83 The variability of the maternal heart rate during labor of pregnant women with pre-eclânpsia and normotensive pregnant women and their correlation with maternal and perinatal outcomes.: Preeclampsia in low and middle income countries

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• 作者：Regina Coeli Marques de Carvalho ; Ruy Silveira Moraes Filho
• 关键词：Keywords ; Preeclampsia ; Heart rate variability ; Gestational age
• 刊名：Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：6
• 期：3
• 页码：217-218
• 全文大小：74 K

文摘

The association of autonomic modulation with maternal and perinatal outcomes was evaluated in preeclamptic women and in normotensive pregnancy women. Studied groups were matched for important determinants of HRV.

ec_2">Methods

This is a prospective cross-sectional study evaluated the HRV in 36 pregnant women with gestational age over 28th weeks. All women had single fetus gestation and did not present any systemic disease prior pregnancy or were not using any type of medication during pregnancy. Seventeen women had preeclampsia (PE) and 19 normotensive pregnant (NP) women. Pregnant women with PE were kept in absolute rest in the left lateral decubitus and submitted to eclampsia prophylaxis with 6 g of magnesium sulfate at 50%, followed by 2 g/h continuous infusion. NP women did not receive any medication. During rest in the left lateral position, in the absence of uterine contractions or pain, patients were monitored Holter ECG recordings used for HRV analysis for 20 min. Natural logarithm (Ln) of mean NN (LnMean NN ), the the standard deviation of NN intervals (LnSDNN), the square root of the mean squared differences of successive NN intervals (LnRMSSD), low frequency (LnLF) and high frequency (LnHF) and LH/HF ration were used to evaluate HRV. Neonatal outcomes were evaluated immediately after birth being registered weight, Apgar index at 6302367&_mathId=si1.gif&_user=111111111&_pii=S2210778916302367&_rdoc=1&_issn=22107789&md5=335bb74283d7523af054e457039e5114" title="Click to view the MathML source">1°$1°$ and 6302367&_mathId=si2.gif&_user=111111111&_pii=S2210778916302367&_rdoc=1&_issn=22107789&md5=77d649af33dffe27935ea6e4c9b0a534" title="Click to view the MathML source">5°$5°$ min and gestational age calculated by Capurro method. To compare the variables between groups we used ANOVA (ANOVA One Way) and for comparison post hoc Tukey test. Multivariable regression was performed using SPSS (Statistical Package for Social Sciences, Inc., Chicago, IL) version 16.0 for Windows. Descriptive data were presented as mean, SD and median. Student t test , Mann–Whitney and Chi-square test were using where apropriated. P 6302367&_mathId=si3.gif&_user=111111111&_pii=S2210778916302367&_rdoc=1&_issn=22107789&md5=daf5e5daf3e93967a4aa040ff6c35bd1" title="Click to view the MathML source"><$<$ 0.05 was considered significant.

ec_3">Results

The comparative analysis of HRV demonstrated that PE women had significantly lower LnSDNN (25,93 ms vs. 41,72 ms, P 6302367&_mathId=si3.gif&_user=111111111&_pii=S2210778916302367&_rdoc=1&_issn=22107789&md5=daf5e5daf3e93967a4aa040ff6c35bd1" title="Click to view the MathML source"><$<$ .05) and LnRMSSD (13,25 ms vs. 24,76 ms, P 6302367&_mathId=si3.gif&_user=111111111&_pii=S2210778916302367&_rdoc=1&_issn=22107789&md5=daf5e5daf3e93967a4aa040ff6c35bd1" title="Click to view the MathML source"><$<$ 0.05). The LnSDNN was inversely correlated with the systolic blood pressure (SPB) (r-0.36, P 6302367&_mathId=si3.gif&_user=111111111&_pii=S2210778916302367&_rdoc=1&_issn=22107789&md5=daf5e5daf3e93967a4aa040ff6c35bd1" title="Click to view the MathML source"><$<$ .05) and diastolic blood pressure (DPB) (r-0,36, P 6302367&_mathId=si3.gif&_user=111111111&_pii=S2210778916302367&_rdoc=1&_issn=22107789&md5=daf5e5daf3e93967a4aa040ff6c35bd1" title="Click to view the MathML source"><$<$ .05) and directly correlated with gestational age (r 0.38, P 6302367&_mathId=si3.gif&_user=111111111&_pii=S2210778916302367&_rdoc=1&_issn=22107789&md5=daf5e5daf3e93967a4aa040ff6c35bd1" title="Click to view the MathML source"><$<$ .05). The LnRMSSD presented a positive correlation with gestational age (r 0.39, P 6302367&_mathId=si3.gif&_user=111111111&_pii=S2210778916302367&_rdoc=1&_issn=22107789&md5=daf5e5daf3e93967a4aa040ff6c35bd1" title="Click to view the MathML source"><$<$ .05). LF/HF was elevated in two groups (PE 7,5; NP 2,97). LnHF was directly correlated with gestational age (r 0.34, P 6302367&_mathId=si3.gif&_user=111111111&_pii=S2210778916302367&_rdoc=1&_issn=22107789&md5=daf5e5daf3e93967a4aa040ff6c35bd1" title="Click to view the MathML source"><$<$ .05). PE women had increased SBP (164,71 mmHg vs. 104,74 mmHg, P 6302367&_mathId=si3.gif&_user=111111111&_pii=S2210778916302367&_rdoc=1&_issn=22107789&md5=daf5e5daf3e93967a4aa040ff6c35bd1" title="Click to view the MathML source"><$<$ .001) and DBP(109,41 mmHg vs. 67,89 mmHg,P 6302367&_mathId=si3.gif&_user=111111111&_pii=S2210778916302367&_rdoc=1&_issn=22107789&md5=daf5e5daf3e93967a4aa040ff6c35bd1" title="Click to view the MathML source"><$<$ .001); newborns had lower weight (2694,67 g vs. 2937,89 g, P 6302367&_mathId=si3.gif&_user=111111111&_pii=S2210778916302367&_rdoc=1&_issn=22107789&md5=daf5e5daf3e93967a4aa040ff6c35bd1" title="Click to view the MathML source"><$<$ .05), lower Apgar Score in the 6302367&_mathId=si1.gif&_user=111111111&_pii=S2210778916302367&_rdoc=1&_issn=22107789&md5=335bb74283d7523af054e457039e5114" title="Click to view the MathML source">1°$1°$ min (7,0 vs. 8,0, P 6302367&_mathId=si3.gif&_user=111111111&_pii=S2210778916302367&_rdoc=1&_issn=22107789&md5=daf5e5daf3e93967a4aa040ff6c35bd1" title="Click to view the MathML source"><$<$ .05) and in the 6302367&_mathId=si2.gif&_user=111111111&_pii=S2210778916302367&_rdoc=1&_issn=22107789&md5=77d649af33dffe27935ea6e4c9b0a534" title="Click to view the MathML source">5°$5°$ min (9,0 vs. 10, P 6302367&_mathId=si3.gif&_user=111111111&_pii=S2210778916302367&_rdoc=1&_issn=22107789&md5=daf5e5daf3e93967a4aa040ff6c35bd1" title="Click to view the MathML source"><$<$ .05). Three neonates from PE women were admitted to the neonatal ICU and one of them dies.

ec_4">Conclusion

The study demonstrated that PE women have lower autonomic modulation by HRFcompared to NP women. This reduction is association to higher maternal blood pressure and lower gestacional age.