Assessment of Cerebral Hemodynamic Changes During Roll-Over Test in Healthy Pregnant Women and Those with Mild and Severe Preeclampsia.

Background: Preeclampsia (PE) and eclampsia are characterized by changes in cerebral hemodynamics, which may result in serious and even life-threatening neurological complications. The aim of the present work was to compare cerebral hemodynamic changes during the roll-over test in women with mild and severe PE. Patients and methods: Healthy pregnant and PE women in their third trimester were studied. Transcranial Doppler (TCD) measurements of the right middle cerebral artery (MCA) were performed in the left lateral position and 5 min after turning to the supine position (roll-over test = ROT). Besides cerebral blood flow measurements, the blood pressure was measured in the right arm using a standard mercury sphygmomanometer. An independent gynecologist categorized the preeclamptic patients into mild and severe groups based on the clinical and laboratory results. The TCD assessors were unaware of the patient grouping while performing the TCD and blood pressure measurements. Results: A total of 21 healthy pregnant females (mean age: 26.1 ± 5.1 yrs), 11 females with mild PE (28.2 ± 6.8 yrs), and 18 females with severe PE (29 ± 7.4 yrs) were studied. A significant increase in the mean arterial pressure was observed in all of the groups during the roll-over test: healthy pregnant patients: from 106.3 ± 16.3 to 113.8 ± 15.9 mmHg; patients with mild PE: from 100 ± 11.2 to 110 ± 8.7 mmHg; and patients with severe PE: from 106.3 ± 16.3 to 113.8 ± 15.8 mmHg. The MCA mean blood flow velocities in the left lateral position were significantly lower in the control patients than in those with PE: MCAV control: 71.2 ± 12.7 cm/s; mild PE: 78.2 ± 19.4 cm/s; and severe PE: 96 ± 15.6 cm/s, p < 0.001. Turning to the supine position resulted in a decrease in the MCAV in all of the groups, but the differences between the groups remained unchanged: controls: 69.5 ± 9.1 cm/s; mild PE: 75.7 ± 17.5 cm/s; and severe PE: 85.7 ± 18.4 cm/s, respectively, p = 0.014. A slight but statistically insignificant increase in the pulsatility index was observed in all of the groups. Conclusions: This is the first study comparing cerebral hemodynamic changes in healthy pregnant females and in those with mild and severe PE during a roll-over test. Changing the posture did not result in changes in the cerebral blood flow velocities in the healthy and preeclamptic pregnant patients. Our results indicate that static cerebral autoregulation is preserved both in the mild and severe preeclamptic patients.