This Article Full Text Full Text (PDF) All Versions of this Article: 52/5/873    most recent HYPERTENSIONAHA.108.117358v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Valensise, H. Articles by Novelli, G. P. Search for Related Content PubMed PubMed Citation Articles by Valensise, H. Articles by Novelli, G. P. Pubmed/NCBI databases Medline Plus Health Information High Risk Pregnancy Pregnancy Related Collections Other hypertension Clinical Studies Echocardiography Related Article

(Hypertension. 2008;52:873.)
© 2008 American Heart Association, Inc.

Original Articles

Early and Late Preeclampsia

Two Different Maternal Hemodynamic States in the Latent Phase of the Disease

Herbert Valensise; Barbara Vasapollo; Giulia Gagliardi; Gian Paolo Novelli

From the Department of Obstetrics and Gynecology (H.V., B.V., G.G.), Tor Vergata University, Rome; and the Department of Cardiology (G.P.N.), San Sebastiano Martire Hospital Frascati (Rome), Italy.

Correspondence to Prof Herbert Valensise, Università di Roma "Tor Vergata", Dipartimento di Ginecologia ed Ostetricia, Isola Tiberina 39, 00100, Roma, Italy. E-mail valensise{at}uniroma2.it

Because early and late preeclampsia (PE) are thought to be different disease entities, we compared maternal cardiac function at 24 weeks gestation in a group of normotensive asymptomatic patients with subsequent development of early (<34 weeks gestation) and late (34 weeks gestation) PE (blood pressure >140/90+proteinuria >300 mg/dL) to detect possible early differences in the hemodynamic state. A group of 1345 nulliparous normotensive asymptomatic women underwent at 24 weeks gestation uterine artery Doppler evaluation and maternal echocardiography calculating total vascular resistance. In the subsequent follow-up 107 patients showed PE: 32 patients had late and 75 had early PE. Five of 32 patients with late PE and 45 of 75 patients with early PE had bilateral notching of the uterine artery at 24 weeks (15.6% versus 60.0%; P<0.05). Total vascular resistance was 1605±248 versus 739±244 dyn · s · cm^–5, and cardiac output was 4.49±1.09 versus 8.96±1.83 L in early versus late PE (P<0.001). Prepregnancy body mass index was higher in late versus early PE (28±6 versus 24±2 kg/m²; P<0.001). Early and late PE appear to develop from different hemodynamic states. Late PE appears to be more frequent in patients with high body mass index and low total vascular resistance; earlier forms of PE appear to be more frequent in patients with lower BMI and with bilateral notching of the uterine artery. These findings support the hypothesis of different hemodynamics and origins for early PE (placental mediated, linked to defective trophoblast invasion with high percentage of altered uterine artery Doppler) and late PE (linked to constitutional factors such as high body mass index).

Key Words: preeclampsia/pregnancy • hemodynamcs • echocardiography

Related Article:

Maternal and Uteroplacental Hemodynamics for the Classification and Prediction of Preeclampsia

Baha M. Sibai
Hypertension 2008 52: 805-806. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				B. M. Sibai Maternal and Uteroplacental Hemodynamics for the Classification and Prediction of Preeclampsia Hypertension, November 1, 2008; 52(5): 805 - 806. [Full Text] [PDF]