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The relevance of maternal cardiovascular situation before labor in the outcome of birth: an observational study.
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  • Daniele Farsetti,
  • Grazia Tiralongo,
  • Ilaria Pisani,
  • Damiano Lo Presti,
  • Giulia Gagliardi,
  • Barbara Vasapollo,
  • Gian Paolo Novelli,
  • Herbert Valensise
Daniele Farsetti
University of Rome Tor Vergata
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Grazia Tiralongo
Policlinico Casilino
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Ilaria Pisani
Policlinico Casilino
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Damiano Lo Presti
Policlinico Casilino
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Giulia Gagliardi
Casilino General Hospital
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Barbara Vasapollo
Policlinico Casilino
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Gian Paolo Novelli
Fondazione PTV Policlinico Tor Vergata
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Herbert Valensise
University of Rome Tor Vergata
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Abstract

Objective: To assess if maternal hemodynamics assessment in healthy women, at the end of pregnancy, before the labor onset, could predict the development of complications during labor. Design: Prospective observational study. Settings: Department of Obstetrics and Gynecology of Casilino Hospital in Rome, University of Tor Vergata. (September 2016 - December 2017) Population: 395 healthy women not in labor at term of pregnancy. Methods: Univariate and multivariate binary logistic regression analysis of association between hemodynamic variables and delivery complications, adjusted for significant prenatal variables. Main Outcome Measures: ORs for hemodynamic parameters and identification of independent risk factors in the prediction of adverse outcome. Results: we observed adverse outcomes in 45 patients (11.39%). Women who developed maternal or fetal complications during delivery were mainly nulliparous (93.33% vs 72.29%, p<0.01), showed higher values of systemic vascular resistances (SVR) (1368.32±228.50. vs 1260.34±271.94 d.s.cm-5, p=0.01) and lower values of cardiac output (CO) (5.38±0.77 vs 5.80±1.20 L/min, p=0.02), compared with women who did not develop complications. ROC curve analysis identified the best cut-offs to predict complicated delivery: SVR > 1135 d.s.cm-5 (OR 7.87, CI 95% 2.39-25.92, p<0.01), CO ≤5.6 L/min (OR 2.38; CI 95% 1.21-4.68, p<0.01), diastolic blood pressure > 79 mmHg (OR 1.89, CI 95%.1.01-3.54, p=0.04), Potential-Kinetic energy Ratio >22 (OR 2.32, 0.95-5.64, p=0.04). The multivariate logistic regression analysis identified as independent predictors of complication the SVR, Flow Time corrected and parity. Conclusion: the assessment of maternal hemodynamics at term of pregnancy could increase the capacity to predict patients at risk during labor.