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
- University of Rome Tor Vergata, Surgical Sciences, Rome, Italy
- Casilino General Hospital, Obstetrics and Gynecology, Rome,
Italy
- 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.