Comparison of maternal third trimester hemodynamics between singleton pregnancy and twin pregnancy
-
Romina-Marina Sima
and
Liana Pleș
Abstract
Objectives
The impedance cardiography (ICG) technique measures the variation of impedance in the thorax due to the physical contractile activity of the heart. Twin pregnancy is characterized by greater maternal hemodynamic changes than a singleton pregnancy.
Methods
In a study on 121 pregnant women in the last trimester we performed ICG, evaluating the following hemodynamic parameters: stroke volume, heart rate, cardiac output, ventricular ejection time, left ventricular ejection time, thoracic impedance, and systemic vascular resistance.
Results
The study included singleton and twin pregnancies. Heart rate values in women with single fetus was lower than in those carrying twins (85 vs. 100 beats/min, p=0.021) as were the stroke volume values (64 vs. 83 mL, p=0.010) and the cardiac output (p<0.0001). Systemic vascular resistance decreased in twin pregnancies compared to singleton pregnancy (p=0.023).
Conclusions
ICG studies are rare, and the validation of their results is an ongoing process. However, the ICG technique is applicable in the third trimester of pregnancy and can yield important information regarding the hemodynamic profile of singleton and twin pregnancies, revealing maternal heart changes specific to twin pregnancies.
Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The study complies with all the relevant national regulations, the tenets of the Helsinki Declaration, and with the authors’ Institutional Ethics Committee guidelines.
References
1. Robson, SC, Hunter, S, Boys, RJ, Dunlop, W. Serial study of factors influencing changes in cardiac output during human pregnancy. Am J Physiol 1989;256:H1060–5. https://doi.org/10.1152/ajpheart.1989.256.4.h1060.Search in Google Scholar
2. Hunter, S, Robson, SC. Adaptation of the maternal heart in pregnancy. Br Heart J 1992;68:540–3. https://doi.org/10.1136/hrt.68.12.540.Search in Google Scholar
3. Mabie, WC, DiSessa, TG, Crocker, LG, Sibai, BM, Arheart, KL. A longitudinal study of cardiac output in normal human pregnancy. Am J Obstet Gynecol 1994;170:849–56. https://doi.org/10.1016/s0002-9378(94)70297-7.Search in Google Scholar
4. Duvekot, JJ, Peeters, LL. Maternal cardiovascular hemodynamic adaptation to pregnancy. Obstet Gynecol Surv 1994;49:S1–14. https://doi.org/10.1097/00006254-199412011-00001.Search in Google Scholar PubMed
5. Kametas, NA, McAuliffe, F, Krampl, E, Chambers, J, Nicolaides, KH. Maternal cardiac function in twin pregnancy. Obstet Gynecol 2003;102:806–15. https://doi.org/10.1097/00006250-200310000-00024.Search in Google Scholar
6. Arya, S, Rao, V, Juvekar, S, Dcruz, AK. Carotid body tumors: objective criteria to predict the Shamblin Group on MR imaging. Am J Neuroradiol 2008;29:1349–54. https://doi.org/10.3174/ajnr.a1092.Search in Google Scholar PubMed PubMed Central
7. Tomsin, K, Mesens, T, Molenberghs, G, Peeters, L, Gyselaers, W. Time interval between maternal electrocardiogram and venous Doppler waves in normal pregnancy and preeclampsia: a pilot study. Ultraschall Med 2012;33:E119–25.10.1055/s-0029-1245698Search in Google Scholar PubMed
8. Tomsin, K, Mesens, T, Molenberghs, G, Gyselaers, W. Diurnal and position-induced variability of impedance cardiography measurements in healthy subjects. Clin Physiol Funct Imag 2011;31:145–50.10.1111/j.1475-097X.2010.00993.xSearch in Google Scholar PubMed
9. Tomsin, K, Mesens, T, Molenberghs, G, Gyselaers, W. Impedance cardiography in uncomplicated pregnancy and pre-eclampsia: a reliability study. J Obstet Gynaecol 2012;32:630–4. https://doi.org/10.3109/01443615.2012.673036.Search in Google Scholar PubMed
10. Parrish, MR, Laye, MR, Wood, T, Keiser, SD, Owens, MY, May, WL, et al.. Impedance cardiography facilitates differentiation of severe and superimposed preeclampsia from other hypertensive disorders. Hypertens Preg 2012;31:327–40. https://doi.org/10.3109/10641955.2010.507850.Search in Google Scholar PubMed
11. da Silva, EG, Carvalhaes, MA, Hirakawa, HS, da Silva, EG, Peracoli, JC. Bioimpedance in pregnant women with preeclampsia. Hypertens Pregnancy 2010;29:357–65. https://doi.org/10.3109/10641950903116523.Search in Google Scholar PubMed
12. Brown, BH, Barber, DC, Morice, AH, Leathard, AD. Cardiac and respiratory related electrical impedance changes in the human thorax. IEEE Trans Biomed Eng 1994;41:729–34. https://doi.org/10.1109/10.310088.Search in Google Scholar PubMed
13. Kubicek, WG, Kottke, J, Ramos, MU, Patterson, RP, Witsoe, DA, Labree, JW, et al.. The Minnesota impedance cardiograph- theory and applications. Biomed Eng 1974;9:410–6.Search in Google Scholar
14. Sramek, BB. Electrical bioimpedance. Med Electron 1983;14:95–103.10.1002/eej.4391030114Search in Google Scholar
15. Muzi, M, Ebert, TJ, Tristani, FE, Jeutter, DC, Barney, JA, Smith, JJ. Determination of cardiac output using ensemble-averaged impedance cardiograms. J Appl Physiol 1985;58:200–5. https://doi.org/10.1152/jappl.1985.58.1.200.Search in Google Scholar PubMed
16. Mallam, M, Rao, KC. Efficient reference-free adaptive artifact cancellers for impedance cardiography based remote health care monitoring systems. SpringerPlus 2016;5:770. https://doi.org/10.1186/s40064-016-2461-5.Search in Google Scholar PubMed PubMed Central
17. Easterling, TR, Benedetti, TJ, Schmucker, BC, Millard, SP. Maternal hemodynamics in normal and preeclamptic pregnancies: a longitudinal study. Obstet Gynecol 1990;76:1061–9.Search in Google Scholar
18. Bamfo, JE, Kametas, NA, Chambers, JB, Nicolaides, KH. Maternal cardiac function in fetal growth-restricted and non-growth-restricted small-for-gestational age pregnancies. Ultrasound Obstet Gynecol 2007;29:51–7. https://doi.org/10.1002/uog.3901.Search in Google Scholar PubMed
19. Duvekot, JJ, Cheriex, EC, Pieters, FA, Peeters, LL. Severely impaired fetal growth is preceded by maternal hemodynamic maladaptation in very early pregnancy. Acta Obstet Gynecol Scand 1995;74:693–7. https://doi.org/10.3109/00016349509021176.Search in Google Scholar PubMed
20. Cohen, SB, Kreiser, D, Erez, I, Kogan, I, Seidman, DS, Schiff, E. Effect of fetal number on maternal serum uric acid concentration. Am J Perinatol 2002;19:291–6. https://doi.org/10.1055/s-2002-34470.Search in Google Scholar PubMed
21. Hsu, CD, Chung, YK, Lee, IS, Chou, K, Copel, JA. Maternal serum uric acid levels in preeclamptic women with multiple gestations. Am J Perinatol 1997;14:613–7. https://doi.org/10.1055/s-2008-1040764.Search in Google Scholar PubMed
22. Meah, VL, Cockcroft, JR, Backx, K, Shave, R, Stohr, EJ. Cardiac output and related haemodynamics during pregnancy: a series of meta-analyses. Heart 2016;102:518–26. https://doi.org/10.1136/heartjnl-2015-308476.Search in Google Scholar PubMed
23. Vartun, A, Flo, K, Wilsgaard, T, Acharya, G. Maternal functional hemodynamics in the second half of pregnancy: a longitudinal study. PloS One 2015;10:e0135300. https://doi.org/10.1371/journal.pone.0135300.Search in Google Scholar PubMed PubMed Central
24. Vartun, A, Flo, K, Widnes, C, Acharya, G. Static and functional hemodynamic profiles of women with abnormal uterine artery Doppler at 22-24 Weeks of Gestation. PLoS One 2016;11:e0157916. https://doi.org/10.1371/journal.pone.0157916.Search in Google Scholar PubMed PubMed Central
25. Morris, R, Sunesara, I, Rush, L, Anderson, B, Blake, PG, Darby, M, et al.. Maternal hemodynamics by thoracic impedance cardiography for normal pregnancy and the postpartum period. Obstet Gynecol 2014;123:318–24. https://doi.org/10.1097/aog.0000000000000104.Search in Google Scholar PubMed
26. Oben, J, Tomsin, K, Mesens, T, Staelens, A, Molenberghs, G, Gyselaers, W. Maternal cardiovascular profiling in the first trimester of pregnancies complicated with gestation-induced hypertension or fetal growth retardation: a pilot study. J Matern Fetal Neonatal Med 2014;27:1646–51. https://doi.org/10.3109/14767058.2013.871700.Search in Google Scholar PubMed
27. Woelkers, DA, Ghashghaei, R, Klisser, K, Archer, T. PP153. Noninvasive assessment of maternal hemodynamic function by electrical impedance cardiography (EIC) and correlation with uterine and umbilical vascular resistance in mid-pregnancy. Pregnancy Hypertens 2012;2:321–2. https://doi.org/10.1016/j.preghy.2012.04.264.Search in Google Scholar PubMed
28. Moertl, MG, Schlembach, D, Papousek, I, Hinghofer-Szalkay, H, Weiss, EM, Lang, U, et al.. Hemodynamic evaluation in pregnancy: limitations of impedance cardiography. Physiol Meas 2012;33:1015–26. https://doi.org/10.1088/0967-3334/33/6/1015.Search in Google Scholar PubMed
29. McIntyre, JP, Ellyett, KM, Mitchell, EA, Quill, GM, Thompson, JM, Stewart, AW, et al.. Validation of thoracic impedance cardiography by echocardiography in healthy late pregnancy. BMC Preg Childbirth 2015;15:70. https://doi.org/10.1186/s12884-015-0504-5.Search in Google Scholar PubMed PubMed Central
30. Orabona, R, Prefumo, F, Zanardini, C, Magri, R, Loardi, C, Cappa, V, et al.. Maternal functional hemodynamics in uncomplicated twin pregnancies: a longitudinal study using impedance cardiography. Acta Obstet Gynecol Scand 2019;98:188–95. https://doi.org/10.1111/aogs.13479.Search in Google Scholar PubMed
31. Lavie, A, Ram, M, Lev, S, Blecher, Y, Amikam, U, Shulman, Y, et al.. Maternal hemodynamics in late gestation and immediate postpartum in singletons vs. twin pregnancies. Arch Gynecol Obstet 2018;297:353–63. https://doi.org/10.1007/s00404-017-4601-8.Search in Google Scholar PubMed
32. Ghi, T, Kuleva, M, Youssef, A, Maroni, E, Nanni, M, Pilu, G, et al.. Maternal cardiac function in complicated twin pregnancy: a longitudinal study. Ultrasound Obstet Gynecol 2011;38:581–5. https://doi.org/10.1002/uog.8915.Search in Google Scholar PubMed
© 2021 Walter de Gruyter GmbH, Berlin/Boston
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Articles in the same Issue
- Frontmatter
- Review
- Neonatal lupus erythematosus – practical guidelines
- Original Articles – Obstetrics
- Optimal timing to screen for asymptomatic bacteriuria during pregnancy: first vs. second trimester
- Amniotic fluid embolism – implementation of international diagnosis criteria and subsequent pregnancy recurrence risk
- COL1A1, COL4A3, TIMP2 and TGFB1 polymorphisms in cervical insufficiency
- Pregnancy and neonatal outcomes of twin pregnancies – the role of maternal age
- Comparison of maternal third trimester hemodynamics between singleton pregnancy and twin pregnancy
- Daily monitoring of vaginal interleukin 6 as a predictor of intraamniotic inflammation after preterm premature rupture of membranes – a new method of sampling studied in a prospective multicenter trial
- Association between the number of pulls and adverse neonatal/maternal outcomes in vacuum-assisted delivery
- Original Articles – Fetus
- The effect of nuchal umbilical cord on fetal cardiac and cerebral circulation-cross-sectional study
- Recognition of facial expression of fetuses by artificial intelligence (AI)
- Correlation of first-trimester thymus size with chromosomal anomalies
- Fetal intracranial structures: differences in size according to sex
- Original Articles – Neonates
- Antenatal care and perinatal outcomes of asylum seeking women and their infants
- Maturation of the cardiac autonomic regulation system, as function of gestational age in a cohort of low risk preterm infants born between 28 and 32 weeks of gestation
- Short Communication
- The impact of transfers from neonatal intensive care to paediatric intensive care
- Letter to the Editor
- Differential microRNA expression in placentas of small-for-gestational age neonates with and without exposure to poor maternal gestational weight gain
