Echocardiographic Assessment of Cardiovascular Hemodynamic Changes in Hypertensive Disorders of Pregnancy

Introduction Hypertensive disorders of pregnancy are a major cause of maternal and perinatal morbidity and mortality worldwide, complicating a significant proportion of pregnancies. Cardiovascular maladaptation plays a central role in disease pathophysiology, yet routine echocardiographic evaluation is not universally practiced. The present study was conducted to evaluate cardiovascular hemodynamic alterations using two-dimensional echocardiography in women with hypertensive disorders of pregnancy and to compare echocardiographic parameters across different severity groups. Materials and methods This hospital-based prospective observational study included 70 pregnant women beyond 20 weeks of gestation with hypertensive disorders of pregnancy. Participants were stratified for analytical comparison into mild (19 (27.1%)), moderate (28 (40.0%)), and severe (23 (32.9%)) groups based on systolic and diastolic blood pressure levels. All women underwent a comprehensive echocardiographic assessment, including systolic parameters (left ventricular volumes, cardiac output, total vascular resistance) and diastolic parameters (E/A ratio, deceleration time, isovolumic relaxation time (IVRT)). Continuous variables were analyzed using one-way ANOVA, and categorical variables using the chi-square test. Pearson correlation assessed associations between blood pressure and echocardiographic parameters. Results Progressive increases in left ventricular end-systolic and end-diastolic volumes and cardiac output were observed with increasing disease severity (p < 0.001). Total vascular resistance decreased significantly across severity groups (p < 0.001). Diastolic dysfunction was present in 51 (72.9%) women and was more frequent in severe disease. The E/A ratio declined significantly with severity (p < 0.001). Significant correlations were noted between systolic blood pressure and cardiac output (r = 0.648, p < 0.001), and a significant negative correlation was observed with the E/A ratio (r = -0.612, p < 0.001). Severe disease was associated with higher rates of preterm delivery (17 (73.9%)), low birth weight (19 (82.6%)), and neonatal intensive care unit (NICU) admission (17 (73.9%)). Conclusion Hypertensive disorders of pregnancy are associated with significant systolic and diastolic hemodynamic alterations that correlate with disease severity and adverse maternal and neonatal outcomes. Two-dimensional echocardiographic evaluation provides valuable insight into cardiovascular involvement in hypertensive pregnancy; however, the findings should be interpreted in the context of an observational study without predictive modeling. However, larger studies with appropriate comparator groups are required to further clarify its clinical and prognostic significance.