Preeclampsia may cause both overperfusion and underperfusion of the brain. A cerebral perfusion based model

Michael Anthony Belfort, Charlotta Grunewald, George Saade, Michael Varner, Henry Nisell

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Background. The hypothesis was that low cerebral perfusion pressure is more common in women with mild preeclampsia as compared to those with severe preeclampsia, while high cerebral perfusion pressure is more common in women with severe preeclampsia than in women with mild preeclampsia. Design. Prospective, observational study. Setting. University teaching hospitals. Methods. Transcranial Doppler ultrasound was used to measure the blood velocity in the middle cerebral arteries of 54 patients with mild preeclampsia and 44 patients with severe preeclampsia. Blood pressure was measured simultaneously. Cerebral perfusion pressure was calculated and plotted on the same axes as data from 63 normal pregnant women. Data outside of the 95% prediction limits were regarded as abnormal. All studies were prior to labor, and before volume expansion or treatment. Analysis: Student's t-test, Mann Whitney U test, and Fisher's exact test as appropriate with two-tailed p < 0.05. Main outcome measure. The number of patients in each group with cerebral perfusion pressure values outside the normal 95% prediction limits. Results. Almost the same number of women with mild (21/54 = 39%) and severe (15/44 = 34%) preeclampsia had measurements within the normal range (p = 0.78). Mild preeclamptic women were more likely to have low (28/54 = 52%) rather than high cerebral perfusion pressure (p < 0.001), while severe preeclamptics were more likely to have high cerebral perfusion pressure (26/44 = 59%) than low (p < 0.001). Conclusions. In preeclampsia the brain can be normally perfused, underperfused and overperfused. Although many women with mild preeclampsia will have underperfusion (52%), and a significant number of women with severe preeclampsia will have overperfusion (59%), many preeclamptic women have cerebral perfusion within the normal range.

Original languageEnglish (US)
Pages (from-to)586-591
Number of pages6
JournalActa Obstetricia et Gynecologica Scandinavica
Volume78
Issue number7
StatePublished - 1999

Fingerprint

Pre-Eclampsia
Cerebrovascular Circulation
Perfusion
Brain
Reference Values
Doppler Ultrasonography
Middle Cerebral Artery
Nonparametric Statistics
Teaching Hospitals
Observational Studies
Pregnant Women
Outcome Assessment (Health Care)
Prospective Studies
Students
Blood Pressure

Keywords

  • Cerebral perfusion pressure
  • Doppler
  • Middle cerebral artery
  • Preeclampsia
  • Pregnancy

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Preeclampsia may cause both overperfusion and underperfusion of the brain. A cerebral perfusion based model. / Belfort, Michael Anthony; Grunewald, Charlotta; Saade, George; Varner, Michael; Nisell, Henry.

In: Acta Obstetricia et Gynecologica Scandinavica, Vol. 78, No. 7, 1999, p. 586-591.

Research output: Contribution to journalArticle

Belfort, Michael Anthony ; Grunewald, Charlotta ; Saade, George ; Varner, Michael ; Nisell, Henry. / Preeclampsia may cause both overperfusion and underperfusion of the brain. A cerebral perfusion based model. In: Acta Obstetricia et Gynecologica Scandinavica. 1999 ; Vol. 78, No. 7. pp. 586-591.
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abstract = "Background. The hypothesis was that low cerebral perfusion pressure is more common in women with mild preeclampsia as compared to those with severe preeclampsia, while high cerebral perfusion pressure is more common in women with severe preeclampsia than in women with mild preeclampsia. Design. Prospective, observational study. Setting. University teaching hospitals. Methods. Transcranial Doppler ultrasound was used to measure the blood velocity in the middle cerebral arteries of 54 patients with mild preeclampsia and 44 patients with severe preeclampsia. Blood pressure was measured simultaneously. Cerebral perfusion pressure was calculated and plotted on the same axes as data from 63 normal pregnant women. Data outside of the 95{\%} prediction limits were regarded as abnormal. All studies were prior to labor, and before volume expansion or treatment. Analysis: Student's t-test, Mann Whitney U test, and Fisher's exact test as appropriate with two-tailed p < 0.05. Main outcome measure. The number of patients in each group with cerebral perfusion pressure values outside the normal 95{\%} prediction limits. Results. Almost the same number of women with mild (21/54 = 39{\%}) and severe (15/44 = 34{\%}) preeclampsia had measurements within the normal range (p = 0.78). Mild preeclamptic women were more likely to have low (28/54 = 52{\%}) rather than high cerebral perfusion pressure (p < 0.001), while severe preeclamptics were more likely to have high cerebral perfusion pressure (26/44 = 59{\%}) than low (p < 0.001). Conclusions. In preeclampsia the brain can be normally perfused, underperfused and overperfused. Although many women with mild preeclampsia will have underperfusion (52{\%}), and a significant number of women with severe preeclampsia will have overperfusion (59{\%}), many preeclamptic women have cerebral perfusion within the normal range.",
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AU - Nisell, Henry

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N2 - Background. The hypothesis was that low cerebral perfusion pressure is more common in women with mild preeclampsia as compared to those with severe preeclampsia, while high cerebral perfusion pressure is more common in women with severe preeclampsia than in women with mild preeclampsia. Design. Prospective, observational study. Setting. University teaching hospitals. Methods. Transcranial Doppler ultrasound was used to measure the blood velocity in the middle cerebral arteries of 54 patients with mild preeclampsia and 44 patients with severe preeclampsia. Blood pressure was measured simultaneously. Cerebral perfusion pressure was calculated and plotted on the same axes as data from 63 normal pregnant women. Data outside of the 95% prediction limits were regarded as abnormal. All studies were prior to labor, and before volume expansion or treatment. Analysis: Student's t-test, Mann Whitney U test, and Fisher's exact test as appropriate with two-tailed p < 0.05. Main outcome measure. The number of patients in each group with cerebral perfusion pressure values outside the normal 95% prediction limits. Results. Almost the same number of women with mild (21/54 = 39%) and severe (15/44 = 34%) preeclampsia had measurements within the normal range (p = 0.78). Mild preeclamptic women were more likely to have low (28/54 = 52%) rather than high cerebral perfusion pressure (p < 0.001), while severe preeclamptics were more likely to have high cerebral perfusion pressure (26/44 = 59%) than low (p < 0.001). Conclusions. In preeclampsia the brain can be normally perfused, underperfused and overperfused. Although many women with mild preeclampsia will have underperfusion (52%), and a significant number of women with severe preeclampsia will have overperfusion (59%), many preeclamptic women have cerebral perfusion within the normal range.

AB - Background. The hypothesis was that low cerebral perfusion pressure is more common in women with mild preeclampsia as compared to those with severe preeclampsia, while high cerebral perfusion pressure is more common in women with severe preeclampsia than in women with mild preeclampsia. Design. Prospective, observational study. Setting. University teaching hospitals. Methods. Transcranial Doppler ultrasound was used to measure the blood velocity in the middle cerebral arteries of 54 patients with mild preeclampsia and 44 patients with severe preeclampsia. Blood pressure was measured simultaneously. Cerebral perfusion pressure was calculated and plotted on the same axes as data from 63 normal pregnant women. Data outside of the 95% prediction limits were regarded as abnormal. All studies were prior to labor, and before volume expansion or treatment. Analysis: Student's t-test, Mann Whitney U test, and Fisher's exact test as appropriate with two-tailed p < 0.05. Main outcome measure. The number of patients in each group with cerebral perfusion pressure values outside the normal 95% prediction limits. Results. Almost the same number of women with mild (21/54 = 39%) and severe (15/44 = 34%) preeclampsia had measurements within the normal range (p = 0.78). Mild preeclamptic women were more likely to have low (28/54 = 52%) rather than high cerebral perfusion pressure (p < 0.001), while severe preeclamptics were more likely to have high cerebral perfusion pressure (26/44 = 59%) than low (p < 0.001). Conclusions. In preeclampsia the brain can be normally perfused, underperfused and overperfused. Although many women with mild preeclampsia will have underperfusion (52%), and a significant number of women with severe preeclampsia will have overperfusion (59%), many preeclamptic women have cerebral perfusion within the normal range.

KW - Cerebral perfusion pressure

KW - Doppler

KW - Middle cerebral artery

KW - Preeclampsia

KW - Pregnancy

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