Abnormal Uterine Artery Research Articles

Static and Functional Hemodynamic Profiles of Women with Abnormal Uterine Artery Doppler at 22-24 Weeks of Gestation.

ObjectiveTo compare cardiac function, systemic hemodynamics and preload reserve of women with increased (cases) and normal (controls) uterine artery (UtA) pulsatility index (PI) at 22–24 weeks of gestation.Materials and MethodsA prospective cross-sectional study of 620 pregnant women. UtA blood flow velocities were measured using Doppler ultrasonography, and PI was calculated. Mean UtA PI ≥ 1.16 (90th percentile) was considered abnormal. Maternal hemodynamics was investigated at baseline and during passive leg raising (PLR) using impedance cardiography (ICG). Preload reserve was defined as percent increase in stroke volume (SV) 90 seconds after passive leg raising compared to baseline.ResultsMean UtA PI was 1.49 among cases (n = 63) and 0.76 among controls (n = 557) (p < 0.0001). Eighteen (28.6%) cases and 53 (9.5%) controls developed pregnancy complications (p <0.0001). The mean arterial pressure and systemic vascular resistance were 83 mmHg and 1098.89±293.87 dyne s/cm5 among cases and 79 mmHg and 1023.95±213.83 dyne s/cm5 among controls (p = 0.007 and p = 0.012, respectively). Heart rate, SV and cardiac output were not different between the groups. Both cases and controls responded with a small (4–5%) increase in SV in response to PLR, but the cardiac output remained unchanged. The preload reserve was not significantly different between two groups.ConclusionPregnant women with abnormal UtA PI had higher blood pressure and systemic vascular resistance, but similar functional hemodynamic profile at 22–24 weeks compared to controls. Further studies are needed to clarify whether functional hemodynamic assessment using ICG can be useful in predicting pregnancy 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.

Do knowledge of uterine artery resistance in the second trimester and targeted surveillance improve maternal and perinatal outcome? UTOPIA study: a randomized controlled trial.

To ascertain whether screening for pre-eclampsia (PE) and intrauterine growth restriction (IUGR) by uterine artery (UtA) Doppler in the second trimester of pregnancy and targeted surveillance improve maternal and perinatal outcomes in an unselected population. This was a multicenter randomized open-label controlled trial. At the routine second-trimester anomaly scan, women were assigned randomly to UtA Doppler or non-Doppler groups. Women with abnormal UtA Doppler were offered intensive surveillance at high-risk clinics of the participating centers with visits every 4 weeks that included measurement of maternal blood pressure, dipstick proteinuria, fetal growth and Doppler examination. The primary outcome was a composite score for perinatal complications, defined as the presence of any of the following: PE, IUGR, spontaneous labor < 37 weeks' gestation, placental abruption, stillbirth, gestational hypertension, admission to neonatal intensive care unit and neonatal complications. Secondary outcomes were a composite score for maternal complications (disseminated intravascular coagulation, maternal mortality, postpartum hemorrhage, pulmonary edema, pulmonary embolism, sepsis), and medical interventions (for example, corticosteroid administration and induction of labor) in patients developing placenta-related complications. In total, 11 667 women were included in the study. Overall, PE occurred in 348 (3.0%) cases, early-onset PE in 48 (0.4%), IUGR in 722 (6.2%), early-onset IUGR in 93 (0.8%) and early-onset PE with IUGR in 32 (0.3%). UtA mean pulsatility index > 90(th) percentile was able to detect 59% of early-onset PE and 60% of early-onset IUGR with a false-positive rate of 11.1%. When perinatal and maternal data according to assigned group (UtA Doppler vs non-Doppler) were compared, no differences were found in perinatal or maternal complications. However, screened patients had more medical interventions, such as corticosteroid administration (relative risk (RR), 1.79 (95% CI, 1.4-2.3)) and induction of labor for IUGR (RR, 1.36 (95% CI, 1.07-1.72)). In women developing PE or IUGR, there was a trend towards fewer maternal complications (RR, 0.46 (95% CI, 0.19-1.11)). Routine second-trimester UtA Doppler ultrasound in an unselected population identifies approximately 60% of women at risk for placental complications; however, application of this screening test failed to improve short-term maternal and neonatal morbidity and mortality. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Maternal uterine artery Doppler in the first and second trimesters as screening method for hypertensive disorders and adverse perinatal outcomes in low-risk pregnancies.

ObjectiveTo assess the maternal demographic characteristics and uterine artery (UA) Doppler parameters at first and second trimesters of pregnancy as predictors for hypertensive disorders (HDs) and adverse perinatal outcomes.MethodsThis prospective cohort study comprised 162 singleton low-risk women undergoing routine antenatal care. The left and right UA were assessed by color and pulsed Doppler and the mean pulsatility and resistance indices as well as the presence of a bilateral protodiastolic notch were recorded at 11 to 14 and 20 to 24 weeks' gestation. Multilevel regression analysis was used to determine the effects of maternal characteristics and abnormal UA Doppler parameters on the incidence of HD, small for gestational age newborn, cesarean section rate, Apgar score <7 at 1st and 5th minute, and admission to the neonatal intensive care unit.ResultsFifteen women (9.2%) developed HD. UA mean resistance index (RI), UA mean pulsatility index, and parity were independent predictors of HD. Compared to the pregnancies with a normal UA mean RI at the first and second trimesters, pregnancies with UA mean RI >95th percentile only at the first trimester showed an increased risk for HD (odds ratio, 23.25; 95% confidence interval, 3.47 to 155.73; P<0.01). Similar result was found for UA mean pulsatility index >95th percentile (odds ratio, 9.84; 95% confidence interval, 1.05 to 92.10; P=0.05). The model including maternal age, maternal and paternal ethnicity, occupation, parity and UA mean RI increased the relative risk for HD (area under receiver operating characteristics, 0.81).ConclusionA first-trimester screening combining maternal characteristics and UA Doppler parameters is useful to predict HD in a low-risk population.

Assaying the enhancer landscape during early placental development to identify a trophoblast invasion transcriptional code and gene-enhancer network

Assaying the enhancer landscape during early placental development to identify a trophoblast invasion transcriptional code and gene-enhancer network

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.

Umbilical Cord Blood CD33 and Erythropoietin Levels of Pregnants with Abnormal Doppler Waveforms and to Compare with Normal Pregnancies

Objective: In this study, we aimed to investigate umbilical cord blood CD33 and erythropoietin (EPO) levels of pregnants with abnormal umbilical and uterine artery doppler waveforms and to compare with normal pregnancies. Materials and Methods: Total 40 pregnant women were included in this study. Of these 40 women, while 20 patients had abnormal umbilical and uterine artery doppler waveforms, the other 20 patients had normal umbilical and uterine artery doppler waveforms. After the delivery, blood samples were taken from umbilical artery of double clemped umbilical cord for blood gas parameters, EPO and CD33 levels. Sociodemographic findings, antepartum, intrapartum test results, labor and delivery characteristics and newborn examination results were recorded. Blood gas parameters, EPO and CD33 levels between groups were analyzed. Mann-Whitney U test and t-test were used as statistical methods. Results: There were no differences between parity, gestational ages and newborn weights of the groups. Cord blood CD33 and EPO levels of group with abnormal umbilical and uterine artery doppler waveforms were significantly higher than group with normal umbilical and uterine artery doppler waveforms (p < 0.01). Conclusion: Pathology on doppler screen shows to us a connection between chronic hypoxemia and abnormal on doppler screen. Preference of high blood CD33 levels for cord blood transplantation especially during last years can also be used with preference of cord blood with abnormal doppler findings.

155-POS

Objectives We examined how mid-pregnancy placental growth factor (PlGF) levels and uterine artery Dopplers predict adverse outcomes in a cohort of high-risk pregnancies. Methods Forty-six patients with high risk pregnancies were recruited between June 2011 and August 2012 from the UCSD Placenta Clinic. Serum PlGF measurements (Alere Inc. Triage platform) were collected and uterine artery (UtA) pulsatility index (PI) and notching were assessed by velocimetry at approximately 24 weeks. Adverse outcomes included pre-eclampsia (PET), pre-term birth 34 weeks (PTB), and/or SGA newborn (birth weight 10%). Results The median gestational age at recruitment was 24.6 weeks. Delivery outcomes were collected from 43 (93.5%) patients. The median gestational age at delivery was 38.9 weeks (range 26.4–41.3 weeks) and 37.2% of patients had Cesarean sections. 32.6% had an adverse outcome (11.6% PET, 4.7% PTB, 25.6% SGA). 16.3% had abnormal UtA Dopplers (mean UtA PI > 1.6 and/or bilateral UtA notching), with no significantly increased risk for an adverse outcome (RR 2.625, 95% CI 0.80–8.6). PlGF measurements were collected from 38 (82.6%) patients. The median PlGF was 287 pg/mL, and 4 patients (10.5%) had a low PlGF ( 55 pg/mL). All patients with a low PlGF had an adverse outcome. The 10 patients (27.0%) with an abnormal PlGF and/or UtA Doppler had a significantly increased risk of an adverse outcome (RR 4.04, 95% CI 1.2–14.2). Adding PlGF measurements to UtA Doppler screening at mid-pregnancy increased the positive likelihood ratio of predicting an adverse outcome from 1.4 to 2.4, and yields a negative likelihood ratio of 0.14. Conclusions There is a significant association between low PlGF at mid-pregnancy and subsequent adverse outcomes. Adding PLGF measurements to UtA Doppler screening improves prediction of adverse outcomes by 71%, as these combined modalities test placental and maternal maladaptation respectively at mid-pregnancy. Disclosures K. Kjos: None. R. Ghashghaei: None. K. Klisser: None. D. Woelkers: None.

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Objectives The objectives of the study were to analyze the influence of maternal demographic characteristics and uterine artery (UA) Doppler parameters on the occurrence of hypertension. Methods This prospective cohort study included 162 low-risk women with singleton pregnancies and no fetal diseases. Maternal demographic data and UA Doppler parameters were collected prospectively twice, first at 11–14 weeks of gestation and second at 20–24 weeks. The presence of an early diastolic notch in the waveform was noted, and the mean pulsatility and resistance indices were calculated during both intervals. Abnormal UA Doppler study was defined as the presence of bilateral uterine artery diastolic notches and/or a mean pulsatility index or resistance index above the 95th percentile for the gestational age. The primary outcome was the development of hypertension. Chi-square test, receiver operating characteristic curve, and multiple logistic regressions were used for statistical analyses. Results Fifteen (9.25%) women developed a hypertensive disorder. Significant independent prediction of hypertension was provided by mean PI, mean RI, and parity. Parity of two was associated with an increase in risk for the condition (OR 5.9, 95% CI 1.01–34.44, p p p Conclusions First-trimester screening combining maternal factors and UA Doppler indices is useful to predict hypertension in a routine care setting and could be investigated for application of targeted prophylactic strategies. Disclosures A.C. Marcolin: None. R.M. Scandiuzzi: None. S.M. Quintana: None. E.D. Moises: None. R.C. Cavalli: None. G. Duarte: None.

Preeclampsia Is Associated with Lower Production of Vascular Endothelial Growth Factor by Peripheral Blood Mononuclear Cells

Recent studies show that vascular endothelial growth factor (VEGF) downregulation is implicated in preeclampsia (PE) pathophysiology. This study assessed the relationship between PE and VEGF levels produced by peripheral blood mononuclear cells (PBMCs) and their serum levels. A cross-sectional design was performed in 36 patients who had hypertensive disorders during pregnancy. We also used a longitudinal design with 12 pregnant women with risk factors for PE development and/or abnormal uterine arteries by Doppler study. VEGF and soluble fms-like tyrosine kinase-1 (sFlt-1) levels were measured for all patients in both designs. sFlt-1 serum was higher in preeclamptic patients (n = 26), whereas VEGF produced by stimulated PBMCs was lower than in healthy pregnant women and VEGF levels produced by stimulated PBMCs were even lower (p <0.003) in severe PE (n = 16). The receiver-operating characteristic curve analysis allowed establishing a cut-off value to identify patients with PE. VEGF production by PBMCs was 339.87 pg/mL. In addition, a robust linear regression model was performed to adjust the variance in VEGF levels. The patients' age decreased VEGF levels and was adjusted by weeks of gestation (WG) in our model. In the longitudinal study, 7/12 patients developed PE. VEGF produced by PBMCs cells was significantly lower in PE at 24-26 WG. VEGF production by PBMCs is inhibited during PE, creating a downregulation of the microenvironment; this deficiency may contribute to the pathogenesis of disease.

Abnormal uterine artery Doppler velocimetry predicts adverse outcomes in patients with abnormal analytes.

Our aim was to determine if uterine artery (UtA) Doppler studies would risk-stratify women with abnormal serum analytes on prenatal genetic screening into those at baseline and increased risk for preeclampsia and small-for-gestational age (SGA). This retrospective cohort study examined outcomes of patients with ⩾one abnormal analyte (PAPP-A<0.3, hCG>3.0, AFP>2.5, inhibin>2.0, or unconjugated estriol<0.3MoM). At approximately 24weeks, we assessed UtA pulsatility index (PI). Preeclampsia, preterm preeclampsia, SGA (birthweight (BW) <10%) and intrauterine growth restriction (IUGR) (BW<3%). We identified 132 patients with ⩾one abnormal analyte, UtA Doppler screening, and delivery outcomes. Twenty-four (18%) had an elevated UtA PI (PI>1.6); preeclampsia occurred in 16 (12%) and 26 (20%) delivered a SGA neonate. Abnormal UtA Doppler PI increased the likelihood of a composite outcome of preeclampsia or SGA from 27% to 71% (LR 6.48 (2.93, 14.30)); a negative UtA Doppler PI reduced the likelihood to 18% (LR 0.57 (0.42, 0.78)). Abnormal UtA Doppler PI increased the likelihood of a more severe composite outcome of preterm preeclampsia or IUGR from 11% to 39% (LR 5.49 (3.03, 9.97)); a negative UtA Doppler study reduced the likelihood to 4% (LR 0.35 (0.16, 0.80)). In patients with abnormal serum analytes, abnormal UtA Doppler PI is significantly associated with preeclampsia or SGA and improves the prediction of these adverse outcomes by 9-15-fold. Providers can incorporate UtA Doppler PI into an abbreviated surveillance regimen; they can be reassured that a normal study markedly decreases the risk of a severe early adverse outcome.

Aspirin and Preeclampsia Prevention in Patients With Abnormal Uterine Artery Blood Flow

Background:Preeclampsia is one of the leading causes of maternal mortality and morbidity. Its prevalence varies between 10-25% among high-risk pregnant patients.Objectives:The aim of this study was to determine whether treatment with acetylsalicylic acid (ASA) reduces the incidence of preeclampsia among pregnant women with abnormal uterine artery flow.Patients and Methods:In this double-blind, placebo controlled trial, 80 high-risk pregnant women with preeclampsia, who had abnormal findings on Doppler ultrasonography at 12-16 weeks of pregnancy (unilateral notch with RI ≥ 0.65 or bilateral notch with RI ≥ 0.55), were randomly divided into two groups; the intervention group was treated with ASA tablet 80 mg, one tablet per day, and the control group was given placebo. Then patients were followed until the end of their pregnancy period, and pregnancy outcomes, including development of preeclampsia, the intrauterine growth retardation (IUGR), prematurity, type of delivery, birth weight, and Apgar score at one and five minutes were assessed. Data were analyzed using the student's t-test, chi-square or Fisher's exact test, and multivariate logistic regression. P values less than 0.05 were considered statistically significant.Results:There were no significant differences between the two groups in terms of baseline characteristics. There was a significant difference between the ASA and placebo groups in the incidence of preeclampsia (2.5% versus 22.5%), adjusting for the neonatal and maternal covariates.Conclusions:ASA prophylaxis can be used for prevention of preeclampsia in high-risk patients with abnormal uterine artery.

Comparison of clinical and perinatal outcomes in early- and late-onset preeclampsia

To compare the clinical and laboratory findings and maternal-perinatal outcomes between women with early-onset preeclampsia (EO-PE) and late-onset preeclampsia (LO-PE). One hundred and fifty-four women with preeclampsia (PE) who delivered in our clinic were included in the study. Perinatal and obstetric outcomes were evaluated. The incidence of abnormal uterine artery (UtA) velocity waveform was significantly higher in the EO-PE group (71.4 vs 30.1 %) (p < 0.001). The incidences of small-for-gestational age, oligohydramnios, Apgar score <7 at 5 min, stillbirth and early neonatal death rates were significantly higher in women with EO-PE compared to LO-PE (p < 0.01). Maternal complications were only recorded in women with severe PE. EO-PE, especially with abnormal UtA Doppler findings defines a placentation abnormality with higher perinatal adverse outcomes.

Ambulatory blood pressure measurements in mid-pregnancy and development of hypertensive pregnancy disorders

Objective: To explore if blood pressure (BP) readings over 24 h is a useful addition to uterine artery Doppler to screen for hypertensive disorders. Methods: In a prospective observational study, we invited nulliparous women with abnormal and normal uterine artery Doppler but normal BP at the time of their routine anomaly scan. BP was measured by the woman using automated apparatus at five specified time intervals over 24 h at 22–24 weeks. Pregnancy outcome was retrieved from delivery suite records, discharge summaries, and letters to general practitioners if necessary. Logistic regression was used to explore the contribution of uterine artery Doppler and BP measurements towards the development of pre-eclampsia. Results: Data were available from 52 women with abnormal and 48 women with normal uterine artery Doppler. Thirteen women developed hypertension in pregnancy. Significant difference was found in the BP of women who did or did not develop hypertensive disorders. BP recordings showed the diurnal variation. Both uterine artery Doppler mean PI and BP showed significant correlation with future development of hypertension. Conclusions: Women can self-measure BP at home. BP readings show diurnal variation. There are significant differences in BP of women who do and do not develop hypertension later in the pregnancy. Use of home BP monitoring over 24 h of the day in mid-pregnancy is unlikely to add to the use of uterine artery Doppler and a one-off BP reading for future development of hypertension in pregnancy.

Effect of aspirin in prevention of adverse pregnancy outcome in women with elevated alpha-fetoprotein

Background: To evaluate the effect of low-dose aspirin in prevention of adverse pregnancy outcomes (APO) in women with second trimester alpha-fetoprotein (AFP) >2.5 multiple of median (MOM) and to compare aspirin effect on women with normal and abnormal uterine artery (UtA) Doppler. The primary outcome was the adverse pregnancy outcome.Methods: This randomized controlled trial was conducted in singleton pregnant women, who had unexplained AFP >2.5 MOM and gestational age between 15 and 18 weeks of gestation. They were assigned randomly to receive either aspirin (N = 65) or control (N = 68). UtA Doppler velocimetry studies were performed at the time of targeted ultrasonographic exam.Results: Two groups were comparable regarding the maternal characteristics. The frequency of APO in aspirin and control groups were 26.1% versus 44.1% (p = 0.045), the frequency of preterm delivery before 34 weeks were 3.2% versus 22.0% in aspirin and control group, p = 0.001. Other outcomes were similar in both groups. The frequency of adverse outcomes in women with abnormal UtA Doppler was 39.1% in aspirin and 60.0% in control group, p = 0.556.Conclusion: Low-dose aspirin reduces APO and delivery before 34 weeks of gestation in pregnant women with unexplained elevated AFP.

O4. Predisposing factors for early- and late-onset preclampsia

Objectives: Early (34.0 wks) and late (>34.0 wks) onset preeclampsia (EO–LO PE) are supposed to have different etiologies, vascular and inflammatory disfunction respectively. The aim of our study is to evaluate general characteristics of women affected by either EO or LO PE, to identify risk factors for the two forms of disease. Study design: Retrospective cohort study of 197 consecutive singleton women diagnosed as preeclamptic at 22.4– 41.4 wks, from 1/2005 to 9/2009, evaluating demographic, clinical, and ultrasonographic (US) variables on hospital admission, in relation to EO vs LO PE. HELLP syndrome and stillbirth cases, and fetus with congenital anomalies were excluded. Obesity was defined as a BMI 30 kg/m2. First abnormal uterine arteries (UtA) Doppler, evaluated in women with history of APO (previous PE/IUGR/SGA), was defined as mean RI > 0.58 or bilateral Notch within 26.0 wks. IUGR was considered as an US AC 35 yrs and UtA Doppler related to EO PE (Table 2), whereas WG > 12 kg to LO PE (p = 0.04; OR = 4.6, CI (95%) = 2.39–8.87). Conclusions: Age > 35 yrs and UtA Doppler appeared risk factors for EO PE, whereas WG > 12 kg for the late form, supporting the hypothesis of a different pathogenesis.

O5. Low-dose aspirin therapy in pregnant women with chronic hypertension

Objectives: Early (34.0 wks) and late (>34.0 wks) onset preeclampsia (EO–LO PE) are supposed to have different etiologies, vascular and inflammatory disfunction respectively. The aim of our study is to evaluate general characteristics of women affected by either EO or LO PE, to identify risk factors for the two forms of disease. Study design: Retrospective cohort study of 197 consecutive singleton women diagnosed as preeclamptic at 22.4– 41.4 wks, from 1/2005 to 9/2009, evaluating demographic, clinical, and ultrasonographic (US) variables on hospital admission, in relation to EO vs LO PE. HELLP syndrome and stillbirth cases, and fetus with congenital anomalies were excluded. Obesity was defined as a BMI 30 kg/m2. First abnormal uterine arteries (UtA) Doppler, evaluated in women with history of APO (previous PE/IUGR/SGA), was defined as mean RI > 0.58 or bilateral Notch within 26.0 wks. IUGR was considered as an US AC 35 yrs and UtA Doppler related to EO PE (Table 2), whereas WG > 12 kg to LO PE (p = 0.04; OR = 4.6, CI (95%) = 2.39–8.87). Conclusions: Age > 35 yrs and UtA Doppler appeared risk factors for EO PE, whereas WG > 12 kg for the late form, supporting the hypothesis of a different pathogenesis.

O6. Uterine artery Doppler in a risk population: What’s its role in the prediction of small for gestational age fetuses?

Objective: The aim of this retrospective study was to assess the role of uterine artery (UtA) Doppler velocimetry in the prediction of small for gestational age (SGA) fetuses in a high risk population. Methods: A population of 145 singleton high risk pregnancies was evaluated with serial UtA Doppler performed within 23 weeks (I UtADoppler) and between 23 and 30 weeks’ gestation (II UtA Doppler). Risk population was composed by women with chronic hypertension or with a previous pregnancy complicated by one of the following: preeclampsia, stillbirth, abruptio placentae, small for gestational age newborns. The association between an abnormal UtA velocimetry (Resistance Index > 0.58 and/or bilateral notch) and the probability to develop SGA fetuses was analysed. SGA fetuses were diagnosed on the base of ultrasonographic measurement of abdominal circumference below the 10 centile. Therapy with low-dose aspirin and/or Low Weight Molecular Heparin was prescribed according with a clinical protocol. Results: Gestational age at delivery, mean birth weight, abnormal UtA Doppler and Umbilical artery Doppler were significantly different between SGA fetuses and not SGA fetuses (Table 1). Particularly 30% of SGA fetuses with an abnormal UtA Doppler had also an abnormal Umbilical artery Doppler (defined as a Pulsatility Index >95 centile). Logistic regression analysis showed that only the abnormal UtA Doppler test performed between 23 and 30 weeks’ gestation independently correlated with SGA fetuses, otherwise ASA was a significant protective factor for SGA fetuses (Table 2). Persistence of abnormal UtA Doppler was associated with a statistically higher rate of SGA. Conclusion: An abnormal UtA Doppler in the late second or early third trimester remained the variable significantly related with SGA fetuses; therefore UtA Doppler evaluation between 23 and 30 weeks could be useful for the management of high risk population. ASA was a significant protective factor for intrauterine growth.

Uterine artery blood flow volume in pregnant women with an abnormal pulsatility index of the uterine arteries delivering normal or intrauterine growth restricted newborns

The aim of this study was to assess and compare uterine artery (UtA) blood flow volume in pregnant patients with an abnormal uterine Doppler pulsatility index (PI) who delivered fetuses with an appropriate weight for gestational age (AGA) or with intrauterine growth restricted (IUGR). We prospectively recruited singleton pregnancies with abnormal uterine arteries P.I. between 18 and 38 weeks of gestation regardless of estimated fetal weight (EFW). Vessel diameter and blood flow velocity were measured along the UtA upstream to the vessel bifurcation in both the right and left UtAs. Uterine blood flow volumes measured in these pregnancies were compared to historical Control-pregnancies. Forty-three patients delivered at term a normal weight newborn (AGA-pregnancies). Thirty patients delivered growth restricted newborns at 32 weeks (i.r. 29–36w) with a median weight of 1160 gr (i.r. 1000–2065 gr) (IUGR-pregnancies). At mid-gestation (18 + 0 − 25 + 6 weeks + days of gestation) a significantly lower uterine blood flow volume per unit weight was observed between the two study groups and compared to controls: 142 ml/min/kg in IUGR-pregnancies, 217 ml/min/kg in AGA-pregnancies and 538 ml/min/kg in Control-pregnancies. These striking differences in blood flow volume were already present at mid-gestation, at a time when EFW was still normal. In late gestation (27 + 0 − 37 + 6 weeks + days of gestation), pregnancies with an abnormal uterine P.I. showed persistently low UtA flow (<50% of controls) even when corrected for fetal weight: 81 ml/min/kg in IUGR-pregnancies, 105 ml/min/kg in AGA-pregnancies, and 193 ml/min/kg in Control-pregnancies; p < 0.0001. Our findings are consistent with other recent studies regarding the association between reduced uterine blood flow volume and fetal growth restriction. However, the study brings new insight into the finding of abnormal uterine P.I. in normally grown fetuses typically dismissed as “falsely abnormal” or “false positive” findings. Our study suggests that blood flow volume measurement may serve as a new tool to assess this group of patients and possibly those with ischemic placental diseases that may provide some basis for therapeutic interventions.

Uterine artery Doppler and adverse pregnancy outcome in women with extreme levels of fetoplacental proteins used for Down syndrome screening

To evaluate the use of second-trimester uterine artery (UtA) Doppler to predict adverse pregnancy outcome in women with extreme levels of fetoplacental proteins used for Down syndrome screening. At a single institution, women screened for Down syndrome were offered second-trimester UtA Doppler examination if they had one of the following on analysis of maternal serum: pregnancy-associated plasma protein-A ≤ 0.28 multiples of the median (MoM) (1% of screened population), inhibin ≥ 3.0 MoM (2%), human chorionic gonadotropin ≥ 4.0 MoM (2%), alpha-fetoprotein (AFP) ≥ 2.5 MoM (2%), estriol ≤ 0.5 MoM (1%). Abnormal UtA Doppler was defined as bilateral or unilateral notching or mean pulsatility index ≥ 1.45. Of 240 women studied, 92 (38.3%) had an adverse pregnancy outcome: small for gestational age (either < 10(th) customized centile (SGA(10) ) or < 5(th) customized centile (SGA(5) )), low birth weight (LBW, < 2.5 kg), preterm delivery (< 37 + 0 weeks of gestation), fetal loss (late miscarriage or stillbirth), placental abruption and gestational hypertension. Of 167 women screened with all five hormones, those with two or more extreme levels (n = 18, 10.8%) were significantly at risk of adverse pregnancy outcome compared with those with only one marker (61.1% vs. 35.6%, P = 0.04). UtA Doppler was abnormal in 20% (32 of 159 women screened) and increased the risk of adverse pregnancy outcome (RR 2.5, 65.6% vs. 26.0%, P < 0.001). SGA(10) , SGA(5) and LBW were significantly more common in women with abnormal UtA Doppler (RR 2.98, 56.2% vs. 18.9%, P < 0.001, RR 4.6, 43.7% vs. 9.4%, P < 0.001 and RR 4.4, 31.2% vs. 7.1%, P < 0.001, respectively). Women with normal Doppler examination still had a 26% risk of adverse pregnancy outcome. In women with extreme levels of feto-placental proteins used for Down syndrome screening, an abnormal second-trimester UtA Doppler examination confers a high risk of adverse pregnancy outcome and SGA in particular, but a normal examination does not rule out an adverse pregnancy outcome.