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The assessment of maternal haemodynamic profile via transthoracic bioreactance as a screening tool for the early prediction of preeclampsia (PE) and normotensive fetal growth restriction (FGR).
Monteith, Cathy
<p>Preeclampsia (PE) and Fetal Growth Restriction (FGR) are common complications of pregnancy. Data presented in this thesis, which mainly originate from the single centre prospective <strong>HAEMODYNAMIC A</strong>ssessment i<strong>N </strong>pregnancy an<strong>D </strong>neonata<strong>L E</strong>chocardiography assessment (HANDLE) study, consolidate knowledge of the haemodynamics of normal pregnancy and the changes and predictive capability in those affected by PE & FGR.</p> <p>The HANDLE study recruited 422 low risk nulliparous women at their first antenatal visit. Following exclusion and patient self-withdrawal a total of 366 women completed the study; 1.6% (n=6) had a pregnancy complicated by PE; 4.9% (n=18) by gestational hypertension (GH) and 6.6% (n=24) by FGR.</p> <p>The objective of the primary analyses of this study was to assess the haemodynamics of pregnancy and the postpartum using NICOM® and the ability of these profiles to predict disease states. Presented in this thesis I have detailed four different haemodynamic profiles in pregnancy. In pregnancies complicated by preeclampsia, HR and SVi when combined with BP became statistically significant predictors at 14 weeks’ gestation (AUC=0.75, p=0.01 and AUC=0.77, p=0.009 respectively). In the postpartum, comparison between non-pregnant controls and those with GH demonstrated persistence of elevated DBP (p=0.01), TPRi (p=0.01) and lower SVi (p=0.03).</p> <p>Secondary analyses were to validate the use of NICOM® in the obstetric population and correlation of biomarkers to haemodynamic variables. In keeping with findings in the adult and neonatal population I have shown that NICOM® is an acceptable alternative method of CO measurement in pregnant women. Evaluation of the biomarkers and haemodynamics at 14 weeks’ showed a weak positive correlation between Apelin 13 and SV (r=0.29; p=0.005) and a weak inverse correlation with TPRi (r=-0.29; p=0.004).</p> <p>In conclusion, uteroplacental disease is a multifactorial complication of pregnancy. This thesis further highlights the need for the development of prediction models especially in the case of FGR.</p> <p>A thesis submitted for the degree of Doctor of Philosophy from the Royal College of Surgeons in Ireland in 2018.</p>
Keyword(s): Haemodynamics; Pregnancy; Preeclampsia; Fetal Growth Restriction; Hypertension.; Medicine and Health Sciences; Obstetrics and Gynecology
Publication Date:
2018
Type: Doctoral thesis
Peer-Reviewed: Yes
Institution: Royal College of Surgeons in Ireland
Citation(s): Monteith, C The assessment of maternal haemodynamic profile via transthoracic bioreactance as a screening tool for the early prediction of preeclampsia (PE) and normotensive fetal growth restriction (FGR) [PhD Thesis]. Dublin: Royal College of Surgeons in Ireland; 2018.
Supervisor(s): Professor Fergal Malone
Professor Afif EL-Khuffash
Related Link(s): https://epubs.rcsi.ie/phdtheses/226/
First Indexed: 2018-11-09 07:16:06 Last Updated: 2018-11-09 07:16:06