10.25419/rcsi.10802309.v1 Cathy Monteith Cathy Monteith 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). Royal College of Surgeons in Ireland 2019 Haemodynamics Pregnancy Preeclampsia Fetal Growth Restriction Hypertension. 2019-11-23 10:34:55 Thesis https://repository.rcsi.com/articles/thesis/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_/10802309 <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>