The relevance of maternal cardiovascular situation before labor in the
outcome of birth: an observational study.
Abstract
Objective: To assess if maternal hemodynamics assessment in healthy
women, at the end of pregnancy, before the labor onset, could predict
the development of complications during labor. Design: Prospective
observational study. Settings: Department of Obstetrics and Gynecology
of Casilino Hospital in Rome, University of Tor Vergata. (September 2016
- December 2017) Population: 395 healthy women not in labor at term of
pregnancy. Methods: Univariate and multivariate binary logistic
regression analysis of association between hemodynamic variables and
delivery complications, adjusted for significant prenatal variables.
Main Outcome Measures: ORs for hemodynamic parameters and identification
of independent risk factors in the prediction of adverse outcome.
Results: we observed adverse outcomes in 45 patients (11.39%). Women
who developed maternal or fetal complications during delivery were
mainly nulliparous (93.33% vs 72.29%, p<0.01), showed higher
values of systemic vascular resistances (SVR) (1368.32±228.50. vs
1260.34±271.94 d.s.cm-5, p=0.01) and lower values of cardiac output (CO)
(5.38±0.77 vs 5.80±1.20 L/min, p=0.02), compared with women who did not
develop complications. ROC curve analysis identified the best cut-offs
to predict complicated delivery: SVR > 1135 d.s.cm-5 (OR
7.87, CI 95% 2.39-25.92, p<0.01), CO ≤5.6 L/min (OR 2.38; CI
95% 1.21-4.68, p<0.01), diastolic blood pressure
> 79 mmHg (OR 1.89, CI 95%.1.01-3.54, p=0.04),
Potential-Kinetic energy Ratio >22 (OR 2.32, 0.95-5.64,
p=0.04). The multivariate logistic regression analysis identified as
independent predictors of complication the SVR, Flow Time corrected and
parity. Conclusion: the assessment of maternal hemodynamics at term of
pregnancy could increase the capacity to predict patients at risk during
labor.