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2022, Number 6

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Med Crit 2022; 36 (6)

Evaluation of cerebral hemodynamics by transcranial Doppler ultrasound in patients with preeclampsia/eclampsia

Ortiz-Larios F, Aguirre-Ávalos G, Mijangos-Méndez JC, Ibarra-Estrada M

Language: Spanish
References: 29
Page: 363-370
PDF size: 267.23 Kb.


ABSTRACT

Introduction: preeclampsia, the most common complication of pregnancy, leads to > 76,000 maternal deaths annually, mainly due to neurological complications. An alteration in cerebral vasoregulation is key in the pathogenesis of these complications. Transcranial Doppler Ultrasound (TCD) evaluates the flow of the main cerebral arteries and could help to predict the development of preeclampsia/eclampsia and its complications. Objective: to determine the most frequent cerebral blood flow changes in preeclampsia/eclampsia. Material and methods: we prospectively analyzed by TCD patients with preeclampsia/eclampsia on admission to the ICU. Results: Eighty patients, 50 with preeclampsia/eclampsia and 30 healthy pregnant women, age 23 ± 6.7, 50% primigravida, 34.8 ± 4.3 weeks gestation. Cerebral perfusion pressure of right middle cerebral arteries > 74 mmHg (sensitivity 0.88, specificity 0.86, AUC 0.92) and right anterior cerebral arteries > 69 mmHg (sensitivity 0.89, specificity 0.93, AUC 0.92), had the highest association with preeclampsia/eclampsia. Posterior cerebral artery blood flow index had significant association with eclampsia (p = 0.02), AUC 0.695 (p = 0.009), with a cut-off ≥ 34.6 cm/s (sensitivity 1.0, specificity 0.43, OR 26). Conclusions: a generalized increase in perfusion pressure is the most common finding in preeclampsia/eclampsia. Hyper flow in the posterior cerebral arteries may predict severe neurological complications.


REFERENCES

  1. Poon LC, Shennan A, Hyett JA, Kapur A, Hadar E, Divakar H, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention. Int J Gynecol Obstet. 2019;145(S1):1-33.

  2. Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension. 2018;72(1):24-43.

  3. Abalos E, Cuesta C, Carroli G, Qureshi Z, Widmer M, Vogel JP, et al. Pre-eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG. 2014;121 Suppl 1:14-24.

  4. Guntupalli KK, Hall N, Karnad DR, Bandi V, Belfort M. Critical illness in pregnancy: Part I: An approach to a pregnant patient in the ICU and common obstetric disorders. Chest. 2015;148(4):1093-1104.

  5. MacKay AP, Berg CJ, Atrash HK. Pregnancy-related mortality from preeclampsia and eclampsia. Obstet Gynecol. 2001;97(4):533-538.

  6. Poston L, McCarthy AL, Ritter JM. Control of vascular resistance in the maternal and feto-placental arterial beds. Pharmacol Ther. 1995;65(2):215-239.

  7. Jones-Muhammad M, Warrington JP. Cerebral blood flow regulation in pregnancy, hypertension, and hypertensive disorders of pregnancy. Brain Sci. 2019;9(9):224.

  8. van Veen TR, Panerai RB, Haeri S, Singh J, Adusumalli JA, Zeeman GG, et al. Cerebral autoregulation in different hypertensive disorders of pregnancy. Am J Obstet Gynecol. 2015;212(4):513.e1-7.

  9. Acerbi G, Scassa C, Pieri A, Liberti G, Iorio A, Caciagli P. Transcranial Doppler examination technique. Ultrasonica. 1988;3:122-125.

  10. Aaslid R, Lundar T, Lindegaard KF, Nornes H. Estimation of cerebral perfusion pressure from arterial blood pressure and transcranial Doppler recordings. In: Miller JD, Teasdale GM, Rowan JO, Galbraith SL, Mendelow AD, eds. Intracranial pressure VI. New York, NY: Springer-Verlag; 1993. pp. 226-229.

  11. Czosnyka M, Matta BF, Smielewski P, Kirkpatrick PJ, Pickard JD. Cerebral perfusion pressure in head-injured patients: A noninvasive assessment using transcranial Doppler ultrasonography. J Neurosurg. 1998;88(5):802-808.

  12. Williams K, Wilson S. Maternal middle cerebral artery blood flow velocity variation with gestational age. Obstet Gynecol. 1994;84(3):445-448.

  13. Riskin-Mashiah S, Belfort MA, Saade GR, Herd JA. Transcranial Doppler measurement of cerebral velocity indices as a predictor of preeclampsia. Am J Obstet Gynecol. 2002;187(6):1667-1672.

  14. Butalia S, Audibert F, Coté AM, Firoz T, Logan AG, Magee LA, et al. Hypertension Canada's 2018 guidelines for the management of hypertension in pregnancy. Can J Cardiol. 2018;34(5):526-531.

  15. Riskin-Mashiah S, Belfort MA. Preeclampsia is associated with global cerebral hemodynamic changes. J Soc Gynecol Investig. 2005;12(4):253-256.

  16. Marsál K. Association of cerebral perfusion pressure with headache in women with pre-eclampsia. BJOG. 2001;108(1):126-127.

  17. van Veen TR, Panerai RB, Haeri S, van den Berg PP, Zeeman GG, Belfort MA. Changes in cerebral autoregulation in the second half of pregnancy and compared to non-pregnant controls. Pregnancy Hypertens. 2016;6(4):380-383.

  18. Belfort MA, Tooke-Miller C, Allen JC, Varner MA, Grunewald C, Nisell H, et al. Pregnant women with chronic hypertension and superimposed preeclampsia have high cerebral perfusion pressure. Br J Obstet Gynaecol. 2001;108(11):1141-1147.

  19. Mijangos-Méndez JC, Aguirre-Avalos G, Corona-Jimenez F, Ortiz-Macias IX, López-Pulgarín JA, et al. Cerebral Vasospasm in cortical blindness associated with preeclamsia/eclampsia syndrome. Gynecol Obstet. 2017;7:454.

  20. Belfort MA, Tooke-Miller C, Allen JC Jr, Dizon-Townson D, Varner MA. Labetalol decreases cerebral perfusion pressure without negatively affecting cerebral blood flow in hypertensive gravidas. Hypertens Pregnancy. 2002;21(3):185-197.

  21. Belfort M, Van Veen T, White GL, Kofford S, Allred J, Postma I, et al. Low maternal middle cerebral artery Doppler resistance indices can predict future development of pre-eclampsia. Ultrasound Obstet Gynecol. 2012;40(4):406-411.

  22. Belfort MA, Varner MW, Dizon-Townson DS, Grunewald C, Nisell H. Cerebral perfusion pressure, and not cerebral blood flow, may be the critical determinant of intracranial injury in preeclampsia: A new hypothesis. Am J Obstet Gynecol. 2002;187(3):626-634.

  23. Lee YJ, Lee S, Jo HN, Kim JM, Kwon BS, Joo JK, et al. Alterations in transcranial Doppler indices of pregnant women with complicated preeclampsia. Pregnancy Hypertens. 2019;15:189-194.

  24. Gierthmühlen J, Allardt A, Sawade M, Wasner G, Baron R. Role of sympathetic nervous system in activity-induced cerebral perfusion. J Neurol. 2010;257(11):1798-1805.

  25. Janzarik WG, Jacob J, Katagis E, Markfeld-Erol F, Sommerlade L, Wuttke M, et al. Preeclampsia postpartum: Impairment of cerebral autoregulation and reversible cerebral hyperperfusion. Pregnancy Hypertens. 2019;17:121-126.

  26. Chhabra S, Tyagi S, Bhavani M, Gosawi M. Late postpartum eclampsia. J Obstet Gynaecol (Lahore). 2012;32(3):264-266.

  27. Brewer J, Owens MY, Wallace K, Reeves AA, Morris R, Khan M, et al. Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia. Am J Obstet Gynecol. 2013;208(6):468.e1-6.

  28. Garg R, Kumar N, Malhotra H. Posterior reversible encephalopathy syndrome in eclampsia. Neurol India. 2018;66(5):1316-1323.

  29. Ghimire S. Eclampsia: feto-maternal outcomes in a tertiary care centre in eastern Nepal. JNMA J Nepal Med Assoc. 2016;54(201):24-28.




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