JCNRJournal of Clinical and Nursing Research2208-36852208-3693Bio-Byword Scientific Publishing Pty. Ltd.10.26689/jcnr.v6i3.3896ArticleDifferent Hemodynamic Types of Preeclampsia Observed Under Ultrasonic Cardiac Output Monitor (USCOM): A Report of Two Caseshttps://artdesignp.com/journal/JCNR/6/3/10.26689/jcnr.v6i3.3896MaZhen2022632022-05-19Preeclampsia is a serious and uncommon complication of pregnancy, which affects 5% to 7% of pregnancies and is associated with maternal and fetal adverse outcomes. Moreover, preeclampsia is a polymorphic disease with different hemodynamic types, thus requiring different therapeutic strategies. As a hemodynamic tool, the ultrasonic cardiac output monitor (USCOM) is useful in the detection of preeclampsia as early as the 5th to 16th week of gestation, with abnormal hemodynamic indicating preeclampsia. Although blood pressure (BP) rises in preeclamptic patients, it is not a sensitive indicator for the diagnosis of preeclampsia. However, hemodynamic may change in the 5th to 11th week of gestation. In this paper, the hemodynamic types of two cases were reported using USCOM. The SV, CO, and SVRI values were significantly different in both the cases, indicating the patients had different types of preeclampsia. The hemodynamic parameters were more useful than blood pressure for managing the two cases. Moreover, the mother and fetal were safe after treatment. If preeclampsia had been assessed only from the perspective of BP, the two cases would have been diagnosed as having mild hypertension, and we would not be able to determine the severity. USCOM allowed the identification of preeclampsia-associated hemodynamics and defined individualized therapeutic targets, which cannot be identified by BP alone.

Roberts JM, August PA, Bakris G, et al., 2013, Hypertension in Pregnancy. Obstet Gynecol, 122(5): 1122-1131. DOI: 10.1097/01.aog.0000437382.03963.88

Ananth CV, Keyes KM, Wapner RJ, 2013, Pre-Eclampsia Rates in the United States, 1980-2010: Age-Period-Cohort Analysis. BMJ, 347: f6564. https://doi.org/10.1136/bmj.f6564

Mammaro A, Carrara S, Cavaliere A, et al., 2009, Hypertensive Disorders of Pregnancy. J Prenat Med, 3(1) 1-5.

2000, Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol, 183(1): S1-S22.

Smith TA, Kirkpatrick DR, Kovilam O, et al., 2015, Immunomodulatory Role of Vitamin D in the Pathogenesis of Preeclampsia. Expert Rev Clin Immunol, 11(9): 1055-1063. DOI: 10.1586/1744666x.2015.1056780

2019, ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstet Gynecol, 133(1): 1. DOI: 10.1097/aog.0000000000003018

Brown MA, Magee LA, Kenny LC, et al., 2018, Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice. Hypertension, 72(1): 24-43. DOI: 10.1161/hypertensionaha.117.10803.

Roberts JM, Cooper DW, 2001, Pathogenesis and Genetics of Pre-Eclampsia. Lancet, 357(9249): 53-56. DOI: 10.1016/s0140-6736(00)03577-7

Sparks TN, Nakagawa S, Gonzalez JM, 2017, Hypertension in Dichorionic Twin Gestations: How Is Birthweight Affected?. J Matern Fetal Neonatal Med, 30(4): 380-385. DOI: 10.3109/14767058.2016.1174209

Cursino T, Katz L, Coutinho I, et al., 2015, Diuretics Vs. Placebo for Postpartum Blood Pressure Control in Preeclampsia (DIUPRE): A Randomized Clinical Trial. Reprod Health, 12: 66. DOI: 10.1186/s12978-015-0057-0

Lain KY, Roberts JM, 2002, Contemporary Concepts of the Pathogenesis and Management of Preeclampsia. Jama, 287(24): 3183-3186. DOI: 10.1001/jama.287.24.3183

Phillips JK, Janowiak M, Badger GJ, et al., 2010, Evidence for Distinct Preterm and Term Phenotypes of Preeclampsia. J Matern Fetal Neonatal Med, 23(7): 622-626. DOI: 10.3109/14767050903258746

Tamas P, Hantosi E, Farkas B, et al., 2017, Preliminary Study of the Effects of Furosemide on Blood Pressure During Late-Onset Pre-Eclampsia in Patients with High Cardiac Output. Int J Gynaecol Obstet, 136(1): 87-90. DOIL 10.1002/ijgo.12019

Hod T, Cerdeira AS, Karumanchi SA, 2015, Molecular Mechanisms of Preeclampsia. Cold Spring Harb Perspect Med, 5: a023473. DOI: 10.1101/cshperspect.a023473

Goulopoulou S, Davidge ST, 2015, Molecular Mechanisms of Maternal Vascular Dysfunction in Preeclampsia. Trends Mol Med, 21(2): 88-97. DOI: 10.1016/j.molmed.2014.11.009

Beevers G, Lip GY, O’Brien E, 2001, ABC of Hypertension: The Pathophysiology of Hypertension. BMJ, 322: 912-916. DOI: 10.1136/bmj.322.7291.912

Guyton AC, Lindsey AW, Kaufmann BN, 1955, Effect of Mean Circulatory Filling Pressure and Other Peripheral Circulatory Factors on Cardiac Output. Am J Physiol, 180(3): 463-468. DOI: 10.1152/ajplegacy.1955.180.3.463

Magee LA, Ramsay G, von Dadelszen P, 2008, What Is the Role of Out-Of-Office BP Measurement in Hypertensive Pregnancy?. Hypertens Pregnancy, 27(2): 95-101. DOI: 10.1080/10641950801950197

Bosio PM, McKenna PJ, Conroy R, et al., 1999, Maternal Central Hemodynamics in Hypertensive Disorders of Pregnancy. Obstet Gynecol, 94(6): 978-984. DOI: 10.1016/S0029-7844(99)00430-5

Troiano NH, 2018, Physiologic and Hemodynamic Changes During Pregnancy. AACN Adv Crit Care, 29(3): 273-283. DOI: 10.4037/aacnacc2018911

Pastore A, Geiger S, Baur D, et al., 2013, Cardiotoxicity After Anthracycline Treatment in Survivors of Adult Cancers: Monitoring by USCOM, Echocardiography and Serum Biomarkers. World J Oncol, 4(1): 18-25. DOI: 10.4021/wjon635w

Vinayagam D, Thilaganathan B, Stirrup O, et al., 2018, Maternal Hemodynamics in Normal Pregnancy: Reference Ranges and Role of Maternal Characteristics. Ultrasound Obstet Gyneco, 51(5): 665-671. DOI: 10.1002/uog.17504

Croke L, 2019, Gestational Hypertension and Preeclampsia: A Practice Bulletin from ACOG. Am Fam Physician, 100(2019): 649-650.

Goulopoulou S, 2017, Maternal Vascular Physiology in Preeclampsia. Hypertension, 70: 1066-1073. DOI: 10.1161/hypertensionaha.117.08821

Kucukbas GN, Sanhal CY, 2019, Plasma Endocan Levels in Early and Late-Onset Preeclampsia. Fetal and Pediatric Pathology, 40(3): 1-8. DOI: 10.1080/15513815.2019.1693674

Valensise H, Vasapollo B, Gagliardi G, et al., 2008, Early and Late Preeclampsia: Two Different Maternal Hemodynamic States in the Latent Phase of the Disease. Hypertension, 52(5): 873-880. DOI: 10.1161/hypertensionaha.108.117358

Marcellin P, Heathcote EJ, Buti M, et al., 2008, Tenofovir Disoproxil Fumarate Versus Adefovir Dipivoxil for Chronic Hepatitis B. N Engl J Med, 359: 2442-2455. DOI: 10.1056/NEJMoa0802878

Vaught AJ, Kovell LC, Szymanski LM, et al., 2018, Acute Cardiac Effects of Severe Pre-Eclampsia. J Am Coll Cardiol, 72(1): 1-11. DOI: 10.1016/j.jacc.2018.04.048

Bridges EJ, Womble S, Wallace M, et al., 2003, Hemodynamic Monitoring in High-Risk Obstetrics Patients, I. Expected Hemodynamic Changes in Pregnancy. Crit Care Nurse, 23(4): 53-62.

Bridges EJ, Womble S, Wallace M, et al., 2003, Hemodynamic Monitoring in High-Risk Obstetrics Patients, II. Pregnancy-Induced Hypertension and Preeclampsia. Crit Care Nurse, 23(5) 52-57.

Marcovici I, 2005, Postpartum Preeclampsia Management with Furosemide: A Randomized Clinical Trial. Obstet Gynecol, 105(4): 899. DOI: 10.1097/01.AOG.0000158755.42961.ee

Stocks G, 2014, Preeclampsia: Pathophysiology, Old and New Strategies for Management. Eur J Anaesthesiol, 31(4): 183-189. DOI: 10.1097/eja.0000000000000044

Siddall E, Khatri M, Radhakrishnan J, 2017, Capillary Leak Syndrome: Etiologies, Pathophysiology, and Management. Kidney Int, 92(1): 37-46. DOI: 10.1016/J.Kint.2016.11.029

Uddin MN, McLean LB, Hunter FA, et al., 2009, Vascular Leak in a Rat Model of Preeclampsia. Am J Nephrol, 30(1): 26-33. DOI: 10.1159/000193220