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Objective: Twin pregnancies are at increased risk of developing hypertensive disorders of pregnancy (HDP) compared with singleton pregnancies, resulting in a substantially higher rate of maternal and perinatal complications. The strain caused by twin pregnancy on the maternal cardiovascular system has not been studied extensively. The objective of this study was to evaluate the changes in maternal cardiac morphology and diastolic function in a cohort of women with normotensive and those with hypertensive twin pregnancies.Methods: This was a cross-sectional study conducted at a tertiary referral university center. Women with singleton or twin pregnancy were enrolled prospectively to undergo maternal transthoracic echocardiography throughout pregnancy. Multiples of the median (MoM) were calculated for each index using a reference group of uncomplicated singleton pregnancies (n = 411) in order to adjust for changes associated with gestational age. Cardiac findings were indexed for body surface area and compared among normotensive twin pregnancies, singleton pregnancies complicated by HDP and twin pregnancies complicated by HDP.Results: The total cohort included 119 HDP singleton pregnancies, 52 normotensive twin pregnancies and 24 HDP twin pregnancies. Left ventricular mass index (LVMi) MoM (median (interquartile range)) did not differ between singleton pregnancies complicated by HDP and normotensive twin pregnancies, but was significantly higher in HDP twin compared with HDP singleton pregnancies (1.31 (1.08-1.53) vs 1.17 (0.98-1.35), P = 0.032). Two diastolic indices, left atrial volume index MoM (1.12 (0.66-1.38) vs 0.65 (0.55-0.84), P = 0.003) and E/e' MoM (1.29 (1.09-1.54) vs 0.99 (0.99-1.02), P = 0.036), were significantly higher in HDP twin compared with normotensive twin pregnancies. In normotensive twin compared with HDP singleton pregnancies, stroke volume index (SVi) MoM was higher (1.20 (1.03-1.36) vs 1.00 (0.81-1.15), P = 0.004) and total vascular resistance index (TVRi) was lower (0.73 (0.70-0.86) vs 1.29 (1.04-1.56), P < 0.0001). In contrast, SVi MoM was lower (1.10 (1.02-1.35) vs 1.20 (1.03-1.36), P = 0.018) and TVRi was higher (1.00 (0.88-1.31) vs 0.73 (0.70-0.86), P = 0.029) in HDP twin compared with normotensive twin pregnancies.Conclusion: The maternal cardiovascular system is altered severely in twin pregnancy with or without HDP. Despite the low total vascular resistance, cardiac changes in normotensive twin pregnancies are comparable to those seen in singleton pregnancies complicated by HDP, reflecting the high cardiovascular demand imposed by twin pregnancy. © 2022 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To investigate the relationship between uterine artery Doppler ultrasound indices and birth weight in women with early-, intermediate- and late-onset pre-eclampsia as compared with women with uneventful pregnancy outcome. Methods In a retrospective, observational cohort study, uterine artery Doppler assessment was carried out at 18 + 0 to 23 + 6 weeks' gestation in 26 893 women attending for routine antenatal care in a tertiary care center. The mean resistance index ( RI) and its relationship to the outcome of pregnancy and birth-weight centiles were evaluated. Results Uterine artery RI showed a significant, negative correlation with birth weight ( r = −0.20, P < 0.0001). Patients with early-onset pre-eclampsia had an increased prevalence of high uterine artery mean RI, above the 90th centile, corresponding to an increased proportion of small-for-gestational age ( SGA) neonates with a birth weight below the 10th centile. In late-onset pre-eclampsia, however, there was an unexpectedly higher proportion of large-for-gestational-age ( LGA) neonates with a birth weight above the 90th centile without a concurrent increase in the prevalence of low uterine artery mean RI below the 10th centile. Conclusions The finding of a bimodal skewed distribution of birth weight, with neonates exhibiting a higher prevalence of both LGA and SGA with late-onset pre-eclampsia, indicates that there are two types of late-onset pre-eclampsia. These findings explain the poor performance of mid-trimester uterine artery Doppler in predicting pre-eclampsia at term and provide insights into the placental origins of the early and late forms of pre-eclampsia. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd [ABSTRACT FROM AUTHOR]

Objective Pre-eclampsia ( PE) is associated with maternal cardiac remodelling and biventricular diastolic dysfunction. Preterm PE alone can also be associated with severe left ventricular hypertrophy and biventricular systolic dysfunction. The aim of this study was to assess whether the maternal cardiovascular profile at mid-gestation in nulliparous normotensive women differs in women destined to develop preterm PE versus those who will develop PE at term. Design Prospective study. Setting Tertiary referral university centre. Population A total of 269 women, including 152 at increased risk of developing PE as determined by mid-gestational uterine artery Doppler assessment. Methods Women underwent blood pressure profiling, echocardio-graphy, cardiac tissue Doppler and strain rate analysis at 20-23 weeks of gestation. Main outcome measures Mid-gestational cardiovascular profile in women with normal pregnancy and those that subsequently developed preterm or term PE. Results Pre-eclampsia subsequently developed in 46 women, including 18 with preterm PE. Women who subsequently developed PE, irrespective of gestation, had evidence of left ventricular concentric remodelling (33%) which was not found in the control women ( P < 0.0001). Only women who developed preterm PE exhibited a high resistance-low volume haemodynamic state at mid-gestation. The latter group also had evidence of left ventricular diastolic or systolic dysfunction (33%) and segmental impaired myocardial relaxation (72%). Conclusions Asymptomatic cardiac diastolic dysfunction is evident at mid-gestation in women who subsequently develop preterm PE but not in those who develop term PE. These cardiac findings are useful in understanding the pathophysiology of PE and corroborate the concept that PE is not a single disorder, but a cluster of symptoms that have several different aetiologies. [ABSTRACT FROM AUTHOR]

Objectives To compare the prevalence of previously undiagnosed cardiac structural abnormalities in pregnant women with normal- and high-resistance midtrimester uterine artery Doppler indices. Methods Maternal transthoracic echocardiography was undertaken in asymptomatic pregnant women after uterine artery Doppler screening for pre-eclampsia at 21-23 weeks' gestation. Women with a mean uterine artery pulsatility index above the 90th centile (1.25) for the local population (multiethnic, socially diverse and migrant) were considered to have high-resistance uteroplacental blood flow indices. The prevalence of newly diagnosed cardiac structural defects in these women was recorded. Results A total of 491 women underwent echocardiography, of whom 205 had high-resistance uterine artery blood flow indices. There were nine previously undiagnosed, functionally significant cardiac defects in the high-resistance uterine artery blood flow group and only one, functionally insignificant cardiac defect in the normal-resistance group (P = 0.005; relative risk = 12.6, 95% confidence interval, 1.60-98.34). Multiple regression analysis demonstrated that both uterine artery Doppler indices (P = 0.024) and ethnicity (P = 0.048) contributed independently towards a higher prevalence of cardiac defects. Conclusions The prevalence of previously undiagnosed maternal cardiac structural abnormalities is significantly increased in women with high midtrimester uterine artery Doppler resistance indices. This observation has important consequences for the current and longterm medical care provided to these patients. Detailed maternal cardiac assessment with echocardiography may be required in migrant women with high uterine artery Doppler indices. [ABSTRACT FROM AUTHOR]

The article presents a study which assesses the relationship between first trimester uterine artery Doppler ultrasound measurements and the development of term and preterm pre-eclampsia. The uterine artery Doppler data in the study indicate that preterm pre-eclampsia in strongly associated with defective invasion of the spiral arteries, in contrast to the findings in term pre-eclampsia which may be a consequence of placental deterioration at pregnancy term.

A letter to the editor is presented in response to the article "Maternal obesity and excess of fetal growth in preeclampsia," by S. Rasmussen and colleagues in the 2014 issue.

An abstract of the article "Maternal cardiovascular adaptation to pregnancy: Novel insights into the pathophysiology of late-onset pre-eclampsia" by K. Melchiorre and others is presented.

An abstract of the article "Impaired mid-gestational maternal cardiac function and left ventricular remodeling in women who subsequently develop preterm but not term preeclampsia," by K. Melchiorre and colleagues is presented.

An abstract of the article "Preeclampsia predisposes to persistent long-term postpartum left ventricular myocardial injury," by K. Melchiorre and colleagues is presented.

An abstract of the conference paper "Maternal cardiac systolic and diastolic function in term pre-eclampsia," by K. Melchiorre and colleagues is presented.

An abstract of the conference paper "Abnormal maternal cardiac diastolic function in pregnancies complicated by early-onset severe pre-eclampsia," by K. Melchiorre, and colleagues is presented.

An abstract of the conference paper "Depressed maternal cardiac longitudinal systolic function in pregnancies complicated by early-onset severe pre-eclampsia" by K. Melchiorre and colleagues is presented.