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Photoplethysmography and Heart Rate Variability for the Diagnosis of Preeclampsia

Euliano, Tammy Y. MD*; Michalopoulos, Kostas PhD; Singh, Savyasachi PhD; Gregg, Anthony R. MD; Del Rio, Mariem MPH*; Vasilopoulos, Terrie PhD; Johnson, Amber M. BS*; Onkala, Allison MPAS*; Darmanjian, Shalom PhD; Euliano, Neil R. PhD; Ho, Monique MD

doi: 10.1213/ANE.0000000000002532
Research Report: PDF Only

BACKGROUND: The goal of this study was to determine a set of timing, shape, and statistical features available through noninvasive monitoring of maternal electrocardiogram and photoplethysmography that identifies preeclamptic patients.

METHODS: Pregnant women admitted to Labor and Delivery were monitored with pulse oximetry and electrocardiogram for 30 minutes. Photoplethysmogram features and heart rate variability were extracted from each data set and applied to a sequential feature selection algorithm to discriminate women with preeclampsia with severe features, from normotensive and hypertensive controls. The classification boundary was chosen to minimize the expected misclassification cost. The prior probabilities of the misclassification costs were assumed to be equal.

RESULTS: Thirty-seven patients with clinically diagnosed preeclampsia with severe features were compared with 43 normotensive controls; all were in early labor or beginning induction. Six variables were used in the final model. The area under the receiver operating characteristic curve was 0.907 (standard error [SE] = 0.004) (sensitivity 78.2% [SE = 0.3%], specificity 89.9% [SE = 0.1%]) with a positive predictive value of 0.883 (SE = 0.001). Twenty-eight subjects with chronic or gestational hypertension were compared with the same preeclampsia group, generating a model with 5 features with an area under the curve of 0.795 (SE = 0.007; sensitivity 79.0% [SE = 0.2%], specificity 68.7% [SE = 0.4%]), and a positive predictive value of 0.799 (SE = 0.002).

CONCLUSIONS: Vascular parameters, as assessed noninvasively by photoplethysmography and heart rate variability, may have a role in screening women suspected of having preeclampsia, particularly in areas with limited resources.

From the *Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida; Convergent Engineering, Newberry, Florida; and Departments of Obstetrics and Gynecology and §Orthopedics and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida.

Accepted for publication August 24, 2017.

Funding: This material is based on study supported by the National Institutes of Health (Grant No. 1R41HD075550-1).

Conflicts of Interest: See Disclosures at the end of the article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Reprints will not be available from the authors.

Clinical trial identification number: UF IRB: 189–2011; URL of the registration site:

Address correspondence to Tammy Y. Euliano, MD, Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Rd, P.O. Box 100254, Gainesville, FL 32610. Address e-mail to

© 2018 International Anesthesia Research Society
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