THE RELEVANCE OF MATERNAL CARDIOVASCULAR SITUATION BEFORE LABOR IN THE OUTCOME OF BIRTH: AN OBSERVATIONAL STUDY.
Daniele Farsetti1,2
Grazia Maria Tiralongo2
Ilaria Pisani2
Damiano Lo Presti2
Giulia Gagliardi2
Barbara Vasapollo2
Gian Paolo Novelli3
Herbert Valensise1,2
  1. University of Rome Tor Vergata, Surgical Sciences, Rome, Italy
  2. Casilino General Hospital, Obstetrics and Gynecology, Rome, Italy
  3. Fondazione PTV Policlinico Tor Vergata, Cardiology, Rome, Italy
Corresponding author:
Daniele Farsetti
dan.farsetti@gmail.com
+39 3395238927
Running Title : Maternal Hemodynamics in Outcome of Birth
Objective : To assess if maternal hemodynamics assessment in healthy women, at the end of pregnancy, before the labor onset, could predict the development of complications during labor.
Design : Prospective observational study.
Settings : Department of Obstetrics and Gynecology of Casilino Hospital in Rome, University of Tor Vergata. (September 2016 - December 2017)
Population : 395 healthy women not in labor at term of pregnancy.
Methods : Univariate and multivariate binary logistic regression analysis of association between hemodynamic variables and delivery complications, adjusted for significant prenatal variables.
Main Outcome Measures : ORs for hemodynamic parameters and identification of independent risk factors in the prediction of adverse outcome.
Results : we observed adverse outcomes in 45 patients (11.39%). Women who developed maternal or fetal complications during delivery were mainly nulliparous (93.33% vs 72.29%, p<0.01), showed higher values of systemic vascular resistances (SVR) (1368.32±228.50. vs 1260.34±271.94 d.s.cm-5, p=0.01) and lower values of cardiac output (CO) (5.38±0.77 vs 5.80±1.20 L/min, p=0.02), compared with women who did not develop complications. ROC curve analysis identified the best cut-offs to predict complicated delivery: SVR > 1135 d.s.cm-5 (OR 7.87, CI 95% 2.39-25.92, p<0.01), CO ≤5.6 L/min (OR 2.38; CI 95% 1.21-4.68, p<0.01), diastolic blood pressure > 79 mmHg (OR 1.89, CI 95% 1.01-3.54, p=0.04), Potential-Kinetic energy Ratio >22 (OR 2.32, 0.95-5.64, p=0.04). The multivariate logistic regression analysis identified as independent predictors of complication the SVR, Flow Time corrected and parity.
Conclusion : the assessment of maternal hemodynamics at term of pregnancy could increase the capacity to predict patients at risk during labor.
Key words: Labour: management, obstetric haemorrhage, maternal physiology, fetal medicine: uteroplacental insufficiency, doppler ultrasound.
Funding statement : no funding.