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Title: | Hemodynamic pathways of gestational hypertension and preeclampsia | Authors: | GYSELAERS, Wilfried | Issue Date: | 2022 | Publisher: | MOSBY-ELSEVIER | Source: | AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 226 (2) , p. S988 -S1005 | Abstract: | Gestational hypertension and preeclampsia are the 2 main types of hypertensive disorders in pregnancy. Noninvasive maternal cardiovascular function assessment, which helps obtain information from all the components of circulation, has shown that venous hemodynamic dysfunction is a feature of preeclampsia but not of gestational hypertension. Venous congestion is a known cause of organ dysfunction, but its potential role in the pathophysiology of preeclampsia is currently poorly investigated. Body water volume expansion occurs in both gestational hypertension and preeclampsia, and this is associated with the common feature of new-onset hypertension after 20 weeks of gestation. Blood pressure, by definition, is the product of intravascular volume load and vascular resistance (Ohm's law). Fundamentally, hypertension may present as a spectrum of cardiovascular states varying between 2 extremes: one with a predominance of raised cardiac output and the other with a predominance of increased total peripheral resistance. In clinical practice, however, this bipolar nature of hypertension is rarely considered, despite the important implications for screening, prevention, management, and monitoring of disease. This review summarizes the evidence of type-specific hemodynamic profiles in the latent and clinical stages of hypertensive disorders in pregnancy. Gestational volume expansion superimposed on an early gestational closed circulatory circuit in a pressure- or volume-overloaded condition predisposes a patient to the gradual deterioration of overall circulatory function, finally presenting as gestational hypertension or preeclampsia-the latter when venous dysfunction is involved. The eventual phenotype of hypertensive disorder is already predictable from early gestation onward, on the condition of including information from all the major components of circulation into the maternal cardiovascular assessment: the heart, central and peripheral arteries, conductive and capacitance veins, and body water content. The relevance of this approach, outlined in this review, openly invites for more in-depth research into the fundamental hemodynamics of gestational hypertensive disorders, not only from the perspective of the physiologist or the scientist, but also in assistance of clinicians toward understanding and managing effectively these severe complications of pregnancy. | Notes: | Gyselaers, W (corresponding author), Ziekenhuis Oost Limburg, Dept Obstet, Genk, Belgium.; Gyselaers, W (corresponding author), Hasselt Univ, Fac Med & Life Sci, Dept Physiol, Hasselt, Belgium. Wilfried.gyselaers@uhasselt.be |
Keywords: | abdominal compartment;bioimpedance spectrum analysis;capacitance;capillary dysfunction;cardiac output;cardiovascular;congestion;Doppler waveform;early-onset preeclampsia;gestational hypertension;gestational physiology;heart rate;hepatic circulation;hepatic veins;impedance cardiography;impedance index;inflammation;intraabdominal pressure;intravenous pressurelate-onset preeclampsia;maternal hemodynamics;peripheral vascular resistance;preeclampsia;renal interlobar veins;splanchnic circulation;stroke volume;total body water;venoconstriction;venous congestion;venous hemodynamics;venous return;venous system | Document URI: | http://hdl.handle.net/1942/37123 | ISSN: | 0002-9378 | e-ISSN: | 1097-6868 | DOI: | 10.1016/j.ajog.2021.11.022 | ISI #: | WOS:000759636700016 | Rights: | 2021 Elsevier Inc. All rights reserved | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2023 |
Appears in Collections: | Research publications |
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Hemodynamic pathways of gestational hypertension and preeclampsia.pdf Restricted Access | Published version | 3.41 MB | Adobe PDF | View/Open Request a copy |
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