Daniela Casati

Objective: To explore maternal cardiac deceleration capacity (DC), a marker of autonomic function derived from heart rate variability analysis, in pregnancies complicated by intrauterine growth restriction (IUGR) and hypertensive disorders of pregnancy (HDP) associated to IUGR (HDP-IUGR) or to appropriate for gestational age fetuses (HDP-AGAf). Methods: Single-center case-control study conducted at Buzzi Children’s Hospital, Milan. Maternal electrocardiograms were analyzed by Phase-Rectified Signal Averaging (PRSA) to obtain cardiac beat-to-beat DC in women with: HDP-IUGR; HDP-AGAf; severe-IUGR; mild- IUGR; uncomplicated pregnancies. IUGR was defined as abdominal circumference Results: Two- hundred and sixty-nine women recruited. Women with HDP-IUGR (n = 35) showed significantly higher cardiac DC compared both to controls (n = 141) (p = 0.003) and women with HDP-AGAf (n = 18) (p = 0.01). Women with severe-IUGR (n = 14) showed significantly higher DC than controls (p = 0.01). Women with mild-IUGR (n = 61) as with HDPAGAf showed no differences in DC compared to controls (both p = 0.3). Conclusion: Elevated cardiac deceleration capacity proves autonomic alterations in mothers with severe placental failure. We present a new bedside approach to explore maternal autonomic cardiovascular regulation that might reflect the severity of placental vascular insufficiency.

Aims: To compare maternal hemodynamic profile during pregnancy and at 6–12 months after delivery in pregnancies with different HDP phenotypes or severe IUGR. Methods: We enrolled patients between 24 and 38 weeks of gestation: HDP with appropriate for gestational age foetuses (HDP-AGAf), HDP with IUGR (HDP-IUGR), severe IUGR and Controls matched for gestational age. Severe IUGR was defined as abdominal circumference Results: Maternal heart rate and CO were reduced and TVR increased during pregnancy, and did not change significantly at follow-up in the 10 HDP-IUGR and in the 8 severe IUGR recruited. Heart rate, CO and TVR in the 8 HDP-AGAf were similar to Controls both during pregnancy and at follow-up except for a significantly increased MAP and a reduced E’/A’ ratio. Discussion: Maternal hemodynamic changes at 6–12 months postpartum varies according to different physio-pathological phenotypes of maternal HDP and placental damage.

Aims: To investigate maternal hemodynamic status in pregnancies complicated by HDP and/or IUGR and by severe IUGR without HDP. Methods: In this prospective study we enrolled pregnant women between 24 and 38 weeks divided in: HDP with appropriate for gestational age fetuses (HDP-AGA), HDP associated with IUGR (HDPIUGR), severe IUGR and a group of controls matched for gestational age. Severe IUGR was defined as abdominal circumference Results: We recruited 16 HDP-AGA, 20 HDP-IUGR, 14 severe IUGR and 19 controls. Heart rate (HR) and CO were significantly decreased and TVR significantly increased in HDP-IUGR and severe IUGR compared to controls. HDP-AGA shows a significantly decrease in E0/A0 compared to all other groups. Discussion: Hemodynamic parameters have different patterns in pregnancies complicated by HDP and/or IUGR. Severe IUGR and HDP-IUGR show a similar profile, despite the absence of abnormal blood pressure in the former group. HDP-AGA, that in our data showed a maternal predisposition to metabolic syndrome, has a different hemodynamic profile, with a predominant diastolic dysfunction respect to the group of HDP-IUGR.

Couplings between uterine contractions (UC) and fetal heart rate (fHR) provide important information on fetal condition during labor. At present, couplings between UC and fHR are assessed by visual analysis and interpretation of cardiotocography. The application of computerized approaches is restricted due to the non-stationarity of the signal, missing data and noise, typical for fHR. Herein, we propose a novel approach to assess couplings between UC and fHR, based on a signal-processing algorithm termed bivariate phase-rectified signal averaging (BPRSA). Electrohysterogram (EHG) and fetal electrocardiogram (fECG) were recorded non-invasively by a trans-abdominal device in 73 women at term with uneventful singleton pregnancy during the first stage of labor. Coupling between UC and fHR was analyzed by BPRSA and by conventional cross power spectral density analysis (CPSD). For both methods, degree of coupling was assessed by the maximum coefficient of coherence (C_PRSA and C_RAW, respectively) in the UC frequency domain. Coherence values greater than 0.50 were consider significant. C_PRSA and C_RAW were compared by Wilcoxon test. At visual inspection BPRSA analysis identified coupled periodicities in 86.3% (63/73) of the cases. 11/73 (15%) cases were excluded from further analysis because no 30 minutes of fECG recording without signal loss was available for spectral analysis. Significant coupling was found in 90.3% (56/62) of the cases analyzed by BPRSA, and in 24.2% (15/62) of the cases analyzed by CPSD, respectively. The difference between median value of C_PRSA and C_RAW was highly significant (0.79 [IQR 0.69–0.90] and 0.29 [IQR 0.17–0.47], respectively; p<0.0001). BPRSA is a novel computer-based approach that can be reliably applied to trans-abdominally acquired EHG-fECG. It allows the assessment of correlations between UC and fHR patterns in the majority of labors, overcoming the limitations of non-stationarity and artifacts. Compared to standard techniques of cross-correlations, such as CPSD, BPRSA is significantly superior.