Diastolic Dysfunction In Pre-Eclamptic And Eclamptic Women Vs Normotensive Pregnant Women:A Case Control Study

Abstract

Background: Pregnancy is associated with enormous changes in various organs, cardiovascular system being no exception to this. In normotensive pregnancy there is certain degree of diastolic dysfunction which is further modified in pre-eclampsia. There is also increased incidence of cardiopulmonary complication in pre-eclampsia and eclampsia. However very few studies were done on the prevalence of diastolic dysfunction in pre-eclampsia and no study was done to find out the same in eclampsia. Objective: • Primary objective: To find out the prevalence of the diastolic dysfunction among pre-eclamptic,eclamptic women and normotensive pregnant women by Doppler echocardiography • Secondary objective: To find out correlation between diastolic dysfunction and cardiopulmonary complications Methodology:Case-control study was done in department of Obstetrics and Gynaecology, at teaching hospital attached to KLE University’s, J. N. medical college, Belagavi. Total sample size of 140 eligible women of which 70 cases were matched for gestational age (confirmed by 1st or 2nd trimester scan) with 70 controls. All the subjects underwent Doppler echocardiographic evaluation by a cardiology resident experienced for 2yrs.All echocardiographies were done antepartum except in 20 eclamptics were it was done postpartum. Results:As per the CONSORT flow diagram, 139 subjects were approached to participate in the study of which 91 were eligible.Of these 91 subjects, 70 consented. These 70subjects were matched with controls of same gestation age confirmed by 1stor 2ndtrimester scan. Echo-cardiographic variables were collected from these 140 subjects. From this study it was observed that there is a statistically significant increase in the prevalance of diastolic dysfunction in pre-eclamptics and eclamptics compared to normotensive pregnant women(p value=0.029).It was also observed increase in cardiopulmonary complications like pulmonary edema inpre-eclamptics and eclamptics(5 out of 70 cases) compared to normotensive pregnant women. All those who developed pulmonary edema had diastolic dysfunction. Conclusion:From this study it was evident thatthere is an increase incidence of diastolic dysfunction in pre-eclampsia and eclampsia. This necessitates close and careful monitoring during the management of such cases especially with reference to cardiopulmonary complications.