Study On Using Pulse Wave For Prediction Of Hypertension Disorder Complicating Pregnancy And Perinatal Outcome

Objective To examine the dynamic trend of pregnant women(pulse wave for short) in the second trimester and later trimester, including systolic blood pressure (SBS), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), total peripheral resistance (TPR), K, mean residence time (Tm) and blood viscosity (V). To investigate the value of predicting hypertension disorder complicating pregnancy and perinatal outcome by the pulse wave. Methods We registered 20-24 weeks'pregnant women at antenatal clinic in January 2007 to July 2008 in Women'and Children's Hospital in Tangshan, then the eligible patients were enrolled into the study after signing informed comment. Normal pregnant women were received routine check-up and MP HDCP test and followed up to postpartum strictly. The MP monitoring system for the eligible patients made by Center of Biomedicine Engineering, Beijing Polytechnic University was used to examine the dynamic trend of pregnant women(pulse wave for short)in the second trimester and later trimester for predicting hypertension disorder complicating pregnancy. The parameters of the test included systolic blood pressure (SBS), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), cardiac index (CI) , total peripheral resistance (TPR), K, mean residence time (Tm) and blood viscosity (V). Mean arterial pressure (MAP),body mass index (BMI) to predicting hypertension disorder complicating pregnancy as control were studied. We analysed the dynamic trend of the pregnant women, and compared the value of pulse wave with MAP and BMI allowing prediction of HDCP and perinatal outcomes.Results A total of 702 eligible pregnant women were enrolled into the trials, but 8 pregnant women were lost. At the end, 694 pregnant women were examined and had integral data. According to the clinical diagnosis, 595 cases with normal pregnant woman, 19 cases with gestational hypertension, 27 cases with mild pre-eclampsia and 53 cases with severe pre-eclampsia.The perinatal fetal abnormity included premature delivery, small for gestational age (SGA), fetal death, stillbirth, fetal growth restriction (FGR) and fetal distress. There were 50 cases with perinatal fetal abnormity, 32 cases with premature delivery, 8 cases with SGA, 6 cases with fetal death or stillbirth, 3 cases with FGR, only 1 case with fetal distress. The hemodynamic parameters of CI in normal pregnant woman during later trimester was higher than the second trimester and TPR was lower than the second trimester, the difference was significant (P < 0.05). The parameters of hemodynamics except HR during normal and HDCP pregnant woman were different both in the second trimester and later trimester. The difference was significant (P < 0.05). As the state of the illness aggravates, MAP,K,TPR,Tm,V were higher and CI was lower than those before.Incidence rate of hypertension disorder complicating pregnancy in the second trimester, forecasting positive group was 204, forecasting negative group was 490, the incidence rate of forecasting positive groups were significantly lower than that in the forecasting positive ( P < 0.001). The sensitivity was 71.72 %; specificity was 81.19 %; positive predictive value was 40.11 %. While MAP and BMI positive predictive value was 21.65% and 18.03%, respectively.The pulse wave was superior to the other methods and the difference was significant (P < 0.001). We could get the same outcome that the pulse wave was superior to the other methods and the difference was significant in the later trimester(P < 0.001). The positive predictive value of pulse wave was not different during the second trimester and later trimester(P>0.05).595 cases with normal pregnant woman ,there were 590 cases with normal perinatal fetal, 3 cases with premature delivery and 2 cases with SGA; 19 cases with gestational hypertension, there were 16 cases with normal perinatal fetal, 2 cases with premature delivery and 1 fetal death or stillbirth; 27 cases with mild pre-eclampsia , there were 23 cases with normal perinatal fetal, 3 cases with premature delivery and 1 case with SGA; 53 cases with severe pre-eclampsia, there were 15 cases with normal perinatal fetal, 24 cases with premature delivery and 5 cases with SGA , 5 cases with fetal death or stillbirth; 3 cases with FGR and 1 case with fetal distress. Kruskal-Wallis Test showed that the perinatal outcomes were different between normal pregnant women and HDCP pregnant women.The perinatal outcomes of normal pregnant women were better than thoses of HDCP pregnant women.The perinatal outcome of forecasting positive group with the method of pulse wave was inferior than forecasting negative group in the second trimester.The difference was significant (P < 0.001). The fetus'birth weight, 1-minute Apgar score in group of forecasting positive were significantly lower than those in group of forecasting negative (P < 0.001), and the same with the method of MAP. While with the method of BMI to forecast perinatal outcome, its worth should be studied more. We could get the same outcome in the later trimester.Using the method of pulse wave to predict perinatal outcome in the second trimester, the sensitivity was 88.00 %; specificity was 75.16 %; positive predictive value was 21.57 %. While MAP and BMI positive predictive value was 9.89% and 8.48%, respectively. The pulse wave was superior to the other methods and the difference was significant (P < 0.001) and so did in the later trimester. Predictive value of pulse wave to forecast perinatal outcome during the second trimester and the later trimester was not different(P>0.05). The pulse wave to predict perinatal outcome was superior to the other methods and the difference was significant (P < 0.001).Conclusions 1. The prediction of hypertension disorder complicating pregnancy with the method of pulse wave had significant implications for clinical practice. Noninvasive methods, true, credible and simple. The optimal cutoff levels of K, TPR and CI were 0.4, 1.2 and 2.5 respectively. 2. The predictive value of pulse wave during the second trimester and the later trimester was equal. 3. The method of pulse wave could forecast the perinatal outcome.