The effect of acute volume expansion and vasodilatation with verapamil on uterine and umbilical artery Doppler indices in severe preeclampsia

Preeclampsia is associated with increased peripheral, uterine, and umbilical artery resistance. Acute blood pressure reduction may result in shunting of blood and sudden fetal distress. We therefore investigated the effects of volume expansion and verapamil therapy on uteroplacental and umbilical re...

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Bibliographic Details
Published in:	Journal of clinical ultrasound Vol. 22; no. 5; p. 317
Main Authors:	Belfort, M, Akovic, K, Anthony, J, Saade, G, Kirshon, B, Moise, Jr, K
Format:	Journal Article
Language:	English
Published:	United States 01-06-1994
Subjects:	Adult Arteries Blood Flow Velocity - drug effects Blood Flow Velocity - physiology Blood Pressure - drug effects Blood Pressure - physiology Blood Volume - drug effects Blood Volume - physiology Cardiac Output - drug effects Cardiac Output - physiology Dextrans - therapeutic use Female Fetus - drug effects Humans Infant, Newborn Oxygen Consumption - drug effects Oxygen Consumption - physiology Placenta - blood supply Plasma Substitutes - therapeutic use Pre-Eclampsia - diagnostic imaging Pre-Eclampsia - therapy Pregnancy Prospective Studies Pulmonary Wedge Pressure - drug effects Pulmonary Wedge Pressure - physiology Regional Blood Flow - drug effects Regional Blood Flow - physiology Ultrasonography Umbilical Arteries - diagnostic imaging Umbilical Arteries - drug effects Umbilical Arteries - physiology Uterus - blood supply Vascular Resistance - drug effects Vascular Resistance - physiology Vasodilation - physiology Verapamil - therapeutic use
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Summary:	Preeclampsia is associated with increased peripheral, uterine, and umbilical artery resistance. Acute blood pressure reduction may result in shunting of blood and sudden fetal distress. We therefore investigated the effects of volume expansion and verapamil therapy on uteroplacental and umbilical resistance during treatment of preeclampsia. Five severe preeclamptics underwent volume expansion and subsequent vasodilatation with an infusion of verapamil. Invasive hemodynamic monitoring and Doppler ultrasonography were used to study changes in maternal, uterine, and umbilical hemodynamics. Volume expansion and subsequent verapamil therapy was associated with significant changes in maternal hemodynamics without significant change in uteroplacental or umbilical resistance. Uterine artery waveform changes were noted, with disappearance of notching in some cases. Volume expansion and verapamil therapy effectively reduces maternal blood pressure in preeclampsia, without adversely affecting uteroplacental or umbilical artery resistance. Uterine artery waveform changes may be associated with improved fetal outcome.
ISSN:	0091-2751
DOI:	10.1002/jcu.1870220506