10.25419/RCSI.10802309.V1
Cathy Monteith
The assessment of maternal haemodynamic profile via transthoracic bioreactance as a screening tool for the early prediction of preeclampsia (PE) and normotensive fetal growth restriction (FGR).
<p>Preeclampsia (PE) and Fetal Growth Restriction (FGR) are common complications of pregnancy. Data presented in this thesis, which mainly originate from the single centre prospective <strong>HAEMODYNAMIC A</strong>ssessment i<strong>N </strong>pregnancy an<strong>D </strong>neonata<strong>L E</strong>chocardiography assessment (HANDLE) study, consolidate knowledge of the haemodynamics of normal pregnancy and the changes and predictive capability in those affected by PE & FGR.</p>
<p>The HANDLE study recruited 422 low risk nulliparous women at their first antenatal visit. Following exclusion and patient self-withdrawal a total of 366 women completed the study; 1.6% (n=6) had a pregnancy complicated by PE; 4.9% (n=18) by gestational hypertension (GH) and 6.6% (n=24) by FGR.</p>
<p>The objective of the primary analyses of this study was to assess the haemodynamics of pregnancy and the postpartum using NICOM® and the ability of these profiles to predict disease states. Presented in this thesis I have detailed four different haemodynamic profiles in pregnancy. In pregnancies complicated by preeclampsia, HR and SVi when combined with BP became statistically significant predictors at 14 weeks’ gestation (AUC=0.75, p=0.01 and AUC=0.77, p=0.009 respectively). In the postpartum, comparison between non-pregnant controls and those with GH demonstrated persistence of elevated DBP (p=0.01), TPRi (p=0.01) and lower SVi (p=0.03).</p>
<p>Secondary analyses were to validate the use of NICOM® in the obstetric population and correlation of biomarkers to haemodynamic variables. In keeping with findings in the adult and neonatal population I have shown that NICOM® is an acceptable alternative method of CO measurement in pregnant women. Evaluation of the biomarkers and haemodynamics at 14 weeks’ showed a weak positive correlation between Apelin 13 and SV (r=0.29; p=0.005) and a weak inverse correlation with TPRi (r=-0.29; p=0.004).</p>
<p>In conclusion, uteroplacental disease is a multifactorial complication of pregnancy. This thesis further highlights the need for the development of prediction models especially in the case of FGR.</p>
Uncategorized
Royal College of Surgeons in Ireland
2019
2019-11-23
2019-11-23
Thesis
21342954 Bytes
10.25419/rcsi.10802309
CC BY-NC-SA 4.0