Date of Award

Summer 2018

Document type


Degree Name

PhD (Doctor of Philosophy)

First Supervisor

Professor Fergal Malone

Second Supervisor

Professor Afif EL-Khuffash


The study was funded by the Health Research Board (HRB) of Ireland and the Rotunda Foundation (previously known as Friends of the Rotunda) through the Medical Research Charities Group (MRCG) joint funding scheme (MRCG-2013-9).


Haemodynamics, Pregnancy, Preeclampsia, Fetal Growth Restriction, Hypertension.


Preeclampsia (PE) and Fetal Growth Restriction (FGR) are common complications of pregnancy. Data presented in this thesis, which mainly originate from the single centre prospective HAEMODYNAMIC Assessment iN pregnancy anD neonataL Echocardiography assessment (HANDLE) study, consolidate knowledge of the haemodynamics of normal pregnancy and the changes and predictive capability in those affected by PE & FGR.

The HANDLE study recruited 422 low risk nulliparous women at their first antenatal visit. Following exclusion and patient self-withdrawal a total of 366 women completed the study; 1.6% (n=6) had a pregnancy complicated by PE; 4.9% (n=18) by gestational hypertension (GH) and 6.6% (n=24) by FGR.

The objective of the primary analyses of this study was to assess the haemodynamics of pregnancy and the postpartum using NICOM® and the ability of these profiles to predict disease states. Presented in this thesis I have detailed four different haemodynamic profiles in pregnancy. In pregnancies complicated by preeclampsia, HR and SVi when combined with BP became statistically significant predictors at 14 weeks’ gestation (AUC=0.75, p=0.01 and AUC=0.77, p=0.009 respectively). In the postpartum, comparison between non-pregnant controls and those with GH demonstrated persistence of elevated DBP (p=0.01), TPRi (p=0.01) and lower SVi (p=0.03).

Secondary analyses were to validate the use of NICOM® in the obstetric population and correlation of biomarkers to haemodynamic variables. In keeping with findings in the adult and neonatal population I have shown that NICOM® is an acceptable alternative method of CO measurement in pregnant women. Evaluation of the biomarkers and haemodynamics at 14 weeks’ showed a weak positive correlation between Apelin 13 and SV (r=0.29; p=0.005) and a weak inverse correlation with TPRi (r=-0.29; p=0.004).

In conclusion, uteroplacental disease is a multifactorial complication of pregnancy. This thesis further highlights the need for the development of prediction models especially in the case of FGR.

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A thesis submitted for the degree of Doctor of Philosophy from the Royal College of Surgeons in Ireland in 2018.