Multisystem Inflammatory Syndrome in Children (MIS-C) treatment is still under debate and involves Intravenous Immunoglobulins (IVIG) and/or steroids. We retrospectively analysed data from the patients admitted to Our Institution during the year 2020 to investigate whether prompt IVIG treatment conditions cardiac dysfunction and need for support and if addition of steroids in different doses correlates with outcomes. Days of fever, time between fever appearance and IVIG treatment, left ventricular ejection fraction (LVEF%) at admission and Cardiac Function Recovery Time (time between worst LVEF and resume of LVEF >55%) were used as outcomes. 38 patients were admitted with MIS-C. All except one received IVIG; 24 received also different Methylprednisolone dosages. Time to IVIG treatment, adjusted for age and sex, correlated with global duration of fever (Coefficient: 1.2; 95% CI:0.73-1.68) and with Vasoactive Inotropic Score (VIS) (Coefficient: 0.09; 95% CI 0.02-0.15), with pericardial effusion (Coefficient: 2.37; 95% CI: 0.45-4.2). Global duration of fever was associated with time to IVIG (Coefficient: 0.8; 95% CI :0.49-1.13) and positive Covid-19 swab (Coefficient: 1.71; 95% CI 0.21-3.22). Cardiac Function Recovery Time did not show differences with different steroid dose regimens. High-dose steroids did not show any benefit in our cohort.

Multisystem inflammatory syndrome is a severe complication of SARS-CoV-2 infection in children (MIS-C). To date, data on long-term sequelae mainly concern cardiac outcomes. All ≤ 18 year olds consecutively admitted to the Buzzi Children’s Hospital with a diagnosis of MIS-C between October 1, 2020, and May 31, 2022, were followed up for up to 12 months by a dedicated multidisciplinary team. They underwent laboratory tests, multi-organ clinical and instrumental assessments, and psychosocial evaluation. 56/62 patients, 40 M, mean age 8.7 years (95

Background A severe multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 has been described after infection. A limited number of reports have analyzed the long-term complications related to pro-inflammatory status in MIS-C. We evaluated multiorgan impairment at the 6-month follow-up in MIS-C. Methods We enrolled 33 pediatric patients consecutively hospitalized for MIS-C and monitored for almost 6 months. The inter-relationship of patient's features and disease severity at admission with long term complications was studied by multivariate analysis. Results Endo-metabolic derangement, cardiac injury, respiratory, renal and gastrointestinal manifestations and neurological involvement are part of the initial presentation. The most abnormalities appear to resolve within the first few weeks, without significant long term dysfunction at the 6-months follow-up, except for endocrine (non-thyroidal illness syndrome in 12.1%, insulin resistance in 21.2%) and neurological system (27.3% cognitive or psychological, behavioral, adaptive difficulties). Endocrine and heart involvement at admission represent a significant factor on the long term sequelae; however no association between severity score and long-term outcome was noted. Conclusions The severity of initial clinical presentation may be associated to organ domain, however it is not related to long term sequelae. The prevalent organ restoration supports a predominant indirect immune-mediated injury triggered by a systemic inflammatory response; however a direct damage due to the viral entry could be not excluded. Eventhought our preliminary results seem to suggest that MIS-C is not a long-term risk condition for children health, a longer follow-up is mandatory to confirm this hypothesis.

Also available from AJOG MFM, the newest member of the AJOG family of journals -Conservative management for placenta accreta spectrum: questions

BACKGROUND:Maternal cardiovascular changes, occurring since the beginning of pregnancy, are necessary for normal placentation and regular evolution of pregnancy.OBJECTIVE:This study aimed to compare the hemodynamic profiles and cardiac remodeling of women with hypertensive disorders of pregnancy and either appropriate for gestational age fetuses or growth-restricted fetuses, women with normotensive pregnancies complicated by fetal growth restriction, and women with uncomplicated pregnancies, during pregnancy and the postpartum period.STUDY DESIGN:A prospective longitudinal case-control design was used for this study. Over the study period, 220 eligible women with singleton pregnancies were selected for the analysis and divided into 4 groups: (1) hypertensive disorders of pregnancy with appropriate for gestational age fetuses; (2) hypertensive disorders of pregnancy with fetal growth restriction; (3) normotensive fetal growth restriction; and (4) controls. Ultrasound fetal biometry and fetoplacental Doppler velocimetry were performed at recruitment. Maternal hemodynamic assessment using transthoracic echocardiography was performed at the time of recruitment by a dedicated cardiologist blinded to maternal clinical data. The same assessments were performed in 104 patients at 32 weeks (interquartile range, 24-40) after delivery by the same cardiologist.RESULTS:During pregnancy, women in the hypertensive-disorders-of-pregnancy-fetal-growth-restriction group showed significantly lower cardiac output and increased compared with those in the control group. These values were associated with concentric remodeling of the left ventricle owing to relatively increased wall thickness, which was not accompanied by an increase in left ventricular mass. Isolated fetal growth restriction presented similar but less important hemodynamic changes; however, there was no change in relative wall thickness. At postpartum follow-up, the hemodynamic parameters of women in the hypertensive-disorders-of-pregnancy-fetal-growth-restriction and isolated-fetal-growth-restriction groups reverted to values similar to those of the control group. Only 8.3% of women in these groups experienced hypertension even in the postpartum period, and asymptomatic stage-B cardiac failure was observed for 17% at echocardiography. In the group of women with hypertensive disorders of pregnancy and appropriate for gestational age fetuses, cardiac output increased as in normal pregnancies, but total vascular resistance was significantly higher; hypertension then occurred, along with ventricular concentric hypertrophy and diastolic dysfunction. At postpartum follow-up, women in the hypertensive-disorders-of-pregnancy-appropriate-for-gestational-age-fetus group showed significantly higher mean arterial pressure, total vascular resistance, and left ventricular mass compared with those in the control group. Persistent hypertension and asymptomatic stage-B cardiac failure were observed in 39.1% and 13% of women in the former group, respectively.CONCLUSION:Pregnancies with hypertensive disorders of pregnancy and fetal growth restriction and normotensive pregnancies with fetal growth restriction were associated with the hemodynamic profile of lower heart rate and cardiac output, most likely because of abnormal adaptation to pregnancy, as confirmed by abnormal changes from pregnancy to the postpartum period. The heart rates and cardiac output of women in the hypertensive-disorders-of-pregnancy-appropriate-for-gestational-age-fetus group showed changes opposite to those observed in the hypertensive-disorders-of-pregnancy-fetal-growth-restriction and fetal-growth-restriction groups. Obesity and other metabolic risk factors, significantly prevalent in women in the hypertensive-disorders-of-pregnancy-appropriate-for-gestational-age-fetus group, predispose to hypertension and cardiovascular diseases during pregnancy and the postpartum period, potentially offering a window for personalized prevention. Such preventive strategies could differ in women with hypertensive disorders of pregnancy and fetal growth restriction characterized by poor early placental development.

Physical activity (PA) is a crucial factor in preventing and treating obesity and related complications. In this one-arm pre–post longitudinal prospective study, we evaluated the effects of a 12-week online supervised training program on cardiac morphology, function and blood pressure (BP) in children with obesity. The training program consisted of three sessions per week, each lasting 60 min. Advanced echocardiographic imaging (tissue Doppler and longitudinal strain analysis) was used to detect subclinical changes in heart function. Categorical variables were described as counts and percentages; quantitative variables as the mean and standard deviation (SD) as they were normally distributed (Shapiro–Wilks test). Pre–post comparisons were made with a paired t-test. A total of 27/38 (71%) enrolled patients (18M/9F, 11 ± 2 years) completed the training protocol and were considered in the analysis. At baseline, no hypertensive patient was noted; all echocardiographic variables were within the normal range. After training, we observed a significant reduction in BP parameters, including systolic BP values and Z-score, diastolic BP values, centiles and Z-score, and mean arterial pressure (all p < 0.05). Significant variations in echocardiographic interventricular septum (IVSd) thickness (p = 0.011), IVSd Z-score (p = 0.001), left ventricular (LV) end-diastolic diameter (p = 0.045), LV posterior wall thickness Z-score (p = 0.017), and LV global longitudinal strain (p = 0.016) were detected. No differences in LV diastolic function and right ventricular strain were noted. PA plays a decisive role in improving BP control and has benefits on left ventricle systolic function, representing a strategic approach to limit CV risk. Online exercise could be an excellent method of training in children with obesity.

BACKGROUND: Maternal cardiovascular adaptations are amplified in twin pregnancies to support the metabolic request of the feto-placental unit. Few studies have evaluated the maternal hemodynamics changes after routine use of laser surgery in the treatment of twin-twin transfusion syndrome. OBJECTIVE: The aim of our study was to evaluate hemodynamic changes in monochorionic twin pregnancies complicated by twin-twin transfusion syndrome before and after treatment with fetoscopic laser surgery. STUDY DESIGN: A prospective observational study from 2020 to 2022, included monochorionic twin pregnancies complicated with twintwin transfusion syndrome undergoing laser surgery between 16 and 26 weeks of gestation. To assess placental function and perfusion, uterine artery pulsatility index, hemoglobin, hematocrit, and soluble fms-like tyrosine kinase-1/placental growth factor ratio sampling prelaser and 24 hours postlaser were measured. Echocardiography by a single cardiologist evaluated maternal hemodynamics at presurgery, 24 hours, and 1 week postlaser. Those data were crosswise compared with cardiovascular indices of uncomplicated monochorionic pregnancies recruited at the same gestational age using nonparametric tests. Moreover, we fitted random-intercept linear regression models to investigate maternal hemodynamic changes according to the amount of amniotic fluid drained during laser surgery. RESULTS: Forty-two twin-twin transfusion syndrome pregnancies with a median gestational age of 19.1 (17.4-20.9) weeks and 15 uncomplicated monochorionic pregnancies at the same gestational age were enrolled. Overall survival rate after laser was 72% with delivery at a median gestational age of 31.5 (27-34) weeks. Significant changes in blood chemistry and placental function were observed in the twin-twin transfusion syndrome group, along with alterations in arterial pressure, heart rate, cardiac output, and ventricular strain, eventually aligning with the uncomplicated group's values by 1 week postlaser. The amount of amniodrainage, with a 1000 ml cut-off, did not significantly impact hemodynamic parameters. Lastly, we detected a percentage of laser surgery complications in agreement with international literature and we did not record any maternal procedure-related problems. CONCLUSION: Our analysis highlighted that maternal cardiovascular status in monochorionic twin pregnancy complicated by twin-twin transfusion syndrome was more dynamic and; 1 week after fetoscopic laser ablation of placental anastomosis completed by amniodrainage, maternal hemodynamic parameters restored to values similar to uncomplicated monochorionic twin pregnancies.

To study maternal cardiovascular and hemodynamic changes in monochorionic (MC) twin pregnancies complicated by Twin–twin transfusion syndrome (TTTS) after treatment with fetoscopic laser ablation (FLA) of placental anastomosis. Prospective observational study of MC twin pregnancies complicated by TTTS treated with FLA of placental anastomosis according to validated criteria, between 16 and 26 gestational age (GA) with at least one survivor. To assess placental function and perfusion, we recorded uterine artery pulsatility index (UtA-PI) and soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PIGF). To evaluate maternal hemodynamic changes, we performed an admission echocardiography and then 24 hours and one week after FLA, including hemodynamic parameters of systolic and diastolic function and cardiac remodelling indices. Data were analysed using paired non-parametric tests. 31 MC twin pregnancies complicated by TTTS treated with FLA of placental anastomosis at mean [± standard deviation (SD)] 19.6 (± 2.3) GA, were preliminary analysed. We found a significant increase in sFlt-1/PIGF between admission and postoperative sample (p < 0.05). Regarding maternal cardiovascular function, we observed an improvement in longitudinal ventricular strain between admission and one week after FLA (p < 0.05). We did not record any maternal procedure-related complications. Preliminary analysis highlighted significant improvement in maternal cardiovascular efficiency after FLA of placental anastomosis in pregnant women with MC twin pregnancies complicated by TTTS. Increasing patients' recruitment and comparing maternal cardiovascular assessment in non-complicated MC twin pregnancies, are needed to evaluate the clinical impact in management.

Multisystem inflammatory syndrome in children (MIS-C) is a severe hyperinflammatory disease related to SARS-CoV2 infection, with frequent cardiovascular involvement in the acute setting. The aim of the study was to evaluate the cardiac function at 6 months. Thirty-two patients diagnosed with MIS-C were enrolled and underwent advanced echocardiogram at discharge and at 6 months. According to the left ventricular ejection fraction (LVEF) at admission, the patients were divided into group A (LVEF < 45%) and group B (LVEF ≥ 45%) and the follow-up results were compared. At discharge, all patients had normal LV and RV systolic function (LVEF 61 ± 4.4%, LV global longitudinal strain −22.1%, TAPSE 20.1mm, s’ wave 0.13m/s, RV free wall longitudinal strain −27.8%) with normal LV diastolic function (E/A 1.5, E/e’ 5.7, and left atrial strain 46.5%) and no significant differences at 6 months. Compared to group B, the group A patients showed a reduced, even if normal, LV global longitudinal strain at discharge (−21.1% vs. −22.6%, p-value 0.02), but the difference was no longer significant at the follow-up. Patients with MIS-C can present with depressed cardiac function, but if treated, the cardiac function recovered without late onset of cardiac disease. This favorable result was independent of the severity of acute LV dysfunction.

Abstract Background Multisystem inflammatory syndrome in children (MIS-C) is a novel condition temporally associated with SARS-CoV2 infection. Cardiovascular involvement is mainly evident as acute myocardial dysfunction in MIS-C. The aim of this study was to describe the cardiac dysfunction in patients with MIS-C, defining the role of severity in the clinical presentations and outcomes in a single cohort of pediatric patients. Methods A single-center retrospective study on patients diagnosed with MIS-C, according to the Center for Disease Control and Prevention (CDC) definition, and referred to Vittore Buzzi Children’s Hospital in Milan from November 2020 to February 2021. Patients were managed according to a local approved protocol. According to the admission cardiac left ventricular ejection fraction (LVEF), the patients were divided into group A (LVEF < 45%) and group B (LVEF ≥45%). Pre-existing, clinical, and laboratory factors were assessed for evaluating outcomes at discharge. Results Thirty-two patients were considered. Cardiac manifestations of MIS-C were reported in 26 patients (81%). Group A included 10 patients (9 M/1F, aged 13 years [IQR 5–15]), and group B included 22 patients (15 M/7 M, aged 9 years [IQR 7–13]). Significant differences were noted among clinical presentations (shock, diarrhea, intensive care unit admission), laboratory markers (leucocytes, neutrophils, and protein C-reactive), and cardiac markers (troponin T and N-terminal pro B-type Natriuretic Peptide) between the groups, with higher compromission in Group A. We found electrocardiogram anomalies in 14 patients (44%) and rhythm alterations in 3 patients (9%), without differences between groups. Mitral regurgitation and coronary involvement were more prevalent in group A. Total length of hospital stay and cardiac recovery time were not statistically different between groups. A recovery of cardiac functioning was reached in all patients. Conclusion Despite significant differences in clinical presentations and need for intensive care, all of the MIS-C patients with significant cardiac involvement in this study completely recovered. This suggests that the heart is an involved organ and did not influence prognosis if properly treated and supported in the acute phase.

ABSTRACTObjectiveTo 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).MethodsA 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.ResultsIn 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.ConclusionFGR 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.

To evaluate maternal hemodynamic profile in pregnancies affected by intrauterine growth restriction (IUGR). In this observational prospective study 76 patients, between 24 gestational weeks to term, were recruited: 43 with mild IUGR (m-IUGR), 14 with severe IUGR (s-IUGR) and 19 controls with uneventful pregnancies. m-IUGR was defined as a fetus with abdominal circumference (AC) <10thcentile and a Doppler velocimetry in umbilical artery <2SD, while s-IUGR was defined when AC <5thcentile and Doppler velocimetry in umbilical artery >2SD. Maternal echocardiography was performed in blind, by a dedicated cardiologist, to measure hemodynamic parameters (cardiac output CO, total vascular resistances TVR), indexes of systolic function (ejection fraction EF, systolic peak S-wave velocity S'), indexes of diastolic function evaluated at tissue Doppler (E'/A' and E/E' ratios) and indexes of cardiac remodelling (left ventricular mass LVM, relative wall thickness RWT). Both m-IUGR and s-IUGR groups have a mean arterial pressure and heart rate similar to controls. CO is significantly reduced and TVR significantly increased in both IUGR groups, compared with controls. Moreover, systolic and diastolic function and indexes of cardiac remodelling don't differ significantly from controls. Maternal hemodynamic profiles appear to be similar in pregnancies affected by intrauterine growth restriction, regardless of the severity of placental damage.

Maternal hemodynamics varies in different clinical phenotypes of preeclampsia: early placental damage associated with fetal growth restriction; maternal cardiovascular risk factors most frequently associated with appropriate feto-placental growth. We compared maternal hemodynamic profile during pregnancy and at 6–12 months postpartum in women affected by Hypertensive Disorder of Pregnancy (HDP), associated with two different feto-placental growth patterns. 89 patients from 24 weeks to term were enrolled in this prospective observational study: 24 HDP with appropriate for gestational age fetus (HDP-AGAf), 27 HDP with intrauterine growth restriction (HDP-IUGR), 16 normotensive women with severe IUGR (s-IUGR), 22 controls. Diagnosis of HDP was made according to the ISSHP criteria, with the exclusion of chronic hypertension. s-IUGR was defined as abdominal circumference <5thcentile and a Doppler velocimetry in umbilical artery >2SD. Maternal echocardiography was performed by a cardiologist blinded to clinical diagnosis, at recruitment and at 6–12 months postpartum. During pregnancy, HDP-IUGR showed significantly lower heart rate (HR), lower cardiac output (CO) and increased total vascular resistances (TVR), compared to controls. s-IUGR presented significantly lower CO and increased TVR, compared to controls. These profiles remained relatively unchanged at 6–12 months postpartum. HDP-AGAf showed increased CO as in control pregnancies, but significantly higher TVR; this group also presented significantly increased left ventricular mass (LVM) and relative wall thickness (RWT), and a reduced E/A ratio, indicating an impaired myocardial relaxation. In post-partum we observed persistently increased MAP values, due to high TVR, in spite of a return to normal HR and CO values. Our hypothesis, that prioritizes the feto-placental phenotype, allowed us to observe a significantly poor cardiovascular adaptation to pregnancy metabolic demands in HDP-IUGR and s-IUGR. This was profoundly different from uneventful pregnancies, characterized by increased HR and CO and low TVR. HDP-AGAf presented similar increase in HR and CO as in controls, but at the cost of diastolic function impairment and of left ventricle remodeling. In postpartum, HR and CO returned to normal, but TVR and MAP remained higher.

Ultrasound in Obstetrics & GynecologyVolume 50, Issue S1 p. 51-51 AbstractsFree Access Abstract withdrawn First published: 16 September 2017 https://doi.org/10.1002/uog.17700Citations: 4AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume50, IssueS1Special Issue: Abstracts of the 27th World Congress on Ultrasound in Obstetrics and Gynecology, 16–19 September 2017, Vienna, AustriaSeptember 2017Pages 51-51 RelatedInformation

To evaluate maternal hemodynamic profile in hypertensive or normotensive pregnancies complicated by intrauterine growth restriction (IUGR). 54 patients affected by hypertensive disorder of pregnancy (HDP: gestational hypertension, pre-eclampsia), between 24 and 40 gestational weeks, were recruited in this observational prospective study: 21 HDP with intrauterine growth restriction (HDP-IUGR), 14 normotensive women with severe IUGR (s-IUGR), 19 controls with uneventful pregnancies. Diagnosis of HDP was made according to the criteria of the ISSHP. s-IUGR was defined as a fetus with abdominal circumference <5th centile and a Doppler velocimetry in umbilical artery >2SD. Maternal echocardiography was performed in blind, by a dedicated cardiologist, to measure hemodynamic parameters (cardiac output CO, total vascular resistances TVR), indexes of systolic function (ejection fraction EF, systolic peak S-wave velocity S'), indexes of diastolic function evaluated at tissue Doppler (E'/A' and E/E' ratios) and indexes of cardiac remodelling (left ventricular mass LVM, relative wall thickness RWT). CO was significantly reduced and TVR significantly increased in both HDP-IUGR and s-IUGR groups compared with controls, even if mean arterial pressure was significantly increased only in the HDP-IUGR group. Heart rate (HR) was significantly reduced only in the HDP-IUGR group. In both groups systolic function, diastolic function and cardiac remodelling indexes didn't show any significant difference compared with controls. HDP-IUGR and s-IUGR groups show a similar hemodynamic profile, even if patients from the latter group are normotensive. The failed cardiovascular adaption to pregnancy denotes a common etiopathogenensis, based on early placental damage. Anti-hypertensive therapy, started as soon as blood pressure increases, may explain why our HDP-IUGR and s-IUGR patients don't develop a pathological concentric hypertrophy, otherwise described by other Authors.

To compare maternal hemodynamic profile during pregnancy and at 6-12 months postpartum in women affected by Hypertensive Disorder of Pregnancy (HDP), associated with different fetoplacental growth patterns. 72 patients from 24 gestational weeks to term were enrolled in this prospective observational study: 18 HDP with appropriate for gestational age fetus (HDP-AGAf), 21 HDP with intrauterine growth restriction (HDP-IUGR), 14 normotensive women with severe IUGR (s-IUGR), 19 controls. Diagnosis of HDP was made according to the criteria of the ISSHP. s-IUGR was defined as abdominal circumference <5thcentile and a Doppler velocimetry in umbilical artery >2SD. Maternal echocardiography was performed in blind by a dedicated cardiologist, at diagnosis and at 6-12 months postpartum. During pregnancy, HDP-IUGR and s-IUGR showed a significantly lower cardiac output (CO) and increased total vascular resistances (TVR), compared with controls. This profile remained almost unchanged at 6-12 months postpartum, even if mean arterial pressure (MAP) returned to pre-pregnancy values in HDP-IUGR. HDP-AGA showed an increased CO and TVR during pregnancy; this group also presented an increased left ventricular mass (LVM) and relative wall thickness (RWT), and a reduced E'/A' ratio, indicating an impaired myocardial relaxation. In post-partum we observed persistently increased MAP values, due to high TVR, in spite of a return to normal HR and CO values. Our hypothesis, that prioritises the fetoplacental phenotype, allowed us to observe a significantly poor cardiovascular adaptation to pregnancy metabolic demands in HDP-IUGR and s-IUGR. This was profoundly different from uneventful pregnancies, characterised by increased HR and CO and lowered TVR. HDP-AGA presented similar increase in HR and CO compared to controls, but at the cost of diastolic function impairment and of left ventricle remodelling. In postpartum, HR and CO returned to normal, but TVR remained high, as well as LVM.

Among AGA fetuses, the correlation between the CPR2 and the CPR reported a high R2 value (0,23 and 0,15 respectively). There were too few observations among the growth restricted fetuses to draw any valid conclusions. Conclusions: This study suggests that CPR2 could be considered as a clinically relevant alternative to the CPR using the MCA. More data are required to validate this parameter as a clinically useful alternative to the currently used CPR.

Aims: To compare maternal hemodynamic profile during pregnancy and at 6–12 months after delivery in pregnancies with different HDP phenotypes or severe IUGR.Methods: We enrolled patients between 24 and 38 weeks of gestation: HDP with appropriate for gestational age foetuses (HDP-AGAf), HDP with IUGR (HDP-IUGR), severe IUGR and Controls matched for gestational age. Severe IUGR was defined as abdominal circumference <5th centile and a PI in umbilical artery42SD. Diagnosis of HDP was made according to the criteria of the ISSHP. Maternal echocardiography was performed during pregnancy and at 6–12 months after delivery to compare in each group cardiac output (CO), total vascular resistance (TVR) and tissue Doppler E’/A’ wave ratio.Results: Maternal heart rate and CO were reduced and TVR increased during pregnancy, and did not change significantly at follow-up in the 10 HDP-IUGR and in the 8 severe IUGR recruited. Heart rate, CO and TVR in the 8 HDP-AGAf were similar to Controls both during pregnancy and at follow-up except for a significantly increased MAP and a reduced E’/A’ ratio.Discussion: Maternal hemodynamic changes at 6–12 months postpartum varies according to different physio-pathological phenotypes of maternal HDP and placental damage.