Bilateral Uterine Artery Doppler Research Articles

Routine ante-natal screening using maternal risk factors and biomarkers for preeclampsia in 11-13+6 weeks of gestation.

Prediction of preeclampsia in first trimester can lead to early initiation of preventative measures, as well as timely therapeutic intervention, that will prevent the maternal and perinatal morbidity and mortality. This study, prediction of preeclampsia at 11-13+6 weeks of gestation, was conducted by using serum placental growth factor (PlGF), serum pregnancy associated plasma protein - A (PAPP-A), uterine artery Doppler indices, and mean arterial pressure (MAP), in low-risk pregnant women. It is an observational longitudinal prospective study. Pregnant women with singleton pregnancies of gestational age 11-13+6 weeks were recruited. MAP, bilateral uterine artery Doppler indices, serum PAPP-A, and PlGF were measured. The follow-up of the patients was regularly done till termination of pregnancy and incidence of preeclampsia were noted. Qualitative variables were compared using Chi-square/Fisher exact test, and sensitivity and specificity of each test were analyzed. Among 139 women, 27 (19%) developed preeclampsia, out of which 10 had early preeclampsia and 17 developed late preeclampsia. By combining all the parameters, the sensitivity in detecting early preeclampsia was found to be 70% and for late preeclampsia cases, 64.7%. The sensitivity of all the parameters in predicting cases of preeclampsia in general is 66.7%, specificity is 74.1%, PPV is 38.3%, and NPV is 72%. The maternal biomarkers serum PAPP-A, serum PlGF, uterine artery PI, MAP have sensitivity of 70% in detecting early preeclampsia cases and for late preeclampsia cases, 64.71%, in first trimester and it will help in early initiation of preventative measures as well as timely therapeutic intervention.

Comparative Investigation of Color Doppler Ultrasonography Parameters of the Uterine Artery in Patients with Post-molar GTN and Patients Recovered from Molar Pregnancy and its Role in Predicting the Probability of Occurrence

Objectives: Hydatiform mole can progress to gestational trophoblastic neoplasia (GTN), and we are looking for non-invasive methods to predict it. Old age, higher serum BHCG levels, and expression of genes, such as VEGF-EG, HIF-1α, and TGF-ß are known as predictive factors. We performed this study to evaluate the role of bilateral uterine artery doppler ultrasound in predicting postmolar- GTN. Methods: In this prospective cohort study, 42 patients with complete molar pregnancy were examined. Inclusion criteria confirmed molar pregnancy by histopathological examination. Exclusion criteria were patients more than 40 years old, patients with completed family childbearing planning, and diagnosis of GTN during the routine histopathological study. Before molar evacuation and four weeks later, bilateral uterine artery doppler sonography to determine the PI, RI, and PSV was performed. Serum BHCG levels were also measured before molar evacuation and weekly after evacuation until it exhibited spontaneous remission or developed GTN. Results: About 36 patients were cured, and six others developed post-molar GTN. The bilateral uterine artery doppler sonography between the two groups showed a lower UA RI in the post-molar-GTN group before evacuation (P=0.048). Data demonstrated significant increases in Right.UA.RI (P=0/008), Left.UA.PI (P=0/037), and Right.UA.PSV (P=0/024) in the spontaneous remission group during 28 days follow-up period. There were no significant differences in these parameters in the GTN group throughout the time of follow-up. Conclusion: It seems that Doppler ultrasound plays a role in predicting GTN following uterine evacuation. A lower resistance in the uterine artery before evacuation and the remaining uterine artery blood flow constant after evacuation is associated with the development of post-molar- GTN.

Investigation of the relationship between diastolic notching in uterine artery Doppler and serum salusin alpha and beta concentrations in the first trimester

Objective Studies have shown that members of the salusin family regulate the migration and proliferation of arterial smooth muscle cells and increase the tendency to atherosclerosis through fibrosis and calcification in the vascular wall. However, the effect of salusins on the uterine artery has not yet been investigated. This study was conducted to investigate whether serum salusin alpha and beta concentrations in the first trimester are associated with diastolic notching in uterine artery Doppler. Methods This non-interventional cohort study was conducted on 88 pregnant women, 44 of whom had diastolic notching on unilateral or bilateral uterine artery Doppler, and 44 of whom did not have diastolic notching on uterine artery Doppler. The uterine artery notch positive and negative groups were compared in terms of serum salusin alpha and beta concentrations. Results The two groups were similar in terms of demographic characteristics (p < 0.05). The median salusin alpha concentration was found to be 689.4 pg/ml in the uterine artery notch positive group, while it was 734.6 pg/ml in the uterine artery notch negative group (p = 0.608). The median salusin beta concentration was found to be 674.5 pg/ml in the uterine artery notch positive group, while it was 693.8 pg/ml in the uterine artery notch negative group (p = 0.453). Participants were regrouped into normal and high uterine artery resistance and compared in terms of serum salusin alpha and beta concentrations. The median salusin alpha concentration was found to be 994.5 pg/ml in the high uterine artery PI group, while it was 685.2 pg/ml in the normal uterine artery PI group (p = 0.698). The median salusin beta concentration was found to be 1,100.8 pg/ml in the high uterine artery PI group, while it was 669.1 pg/ml in the normal uterine artery PI group (p = 0.584). Conclusion Although the sample size was too small to draw a definitive conclusion, our results indicate that uterine artery diastolic notching or increased resistance in the uterine artery does not appear to be associated with serum salusin alpha or beta concentrations.

Uterine Artery Doppler Ultrasound Measurement of Preterm Labor in Pregnant Women with Threatened Preterm Labor

Introduction: One of the most common causes of hospitalisation during pregnancy is preterm labour. Nearly one-fifth of women hospitalised for preterm labour. The frequency of preterm births is about 12%–13% in the USA and 5%–9% in many other developed countries. One of the main causes of preterm delivery is preterm premature rupture of membranes, while pre-eclampsia and foetal growth restriction (FGR) can be identified as other common causes that could lead to such complications. Objective: to assess the value of uterine artery doppler ultrasound measured of preterm labor in pregnant women with threatened preterm labor. Methods: We performed a single-center cohort study was carried out at Obstetrics and Gynecology, Sylhet MAG Osmani Medical College Hospital &amp; Jalalabad Clinic, Modhushohid, Sylhet, Bangladesh from January to December 2020. Total 141 women were selected for the present study after applying inclusion and exclusion criteria. All participating women signed informed written consent. The study included singleton pregnant women who present to the casualty at gestations between 28 and 34 weeks of gestation with symptoms and signs of threatened preterm labor (defined as presence of at least one uterine contraction per 10 minutes, lasting at least 30 seconds, with a cervical dilatation ≤ 3 cm, and a cervical effacement &lt; 80%). On admission, during obstetric ultrasound scanning, bilateral uterine artery Doppler ultrasound velocimetry was performed using the transabdominal technique. Uterine artery Doppler scans were both conducted at the peak of uterine contraction and in between contractions when the uterus is fully relaxed. Results: Total 141 women presenting with threatened preterm labor were included in the study. The mean gestational age at presentation was 30.86 ± 1.71 weeks (range: 28 – 33.86 weeks). Among 45 (31.9%) delivered within 7 days, while 96 (68.1%) delivered after 7 days of presentation. The mean uterine artery pulsatility index (UA-PI) measured both basally and at the peak contraction were significantly higher among women who delivered within 7 days. ROC curves showed that both basal and contraction UA-PI were significant predictors of delivery within 7 days. There was a significant negative correlation between contraction UA-PI and birth weight. Conclusion: Uterine artery Doppler ultrasound velocimetry measured in women with threatened preterm labor, seems to be a significant predictor of actual preterm labor within 7 days of admission.

S-11-1: ARTERIAL STIFFNESS AND HEMODYNAMIC PARAMETERS FOR THE EARLY PREDICTION OF PREECLAMPSIA: A PROSPECTIVE COHORT STUDY

Objective: Preeclampsia is a leading complication of pregnancy, yet there remains no reliable clinical tool for its early prediction. Assessment of vascular dysfunction, a central feature of preeclampsia, by arterial stiffness and hemodynamic measurements could be a promising tool for preeclampsia prediction. This study aimed to evaluate 1) arterial stiffness and hemodynamic parameters as an early predictive tool for preeclampsia, and 2) longitudinal changes in these parameters and identify changepoints prior to preeclampsia onset. Design and method: In this prospective longitudinal cohort study of women with singleton high-risk pregnancies (n = 236), arterial stiffness (carotid-femoral pulse wave velocity, cfPWV) and wave reflection (augmentation index [AIx], and time to wave reflection [T1R]) were assessed using applanation tonometry (SphygmoCor, AtCor) at 10–13 weeks and repeated every 4 weeks throughout pregnancy. Circulating angiogenic biomarkers (soluble fms-like tyrosine kinase, and placental growth factor) were measured (Quantikine, R&amp;D Systems) at each trimester, and a bilateral uterine artery Doppler (UAD) was performed in the second trimester. The predictive ability of arterial stiffness was compared to that of peripheral blood pressure, UAD indices, as well as angiogenic biomarkers. Furthermore, changepoints in cfPWV, AIx, and T1R were compared between women who did and did not subsequently develop preeclampsia. Results: A first-trimester 1 m/s increase in cfPWV was associated with 64% increased odds (p &lt; 0.05), while a 1 ms increase in T1R with 11% decreased odds for preeclampsia (p &lt; 0.01). The area under the curve of arterial stiffness, blood pressure, ultrasound indices, and angiogenic biomarkers was 0.84, 0.68, 0.66, and 0.64, respectively (Figure). A changepoint in cfPWV was detected at 14–17 weeks. cfPWV then increased in women who subsequently developed preeclampsia but decreased in women who did not; a 1.2 m/s difference in cfPWV between the groups was observed at 22–25 weeks. An increase in AIx was noted at 18–21 weeks while at 30–33 weeks in women who did and did not develop preeclampsia, respectively. Conclusions: Arterial stiffness and wave reflection were higher in the first trimester and throughout pregnancy in women destined to develop preeclampsia. These indices predicted preeclampsia earlier (in the first trimester) and with greater ability than blood pressure, UAD, and/or angiogenic biomarkers. Furthermore, altered vascular adaptations in the early second trimester were observed in women who subsequently developed preeclampsia. These findings demonstrate the potential clinical utility of arterial stiffness and hemodynamic parameters as an early screening tool for preeclampsia, which can be used to inform clinical management of high-risk pregnancies.

Role of Uterine Artery Doppler in Prediction of Preeclampsia: A Prospective Analytical Study

Introduction: Preeclampsia is pregnancy specific hypertensive disorder of pregnancy which is associated with both high maternal and perinatal morbidity and mortality. Timely prediction and management in time, are the two key factors for prevention of these morbidities and mortalities. The aim of present study was to evaluate role of uterine artery doppler in prediction of preeclampsia in second and third trimester of pregnancy in Indian setting. Materials and Methods: This was a prospective analytical study done at department of Obstetrics and Gynaecology, King George Medical university, Lucknow over a period of one year. After ethical approval (Institutional Ethics Committee, KGMU, Lucknow, Ref. Code: 92nd ECM II B- thesis P/29.) and informed consent from every patient, recruitment was done. Group I had 120 normotensive patients and Group 2 had 100 preeclampsia patients at time of enrollment. Bilateral uterine artery doppler was done for every patient and patient were further followed for maternal and perinatal outcome. Results: Total 220 patients were studied. In Group 1, 15 patients developed preeclampsia. Both groups were comparable for maternal age and parity. However, BMI was found to be significantly higher in the patients of Preeclampsia group. Uterine artery doppler, showed statistically significant difference and it was high in preeclampsia group. It had high negative predictive value. Gestation of termination was significantly lower in preeclampsia group. Fetal birth weight was significantly lower in preeclampsia group. Conclusion: Uterine artery doppler is a non-invasive test with high negative predictive value which should be utilized for prediction of preeclampsia for all pregnant patients.

Combined Maternal Serum C3 Activation and Uterine Artery Doppler at 14-20 Weeks as Predictors for Pre-Eclampsia in Primigravida

Background: Preeclampsia is a multisystem disorder of pregnancy, which complicates 3%-5% of pregnancies in the western world. It is a major cause of maternal morbidity and mortality worldwide. The cardinal clinical features of the condition are hypertension and proteinuria occurring after 20 weeks gestation in women who were not previously known to be hypertensive. Objective: This study was aimed to assess the efficacy of C3 estimation and measurement of bilateral uterine artery Doppler before 20 weeks of pregnancy for prediction of preeclampsia in primigravida. Methods: The study was performed at the Antenatal Care Unit, Obstetrics and Gynecology Department, Sayed Galal Hospital, Al Azhar University on 131 pregnant women at 14-20 gestational weeks during period from July 2017 to December 2017 gestation attending. Results: On follow up the population of the study 131 pregnant women had completed the study that were classified to 119 (90.8%) with no pre-eclampsia and 12 (9.2%) developed preeclampsia, As regards the Patients characteristics there was no statistical significant difference between the two groups as regard age, height, weight, gestational age, SBP and DPB at enrollment (p-value>0.05). There was a significant difference regarding BMI as (p value < 0.05), with more increasing BMI and decreasing gestational age at delivery in preeclampsia group in comparison with the no preeclampsia group. As regards the C3, there was statistically highly significant difference between the two groups regarding serum C3 level as p value <0.05, with lower levels of C3 serum levels in preeclampsia group. Receiver operator characteristics (ROC) curves were constructed for estimating the association between pre-eclampsia and serum C3 level. A significant association was found with serum C3 level being a significant predictor with lower values in cases with pre-eclampsia than in normal cases [area under the curve (AUC) = 0.935, 95% CI (0.878 to 0.9711.35), best cut off (≤53.1), sensitivity of 83.3%, specificity of 100% positive predictive value (PPV) of 100% and negative predictive value (NPV) of 98.3%. Conclusion: This study demonstrates that lower level of maternal serum C3 in the early second trimester (14-20 weeks gestation) and abnormal increasing in uterine artery indices (PI and RI) are associated with developing pre-eclampsia several months later in pregnancy.

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.

THE ROLE OF SECOND TRIMESTER UTERINE ARTERY DOPPLER ULTRASOUND,INHIBIN-A AND PLACENTAL GROWTH FACTOR IN PREDICTION OF PREECLAMPSIA.

ABSTRACT Objective: to evaluate the role of second trimester uterine artery Doppler ultrasound velocimetry (UADV), maternal serum Inhibin-A andplacental growth factor (PLGF) concentrations and as predictors of preeclampsia. Study design: Cohort study. Methodology: This prospective study was conducted at Obstetrics & Gynecology department, Alazhar University hospitals, Cairo, Egypt between May 2012 and May 2014. Ninety low risk normotensive singleton pregnant women were recruited for the study. Blood samples were collected at 16- 18 weeks, centrifuged to extract the serum then stored at – 80 °C until tested for inhibin-A and free PLGF levels. At 22-24 weeks, bilateral uterine artery Doppler velocimetry were recorded. The primary outcome was preeclampsia defined as hypertension with proteinuria after 20 weeks gestation. Women who developed preeclampsia were compared against normotensive control group. Statistical analysis: Receiver operating characteristics (ROC) curves were used for detection of the sensitivity and specificity and cut off value for each predictor using SPSS version 21 for analysis (IBM Inc., Chicago, Illinois, USA). Results: Eight cases out of 90 had developed preeclampsia. Women who developed preeclampsia had significantly higher median uterine artery resistance index (UARI) (0.645 ± 0.3 vs. 0.485 ± 0.16, P = 0.009) and significantly lower median uterine artery pulsitility index (UAPI) (0.625 ± 0.24 vs. 1.0 ± 0.68 with P= 0.001) than normotensive control group.Maternal serum inhibin-A level was significantly higher in women with preeclampsia than the normotensive control group (1375 ± 1431 vs. 540 ± 1900 with P = 0.016) while level of PLGF was non-significantly lower in women with preeclampsia than the normotensive control group (275.5 ± 369 vs. 390 ± 583 with P = 0.156). ROC curves were analysed for cases and control groups, areas under the curve (AUC) was 0.709 (95% CI, 0.527– 0.891, P = 0.016) for UARI with sensitivity of 87.5%, specificity 74% at cut off value ≥ 0.5650, AUC was 0.848 (95% CI, 0.742– 0.955, P = 0.001) for UAPI with sensitivity of 80%, specificity 74% at cut off value ≤ 0.735, AUC was 0.758 (95% CI, 0.566 - 0.951, P = 0.016) for Inhibin-A with a sensitivity of 75%, specificity of 80% at cut off value of ≥ 832.5 pg/ml and finally AUC was 0.652 (95% CI, 0.447 – 0.858 and P = 0.165) for PLGF with a sensitivity of 74% and specificity of 50% at cut off value of ≤ 205 pg/ml. Conclusion: second-trimester uterine artery Doppler indices, serum Inhibin-A and PLGF and may be helpful as a predicting markers for preeclampsia. Key words: Inhibin-A, placental growth factor, Doppler indices, uterine artery, Preeclampsia.

O23. STEPS (Study of Early Preeclampsia in Spain): sFlt-1/PlGF for the prediction of early-onset preeclampsia in singleton pregnancies

Introduction The soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio is CE-mark approved for short-term prediction of preeclampsia in women with clinical suspicion of the syndrome (gestational age 24weeks+0d–36weeks+6d). Objectives We evaluated sFlt-1/PlGF as a predictive marker for early-onset preeclampsia in women at high risk of preeclampsia. Methods STEPS (prospective/multicenter) included pregnant women with preeclampsia risk factors (including history of IUGR/preeclampsia/eclampsia/HELLP syndrome, pre-gestational diabetes, antiphospholipid antibodies, and abnormal uterine artery Doppler). Primary objective: to show that sFlt-1/PlGF was predictive of early-onset preeclampsia ( ® sFlt-1 and PlGF assays, cobas electrochemiluminescence platform, Roche Diagnostics, Germany); bilateral uterine artery Doppler; blood pressure/proteinuria/preeclampsia status assessment. Results were compared by ANOVA/Dunnet and Wilcoxon signed-rank test. For prediction of early-onset preeclampsia, the area under the curve (AUC) of receiver operating characteristic curves (ROC) was calculated. Singleton pregnancies are reported. Results 819 subjects were enrolled. Of 442 women with singleton pregnancies 42 (9.5%) developed preeclampsia (14 early-onset/28 late-onset). The mean (SD) sFlt-1/PlGF ratio at 20, 24, and 28 weeks was: 7.86 (8.61), 5.9 (12.38) and 4.59 (5.65) for subjects who did not develop preeclampsia (control); 53.15 (61.79), 69.25 (105.53) and 180.37 (241.83) for early-onset preeclampsia; and 7.81 (4.45), 5.09 (3.34) and 13.39 (34.52) for late-onset preeclampsia. Compared with early-onset preeclampsia the sFlt-1/PlGF ratio was significantly lower for control, chronic hypertension, transient hypertension, and late-onset preeclampsia (Figure). Prediction of early-onset preeclampsia (ROC AUC [95% CI]) was best for sFlt-1/PlGF plus clinical data (0.94 [0.90–0.98], 0.94 [0.89–1.0], 0.94 [0.86–1.0], at 20, 24 and 28 weeks) vs sFlt-1/PlGF alone (0.78 [0.62–0.95], 0.82 [0.65–0.98], 0.86 [0.72–1.0]) or Doppler alone (0.71 [0.56–0.86], 0.73 [0.54–0.91], 0.87 [0.74–1.0]). Conclusion The sFlt-1/PlGF ratio can improve prediction of early-onset preeclampsia for women at high risk of preeclampsia.

The outcomes and benefits of hysteroscopic procedures in women with recurrent implantation failure (RIF) after in vitro fertilization (IVF)

OBJECTIVE: Our goal is to present the first clinical pregnancy following uterus transplantation. DESIGN: Case report. MATERIALS AND METHODS: In 2011,uterus allotransplantation was performed in a patient with complete mullerian agenesis from a deceased donor.Eight embryos were vitrified before the transplantation procedure. Embryo transfer was planned following confirmation of graft stability and safe serum immunosuppressive levels. RESULTS: Immunosuppressive and infection prophylaxis therapies were started. Bilateral uterine artery doppler ultrasonography, cervical and endometrial biopsies demontrated no signs of thromboses or rejection. Starting from first month, the patient had menstrual bleeding with almost every cycle. Eighteen months after uterus allotransplantation and confirmation of the graft stability, one thawed embryo was transferred to the allotransplanted uterus. Serum human chorionic gonadotrophin levels and transvaginal ultrasonography confirmed a viable intrauterine pregnancy. CONCLUSION: Experimental animal and human research are promising to show allo uterus transplantation might be an alternative for fertility restoration.

First Trimester Maternal Serum PlGF, Free β-hCG, PAPP-A, PP-13, Uterine Artery Doppler and Maternal History for the Prediction of Preeclampsia

Routine screening of pregnant women for risk factors for preeclampsia (PE) is recommended. However, the detection rate using only maternal history is poor. In a study published in the mid-90’s, use of bilateral uterine artery Doppler (UtA Doppler) velocimetry for screening had high sensitivity, but poor specificity. Data from recent studies suggest that a better approach for PE screening includes integration of UtA Doppler with both maternal history and biochemical serum markers that have been associated with placental and endothelial dysfunction. However, the additive value of placental biomarkers measured during the first trimester to predict which women will subsequently develop PE has not been established. This prospective cohort study was designed to estimate the ability of a model based on integration of maternal history, serum biomarkers, and UtA Doppler in the first trimester to predict hypertensive disorders of pregnancy. Information was obtained on maternal history, UtA Doppler, and for 4 serum biomarkers, PAPP-A, placental growth factor (PlGF), PP-13 and free β human chorionic gonadotropin (β-hCG). Two PE predictive models were developed for outcomes of gestational hypertension, PE, early-onset PE, and late-onset PE. With the first model, multivariate analysis included all maternal variables and markers—those that were statistically significant as well as those that were not. The second model was performed following a stepwise backward logistic regression and included only statistically significant factors (P < 0.05). For both models, sensitivity was calculated for fixed false-positive rates (FPRs) of 5%, 10%, 15%, and 20% from the receiver operating characteristic curves. Of the 2118 women included in the analysis, 46 (2.2%) developed gestational hypertension, and 25 (1.2%) developed PE, including 12 (0.6%) with early-onset PE and 13 (0.6%) with late-onset PE. The detection rates for early-onset PE using serum PlGF, free β-hCG, and chronic hypertension as predictors of early-onset PE for a fixed FPR of 10% and 5% were 75% and 67%, respectively. Using the same PE predictive model, the combination of UtA pulsatility index (PI) with PlGF and chronic hypertension reached a sensitivity of 60% but with a 20% FPR. These findings suggest that integration of maternal characteristics and first-trimester maternal serum biomarkers (free β-hCG and PlGF) may provide a useful screening test for early-onset PE. Although UtA PI is statistically significant in the overall PE model, it does not improve the detection rate of early-onset PE.

Comparison of uterine artery Doppler in pregnant women with thrombophilia treated by LMWHs and without thrombophilia

The aim of this study was to use uterine artery Doppler ultrasonography to investigate the cases of women with thrombophilia who used LMWH during the 18-22-week period of gestation. This retrospective study was conducted at our university between January 2005 and July 2010. 64 patients were treated with low-dose LMWHs (enoxaparine 40mg) from the beginning of pregnancy until 36weeks of gestation. Fifty control subjects were also included in this study. Transabdominal ultrasound examination and bilateral uterine artery Doppler measurements pulsatility index (PI), resistive index (RI), and systole/diastole measurement (S/D) were performed during the 18-22-weeks period of gestation. No significant differences were found between the groups with respect to maternal age or gestational age at the time of uterine artery Doppler. However, the mean PI (1.07±0.46 for LMWH group and 0.91±0.31 for control, p=0.036) and the mean RI (0.59±0.12 for LMWH group and 0.54±0.10 for control, p=0.021) were significantly higher in the trombophilia group. Women with trombophilia still have an increased mean PI and RI, as determined by uterine artery Doppler ultrasonography during the 18-22-week period of gestation, even if they use LMWH.

First-trimester serum analytes, biophysical tests and the association with pathological morphometry in the placenta of pregnancies with preeclampsia and fetal growth restriction

Objective We test the hypothesis that first-trimester serum analytes, 4-D power Doppler placental vascular indices and uterine artery Doppler (UAD) predicts abnormal placental morphometry in pregnancies with preeclampsia (PE) and fetal growth restriction (FGR). Study design Maternal serum analytes (PAPP-A, hCG, ADAM12s, and PP13), bilateral UADs, and placental vascular indices were measured at 11–14 weeks in a nested-case control study within a prospective cohort of women followed from the first-trimester to delivery. Vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were obtained from 4-D power Doppler histograms. Serum analytes were measured using immunofluorometric assays and values converted to multiples of the median (MoM) for gestational age. Morphometric analysis was performed on placentas from pregnancies complicated by PE ( n = 13), gestational hypertension (HBP, n = 7) and FGR (defined as fetal weight <10th percentile with abnormal umbilical artery Doppler: n = 7); and 20 uncomplicated pregnancies. Two pregnancies had both FGR and PE. Each placenta was weighed and random samples taken, and fixed in formalin within 1 h of delivery. Hematoxylin & Eosin stained slides were analyzed by design-based stereology to quantify linear dimensions, surface areas and volumes of placental components. Paired t-test and ANOVA with adjustments for multiple comparisons were used. Results The surface areas of terminal and intermediate villi as well as the volume of terminal villi were significantly smaller in placentas from pregnancies complicated by FGR and PE. Compared with the control group the mean PAPP-A (MoM) was lower in the pregnancies with abnormal placenta morphometry (1.1 ± 0.5 versus 0.7 ± 0.5, P = 0.03). The morphometric indices were lower in those pregnancies with low PAPP-A and IUGR compared with preeclampsia. Conclusion First-trimester PAPP-A levels are associated with abnormal placental morphometry at delivery in pregnancies with PE and IUGR. These findings may explain the association between adverse pregnancy outcomes and first-trimester PAPP-A.

Sclérodermie et grossesse

Pregnancy in women diagnosed with systemic sclerosis is an infrequent situation with a generally favourable outcome according to the most recent studies. Women with systemic sclerosis who wish to become pregnant should obtain preconception counselling in order to withdraw teratogenic drugs and to carefully assess the disease activity. Severe organ impairment, early diffuse systemic sclerosis and pulmonary hypertension ought to discourage patients from pregnancy, as these situations are at high risk of complications for both mother and fetus during pregnancy and puerperium. During pregnancy, the most frequent maternal complication is worsening of gastroesophageal reflux, and the most severe complications are renal crisis and flaring arterial pulmonary hypertension. Angiotensin converting enzyme inhibitors are indicated at any stage of the pregnancy if renal crisis is suspected. Adverse obstetric outcomes are dominated by prematurity which may be the consequence of intra-uterine growth restriction or preeclampsia. Those complications might account for systemic sclerosis-associated vasculopathy, or for the presence of antiphospholipid antibodies. Patients with a previous history of placental insufficiency might benefit from treatment with aspirin, low dose anticoagulants or even nitric oxide donors. During the pregnancy, abnormal bilateral uterine artery Doppler is a predictor of vascular insufficiency and might guide initiation of further preventive treatments. Multicentric prospective cohort studies are warranted to identify more precisely the predictors of pregnancy-related complications and to define the best management of these patients.

OP14.11: Bilateral uterine artery notching in the first trimester is associated with a small risk for IUGR among patients treated with low dose aspirin

Assess whether bilateral uterine artery notching in the first trimester is associated with an increased risk for IUGR among patients directed to take low dose aspirin. A retrospective database search was conducted for Jan. 1, 2007—Sept. 2008 to identify all patients with first trimester screening exams in our practice with bilateral uterine artery Doppler notching identified and for whom additional follow up was provided. When bilateral uterine artery notching was identified, low dose aspirin was recommended unless contraindicated. Patients were seen for second trimester and third trimester ultrasound assessments where indicated. IUGR was defined as EFW < 10th percentile (Hadlock 1991) or abdominal circumference less than 5th percentile. A total of 67 singleton gestations were identified with the finding of bilateral uterine artery notching at less than 15 weeks gestation. 53 patients met inclusion criteria (no other maternal factors, second trimester follow up exam in our office). Of those 14 excluded, 10 did not have a second trimester follow up in our office, and the other 4 had historical factors (APAS, severe first trimester oligohydramnios, hypothyroidism). Of the 53, 25 had been referred for first trimester screening with AMA. 28 were referred for first trimester screening (less than 35 years of age). Only 15 of 53 still had bilateral notching on second trimester exam, while 11 had unilateral notching. The rate of third trimester IUGR with either unilateral or bilateral notching remaining was 4% (1 of 26, case with abdominal circumference less than 5th). The finding of bilateral uterine artery notching on first trimester screening examination was associated with a small risk for IUGR among a cohort of women advised to take low dose aspirin. Only 20% still had notching in the second trimester, of which 4% developed third trimester IUGR.

Clinical significance of uterine artery blood flow velocity waveforms during provoked uterine contractions in high-risk pregnancy.

To determine whether, in a group of high-risk pregnancies undergoing an oxytocin challenge test (OCT), uterine artery Doppler velocimetry will identify fetuses at risk of distress during the provoked contractions. Bilateral uterine artery Doppler velocimetry was performed simultaneously with electronic fetal heart rate (FHR) recordings in 67 high-risk pregnancies subjected to an OCT. Flow velocity waveforms (FVWs) were classified according to pulsatility index (PI), presence of diastolic notching and a novel classification of FVW shapes. The OCT was classified as negative (normal) or positive (late FHR decelerations). Only OCT-negative cases were allowed a trial of vaginal delivery. Non-parametric statistical methods were used to test for differences between the OCT groups. There was no difference in prevalence of high PI or diastolic notching in OCT-positive (n = 10) and OCT-negative (n = 57) cases at basal (resting) measurements or between uterine contractions in either uterine artery (P > or = 0.3). During contractions the PI could not be used for assessment due to the biphasic shape of the FVWs, but there was no difference in distribution of FVW classes between the groups in either the placental side (P > or = 0.3) or contraplacental side (P > or = 0.6) uterine artery. No significant associations between PI or FVW class distribution and birth asphyxia or operative delivery for fetal distress in labor were found (P > or = 0.1). During uterine contractions there is no difference in uterine artery FVW pattern between OCT-positive and OCT-negative cases. Recording of uterine artery FVWs during the OCT seems to be of limited clinical relevance.

P016: Bilateral uterine artery Doppler during the first trimester scan: Is it really useful in prediction of preeclampsia in a low risk population?

P016: Bilateral uterine artery Doppler during the first trimester scan: Is it really useful in prediction of preeclampsia in a low risk population?