ISUOG Consensus Statement on maternal hemodynamic assessment in hypertensive disorders of pregnancy and fetal growth restriction

Pregnancy presents a unique cardiovascular challenge. Profound maternal hemodynamic adjustments result from a complex interplay between the maternal cardiovascular system and uteroplacental perfusion, which permits fetal development while maintaining healthy maternal homeostasis. Failure to meet this challenge can lead to maternal hypertensive complications (hypertensive disorders of pregnancy (HDP)) and/or fetal growth disorders (fetal growth restriction (FGR)). Monitoring and management of HDP and FGR has been based largely on maternal blood pressure (BP) monitoring and fetal growth assessment. Promising research offers the prospect of a less reactive and more proactive approach. Maladaptation to the requirements of pregnancy can be detected in a preclinical phase of HDP and FGR by maternal hemodynamic assessment, offering opportunities for targeted hemodynamic interventions. Pregnancy also serves as a stress test for future cardiovascular health, especially if superimposed upon subclinical cardiometabolic or cardiovascular vulnerabilities. This Consensus Statement provides an update on the role of maternal hemodynamic assessment in HDP and FGR.