Multivariable evaluation of maternal hemodynamic profile in pregnancy complicated by fetal growth restriction: prospective study.

OBJECTIVE: To evaluate the association between fetal growth restriction (FGR) and maternal hemodynamic parameters using multivariable analysis, adjusting for major confounding factors, such as hypertensive disorders of pregnancy (pre-eclampsia and gestational hypertension). METHODS: A prospective cohort study was conducted between January 2013 and April 2016. Two cohorts of patients were recruited, between 24 and 39 weeks of gestation, in a high-risk outpatient setting. These cohorts comprised 49 appropriate-for-gestational-age singleton fetuses and 93 that were FGR (abdominal circumference (AC) at recruitment in the second half of pregnancy ≤ 10th percentile with a previous normal AC at 20-22 weeks). Maternal echocardiography was performed at the time of enrolment and included hemodynamic parameters of systolic and diastolic function and cardiac remodeling indices. Data were analyzed using a multivariable generalized linear model to estimate the association of FGR with maternal hemodynamic parameters after adjusting for significant confounding factors. RESULTS: In the multivariable analysis, after adjustment for hypertensive disorders of pregnancy and smoking, FGR was associated with a 14% increase in maternal total vascular resistance, 16% reduction in cardiac output, 13% reduction in left ventricular mass and 11% reduction in heart rate; similar results were observed for the corresponding indexed parameters. Hypertensive disorders of pregnancy in the absence of FGR were associated with a 25% increase in total vascular resistance, 16% increase in left ventricular mass and 14% reduction in diastolic function; similar results were observed for the corresponding indexed parameters. CONCLUSION: FGR is significantly and independently associated with several maternal hemodynamic parameters, even after adjustment for major confounding factors, such as hypertensive disorders of pregnancy. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Assisted reproductive technologies and uterine factors influencing their success.

Congenital and acquired uterine factors are known to influence the success of assisted reproductive technologies (ARTs). Several studies analyzed the role of uterine septa, adenomyosis, myomas, endometrial polyps and intrauterine adhesions in female infertility. All of them might cause defective endometrial receptivity and consequently decreased embryo implantation and pregnancy rate. In particular, septate uterus represents the most frequent Müllerian anomaly leading to an increased risk of abortion. Many studies evaluated the role of hysteroscopic metroplasty on fertility outcomes, but this topic remains controversial. The role of adenomyosis in infertility is still debated and, even if different mechanisms have been described to explain implantation failure, there are still conflicting findings on the impact of adenomyosis on ART. The effects of myomas on fertility mainly depend on their type, so that submucous have a detrimental impact on fertility, subserous seem to have no effect, while there is no clear consensus regarding the effect of intramural. Consequently, the potential influence of myomectomy on fertility outcomes depends on the type, being mandatory only the hysteroscopic treatment of submucous myomas. The effect of endometrial polyps on endometrial receptivity and fertility is not clear, even if some studies identified improvement in pregnancy rates after hysteroscopic polipectomy. In presence of intrauterine adhesions, infertility represents the most common manifestation and the restoring of normal uterine cavity should be always pursued when possible.