Health-related quality of life after obstetric intensive care admission: Comparison with the general population.

PURPOSE: To examine health-related quality of life (HRQoL) in obstetric patients after intensive care discharge, with comparison to age-appropriate reference values from the general Finnish female population. MATERIAL AND METHODS: Retrospective register-based study. Four multidisciplinary intensive care units at Finnish university hospitals participated. RESULTS: A total of 291 obstetric patient were admitted to the ICU, of whom 114 (39%) completed follow-up measurements. At baseline (pre-intensive care admission), patients showed lower physical (mobility, self-care, pain/discomfort) and social (usual activities) dimensions compared to reference values. Baseline overall health status (EQsum) was lower than reference values. However EQsum increased over six months (mean, 0.907 to 0.946) such that follow-up values were similar to reference values. At follow-up, 18.4% of patients showed poorer HRQoL (mean, 0.764; range, 0.638-0.885) compared to reference values. Multiparous patients showed lower scores than primiparous patients. EQ VAS scores were lower at baseline, but increased over six months (72.12 to 87.5) such that follow-up values were similar to reference values. CONCLUSIONS: The baseline HRQoL of study population was lower than that of the general population, but after six months, the mean values were comparable to reference value. However, one in five patients still experienced impaired QOL at follow-up.

Natriuretic peptides and hemodynamics in preeclampsia.

OBJECTIVE: The purpose of this study was to evaluate the relationship between natriuretic peptides (NT-proANP and NT-proBNP) and hemodynamic parameters in preeclampsia. STUDY DESIGN: This was a cross-sectional study of 19 preeclamptic, 15 chronic hypertensive, and 26 normotensive women in the third trimester of pregnancy. Stroke index (SI), heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI), and left cardiac work index (LCWI) were derived by whole-body impedance cardiography. Systolic blood pressure (SAP), diastolic blood pressure (DAP), and mean arterial pressure (MAP) were measured. The plasma levels of NT-proANP and NT-proBNP were determined with radioimmunoassays. RESULTS: NT-proANP and NT-proBNP concentrations were significantly higher in preeclamptic women compared to chronic hypertensive and normotensive pregnancies. Preeclamptic women had lower CI and HR and higher SAP, MAP, and SVRI than the control groups. In preeclampsia NT-proANP correlated significantly with SAP and SVRI; meanwhile, NT-proBNP correlated significantly with SVRI and CI. These correlations persisted in the subgroup of nonmedicated preeclamptic women, except in the case of NT-proBNP and CI. CONCLUSION: High NT-proANP and NT-proBNP concentrations in preeclampsia reflect the strain on the heart caused by high afterload, rather than the function of the heart expressed as SI or CI.

Arterial stiffness in preeclamptic and chronic hypertensive pregnancies.

OBJECTIVE: To assess arterial stiffness in pregnancies complicated by hypertensive disorders: preeclampsia and chronic hypertension. STUDY DESIGN: Twenty preeclamptic and 18 chronic hypertensive parturients were studied. The reference data were obtained from 29 healthy pregnant women and 29 non-pregnant women. Systolic blood pressure (SAP), diastolic blood pressure (DAP), mean arterial pressure (MAP) and pulse pressure (PP) were measured. Stroke index (SI), heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI) and pulse wave velocity (PWV) were derived by whole-body impedance cardiography. Arterial compliance was defined as the SI to PP ratio (SI/PP). RESULTS: Significantly higher PP and PWV and lower SI/PP were observed in preeclamptic compared to uncomplicated pregnancies. Preeclamptic pregnancies also differed from chronic hypertensive pregnancies by higher PP and lower SI/PP. Women with chronic hypertension had significantly higher PWV than the control group, but PP and SI/PP were not different. In both hypertensive groups SVRI was exceptionally high. CONCLUSIONS: Besides the vasoconstriction of smaller peripheral arteries, our finding of increased arterial stiffness in preeclamptic pregnancies suggests that also larger arteries with altered viscoelastic properties are involved in the aberrant hemodynamics of preeclampsia. Compared to preeclamptic subjects, women with chronic hypertension shared a common feature of high systemic vascular resistance, but changes in arterial stiffness were less than in preeclampsia.