Enrico Ferrazzi

Tuesday, 27 November 2018 | 3:00 pm

Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico Milano, Full Professor of Obstetrics and Gynecology, Dept. of Clinical Sciences and Community Health, University of Milan, ITALY

Maternal cardio-vascular system and clinical phenotypes of hypertensive disorders in pregnancy

(Host: S. Zacchigna)

 During pregnancy, maternal cardiovascular function changes,leading to an increased maternal vascular bed capacity,plasma volume, heart rate (HR), cardiac output (CO), arterial compliance, ventricular morphology and systolic and diastolic cardiac function. These changes are profoundly subverted byhypertensive disorders of pregnancy traditionally classified according to the time at onset of the disease New evidences are emerging as regards different clinicalphenotype of Hypertensive disorders in pregnancy.Significantly low cardiac output and high total vascular resistance characterize women with hypertensive disorders of pregnancy associated with small for gestational age dueto placental insufficiency, independent of the gestationalage at the onset of hypertension. Cardiovascular parameters appears to be not significantly different in the women withappropriate-for-gestational-age affected by preeclampsia orgestational hypertension. These findings support the view that maternal hemodynamics may be a candidate diagnostic tool to identify hypertensive disorders in pregnancies associatedwith small-for-gestational-age fetuses. This additional toolmatches other reported evidence provided by uterine Dopplervelocimetry, low vascular growth factors in the first trimester,and placental pathology. Obesity is an hemodynamic gamechanger associated with a significantly higher cardiac output and outweighs other determinants of hemodynamics in92 pregnancy; therefore, in future studies on hypertensive disorders, obesity should be studied as an additional disease and not simply as a demographic characteristic.