International Session Award. Non-invasive cutaneous cardiovascular dynamics (CVD) as a predictor of preterm delivery: a pilot study.

AIM: To assess the clinical value of cardiovascular dynamics (CVD) pattern of 'positive cycling' in predicting true preterm labor. METHODS: Patients with a clinical diagnosis of preterm labor had CVD measurement with a non-invasive miniature pressure transducer applied to the fingertip concomitantly with uterine activity monitoring. Based on previous work by our group, the rapid ejection time (RET) reflects arterial compliance; an elevated RET is suggestive of vasoconstriction. Positive cycling is present when the RET shows elevation with uterine contractions and negative cycling is present when there are no changes in the RET with uterine contractions. RESULTS: Twenty-seven women had negative CVD cycling and nine had positive CVD cycling. There was no difference between the two groups in initial gestational age, cervical effacement or cervical dilation at testing. However, the mean interval from testing to delivery was 1.56 (SEM+/-0.29) days for positive cycling and 39 days (+/-5.25) for negative cycling (P < 0.001). CONCLUSION: Non-invasive cardiovascular patterns of positive cycling appear predictive of preterm delivery.

The effects of cardiovascular dynamics monitoring in the outpatient management of pregnancy hypertension.

OBJECTIVE: Our purpose was to assess the effects of the adjunctive use of cardiovascular dynamics monitoring in the ambulatory management of 199 pregnant patients with severe hypertension. STUDY DESIGN: A prospective, observational study was performed. Determinants of mean arterial pressure were computed by using the Hon monitor. Indicators of arterial compliance and effective blood volume were developed. All patients were monitored in the outpatient clinic; additionally, 19 patients self-tested at home. No rigid medication protocol was followed, but furosemide was used in most cases when cardiovascular dynamics monitoring patterns were consistent with volume loading. Otherwise, vasodilators were prescribed. The t test for independent samples was used to compare the home-monitored subgroup with the outpatient-only group. RESULTS: Pregnancy was prolonged by 74 +/- 63.9 days (mean +/- SD). Mean gestation was 37.6 +/- 2.9 weeks, and mean birth weight was 2882.4 +/- 837 g. The primary cesarean delivery rate was 23.7%, but only 15 (7.5%) cesarean deliveries were performed because of failed therapy. The 19 home-monitored patients gained 108 +/- 75 days (83.1 +/- 42.2 days beyond 20 weeks). CONCLUSION: Adjunctive cardiovascular dynamics monitoring may have a role in the evaluation and management of hypertension during pregnancy.