Assessment of system-related hemodynamics and tissue hydration in female patients with preeclampsia

tients with preeclampsia. Cardiometry; Issue 16; May 2020; р.6266; DOI: 10.12710/cardiometry.2020.16.6266; Available from:

According to the applicable WHO statistics data referred to 2017, hypertension conditions in pregnancies occupy the second place in the maternal mortality structure that is reported in 14% of the parturient women lethal outcomes [1,11,24-25]. As to the Russian national statistics data, at least the 19% parturien-cy cases are accompanied by arterial hypertension. So, arterial hypertension reaching the 15,7% level ranks the 4th in the framework of the maternal mortality [4]. The high likelihood of invalidation or even maternal and infant mortality requires further particular attention to be paid to studies of possible causes and approaches to treatment of arterial hypertension [1216]. The proposed personalized approach to health care for this sort of patients will result in a reduction of the perinatal loss and an optimization of intensive unite costs.

Materials and methods

Our studies have been conducted in two groups covering a total of 154 examinees, having age-, BMI-, intervention-scope- and anesthesia-technique-comparable features. All patients have been observed in the early post-surgery period in intensive care unit after the completed caesarean section procedures involving regional anesthesia techniques. In order to find the most descriptive, typical, values in our sorted sampling data set, we have utilized the median, since it has been required to minimize effects by some outliers in the sequence that skew the average of our statistics values [6]. Both groups are homogenous by all analyzed indices that has been established with the use of the variance estimator [7]. The main test group of the patients (n=75, with an average age of 29, an average BMI = 27) has included multifetal pregnancies versus the reference group, which has covered the singleton pregnancies only (n=79, with n average age of 31.5, an average BMI = 29.5). For all the patients, their medical history records have not contained any events of arterial hypertension before their pregnancies. Under the pregnancy conditions, for the patients in both groups, AP systolic values exceeding 140 mm Hg and AP diastolic values exceeding 100 mm Hg have been reported.

The collected data have been automatically analyzed with the use of monitor-equipped system KM-AR-01 DIAMANT V11.0. The respective normal value is taken to be 100%. The norms of the MV and SV parameters have been computed on the basis of the clinical data obtained with utilization of the impedance measuring technique that involves an application of the sigma interval as a limit of allowable measurements for the given device. Based on the clinical data collected, the normal value of MV is 3.1 ± 0.7 l×min-1×m-2, and the normal value of the SV parameter in females reaches 42± 8 ml×m-2. The normal value of TPR is assumed to be 1100 – 1900 din×s.×cm-5. The proper normal values of the extracellular fluid volume have been derived from the formulas by Hidalgo at al. The respective extracellular blood volume = the circulating blood volume x 2,60, where 2.60 is an empirical coefficient proposed by S.Albert. The interstitial fluid volume has been taken to be equal to the difference between the total fluid volume and the extracellular fluid volume [9]. Besides, we have calculated complete sets of the following data with the above monitor-based system 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 systole time (QX), a blood volume parameter (BV) and a homeostasis load index (HL).

Preeclampsia is a severe complication in pregnancy, and it is very often is accompanied by developing polyorganic pathology. When the first symptoms of preeclampsia appear, laboratory testing is mandato-rily required to deliver the biochemistry markers as follows: Alanine Aminotransferase (ALT), Aspartate aminotransferase (AST), Blood urea nitrogen (BUN),

Creatinine, Lactate dehydrogenase (LDH), free He-moglobine and Proteinuria.

Results and discussion

We have completed our studies on central hemodynamics in patients of both groups in the early post-surgery period against developing AH. According to Clinical Guidelines “Hypertension Disorders in Pregnancy and Post-Partum Period. Preeclampsia, Eclampsia. Clinical Recommendations. Treatment procedure records” approved by the Russian National Association of Anesthesiologists and Resuscitators, an abnormal increase in the AP level has been treated as a preeclampsia marker; in connection therewith the patients have received magnesium therapy in accordance with the schedule as follows: intravenous 25% magnesium MgSo4, 4000 mg within 15 minutes, subsequently micro-jet injection of 1000 mg/hr [10].

The data on hemodynamics, reported upon the studies, have shown significant differences in some indicator values. To illustrate this statement, it should be noticed that the MV and SV values: MV = 2.46 l/min×m2, SV = 33.95 ml/m2 recorded in the main test group have markedly exceeded those reported for the reference group: MV = 1.7 l/min×m2, SV = 24.55 ml/m2 (by 44% in case with MV and by 38% in case with SV, respectively). In its turn, the TPR, CBV values and extracellular fluid parameter recorded in the main test group have been found to be lower than those reported in the reference group (TPR is lower by 55%, CVB is lower by 8,5%, and the intracellular fluid volume has a decrease by 10,5%). The ITC parameter is at the lower limit of the norm (74.6) in the main test group that points to the fact that there is no peripheral vascular spasm available. The RVF parameter in the reference group patients exceeds the normal values (1,3) that bears witness to the fact that there is a strong impact of the intratho-racic pressure on the venous return. A brief survey of the compared hemodynamics data are given further herein in Table 1.

Table 1

	"Q QI < T CL E <	. E > c SI	Ё 5>	E Q- о 1— V) ,c			CL CL	H	>		Q	ф 5	T
Main test group	163 /95	2.46	33,95	1936	74,6	1,23	0,12	0,32	0,17	0,26	0,44	0,44	114	107	105	98
Reference group	165 / 107	1.7	24.55	3014	75,9	1,3	0,12	0,3	0,15	0,27	0,43	0,42	100	116	115.5	99

Table 2

	"О с о о Z	СО	го ф СП <	_о X	£	ал о □_	о Е го ф 5	8 О-	с Z) <	с Z) 1— ип <	I ф ф U-	с Z) ±*	с 'ф о IX	о гм Е §
Main test group	75	27	29	110	32	184	4	68	32	36	0,22	375	0.8	5.1
Reference group	79	30	31.5	111	34	177	4,7	75	63	77	0,66	628	4.5	9.9

The recorded significant differences in the lab biochemistry data have engaged our attention, too. The deviations of the most important markers of preeclampsia ALT, ACT and LDH have been reported to be doubled values in the reference group, and the respective values of biochemistry in the main test group have primarily remained within the tolerable range. The proteinurea level in the main test group has reached 0,8 g/l, and the averaged level thereof in the reference group has been reported to be 4,5 g/l that is an indication of involvement of kidneys in pathology process. Intra-abdominal hypertension in the reference group is added to the developing preeclampsia process as mentioned above. In the main test group, the average IAP value has remained at the upper limit of the norm. The major biochemistry markers of preeclampsia are summarized by Table 2 given further herein.

The validity of the survey statistics data on the main test group patients shows that the arterial hypertension pathogenesis in multifetal pregnancies may be related to the stroke volume parameters. As to the reference group, covering the singleton pregnant patients, high TPR levels, indicating vascular spasm, may be treated as the deciding factor for developing AH. The increased averaged values of the extracellular fluid volume, exceeding the norm by 15,5%, in the reference group patients with singleton pregnancies demonstrate that there is an increase in the interstitial fluid volume that may partly explain the high averaged BMI valves of the mentioned patients that is manifested by pronounced edema cases.

Conclusions

• 1.    With respect to developing AH in the main test group covering multifetal pregnancies, attention should be drawn to the fact that there is a relatively high level of the SV (MV) parameter with the normal TPR data. The obtained evidence data show that AH

• 2.    The conducted studies have demonstrated that Arterial Hypertension in the singleton pregnant patients from the reference group develops fully in accordance with the modern concept of the preeclampsia pathogenesis.

• 3.    Administration of the proper hypotensive therapy, considering the pathogenesis aspects in a proper manner, taking into account the systemic hemodynamics data and tissue hydration assessments, can produce a positive outcome in the therapy with minimized medication.

• 4.    The corrective measures to improve the infusion loading on the basis of the tissue hydration assessments are substantiated by the valid pathogenesis assumption.

in multifetal pregnancies may develop without vascular spasm.

Statement on ethical issues

Research involving people and/or animals is in full compliance with current national and international ethical standards.

Conflict of interest

None declared.

Author contributions

The authors read the ICMJE criteria for authorship and approved the final manuscript.