Prediction of superimposed preeclampsia using uterine artery Doppler velocimetry in women with chronic hypertension

OBJECTIVE: To assess the role of uterine artery (UtA) Doppler to predict superimposed preeclampsia in women with chronic hypertension. METHODS: In a cohort of 182 women with chronic hypertension, UtA Doppler studies were performed before 25 weeks (mean 19.7 +/- 2.1 weeks) and repeated later in pregnancy (mean 28.5 +/- 3.7 weeks). RESULTS: The incidence of preeclampsia was 13% (24/182). Rates of preeclampsia increased with advancing gestation of abnormal UtA Doppler: 7% when UtA Doppler were normal at early exam, 18% when abnormal at early exam, and 28% when abnormal at late exam (Chi-square for trend: P < 0.001). The rate of preeclampsia among 40 women with abnormal early but normal late UtA Doppler was similar to that of women with normal findings at early exam (8 vs 7%; P = 1.00). Logistic regression analysis showed that the ability of UtA Doppler to predict preeclampsia was independent from other variables [Odds Ratio (OR) 7.1, 95% Confidence Interval (CI) 2.6-18.9). Receiver operating characteristic (ROC) curve identified a UtA value of 0.58 as the optimal threshold for the prediction of preeclampsia. CONCLUSION: The later in pregnancy the abnormal UtA Doppler findings are observed, the greater the risk of preeclampsia. Normalization of UtA Doppler after 25 weeks reduces the risk of preeclampsia to 8%.     

Pregnancy surveillance with Doppler velocimetry of uterine and umbilical arteries

Previous studies with Doppler velocimetry have demonstrated a strong correlation between abnormal waveforms and fetal-maternal disease. This study was designed to evaluate the potential role of Doppler velocimetry as a screening test in routine prenatal care. Two hundred fifty-five pregnant women had routine monthly Doppler (systolic/end-diastolic ratio) studies on the uterine and umbilical arteries starting in the twentieth week of gestation. When a cutoff value of 3 was used at 30 weeks for the umbilical arteries, there were 35 (13%) positive tests. In 20 of these values fell to less than 3 in the ensuing weeks and were considered false positive. The remaining 15 babies demonstrated positive clinical pathologic correlates. When a value of 2.6 was used at 26 weeks for uterine arteries, there were nine positive results, seven of which had clinical pathologic correlates. This study suggested an overall positivity rate of 7%; therefore it provides encouragement for a larger venture in which screening and impact on decision making are evaluated.     

Genetic thrombophilias and uterine artery Doppler velocimetry and preeclampsia.

OBJECTIVE: The aim of this study was to evaluate the correlation between genetic thrombophilic mutations, uterine artery Doppler at 24 weeks of gestation and preeclampsia. METHODS: In a case control study we performed the genetic analysis for Leiden mutation of factor V gene (FV), G20210A mutation of the prothrombin gene (PT) and C677T polymorphism of the methylenetetrahydrofolate reductase (MTHFR) gene in 103 women that had already attended routine ultrasonography scanner at 20 weeks at our Department. RESULTS: The frequency of heterozygous carriers of the factor V Leiden was 17.4% in the women with preeclampsia and abnormal artery Doppler compared with 3.12% in the patients with normal pregnancies. This difference was statistically significant (P<0.05). The frequency of mutation G20210A of prothrombin gene was 1.5 vs. 4.3% between women with normal pregnancies and with preeclampsia. This difference is not statistically significant. The frequency of homozygous patients for the C677T mutation of MTHFR gene among the patients with preeclampsia was 21.7% and in the control group was 10.3%, but this difference is not statistically significant. No thrombophilic gene variants were found in women with preeclampsia and normal uterine artery Doppler. CONCLUSION: We demonstrated the important association between factor V Leiden mutation, abnormal uterine Doppler at 24 weeks and preeclampsia in our population.     

Doppler velocimetry in patients with preeclampsia

Doppler velocimetry is a fast and convenient method for monitoring of fetal well being in high risk pregnancies. Doppler velocimetry is more specific and sensitive method of fetal surveillance than cardiotocography. The study's objective is to prove Doppler's effectiveness in predicting perinatal outcome in preeclamptic pregnancies. A retrospective study is designed, including pregnant women, diagnosed with preeclampsia, admitted to Maternity hospital "Majchin dom" for ten years. Doppler study was made and results were correlated to Apgar score, umbilical artery pH and base excess of the neonate at delivery. A correlation between RI of umbilical artery, uterine arteries and Apgar score at 5th minute was demonstrated. In severe cases correlation between RI of umbilical artery and neonatal pH was found. CONCLUSION: Doppler velocimetry is an effective method of fetal surveillance in pregnancies, complicated by preeclampsia     

Role of Doppler velocimetry of uterine arteries and ambulatory blood pressure monitoring in detecting pregnancies at risk for preeclampsia

AIM: The aim of this study is to evaluate the performance of ambulatory blood pressure monitoring (ABPM) in association with Doppler velocimetry of uterine arteries in the detection of preeclampsia (PE). METHODS: In a prospective study, 22 patients at risk for the development of PE have been en-rolled: 17 were nulliparous women with increased resistances in uterine arteries at 24 weeks and 5 had an obstetric history of PE. All patients were tested with ABPM and uterine arteries Doppler velocimetry. A resistance index (RI) higher than 0.62 for the Doppler velocimetry and a diastolic midline estimating statistic of rhythm (MESOR) higher than 68 for the ABPM were considered abnormal. Patients were followed longitudinally until delivery. The occurrence of PE and low birth weight were considered as gestational outcomes endpoints. RESULTS: Overall, the mean gestational age at delivery was 36.3+/-3.4 weeks (range 29.4-41). Six out of 22 (27.2%) patients developed PE; 4 out of 22 (18%) newborns were small for gestational age (SGA) <5 degrees percentile. In the prediction of PE, ABPM in association with Doppler velocimetry showed a positive predictive value (PPV) of 42% and a negative predictive value (NPV) of 90%, for the development of low birth weight the PPV was 33% and the NPV 100%. CONCLUSION: This study shows that ABPM in association with Doppler velocimetry evaluation is a useful test to detect patients at high risk for the development of PE.     

Postpartum uterine artery Doppler velocimetry among patients following a delivery complicated with preeclampsia

Objective: To evaluate postpartum uterine artery (UtA) velocimetry in patients following severe preeclampsia (PET) as compared with normotensive controls. Study Design: Postpartum UtA velocimetry was obtained prospectively during the early postpartum period. The right and left UtA pulsatility index (PI) was measured and the presence of an early diastolic notch was noted. For categorical variables, the χ2 test or Fisher exact was used as appropriate and for continuous variables the t-test was used. The p value <0.05 was considered statistically significant. Results: Thirty-one patients following severe PET and 52 normotensive controls were included in the study. Following severe PET, higher rates of intrauterine growth restriction, cesarean delivery, preterm delivery and accordingly lower neonatal birth weight were noted. Postpartum UtA velocimetry measurements were performed on average 51.2?h after delivery (range 8–169). Right and left UtA PI was comparable between patients following severe PET and controls. The presence of unilateral and bilateral early diastolic notches were significantly higher in patients following severe PET. Conclusions: The pathophysiology of uterine involution and the physiologic return of the uterine arteries to the non-pregnant state may be different following severe PET.     

Post-delivery oxidative stress in women with preeclampsia or IUGR

AIM: To compare oxidative stress in patients with preeclampsia (PE) or intrauterine growth restriction (IUGR) vs. normal pregnancy (controls) during 48 h after delivery. STUDY DESIGN: Women with singleton pregnancies were recruited immediately after delivery (gestational age >26.0 weeks). Women with PE or IUGR were matched with healthy controls by age, BMI, gestational age and delivery mode. Venous blood samples and urine samples were tested for oxidative stress products 24 h and 48 h after delivery. RESULTS: Plasma malondialdehyde (MDA) concentration 24 h after delivery was significantly higher in subjects with PE or IUGR (3.41+/-1.14 micromol/L, n=20) than in controls (2.91+/-0.82 micromol/L, n=38) (P=0.04). Urine iPF(2alpha)-VI declined from 24 to 48 h after delivery significantly in controls (P=0.006) and not in subjects with PE or IUGR (P=0.71). CONCLUSION: Of the markers tested only MDA is indicating higher oxidative stress in women with PE/IUGR than in normal pregnancy and only at 24 h after delivery. No consistent pattern of change in the oxidative stress markers exists between 24-48 h after delivery.     

Doppler velocimetry measured in retrochorionic space and uterine arteries during early human pregnancy

The natural course of uterochorionic vascular resistance during the first trimester of pregnancy is described. We performed a weekly study using a pulsed Doppler in 25 normal pregnancies, with a total of 191 examinations made. The flow velocity waveform was studied simultaneously in the retrochorionic area as well as in the uterine arteries. Different velocimetry indices were analysed, which demonstrated the feasibility of the (D/S) x 100 index for study of the retrochorionic vessels and of the Pourcelot index (S-D/S) for the uterine arteries. A gradual weekly decrease in flow resistance was found, with significant differences before [(D/S) x 100 = 52.01 +/- 8.33; S-D/S = 0.83 +/- 0.09] vs after the 9th week [(D/S) x 100 = 58.9 +/- 8.78; S-D/S = 0.72 +/- 0.10]. Further evaluation of its predictive and diagnostic value in gestational pathology is necessary.     

An integrated model for the prediction of preeclampsia using maternal factors and uterine artery Doppler velocimetry in unselected low-risk women

OBJECTIVE: The purpose of this study was to develop a predictive model for preeclampsia. STUDY DESIGN: This was a prospective screening study for preeclampsia using uterine artery Doppler ultrasound in unselected low-risk singleton pregnancies at community hospitals in the UK (n = 32,157). Logistic regression models were developed and their predictive ability assessed using the area under the receiver operator curve (AROC). RESULTS: Six hundred twelve (2.0%) women developed preeclampsia, and 144 (0.5%) required early delivery (<34 weeks). A model using both maternal and ultrasound factors had an AROC of 0.798, which was higher than ultrasound alone (0.729, P < .0001) or maternal factors alone (0.712, P < .0001). In early onset disease, the ROC of ultrasound alone (0.922) was not significantly improved by adding maternal predictors (0.945, P = .27). In contrast, late onset disease was better predicted by the combined model (AROC 0.798) than ultrasound alone (AROC 0.729, P < .0001) or maternal factors alone (AROC 0.712, P < .0001). CONCLUSION: The combination of uterine artery Doppler ultrasound and maternal factors provided the best estimate of risk.     

Cocaine decreases urinary prostacyclin release in pregnancy: correlation with uterine and umbilical Doppler velocimetry

Objective:?The purpose of this study was to determine maternal urinary prostacyclin and thromboxane excretion in patients with recent cocaine use, compared to cocaine-free controls, and correlate the findings with Doppler velocimetry. Study design:?Seventeen patients admitted withpremature rupture of membranes between the gestational ages of 24 and 34 weeks were tested for urinary cocaine metabolites. Eleven patients had positive screening and six patients were negative and served as controls. After initial stabilization, 24-hurine collections were obtained and were assayed for the prostacyclin metabolite 2,3-dinor-6-keto-PGF_1α, and the thromboxane metabolite 2,3-dinor TXB2. These patients underwent uterine and umbilical arterial Doppler velocimetry expressed as the pulsatility index. Statistical analysis was performed by the SPSS statistical package using the non-paired Student ttest, and Spearman correlation coefficient with p?<?0.05 being considered significant. Results:?Compared withcontrols, urinary excretion of prostacyclin in pregnant women with recent cocaine use was significantly lower. The pulsatility index of the uterine arteries of the cocaine-positive individuals was higher than in controls and had a significant inverse correlation withprostacyclin metabolite excretion. Umbilical arterial velocimetry was similar in the two groups. Conclusion:?Recent cocaine ingestion in pregnant women decreases production of prostacyclin and negatively affects the pulsatility index of the uterine artery.     

Identification of patients at risk for preeclampsia with the use of uterine artery Doppler velocimetry and copeptin

Purpose: To investigate the relationship between maternal copeptin levels and uterine artery Doppler examination and progress of preeclampsia.

Materials and methods: A cross-sectional study was designed with women those were screened at 20?+?0 – 24+ 6 weeks’ gestation between May 2014 and August 2014. The obstetric records of all normotensive women were examined. Uterine artery Doppler velocimetry results and serum copeptin levels were measured. The patients were divided into two groups according to normal (n?=?67) and abnormal uterine artery Doppler (n?=?21) findings.

Results: Maternal age was significantly lower in group 1 (n?=?21, 23.9%) than in group 2 (n=?67, 76.1%) (p?p?=?0.002).

Conclusions: Copeptin levels are significantly higher in patients who develop preeclampsia.     

Doppler velocimetry of intraplacental fetal arteries

Doppler velocimetry of the umbilical and intraplacental fetal arteries was studied by color flow mapping in 39 normal pregnancies. The systolic-diastolic ratio (S/D) and pulsatility index of the intraplacental fetal artery downstream to the umbilical artery decreased significantly with advancing gestational age, and its S/Ds were persistently lower than those of the umbilical artery. The difference in the S/D between the umbilical artery and its intraplacental downstream branches decreased with advancing gestational age and approached zero as the pregnancy progressed to term. We conclude that intraplacental fetal arteries, possibly fetal arteries in main stem villi, can be imaged by color flow mapping and that there is a significant "resistance gradient" between the intraplacental fetal artery and the umbilical artery. Intraplacental fetal artery velocimetry using color flow mapping may give further insights into the umbilical-placental circulation.     

Cocaine decreases urinary prostacyclin release in pregnancy: correlation with uterine and umbilical Doppler velocimetry.

OBJECTIVE: The purpose of this study was to determine maternal urinary prostacyclin and thromboxane excretion in patients with recent cocaine use, compared to cocaine-free controls, and correlate the findings with Doppler velocimetry. STUDY DESIGN: Seventeen patients admitted with premature rupture of membranes between the gestational ages of 24 and 34 weeks were tested for urinary cocaine metabolites. Eleven patients had positive screening and six patients were negative and served as controls. After initial stabilization, 24-h urine collections were obtained and were assayed for the prostacyclin metabolite 2,3-dinor-6-keto-PGF(1alpha), and the thromboxane metabolite 2,3-dinor TXB2. These patients underwent uterine and umbilical arterial Doppler velocimetry expressed as the pulsatility index. Statistical analysis was performed by the SPSS statistical package using the non-paired Student t test, and Spearman correlation coefficient with p < 0.05 being considered significant. RESULTS: Compared with controls, urinary excretion of prostacyclin in pregnant women with recent cocaine use was significantly lower. The pulsatility index of the uterine arteries of the cocaine-positive individuals was higher than in controls and had a significant inverse correlation with prostacyclin metabolite excretion. Umbilical arterial velocimetry was similar in the two groups. CONCLUSION: Recent cocaine ingestion in pregnant women decreases production of prostacyclin and negatively affects the pulsatility index of the uterine artery.     

Transvaginal pulsed Doppler velocimetry in fetal arteries

Summary Transabdominal pulsed Doppler velocimetry in fetal arteries might be difficult with extreme obesity, anhydramnios, cord presentation and an unfavourable position of the fetal head. A vaginal transducer gets closer to the presenting part of the fetus and therefore has advantages for Doppler velocimetry in fetal arteries.     

Prediction of preeclampsia or intrauterine growth restriction by second trimester serum screening and uterine Doppler velocimetry

OBJECTIVE: To assess the performance of screening for preeclampsia and intrauterine growth restriction by combining second trimester maternal serum screening and uterine Doppler ultrasound. METHODS: A cohort of 2,615 women underwent both maternal serum screening (using human chorionic gonadotropin (hCG) and alpha-fetoprotein (AFP)), and second trimester uterine artery Doppler. The sensitivity, specificity and predictive value of different combinations of both tests were compared. RESULTS: The mean values for hCG and AFP were significantly higher in women with subsequent preeclampsia (p < 0.0003 and p < 0.03, respectively). Taking into account obstetrical history, hCG and AFP levels, notching on uterine artery Doppler and parity, the adjusted odds ratios were significantly higher for a high level of hCG for preeclampsia, intrauterine growth restriction (IUGR) and pregnancy-induced hypertension. AFP level >1.5 MoM (multiples of the median) was significantly correlated with subsequent IUGR. The presence of a uterine notch was associated with a significantly higher risk of both preeclampsia and IUGR. The combination of an elevated serum level and the presence of a uterine notch had a positive predictive value (PPV) for preeclampsia of 25 and 21% for hCG and AFP, respectively. The combination of a bilateral notch with a low level of hCG or a high level of AFP had a PPV for IUGR of 50 and 43%, respectively. The sensitivity of the different tests ranged from 2 to 40%. CONCLUSION: The combination of serum markers and abnormal uterine Doppler ultrasound improves the identification of women at risk for subsequent pregnancy complications. These results should encourage care providers to perform a uterine Doppler ultrasound when serum markers are abnormal. However, the sensitivity of these tests is too low to provide an efficient generalized screening.     

Doppler velocimetry and cytofluorimetric analysis in uterine myomas

BACKGROUND: To correlate resistance indices (RI) of vessels detected by transvaginal Doppler velocimetry to the proliferative fraction (PF) calculated by flow cytometry in uterine myomas. A prospective study was carried out on patients scheduled for surgery because of symptomatic uterine myomas. A group of 26 myomas characterized by the presence of detectable vessels at Doppler analysis in the inner part of the mass were included in the study. METHODS: The day before surgery patients were studied with both conventional and color Doppler ultrasonography. The volume of the myoma was recorded. The lowest value of RI obtained by Doppler analysis of the vessels within the myoma was considered for the study. Samples from myomas were processed and analyzed by flow cytometry. A PF, representing the cumulative frequency of cells in the S and G2/M phases of the cell cycle, was considered for the analysis. RESULTS: No statistically significant correlation was observed between RI and PF (r = 0.06, p = 0.74). Regression analysis of the intratumoral RI values on the volume of the myoma showed a significant negative correlation (r = -0.46, p = 0.012). CONCLUSIONS: Preoperative Doppler evaluation of uterine myomas did not provide predictive information of the proliferative status of the neoplasm. A significant correlation was found between the volume of the myoma and RI.     

Angiogenic factors for the prediction of pre-eclampsia in women with abnormal midtrimester uterine artery Doppler velocimetry

OBJECTIVE: To determine whether assessing uterine perfusion and angiogenic factors concurrently in the second trimester improves the prediction of pre-eclampsia and intrauterine growth restriction (IUGR). METHOD: Plasma levels of soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) were measured for 108 women with abnormal uterine perfusion on Doppler velocimetry in the 23rd week. Later, 33 cases of pre-eclampsia and 9 of IUGR developed. RESULTS: Compared with the plasma levels of the women whose pregnancies remained normal, sFlt-1 levels were significantly higher and PlGF levels significantly lower in the women whose pregnancies became complicated by pre-eclampsia and/or IUGR (P<0.001). The alterations were more pronounced in cases of early-onset pre-eclampsia and in cases of IUGR that necessitated delivery before 34 weeks. Using the sFlt-1/PlGF ratio, these complications could be predicted with 98% sensitivity, 95% specificity, and 93% positive predictive value. CONCLUSION: Measuring uterine perfusion and angiogenic factors concurrently in the second trimester improved the prediction of pre-eclampsia and IUGR.     

早发型重度子(癎)前期母体子宫动脉及胎儿血流动力学的研究

目的通过观察分析早发型重度子痢前期母儿血液动力学变化特点，结合其母儿预后，进一步探讨母儿血流动力学监测在早发型重度子痢前期的临床诊治及预后估计中的应用价值。方法采用前瞻性病例一对照研究方法，应用彩色多普勒超声对36例早发型重度子痢前期和72例正常同期孕妇进行血液动力学有关参数测定（包括UA-S／D、UA—PI、MCA—S／D、MCA-PI、UtA—S／D、UtA-PI），并结合其预后进行统计分析。结果在早发型重度子痢前期组和正常妊娠组，胎儿UA、MCA血流及孕妇UtA血流的S／D、PI值均随着妊娠的进展，呈逐渐下降的趋势，早发型重度子痢前期的UA—S／D，UA-PI，UtA-S／D，UtA-PI比正常妊娠时明显增高（P〈0．05），而MCA-S／D和MCA—PI在妊娠33周前则比正常妊娠组降低，妊娠33周后有显著性差异。当早发型重度子痢前期出现母胎血流动学变化时，围产儿不良结局的发生率高于正常妊娠组。本研究中有7例胎儿产前出现脐动脉舒张末期血流缺如（AEDV），全部合并FGR，围产儿死亡6例。结论母胎血流动学参数在早发型重度子痢前期时常发生明显的改变，并与不良的围产儿结局有关，AEDV的出现意味着胎儿循环已出现或临近失代偿阶段，警示预后不良。     

Effect of antioxidants in women with increased risk of preeclampsia. The role of oxidative stress in preeclampsia

New frontiers have been opened lately in the understanding of the patho-phisiology of preeclampsia thus giving new directions in the process of therapy of this condition. Oxidative stress is a condition characterized by peroxidants predominating over antioxidants. Numerous intensive studies are carried out to reveal the role of oxidative stress in the pathogenesis of preeclampsia.