Cerebral perfusion pressure and autoregulation in eclampsia-a case control study

Am J Obstet Gynecol. 2021 Aug;225(2):185.e1-185.e9. doi: 10.1016/j.ajog.2021.03.017. Epub 2021 Mar 17.


Background: Dynamic cerebral autoregulation and cerebral perfusion pressure are altered in pregnancies complicated by preeclampsia compared with normotensive pregnancies, but the connections of dynamic cerebral autoregulation, cerebral perfusion pressure, and cerebral complications in preeclampsia remain unclear.

Objective: This study aimed to assess dynamic cerebral autoregulation and cerebral perfusion pressure after delivery in women with eclampsia, in women with preeclampsia both with and without severe features, and in normotensive women.

Study design: This was a prospective case control study at a large referral hospital in Cape Town, South Africa. The recruitment of participants was done at diagnosis (cases) or at admission for delivery (controls). Transcranial Doppler examinations with continuous noninvasive blood pressure measurements and end-tidal CO2 monitoring were conducted for cases and controls after delivery. Cerebral perfusion pressure and dynamic cerebral autoregulation index were calculated, and values were compared among groups.

Results: We included 16 women with eclampsia, 18 women with preeclampsia with severe features, 32 women with preeclampsia without severe features, and 21 normotensive women with uncomplicated pregnancies. Dynamic cerebral autoregulation was depressed in pregnant women with eclampsia; (autoregulation index, 3.9; interquartile range, 3.1-5.2) compared with all other groups (those with preeclampsia with severe features, autoregulation index, 5.6 [interquartile range, 4.4-6.8]; those with preeclampsia without severe features, autoregulation index, 6.8 [interquartile range, 5.1-7.4]; and normotensive controls, autoregulation index, 7.1 [interquartile range, 6.1-7.9]). Pregnant women with eclampsia had increased cerebral perfusion pressure (109.5 mm Hg; interquartile range, 91.2-130.9) compared with those with preeclampsia without severe features and those with normal blood pressure (84 mm Hg [interquartile range, 73.0-122.0] and 80.0 mm Hg [interquartile range, 67.5-92.0], respectively); furthermore, there was no difference in cerebral perfusion pressure between pregnant women with eclampsia and pregnant women with preeclampsia with severe features (109.5 mm Hg [interquartile range, 91.2-130.9] vs 96.5 mm Hg [interquartile range, 75.8-110.5]).

Conclusion: Cerebral perfusion pressure and dynamic cerebral autoregulation are altered in eclampsia and may be important in the pathophysiological pathway and constitute a therapeutic target in the prevention of cerebral complications in preeclampsia.

Keywords: cerebral autoregulation; cerebral blood flow; cerebral perfusion pressure; preeclampsia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Arterial Pressure
  • Brain / blood supply*
  • Carbon Dioxide
  • Case-Control Studies
  • Cerebrovascular Circulation*
  • Eclampsia / physiopathology*
  • Female
  • Fourier Analysis
  • HELLP Syndrome / etiology
  • HELLP Syndrome / physiopathology
  • Hemodynamics
  • Homeostasis*
  • Humans
  • Middle Cerebral Artery / diagnostic imaging*
  • Pre-Eclampsia / physiopathology*
  • Pregnancy
  • Prospective Studies
  • Pulmonary Edema / etiology
  • Pulmonary Edema / physiopathology
  • Renal Insufficiency / etiology
  • Renal Insufficiency / physiopathology
  • Severity of Illness Index
  • Ultrasonography, Doppler, Transcranial
  • Young Adult


  • Carbon Dioxide