Objective: Pre-eclampsia is a serious complication of pregnancy with high morbidity and mortality and an incidence of 3-5% in all pregnancies. Early prediction is still insufficient in clinical practice. Although most pre-eclamptic patients have pathological uterine perfusion in the second trimester, perfusion disturbance has a positive predictive accuracy (PPA) only of approximately 30%. Methods: Non-invasive continuous blood pressure recordings were taken simultaneously via a finger cuff for 30 min. Time series of systolic as well as diastolic beat-to-beat pressure values were extracted to analyse heart rate and blood pressure variability and baroreflex sensitivity in 102 second-trimester pregnancies, to assess predictability for pre-eclampsia (n = 16). All women underwent Doppler investigations of the uterine arteries. Results: We identified a combination of three variability and baroreflex parameters to best predict pre-eclampsia several weeks before clinical manifestation. The discriminant function of these three parameters classified patients with later pre-eclampsia with a sensitivity of 87.5%, a specificity of 83.7%, and a PPA of 50.0%. Combined with Doppler investigations of uterine arteries, PPA increased to 71.4%. Conclusions: This technique of incorporating one-stop clinical assessment of uterine perfusion and variability parameters in the second trimester produces the most effective prediction of pre-eclampsia to date.

Blood pressure variability, Doppler sonography, Heart rate variability, Pre-eclampsia, Prediction
dx.doi.org/10.1097/01.hjh.0000217858.27864.50, hdl.handle.net/1765/62127
Journal of Hypertension
Department of Pharmacology

Walther, T, Wessel, N, Malberg, H, Voss, A, Stepan, H, & Faber, R. (2006). A combined technique for predicting pre-eclampsia: Concurrent measurement of uterine perfusion and analysis of heart rate and blood pressure variability. Journal of Hypertension, 24(4), 747–750. doi:10.1097/01.hjh.0000217858.27864.50