Publication:

Significance of 2 dimensional-echocardiography in hypertensive disorders of pregnancy: a study in tertiary care centre, Ahmedabad, Western India

Background Echocardiography is a safe, non-invasive technique to assess cardiac structure and function in pregnancy. Understanding the structure and function of the heart in hypertensive women is important in terms of timely diagnosis, better management and good prognosis. This study will focus on the importance and feasibility of Echocardiography as a routine investigation tool in hypertensive disorders of pregnancy.

Methods This is a retrospective study of 150 cases of hypertension in pregnancy conducted at the Obstetrics and Gynaecology department of a tertiary care centre in the year June 2019-July 2020. Data was analysed in terms of complications seen in women who had structural and functional abnormalities in the echocardiographic scan in comparison to those hypertensive women who had a normal scan.  The important Echocardiographic parameters were compared amongst cases of hypertension and their impact on fetomaternal outcome was discussed.

Results In this study conducted amongst 150 pregnant women suffering from different forms of hypertensive disorders  presenting in our institute for routine workup in the year 2019-2020, 12(8%) had chronic hypertension, 75(50%) had gestational hypertension, whereas 63(42%) had pre- eclampsia. The incidence of structural valvular lesions in these categories as 2%, 3.34% and 4% respectively. Deranged echocardiographic parameters like decreased Left Ventricular Ejection Fraction in 10%, decreased stroke volume in 28.6% and increased Left Ventricular mass in 26.6% are seen more in cases of pre-eclampsia compared to gestational hypertension and chronic hypertension.

Conclusions Echocardiography is a valuable tool to stratify risk and can guide management in gestational hypertension, chronic hypertension and preeclampsia. Changes in cardiac function and morphology are recognizable at an asymptomatic early stage and correlate with disease severity and adverse outcomes. Preeclampsia has a greater impact on the heart than gestational hypertension, and changes are most pronounced in early onset, severe disease. Studying the cardiac structure and function in early trimesters can bring about better maternal and fetal outcome.