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Maternal cardiac output in early labour: a possible link with obstetrics risks?

Herbert Valensise, Grazia Maria Tiralongo, Ilaria Pisani, Daniele Farsetti, Damiano Lo Presti, Giulia Gagliardi, Ripalta Marica Basile, Gian Paolo Novelli, Barbara Vasapollo

Published: Ultrasound Obstet Gynecol. 2017 Mar 10. doi: 10.1002/uog.17454

Materials and methods: a prospective observational study was conducted on 77 pregnant women at term with diagnosis of initial labour. We obtained haemodynamic indices using the USCOM® system. Patients were followed until the end of labour to check for foetal–neonatal and maternal outcomes.

Results: Eleven patients (14.3%) showed a complication during labour: 7 foetal distress and 4 maternal complications (post-partum haemorrhage and/or uterine atony). Patients with complications during labour showed lower values of cardiac output (5.6±1.0 versus 6.7±1.3 L/min, p=0.01), cardiac index (3.1±0.6 versus 3.5±0.7L/min/m2, p=0.04), and
higher total vascular resistance (1195.3±205.3 versus 1017.8±225.6 dyne.sec.cm-5, p=0.017), compared to uncomplicated patients. The Roc curve analysis showed a cut-off for cardiac output≤5.8 L/min (sensitivity 81.8%, specificity 69.7%), for cardiac index ≤2.9 L/min/m2 (sensitivity 63.6%, specificity 76.9%), and total vascular resistance
>1069 dyne.sec.cm-5 (sensitivity 81.8%, specificity 63.6%).

Conclusions: the study of maternal cardiovascular adaptation at the end of pregnancy might identify patients at risk during labour. In particular a low cardiac output and high total vascular resistance are associated to higher risk of foetal distress or maternal complications.