and fetus. Pregnancy induces physiologic alterations that closely mirror the changes expected in a critically ill patient. These changes can be predictable depending on the gestational age and trimester and will directly impact the pharmacokinetic profile of medications commonly used in the ICU; examples include decreased gastric emptying, increased blood and plasma volume, increased glomerular filtration, and increased cardiac output...

OBJECTIVE: Bariatric surgery is a successful treatment for sustainable weight loss and has been associated with improvement in cardiovascular function. Pregnancy after bariatric surgery is becoming increasingly common; however, little is known about the maternal cardiovascular system postsurgery. The aim of this study was to investigate maternal cardiovascular adaptation to pregnancy in women with previous bariatric surgery, compared with that in women with no history of weight-loss surgery and an early-pregnancy body mass index (BMI) similar to the presurgery BMI of the postbariatric women...

We report a case of a 35-year-old pregnant female of Afghan origin who was admitted to the intensive care unit (ICU) because of pulmonary edema development when she was in the 30th week of gestation. During the bedside examination, the transthoracic echocardiogram (TTE) revealed severe mitral valve stenosis and pulmonary hypertension. The patient went into treatment with metoprolol for the control of tachycardia and furosemide for the prevention of fluid overload. During the 32nd week of gestation, the medical council decided on a cesarean section (CS) to be carried out under general anesthesia...

BACKGROUND: A strong body of evidence has now coalesced indicating that some obstetrical syndromes may result from maladaptive responses of the maternal cardiovascular system. Longitudinal studies have shown that these changes are complex and present before the clinical recognition of preeclampsia and fetal growth restriction, suggesting that hemodynamic maladaptation may play an etiologic role in obstetrical complications. Chronic hypertension is one of the most frequent complications of pregnancy, and recent evidence suggests that control of mild hypertension in early pregnancy improves outcome...

OBJECTIVES: Hemodynamics abnormalities and brain development disorders were previously reported in fetuses and children with transposition of the great arteries (TGA) and intact ventricular septum (TGA&IVS). A ventricular septal defect (VSD) is thought to be an additional risk factor for brain development, but literature describing this population is sparse. The objectives of this report were to (1) assess fetal cardiac hemodynamics throughout pregnancy, (2) monitor cerebral hemodynamics and oxygen metabolism in neonates, and (3) compare these data between TGA&IVS, TGA&VSD and age-matched controls...

BACKGROUND: Maternal cardiovascular changes, occurring since the beginning of pregnancy, are necessary for normal placentation and regular evolution of pregnancy. OBJECTIVE: This study aimed to compare the hemodynamic profiles and cardiac remodeling of women with hypertensive disorders of pregnancy and either appropriate for gestational age fetuses or growth-restricted fetuses, women with normotensive pregnancies complicated by fetal growth restriction, and women with uncomplicated pregnancies, during pregnancy and the postpartum period...

BACKGROUND: Preeclampsia (PE), compared to gestational hypertension (GH) has traditionally been considered the worse end of the spectrum of hypertensive disorders in pregnancy. It is associated with worse pregnancy outcomes and future cardiovascular morbidities. Both hypertensive disorders may be associated with cardiac maladaptation in pregnancy. However, previous studies were limited by small numbers, paucity of longitudinal data and unaccounted for the contribution of maternal characteristics that can affect hemodynamics...

OBJECTIVE: To compare the fetal cardiac morphology and functions of the early-onset fetal growth restriction (EO-FGR) and late-onset fetal growth restriction (LO-FGR) groups with gestational weeks-matched controls. METHODS: A total of 164 pregnant women were included, 28 of whom were in the EO FGR, 54 in the LO FGR, and 82 in the control group. Fetal echocardiographic evaluation was performed with two-dimensional (2D), M-mode, and tissue Doppler imaging (TDI) and pulsed wave (PW) Doppler...

OBJECTIVE: To examine the vascular phenotype at 35-37 weeks' gestation in women with gestational diabetes mellitus (GDM) by comparison to those without GDM, with the use of ophthalmic artery Doppler and pulse wave velocity. METHODS: This was a prospective observational study in women attending for a routine hospital visit at 35+0 to 37+6 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, ophthalmic artery Doppler for calculation of the peak systolic velocity (PSV) ratio and pulse wave velocity for assessment of cardiac output, stroke volume, total peripheral resistance, central systolic and diastolic blood pressure, pulse wave velocity and augmentation index...