The January issue is a special issue on Maternal Hemodynamics and is completely free to access. It contains a range of articles that focus on the validation of methods for hemodynamic assessment, monitoring of hemodynamics to guide therapy, hemodynamics in uteroplacental disorders, and postpartum maternal evaluation.
Perspective by UOG’s Editor-in-Chief
Editor-in-Chief, Basky Thilaganathan, introduces the special issue with an article that highlights the importance of maternal hemodynamics and their relevance to placental syndromes. A video podcast of the accompanying TED Talk of this perspective article can be accessed here.
Maternal Hemodynamics: a 2017 update
The guest Editors of this special issue, Chahinda Ghossein-Doha, Asma Khalil and Christoph Lees, summarise the findings of recent research on maternal hemodynamics, providing an update on the current knowledge in this increasingly important field of obstetrics, and discuss why this topic is so relevant.
Validation and cross-comparison
Cardiac structure and function can be assessed by echocardiography or by more invasive methods, such as the Swan–Ganz catheter. The problem with so many different methods for evaluation is validation. A number of studies in this issue compare different methods of hemodynamic assessment: Cornette et al. compared assessment of cardiac output in pregnant women by non-invasive echocardiography and by invasive pulmonary artery catheterization, showing excellent correlation, and Vinayagam et al. compared two different cardiac output monitors with echocardiography, demonstrating good agreement, especially in the third trimester.
It is known that pregnancy influences the maternal cardiovascular system to ensure sufficient supply of oxygen and nutrients to the fetus. This hemodynamic adaptation to accommodate pregnancy is illustrated in a number of articles in this issue, with some studies determining the longitudinal changes throughout pregnancy and others showing how these changes can be used to predict adverse pregnancy outcomes such as pre-eclampsia and delivery of small- or large-for-gestational-age neonates.
Studies in this issue focus on serial hemodynamic monitoring to guide antihypertensive treatment in pregnancy. Stott et al. were able to identify women who would not respond to treatment and would require additional vasodilatory therapy, enabling women to be triaged accordingly prior to administration of the antihypertensive drug. Ambrozic et al. used lung and cardiac ultrasound to assess fluid tolerance and responsiveness in severely pre-eclamptic women and found that excess lung water can be identified before the appearance of clinical signs. Utilising this assessment method could help clinicians identify women with severe pre-eclampsia and help determine their subsequent management.
The articles by Stott et al. were also chosen for Journal Club. Download the accompanying Journal Club slides.
Cardiovascular adaptations to pregnancy may still be present even after delivery. A systematic review by Milic et al. found atherosclerosis present at the time of pre-eclampsia and up to 10 years after the affected pregnancy. In another study by Orabona et al., microcirculatory function was found to be compromised in women with previous pre-eclampsia, persisting up to 4 years postpartum in some cases. In the same cohort, they also reported persistent subclinical contractile impairment of the whole heart. Breetveld et al. found heart failure Stage B to be associated with previous pre-eclampsia, it developing in a quarter of these women. However, they observed that more than 60% of women with heart failure Stage B in the first year after pregnancy recovered within 4 years.