Hemodynamic Profiling: Assessment of Techniques, Methodology, and Reproducibility
摘要
During pregnancy, the maternal cardiovascular system undergoes significant structural and functional changes. These adaptations are essential to ensure optimal interaction between the maternal cardiovascular system and uteroplacental circulation. Failure to achieve such adaptations can result in hypertensive disorders of pregnancy, which are both clinically and hemodynamically heterogeneous. The underlying mechanisms and maternal hemodynamic profiles vary widely. Traditionally, monitoring maternal cardiovascular status has relied primarily on blood pressure measurement. However, incorporating additional parameters, such as cardiac output (CO), systemic vascular resistance (SVR), augmentation index (AIx), pulse wave velocity (PWV), and Doppler assessment of uterine, umbilical, or ophthalmic arteries, enables a more comprehensive hemodynamic evaluation. This expanded profiling allows identification of which components of the cardiovascular system are most affected, supporting more targeted and individualized management. The hemodynamic profile can be assessed using various techniques, each with distinct characteristics, advantages, and limitations. Selecting the most appropriate method depends on factors such as accuracy, feasibility, operator dependence, and validation in pregnancy. This chapter focuses on comparing available methods and devices for measuring hemodynamic parameters that are relatively easy to implement in clinical practice and relevant to obstetric care.