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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 3, May/June 2019
AFRICA
183
using combined Doppler echocardiography (maternal and
foetal), electrographic monitoring, and cardiac biomarkers such
as brain natriuretic peptide to properly manage the complex
obstetric syndrome of pre-eclampsia and its related phenotypes,
in an attempt to detect early cardiovascular changes and reduce
both maternal and foetal morbidity and mortality rates.
Conclusion
An integrated model of materno-foetal cardiac dysfunction
in severe pre-eclampsia is presented, whereby chronic
trophoblastic ischaemia is the central role player, releasing
vasoactive substances that induce haemodynamic alterations
in the materno-foetal complex. This scenario is augmented
and modified by ‘latent’ maternal cardiovascular dysfunction
and increased maternal cathecolamine secretion on the one
hand, and altered foetal signalling mechanisms on the other.
All three components of the materno-placental-foetal complex
are in interplay and in constant interaction with each other.
This unified hypothesis may explain the development of both
maternal and foetal morbidity and/or mortality on a unitary
basis in severe, complicated pre-eclampsia. Maternal and foetal
echocardiography should therefore be incorporated in the work-
up of severe pre-eclampsia to risk-stratify these cases, in order
to enable clinicians to choose the appropriate acute hypertensive
drug therapy and plan optimal management pathways.
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