Bilateral Notches Research Articles

Prenatal air pollution exposure, smoking, and uterine vascular resistance.

Prenatal exposure to air pollution and smoking increases the risk of pregnancy complications and adverse birth outcomes, but pathophysiologic mechanisms are still debated. Few studies to date have examined the influence of air pollution on uterine vascular resistance and no studies have examined the independent impact of these exposures. We aimed to assess the impact of prenatal exposure to traffic-related air pollution and smoking on uterine vascular resistance. Our study included 566 pregnant women recruited between 1993 and 1996 in Los Angeles who completed visits at three gestational ages. Information on smoking was collected and uterine vascular resistance was measured at each visit by Doppler ultrasound. We calculated three resistance indices: the resistance index (RI), the pulsatility index (PI), and the systolic/diastolic (S/D) ratio. We estimated exposure to NO2 at the home address of the mother using a land use regression (LUR) model and to NOx using CALINE4 air dispersion modeling. We used generalized linear mixed models to estimate the effects of air pollution and smoking on uterine vascular resistance indices. LUR-derived NO2 and CALINE4-derived NOx exposure increased the risk of high uterine artery resistance in late pregnancy. Smoking during pregnancy also increased the risk of higher uterine resistance and contributed to bilateral notching in mid-pregnancy. Our results suggest that uterine vascular resistance is a mechanism underlying the association between smoking and air pollution, and adverse birth outcomes.

New Directions of Maternal Factors and Ultrasound Markers in the Prediction of Early and Late Pre-Eclampsia

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The Study of Predictive Value of Uterine Artery Doppler in Incidence of Preeclampsia and Intrauterine Growth Restrictions in Pregnant Women

Objectives: Preeclampsia is considered as one of the most important causes of death among pregnant women all around the world. This study aimed to study the predictive value of uterine artery Doppler ultrasonography in the incidence of preeclampsia and the intrauterine growth restriction (IUGR) in pregnant women who attended Fatemieh hospital. Materials and Methods: This study was performed by the prospective cohort method and the statistical population included 108 pregnant women, in their 18-22 weeks of pregnancy, with a singleton pregnancy who referred to the prenatal Fatemieh Hospital of Hamadan during 2013-2016. The uterine artery Doppler ultrasonography was performed and the incidence of IUGR and the occurrence of preeclampsia in the followed pregnancy was evaluated in these patients. Data were analyzed by SPSS 16.0 using the chi-square and Mann-Whitney U statistical tests. Results: The mean difference of pulsatility index (PI) in patients with preeclampsia was statistically significant compared to healthy individuals (P=0.001). In addition, the mean difference of PI in individuals with infants suffering from IUGR was statistically significant compared with the infants not suffering from the IUGR (P=0.001). Further, the incidence of preeclampsia and IUGR in women with a bilateral notch in ultrasonography was significantly greater than those of the women with no report of a bilateral notch in ultrasonography (P=0.001). Conclusions: Therefore, Doppler ultrasonography of the uterine artery has a predictive value in preeclampsia among pregnant women.

Periodic System of Closely Located Holes in an Elastic Plane Under the Conditions of Antiplane Deformation

We construct a singular integral equation of an antiplane periodic problem of the theory of elasticity for an isotropic plane weakened by smooth curvilinear holes. A numerical solution of the problem is obtained in the case of closely located holes with rounded V-shaped vertices made in the elastic plane under the conditions of uniform shear at infinity. On this basis, we determine the stress concentration factors at the rounded vertices of a bilateral V-shaped semiinfinite notch. By using the well-known relation between the stress intensity and stress concentration factors for sharp and rounded V-shaped notches, we perform the limit transition to a bilateral sharp V-shaped notch. The dependence of the stress intensity factor at the sharp vertices of a bilateral V-notch on its apex angle is determined.

Hearing health across a lifespan: Hearing screening from cradle to grave

The 2016 National Academies of Sciences, Engineering, and Medicine report “Hearing Health Care for Adults: Priorities for Improving Access and Affordability” included a call to action for government agencies to strengthen efforts to collect, analyze, and disseminate population-based data on hearing loss in adults. In partial response, the Centers for Disease Control and Prevention (CDC) analyzed the most recent available data collected both by questionnaire and audiometric tests of participants aged 20–69 years in the 2011–2012 National Health and Nutrition Examination Survey to determine the presence of audiometric notches indicative of noise-induced hearing loss. Prevalence of both unilateral and bilateral audiometric notches and their association with self-reported exposure to loud noise were calculated. Nearly one in four adults had audiometric notches, suggesting a high prevalence of noise-induced hearing loss. The prevalence of notches was higher among males. Almost one in four U.S. adults who repor...

12: The predictive capacity of Uterine artery Doppler for preterm birth - a prospective cohort study

Mid-trimester Uterine Artery (UtA) resistance measured with Doppler sonography is known to be predictive for preeclampsia and thus iatrogenic preterm birth (iPTB). In view of the emerging association between hypertensive disease in pregnancy and spontaneous preterm birth (sPTB), we hypothesized that UtA resistance could predict sPTB. We performed a prospective cohort study. During the 18-22 week routine fetal anomaly scan we measured UtA resistance in singleton pregnancies. Pregnancies complicated by major congenital anomalies were excluded. We classified the resistance in the uterine artery (no notch, unilateral notch or bilateral notch) and related it to sPTB and iPTB, defined as delivery before 37 weeks, using likelihood ratios. Furthermore, we assessed whether the UtA Pulsatility Index (PI) was associated with the risk of sPTB. Between January 2009 and December 2016, we included 2,987 women. Mean gestational age at measurement was 19+6 weeks. There were 79 (2.6%) women with a bilateral notch and 134 (4.5%) with a unilateral notch. Mean gestational age at birth was 39+0 weeks, 6.3 % had sPTB while 4.0 % had iPTB. Mean UtA resistance was 1.11 in the sPTB group compared to 1.05 in the term group (p <0.001). The risk of PTB was increased with high UtA resistance (OR 2.6 per unit ; 95% CI 2.0-3.4). Figure 1 shows the time to delivery. The prevalence of spontaneous preterm birth increased from 6.1% in women with normal uterine arteries to 9.0% in women with a unilateral notch and 10.1% in women with a bilateral notch (Table 1). For iPTB, these rates were 3.4%, 9.0% and 19.0% respectively. Likelihood ratios for the prediction of sPTB were 1.5 (95% CI 0.8-2.7) and 1.7 (95% CI 0.8-3.6) for unilateral and bilateral notches respectively, and 2.6 (95% CI 1.4-4.6) and 6.0 (95% CI 3.3-10.3) for iPTB. Of all women with bilateral notching 29.1% delivered preterm. Mid-Trimester UtA resistance measured at 19 weeks gestation predicts sPTB.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Supraorbital nerve exits: positional variations and localization relative to surgical landmarks.

Significant variations exist in the occurrence, form, and position of supraorbital nerve exits through the frontal bone. Detailed knowledge of the positional variations of supraorbital exits is important to ensure safe and successful regional anesthesia, and to avoid iatrogenic nerve injuries during surgery of the orbitofacial region. Supraorbital nerve exits from 116 sides of 58 dry intact adult skulls (37 male and 21 female) in a Sri Lankan population were examined to determine the morphological features and the precise position in relation to the facial midline, temporal crest of frontal bone, and frontozygomatic suture. A majority of supraorbital nerve exits existed as notches (73.8%) and the rest as foramina (26.2%). Accessory exits were seen in 18.9% skulls. Of the skulls examined, 55.1% displayed bilateral supraorbital notches, 8.6% had bilateral supraorbital foramina, and 36.3% had a notch on one side and a foramen on the contralateral side. In males, the supraorbital nerve exit was located 23.64±3.49 mm laterally from the facial midline, 27.86±2.76 mm medially from the temporal crest of the frontal bone, 28.66±2.56 mm from the frontozygomatic suture, and 2.12±1.07 mm above the supraorbital margin in the case of a foramen, and in females 22.69±3.28 mm laterally from the facial midline, 26.32±3.02 medially from temporal crest of frontal bone, 27.29±3.05 from the frontozygomatic suture, and 2.99±1.49 mm above the supraorbital margin when it existed as a foramen. The observations made in this study will be useful when planning a supraorbital nerve block and surgery in the supraorbital region.

EP16.17: Contribution of uterine artery Doppler in the prediction of uteroplacental insufficiency

A prospective descriptive study was conducted in Department “A” of gynecology and obstetrics in the maternity centre of Tunis. We followed 50 patients, with previous pregnancy complications correlated to placental insufficiency. Patients were randomised in two groups. The first group received Aspirin. The second one received Aspirin + Enoxaparin. For each patient, uterine artery Doppler was performed in the first, second then third trimesters. We evaluated the presence of uterine artery notch. Adverse pregnancy outcomes were notified and correlated to the sonographic results. Iatrogenic events were recorded. A first trimester bilateral uterine artery notch was found in 36% of the patients. A second trimester bilateral notch was found in 18% of the cases. 20% of patients had a unilateral notch in the second trimester. 6 % (n=3) of included patients had severe pregnancy outcome (2 cases of fetal death and 1 severe pre-eclampsia) These 3 patients had persistent bilateral uterine Artery Doppler notch. Mild complications were found in 7% of cases (mild pre-eclampsia). Severe adverse pregnancy outcomes seem to be correlated to the persistence of uterine Artery Doppler Notch after the first trimester despite the use of Aspirin and enoxaparin. Uterine artery Doppler screening could be a non invasive method to predict uteroplacental insufficiency in high risk populations. Persistent bilateral uterine artery notch could predict late severe adverse pregnancy outcome. Its association with maternal characteristics study and biochemical markers could better its predictive value.

EP11.04: Umbilical cord cyst as an incidental finding on ultrasound

A 22-year old woman (G1P0) was referred to our maternal intensive care unit with a first episode of vaginal blood loss at a gestational age of 30 weeks and 6 days. Ultrasound investigation showed an anterior non-previa placenta without signs of retro-placental hematoma. As accidental finding, a multiloculair anechogenic umbilical cord cyst of 69 mm located at the placental insertion of the cord was observed. There were no other fetal anomalies. Uterine artery Doppler demonstrated a bilateral notch. The estimated fetal weight was 1500 grams (21st percentile). The umbilical artery and middle cerebral artery PI were within normal limits, the cerebroplacental ratio was below P5. Umbilical cord cysts (UCC) are remnants of the omphalo-mesenteric duct and differential diagnosis has to be made with pseudo-cysts (edema or liquefaction of Wharton's jelly). Histologic examination can distinguish by observing no epithelial lining in pseudo-cysts compared to true cysts. The embryologic origin of UCC is unclear, yet communication with a patent urachal system has been suggested. At 7-13 weeks gestational age, umbilical cord cysts may have a prevalence of up to 3%, however, they most often disappear without sequelae after the first trimester. Cysts that remain during the second and third trimester and that are located at the placental or fetal insertion of the cord, are more likely to coincide with other fetal abnormalities or fetal growth restriction. Persistent UCC are associated with Trisomy 13 or Trisomy 18 in up to 20% of cases reported. Fetal genotyping is thus indicated when other fetal malformations are present or in case of persistent UCC.

First trimester uterine artery Doppler, sFlt-1 and PlGF to predict preeclampsia in a high-risk population

Objective: The study aims to evaluate the accuracy of combining uterine artery Doppler (UAD), PlGF and sFlt-1 in the first trimester for preeclampsia screening.Methods: Prospectively enrolled women at high risk of preeclampsia were included. Transabdominal UAD measurements and serum biomarkers were collected between 11 and 13 weeks of gestation in three university hospitals and in one general hospital. The main outcome was preeclampsia. UAD parameters and biomarker levels among women with preeclampsia were compared with those of women in the unaffected group in univariate and multivariate analyses.Results: Out of 226 women included from May 2007 to January 2011, 27 (11.9%) women developed preeclampsia. Among women affected by preeclampsia, the lowest pulsatility index was higher (p = 0.02), bilateral notching was more frequent (p = 0.01), and PlGF was lower (p < 0.001). No significant differences were observed for other indicators. The multivariate model, adjusted for laboratory and sonographic indicators, had an area under the curve (AUC) estimated at 0.76, which was not significantly different from the AUC of the univariate model adjusted only for PlGF (p = 0.7).Conclusion: In a high-risk population, PlGF in the first trimester is useful for predicting preeclampsia, but neither sFlt-1 nor any UAD indices improved the prediction of preeclampsia.

Vital Signs: Noise-Induced Hearing Loss Among Adults - United States 2011-2012.

IntroductionThe 2016 National Academies of Sciences report “Hearing Health Care for Adults: Priorities for Improving Access and Affordability” included a call to action for government agencies to strengthen efforts to collect, analyze, and disseminate population-based data on hearing loss in adults.MethodsCDC analyzed the most recent available data collected both by questionnaire and audiometric tests of adult participants aged 20–69 years in the 2011–2012 National Health and Nutrition Examination Survey (NHANES) to determine the presence of audiometric notches indicative of noise-induced hearing loss. Prevalence of both unilateral and bilateral audiometric notches and their association with sociodemographics and self-reported exposure to loud noise were calculated.ResultsNearly one in four adults (24%) had audiometric notches, suggesting a high prevalence of noise-induced hearing loss. The prevalence of notches was higher among males. Almost one in four U.S. adults who reported excellent or good hearing had audiometric notches (5.5% bilateral and 18.0% unilateral). Among participants who reported exposure to loud noise at work, almost one third had a notch.Conclusions and Implications for Public Health PracticeNoise-induced hearing loss is a significant, often unrecognized health problem among U.S. adults. Discussions between patients and personal health care providers about hearing loss symptoms, tests, and ways to protect hearing might help with early diagnosis of hearing loss and provide opportunities to prevent harmful noise exposures. Avoiding prolonged exposure to loud environments and using personal hearing protection devices can prevent noise-induced hearing loss.

Analysis of audiometric notch as a noise-induced hearing loss phenotype in US youth: data from the National Health And Nutrition Examination Survey, 2005–2010

Objective: Bilateral audiometric notch (BN) at 4000–6000 Hz was identified as a noise-induced hearing loss (NIHL) phenotype for genetic association analysis in college-aged musicians. This study analysed BN in a sample of US youth. Design: Prevalence of the BN within the study sample was determined and logistic-regression analyses were performed to identify audiologic and other demographic factors associated with BN. Computer-simulated “flat” audiograms were used to estimate potential influence of false-positive rates in estimating the prevalence of the BN. Study sample: 2348 participants (12–19 years) following the inclusion criteria were selected from the National Health and Nutrition Examination Survey data (2005–2010). Results: The prevalence of BN was 16.6%. Almost 55.6% of the participants showed notch in at least one ear. Noise exposure, gender, ethnicity and age showed significant relationship with the BN. Computer simulation revealed that 5.5% of simulated participants with “flat” audiograms showed BN. Conclusion: Association of noise exposure with BN suggests that it is a useful NIHL phenotype for genetic association analyses. However, further research is necessary to reduce false-positive rates in notch identification.

Occupational noise exposure, hearing loss, and notched audiograms in the HUNT Nord-Trøndelag hearing loss study, 1996-1998.

Objectives/HypothesisTo study the prevalence and usefulness of audiometric notches in the diagnosis of noise‐induced hearing loss (NIHL).Study DesignAudiograms and data on noise exposure from 23,297 men and 26,477 women, aged 20 to 101 years, from the Nord‐Trøndelag Hearing Loss Study, 1996–1998.MethodsThe prevalence of four types of audiometric notches (Coles, Hoffman, Wilson) and 4 kHz notch were computed in relation to occupational noise exposure, age, sex, and report of recurrent ear infections.ResultsThe prevalence of notches in the 3 to 6 kHz range (Wilson, Hoffman, and Coles) ranged from 50% to 60% in subjects without occupational noise exposure, and 60% to 70% in the most occupationally noise‐exposed men. The differences were statistically significant only for bilateral notches. For 4 kHz notches, the prevalence varied from 25% in occupationally nonexposed to 35% in the most occupationally exposed men, and the differences were statistically significant for both bilateral and unilateral notches. For women, the prevalence of notches was lower than in men, especially for 4 kHz notches, and the differences between occupationally noise exposed and nonexposed were smaller. Recreational exposure to high music was not associated with notched audiograms.ConclusionsThe detection of bilateral notches and unilateral 4 kHz notches is of some value in diagnosing NIHL, especially in men.Level of Evidence4 Laryngoscope, 127:1442–1450, 2017

Prediction of adverse pregnancy outcomes using uterine artery Doppler imaging at 22-24 weeks of pregnancy: A North Indian experience.

Objective:The aim of this study was to assess the predictive value of uterine artery Doppler imaging at 22-24 weeks of gestation for adverse pregnancy outcomes.Materials and Methods:This was a prospective study in which uterine artery Doppler was performed at 22-24 weeks of gestation in 165 pregnant women with singleton pregnancies. A pulsatility index (PI) more than 1.45 or bilateral uterine notching was labeled as abnormal Doppler. The pregnancy outcome was assessed in terms of normal outcome, preeclampsia, fetal growth restriction (FGR), low birth weight, spontaneous preterm delivery, oligohydramnios, fetal loss or at least one adverse outcome.Results:Out of 165 patients, 35 (21.2%) had abnormal second trimester uterine artery Doppler. In pregnancies that resulted in preeclampsia (PE), (n=21), FGR, (n=21), and low birth weight (n=39), the median uterine artery PI was higher (1.52, 1.41, and 1.27 respectively). In the presence of abnormal Doppler, the risk of PE [OR=10.7, 95% confidence interval (CI): (3.91-29.1); p<0.001], FGR [OR=4.34, 95% CI: (1.62-11.6); p=0.002], low birth weight [OR=6.39, 95% CI: (3.16-12.9); p<0.001] and the risk of at least one obstetric complication [OR=8.73, 95% CI: (3.5-21.3); p<0.001] was significantly high. The positive predictive value of abnormal uterine artery Doppler was highest for preeclampsia (36.84%) among all adverse pregnancy outcomes assessed.Conclusion:Uterine artery Doppler ultrasonography at 22-24 weeks of gestation is a significant predictor of at least one adverse pregnancy outcome, with the highest prediction for preeclampsia.

Impact of High‐Flavanol and High‐Theobromine Chocolate Consumption on Blood Glucose Homeostasis in Women at Risk of Preeclampsia: a Double Blind Randomized Clinical Trial

Preeclampsia (PE) is characterized by generalized endothelial dysfunction and impaired maternal tissue perfusion, and insulin resistance is a prominent feature of this disease. A history of PE has also been associated with higher fasting glucose concentrations and higher risk of type 2 diabetes later in life. Despite controversy among previous studies, flavanol‐rich chocolate consumption during pregnancy could have beneficial effects on the risk of PE. Theobromine, a major constituent of dark chocolate, also possesses vasodilatation properties. To our knowledge, no study has investigated the effect of flavanol‐rich chocolate consumption on blood glucose homeostasis in pregnant women at risk of PE.ObjectiveTo assess the impact of high‐flavanol and high‐theobromine chocolate consumption on fasting glucose and insulin concentrations in pregnant women at risk of PE.MethodsA single‐center randomized controlled trial was conducted in women with singleton pregnancy between 11 and 14 weeks gestation. Uterine artery Doppler was performed and women with bilateral diastolic notches and either a uterine artery pulsatility index (PI) &gt;95th percentile on one side and/or bilateral PI&gt;50th percentile were considered as potentially eligible for randomization. A total of 131 pregnant women were randomly assigned to either high‐flavanol, high theobromine (HFHT) or low‐flavanol, low‐theobromine (LFLT) chocolate groups. Women had to consume a total of 30 g of chocolate on a daily basis for 12 weeks. Fasting blood samples and anthropometric variables were measured at baseline and at 12 weeks.ResultsNo significant group by time interaction was found in fasting glucose and insulin concentrations after 12 weeks of chocolate consumption. A significant time effect was observed in fasting insulin concentrations in both HFHT and LFLT chocolate groups (p&lt;0.0001), with similar increases in fasting insulin concentrations at 12 weeks. A significant time effect was observed in fasting glucose in the LFLT chocolate group only (p= 0.002), with a significant decrease of 4.9% in fasting glucose concentrations at 12 weeks. A significant group by time interaction was noted for body weight (p=0.03), with a greater weight gain in the HFHT group.ConclusionOur results suggest that HFHT chocolate consumption during pregnancy in women at risk of PE does not conduct to more beneficial effect on fasting glucose concentrations compared to LFLT chocolate.Support or Funding InformationThis research project was supported by Canadian Institute of Health Research by the Jeanne and Jean‐Louis Lévesque Perinatal Research Chair at Laval University.

Utility of uterine artery Doppler and pulsatility index at 11-14 weeks of normal pregnancy in prediction of preeclampsia in third trimester

Introduction: Preeclampsia affects 5-8% of women in pregnancy and leading cause of maternal mortality. The present study was done to predict the development of preeclampsia in patients with uterine artery pulsatility index (PI) >1.71 and the presence of diastolic notch at 11-14 weeks of gestation belonging to low risk population. Methods: Women attending routine antenatal care were offered an early transvaginal ultrasound scan between 11-14 weeks including uterine artery doppler assessment. Mean PI and presence or absence of bilateral early diastolic notch was also noted. All patients were followed up to term for the development of preeclampsia. Results: Out of 100 patients, 22% developed preeclampsia of which 15 (68.18%) cases showed the presence of diastolic notch and 12 (54.54%) cases had PI >1.71 (p 1.71 (p 140mm of Hg at 11-14 weeks of gestation developed preeclampsia (p<0.05). Conclusion: Presence of diastolic notch and PI of >1.71 in uterine artery colour doppler at 11-14 weeks of gestation serves as a good predictor of preeclampsia at term, in pregnancies with no other associated risk factors.

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.

Reduced placental volume and flow in severe growth restricted fetuses

OBJECTIVES:To evaluate placental volume and vascular indices in pregnancies with severe fetal growth restriction and determine their correlations to normal reference ranges and Doppler velocimetry results of uterine and umbilical arteries.METHODS:Twenty-seven fetuses with estimated weights below the 3rd percentile for gestational age were evaluated. Placental volume and vascular indices, including vascularization, flow, and vascularization flow indices, were measured by three-dimensional ultrasound using a rotational technique and compared to a previously described nomogram. The observed-to-expected placental volume ratio for gestational age and observed-to-expected placental volume ratio for fetal weight were calculated. Placental parameters correlated with the Doppler velocimetry results of uterine and umbilical arteries.RESULTS:The mean uterine artery pulsatility index was negatively correlated with the observed-to-expected placental volume ratio for gestational age, vascularization index and vascularization flow index. The observed-to-expected placental volume ratio for gestational age and observed-to-expected placental volume ratio for fetal weight and vascularization index were significantly lower in the group with a bilateral protodiastolic notch. No placental parameter correlated with the umbilical artery pulsatility index.CONCLUSIONS:Pregnancies complicated by severe fetal growth restriction are associated with reduced placental volume and vascularization. These findings are related to changes in uterine artery Doppler velocimetry. Future studies on managing severe fetal growth restriction should focus on combined results of placental three-dimensional ultrasound and Doppler studies of uterine arteries.

The Frequency of Peripheral Blood CD4+FoxP3+ Regulatory T Cells in Women With Pre-eclampsia and Those With High-risk Factors for Pre-eclampsia

Objective: We compared the frequency of peripheral blood Treg cells in women with pre-eclampsia (PE) and in those without, and investigated whether the frequency of Treg cells in women with high-risk factor for PE changed during pregnancy. Methods: We examined the frequency of CD4+FoxP3+ Treg cells in the peripheral blood using flow cytometry. Eleven women with PE and 10 women without PE (controls) were included. Every control had any risk factors for PE, such as high blood pressure, bilateral notching or a past history of PE or gestational hypertension. Blood sampling was conducted 1–3 times in the controls. Results: No significant differences were observed in the frequency of Treg cells between women with PE and the controls [mean ± SE (%): 5.74 ± 0.91 versus 5.48 ± 0.94, p = 0.843]. In five controls with serial sampling, the frequency of Treg cells significantly decreased from 5.83 ± 1.20 to 2.99 ± 0.54 (p = 0.046) (week of the first sampling to that of the last sampling [mean ± SD]: 21.5 ± 1.6 weeks to 31.2 ± 2.5 weeks). Conclusion: The frequency of Treg cells in women with PE was almost identical to that in the controls. The frequency of Treg cells in the controls was reduced by half from the second trimester to the third trimester. These results suggested that the levels of Treg cells in a high-risk pregnant cohort were decreased to those in women with PE in the third trimester irrespective of the occurrence of PE.

EP05.03: Reproducibility and repeatability of uterine artery Doppler pulsatility index and bilateral diastolic notch between 11–14 weeks of gestation

To assess intraobserver repeatability and interobserver reproducibility of uterine artery (UtA) Doppler Pulsatility Index (PI) and presence/absence of bilateral diastolic notch between 11–14 weeks of gestation Singleton pregnancies attending for first trimester anomaly scan/Down's risk assessment at São Paulo Federal University were recruited. Doppler analysis of both UtA was carried out abdominally in 50 consecutive pregnant twice by the first examiner (GL) and then once by a second examiner (PN). Both examiners are experienced on Fetal Doppler Ultrasound with Certificate of Competence issued by FMF. Left and right UtA PI were assessed and mean PI was calculated. In addition, both examiners classified qualitatively the blood flow with regard to the presence or absence of a bilateral early diastolic notch. Mean BMI, mean CRL and proportion of nulliparous in the study population was 25.4, 65.2 mm (12w6d) and 34%, respectively. Mean UtA PI and standard deviation was 1.72 (0.44) and 1.67 (0.44) for the first and second measurements of the first examiner (GL) respectively. Mean UtA PI and standard deviation was 1.72 (0.44) and 1.65 (0.41) for the first measurement of the first examiner and measurement of the second examiner (GL X PN) respectively. In both comparison (GL X GL and GL X PN), differences between measurements were not statistically significant (p value = 0.051 for both).Bilateral early diastolic notch had high level of agreement in both intra and interobserver analysis, as shown by Kappa coefficient of 0.854 and 0722 respectively First trimester UtA Doppler quantitative and qualitative assessment has high reproducibility and repeatability, when performed by experienced examiners.