Maternal cardiovascular function and risk of intrapartum fetal compromise in women undergoing induction of labor: pilot study (2025)

Maternal cardiac output in early labour: a possible link with obstetrics risks?

Ultrasound in Obstetrics & Gynecology, 2017

Objective To determine if hemodynamic assessment in 'low-risk' pregnant women at term with an appropriate-for-gestational age (AGA) fetus can improve the identification of patients who will suffer maternal or fetal/neonatal complications during labor. Methods This was a prospective observational study of 77 women with low-risk term pregnancy and AGA fetus, in the early stages of labor. Hemodynamic indices were obtained using the UltraSonic Cardiac Output Monitor (USCOM ®) system. Patients were followed until the end of labor to identify fetal/neonatal and maternal outcomes, and those which developed complications of labor were compared with those delivering without complications. Results Eleven (14.3%) patients had a complication during labor: in seven there was fetal distress and in four there were maternal complications (postpartum hemorrhage and/or uterine atony). Patients who developed complications during labor had lower cardiac output (5.6 ± 1.0 vs 6.7 ± 1.3 L/min, P = 0.01) and cardiac index (3.1 ± 0.6 vs 3.5 ± 0.7 L/min/m 2 , P = 0.04), and higher total vascular resistance (1195.3 ± 205.3 vs 1017.8 ± 225.6 dynes × s/cm 5 , P = 0.017) early in labor, compared with those who did not develop complications. Receiver-operating characteristics curve analysis to determine cutoffs showed cardiac output ≤ 5.8 L/min (sensitivity, 81.8%; specificity, 69.7%), cardiac index ≤ 2.9 L/min/m 2 (sensitivity, 63.6%; specificity, 76.9%) and total vascular resistance > 1069 dynes × s/cm 5 (sensitivity, 81.8%; specificity, 63.6%) to best predict maternal or fetal/neonatal complications. Conclusions The study of maternal cardiovascular adaptation at the end of pregnancy could help to identify low-risk patients who may develop complications during

Preterm delivery and elevated maternal total vascular resistances (a prelude to the future maternal cardiovascular risk?)

Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2016

The purpose of our study was to evaluate the maternal hemodynamic profile in women with diagnosis of threatened preterm delivery (TPD) in order to understand the possible pathophysiologic mechanism leading to an increased lifetime risk for future cardiovascular disease. 68 patients with diagnosis of TPD were enrolled and assessed through non-invasive method (USCOM(®) ) for the determination of hemodynamic parameters. Cervix length assessment, vaginal and rectal swabs, blood inflammatory indexes, foetal vessel Doppler velocimetry, gestational age at the time of delivery and neonatal outcomes were also considered. The population was divided into two groups according to total vascular resistance (TVR) in Group A ≤ 1000 dynes.sec.cm(-5) , and Group B > 1000 dynes.sec.cm(-5) . C-reactive protein (CRP) was higher in Group B vs. Group A, suggesting a systemic inflammation status. Group B delivered earlier (32 weeks + 4 days vs 38 weeks + 2 days, p <0.01), and neonatal outcome was wor...

Comparative Analysis of Neonatal Effects in Pregnant Women with Cardiovascular Risk versus Low-Risk Pregnant Women

Journal of Clinical Medicine

Background: Cardiovascular diseases are a leading cause of mortality and morbidity worldwide. Pregnancy imposes unique physiological changes on a woman’s cardiovascular system. Materials and Methods: A cohort of 68 participants, comprising 30 pregnant women with cardiovascular risk and 38 without cardiovascular risk, was recruited for this study. These participants were prospectively followed during their pregnancies from 2020 to 2022 at the Obstetrics and Gynecology Department of the “Pius Brînzeu” Emergency County Clinical Hospital in Timişoara, Romania. All women included in this study underwent cesarean section deliveries at the same medical facility. Data regarding the gestational weeks at delivery, birth weight, and Apgar scores assessed by neonatologists were collected for each participant. Statistical analyses were performed to compare the neonatal effects between the two groups. Results: The results of this study revealed significant differences between the groups in terms ...

Pregnancy and Cardiovascular Disease

The cardiovascular system undergoes significant changes during pregnancy to adapt to and accommodate the increased metabolic demands of the fetus and the mother. 1-5 These adaptations produce an important hemodynamic burden on patients with underlying heart disease, and confer an increase in morbidity and mortality. Furthermore, pregnancy may cause specific cardiovascular disorders, which can impose a risk to the pregnant woman and to her fetus. It is estimated that in the western world 0.2-4% of all pregnancies are complicated by cardiovascular diseases (CVD). 4 This risk is in the ascending order as the age of first pregnancy is increasing and as the number of cardiovascular risk factors is rising (e.g. smoking, hypercholesterolemia, diabetes, hypertension, obesity). During pregnancy, the most frequent cardiovascular events relate to hypertension (6-8%). On the other hand, in the western world, the most frequent CVD present during pregnancy is congenital heart disease-CHD (circa 75%), 4,6,7 while rheumatic heart disease predominates in the other countries (circa 70%) and CHD is seen in ~15%. In pregnant women with heart disease, maternal death is estimated around 1% but it varies depending on the underlying CVD; neonatal complications occur in 20-28% and neonatal mortality ranges between 1% and 4%. In general, CVDs are the most common cause of maternal death during pregnancy in the Western industrialized world. 4 Thus, women of child-bearing age with CVD or cardiovascular risk factors should be counseled and managed early by an interdisciplinary team of gynecologists, cardiologists, and, when necessary, cardiothoracic surgeons. To meet the metabolic demands of mother and fetus, cardiac output increases 1 L/min at 8 weeks' gestation, representing >50% of the total change seen, which culminates in an increase of cardiac output of 30-50% during normal pregnancy, maintained until term. 9,10 Cardiac output increases primarily because of stroke volume rather than heart rate, at least in early pregnancy, while later the heart rate also increases. By 8 weeks' gestation, systemic vascular resistance has fallen to 70% of its preconceptional value. The majority of the pregnancy-induced changes in these parameters occur during the embryonic period. Plasma volume has increased by ~40% at 24 weeks of gestation. Blood pressure falls mainly due to vasodilation, primarily conferred by nitric oxide and relaxin, affecting both systolic and diastolic components. In the third trimester, diastolic pressure gradually rises and may normalize to baseline values at term. Another important aspect of the cardiovascular status in pregnancy relates to hemostatic changes, which lead to hypercoagulability via an increase in concentration of coagulation factors, fibrinogen, and

Quantification of Posterior Risk Related to Intrapartum FIGO 2015 Criteria for Cardiotocography in the Second Stage of Labor

Fetal Diagnosis and Therapy

Introduction: Intrapartum cardiotocography (CTG) was used for several decades to detect a stressed fetus so that delivery can be expedited to prevent birth asphyxia. The main aim of the study was to calculate the risk of neonatal acidemia (pH ≤ 7.10) according to duration of the 2nd stage of labor and occurrence of the International Federation of Gynecology and Obstetrics (FIGO) 2015 CTG classification parameters. Materials and Methods: This was a retrospective case-control study on 552 pregnancies receiving continuous CTG monitoring in labor and immediate hemogasanalysis at birth. Cases with umbilical artery (UA) pH ≤ 7.10 and controls with UA pH ≥ 7.10 were matched for parity and gestational age at delivery, with ratio 1:5. Logistic regression analysis, adjusted for the expected risk in the general population, was used to calculate the baseline risk of UA pH ≤ 7.10 in the absence of any CTG pathological feature and those associated with pathological CTG patterns occurring in the 2...

The Incidence of Maternal Artefact During Intrapartum Fetal Heart Rate Monitoring

Journal of obstetrics and gynaecology Canada, 2014

Objective: To determine the incidence of maternal heart rate artefact (MHRA) when monitoring fetal heart rate (FHR) in labour and to determine obstetrical factors associated with MHRA. Methods: In a prospective observational study, maternal and fetal heart rates were displayed simultaneously to document the superimposition of the maternal heart rate (MHR) on FHR tracings. All women in labour who were undergoing external fetal monitoring (EFM) at the Ottawa Hospital from October 2011 to March 2012 were eligible. Every episode of MHRA was documented and classified according to its clinical significance. Wilcoxon test, t tests, and chi-square tests were used to identify time-related differences and obstetrical factors (epidural analgesia, fetal presentation, multiple gestation, maternal BMI, umbilical cord arterial pH, five-minute Apgar scores) that were associated with a potential adverse outcome. Results: We assessed 1313 tracings with simultaneous displays of the MHR and FHR in labour. MHRA was present at least once in 721 tracings (55%). Of these tracings, 35 were classified as having one or more episodes that might have led to an adverse outcome (either false positive or false negative), giving an incidence of 2 .7% of all women in labour. In 33 tracings, the MHRA masked an abnormal FHR tracing. In two tracings, the MHRA masked a normal FHR, which might have resulted in misinterpretation of the tracing (i .e ., false positive), leading to unnecessary intervention. Conclusion: The incidence of MHRA is higher than currently thought, and in more than 2% of women in labour may lead to adverse outcomes. We propose routine use of simultaneous maternal and FHR monitoring for women undergoing EFM, especially during the second stage of labour .

Evaluation of fetomaternal outcome in pregnancies complicated by heart disease: our experience at a tertiary care centre

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016

Background: Heart disease is an important cause of indirect maternal deaths accounting for 20% of all cases, complicating approximately 1% of all pregnancies. During pregnancy, increased cardiac demands potentially increase morbidity and mortality in women with underlying heart disease. This study illustrates the fetomaternal outcome in pregnancies complicated by heart disease. Methods: This study is a prospective observational study which was carried out from December 2013 to August 2015 at a tertiary care teaching hospital of armed forces India. A total of forty four pregnant women with heart disease were attended during the study period. Various parameters were used to measure maternal outcome like preterm labour, cesarean delivery, congestive cardiac failure, maternal mortality, while fetal outcome was measured in terms of low birth weight, prematurity, intrauterine growth restriction, perinatal mortality and intrauterine death. Results: A total of 7545 pregnant women delivered during the study period, of which 94 were patients with heart disease giving a prevalence of 1.2%. Acquired valvular heart lesions were found in 61 patients (64.9%) with mitral valve being the commonest valve affected in 69 patients (73.4%), others were congenital. Of the group, 89 patients were in NYHA class I and 05 in NYHA class II. Majority, 44 patients (46.8%) delivered vaginally while 31 patients (33%) underwent a cesarean delivery and 30 babies (31.9%) were low birth weight. There was no neonatal mortality. Maternal mortality was low (1.1%), while 43 (45.7%) had obstetric complications. Conclusions: Multidisciplinary team approach involving obstetrician, neonatologist, cardiologist and anesthesiologist led to the favorable outcome in our study. Key determinant of adverse fetomaternal outcome was the poor functional class of NYHA.

An association between preterm delivery and long-term maternal cardiovascular morbidity

American Journal of Obstetrics and Gynecology, 2013

The purpose of this study was to investigate whether a history of preterm delivery (PTD) poses a risk for subsequent maternal long-term cardiovascular morbidity. STUDY DESIGN: A population-based study compared the incidence of cardiovascular morbidity in a cohort of women who delivered preterm (<37 weeks' gestation) and those who gave birth at term at the same period. Deliveries occurred during the years 1988-1999 with follow up until 2010. Kaplan-Meier survival curves were used to estimate cumulative incidence of cardiovascular hospitalizations. Cox proportional hazards models were used to estimate the adjusted hazard ratios for cardiovascular hospitalizations. RESULTS: During the study period 47,908 women met the inclusion criteria; 12.5% of the patients (n ¼ 5992) delivered preterm. During a follow-up period of >10 years, patients with PTD had higher rates of simple and complex cardiovascular events and higher rates of total cardiovascular-related hospitalizations. A linear association was found between the number of previous PTD and future risk for cardiovascular hospitalizations (5.5% for !2 PTDs; 5.0% for 1 PTD vs 3.5% in the comparison group; P < .001). The association remained significant for spontaneous vs induced PTD and for early (<34 weeks) and late (34 weeks to 36 weeks 6 days' gestation) PTD. In a Cox proportional hazards model that adjusted for pregnancy confounders such as labor induction, diabetes mellitus, preeclampsia, and obesity, PTD was associated independently with cardiovascular hospitalizations (adjusted hazard ratio, 1.4; 95% confidence interval, 1.2e1.6). CONCLUSION: PTD is an independent risk factor for long-term cardiovascular morbidity in a follow-up period of more than a decade.

Cardiovascular Changes During Pregnancy, Labour and Puerperium

Background & Objectives: Maternal physiology undergoes many changes during pregnancy which are largely secondary to the effects of progesterone and estrogen which are produced predominantly by the ovary in the first 12 weeks of pregnancy and thereafter, produced by the placenta. These changes enable the fetus and placenta to grow and prepare the mother and baby for childbirth. Materials & Methods: This is a longitudinal study conducted among 30 female subjects in age group 18 to 30 years. Heart rate, Blood pressure (SBP, DBP, and MABP) was measured. SV and CO were calculated using Echocardiography. Results: In our study, we observed an increase in heart rate, SBP, SV and CO with a decrease in hematocrit during the three trimesters of pregnancy. Conclusion: We observed a gradual increase in SBP with a peak value during labour and also found an increase in SBP in puerperium. The DBP and mean arterial BP decreased to maximum during second trimester and an increase in DBP and mean arterial BP was observed from labour till day 1 of puerperium.DBP decreased during first and second week of puerperium with a slight increase in mean arterial BP. SV and CO gradually increased and reached a maximum during labour and continued to increase during puerperium. Summary: The cardiovascular physiological adaptations of pregnancy represent an efficient oxygen carrying capacity state which delivers adequate oxygen and nutrients for both the mother and fetus. Cardiovascular disorders remain an important cause of maternal morbidity and mortality and of adverse fetal outcomes. Hypertensive disorders account for a significant proportion of this group of pregnancy-associated complications. Understanding the normal cardiovascular changes in pregnancy is essential to caring for patients with cardiovascular disease.

Serial noninvasive evaluation of cardiovascular hemodynamics during pregnancy

American journal of …, 1987

M-mode echocardiography, in combination with electrocardiography and phonocardiography, has been used to measure pulmonary capillary pressure as well as other cardiac functions. Serial hemodynamic evaluations by use of this technique were performed in seven healthy pregnant women in the recumbent position. Each patient had five studies: four antenatal studies and one postpartum study that served as a control. Mean pulmonary capillary pressure was within normal limits throughout pregnancy and the puerperium. Cardiac output did not increase significantly by the end of the first or second trimester but became elevated by 31 % in the early third trimester. This elevation in cardiac output persisted until delivery and resulted from a comparable increase in heart rate. Stroke volume and ejection fraction did not change significantly, while peripheral vascular resistance fell, although not significantly, reaching a nadir at approximately 28 weeks of gestation. Our findings indicate that maternal cardiac output increases due to an increased heart rate and reduced afterload.