To measure the effect of noninvasive positive airway pressure ventilation on maternal hypertension and fetal blood flow in women with pregnancy-associated hypertension during wakefulness.
Pregnant women hospitalized with new onset pregnancy-associated hypertension were screened for participation. Women were excluded with multiple gestations, fetal anomalies, sleep disorder or comorbid illness. Two women were enrolled. Both patients underwent a comprehensive sleep/wake history and performed an Epworth Sleepiness Scale. Both patients had blood pressure and umbilical artery dopplers performed with and without 15 cmH2O continuous positive airway pressure(CPAP).
The first patient was a 35 year-old at 32 weeks gestation with an Epworth score of 7 and no snoring. She had a mean arterial blood pressure (MAP)of 97, fetal heart rate of 156 beats per minute (bpm), and a mid-cord umbilical artery systolic/diastolic (S/D) ratio of 1.88. On CPAP 15 cmH2O, her MAP decreased to 85 with a fetal heart rate of 174 bpm and a S/D ratio of 1.81. She continued to use an auto-titrating CPAP with an average pressure of 5-6 cmH2O. She underwent Cesarean section at 37 weeks to deliver a viable 2860 gram baby with an APGAR score of 8. The second patient was a 26 year-old at 35 weeks with an Epworth score of 8 and loud snoring. Her MAP was 121, with a fetal heart rate of 156 bpm and S/D ratio of 2.61. On CPAP 15 cmH2O, her MAP decreased to 110, with a fetal heart rate of 136 bpm and S/D ratio of 2.66. Her blood pressure was inadequately controlled and she also underwent Cesarean section. She delivered a viable 2565 gram baby with an APGAR of 7.
In our patients, the use of CPAP resulted in improved daytime maternal-fetal hemodynamics. It would appear that even a small amount of positive pressure may result in an improvement in hemodynamics.
We propose that the use of continuous positive airway pressure in pregnancy-associated hypertension may result in an improvement in maternal-fetal hemodynamics.
D.A. Hutter, None.