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Objective Most studies during pregnancy have assessed maternal left ventricular (LV) function by load-dependent indices, assessing only chamber function. The aim of this study was to assess afterload-adjusted LV myocardial and chamber systolic function at 24 weeks’ gestation and 6 months postpartum in high-risk normotensive pregnant women. Methods A group of 118 high-risk women with bilateral notching of the uterine arteries underwent an echocardiographic examination to evaluate midwall mechanics (midwall shortening (mFS%) and stress-corrected midwall shortening (SCmFS%)) of the LV at 24 weeks’ gestation and 6 months postpartum. Patients were followed until delivery and pregnancies were classified retrospectively as uneventful (uncomplicated outcome) or complicated. A control group of 54 low-risk women with uneventful pregnancies without bilateral notching was also enrolled. Results The pregnancy was uneventful in 74 (62.7%) women, whereas 44 (37.3%) developed complications. At 24 weeks’ gestation, mFS% and SCmFS% were greater in the uncomplicated-outcome compared with the complicated-outcome group (25.9 ± 4.8 vs 18.8 ± 5.0%, P < 0.001 and 107.9 ± 18.4 vs 77.9 ± 20.7%, P < 0.001 , respectively). At 6 months postpartum, SCmFS% remained greater in the uncomplicated-outcome compared with the complicated-outcome group (100.4 ± 21.6 vs 87.8 ± 19.1, P < 0.05 ). In the uncomplicated outcome group, SCmFS% was higher during pregnancy than it was postpartum, whereas in the complicated outcome group, it was lower during pregnancy than it was postpartum ( P < 0.05 ). Conclusions Maternal cardiac midwall mechanics appear to be enhanced (SCmFS% increased compared with controls) during pregnancy compared with postpartum in high-risk patients with uncomplicated pregnancy, whereas midwall mechanics are depressed both during pregnancy and postpartum in patients with pregnancy complications [ABSTRACT FROM AUTHOR]

Introduction Maternal cardiovascular system adapts to pregnancy thanks to complex physiological mechanisms that involve cardiac output, total vascular resistance (TVR) and water body distribution. Abnormalities of this adaptive mechanism are connected with hypertensive disorders and foetal growth restriction. Moreover, maternal serum PAPP-A is considered a biochemical marker extensively used for the first trimester screening of PE. Objective To identify patients at high risk of developing hypertensive complications of pregnancy during the first trimester through the use of non-invasive methods such as USCOM (Ultrasonic Cardiac Output Monitor), bioimpedance and biochemical marker. Materials and Methods We enrolled 96 healthy normotensive women with normal Body Mass Index during the first trimester of pregnancy (from 11 + 0 to 13 + 6 weeks of gestation) obtaining all measurements with the USCOM system, Bioimpedance and collecting MoM values of PAPP-A Results Patients were divided into two groups: Group A ( n = 54) with TVR < 1200 dynes.sec.cm-5, Group B ( n = 42) with TVR >1200 dynes sec cm −5 . 10% ( n = 10) of our study population developed pregnancy complications as IUGR and hypertensive disorders. In this group 81% of patients presented high TVR values and 37% PAPP-A<0.4 MoM. Higher values of the Cardiac Output and Stroke Volume have been highlighted in the group A ( p < 0.05). No statistically significant difference was identified in terms of water distribution, mean arterial pressure (MAP), heart rate, inotropy index and flow time corrected between the two groups (Table 1). Moreover, as shown in Table 2, we found a statistically significant lower Fat Mass percentage in complicated pregnancies with higher TVR values with respect uncomplicated pregnancies in Group B (23% vs 26% of Fat Mass). Conclusions High TVR and lower Fat Mass during the first weeks of gestation may be an early marker of cardiovascular maladaptation more than the evaluation of PAPP-A values and blood pressure assessment. [ABSTRACT FROM AUTHOR]

Objectives Therapy with nitric oxide (NO) donors in addition with plasma volume expansion in pregnancy complicated by fetal growth restriction (FGR) could improve pregnancy outcome. Aim of our study was to identify a good marker showing the improvement in fetal growth and maternal hemodynamics. Methods A prospective case-control study was conducted. We followed 40 women with singleton pregnancy between 28 and 30 weeks of gestation with diagnosis of FGR (abdominal circumference CA < 5°pc) and Systemic Vascular Resistance (SVR) > 1200 dynes.sec.cm-5, divided in two groups: Group A, treated with transdermal patches of NO donors (5 mg/24 h) and oral fluids (2–3 lt) and Group B treated with oral fluids only. We evaluated SVR, cardiac output (CO), inotropy index (INO) and the trend of abdominal circumference percentile at the diagnosis, after 2 and 4 weeks of treatment. We obtained the hemodynamic measurements with the USCOM system. Results Group A showed an increase in CO (+14% after 2 weeks and +8% after 4 weeks), an increase in INO (+29% and +2%) and a decrease in SVR (−12% and −9%). A significant improvement in abdominal circumference percentile was shown (increase of 44% after 2 weeks and 33% after 4 weeks). Group B showed a small increase in SVR (+1% after 2 weeks and +2% after 4 weeks), stable values of INO and CO (−4% and +5% for INO and −1% and +1% for CO), and a reduction in CA percentile (−16% and −18%). Conclusions CO, SVR and INO showed an improvement consonant with the trend of abdominal circumference percentile; they could be a good method to evaluate the prolongation of gestation and the increase in fetal growth. Disclosures G. Gagliardi: None. D. Lo Presti: None. G. Tiralongo: None. I. Pisani: None. R. Scala: None. G. Novelli: None. B. Vasapollo: None. H. Valensise: None. [ABSTRACT FROM AUTHOR]

Introduction: In pregnancy there is an increase in maternal cardiac output (CO) and a reduction in total vascular resistance (TVR). Abnormalities of this adaptive mechanisms lead to numerous disorders of pregnancy. Moreover the mother’s body water composition undergoes important modifications in total body water (TBW), extracellular and intracellular body water (EBW, IBW). Objectives: Aim of the study is to identify a group of patients at high risk of developing hypertensive complications of pregnancy in frist trimester. Method: To investigate hemodynamic changes and distribution of body water during the frist trimester of pregnancy, we conducted an observational study. We evaluated CO, TVR and Time Flow Corrected (TFc) with the USCOM system, a non invasive method. Patients were, also, subjected to BIA (Body Impedance Assessment). Results: We enrolled 120 healthy pregnant women. 20 patients, were excluded for bad signal. Absolute values of haemodynamic and body impedance measures are shown in Fig. 1. Patients were divided in two groups:Group A with TVR>1200 dyne and Group B with TVR<1200 dyne. CO values were higher in group B. There wasn’t significant differences in TBW, haematocrit, TFc and WBI (water balance index: TBW/Hct) between the two groups. Conclusion: Our results show that at costant values of TBW, Hct and WBI,we can find difference in term of TVR and CO in the first trimester of pregnancy. These parameters may improve the accuracy of screening in clinical practice.▪ [Copyright &y& Elsevier]

Introduction: From early pregnancy, maternal hemodynamic profile begins to change. The absence of these changes leads to increased risk of complication during the gestation. Objectives: Aim of this study is to understand in early pregnancy the behaviour of total vascular resistances (TVR) as a sign of maternal cardiovascular adaptation to pregnancy. Method: A cross section study was conducted. We followed 160 healthy women with singleton pregnancy during the first trimester of gestation. We evaluated cardiac output (CO) and TVR at 7, 9 and 11 weeks of gestation. We obtained the following haemodynamic measurements with the USCOM system, a non invasive method: heart rate (HR), systolic and diastolic blood pressure (SBP, DBP), CO and TVR. Results: 160 healthy pregnant women were selected, 8 patients, were excluded for a bad signal. Absolute values of the haemodynamic measures are shown in Fig. 1.▪ 41 patients underwent spontaneous embryonic demise. This last group of patients showed in 54% (group A) TVR values within the normal limits (TVR<1200), while 46% patients (group B) showed TVR values well above the normal limits (TVR>1200) and CO values below the normal adaptation to pregnancy. Table 1 shows hemodynamic measures for the group A and group B; we found differences in term of CO, TVR and PAS between the two groups. Conclusion: Elevated TVR might indicate an abnormal vascular adaptation already in first weeks of pregnancy. Moreover, in women who undergo to abortion, elevated TVR could be use to distinguish genetic or environmental causes of miscarriage. [Copyright &y& Elsevier]