Uterine Artery Doppler Velocimetry Research Articles

Comment on “First trimester uterine artery Doppler velocimetry in the prediction of birth weight in a low‐risk population”

Comment on “First trimester uterine artery Doppler velocimetry in the prediction of birth weight in a low‐risk population”

OC20.06: Usefulness of uterine artery Doppler velocimetry in diagnosing placenta accreta in placenta previa patients

<scp>OC</scp>20.06: Usefulness of uterine artery Doppler velocimetry in diagnosing placenta accreta in placenta previa patients

Postpartum uterine artery Doppler velocimetry among patients following a delivery complicated with preeclampsia

Objective: To evaluate postpartum uterine artery (UtA) velocimetry in patients following severe preeclampsia (PET) as compared with normotensive controls. Study Design: Postpartum UtA velocimetry was obtained prospectively during the early postpartum period. The right and left UtA pulsatility index (PI) was measured and the presence of an early diastolic notch was noted. For categorical variables, the χ2 test or Fisher exact was used as appropriate and for continuous variables the t-test was used. The p value <0.05 was considered statistically significant. Results: Thirty-one patients following severe PET and 52 normotensive controls were included in the study. Following severe PET, higher rates of intrauterine growth restriction, cesarean delivery, preterm delivery and accordingly lower neonatal birth weight were noted. Postpartum UtA velocimetry measurements were performed on average 51.2 h after delivery (range 8–169). Right and left UtA PI was comparable between patients following severe PET and controls. The presence of unilateral and bilateral early diastolic notches were significantly higher in patients following severe PET. Conclusions: The pathophysiology of uterine involution and the physiologic return of the uterine arteries to the non-pregnant state may be different following severe PET.

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.

Maternal plasma concentrations of sST2 and angiogenic/anti-angiogenic factors in preeclampsia

Objectives: Angiogenic/anti-angiogenic factors have emerged as one of the promising biomarkers for the prediction of preeclampsia. Since not all patients with preeclampsia can be identified by these analytes, the search for additional biomarkers continues. The soluble form of ST2 (sST2), a protein capable of binding to interleukin (IL)-33 and thus contributing to a Th1-biased immune response, has been reported to be elevated in maternal plasma of women with preeclampsia. The aims of this study were to examine: (1) differences in maternal plasma concentrations of sST2 and IL-33 between women diagnosed with preeclampsia and those having uncomplicated pregnancies; (2) the relationship between sST2, umbilical and uterine artery Doppler velocimetry, and the severity of preeclampsia; and (3) the performance of sST2 and angiogenic/anti-angiogenic factors in identifying patients with preeclampsia at the time of diagnosis.Methods: This cross-sectional study included women with preeclampsia (n = 106) and women with an uncomplicated pregnancy (n = 131). Plasma concentrations of sST2, IL-33, soluble vascular endothelial growth factor receptor (sVEGFR)-1, soluble endoglin (sEng) and placental growth factor (PlGF) were determined by enzyme linked immune sorbent assay. Area under the receiver operating characteristic curve (AUC) for the identification of preeclampsia was examined for each analyte.Results: (1) Patients with preeclampsia had a higher mean plasma concentrations of sST2 than those with an uncomplicated pregnancy (p < 0.0001), while no significant difference in the mean plasma concentration of IL-33 between the two groups was observed; (2) the magnitude of this difference was greater in early-onset, compared to late-onset disease, and in severe compared to mild preeclampsia; (3) sST2 plasma concentrations did not correlate with the results of uterine or umbilical artery Doppler velocimetry (p = 0.7 and p = 1, respectively) among women with preeclampsia; (4) sST2 correlated positively with plasma concentrations of sVEGFR1-1 and sEng (Spearman’s Rho = 0.72 and 0.63; each p < 0.0001), and negatively with PlGF (Spearman’s Rho = −0.56, p < 0.0001); and (5) while the AUC achieved by sST2 and angiogenic/anti-angiogenic factors in identifying women with preeclampsia at the time of diagnosis were non-significantly different prior to term (<37 weeks of gestation), thereafter the AUC achieved by sST2 was significantly less than that achieved by angiogenic/anti-angiogenic factors.Conclusions: Preeclampsia is associated with increased maternal plasma concentrations of sST2. The findings that sST2 concentrations do not correlate with uterine or umbilical artery Doppler velocimetry in women with preeclampsia suggest that elevated maternal plasma sST2 concentrations in preeclampsia are not related to the increased impedance to flow in the utero-placental circulation. The performance of sST2 in identifying preeclampsia at the time of diagnosis prior to 37 weeks of gestation was comparable to that of angiogenic/anti-angiogenic factors. It remains to be elucidated if an elevation of maternal plasma sST2 concentrations in pregnancy is specific to preeclampsia.

Interleucina 6 plasmática y velocimetría doppler de las arterias uterinas en preeclámpsicas y embarazadas normotensas sanas

ObjectiveTo determine interleukin-6 concentrations and analyse their relationship with doppler velocimetry in patients with preeclampsia and healthy normotensive pregnant women. Material and methodsA total of 160 patients were selected, of whom 47 were patients with severe preeclampsia (group A), 33 with mild preeclampsia (group B), and 80 healthy pregnant women with ages similar to patients in the two study groups selected as controls (group C). Blood samples for interleukin-6 and measurements of pulsatility index, resistance index and systolic/diastolic blood flow ratio of uterine arteries were performed before labour on all patients, and immediately after diagnosis in the preeclampsia groups. ResultsPatients in groups A and B (preeclampsia) had higher interleukin-6 concentrations than group C (P<.05). Measurements of pulsatility index, resistance index and systolic/diastolic blood flow ratio of uterine arteries were higher in both groups of preeclampsia patients (P<.05). There was a significant relationship between the plasma interleukin-6 concentrations and all three evaluated doppler velocimetry parameters (P<.05). ConclusionPreeclampsia patients had higher plasma interleukin-6 concentrations than normotensive pregnant women, and there was a significant correlation between plasma concentrations and parameters of doppler velocimetry of uterine arteries.

Maternal plasma concentrations of angiogenic/antiangiogenic factors in the third trimester of pregnancy to identify the patient at risk for stillbirth at or near term and severe late preeclampsia

To determine whether maternal plasma concentrations of placental growth factor (PlGF), soluble endoglin (sEng), and soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) at 30-34 weeks of gestation can identify patients at risk for stillbirth, late preeclampsia, and delivery of small-for-gestational-age (SGA) neonates. A prospective cohort study included 1269 singleton pregnant women from whom blood samples were obtained at 30-34 weeks of gestation and who delivered at >34 weeks of gestation. Plasma concentrations of PlGF, sEng, and sVEGFR-1 were determined by enzyme-linked immunosorbent assay. The prevalence of late (>34 weeks of gestation) preeclampsia, severe late preeclampsia, stillbirth, and SGA was 3.2% (n = 40), 1.8% (n = 23), 0.4% (n = 5), and 8.5% (n = 108), respectively. A plasma concentration of PlGF/sEng <0.3 MoM was associated with severe late preeclampsia (adjusted odds ratio, 16); the addition of PlGF/sEng to clinical risk factors increased the area under the receiver-operating characteristic curve from 0.76 to 0.88 (P = .03). The ratio of PlGF/sEng or PlGF/sVEGFR-1 in the third trimester outperformed those obtained in the first or second trimester and uterine artery Doppler velocimetry at 20-25 weeks of gestation for the prediction of severe late preeclampsia (comparison of areas under the receiver-operating characteristic curve; each P ≤ .02). Both PlGF/sEng and PlGF/sVEGFR-1 ratios achieved a sensitivity of 74% with a fixed false-positive rate of 15% for the identification of severe late preeclampsia. A plasma concentration of PlGF/sVEGFR-1 <0.12 MoM at 30-34 weeks of gestation had a sensitivity of 80%, a specificity of 94%, and a likelihood ratio of a positive test of 14 for the identification of subsequent stillbirth. Similar findings (sensitivity 80%; specificity 93%) were observed in a separate case-control study. Risk assessment for stillbirth and severe late preeclampsia in the third trimester is possible with the determination of maternal plasma concentrations of angiogenic and antiangiogenic factors at 30-34 weeks of gestation.

Hypertensive syndrome in pregnacy: How to predict

Preeclampsia complicates about 5% of all pregnancies worldwide. It is a major cause of maternal, fetal and neonatal morbidity and mortality. The aim of this systematic review was to study the literature on the predictive potential of screening for preeclampsia based on serum markers and uterine artery Doppler velocity waveform assessment. First-trimester uterine artery Doppler can identify over half of women who will develop preeclampsia. Detection rates may be increased by a combination with maternal serum markers. In screening for early preeclampsia, the detection rate for a 10% falsepositive rate was 96.3% for a combination of maternal factors, soluble endoglin, placental growth factor and uterine artery lowest Pulsatility Index. First trimester placental protein 13 predicts preeclampsia in women at increased a priori risk and predicts early-onset better than late-onset disease. The Fetal Medicine Foundation has released in 2009 the new software to allow calculation of risks for preeclampsia and gestational hypertension. Uterine artery Doppler velocimetry in combination with some biochemical markers seems to be an effective first-trimester screening tool for preeclampsia and in particular early-onset preeclampsia.

Predicting Pre-Eclampsia &amp; Fetal Growth Restriction through Second Trimester Uterine Artery Doppler Sonography: An Indian experience

7,8 . The performance of uterine artery Doppler velocimetry as a screening test seems to depend on the prevalence of the adverse outcome in the studied population and whether the adverse outcomes are assessed individually or collectively. In the light of these controversies and conflicting recommendations, there seems to be a need for more data from properly designed research studies. There is also a need to clarify the specific parameters measured in the Doppler procedure in order that the predictions can be simpler for use in common practice by obstetricians. Further, most studies are done in developed countries and there are hardly any studies examining Doppler ultrasonography critically in developing world such as in India, where pre-eclampsia and fetal growth restrictions are quite common. In this paper, experiences in the use of Doppler during the second trimester of women attending a multispecialty hospital in the outskirts of Bangalore city in Karnataka state, India, are presented with a brief discussion on future research ideas.

First‐trimester uterine artery Doppler velocimetry in the prediction of birth weight in a low‐risk population

To study the relationship between first-trimester uterine artery (UtA) Doppler velocimetry and birth weight in an unselected, low-risk obstetric population. This is a prospective study of 415 low-risk pregnant women who underwent a first-trimester ultrasound evaluation between 11 and 13 weeks of gestation. Blood flow velocimetry waveforms from both UtAs were obtained and the pulsatility index (PI) measured and recorded. Clinical records were reviewed for pregnancy outcomes. Birth weight was expressed as z-scores, and the Spearman correlation coefficient (ρ) was used to calculate the relationship between the mean, delta, and lowest UtA PI values and birth weight. There was no correlation between the mean and delta UtA PI values and birth weight. However, a significant correlation between the lowest UtA PI value and birth weight (ρ = -0.121; p = 0.013) was noted. Our study found a clinically significant correlation between the lowest UtA PI value and birth weight in an unselected, low-risk pregnant population. Because fetal growth is a multifactorial process in which placentation is only one of the factors involved, the use of a single parameter such as Doppler velocimetry remote from the delivery to predict birth weight in a low-risk population seems to be less useful than in the high-risk population.

Aspirin in the prevention of pre‐eclampsia in high‐risk women: a randomised placebo‐controlled PREDO Trial and a meta‐analysis of randomised trials

To study the effect of aspirin in the prevention of pre-eclampsia in high-risk women. Randomised, double-blinded, placebo-controlled trial. Maternity clinics in ten Finnish hospitals participating in the PREDO Project. A total of 152 women with risk factors for pre-eclampsia and abnormal uterine artery Doppler velocimetry. Participants were randomised to start either aspirin 100 mg/day or placebo at 12 + 0 to 13 + 6 weeks + days of gestation. Because of the limited power of this trial, we also conducted a meta-analysis of randomised controlled trials that included data on 346 women with abnormal uterine artery Doppler flow velocimetry, and aspirin 50-150 mg/day started at or before 16( ) weeks of gestation. Pre-eclampsia, gestational hypertension and birthweight standard deviation (SD) score. Outcome measures for the meta-analysis were pre-eclampsia, severe pre-eclampsia, preterm (diagnosed <37 + 0 weeks of gestation) and term pre-eclampsia. From the 152 randomised women, 121 were included in the final analysis. Low-dose aspirin did not reduce the rate of pre-eclampsia (relative risk [RR] 0.7, 95% CI 0.3-1.7); gestational hypertension (RR 1.6, 95% CI 0.6-4.2); early-onset pre-eclampsia (diagnosed <34 + 0 weeks of gestation) (RR 0.2, 95% CI 0.03-2.1); or severe pre-eclampsia (RR 0.4, 95% CI 0.1-1.3); and the results were not statistically significant in an intention-to-treat analysis. However, our meta-analysis, including the current data, suggested that low-dose aspirin initiated before 16 weeks of gestation reduces the risk of pre-eclampsia (RR 0.6, 95% CI 0.4-0.8) and severe pre-eclampsia (RR 0.3, 95% CI 0.1-0.7). Our trial showed no statistically significant effect of aspirin in preventing pre-eclampsia in high-risk women. However, our meta-analysis suggested that aspirin may reduce the incidence of pre-eclampsia.

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.

The Utility of Uterine Artery Doppler Velocimetry in Prediction of Preeclampsia in a Low-Risk Population

The underlying pathophysiology of preeclampsia is thought to be abnormal trophoblast invasion of the spiral arteries leading to maldevelopment of uteroplacental perfusion. We estimated whether uterine artery Doppler measurements made in the early second trimester would predict the subsequent development of preeclampsia. Uterine artery Doppler measurements before 21 weeks of gestation (median 16.6 weeks) were correlated with subsequent development of preeclampsia in a cohort of 2,188 low-risk nulliparous women in a randomized control trial of antioxidant supplementation for prevention of preeclampsia. Preeclampsia developed in 165 (7.5%) women. Development of preeclampsia overall was associated with increased resistance index, pulsatility index, a pulsatility index or resistance index multiple of the median at or above the 75th percentile but not the presence of a notch or a bilateral notch before 21 weeks of gestation. The sensitivity was 43% (95% confidence interval [CI] 35-51) and specificity 67% (95% CI 65-69) for prediction of preeclampsia overall. The presence of a notch or bilateral notch, resistance index, and pulsatility index multiple of the median was significantly associated with early onset (before 34 weeks of gestation) compared with late onset or no preeclampsia (odds ratio [OR] 6.9, 95% CI 2.3-20.9; sensitivity 78%, 95% CI 52-94; specificity 66%, 95% CI 64-68). The presence of a notch or resistance index multiple of the median at or above the 75th percentile increased the odds of developing severe compared with mild or no preeclampsia (OR 2.2, 95% CI 1.4-3.7; sensitivity 53%, 95% CI 40-65; specificity 66%, 95% CI 64-68). Our data show poor sensitivity of second-trimester Doppler ultrasound measurements for prediction of preeclampsia overall in a well-characterized, low-risk, nulliparous population. The technique has utility in identifying poor trophoblast invasion of spiral arteries of a magnitude that severely compromises uteroplacental blood flow and gives early-onset disease. II.

Uterine artery Doppler velocimetry and obstetric outcomes in connective tissue diseases diagnosed during the first trimester of pregnancy

To evaluate the effect of connective tissue disease (CTD) diagnosed during the first trimester on uterine arteries (UtA) Doppler velocities and on pregnancy outcomes. Pregnant women were screened for CTDs during the first trimester, using a questionnaire, testing for autoantibodies, rheumatologic examination and UtA Doppler evaluations. Out of 3932 women screened, 491 (12.5%) were screened positive at the questionnaire; of them, 165(33.6%) tested positive for autoantibodies, including 66 eventually diagnosed with undifferentiated connective tissue disease (UCTD), 28 with a definite CTD and 71 with insufficient criteria for a diagnosis. Controls were 326 women screened negative for autoantibodies. In logistic analysis, women diagnosed with either UCTD (OR = 7.9, 95% CI = 2.3-27.3) or overt CTD (OR = 24.9, 95% CI = 6.7-92.4), had increased rates of first trimester bilateral UtA notches compared with controls. The rates of bilateral UtA notches persisting in the second (15/94 vs 0/326, p < 0.001) and third trimesters (7/94 vs 0/326, p < .001) were higher among women with CTDs than in controls. The risk of complications (preeclampsia, fetal growth restriction, prematurity, diabetes, fetal loss) was higher (OR = 7.8, 95% CI = 3.6-17.0) among women with CTDs than in controls. Women with undiagnosed CTDs have higher rates of bilateral UtA Doppler notches throughout pregnancy and increased rates of adverse pregnancy outcomes than controls.

OP09.10: Early postpartum uterine artery Doppler velocimetry among patients with severe pre‐eclampsia compared to normotensive controls

OP09.10: Early postpartum uterine artery Doppler velocimetry among patients with severe pre‐eclampsia compared to normotensive controls

Comparison of two different sites of measurement for transabdominal uterine artery Doppler velocimetry at 11–13 weeks

To compare the feasibility of two transabdominal approaches for performing first-trimester uterine artery (UtA) Doppler and to evaluate the correlation with pulsatility index (PI) in the second trimester. This was a prospective longitudinal Doppler study of the uterine arteries at 11-13 and 21-22 weeks' gestation. Transabdominal ultrasound and color Doppler were used to measure the UtA-PI of the ascending branch of the uterine artery at the level of the internal cervical os (Site A) and at the level of the apparent crossover with the external iliac artery (Site B) at 11-13 weeks, and at Site B only at 21-22 weeks. In all cases the measured left and right PI were converted to a multiple of the median (MoM) for gestational age, and the intercorrelation between the measurements at different sites and gestational ages was calculated using non-parametric analysis (Spearman's rank correlation). Satisfactory measurements were obtained at 11-13 weeks from both uterine arteries in all 81 women at Site A and in 50 (62%; 95% CI, 50-72%) at Site B (P < 0.01). Measurements were obtained at Site B at 21-22 weeks in all cases. In the 50 cases with measurements from both sites at 11-13 weeks, the correlation of PI-MoMs between Sites A and B at 11-13 weeks was only moderate (ρ = 0.61). The correlation between first-trimester UtA-PI MoMs at Site A and second-trimester UtA-PI MoMs was stronger than that between first-trimester UtA-PI MoMs at Site B and second-trimester UtA-PI MoMs (ρ = 0.73 vs ρ = 0.47, P < 0.01). Evaluation of UtA-PI at 11-13 weeks can be achieved at the level of the internal cervical os in a greater proportion of women than at the level of the apparent crossover with the external iliac vessels, and the measurements obtained correlate better with second-trimester UtA-PI.

Prediction of Preeclampsia by Midtrimester Uterine Artery Doppler Velocimetry in High-Risk and Low-Risk Women

To observe the role of uterine artery Doppler flow velocimetry at midtrimester in prediction of preeclampsia. 179 women carrying <16weeks of pregnancy, with singleton fetus and without any fetal anomaly were recruited and were divided in high-risk and low-risk group. Doppler velocimetry of uterine artery was done at 24-26weeks. Any notch in uterine artery, unilateral or bilateral, or RI>0.6, was considered abnormal. Women were followed up and development of preeclampsia noted. Sensitivity and specificity of abnormal uterine artery Doppler study for prediction of preeclampsia were 73.33 and 86.48% in high-risk and 57.14 and 95.83% in low-risk group, respectively. Relative risk with 95% confidence interval was 5.427 (2.272-12.958) in high-risk and 13.65 (5.669-32.865) in low-risk women. Doppler velocimetry of uterine artery at 24weeks can be used as a reliable screening test for prediction of preeclampsia in both high-risk and low-risk women.

Combination of uterine artery Doppler velocimetry and maternal serum placental growth factor estimation in predicting occurrence of pre-eclampsia in early second trimester pregnancy: a prospective cohort study

To determine the effectiveness of the combined use of uterine artery Doppler velocimetry (UADV) and estimation of maternal serum placental growth factor (PlGF) levels in early second trimester (20-22 weeks of gestation) in identifying pregnant women at risk of developing pre-eclampsia. Prospective cohort study on 1104 pregnant women with singleton pregnancies between May 2009 and December 2010. UADV and maternal serum PlGF estimation were done at 20-22 weeks' gestation. Association between the two variables and the occurrence of pre-eclampsia was analyzed by logistic regression analysis and odds ratio was computed. The results were considered significant when p was <0.05. Logistic regression analysis showed that both abnormal UADV (odds ratio (OR) 4.1; 95% CI 2.3-7.2; p=0.000) and serum PlGF<188pg/ml (OR 3.6; 95% CI 1.95-6.5; p=0.000) are independent variables in the occurrence of pre-eclampsia, and the difference between the association of these two variables with pre-eclampsia was statistically insignificant as 95% CI values overlap. Multivariate logistic regression analysis showed that a combination of abnormal UADV and serum PlGF<188pg/ml at 20-22 weeks had a very poor association (OR 1.1; 95% CI 0.3-3.8; p=0.938) with the occurrence of pre-eclampsia, as the 95% CI values encompass 1 and p is >0.05. UADV and maternal serum PlGF estimation at 20-22 weeks of gestation are strong predictors of the occurrence of pre-eclampsia when used individually but in combination their association with pre-eclampsia is not significant.

Comparative Study of Endothelial Function and Uterine Artery Doppler Velocimetry between Pregnant Women with or without Preeclampsia Development.

Background. Poor placentation and systemic endothelial dysfunction have been identified as main events in Preeclampsia (PE). The relationship and chronology of these phenomena are important if we are to understand the pathophysiological mechanisms underlying this major clinical problem. Objectives. To compare the evolution of placentation and endothelial function in normotensive and preeclamptic pregnancies. Patients and methods. In a prospective cohort study, 59 pregnant women with a high risk of developing PE were subjected to flow-mediated dilation (FMD) and to Doppler velocimetry of uterine arteries in order to obtain their Pulsatility Index (UtA-PI). The variations in the FMD and UtA-PI values, between 16+0 and 19+6 and 24+0 and 27+6 weeks of gestation, were compared, taking PE development into consideration. Results. Nine patients developed PE and the other 50 women remained normotensive. At 16+0 to 19+6 weeks of pregnancy, patients that developed PE presented higher values of UtA-PI than the normotensive group, but there was no difference in FMD results between them. At 24+0 to 27+6 weeks, the patients that developed PE presented higher values of UtA-PI and lower values of FMD than the women that remained normotensive. Conclusions. These results corroborate the evidence that endothelial injury is secondary to poor placentation.

The Utility of Uterine Artery Doppler Velocimetry in Prediction of Preeclampsia in a Low-Risk Population:

The Utility of Uterine Artery Doppler Velocimetry in Prediction of Preeclampsia in a Low-Risk Population: