Maternal diastolic function in asymptomatic pregnant women with bilateral notching of the uterine artery waveform at 24 weeks' gestation: a pilot study

Objective To study second-trimester maternal cardiac adaptation in asymptom atic patients at risk, on the basis of abnormal uterine artery Doppler, for the development of gestational hypertension or having a small-for-gestatio nal age fetus. Fetal and maternal outcomes were verified at the end of preg nancy. Methods Thirty-six normotensive women with abnormal uterine artery waveform s underwent maternal echocardiographic examination at 24 weeks' gestation. Results Twenty-one women (58.3%) subsequently showed normal outcome; 12 pat ients developed gestational hypertension (33.3%) and three (8.3%) had small -for-gestational age newborns. Left ventricular outflow tract, left ventric ular diastolic dimensions and atrial and ventricular function were signific antly lower in the pathological outcome group. Diastolic function parameter s were significantly different between the two groups: peak mitral E-wave a nd A-wave and A-wave duration showed lower values in the pathological outco me group. Isovolumetric relaxation time of the left ventricle was significa ntly longer in the pathological outcome group. The prevalence of an altered geometric pattern was 14.3% (3/21) in the normal and 80% (12/15) in the pa thological outcome groups (P < 0.001). Conclusions Women who subsequently develop a complication of Pregnancy tend to display abnormal cardiac adaptation. An abnormal placentation process, expressed by an elevated resistance index and the presence of notches in th e uterine artery waveform, are likely to cause an adaptative mechanism invo lving the whole cardiovascular system. A pathological outcome of pregnancy is associated with the failure of this process.