Management of pregnancies complicated by PET and/or IUGR remains one of the greatest challenges in obstetrics. The morbidity, both maternal and fetal, associated with these conditions is considerable. While there are identifiable clinical risk factors for the development of these disorders of uteroplacental origin, the majority of cases are encountered in the apparent ‘low-risk’ population. Provision of antenatal care is centred on regular maternal and fetal surveillance in order to enable timely identification of these complications. Frequently, however, clinical evidence of underlying uteroplacental dysfunction only emerges at a late stage in the disease process. With advanced disease the only therapeutic intervention is delivery of the fetus and placenta. Prolonging the pregnancy is associated with the risk of increasing maternal morbidity, maternal mortality and inuterofetal demise. As PET frequently occurs at very preterm gestations these risks must be balanced against the risks associated with delivery of a preterm infant. Identifying mothers at risk of developing disease early in the pregnancy, before clinical disease becomes apparent, has several advantages.
Haemodynamic Assessment iNpregnancy anDneonataL Echocardiography
Principal Investigator – Prof. Afif El-Khuffash
We hypothesise that serial evaluation of maternal Hemodynamic variables using NICOM can identify different hemodynamic patterns associated with IUGR and PET, when compared with normal pregnancies.
We also hypothesise that infants born to mothers with PET and IUGR have impaired myocardial performance.
If this hypothesis is proven, the potential exists to use this test on a global scale in pregnancy. There is also evidence supporting increased long-term cardiovascular risk for women who have had a pregnancy complicated by diseases of uteroplacental origin. Underlying Hemodynamic aberrations in these patients may be a factor in this increased long-term risk. Assessing the maternal Hemodynamic profile in the postnatal period will enable us to study whether or not Hemodynamic changes identified during pregnancy persist following delivery. This may further our understanding of the enhanced cardiovascular risk seen in these women.
The characterisation of the myocardial performance of infants born to mothers with PET will help direct the care of those infants and also guide the use of cardiotropic agents. The myocardial performance of infants born to mothers with PET and IUGR may be different to those born to healthy pregnancies. The use of newer echocardiographic techniques has not been applied to those infants. Establishing reference ranges for these new echocardiographic markers of ventricular function in the neonatal population will pave the way for further research and clinical care in this field. Knowing the expected measurements of a relatively steady state will allow further research into the effects of diseases (such as sepsis, asphyxia, and respiratory distress) and the impact of therapeutic interventions (such as mechanical ventilation, inotropes and surfactant administration) on myocardial function. In addition, these markers may be used in the future to detect early myocardial compromise, determine the appropriate treatment strategy, and monitor treatment response.