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DOI: 10.1055/s-0029-1245698
© Georg Thieme Verlag KG Stuttgart · New York
Time Interval Between Maternal Electrocardiogram and Venous Doppler Waves in Normal Pregnancy and Preeclampsia: A Pilot Study
Zeitintervall zwischen maternem Elektrokardiogramm und venösen Dopplerwellen bei normaler Schwangerschaft und Präeklampsie: eine PilotstudiePublication History
received: 29.1.2010
accepted: 12.7.2010
Publication Date:
11 October 2010 (online)
![](https://www.thieme-connect.de/media/ultraschall/201207/lookinside/thumbnails/10.1055-s-0029-1245698-1.jpg)
Zusammenfassung
Ziel: Beurteilung des Zeitintervalls zwischen maternem Elektrokardiogramm (EKG) und venösen Dopplerwellen zu verschiedenen Zeitpunkten bei unkomplizierten Schwangerschaften (UP) und bei Präeklampsie (PE). Material und Methoden: Querschnittsstudie bei 40 unkomplizierten Einlingsschwangerschaften, die in vier 10er-Gruppen entsprechend dem Gestationsalter eingeteilt wurden: 10.–14. Schwangerschaftswoche (SSW; UP 1), 18.–23. SSW (UP2), 28.–33. SSW (UP3) und ≥ 37. SSW (UP4). Zudem wurde ein fünfte Gruppe von zehn Frauen mit PE eingeschlossen. Die Untersuchung der Dopplerflüsse in den renalen interlobären Venen (RIV) und den hepatischen Venen (HV) wurde entsprechend standardisierter Kriterien zusammen mit einem maternalen EKG durchgeführt. Das Zeitintervall zwischen der P-Welle im EKG und der korrespondierenden A-Deflektion der venösen Dopplerwelle wurde bestimmt (PA) und ins Verhältnis zur Dauer des Herzzyklus (RR) gesetzt (PA/RR). Ergebnisse: In hepatischen Venen war PA/RR länger in UP 4 als in UP 1 (0,48 ± 0,15 versus 0,29 ± 0,09, p ≤ 0,001). Der Vergleich aller UP Gruppen zeigte einen graduellen PA/RR Anstieg mit zunehmendem Gestationsalter. Bei PE ist die HV PA/RR kürzer als in UP 3 (0,25 ± 0,09 versus 0,42 ± 0,14, p < 0,01); dieser Unterschied persistierte auch unter antihypertensiver Therapie (0,28 ± 0,06 versus 0,42 ± 0,14, p ≤ 0,01, n = 6). Ähnliche Ergebnisse ergaben sich bei beiden Nieren. In UP 1 aber nicht in UP 3 oder UP 4 war der HV PA/RR kürzer in der Leber als in der linken und rechten Niere (0,29 ± 0,09 versus 0,38 ± 0,12, p < 0,01, und versus 0,36 ± 0,09, p ≤ 0,01). Schlussfolgerung: PA/RR ist organspezifisch und gestationsabhängig und scheint in Bezug zum venösen Gefäßtonus und/oder dem intravaskulären Füllungszustand zu stehen. Erhöhte Werte mit zunehmendem Gestationsalter stimmen mit bekannten Parametern maternaler kardiovaskulärer Adaptation überein. Kürzere Werte bei PE sind vereinbar mit der kardiovaskulären Maladaptation. Unsere Pilotstudie eröffnet neue Forschungsmöglichkeiten hinsichtlich der Wertigkeit des Zeitintervalls zwischen maternalem EKG und venösen Dopplerwellen als neuer Parameter zur Untersuchung der kardiovaskulären (Patho-)Physiologie und des maternalen venösen Kompartiments während der Schwangerschaft mit der Duplexsonografie.
Abstract
Purpose: To evaluate the time interval between maternal electrocardiogram (ECG) and venous Doppler waves at different stages of uncomplicated pregnancy (UP) and in preeclampsia (PE). Materials and Methods: Cross-sectional pilot study in 40 uncomplicated singleton pregnancies, categorized in four groups of ten according to gestational age: 10 – 14 weeks (UP1), 18 – 23 weeks (UP2), 28 – 33 weeks (UP3) and ≥ 37 weeks (UP4) of gestation. A fifth group of ten women with PE was also included. A Doppler flow examination at the level of renal interlobar veins (RIV) and hepatic veins (HV) was performed according to a standard protocol, in association with a maternal ECG. The time interval between the ECG P-wave and the corresponding A-deflection of the venous Doppler waves was measured (PA), and expressed relative to the duration of the cardiac cycle (RR), and labeled PA/RR. Results: In hepatic veins, the PA/RR is longer in UP 4 than in UP 1 (0.48 ± 0.15 versus 0.29 ± 0.09, p ≤ 0.001). When all UP groups were compared, the PA/RR increased gradually with gestational age. In PE, the HV PA/RR is shorter than in UP 3 (0.25 ± 0.09 versus 0.42 ± 0.14, p < 0.01) and this difference persisted under anti-hypertensive treatment (0.28 ± 0.06 versus 0.42 ± 0.14, p ≤ 0.01, n = 6). Similar results were found in both kidneys. In UP 1 but not in UP 3 or UP 4, the HV PA/RR is shorter in the liver than in the left and right kidney (0.29 ± 0.09 versus 0.38 ± 0.12, p < 0.01, and versus 0.36 ± 0.09, p ≤ 0.01). Conclusion: The PA/RR is organ-specific and gestation-dependent, and is considered to relate to venous vascular tone and/or intravascular filling. Increased values at advanced gestational stages are consistent with known features of maternal cardiovascular adaptation. Shorter values in preeclampsia are consistent with maternal cardiovascular maladaptation mechanisms. Our pilot study invites more research of the relevance of the time interval between maternal ECG and venous Doppler waves as a new parameter for studying the gestational cardiovascular (patho)physiology of the maternal venous compartment by duplex sonography.
Key words
veins - electrocardiography (ECG) - ultrasound Doppler - pregnancy
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Kathleen Tomsin
Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg
Schiepse Bos 6
3600 Genk
Phone: ++ 32/89/32 75 24
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Email: kathleen_tomsin@hotmail.com