O133. Fetal renal vascularisation in pregnancy induced hypertension complicated by gestational diabetes or intrauterine growth restriction

Abstract

Introduction The prevalence of pregnancy induced hypertension is 5.6 per year.The incidence of pregnancy induced hypertension increased from 2.3 per 1000 deliveries to 5.4 in the last decade.Pregnancy induced hypertension is 3–6% of all pregnancies in Hungary.It is an important cause of feto-maternal morbidity and mortality. Objectives Our goal was to analyze fetal renal vascularisation in pregnancies complicated by pregnancy induced hypertension (PIH) and gestational diabetes (GDM) or intrauterine growth restriction (IUGR) by 3-dimensional sonography using VOCAL (Virtual Organ Computer-Aided Analysis) method. Methods 66 pregnant women who were examined between 20 and 38 weeks of their gestations complicated by PIH ( N =32), PIH+GDM ( N =14), PIH+IUGR ( N =20) were involved in this prospective longitudinal survey.During the study fetal kidneys were evaluated separately by 3-dimensional power Doppler technique using the VOCAL method.The following measurements were performed concerning the right and left kidneys:vascularisation index, flow index, vascularisation flow index.Wilcoxon rank-sum test was carried out to assess the relationship between fetal renal vascularisation in pregnancies complicated by PIH, PIH+GDM and PIH+IUGR. Student's t -test was utilized to reveal the concordance between fetal renal vascularisation in normal and complicated cases. Results The mean values of fetal renal vascularisation decreased in complicated cases.Significant difference ( p 〈0.01) could be observed between pregnancies complicated by PIH (VI mean±SD :5.15±0.59%, FI mean±SD :35.75±3.77, VFI mean±SD :1±0.27), PIH+GDM (VI mean±SD :2±0.32%, FI mean±SD :29±02.8, VFI mean±SD :0.5±0.12) and PIH+IUGR (VI mean±SD :2.3±0.57%, FI mean±SD :31.6±6.8, VFI mean±SD :0.7±0.17).The mean values (±SD) of fetal renal volume were significantly less in pregnancies complicated by PIH+GDM, and more in PIH+IUGR pregnancies compared to PIH cases (mean values (±SD): V PIH :15±7ml, V PIH+GDM :13±4ml, V PIH+IUGR :8.5±2.1ml ( p p Conclusion Fetal renal vascularisation indices were significantly diminished in GDM and IUGR cases. Fetal downregulated vascularisation had influence on fetal renal development, thus on fetal renal volumes. PIH has a harmful effect not only on maternal, but also on fetal morbidity.