Physiological adaptation of maternal plasma volume during pregnancy: a systematic review and meta-analysis

Fulltext:
170510.pdf
Embargo:
until further notice
Size:
407.8Kb
Format:
PDF
Description:
publisher's version
Publication year
2017Source
Ultrasound in Obstetrics & Gynecology, 49, 2, (2017), pp. 177-187ISSN
Publication type
Article / Letter to editor

Display more detailsDisplay less details
Organization
Gynaecology
Journal title
Ultrasound in Obstetrics & Gynecology
Volume
vol. 49
Issue
iss. 2
Page start
p. 177
Page end
p. 187
Subject
Radboudumc 16: Vascular damage RIHS: Radboud Institute for Health SciencesAbstract
OBJECTIVE: To describe the physiological pattern of gestational plasma volume adjustments in normal singleton pregnancy and compare this with the pattern in pregnancies complicated by pregnancy-induced hypertension, pre-eclampsia or fetal growth restriction. METHODS: We performed a meta-analysis of the current literature on plasma volume adjustments during physiological and complicated pregnancies. Literature was retrieved from PubMed (NCBI) and EMBASE (Ovid) databases. Included studies reported both reference plasma volume measurements (non-pregnant, prepregnancy or postpartum) and measurements obtained during predetermined gestational ages. Mean differences bet ween the reference and pregnancy plasma volume measurements were calculated for predefined intervals of gestational age using a random-effects model described by DerSimonian and Laird. RESULTS: Thirty studies were included in the meta-analysis with publication dates ranging from 1934 to 2007. Plasma volume increased in the first weeks of pregnancy, with the steepest increase occurring during the second trimester. Plasma volume continued to increase in the third trimester with a pooled maximum increase of 1.13 L (95% CI, 1.07-1.19 L), an increase of 45.6% (95% CI, 43.0-48.1%) in physiological pregnancies compared with the reference value. The plasma volume expansion in gestational hypertensive and growth-restricted pregnancies was 0.80 L (95% CI, 0.59-1.02 L), an increase of 32.3% (95% CI, 23.6-41.1%) in the third trimester, a smaller increase than in physiological pregnancies (P < 0.0001). CONCLUSIONS: During physiological pregnancy, plasma volume increases by, on average, more than 1 L as compared with non-pregnant conditions. In pregnancies complicated by pregnancy-induced hypertension, pre-eclampsia or fetal growth restriction, plasma volume increase in the third trimester is 13.3% lower than in normal pregnancy. Copyright (c) 2016 ISUOG. Published by John Wiley & Sons Ltd. Adaptacion fisiologica del volumen del plasma materno durante el embarazo: una revisi\xF3n sistematica y metaanalisis RESUMEN OBJETIVO: Describir el patron fisiologico de los cambios en el volumen del plasma gestacional en embarazos normales con feto unico y compararlo con el patron en los embarazos complicados por hipertension gestacional, preeclampsia o restriccion del crecimiento fetal. METODOS: Se realizo un metaanalisis de la literatura actual sobre los cambios en el volumen de plasma durante embarazos complicados y fisiologicos. La literatura se obtuvo de las bases de datos PubMed (NCBI) y EMBASE (Ovid). Los estudios incluidos mencionaban tanto mediciones de referencia del volumen plasmatico (no embarazada, antes del embarazo o despues del parto) como mediciones tomadas a edades gestacionales predeterminadas. Se calcularon las medias de las diferencias entre las mediciones de referencia y las del embarazo para el volumen plasmatico a intervalos predefinidos de la edad gestacional, utilizando un modelo de efectos aleatorios descrito por DerSimonian y Laird. RESULTADOS: En el metaanalisis se incluyeron treinta estudios con fechas de publicacion entre 1934 y 2007. El volumen plasmatico aumento en las primeras semanas de embarazo y el mayor incremento se produjo durante el segundo trimestre. El volumen de plasma continuo aumentando en el tercer trimestre con un aumento combinado maximo de 1,13L (IC 95%, 1,7-1,19 L), lo que supone un aumento del 45,6% (IC 95%, 43,0-48,1%) en embarazos fisiologicas en comparacion con el valor de referencia. El aumento del volumen plasmatico en los embarazos con hipertension y con crecimiento intrauterino restringido fue de 0,80L (IC 95%, 0,59-1,02 L), lo que supone un aumento del 32,3% (IC 95%, 23,6-41,1%) en el tercer trimestre, y un incremento menor que en los embarazos fisiologicos (P <0,0001). CONCLUSIONES: Durante el embarazo fisiologico el volumen de plasma aumenta, en promedio, mas de 1L, en comparacion con el de las no embarazadas. En los embarazos complicados por hipertension gestacional, preeclampsia o restriccion del crecimiento fetal, el aumento del volumen plasmatico en el tercer trimestre es un 13,3% menor que en el embarazo normal. :meta : , : metaPubMed(NCBI)EMBASE(Ovid)()DerSimonianLaird, : Meta30,19342007,,1.13 L(95% CI,1.07~1.19 L),,45.6%(95% CI,43.0%~48.1%)0.80 L(95%CI,0.59~1.02 L),32.3%(95% CI,23.6%~41.1%),(P<0.0001) : ,,1 L,13.3%.
This item appears in the following Collection(s)
- Academic publications [202914]
- Electronic publications [101091]
- Faculty of Medical Sciences [80065]
Upload full text
Use your RU credentials (u/z-number and password) to log in with SURFconext to upload a file for processing by the repository team.