DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20205782

Significance of 2 dimensional-echocardiography in hypertensive disorders of pregnancy: a study in tertiary care centre, Ahmedabad, Western India

Purvi M. Parikh, Vishwa M. Goswami, Sapana R. Shah, Rupa C. Vyas, Hiral Damor

Abstract


Background: Echocardiography is a safe, non-invasive technique to assess cardiac structure and function in pregnancy. Understanding the structure and function of the heart in hypertensive women is important in terms of timely diagnosis, better management and good prognosis. This study will focus on the importance and feasibility of Echocardiography as a routine investigation tool in hypertensive disorders of pregnancy.

Methods: This is a retrospective study of 150 cases of hypertension in pregnancy conducted at the Obstetrics and Gynaecology department of a tertiary care centre in the year June 2019-July 2020. Data was analysed in terms of complications seen in women who had structural and functional abnormalities in the echocardiographic scan in comparison to those hypertensive women who had a normal scan.  The important Echocardiographic parameters were compared amongst cases of hypertension and their impact on fetomaternal outcome was discussed.

Results: In this study conducted amongst 150 pregnant women suffering from different forms of hypertensive disorders  presenting in our institute for routine workup in the year 2019-2020, 12(8%) had chronic hypertension, 75(50%) had gestational hypertension, whereas 63(42%) had pre- eclampsia. The incidence of structural valvular lesions in these categories as 2%, 3.34% and 4% respectively. Deranged echocardiographic parameters like decreased Left Ventricular Ejection Fraction in 10%, decreased stroke volume in 28.6% and increased Left Ventricular mass in 26.6% are seen more in cases of pre-eclampsia compared to gestational hypertension and chronic hypertension.

Conclusions: Echocardiography is a valuable tool to stratify risk and can guide management in gestational hypertension, chronic hypertension and preeclampsia. Changes in cardiac function and morphology are recognizable at an asymptomatic early stage and correlate with disease severity and adverse outcomes. Preeclampsia has a greater impact on the heart than gestational hypertension, and changes are most pronounced in early onset, severe disease. Studying the cardiac structure and function in early trimesters can bring about better maternal and fetal outcome.


Keywords


Echocardiography, Hypertension, Left ventricular mass, Preeclampsia, Pregnancy

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References


Sajith M, Nimbargi V, Modi A, Sumariya R, Pawar A. Incidence of Pregnancy induced Hypertension and prescription pattern of antihypertensive drugs in pregnancy. Int J Pharmacol Sci Res. 2014;5(4):163-70.

Vigil-De Gracia P, Montufar-Rueda C, Ruiz J. Expectant management of severe preeclampsia and preeclampsia superimposed on chronic hypertension between 24 and 34 weeks’ gestation. Eur J Obstet Gynecol Reprod Biol. 2003;107:24-7.

Say L, Chou D, Gemmil A, Tuncalp O, Moller AB, Daniell J, et al. Global causes of maternal death: a WHO Systemic analysis Lancet Global Health. 204;2:e323-e333.

National High Blood Pressure Education Program, Working Group on High Blood Pressure.Report of the National High Blood Pressure Education Program in Pregnancy. Am J Obstet Gynecol. 2000;183:S1-S22.

Castleman JS, Ganapathy R, Taki F, Lip GY, Steeds RP, Kotecha D. Echocardiographic structure and function in hypertensive disorders of pregnancy: a systematic review. Circulation: Cardiovas Imaging. 2016;9(9):e004888.

Robson SC, Hunter S, Boys RJ, Dunlop W. Serial study of factors influencing changes in cardiac output during human pregnancy. Am J Physiol. 1989;256(4 pt 2):H1060–H1065.

Rubler S, Damani PM, Pinto ER. Cardiac size and performance during pregnancy estimated with echocardiography. Am J Cardiol. 1977;40:534–40.

Robson SC, Boys RJ, Hunter S. Doppler echocardiographic estimation of cardiac output: analysis of temporal variability. Eur Heart J. 1988;9:313–8.

Hunter S, Robson SC. Adaptation of maternal heart in Pregnancy. Br Heart J. 1992;68:540-3.

Poppas A, Shroff SG, Korcarz CE, Hibbard JU,Berger DS, Lindheimer MD, et el. Serial assessment of the cardiovascular system in normal pregnancy. Role of arterial compliance and pulsatile arterial load. Circulation. 1997;95:2407-15.

Zou C, Wu X, Zhou Q, Zhang Y, Lyu R, Zhang J. Frequency and predictors of recovery of normal left ventricular ejection fraction and end-diastolic diameter in patients with dilated cardiomyopathy. OCT. 2014;42(10):851-5.

Jain N, Verma A, Rajoria L. Evaluation of Echocardiographic Systolic Parameters in Pre-Eclamptics and Normotensives Women. J Obstet Gynecol India. 2016;66(1):187-91.

Vázquez Blanco M, Grosso O, Bellido CA, Iavıécoli OR, Berensztein CS, Ruda Vega H, et al. Left ventricular geometry in pregnancy-induced hypertension. American J Hypertension. AJH 2000;13:226-30.

Lindley KJ, Conner SN, Cahill AG, Novak E, Mann DL. Impact of preeclampsia on clinical and functional outcomes in women with peripartum cardiomyopathy. Circulation: Heart Failure. 2017;10(6):e003797.

Solanki R, Maitra N. Echocardiographic assessment of cardiovascular hemodynamics in preeclampsia. J Obstet Gynecol India. 2011;61(5):519-22.

Hameed A, Karaalp IS, Tummala PP, Wani OR, Canetti M, Akhter MW, et al. The effect of valvular heart disease on maternal and fetal outcome of pregnancy. ACC. 2001;37(3):893-9.

Wei J, Liu CX, Gong TT, Wu QJ, Wu L. Cigarette smoking during pregnancy and preeclampsia risk: a systematic review and meta-analysis of prospective studies. Onco Target. 2015;6:43667–78.

Shah S, Chryssos ED, Parker H. Magnetic Resonance IMAGING: A Wealth of Cardiovascular Information. Oschner J. 2009;9(4):266-77.