Abnormal Uterine Artery Doppler Findings Research Articles

Prevalence and Clinical Significance of Factor V Leiden Mutation in Egyptian Preeclamptic Women

Background: Factor V [Leiden] mutation, also known as activated protein-C resistance, is the most common of the inherited thrombophilias. Aim of the work: The present study aimed to ass the prevalence of factor V Leiden mutation in a group of Egyptian pregnant women and its relation to maternal and neonatal outcomes. Patients and methods: The present prospective study included 130 preeclamptic women with a singleton pregnancy in the 3rd trimester. Blood samples were obtained for DNA analysis to assay factor V Leiden mutation. Transabdominal obstetric ultrasound examination was performed to confirm the fetal number, viability, presentation, estimated fetal weight, position & grade of the placenta, amount of liquor, biophysical profile, and gestational age. This was achieved through the measurements of the biparietal diameter, head circumference, abdominal circumference, and femur length. Flow velocity waveforms were obtained from each uterine artery. Results: Factor V Leiden [FVL] mutation was identified in 20 patients [15.4 %]. Comparison between women with FVL and women without revealed a significantly higher frequency of intrauterine growth restriction [IUGR], intrauterine fetal death [IUFD], small for gestational age [SGA], preterm labor, and intensive care unit [ICU] admission among women with FVL mutation. They also have a significantly higher frequency of abnormal Doppler findings, abruptio placenta, and placental infarction. Conclusion: The present study suggested that maternal and neonatal complications in PE patients may be related to FVL, abnormal uterine artery Doppler findings, and placental infarction.

Prognostic role of uterine artery Doppler in early- and late-onset preeclampsia with severe features.

To correlate uterine artery Doppler findings with maternal and neonatal outcomes in early- and late-onset preeclampsia with severe features. Doppler scan was done in both uterine arteries. Maternal and neonatal outcomes in women with abnormal and normal Doppler results were compared. Abnormal Doppler results were present in 45 women (75%). Thirty-four (56.7%) women had abnormal RI, 19 (31.6%) had abnormal PI, and 36 (60%) had diastolic notch. Of the women who participated in the study, 21.6% developed maternal complications, and the majority belonged to the early-onset severe preeclampsia group. Diastolic notch was twofold more frequent in the early group. RI was abnormal in 63% of the early-onset and 50% of the late-onset group. Pregnancies with early-onset preeclampsia who had abnormal uterine artery Doppler findings were at high risk for both maternal and neonatal complications, whereas those who had late-onset preeclampsia with abnormal Doppler findings only had an increased risk of perinatal complications.

Do low-risk nulliparous women with abnormal uterine artery Doppler in the third trimester have poorer perinatal outcomes? A longitudinal prospective study on uterine artery Doppler in low-risk nulliparous women and correlation with pregnancy outcomes

Objective: To evaluate uterine artery (UtA) Doppler over the course of pregnancy in low-risk nulliparous women and to analyze whether an abnormal uterine artery pulsatility index (UtA-PI) at a 32–34 week’ scan implies poorer perinatal outcomes.Methods: An observational prospective study was carried out including 616 low-risk nulliparous women. Women with any of the following were excluded: fetal abnormalities, multiple pregnancy, and heparin, metformin or hypotensive treatment. Maternal characteristics, mean arterial pressure measurements and UtA Doppler findings were recorded longitudinally.Results: Complete pregnancy data were available for 489/616 women (79.3%). Of these, 385 women had a normal UtA-PI throughout pregnancy (Group 0), while 50 (10.1%) had an UtA-PI > 95th percentile in the first or the second trimester that normalized in the third trimester (Group 1), and 56 (11.4%) had an abnormal UtA-PI in the third trimester (Group 2). We found that the rate of pre-eclampsia (PE) was higher in Group 2 (7/56 versus 4/435, p = 0.003) as was the rate of intrauterine growth restriction (IUGR) (6/56 versus 14/435, p = 0.02).Conclusions: Low-risk nulliparous women with abnormal UtA Doppler findings in the third trimester are at a higher risk of developing PE and having a baby with IUGR.

Ischemia-Modified Albumin (IMA): A Novel Marker for Preeclampsia Independent of Uterine Artery Notching Identified by Doppler Ultrasound

Objective: To determine the predictive value of second trimester serum ischemia-modified albumin (IMA) levels for preeclampsia (PE), small for gestational age (SGA) and gestational diabetes mellitus (GDM). Methods: The study was conducted at a tertiary care hospital between May and August 2014. Healthy pregnant women (n = 88) who were screened for fetal anomalies with ultrasound at 20–24 weeks of gestation were included in the study. Doppler measurements of the bilateral uterine arteries were performed in all the patients. Serum samples were obtained for an IMA assay. The maternal serum IMA levels were compared in pregnant women who had normal and abnormal uterine artery Doppler findings, including notching, and also in pregnant women who subsequently developed PE, SGA, and GDM during the follow-up period. Results: Uterine artery notching was not significantly predictive for PE, GDM or SGA (p > 0.05). There was no significant difference between notching of the uterine arteries and serum IMA levels (p > 0.05). Eight pregnant women (9.1%) subsequently developed PE. Serum IMA levels were significantly elevated in patients with PE compared with patients who did not subsequently develop PE (p = 0.002). However, serum IMA levels were not significantly different in patients who subsequently developed SGA and GDM compared with women who did not (p > 0.05). There was no correlation between serum IMA levels and maternal characteristics and laboratory findings. Conclusion: Maternal serum IMA levels at 20–24 weeks’ gestation might be a predictive biomarker for PE, independent of notching of the uterine arteries, maternal characteristics and laboratory findings.

Clinical utility of third-trimester uterine artery Doppler in the prediction of brain hemodynamic deterioration and adverse perinatal outcome in small-for-gestational-age fetuses.

To assess the clinical value of third-trimester uterine artery (UtA) Doppler ultrasound in the prediction of hemodynamic deterioration and adverse perinatal outcome in term small-for-gestational-age (SGA) fetuses. UtA Doppler parameters, cerebroplacental ratio (CPR) and fetal middle cerebral artery (MCA) pulsatility index (PI) were evaluated weekly, starting from the time of SGA diagnosis until 24 h before induction of labor, in a cohort of 327 SGA fetuses with normal umbilical artery PI (< 95th centile), delivered at > 37 weeks' gestation. Differences in the sequence of CPR and MCA-PI changes < 5th centile, between the group with normal UtA Doppler indices at diagnosis and those with abnormal UtA indices, were analyzed by survival analysis. In addition, the use of UtA Doppler value, alone or in combination with a brain Doppler scan before delivery, to predict the risk of Cesarean section, Cesarean section for non-reassuring fetal status (NRFS), neonatal acidosis and neonatal hospitalization was evaluated by logistic regression analysis, adjusted for gestational age at birth and birth-weight percentile. Abnormal UtA Doppler at diagnosis of SGA was associated with a higher risk of developing abnormal brain Doppler indices before induction of labor than in those with a normal UtA at diagnosis (62.7% vs 34.6%, respectively; P < 0.01). Compared to those with normal UtA Doppler indices, those with abnormal UtA Doppler findings were associated with a higher risk of intrapartum Cesarean section (52.2% vs 37.3%, respectively; P = 0.03), Cesarean section for NRFS (35.8% vs 23.1%, respectively; P = 0.03), neonatal acidosis (10.4% vs 7.7%, respectively; P = 0.47) and neonatal hospitalization (23.9% vs 16.5%, respectively; P = 0.16). Logistic regression analysis indicated that UtA Doppler findings were not significantly associated with adverse perinatal outcome independent of brain Doppler findings. UtA Doppler indices predict adverse perinatal outcome, but do not help to improve the predictive value of brain Doppler indices. However, at the time of SGA diagnosis they identify the subgroup of fetuses at highest risk of progression to abnormal brain Doppler findings.

Uterine and umbilical artery Doppler at 28 weeks for predicting adverse pregnancy outcomes in women with abnormal uterine artery Doppler findings in the early second trimester.

The objective of this study was to determine the contribution of uterine (UtA) and umbilical arteries (UA) Doppler examination at 28 weeks to predict adverse pregnancy outcomes in women who had increased resistance in UtA in the early second trimester. Women with UtA mean pulsatility index (PI) above the 95th centile at 19-22 weeks of gestation were offered a growth scan including Doppler examination of UtA and UA at 28 weeks. Adverse pregnancy outcomes included small for gestational age (SGA), defined as birth weight below the tenth centile, preeclampsia (PE) and early-onset PE (PE before 34 weeks). We studied 266 pregnant women with elevated PI in the UtAs in the second trimester and ultrasound reassessment at 28 weeks. UtA PI >95th centile at 28 weeks was associated with subsequent PE [odds ratio (OR): 10.0, 95% CI: 2.3-43.5], early-onset PE (OR: 57.7, 95% CI: 3.8-87.6) and SGA less than the tenth centile (OR: 5.5, 2.2-13.9). UA PI >95th centile at 28 weeks was not significantly associated with any adverse outcome. In women with abnormal UtA Doppler in the early second trimester scan, persistence of elevated UtA PI, but not abnormal UA PI, is associated with adverse pregnancy outcomes including PE, early-onset PE and SGA. © 2014 John Wiley & Sons, Ltd.

Combination of plasma-soluble fms-like tyrosine kinase 1 and uterine artery Doppler for the prediction of preeclampsia in cases of elderly gravida

The aim of this study was to determine the predictive value of the combination of plasma-soluble fms-like tyrosine kinase 1 (sFlt-1) and uterine artery Doppler for the detection of preeclampsia in women of advanced age at 16-18 weeks of gestation and to identify associations between other pregnancy complications and abnormalities of these combined tests. The maternal plasma sFlt-1 level was measured, and uterine artery Doppler was performed at 16-18 weeks of gestation in 314 cases of elderly gravida. The main outcome was preeclampsia. Fourteen women (4.46%) developed preeclampsia. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of uterine artery Doppler combined with plasma sFlt-1 for preeclampsia prediction were 28.6, 95.7, 23.5 and 96.6%, respectively. For the prediction of early-onset preeclampsia, the sensitivity, specificity, PPV and NPV were 80, 95.8, 23.5 and 99.7%, respectively. Patients with abnormal uterine artery Doppler findings and an abnormal plasma s Flt-1 level (greater than 1724.5 pg ml(-1)) had a higher risk of preterm delivery (relative risk (RR)=3.38, 95% confidence interval (CI) 1.47-7.59), neonatal respiratory distress syndrome (RR=52.06, 95% CI 5.71-474.45) and perinatal death (RR=17.35, 95% CI 1.13-265.64). Our findings indicate that the combination of uterine artery Doppler and sFlt-1 level at 16-18 weeks of gestation in cases of elderly gravida has a high predictive value for early-onset preeclampsia, but not for overall preeclampsia. This combination test may be a useful early second trimester screening test for the prediction of early-onset preeclampsia in cases of elderly gravida.

Third‐Trimester Abnormal Uterine Artery Doppler Findings Are Associated With Adverse Pregnancy Outcomes

To evaluate the association between third-trimester abnormal uterine artery Doppler findings and pregnancy outcomes. A prospective study was designed, including 198 consecutive singleton pregnancies between 27 and 41 weeks' gestation. In the study population, 144 had normal uterine artery Doppler waveforms, 37 had unilateral pathologic waveforms, and 17 had bilateral pathologic waveforms. Eighty patients had intrauterine growth restriction (IUGR), preeclampsia toxemia, or both, and 118 had no complications and served as a control group. The uterine artery Doppler waveform was considered abnormal when a notch or pulsatility index above the 90th percentile was noted. In patients with bilateral pathologic uterine artery Doppler waveforms, the rates of cesarean delivery, small-for-gestational-age (SGA) neonates, preterm delivery, and low Apgar scores were increased compared to patients with normal or pathologic unilateral waveforms (P = .009; P > .001; P = .007; P > .001, respectively). The incidence rates for SGA neonates, cesarean delivery, and preterm delivery were significantly higher among patients without IUGR or preeclampsia toxemia when associated with pathologic bilateral waveforms in comparison to normal waveforms (P = .01 for all). A bilateral pathologic waveform was found to be an independent risk factor for cesarean delivery and SGA neonates. The incidence rates for SGA neonates and preterm delivery were significantly higher among patients with IUGR and/or preeclampsia toxemia when associated with bilateral abnormalities in comparison to normal waveforms (P = .01 for both). Third-trimester abnormal uterine artery Doppler findings are associated with worse perinatal outcomes among patients both with and without pregnancy complications.

Gebelik Komplikasyonlarının Öngörüsünde Maternal İkinci Trimester AFP, HCG, ESTRİOL Değerleri ve Uterin Arter Doppler Bulguları Arasındaki İlişkinin Değerlendirilmesi

Gebelik Komplikasyonlarının Öngörüsünde Maternal İkinci Trimester AFP, HCG, ESTRİOL Değerleri ve Uterin Arter Doppler Bulguları Arasındaki İlişkinin Değerlendirilmesi

The outcome of isolated short femur length at mid T scan

ObjectivesTo examine the outcome of fetuses diagnosed with short femur length at the time of the routine anomaly scan.MethodsThis was a retrospective review of 58 pregnancies referred to fetal medicine...

Association of Vascular Endothelial Growth Factor &lt;emph type="ital"&gt;+936 C/T&lt;/emph&gt; Single-Nucleotide Polymorphism With Pregnancies Complicated by Small-for-Gestational-Age Babies

To examine whether single-nucleotide polymorphisms (SNPs) in VEGFA (-2578 C/A and +936 C/T) associate with small-for-gestational-age (SGA) pregnancies and to identify their effects on first-trimester placental VEGFA expression. Multicenter prospective cohort study. Adelaide, Australia, and Auckland, New Zealand. A total of 3234 nulliparous pregnant women, their partners, and their infants. The SNPs in the parent-infant trios and first-trimester placentae (n = 74) were genotyped. Placental VEGFA messenger RNA expression was determined by quantitative reverse transcription-polymerase chain reaction. Small for gestational age was defined as a birth weight less than the 10th customized birth weight percentile adjusted for maternal height, weight, parity, and ethnicity and for gestational age at delivery and infant sex. Uterine and umbilical artery Doppler was performed at 20 weeks' gestation, and resistance indices greater than the 90th percentile were considered abnormal. Of 2123 pregnancies, 1176 (55.4%) were uncomplicated and 216 (10.2%) had SGA infants. Neonatal VEGFA +936 C/T SNP associates with SGA (adjusted odds ratio [aOR], 1.6; 95% CI, 1.0-2.3), SGA with abnormal Doppler findings (aOR, 3.5; 95% CI, 1.8-7.1), lower birth weight (P = .006), customized birth weight percentile (P = .049), and abnormal uterine artery Doppler findings (OR, 2.5; 95% CI, 1.2-5.4). Maternal VEGFA +936 C/T associates with abnormal umbilical artery Doppler findings (OR, 1.5; 95% CI, 1.1-2.2). VEGFA +936 CT+TT first-trimester placentae have 36% lower VEGFA messenger RNA expression compared with CC (P = .045). Neonatal VEGFA +936 C/T associates with SGA, and the association is stronger for SGA with abnormal uterine or umbilical artery Doppler findings. The SNP also associates with reduced first-trimester placental VEGFA expression, suggesting that it may have a role in the pathogenesis of SGA. Trial Registration clinicaltrials.gov Identifier: ACTRN12607000551493.

Sonographic Maturation of the Placenta at 30 to 34 Weeks Is Not Associated With Second Trimester Markers of Placental Insufficiency in Low-risk Pregnancies

ObjectiveAdvanced placental maturation (Grannum [G] grade 3) before term is associated with adverse perinatal outcomes associated with placental insufficiency. The nature and timing of the underlying pathology of this process is presently unclear. We hypothesized that advanced placental maturation at 30 to 34 weeks’ gestation is not associated with established second trimester markers of severe placental dysfunction. MethodsIn a cohort study of 1238 low-risk Caucasian women with singleton pregnancies who had sonographic assessment of placental maturation and fetal growth at 34 weeks, the results of maternal serum screening (MSS) and uterine artery Doppler (UtAD) flow studies at 16 weeks were related to adverse perinatal outcomes associated with placental insufficiency: antepartum hemorrhage, preeclampsia, preterm birth < 37 weeks, small for gestational age (<10th percentile), or postnatal evidence of intrauterine growth restriction (IUGR; ponderal index < 5th percentile). ResultsG1 was found in 127 women (10.3%), G2 was found in 18 women (1.5%), and no cases of G3 were observed. Advanced Grannum grading was significantly associated with IUGR (48 [4.4%] in G0, 9 [7.1%] in G1, 5 [27.8%] in G2; P < 0.001), but was dependent on smoking status. IUGR was not predicted by abnormal MSS or abnormal UtAD findings at either the second or third trimester ultrasounds. ConclusionG2 maturation at 30 to 34 weeks’ gestation is associated with mild IUGR at delivery in low-risk women and with smoking. IUGR was not predicted by either second or third trimester markers of severe placental dysfunction. Future studies directly observing the placenta in the late third trimester may aid the elusive diagnosis of “late-onset” mild IUGR.

Uterine venous blood flow in normal and complicated pregnancies: a methodological study

To investigate the possibility of recording Doppler flow signals from the maternal uterine veins (UtVs) during pregnancy and to assess the relationship between UtV signals and other Doppler parameters as well as pregnancy outcomes. Transabdominal Doppler ultrasound examination of the UtVs on both sides of the uterus was performed in 40 normal and 44 high-risk singleton pregnancies at 23-39 weeks' gestation. The UtV was identified using color Doppler imaging and the flow velocity signals of the UtV and uterine artery (UtA) were recorded. Morphological examination of the placenta was carried out in 45 of the pregnancies (14 uncomplicated and 31 high-risk pregnancies). Flow-velocity signals of the UtVs were recorded from at least one side of the uterus in all patients (success rate of 81 and 89% for the right and left UtV, respectively). Three types of flow-velocity pattern were identified: continuous non-pulsatile flow (Type I, n = 70), pulsatile flow with a notch touching the zero line (Type II, n = 6) and pulsatile flow with absent flow signals for part of the heart cycle (Type III, n = 8). The UtA pulsatility index was significantly higher in women with UtV Types II and III than in those with UtV Type I (P = 0.039). Similarly, UtV Types II and III were more often found in pregnancies with bilateral UtA notching (P = 0.013) and with UtA score 3-4 (P = 0.024) than in those with normal UtA. No statistically significant association was found between the UtV flow pattern and abnormal histopathological findings in the placenta, or between the UtV and umbilical artery findings. It is possible to record Doppler signals from the UtVs in the late second and third trimesters of pregnancy. Pulsatile flow-velocity patterns of the UtVs are associated with abnormal UtA Doppler findings.

Doppler Velocimetry In Normal And Hypertensive Pregnancy

Objectives: This study was conducted to find doppler velocimetric indices of the uterine and umbilical artery in normotensive and hypertensive pregnancy and to detect SGA fetuses with abnormal velocimetric index.Study design: Two hundred women of third trimester in antenatal clinic were studied: hypertensive and normotensive 100 each. Baseline investigations and doppler velocimetry of both the uterine arteries and umbilical artery was done. Statistical analysis of data was done using the EPI-info 6 (CDC (US) / WHO). Result: The mean SD ratio of Uterine Artery decreased from 6.15 at 32-34 weeks to 3.06 at 38-40 weeks in the hypertensive group. Abnormal uterine artery doppler findings were reported in 55% of hypertensives. In the hypertensive group 92.10% of cases with SGA babies and 32.25% of cases with AGA babies had abnormal uterine artery Doppler findings.Conclusion: Abnormal doppler findings of the uterine and umbilical are more common in SGA fetuses.

Outcome of Fetuses With Antenatally Diagnosed Short Femur

Short femur-below the fifth centile for gestational age might reflect inaccurate dating or may be a normal variant in a constitutionally small fetus, but it also has been associated with skeletal dysplasias and chromosomal abnormalities. Recent studies have reported an association between isolated short femur in the second trimester and delivery of a small-for-gestational age infant, possibly as the result of uteroplacental insufficiency. This retrospective study reviewed all pregnancies seen at a tertiary referral unit at 18-24 weeks' gestation with a fetal femur length below the fifth centile for gestational age. The gestational age and the size of the fetal nuchal translucency had been determined as part of a Down syndrome screening test at 11-14 weeks' gestation. Repeated fetal measurements identified 11 fetuses who did not have short femur. Of the 118 remaining cases, detailed ultrasonographic examination demonstrated associated abnormalities in 46, or 39%. Among these cases, the associated conditions were skeletal dysplasia (35%), chromosomal abnormalities (22%), and genetic syndromes (9%). In 35% of cases, the fetus had multiple anomalies without a specific diagnosis. In 72 instances, 61% of the total, short femur was an isolated finding. In 46% of isolated cases, evaluation revealed early, severe intrauterine growth restriction with abnormal umbilical artery Doppler findings, and delivery took place before 37 weeks' gestation. In 90% of these cases, abnormal uterine artery Doppler findings were apparent at the time of presentation. Preeclampsia developed in 36% of these pregnancies, and the rate of intrauterine death was 33%. Both of these events were considerably less frequent when uterine artery Doppler imaging was normal. In pregnancies with short fetal femur, the major determinants of outcome are the presence of other fetal abnormalities and abnormal uterine artery Doppler findings.

Outcome of fetuses with antenatally diagnosed short femur

To examine the outcome of fetuses diagnosed with short femur length at the time of the routine anomaly scan. This was a retrospective review of all pregnancies referred to a tertiary referral unit with fetal femur length below the 5(th) centile for gestation at 18-24 weeks of gestation. All patients had undergone pregnancy dating and assessment of the risk of chromosomal abnormalities by measurement of fetal nuchal translucency at 11 to 13 + 6 weeks. Over 5 years, 129 cases were evaluated. Detailed ultrasound examination showed associated fetal abnormalities in 46 (36%) cases, and these were classified as non-isolated. In this group, skeletal dysplasias (n = 16), chromosomal abnormalities (n = 10) and genetic syndromes (n = 4) were the most common associations. In contrast, there were no cases of chromosomal abnormalities or skeletal dysplasia in the 83 (64%) isolated cases. Early severe intrauterine growth restriction (IUGR) with abnormal umbilical artery Doppler findings and delivery before 37 weeks occurred in 33/83 (40%) cases with isolated short femur, and 90% of these had abnormal uterine artery Doppler findings at the time of presentation. These pregnancies also had high rates of pre-eclampsia (36%) and intrauterine death (33%). Those with normal uterine artery Doppler imaging were at low risk for these complications. In a population previously screened by first-trimester fetal nuchal translucency measurement, the finding of isolated short femur at 18-24 weeks is unlikely to be due to aneuploidy. Severe IUGR associated with high mortality occurs in 40%, making uterine artery Doppler evaluation a useful clinical tool.

Combining mid-trimester maternal plasma homocysteine with uterine artery doppler velocimetry: is it useful?

To investigate the possible association between mid-trimester maternal plasma homocysteine concentration, uterine artery Doppler measurements in a two-stage screening strategy, and outcome of pregnancy. This prospective observational study was conducted on healthy women undergoing screening for pre-eclampsia by uterine artery Doppler velocimetry at 20-22 and 24-26 weeks of gestation. Abnormal uterine artery blood flow was defined as an average resistance index (RI) > 0.58 and/or bilateral early diastolic notch. Homocysteine measurement was performed by two competitive immunoassay methods involving two steps at 20-22 and 24-26 weeks' gestation. Sixty women enrolled. Abnormal Doppler findings were found in 18 of 60 (30%) women at 20-22 weeks of gestation. This proportion was reduced to 10% (6/60) at 24-26 weeks of gestation, and two of these six women developed pre-eclampsia later in pregnancy. There was no significant difference in the maternal plasma homocysteine levels in women with abnormal Doppler findings when compared with controls at first and second visits (p > 0.05). Mid-trimester maternal homocysteine concentration is not elevated in women with abnormal uterine artery Doppler findings in a two-stage screening method.

Uterine artery Doppler and mid-trimester maternal plasma homocysteine in subsequent pre-eclampsia

To investigate whether mid-trimester maternal plasma homocysteine concentration is elevated in women who develop pre-eclampsia and in those women identified at high risk by abnormal uterine artery Doppler examination. This was a multicenter study involving healthy women undergoing screening for pre-eclampsia by uterine artery Doppler velocimetry at 22-24 weeks' gestation. Abnormal uterine artery blood flow was defined as a mean pulsatility index (PI) above the 95th centile (1.6). Controls (mean PI < 1.6) were matched for gestational age and date of blood sample collection. Maternal plasma homocysteine concentration was measured retrospectively using a chemiluminescent immunoassay. In total, 683 women were recruited. Maternal plasma homocysteine concentration did not vary with gestation. Maternal plasma homocysteine concentration in women who subsequently developed pre-eclampsia (n = 80, 12%) was not significantly different from women with uncomplicated pregnancies (n = 536, 78%) (median 5.1, range 2.7-14.1 micromol/l vs. median 5.5, range 1.9-27.9 micromol/l, p = 0.44). There were no significant differences in the maternal plasma homocysteine concentration in women with abnormal uterine artery Doppler findings (n = 275) compared with controls (n = 408), (median 5.6, range 2.6-17.7 micromol/l vs. median 5.4, range 1.9-27.9 micromol/l, p = 0.13). Mid-trimester maternal plasma homocysteine concentration is not elevated in women who developed pre-eclampsia even in those at high risk defined by abnormal uterine artery Doppler velocimetry.

Uterine artery Doppler and mid-trimester maternal plasma homocysteine in subsequent pre-eclampsia

Objective: To investigate whether mid-trimester maternal plasma homocysteine concentration is elevated in women who develop pre-eclampsia and in those women identified at high risk by abnormal uterine artery Doppler examination. Methods: This was a multicenter study involving healthy women undergoing screening for pre-eclampsia by uterine artery Doppler velocimetry at 22-24 weeks' gestation. Abnormal uterine artery blood flow was defined as a mean pulsatility index (PI) above the 95th centile (1.6). Controls (mean PI < 1.6) were matched for gestational age and date of blood sample collection. Maternal plasma homocysteine concentration was measured retrospectively using a chemiluminescent immunoassay. Results: In total, 683 women were recruited. Maternal plasma homocysteine concentration did not vary with gestation. Maternal plasma homocysteine concentration in women who subsequently developed pre-eclampsia (n = 80, 12%) was not significantly different from women with uncomplicated pregnancies (n = 536, 78%) (median 5.1, range 2.7-14.1 μmol/l vs. median 5.5, range 1.9-27.9 μmol/l, p = 0.44). There were no significant differences in the maternal plasma homocysteine concentration in women with abnormal uterine artery Doppler findings (n = 275) compared with controls (n = 408), (median 5.6, range 2.6-17.7 μmol/l vs. median 5.4, range 1.9-27.9 μmol/l, p = 0.13). Conclusion: Mid-trimester maternal plasma homocysteine concentration is not elevated in women who developed pre-eclampsia even in those at high risk defined by abnormal uterine artery Doppler velocimetry.

Doppler assessment of the maternal interlobar renal and uterine arteries in mid‐pregnancy in women at low and high risk for pregnancy‐induced hypertension

Purpose The purpose of this study was to examine the relationship between vascular resistance of the maternal intrarenal arteries and the main uterine arteries in pregnant women at low and high risk for pregnancy-induced hypertension. Methods The resistance indices (RIs) in the main uterine arteries and the interlobar branches of the right renal artery were measured by duplex Doppler sonography in 338 pregnant women at 21–24 weeks of gestation, including 175 women at high risk for pregnancy-induced hypertension. Of those, 54 patients had repeat Doppler measurements during pregnancy. Results Cross-sectional data showed no correlation between the RIs in the right interlobar renal arteries and either uterine artery. Furthermore, no relationship existed between persistent diastolic notching in the uterine arteries and the RI in the renal circulation. The mean renal artery RI was 0.62. Compared to that in patients with a normal outcome, the renal artery RI was not significantly different in patients who developed proteinuric pregnancy-induced hypertension (PPIH) or severe pregnancy-induced hypertension (PIH) later during pregnancy. Multiple analysis of variance for longitudinal data showed no correlation between the RI in the maternal renal arteries and gestational age, severe PIH, or PPIH. Conclusions The RIs in the maternal intrarenal arteries and the main uterine arteries are not related to each other in pregnant women, even in patients with abnormal uterine artery Doppler findings, severe PIH, or PPIH. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound 26:239–245, 1998.