Cerebro vascular reactivity (CVR) of middle cerebral artery in response to CO25% inhalation in preeclamptic women

Abstract Objective: To compare the cerebro vascular reactivity (CVR) of middle cerebral artery (MCA) in response to CO25% inhalation between preeclamptic and normotensive pregnant women, also, between mild and severe preeclampsia. Study design: A comparative study was performed on 61 women with preeclampsia and 65 normotensive pregnant women who were in the third trimester of gestation. MCA transcranial Doppler ultrasound was used to measure CVR in response to CO25% inhalation. Pulsatility index (PI), resistance index (RI), blood pressure, maternal age, gestational age and gravidity were also recorded. Results: Baseline PI and RI were lower in the preeclamptic group (p < 0.05). Inhalation of CO25% caused significant increase in CVR among normotensive pregnant women in comparison with preeclamptic group (1.006 ± 0.229 versus 0.503 ± 0.209, p = 0.0001). Significantly, more cerebral vasodilatation was found among mild preeclamptic women in comparison with severe preeclamptic women (0.583 ± 0.193 versus 0.383 ± 0.173, p = 0.0001). The receiver operating characteristics curve analysis revealed acceptable difference between CO2 stimulation test of preeclamptic and normotensive women (Area under curve = 0.973, p = 0.0001). Conclusion: CVR in response to CO25% is less in preeclamptic pregnant women than normotensives, also, in severe preeclampsia, it is less than mild preeclampsia.

[1]  K. Williams,et al.  Maternal transcranial Doppler in pre‐eclampsia and eclampsia , 2003, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[2]  C. Rodeck,et al.  Severe Preeclampsia and Cerebral Blood Volume Response to Postural Change , 2003, Obstetrics and gynecology.

[3]  G. Saade,et al.  Transcranial doppler measurement of cerebral velocity indices as a predictor of preeclampsia. , 2002, American journal of obstetrics and gynecology.

[4]  G. Saade,et al.  Cerebrovascular Reactivity in Normal Pregnancy and Preeclampsia , 2001, Obstetrics and gynecology.

[5]  E. vanBavel,et al.  Vascular function in preeclampsia. , 2000, Cardiovascular research.

[6]  R. Schwartz,et al.  CORTICAL BLINDNESS IN SEVERE PREECLAMPSIA: COMPUTED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING, AND SINGLE‐PHOTON‐EMISSION COMPUTED TOMOGRAPHY FINDINGS , 2000, Obstetrics and gynecology.

[7]  K. Williams,et al.  Persistence of cerebral hemodynamic changes in patients with eclampsia: A report of three cases. , 1999, American journal of obstetrics and gynecology.

[8]  G. Saade,et al.  Association of cerebral perfusion pressure with headache in women with pre‐eclampsia , 1999, British journal of obstetrics and gynaecology.

[9]  G. Saade,et al.  Preeclampsia may cause both overperfusion and underperfusion of the brain, A cerebral perfusion based model , 1999, Acta obstetricia et gynecologica Scandinavica.

[10]  Michael A. Varner,et al.  Effects of blood pressure on orbital and middle cerebral artery resistances in healthy pregnant women and women with preeclampsia. , 1999, American journal of obstetrics and gynecology.

[11]  H. Fürst,et al.  Application of transcranial Doppler sonography to evaluate cerebral hemodynamics in carotid artery disease. Comparative analysis of different hemodynamic variables. , 1995, Stroke.

[12]  K. Williams,et al.  Maternal Middle Cerebral Artery Blood Flow Velocity Variation With Gestational Age , 1994, Obstetrics and gynecology.

[13]  M. Matsumoto,et al.  Reactivity of cerebral blood flow to carbon dioxide in hypertensive patients: evaluation by the transcranial Doppler method. , 1994, Journal of hypertension.

[14]  B. Sibai,et al.  Eclampsia: VI. Maternal-perinatal outcome in 254 consecutive cases , 1990 .

[15]  C. Redman,et al.  Eclampsia still kills , 1988, British medical journal.

[16]  R. Raschke Cerebral perfusion pressure, and not cerebral blood flow, may be the critical determinant of intracranial injury in preeclampsia: a new hypothesis. , 2003, American journal of obstetrics and gynecology.

[17]  Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. , 2000, American journal of obstetrics and gynecology.