Characteristics of changes in fetal doppler blood flow parameters in women with gestational hypertension at different stages of pregnancy

Authors

DOI:

https://doi.org/10.18370/2309-4117.2023.68.66-69

Keywords:

gestational hypertension, pregnant women, blood pressure, ultrasound examination, Doppler indices

Abstract

Research objectives: to determine the resistance index, pulsatile index and systolic-diastolic ratio in the fetal middle cerebral artery, fetal aorta and umbilical artery in women with gestational hypertension (GH).
Materials and methods. The main group included 50 pregnant women with GH, the control group included 50 healthy pregnant women. Blood pressure level and ultrasound dopplerometric indicators of fetal blood flow were determined at the 20th, 25th, 30th, 35th, and 40th weeks of pregnancy.
Results. Changes in Doppler blood flow indicators in the umbilical artery in women of the main group were observed earlier than changes in these indicators in the fetal aorta, namely from the 30th week of pregnancy: the resistance index was 0.46 ± 0.08, the pulsatility index was 0.8 ± 0.23, the systolic-diastolic ratio was 2 ± 0.19, and in women of the control group these indicators were 0.69 ± 0.17, 1.46 ± 0.21 and 3 ± 0.33, respectively.
At the 35th week of pregnancy, the trend towards a decrease in dopplerometric indicators of blood flow in the umbilical artery in women of the main group continued, the value of these indicators was: resistance index – 0.42 ± 0.09, pulsatility index – 0.68 ± 0.23, systolic diastolic ratio – 1.8 ± 0.16, and in women of the control group these indicators were 0.68 ± 0.13, 1.43 ± 0.11 and 2.94 ± 0.24, respectively.
The lowest Doppler parameters of blood flow in the umbilical artery in women of the main group were at 40th week: resistance index – 0.37 ± 0.07, pulsatility index – 0.63 ± 0.21, systolic-diastolic ratio – 1.6 ± 0.13, and in women of the control group these indicators were 0.67 ± 0.11, 1.4 ± 0.1, and 2.87 ± 0.21, respectively.
Conclusions. Blood flow indicators in the aorta and umbilical arteries, as well as in the middle cerebral artery of the fetus in women with GH differ from such indicators in healthy women. Decreased blood flow may indicate a risk of hypoxia and neurological problems for fetus. Therefore, it is important to diagnose GH in time and monitor fetal blood flow indicators using ultrasound to prevent possible complications and preserve the fetus and mother health.

Author Biographies

Vol. V. Podolskyi, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”, Kyiv

MD, chief researcher, head of the Department of Health Problems of Fertile Aged Women

V.V. Podolskyi, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”, Kyiv

MD, professor, deputy director, chief of the Department of health problems of fertile aged women

V.M. Znak, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”, Kyiv

Doctorate student, Department of Health Problems of Fertile Aged Women,

References

  1. American College of Obstetricians and Gynecologists. “Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy.” Obstet Gynecol 122.5 (2013): 1122–31. DOI: 10.1097/01.AOG.0000437382.03963.88
  2. Antwi, E., Amoakoh-Coleman, M., Vieira, D.L., et al. “Systematic review of prediction models for gestational hypertension and preeclampsia.” PLoS One 15.4 (2020): e0230955. DOI: 10.1371/journal.pone.0230955. PMID: 32315307; PMCID: PMC7173928.
  3. Leffert, L., Prodan, C.I., Peters, N. “Gestational Hypertension: The Pregnancy Stress Test for Cognitive Impairment.” Neurology 96.5 (2021): 193–4. DOI: 10.1212/WNL.0000000000011364. PMID: 33380499.
  4. Henderson, I., Quenby, S. “Gestational hypertension and childhood atopy: a Millennium Cohort Study analysis.” Eur J Pediatr 180.8 (2021): 2419–27. DOI: 10.1007/s00431-021-04012-3. PMID: 33770273; PMCID: PMC8285347.
  5. Wisner, K. “Gestational Hypertension and Preeclampsia.” MCN Am J Matern Child Nurs 44.3 (2019): 170. DOI: 10.1097/NMC.0000000000000523. PMID: 31033586.
  6. Clark, S.L., Saade, G.A., Tolcher, M.C., et al. “Gestational hypertension and “severe” disease: time for a change.” Am J Obstet Gynecol 228.5 (2023): 547–52. DOI: 10.1016/j.ajog.2022.11.1280. PMID: 36396107.
  7. Pollock, J.D., Murray, I.V., Bordes, S.J., et al. Physiology, Cardiovascular Hemodynamics. StatPearls. Treasure Island (FL): StatPearls Publishing (2023).
  8. Su, X., Liu, Y., Li, G., et al. “Associations of Hypothyroxinemia With Risk of Preeclampsia-Eclampsia and Gestational Hypertension.” Front Endocrinol (Lausanne) 12 (2021): 777152. DOI: 10.3389/fendo.2021.777152. PMID: 34803932; PMCID: PMC8600315.
  9. Ngene, N.C., Daef, G. “Transient gestational hypertension and pre-eclampsia: Two case reports and literature review on the need for stringent monitoring.” S Afr Fam Pract 63.1 (2004): e1-e6. DOI: 10.4102/safp.v63i1.5236. PMID:33764141; PMCID: PMC8377990.
  10. Gyselaers, W. “Hemodynamic pathways of gestational hypertension and preeclampsia.” Am J Obst Gynecol 226.2S (2022): S988–S1005. DOI: 10.1016/j.ajog.2021.11.022
  11. Tsakiridis, I., Giouleka, S., Arvanitaki, A., et al. “Gestational Hypertension and Preeclampsia: An Overview of National and International Guidelines.” Obstet Gynecol Surv 76.10 (2021): 613–33. DOI: 10.1097/OGX.0000000000000942. PMID: 34724074.
  12. Sinkey, R.G., Battarbee, A.N., Bello, N.A., et al. “Prevention, Diagnosis, and Management of Hypertensive Disorders of Pregnancy: a Comparison of International Guidelines.” Curr Hypertens Rep 22.9 (2020): 66. DOI: 10.1007/s11906-020-01082-w. PMID: 32852691; PMCID: PMC7773049.
  13. Hauspurg, A., Parry, S., Mercer, B.M., et al. “Blood pressure trajectory and category and risk of hypertensive disorders of pregnancy in nulliparous women.” Am J Obst Gynecol 221.3 (2019): 277.e1–277.e8. DOI: 10.1016/j.ajog.2019.06.031
  14. Darwin, K.C., Federspiel, J.J., Schuh, B.L., et al. “ACC-AHA Diagnostic Criteria for Hypertension in Pregnancy Identifies Patients at Intermediate Risk of Adverse Outcomes. ACOG criteria may be more similar than previously understood.” Am J Perinatol 38.1 (2021): e249–e255. DOI: 10.1055/s-0040-1709465
  15. Nagasawa, Y., Nanami, M., Kuragano, T., Ishihara, M. “Melatonin and gestational hypertension.” Hypertens Res 44.11 (2021): 1540–2. DOI: 10.1038/s41440-021-00722-1. PMID: 34385689.
  16. Maheu-Cadotte, M.A., Pépin, C., Lavallée, A., et al. “CE: Gestational Hypertension, Preeclampsia, and Peripartum Cardiomyopathy: A Clinical Review.” Am J Nurs 119.11 (2019): 32–40. DOI: 10.1097/01.NAJ.0000605352.84144.a2. PMID: 31651497.
  17. Block-Abraham, D.M., Adamovich, D., Turan, O.M., et al. “Maternal blood pressures during pregnancy and the risk of delivering a small-for-gestational-age neonate.” Hypertens Pregnancy 35.3 (2016): 350–60. DOI: 10.3109/10641955.2016.1150487
  18. Podolskyi, Vl.V., Podolskyі, V.V. Optimisation of treatment of disorders of vegetative homeostasis in women with changes in reproductive health. Information letter. Kyiv (2017): 4 p.
  19. Brown, M.A., Magee, L.A., Kenny, L.C., et al. “Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice.” Hypertension 72.1 (2018): 24–43. DOI: 10.1161/HYPERTENSIONAHA.117.10803
  20. Fishel Bartal, M., Lindheimer, M.D., Sibai, B.M. “Proteinuria during pregnancy: definition, pathophysiology, methodology, and clinical significance.” Am J Obstet Gynecol 226.2S (2022): S819–S834. DOI: 10.1016/j.ajog.2020.08.108. PMID: 32882208.
  21. Vonck, S., Staelens, A.S., Lanssens, D., et al. “Low Volume Circulation in Normotensive Women Pregnant with Neonates Small for Gestational Age.” Fetal Diagn Ther 46.4 (2019): 238–45. DOI: 10.1159/000495507
  22. Phoswa, W.N., Khaliq, O.P. “The Role of Oxidative Stress in Hypertensive Disorders of Pregnancy (Preeclampsia, Gestational Hypertension) and Metabolic Disorder of Pregnancy (Gestational Diabetes Mellitus).” Oxid Med Cell Longev 2021 (2021): 5581570. DOI: 10.1155/2021/5581570. PMID: 34194606; PMCID: PMC8184326.
  23. Feng, X., Liu, Y., Zhang, Y., et al. “New views on endothelial dysfunction in gestational hypertension and potential therapy targets.” Drug Discov Today 26.6 (2021): 1420–36. DOI: 10.1016/j.drudis.2021.03.001. PMID: 33677145.
  24. Whelton, P.K., Carey, R.M., Aronow, W.S., et al. “2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/ NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.” J Am Coll Cardiol 71.19 (2018): e127–e248. DOI: 10.1016/j.jacc.2017.11.006
  25. de Almeida, L.G.N., Young, D., Chow, L., et al. “Proteomics and Metabolomics Profiling of Platelets and Plasma Mediators of Thrombo-Inflammation in Gestational Hypertension and Preeclampsia.” Cells 11.8 (2022): 1256. DOI: 10.3390/cells11081256. PMID: 35455936; PMCID: PMC9027992.
  26. Bello, N.A., Zhou, H., Cheetham, T.C., et al. “Prevalence of Hypertension Among Pregnant Women When Using the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines and Association with Maternal and Fetal Outcomes.” JAMA Netw Open 4.3 (2021): e213808. DOI: 10.1001/jamanetworkopen.2021.3808. Erratum in: JAMA Netw Open 4.4 (2021): e2112000. PMID: 33787907; PMCID: PMC8013820.
  27. Nobles, C.J., Mendola, P., Mumford, S.L., et al. “Preconception Blood Pressure and Its Change Into Early Pregnancy: Early Risk Factors for Preeclampsia and Gestational Hypertension.” Hypertension 76.3 (2020): 922–9. DOI: 10.1161/HYPERTENSIONAHA.120.14875. PMID: 32755413; PMCID: PMC7456510.
  28. Li, Q., Xu, S., Chen, X., et al. “Folic Acid Supplement Use and Increased Risk of Gestational Hypertension.” Hypertension 76.1 (2020): 150–6. DOI: 10.1161/HYPERTENSIONAHA.119.14621. PMID: 32389074.
  29. Unger, T., Borghi, C., Charchar, F., et al. “2020 International Society of Hypertension global hypertension practice guidelines.” J Hypertens 38.6 (2020): 982–1004. DOI: 10.1097/HJH.0000000000002453
  30. Amanak, K., Sevil, U., Karacam, Z. “The impact of prenatal education based on the Roy adaptation model on gestational hypertension, adaptation to pregnancy and pregnancy outcomes.” J Pak Med Assoc 69.1 (2019): 11–7. PMID: 30623905.
  31. Wilkerson, R.G., Ogunbodede, A.C. “Hypertensive Disorders of Pregnancy.” Emerg Med Clin North Am 37.2 (2019): 301–16. DOI: 10.1016/j.emc.2019.01.008. PMID: 30940374.
  32. Podolskyi, Vl.V., Podolskyі, V.V. “Psychosomatic characteristics of the implementation of psychological protection mechanisms in women of fertile age.” Women’s Health 3.129 (2018): 114–7.
  33. Rezaei Ardani, A., Tara, F., Naghizadeh Kashani, S., et al. “Is gestational hypertension associated with affective temperaments?” Hypertens Pregnancy 39.2 (2020): 159–64. DOI: 10.1080/10641955.2020.1749279. PMID: 32243200.

Published

2023-06-30

How to Cite

Podolskyi, V. V., Podolskyi, V., & Znak, V. (2023). Characteristics of changes in fetal doppler blood flow parameters in women with gestational hypertension at different stages of pregnancy. REPRODUCTIVE ENDOCRINOLOGY, (68), 66–69. https://doi.org/10.18370/2309-4117.2023.68.66-69

Issue

Section

Pregnancy and childbirth