Nicholas Kametas

• King's College Hospital NHS Foundation Trust

Objective To examine the postnatal course of the ophthalmic artery (OA) Doppler in women with hypertensive disorders of pregnancy (HDP) and evaluate the correlation between OA Dopplers and poor postnatal blood pressure control and renal dysfunction at 2‐3 and 6‐9 weeks postnatally. Methods Prospective cohort study of women with singleton pregnanci...

Objective To compare the predictive performance for delivery with preeclampsia (PE) within 2 weeks of assessment in women with chronic hypertension at 24‐41 weeks’ gestation between serum glycosylated fibronectin (GlyFn) concentration, serum placental growth factor (PlGF) concentration and soluble fms‐like tyrosine kinase‐1 (sFLT‐1) / PlGF concentr...

Objective: To compare the predictive performance for delivery with preeclampsia (PE) within 2 weeks of assessment in women with new onset hypertension at 24-41 weeks' gestation between serum glycosylated fibronectin (GlyFn), serum placental growth factor (PlGF) concentration and soluble fms-like tyrosine kinase-1 (sFLT-1) / PlGF concentration rati...

Objective: To compare the predictive performance for delivery with preeclampsia (PE) at less than three weeks and at any stage after assessment at 35+0 - 36+6 weeks' gestation by serum placental growth factor (PlGF) and the soluble fms-like tyrosine kinase-1 (sFLT-1) to PlGF ratio with the competing risks model utilizing maternal risk factors, mea...

Objectives: To compare the longitudinal maternal hemodynamic changes throughout gestation between different groups stratified according to booking weight and assess the relative influence of height, booking weight and gestational weight gain on cardiac adaptation. Methods: This was a prospective, longitudinal study assessing maternal hemodynamic...

( Anaesthesia . 2020;75:1307–1313) This study aimed to use 2-dimensional transthoracic echocardiography (TTE) and the Non-Invasive Cardiac Output Monitor (NICOM) to investigate distinct hemodynamic patterns found in pregnancy to determine whether those measurements could be used to predict and prevent preeclampsia and fetal growth restriction. The...

Objective: To examine the changes in ophthalmic artery Doppler indices and their association with changes in mean arterial blood pressure (MAP) and systolic and diastolic blood pressure in women with hypertensive disorders of pregnancy, presenting with high blood pressure and receiving antihypertensive medication. Methods: Prospective cohort stu...

Objectives: To compare the longitudinal maternal hemodynamic changes throughout gestation between different age groups. Methods: This was a prospective, longitudinal study assessing maternal hemodynamics by bioreactance technique at 11+0 -13+6 , 19+0 -24+0 , 30+0 -34+0 and 35+0 -37+0 weeks' gestation. Women were divided into four groups accordin...

Objectives Chronic hypertension complicates 1-2% of pregnancies and it is increasingly common. Women with chronic hypertension are easily-recognized and in touch with a wide variety of healthcare providers before, during, and after pregnancy, mandating that chronic hypertension in pregnancy be within the scope of many practitioners. We reviewed rec...

Preeclampsia at term accounts for half of maternal deaths from hypertensive disorders. We aimed to assess differences in maternal cardiac indices at 35+0 to 36+6 weeks' gestation between women who subsequently developed preeclampsia at term compared with those with uncomplicated pregnancy and to evaluate whether cardiac indices offer incremental pr...

Maternal cardiac dysfunction is associated with pre‐eclampsia, fetal growth restriction and haemodynamic instability during obstetric anaesthesia. There is growing interest in the use of non‐invasive cardiac output monitoring to guide antihypertensive and fluid therapies in obstetrics. The aim of this study was to validate thoracic bioreactance usi...

Question Mean arterial pressure (MAP) is a useful biomarker for the screening of preeclampsia (PE). However, MAP, a function of cardiac output and peripheral resistance, is dependent on other maternal characteristics and, for its effective use in screening, these need to be taken into account. One such characteristic is the use of anti-hypertensive...

Question The risks of developing adverse pregnancy outcomes aside from recurrence of preeclampsia (PE), such as gestational diabetes (GDM), in women with previous gestational hypertension have not been widely reported. In addition, most existing studies include women with chronic hypertension, a significant predictor for the PE recurrence. Finally,...

Question Recent studies have demonstrated that different parameters of blood pressure may hold valuable information not only in the diagnosis of preeclampsia (PE) but also in identifying women in their first and second trimester at risk of developing PE later in the pregnancy. One such promising component is mean arterial blood pressure (MAP). This...

Question Previous studies evaluating pregnancy outcomes in chronic hypertension use older definitions of preeclampsia (i.e. co-existence of hypertension and proteinuria). Since the publication of the more inclusive criteria for preeclampsia (PE) by the International Society for the Study of Hypertension in Pregnancy (ISSHP) in 2014, the impact on t...

Objective: The aim of this study was to evaluate the accuracy of the Omron MIT Elite automated device in pregnant women with an arm circumference of or above 32 cm, using the British Hypertension Society validation protocol. Methods: Blood pressure was measured sequentially in 46 women of any gestation requiring the use of a large cuff (arm circ...

Objective: Firstly, to validate the Withings BP-800 automated device for use in pregnancy and, secondly, to assess the impact of maternal somatometric and demographic variables on the accuracy of the device. Design: Prospective observational study. Setting: Kings College Hospital, London, UK. Population: Forty-seven women of any gestation....

The study aimed to develop prediction algorithms for hypertensive disorders based on multivariate analysis of factors from the maternal history and compare the estimated performance of such algorithms in the prediction of early preeclampsia (PE), late-PE and gestational hypertension (GH) with that recommended by the National Institute for Clinical...

To investigate maternal cardiac adaptation in the first trimester of pregnancy with increasing maternal parity. This was a cross-sectional study carried out at the antenatal clinic of a teaching hospital. We examined 4689 pregnant women at 11 + 0 to 13 + 6 weeks of gestation, performing two-dimensional echocardiography of the maternal left ventricl...

To compare maternal cardiac function between pregnancies complicated by normotensive and pre-eclamptic intrauterine growth restriction (IUGR). Two-dimensional Doppler echocardiography and Doppler tissue imaging (DTI) were used to examine 19 pregnant women with IUGR and 17 with pre-eclampsia complicated by IUGR at 20-38 weeks of gestation. Indices w...

To determine the prevalence of blood pressure inter-arm difference (IAD) in early pregnancy and to investigate its possible association with maternal characteristics. A cross-sectional observational study. Routine antenatal visit in a university hospital. A total of 5435 pregnant women at 11-14 weeks of gestation. Blood pressure was taken from both...

To determine the performance of screening for pre-eclampsia by maternal characteristics, urine albumin concentration and albumin-to-creatinine ratio (ACR) at 11(+0) to 13(+6) weeks. Prospective cross-sectional observational study. Routine antenatal visit. A total of 2679 pregnant women at 11(+0) to 13(+6) weeks of gestation. Maternal variables, uri...

This study reports on the interdependence of intra-individual blood pressure (BP) variability and the BP level in early pregnancy. The higher the BP, the more exaggerated the drop from the first to the second reading and the higher the intra-individual standard deviation.

It is clear that preeclampsia is not—as previously thought—a uniformly high-resistance, volume-contracted state. Instead, hemodynamic features range from a hyperdynamic state with elevated cardiac output (CO) and increased left ventricular (LV) function to a vasoconstrictive state with decreased CO and reduced LV function. Variable profiles of syst...

To assess maternal cardiac function in nulliparous women in the first trimester of pregnancy and evaluate its potential role for predicting pre-eclampsia and small for gestational age (SGA). Prospective, observational, cross-sectional study. Maternity unit of a teaching hospital. Nulliparous women with singleton pregnancies presenting consecutively...

Tissue Doppler imaging (TDI) is an echocardiographic technique that evaluates longitudinal myocardial tissue velocities during left ventricular systolic and diastolic function, relatively independently of loading conditions. Limited data are available regarding maternal cardiac function using TDI. The aim of this study was to construct reference ch...

To compare maternal cardiac function in women with intrauterine growth restriction (IUGR) to those with small-for-gestational age (SGA) pregnancies (non-IUGR). This was a cross-sectional study involving maternal echocardiography and uterine, umbilical and fetal middle cerebral artery Doppler assessment in 52 normotensive women at 20-36 weeks' gesta...

To assess the maternal central haemodynamics in normotensive women with pregnancies complicated by severe fetal growth restriction (FGR). Cross-sectional study. A tertiary referral fetal medicine unit. The study groups comprised 107 women with normal singleton pregnancies and 20 with singleton pregnancies complicated by FGR at 25-37 weeks. In the l...

Mercury-independent devices are increasingly being used in clinical practice as mercury will soon be removed from clinical use as a result of environmental, health and safety concerns. The aim of this study was to evaluate the accuracy of a portable aneroid device in an adult population at high altitude by following the part of the protocol of the...

To investigate the accuracy of intrapartum transvaginal digital examination in defining the position of the fetal head before instrumental delivery. In 64 singleton pregnancies undergoing instrumental delivery the fetal head position was determined by transvaginal digital examination by the attending obstetrician. Immediately after or before the cl...

To investigate the accuracy of intrapartum transvaginal digital examination in defining the position of the fetal head. In 496 singleton pregnancies in labor at term, the fetal head position was determined by routine transvaginal digital examination by the attending midwife or obstetrician. Immediately before or after the clinical examination, the...

To evaluate changes in left ventricular mass and diastolic function during normal pregnancy. This was a cross-sectional study of 125 pregnant women at 9-42 weeks of gestation and 19 non-pregnant female controls. Two-dimensional and M-mode echocardiography of the maternal left ventricle and left atrium was performed. During pregnancy left ventricula...

Circumferential fiber shortening has been the dominant basis for conventional analysis by echocardiography of left ventricular systolic function during pregnancy. Results in the literature have been conflicting due mainly to the fact that geometric assumptions for the calculation of these indices are made that may not be valid due to changes in lef...

1. To measure blood gases and minute ventilation in healthy women with normal pregnancies, compare with non-pregnant women both at sea level and at high altitude; 2. to relate the results at altitude with duration of residence there. Cross-sectional study. Antenatal clinics at sea level in Lima, Peru and at high altitude 4300m in Cerro de Pasco, Pe...

The possible effect of assisted reproduction on first-trimester screening for trisomy 21 was examined by fetal nuchal translucency thickness (NT), maternal serum free beta-human chorionic gonadotrophin (HCG) and pregnancy-associated plasma protein-A (PAPP-A). Parameters were measured at 11-14 weeks in 411 singleton pregnancies achieved by controlle...

To assess insulin sensitivity and beta-cell function associated with lower maternal fasting plasma glucose levels at high altitude compared with sea level. We studied 215 pregnant women at 8-42 weeks of gestation in Peru. The women were recruited from Cerro de Pasco, which is situated 4,370 m (14,340 feet) above sea level, and Lima, which is at sea...

To investigate haemorheological changes during pregnancy in a Latin American population and compare to previously published data from Caucasian populations. Design: Cross-sectional study. Population: 75 pregnant women at 10-36 wk of gestation and 17 non-pregnant female controls in Lima, Peru. All the women and their ancestors for three generations...

To compare plasma glucose in pregnant women living at very high altitude; pregnant women living at sea level; non-pregnant women living at very high altitude; and non-pregnant women living at sea level. Cross-sectional study. Ninety-four pregnant women attending for routine antenatal care at 8-42 weeks of gestation in Cerro de Pasco, Peru which is...

To assess endothelial function in normal pregnancy by non-invasive methods. Flow-mediated dilatation of the brachial artery was measured by ultrasonography in 157 women with normal singleton pregnancies between 10 and 40 weeks' gestation and 19 non-pregnant controls. Flow-mediated dilatation in the non-pregnant controls was 6.42 +/- 2.45%. In pregn...