![]() Another data from Doppler waveform analysis is the peak systolic velocity ( S) to peak diastolic velocity ( D) ratio ( S: D ratio) which seems to be the most commonly used due to its simplicity. Increased umbilical artery pulsatility index is commonly associated with adverse perinatal outcome (Yoon et al. It is the most dependable marker of the degree of resistance in a specific blood vessel. ![]() Pulsatility index which represents the variability of the flow velocity in a vessel, equal to the difference between the peak systolic (S) and minimum diastolic (D) velocities divided by the mean velocity during the cardiac cycle. Furthermore, the presence of abnormal flow-velocity waveforms is frequently associated with impaired oxygen and substrate accessibility to the fetus, fetal growth retardation, and high maternal and perinatal mortality (Schneider and Schulman 1995). These abnormalities are in charge of endothelial dysfunction (Roberts 1998), with vascular hyperpermeability, and hypertension.ĭoppler velocimetry provides a direct exhibition of this process, because it may detect the persistence of high resistance in utero-placental vessels that are suggestive of a reduced placental and fetal perfusion (Neilson and Alfirevic 1998). In addition, oxidative stress actuates release of substances into the maternal circulation such as free radicals, cytokines, and vascular endothelial growth factor 1. Increased uterine arterial resistance triggers higher sensitivity to vasoconstriction and subsequently chronic placental ischemia and oxidative stress, which cause intrauterine fetal growth retardation (FGR) and death. This might be because of the nitric oxide pathway that controls the vascular tone. Preeclampsia has a complex pathophysiology the essential etiopathogenesis being played by the placenta (Roberts and Cooper 2001), as defective invasion of the spiral arteries by cytotrophoblast cells is detected during preeclampsia (Fisher et al. Preeclampsia is further sub classified into, mild and severe, early onset and late-onset syndrome (American College of Obstetricians and Gynecologists Hypertension in Pregnancy 2013). Albeit most influenced pregnancies convey at term or close term with adverse maternal and fetal outcome, these pregnancies are at expanded danger for maternal and fetal mortality or morbidity worldwide (Hutcheon et al. Preeclampsia (PE) is a multi-system disorder of widespread vascular endothelial malfunction and vasospasm, characterized by new onset of hypertension and either proteinuria or end-organ dysfunction or both after 20 weeks of gestation in a formerly normotensive woman. Fetal heart rate did not change significantly after treatment in both groups. Both drugs are reassuring as they are not related to any significant changes in fetoplacental circulation. We concluded that both labetalol and hydralazine intravenous infusion regimens are well tolerated and effective in controlling severe hypertension in pregnant women with severe preeclampsia in combination with magnesium sulfate. No significant changes in the umbilical and middle cerebral arteries pulsatility index, resistance index, and systolic/diastolic ratio before and after treatment were noted in both groups. ResultsĪ significant reduction of the maternal blood pressure was achieved in both groups, with significant reduction of maternal heart rate in group A. Blood pressure, maternal heart rate, fetal heart rate, and Doppler ultrasound indices of umbilical and middle cerebral arteries were studied before and after treatment. ![]() Group A: 25 patients received labetalol with magnesium sulfate, and group B: 25 patients received hydralazine with magnesium sulfate by intravenous infusion in an escalating manner according to response until the target blood pressure ≤ 145/95 mmHg was achieved. In this prospective comparative randomized study, a total of 50 pregnant women in severe preeclampsia with gestational age ≥ 32 weeks were randomly recruited into two groups. The aim of this study was to compare the effectiveness of two different protocols, labetalol with magnesium sulfate versus hydralazine with magnesium sulfate intravenous infusion with respect to their impact on maternal and fetal hemodynamics in severe preeclampsia. ![]()
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