Open Access e-Journal Cardiometry No.16 May 2020

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ORIGINAL RESEARCH Submitted: 18.02.2020; Accepted: 28.03.2020; Published online: 21.05.2020Assessment of system-relatedhemodynamics and tissuehydration in female patientswith preeclampsiaNikolay N. Chernov 1 *, Aleksandr A. Bezverkhii 11Southern Federal UniversityRussia, 347900, Taganrog, Shevchenko st. 2*Corresponding author:e-mail: nnchernov@sfedu.ruAbstractHypertension disorders are reported to cover up to 10% ofpregnancies in the world. It is precisely the arterial hypertensionthat is the leading cause of developing serious complications,long-term invalidation and high maternal and infant mortalityrates. In the context of the maternal mortality, preeclampsia maybe attributed to 25% of all lethal outcomes. Preeclampsia occupiesthe second place in the maternal mortality structure. Multifetalpregnancy is a risk factor for developing of preeclampsia.The given study has been designed to obtain main datameasured in pregnant patients experiencing preeclampsia. Theobtained data have been compared with parameters showingchanges in intra-abdominal pressure (IAP) and biochemistrydata in singleton versus multifetal pregnancies. Our study hasshown that arterial hypertension in multifetal pregnancies maydevelop due to some factors not typical of preeclampsia pathogenesis.As a result, we may assume that establishing diagnosisPreeclampsia on the basis of arterial hypertention alone mayinvolve an inaccuracy. Therefore, in making the proper diagnosticsto differentiate between preeclampsia and other causesof arterial hypertension, it is reasonable to use some additionalexamination techniques like an impedance measuring method.The hemodynamic data collected therewith can be effectivelyused in selection of the most suitable hypotensive therapy andadjustment of infusion therapy.KeywordsPreeclampsia, Hemodynamics, Tissue hydration, Intra-abdominalhypertension, Arterial hypertension, Multifetal pregnancyImprintNikolay N. Chernov, Aleksandr A. Bezverkhii. Assessment of system-relatedhemodynamics and tissue hydration in female pa-66; DOI: 10.12710/cardiometry.2020.16.6266; Available from:tients with preeclampsia. Cardiometry; Issue 16; May 2020; р.62-http://www.cardiometry.net/issues/no16-may-2020/hemodynamics-and-tissue-hydrationIntroductionAccording to the applicable WHO statistics datareferred to 2017, hypertension conditions in pregnanciesoccupy the second place in the maternal mortalitystructure that is reported in 14% of the parturientwomen lethal outcomes [1,11,24-25]. As to the Russiannational statistics data, at least the 19% parturiencycases are accompanied by arterial hypertension. So,arterial hypertension reaching the 15,7% level ranksthe 4th in the framework of the maternal mortality[4]. The high likelihood of invalidation or even maternaland infant mortality requires further particularattention to be paid to studies of possible causes andapproaches to treatment of arterial hypertension [12-16]. The proposed personalized approach to healthcare for this sort of patients will result in a reductionof the perinatal loss and an optimization of intensiveunite costs.The aim of our study has been to identify types ofpossible hemodynamics disorders in singleton andmultifetal pregnancies complicated with arterial hypertension.Besides, it has been designed to assesschanges in fluid distribution in a pregnant woman versusthe respective normal value recorded in non-pregnancy,with the use of the technique of impedancemeasuring. Thereupon, it has been designed to reveala relationship between the type of the hemodynamicdisorders involving arterial hypertension and the respectiveclinical symptoms & laboratory data.Materials and methodsOur studies have been conducted in two groupscovering a total of 154 examinees, having age-, BMI-,intervention-scope- and anesthesia-technique-comparablefeatures. All patients have been observed inthe early post-surgery period in intensive care unitafter the completed caesarean section procedures involvingregional anesthesia techniques. In order tofind the most descriptive, typical, values in our sortedsampling data set, we have utilized the median, since ithas been required to minimize effects by some outliersin the sequence that skew the average of our statistics62 | Cardiometry | Issue 16. May 2020
values [6]. Both groups are homogenous by all analyzedindices that has been established with the use ofthe variance estimator [7]. The main test group of thepatients (n=75, with an average age of 29, an averageBMI = 27) has included multifetal pregnancies versusthe reference group, which has covered the singletonpregnancies only (n=79, with n average age of 31.5, anaverage BMI = 29.5). For all the patients, their medicalhistory records have not contained any events ofarterial hypertension before their pregnancies. Underthe pregnancy conditions, for the patients in bothgroups, AP systolic values exceeding 140 mm Hg andAP diastolic values exceeding 100 mm Hg have beenreported.Aссording to the latest data, preeclampsia developsas a result of a placenta anomaly that leads to arelease of antiangiogenic factors of the sFlt1 type andsoluble endoglins (sEng) produced in higher thannormal quantities, which provoke an endothelial dysfunction.At stage two of preeclampsia developing,permeability of the vascular walls increases that initiatesa vasoconstriction, an increase in the total peripheralresistance (TPR), an activation of coagulationand thrombotic microangiopathy. Further rise in thetransmural pressure triggers TPR growing and aggravatesthe developing pathology process [5,17-20]. Allthe above listed factors make an effect on developingarterial hypertension, alterations in the heart performanceand, in some severe cases, even polyorganicinsufficiency [8]. Based on these data, we think thatfor the pregnant patients suffering from arterial hypertensionit is reasonable to assess the volume of extracellularliquid, which is made up of the circulatingblood volume (CBV), the interstitial fluid quantityand the intracellular fluid volume. An assessment ofhemodynamics data, like the total peripheral resistance(TPR), the minute volume (MV) and the strokevolume (SV), is the most informative way indicatingthe actual condition of the vascular bed and the heartperformance status. In doing so, the contractility ofthe heart should be estimated preferably by assessingstroke volume values (SV). This parameter showsthe most sensitivity to alterations in hemodynamics,since under developing pathology process conditions,at the stage of compensation, certain mechanisms areactivated to maintain the MV values within the conditionallyspecified normal range [9]. So, in case of adecreased stroke volume, tachycardia develops that finallycontributes to the maintenance of the MV valueswithin their normal range. An assessment of the integraltonicity coefficient (ITC) is descriptive of the actualcondition of the arterial system tonus. ITC readilyillustrates what shared time takes the diastolic spanwithin the total cardiac cycle duration. An increasedvalue of this parameter, exceeding the norm, reachingthe level of 76 ± 1,6, is an indication of the centralizationin the blood supply. The respiratory variationfactor (RVF) responsible for stroke volume changes isa fingerprint to characterize the venous return. TheRVF normal values are within the range from 1.14 to1.24. Values exceeding the normal parameters thereofare indicators of respiration disorders, the genesis ofwhich are attributed to pulmonary, cardiac or combineddiseases.The collected data have been automatically analyzedwith the use of monitor-equipped system KM-AR-01 DIAMANT V11.0. The respective normal valueis taken to be 100%. The norms of the MV and SVparameters have been computed on the basis of theclinical data obtained with utilization of the impedancemeasuring technique that involves an applicationof the sigma interval as a limit of allowable measurementsfor the given device. Based on the clinical datacollected, the normal value of MV is 3.1 ± 0.7 l×min-1×m-2, and the normal value of the SV parameter infemales reaches 42± 8 ml×m-2. The normal value ofTPR is assumed to be 1100 – 1900 din×s.×cm-5. Theproper normal values of the extracellular fluid volumehave been derived from the formulas by Hidalgo at al.The respective extracellular blood volume = the circulatingblood volume x 2,60, where 2.60 is an empiricalcoefficient proposed by S.Albert. The interstitial fluidvolume has been taken to be equal to the difference betweenthe total fluid volume and the extracellular fluidvolume [9]. Besides, we have calculated complete setsof the following data with the above monitor-basedsystem as listed below: a pre-ejection period (PEP),an ejection time (LVT), an isovolemic relaxation time(IVR), a filling time (FT), a diastole time (DTI), a systoletime (QX), a blood volume parameter (BV) and ahomeostasis load index (HL).Preeclampsia is a severe complication in pregnancy,and it is very often is accompanied by developingpolyorganic pathology. When the first symptoms ofpreeclampsia appear, laboratory testing is mandatorilyrequired to deliver the biochemistry markers asfollows: Alanine Aminotransferase (ALT), Aspartateaminotransferase (AST), Blood urea nitrogen (BUN),Issue 16. May 2020 | Cardiometry | 63
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