Gestational Hypervolemic Hypertension Is Clinically Different from “Classical” Preeclampsia

Abstract

Objective: Homogenous pathogenesis of preeclampsia has been challenged. We examined the clinical characteristics of preeclamptic patients with discordant fetal growth which is one of the controversial issues in preeclampsia. Methods: Clinical index values including central hemodynamics of third-trimester preeclamptic patients with distinct fetal birth weights (group A: birth weight ≥ 50th percentile; n = 23 and group B: birth weight < 50th percentile; n = 14) were compared. Results: Pregnant women of group A were characteristically obese and edematous, but no fetal complications were observed. Patients of group B were younger, onset of preeclampsia was earlier, proteinuria was more severe, and fetal compromise was frequent. A marked difference between the two groups was noticed in central hemodynamics as the mean of CO (cardiac output) was 8.5 and 5.6 l/min in group A and B, respectively (p < 0.001). CO of less than 7.45 l/min was found to be associated with fetal birth weight below 50th percentile (OR = 15.6; 95% CI: 3.2 and 45.8, p = 0.001). Conclusions: Augmented CO in pregnancy may ensure efficient placental blood supply, but it may cause hypertension with subsequent moderate proteinuria. This condition, however, seems to be different from the “classical” preeclampsia.

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Hantosi, E. , Ifi, Z. , Jeges, S. , Bódis, J. and Tamás, P. (2014) Gestational Hypervolemic Hypertension Is Clinically Different from “Classical” Preeclampsia. Open Access Library Journal, 1, 1-4. doi: 10.4236/oalib.1100751.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Lain, K.Y. and Roberts, J.M. (2002) Contemporary Concepts of the Pathogenesis and Management of Preeclampsia. JAMA, 287, 1383-1386.
http://dx.doi.org/10.1001/jama.287.24.3183
[2] Sibai, B.M. (2008) Intergenerational Factor. A Missing Link for Preeclampsia, Fetal Growth Restriction, and Cardiovascular Disease? Hypertension, 51, 993-994.
http://dx.doi.org/10.1161/HYPERTENSIONAHA.107.104489
[3] Xiong, X., Demianczuk, N.N., Buekens, P. and Saunders, L.D. (2000) Association of Preeclampsia with High Birth Weight for Age. American Journal of Obstetrics & Gynecology, 183, 148-155.
http://dx.doi.org/10.1016/S0002-9378(00)24793-5
[4] Rasmussen, S. and Irgens, L.M. (2003) Fetal Growth and Body Proportion in Preeclampsia. Obstetrics & Gynecology, 101, 575-583.
http://dx.doi.org/10.1016/S0029-7844(02)03071-5
[5] Vatten, L.J. and Skjaerven, R. (2004) Is Preeclampsia More than One Disease? BJOG, 111, 298-302.
http://dx.doi.org/10.1111/j.1471-0528.2004.00071.x
[6] van Oppen, A.C.C., Stigter, R.H. and Bruinse, H.W. (1996) Cardiac Output in Normal Pregnancy: A Critical Review. Obstetrics & Gynecology, 87, 310-318.
http://dx.doi.org/10.1016/0029-7844(95)00348-7
[7] Tamás, P., Szilágyi, A., Jeges, S., Vizer, M., Csermely, T., Ifi, Z., Bálint, A. and Szabó, I. (2007) Effects of Maternal Central Hemodynamics on Fetal Heart Rate Patterns. Acta Obstetricia et Gynecologica Scandinavica, 86, 711-714.
http://dx.doi.org/10.1080/00016340701252217
[8] Visser, W. and Wallenburg, H.C.S. (1991) Central Hemodynamic Observations in Untreated Preeclamptic Patients. Hypertension, 17, 1072-1077.
http://dx.doi.org/10.1161/01.HYP.17.6.1072
[9] Easterling, T.R. and Benedetti, T.J. (1989) Preeclampsia: A Hyperdynamic Disease Model. American Journal of Obstetrics & Gynecology, 160, 1447-1453.
http://dx.doi.org/10.1016/0002-9378(89)90869-7
[10] Naeye, R.L. (1981) Maternal Blood Pressure and Fetal Growth. American Journal of Obstetrics & Gynecology, 141, 780-787.
[11] Callaway, L.K., O’Callaghan, M. and McIntyre, H.D. (2009) Obesity and Hypertensive Disorders of Pregnancy. Hypertension in Pregnancy, 28, 473-493.
http://dx.doi.org/10.3109/10641950802629626
[12] Dunlop, W., Furness, C. and Hill, L.M. (1978) Maternal Haemoglobin Concentration, Haematocrit and Renal Handling of Urate in Pregnancies Ending in the Births of Small-for-Dates Infants. BJOG, 85, 938-940.
[13] Chaffin, D.G. and Webb, D.G. (2009) Outcomes of Pregnancies at Risk for Hypertensive Complications Managed Using Impedance Cardiography. American Journal of Perinatology, 26, 717-721.
http://dx.doi.org/10.1055/s-0029-1223283
[14] Kublickas, M., Lunell, N.-O., Nisell, H. and Westgren, M. (1996) Maternal Renal Artery Blood Flow Velocimetry in Normal and Hypertensive Pregnancies. Acta Obstetricia et Gynecologica Scandinavica, 75, 715-719.
http://dx.doi.org/10.3109/00016349609065733
[15] Rolfo, A., Racano, A., Tal, R., Tagliaferro, A., Ietta, F., Wang, J., Post, M. and Caniggia, I. (2010) Abnormalities in Oxygen Sensing Define Early and Late Onset Preeclampsia as Distinct Pathogenesis. PLoS One, 5, e13288.

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