Maternal Hemodynamic Assessment at Term for Prediction of Adverse Neonatal Outcomes: The Experience from a Referral Italian Hospital.

Abstract

Objective: Our study aims to explore the possible predictive role of Ultrasound Cardiac Output Monitoring (USCOM) parameters toward unfavorable maternal and neonatal complications during labor and delivery in a cohort of women followed by the high-risk pregnancy clinic of a tertiary Italian hospital.

Study design: A prospective, monocentric descriptive study was run at the AOU Policlinico of Modena. USCOM was implemented in March 2022. Patients in charge of the high-risk pregnancy clinic who received USCOM hemodynamic monitoring during their whole pregnancy were included in the study, with the last examination performed around 37 weeks. By considering the characteristics of labor and delivery, they were divided into two groups (complicated delivery and uncomplicated delivery). Adverse maternal outcomes (AMOs) and adverse neonatal outcomes (ANOs) were prospectively collected from electronic records and analyzed using the R version 4.3.2 statistical software. Continuous variables were presented as means with standard deviations, and categorical variables as counts and percentages.

Results: While maternal and perinatal variables, including maternal age, parity, and anthropometric measures, were comparable between groups, significant differences emerged in the USCOM measurements. Cardiac output (CO) was significantly lower in the group with ANO compared with uneventful neonates (4.35 ± 1.42 L/min vs. 4.97 ± 1.44 L/min; adjusted odds ratio [aOR] = 0.79; 95% CI: 0.49, 0.99, p = 0.049). Additionally, peak velocity of ventricular ejection (VPK) was significantly reduced in neonates with ANO compared with neonates without adverse complications (0.92 ± 0.27 vs. 1.08 ± 0.42; aOR = 0.08, 95% CI: 0.01-0.63, p = 0.016). Finally, cardiac index was lower (2.26 ± 0.67 vs. 2.54 ± 0.74, aOR = 0.49; 95% CI: 0.23-1.03, p = 0.060) and systemic vascular resistance was higher (1,800.9 ± 546 vs. 1,638.2 ± 588.4, aOR = 1.00; 95% CI: 1.00-1.00, p = 0.245) in the ANO group comparing with those without ANO, although both results do not reach statistical significance.

Conclusion: Our findings suggest that the implementation of USCOM in clinical practice may enhance the identification of women at increased risk for ANOs, particularly those presenting with low CO and reduced ventricular peak velocity (VPK) before labor. Further studies with larger sample sizes are needed to confirm and strengthen these observations.

Key points: · USCOM identifies women at increased risk for adverse neonatal outcomes.. · USCOM improves the quality and safety of obstetric care.. · USCOM is applicable across obstetric settings, including labor wards..