Abstract
Introduction: Hypertensive disorders of pregnancy (HDP) and fetal growth restriction (FGR) represent two of the main pregnancy complications and are associated with an increased risk for the mother and her child to develop long term health complications. There is not yet a complete understanding of the physiopathology of these disorders. Historically, the placenta was the major focus of research to understand HDP and FGR. However, there is now a growing body of evidence supporting the significant contribution of the maternal cardiovascular system in the origins of these diseases. In this regard,maternal and fetal ultrasound and non-invasive devices have become important tools in the study of maternal hemodynamics and fetal growth.Objective and hypothesis: The overall objective of this research is to characterise and evaluate the feasibility of a combination of Ophthalmic artery Doppler and maternal cardiovascular system assessment for the study of HDP and FGR, and in consequence, improve diagnostic capability of these pathologies. I hypothesise that they will provide a useful tool for diagnosis and characterization of HDP and FGR.
Methods: A prospective observational cohort study was conducted in a tertiary hospital between December 2020 to December 2021.Ophthalmic and uterine artery Doppler along with maternal hemodynamics and pulse wave analysis were assessed in 168 women with singleton pregnancies at 28 to 40 weeks gestation. Analysis of 10 maternal plasma biomarkers was also performed in 61 patients. The total cohort was sub-divided into women with hypertension and/or delivering a small baby and compared to nonhypertensive and non-growth restricted controls.
Results: Complicated pregnancies (HDP/FGR) had an increase in systemic vascular resistance and worse hemodynamic profile when compared with controls. Only one Ophthalmic artery Doppler parameter (peak systolic velocity ratio, PSVR) was significantly higher in both hypertensive group and in normotensive individuals with a small for gestational age neonate.
Although the Doppler study of the Ophthalmic artery was well accepted by the patients and a fast and easy method, maternal cardiovascular assessment with non-invasive devices presented technical difficulties that caused the exclusion of nearly one third of the cohort.
Biomarkers of placental dysfunction were significantly different between the study groups, however no correlation was found between maternal blood levels of biomarkers and Ophthalmic artery Doppler measurements.
Discussion: Ophthalmic artery Doppler assessment could be a useful tool to use in daily clinical practice to improve diagnostic capability of hypertensive disorders or fetal growth restriction during pregnancy.
| Date of Award | 2023 |
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| Original language | English |
| Awarding Institution |
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| Sponsors | European Union |
| Supervisor | Colin Murdoch (Supervisor), Asma Khalil (Supervisor) & Faisel Khan (Supervisor) |