Maternal Ophthalmic Artery Doppler Research Articles

Preeclampsia Management and Maternal Ophthalmic Artery Doppler Measurements between 19 and 23 Weeks of Gestation.

Background: The ophthalmic Doppler is a reliable and impartial way to assess the severity of preeclampsia (PE). The study aimed to assess the potential utility of Doppler measurements of the maternal ophthalmic arteries during the weeks 19-23 of gestation, both independently and in combination with established biomarkers for PE. Methods: A prospective cohort study was conducted involving women who were recruited from a variety of standard appointments, including booking, scanning, and regular prenatal visits. A total of 200 women that were divided into high-risk and low-risk groups for developing PE were involved during the period between April 2023 and November 2023. Results: The ophthalmic ratio had significantly higher values in high-risk patients than in low-risk women (p = 0.000). There was a significant relationship between PSV2/PSV1 and gestational age at birth in women with PE compared to the ones who did not develop PE. Conclusions: An ophthalmic artery Doppler can play a crucial role in the early detection of PE, allowing for timely intervention and management. Incorporating the ophthalmic artery Doppler as a screening tool for PE in Bulgaria has the potential to improve early detection, risk stratification, and overall maternal and fetal health outcomes.

Ophthalmic artery Doppler at 36 weeks' gestation in prediction of pre-eclampsia: validation and update of previous model.

To validate and extend a model incorporating maternal ophthalmic artery Doppler at 35-37 weeks' gestation in the prediction of subsequent development of pre-eclampsia (PE). This was a prospective validation study of screening for PE (defined according to the 2019 American College of Obstetricians and Gynecologists criteria) by maternal ophthalmic artery peak systolic velocity (PSV) ratio in 6746 singleton pregnancies undergoing routine care at 35 + 0 to 36 + 6 weeks' gestation (validation dataset). Additionally, the data from the validation dataset were combined with those of 2287 pregnancies that were previously used for development of the model (training dataset), and the combined data were used to update the original model parameters. The competing-risks model was used to estimate the individual patient-specific risk of delivery with PE at any time and within 3 weeks from assessment by a combination of maternal demographic characteristics and medical history with PSV ratio alone and in combination with the established PE biomarkers of mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), serum placental growth factor (PlGF) and serum soluble fms-like tyrosine kinase-1 (sFlt-1). We evaluated the predictive performance of the model by examining, first, the ability to discriminate between the PE and non-PE groups using the area under the receiver-operating-characteristics curve and the detection rate (DR) at fixed screen-positive (SPR) and false-positive rates of 10% and, second, calibration by measuring the calibration slope and calibration-in-the-large. McNemar's test was used to compare the performance of screening by a biophysical test (maternal factors, MAP, UtA-PI and PSV ratio) vs a biochemical test (maternal factors, PlGF and sFlt-1), low PlGF concentration (< 10th percentile) or high sFlt-1/PlGF concentration ratio (> 90th percentile). In the validation dataset, the performance of screening by maternal factors and PSV ratio for delivery with PE within 3 weeks and at any time after assessment was consistent with that in the training dataset, and there was good agreement between the predicted and observed incidence of PE. In the combined data from the training and validation datasets, good prediction for PE was achieved in screening by a combination of maternal factors, MAP, UtA-PI, PlGF, sFlt-1 and PSV ratio, with a DR, at a 10% SPR, of 85.0% (95% CI, 76.5-91.4%) for delivery with PE within 3 weeks and 65.7% (95% CI, 59.2-71.7%) for delivery with PE at any time after assessment. The performance of a biophysical test was superior to that of screening by low PlGF concentration or high sFlt-1/PlGF concentration ratio but not significantly different from the performance of a biochemical test combining maternal factors with PlGF and sFlt-1 for both PE within 3 weeks and PE at any time after assessment. Maternal ophthalmic artery PSV ratio at 35-37 weeks' gestation in combination with other biomarkers provides effective prediction of subsequent development of PE. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Changes in opthalmic artery doppler velocimetry in women with preeclampsia in Kano, Nigeria.

Hypertensive disorders in pregnancy are among the most serious complications of pregnancy and represent important contributors to maternal and neonatal morbidity and mortality worldwide. Preeclampsia (PE)-eclampsia syndrome is the most important hypertensive gestational condition. Maternal ophthalmic artery Doppler velocimetry enables the identification of pregnant women with increased cerebral blood flow who are at risk of developing severe PE and eclampsia. Hence the need to determine the changes in ophthalmic artery Doppler velocimetric indices in PE in Kano,Nigeria becomes paramount. Ninety-six patients with the clinical diagnosis of PE and 96 normotensive pregnant controls between 20 and 40 weeks' gestational age were recruited for this study. Ophthalmic artery Doppler velocimetric indices of the two groups were measured and documented. The mean velocimetric measurements in the control group were as follows: peak systolic velocity (PSV) = 38.04 ± 13.68 cm/s, End-diastolic volume (EDV) =9.14 ± 3.65 cm/s, resistivity index (RI) = 0.75 ± 0.091, pulsatility index (PI) =1.62 ± 0.55, peak mesodiastolic velocity (PMDV) = 21.02 ± 8.83 cm/s, peak ratio (PR) = 0.56 ± 0.14. The mean velocimetric indices in the PE group were PSV = 44.59 ± 11.54 cm/s, EDV = 12.23 ± 2.66 cm/s, RI = 0.71 ± 0.069, PI = 1.67 ± 0.42, PMDV = 32.27 ± 9.12 and PR = 0.72 ± 0.10. There is a significant difference in the ophthalmic artery Doppler velocimetric indices between women with PE and normal pregnant women. Ophthalmic artery Doppler ultrasound is a useful tool in monitoring the hemodynamic changes in cerebral circulation in PE.

Ophthalmic artery Doppler at 11-13 weeks' gestation in prediction of pre-eclampsia.

To examine the potential value of maternal ophthalmic artery Doppler at 11-13 weeks' gestation, alone and in combination with the established first-trimester biomarkers of pre-eclampsia (PE), including uterine artery pulsatility index (UtA-PI), mean arterial pressure (MAP), serum placental growth factor (PlGF) and serum pregnancy-associated plasma protein-A (PAPP-A), in the prediction of subsequent development of PE. This was a prospective observational study in women attending for a routine hospital visit at 11 + 0 to 13 + 6 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, ultrasound examination for fetal anatomy and growth, assessment of flow velocity waveforms from the maternal ophthalmic arteries and calculation of the second-to-first peak systolic velocity (PSV) ratio, and measurement of MAP and serum PAPP-A. In addition, a case-control study was carried out for measurement of PlGF in stored samples from cases that developed PE and unaffected controls. The values of PSV ratio, UtA-PI, MAP, PAPP-A and PlGF were converted to multiples of the median or deltas to remove the effects of maternal characteristics and medical history. The competing-risks model was used to estimate the individual patient-specific risk of delivery with PE at < 37 and < 41 + 3 weeks' gestation for various combinations of markers. Performance was assessed using detection rates, at a fixed false-positive rate (FPR), and areas under the receiver-operating-characteristics curves. Modeled performance was also assessed. The study population of 4066 pregnancies contained 114 (2.8%) that developed PE, including 25 (0.6%) that delivered with PE at < 37 weeks' gestation. The PSV ratio was significantly increased in PE pregnancies, and the effect of PE depended on gestational age at delivery, with the deviation from normal being greater for early than for late PE. Modeling demonstrated that the addition of PSV ratio improved the detection rate, at a 10% FPR, of preterm PE provided by maternal risk factors alone (from 46.3% to 58.4%), maternal factors, MAP and UtA-PI (65.9% to 70.6%), and maternal factors, MAP, UtA-PI and PlGF (74.6% to 76.7%). The PSV ratio did not improve the prediction of term PE provided by any combination of biomarkers. Ophthalmic artery PSV ratio at 11-13 weeks' gestation is a potentially useful biomarker for prediction of subsequent development of preterm PE, but larger studies are needed to validate this finding. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Evaluation of maternal ophthalmic artery Doppler indices and its correlation with fundoscopic changes in normotensive and pre-eclamptic pregnancies: A comparative study

Background: Preeclampsia is a multisystem disease characterized by the development of hypertension after 20 weeks of gestation in a previously normotensive woman with the presence of proteinuria, severity leading to target organ injury, including liver, kidney, heart, lungs, brain and pancreas. We evaluated the ophthalmic artery Doppler indices (PSV, EDV, PI, RI) in normotensive and in pre-eclampic pregnancies and correlated the Doppler indices changes with fundoscopic findings. Materials and methods: Orbital Ultrasonography was performed on the pregnant women who developed high blood pressure after 20 weeks of gestation and on the normal pregnant women as control and the Doppler indices of ophthalmic artery were determined. Fundoscopic examination of the patients was done with direct ophthalmoscope. Hypertensive Retinal changes observed in both eyes were taken as positive findings. Results: The study showed that PSV, RI and PI and S/D ratio were reduced in pre-eclampic patients when compared with healthy normotensive pregnant women while EDV was increased in pre-eclampic patients when compared with healthy normotensive pregnant women. Statistically significant relationship among Doppler parameters namely PSV, EDV, PI, RI, S/D values between normotensive and pre-eclampic patients was noted. Fundoscopic changes were noted among sever pre-eclampsia patients. Conclusions: Ophthalmic artery Doppler Ultrasonography can detect pre-eclampsia in early stages when compared to fundoscopy and is a cheap, noninvasive, readily available, safe, and reliable tool for evaluation of the central hemodynamic changes in normal pregnancy, and even more so in PE.

Ophthalmic artery Doppler in combination with other biomarkers in prediction of pre-eclampsia at 35-37 weeks' gestation.

To examine the potential value of maternal ophthalmic artery Doppler at 35-37 weeks' gestation in combination with the established biomarkers of pre-eclampsia (PE), including mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), serum placental growth factor (PlGF) and serum soluble fms-like tyrosine kinase-1 (sFlt-1), in the prediction of subsequent development of PE. This was a prospective observational study in women attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, ultrasound examination for fetal anatomy and growth, assessment of flow velocity waveforms from the maternal ophthalmic arteries, and measurement of MAP, UtA-PI, serum PlGF and serum sFlt-1. The competing-risks model was used to estimate the individual patient-specific risks of delivery with PE at any time and at < 3 weeks after assessment by a combination of maternal demographic characteristics and medical history with biomarkers. The area under the receiver-operating-characteristics curve and detection rate (DR) of delivery with PE, at a 10% false-positive rate (FPR), in screening by combinations of maternal factors with ophthalmic artery second to first peak of systolic velocity ratio (PSV ratio), MAP, UtA-PI, serum PlGF and serum sFlt-1 were determined. The modeled performance of screening for PE was also estimated. The study population of 2287 pregnancies contained 60 (2.6%) that developed PE, including 19 (0.8%) that delivered with PE at < 3 weeks after assessment. The PSV ratio improved the prediction of PE with delivery at any stage after assessment provided by maternal factors alone (from 25.4% to 50.6%), maternal factors and MAP (54.3% to 62.7%), maternal factors, MAP and PlGF (68.3% to 70.8%) and maternal factors, MAP, PlGF and sFlt-1 (75.7% to 76.7%), at a FPR of 10%. The PSV ratio also improved the prediction of PE with delivery at < 3 weeks after assessment provided by maternal factors alone (from 31.0% to 69.4%), maternal factors and MAP (74.1% to 83.4%), maternal factors, MAP and UtA-PI (77.1% to 85.0%) and maternal factors, MAP and PlGF (84.8% to 88.6%). The empirical results for DR at a 10% FPR were consistent with the modeled results. Screening by a combination of maternal factors with MAP and PSV ratio also detected 59.4% (95% CI, 58.6-82.5%) of cases of gestational hypertension with delivery at any stage after assessment, and 86.7% (95% CI, 82.4-100%) of those with delivery at < 3 weeks after assessment. Ophthalmic artery Doppler could potentially improve the performance of screening for PE at 35-37 weeks, especially imminent PE with delivery within 3 weeks after assessment, but further studies are needed to validate this finding. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Ophthalmic artery Doppler in combination with other biomarkers in prediction of pre-eclampsia at 19-23 weeks' gestation.

To examine the potential value of maternal ophthalmic artery Doppler at 19-23 weeks' gestation on its own and in combination with the established biomarkers of pre-eclampsia (PE), including uterine artery (UtA) pulsatility index (PI), mean arterial pressure (MAP), serum placental growth factor (PlGF) and serum soluble fms-like tyrosine kinase-1 (sFlt-1), in the prediction of subsequent development of PE. This was a prospective observational study of women attending for a routine hospital visit at 19 + 1 to 23 + 3 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, ultrasound examination for fetal anatomy and growth, assessment of flow velocity waveforms from the maternal ophthalmic arteries, and measurement of MAP, UtA-PI, serum PlGF and serum sFlt-1. Waveforms were obtained from the ophthalmic arteries in sequence from the right eye, left eye and again from the right and then left eye. We recorded the average of the four measurements, two from each eye, for the following four indices: first peak of systolic velocity; second peak of systolic velocity; PI; and the ratio of the second to first peak of systolic velocity (PSV ratio). The measurements of the four indices were standardized to remove the effects of maternal characteristics and elements from the medical history. The competing-risks model was used to estimate the individual patient-specific risks of delivery with PE at < 37 and ≥ 37 weeks' gestation and to determine the area under the receiver-operating-characteristics curve (AUC) and detection rate (DR), at a 10% false-positive rate (FPR), in screening by a combination of maternal demographic characteristics and medical history with biomarkers. The modeled performance of screening for PE was also estimated. The study population of 2853 pregnancies contained 76 (2.7%) that developed PE, including 18 (0.6%) that delivered with PE at < 37 weeks' gestation. The ophthalmic artery PSV ratio was significantly increased in PE pregnancies, and the PE effect depended on gestational age at delivery; the deviation from normal was greater for early than late PE. The second peak of systolic velocity was also increased in PE pregnancies, but the effect did not depend on gestational age at delivery. The other two ophthalmic artery indices of first peak of systolic velocity and PI were not significantly affected by PE. The PSV ratio improved the prediction of preterm PE provided by maternal factors alone (from 56.1% to 80.2%), maternal factors, MAP and UtA-PI (80.7% to 87.9%), maternal factors, MAP, UtA-PI and PlGF (85.5% to 90.3%) and maternal factors, MAP, UtA-PI, PlGF and sFlt-1 (84.9% to 89.8%), at a FPR of 10%. The PSV ratio also improved the prediction of term PE provided by maternal factors alone (from 33.8% to 46.0%), maternal factors, MAP and UtA-PI (46.6% to 54.2%), maternal factors, MAP, UtA-PI and PlGF (45.2% to 53.4%) and maternal factors, MAP, UtA-PI, PlGF and sFlt-1 (43.0% to 51.2%), at a FPR of 10%. The empirical results for DR at a 10% FPR were consistent with the modeled results. The second peak of systolic velocity did not improve the prediction of either preterm or term PE provided by maternal factors alone. Ophthalmic artery PSV ratio at 19-23 weeks' gestation, both on its own and in combination with other biomarkers, is potentially useful for prediction of subsequent development of PE, especially preterm PE, but larger studies are needed to validate this finding. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Ophthalmic artery Doppler in prediction of pre-eclampsia at 35-37 weeks' gestation.

First, to examine the potential value of maternal ophthalmic artery Doppler at 35-37 weeks' gestation in the prediction of subsequent development of pre-eclampsia (PE), and, second, to examine the variability between repeat measurements in the same eye and variability in measurements between the two eyes. This was a prospective observational study in women attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. The visit included recording of maternal demographic characteristics and medical history and assessment of flow velocity waveforms from the maternal ophthalmic artery. Waveforms were obtained in sequence from the right eye, left eye and again from the right and then left eye. We recorded the average of the four measurements, two from each eye, for the following four indices: first peak of systolic velocity; second peak of systolic velocity; pulsatility index; and the ratio of the second to first peak of systolic velocity (PSV ratio). The measurements of the four indices were standardized to remove the effects of maternal characteristics and elements from the medical history. The competing-risks model was used to determine the detection rate (DR) of delivery with PE at any time and at < 3 weeks after assessment, at a 10% false-positive rate (FPR), in screening by maternal factors alone and a combination of maternal factors and the adjusted value of each of the four ophthalmic artery indices. The study population of 2287 pregnancies contained 60 (2.6%) that developed PE, including 19 (0.8%) that delivered with PE at < 3 weeks after assessment. The DR, at 10% FPR, of delivery with PE at any time after assessment by maternal factors was 25.0% (95% CI, 14.7-37.9%), and this increased by 25 percentage points to 50.0% (95% CI, 36.8-63.2%) with the addition of the adjusted PSV ratio (P = 0.005); the respective values for delivery with PE at < 3 weeks after assessment were 31.6% (95% CI, 12.6-56.6%) and 57.9% (95% CI, 33.5-79.8%). The other ophthalmic artery indices did not improve the prediction provided by maternal factors alone. There was good correlation between the first and second measurements of PSV ratio from the same eye (right eye r = 0.823, left eye r = 0.840), but poorer correlation in the first and second measurements between the two eyes (first measurement r = 0.690, second measurement r = 0.682). In screening by maternal factors and PSV ratio for PE with delivery at any stage after assessment, the estimated DR, at 10% FPR, was 50.0% when the average of four measurements was used (two from each eye), 49.1% when the average of one measurement from each eye was used, 47.3% when the average of two measurements from the same eye was used, and 45.8% when only one measurement was used. Ophthalmic artery PSV ratio at 35-37 weeks' gestation can predict subsequent delivery with PE, especially if this occurs within 3 weeks after assessment. In the assessment of ophthalmic artery Doppler, it is necessary to use the average of one measurement from each eye to minimize variability of measurements. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Maternal ophthalmic artery Doppler ultrasonography in preeclampsia and pregnancy outcomes.

To examine the association of ophthalmic artery (OA) Doppler measure - the ratio of velocity peaks (PR) - to adverse pregnancy outcomes in preeclampsia. Prospective cohort study of 56 women with preeclampsia that underwent Doppler measurements of OA flow, medial to optic nerve. PR results were classified as normal (PR < 0.78), abnormal (PR 0.78-0.98), or highly abnormal (PR ≥ 0.99). Attending clinicians were blinded to OA Doppler results. The primary endpoints were (1) a composite of adverse maternal outcomes-central nervous system injury (eclampsia or posterior reversible encephalopathy syndrome), HELLP syndrome, hypertensive crisis, maternal admission to the intensive care unit, and maternal death-and (2) a composite of adverse perinatal outcomes-birth weight <10th percentile for gestational age, neonatal acidemia, 5-min Apgar score <7, admission of infants weighing >2500 g to the neonatal intensive care, preterm birth <32 weeks, fetal or neonatal death. Adverse maternal outcomes became more frequent as the PR values increased (p=.005). The occurrence of hypertensive crisis after hospital admission (secondary endpoint) was also positively associated with PR values (p=.001). Adverse perinatal outcomes were not associated with PR values (p=.551), but women in the highly abnormal PR group (PR ≥ 0.99) had the earliest deliveries (p=.001) and the smallest newborns (p=.004). All women in the highly abnormal PR group (n=16) had an adverse outcome. Maternal OA Doppler PR ≥ 0.99 in preeclampsia may identify women at increased risk of adverse maternal outcomes and pregnancies at the greatest risk of preterm birth.

A Study of Maternal Ophthalmic Artery Doppler Indices in Diabetics and Smokers

The aims of this study are to characterize the ophthalmic artery (OA) perfusion in smoker pregnant ladies, diabetic pregnant ladies and smoker diabetic pregnant ladies using Doppler indices and to compare with normal healthy pregnancy. The sample was divided into 4 groups: group 1 were normal healthy pregnant ladies (N=57) , group 2 were smokers pregnant ladies (N=44) ,group 3 were diabetic pregnant ladies (N=64),and group 4 were diabetic smoke pregnant ladies (N=71) ladies. All groups were examined and assessed during the pregnancy period for OA Doppler indices of both right and left eyes. The resistive index (RI), pulsatility index (PI), and mean velocity (MV) were determined. Comparisons were performed between the norms and the other three groups. Result showed significant increasing in RI,PI in the right and left eyes in all groups at p≤0.000 except in smoker pregnant ladies p≤ 0.069 , the PI decreased in the third trimester,as well the MV decreased significantly with advancing GA. A significant differences were detected between norms and the three groups at p≤0.000 In conclusion, Doppler velocimetry is an acknowledged technique for evaluation of the RI, PI, and MV in the OA. Regarding the results smoking provokes perfusion changes in ophthalmic artery in smoker pregnant ladies. Thus, there are signs of an OA vasoconstriction and hypoperfusion . OA blood flow velocity was decreased in diabetic pregnant ladies.

Second Trimester Screening of Preeclampsia Using Maternal Characteristics and Uterine and Ophthalmic Artery Doppler.

To establish the performance of a multi-parametric test including maternal risk factors and maternal uterine and ophthalmic artery Doppler in the second trimester of pregnancy for the prediction of preeclampsia (PE). We performed a prospective observational cohort study with pregnant women who underwent a second trimester morphology scan. Maternal uterine and ophthalmic artery Doppler examinations were performed in 415 singleton pregnancies between 18 and 23 weeks of gestation. Additional history was obtained through participant questionnaires, and follow-up occurred to the time of discharge post-delivery. The control and PE groups were compared to continuous variables using the Kruskal-Wallis test and to categorical variables using the Chi-square and Fisher exact tests. Univariate and multivariate logistic regression analyses were performed to determine the best model for the prediction of PE. 40 (9.6 %) pregnant women developed PE. We observed significant differences in the body mass index (BMI) (p < 0.001), parity (p < 0.001), mean arterial pressure (MAP) (p < 0.001), and pulsatility index (PI) of uterine artery Doppler (p < 0.001) between PE and control groups. The best model for the prediction of PE included maternal characteristics, MAP, maternal uterine and ophthalmic artery Doppler with area under receiver operating characteristics (ROC) curve of 0.710 (95 % confidence interval, 613 - 0.807) with a sensitivity of 45 % to a false-positive rate of 10 % and 35 % to a false-positive rate of 5 %. Maternal ophthalmic artery Doppler did not promote a significant increase in the PE detection rate during the second trimester scan.

P05.08: Second trimester maternal ophthalmic artery Doppler for prediction of pre‐eclampsia

P05.08: Second trimester maternal ophthalmic artery Doppler for prediction of pre‐eclampsia

Maternal ophthalmic artery Doppler velocimetry in pre-eclampsia in Southwestern Nigeria.

BackgroundPre-eclampsia (PE) poses a serious challenge to maternal and fetal health in Africa. It is associated with hemodynamic changes that may affect the internal carotid/ophthalmic artery circulation with consequent neuro-ophthalmic manifestations. Ophthalmic artery Doppler (OAD) ultrasound is an important tool that can be used to detect hemodynamic changes in PE and monitor its severity. In this study, we evaluated hemodynamic changes on OAD ultrasound in the ophthalmic arteries of pre-eclamptic women and compared these with values in healthy pregnant women.MethodsOAD parameters, such as, peak systolic velocity, peak diastolic velocity, end diastolic velocity, pulsatility index, and peak ratio, were measured on transorbital triplex ultrasound scan with a 7–10 MHz multifrequency linear transducer in 42 consenting pre-eclamptic patients and 41 pregnant controls matched for maternal age, gestational age, and parity at the Department of Radiology, University College Hospital, Ibadan. Univariate, bivariate, and receiver operating characteristic curve data analyses were performed. P<0.05 was considered to be statistically significant.ResultsMean resistivity index, pulsatility index, and peak systolic velocity were significantly lower in pre-eclamptic patients than in the controls. Mean peak diastolic velocity, end diastolic velocity, and peak ratio were significantly higher in the pre-eclamptic group. The receiver operating characteristic curve showed that the resistivity index (sensitivity 75%, specificity 77.8%) could distinguish mild from severe PE while the peak ratio (sensitivity 90.5%, specificity 81.3%) could accurately detect PE.ConclusionOAD ultrasound can be used to monitor patients with PE for early detection of progression to severe forms before cerebral complications develop. OAD screening of patients at high risk for PE can also detect early changes of hemodynamic derangement.

Predicting small for gestational age in the first trimester of pregnancy using maternal ophthalmic artery Doppler indices

Objective: To assess the capacity of maternal ophthalmic Doppler indices for predicting small for gestational age (SGA) newborns in the first trimester of pregnancy.Methods: We performed a prospective observational cohort study involving 499 singleton pregnancies during the first trimester scan (11–14 weeks). The following maternal ophthalmic Doppler indices were assessed: pulsatility index (PI), first diastolic peak velocity (PD1) and peak ratio (PR) = PD1/peak systolic velocity. We considered SGA all newborns with weight below 10th percentile. We used chi-square test (χ2) to compare the groups. We used area under receiver operating characteristics (ROC) curves with 95% confidence intervals (CI) and detection rate of 5% of false positive of each maternal ophthalmic Doppler index and the mean uterine artery PI for prediction SGA.Results: 27 (5.4%) patients delivered SGA newborns, 12 (2.4%) patients developed preeclampsia (PE) and delivered SGA newborns, and 460 had uneventful pregnancies (controls). We observed significant difference of PI and PR between SGA (SGA and SGA+PE) and control groups, p = 0.043 and p = 0.014, respectively. To 5% of false positive, the detection rate of SGA (SGA and SGA+PE groups) using PI, PD1 and PR were 14.8, 3.7, 14.8, 16.7, 16.7 and 16.7%, respectively. Mean uterine PI was significantly higher in the SGA+PE group (p = 0.003).Conclusion: The isolated use of maternal ophthalmic Doppler indices or in combination with uterine artery Doppler, in the first trimester of pregnancy, was not efficient to predict SGA newborns.

First‐trimester maternal ophthalmic artery Doppler analysis for prediction of pre‐eclampsia

To determine the performance of a multiparametric test comprising maternal risk factors, uterine artery Doppler and ophthalmic artery Doppler in the first trimester of pregnancy for the prediction of pre-eclampsia (PE). This prospective observational cohort study recruited patients in the first trimester of pregnancy. Maternal uterine artery and ophthalmic artery Doppler assessments were performed in 440 singleton pregnancies at 11-14 weeks of gestation. Additional history was obtained through participant questionnaires, and follow-up occurred to discharge postdelivery. The normotensive and pre-eclamptic groups were compared using parametric (Student's t-test) and non-parametric (Mann-Whitney U-test) tests. Univariable and multivariable logistic regression analyses were performed to determine which biophysical factors, and which of the factors among the maternal characteristics and medical and obstetric history, had a significant contribution to the prediction of PE in a multiparametric model. Thirty-one (7%) patients developed PE, including nine (2%) who required delivery before 34 weeks (early PE) and 22 (5%) with late PE. There were statistically significant differences in uterine artery pulsatility index (UtA-PI) and ophthalmic artery first diastolic peak (PD1) mean values between the PE and control groups. In a multiparametric model, both UtA-PI and PD1 achieved a 67% detection rate for early PE, although when combined, the detection rate only increased to 68%. The efficiency of ophthalmic artery PD1 in the first trimester as a predictive marker for the later development of PE was approximately equal to that described for uterine artery Doppler. Although these findings do not support the replacement of uterine artery Doppler analysis in multiparametric predictive models for PE, they do provide novel insights into first-trimester maternal systemic vascular changes that precede the clinical development of this condition.

Reference values of maternal ophthalmic artery doppler variables in the first trimester of normal pregnancy

The aim of this study was to establish normative data for ophthalmic artery Doppler variables in the first trimester of normal pregnancy. Maternal ophthalmic artery Doppler signals were recorded in 409 singleton pregnancies at 11-14 weeks' gestation, in mothers presenting consecutively for routine antenatal care. Pulsatility and resistance indices (PI, RI), peak systolic velocity (PSV), first peak diastolic velocity (PD1), and peak ratio (PR) were measured. Quartile regression was used to estimate reference ranges in the late first trimester of pregnancy. Mean ± SD values for maternal ophthalmic artery Doppler parameters between 11 and 14 weeks' gestation were RI = 0.81 ± 0.12, PI = 2.06 ± 0.57, PSV = 36.41 ± 12.1, PD1 = 21.07 ± 7.62, and PR = 0.58 ± 0.11. All clinical and Doppler variables were normally distributed. PD1 values were higher in patients who smoked, and in those with diabetes or a history of pre-eclampsia. PR values were higher in patients with diabetes and chronic hypertension, and lower in the nulliparous; these values declined as gestation advanced from 11 to 14 weeks, whereas the other variables remained unchanged. We provide reference values for maternal ophthalmic artery Doppler variables in the first trimester of normal pregnancy.

Maternal Ophthalmic Artery Doppler Indices in Type 1 Diabetes during Pregnancy

This Study aimed to assess the Doppler indices for ophthalmic artery in type 1diabetic pregnant ladies. Inclusion criteria were 15diabetic pregnant ladies, their ages were (30-39), 14 healthy pregnant non diabetic ladies aged (30-37), and 15 healthy non pregnant non diabetic subjects aged (30-41) were selected as control group. Pregnant ladies with eye disease or pregnancy abnormality or preeclampsia were excluded. Ultrasound examination for both eyes were obtained using 7.5MHZ high resolution ultrasound machine. Readings of Ophthalmic artery Doppler indices (resistive index (RI), pulsatility index (PI)) for type 1 diabetes ladies were found to be greater when compared with the control group values and Mean Velocity (MV) was of lower values. The mean values ± SD were as follows: for right eye: resistive index, 1.3 ± 0.2 (P < .005 Control0.8 ± 0.1); pulsatility index, (3.6 ± 0.4 (P < .005Control1.6 ± 0.4); Mean Velocity (MV) 5.2 ± 1.1(P < .005 Control 8.4 ± 3.2). For left eye resistive index, 1.4 ± 0.2 (P < .005 Control 0.7 ± 0.1); pulsatility index, 3.3 ± 0.5 (P < .005Control 1.6 ± 0.3); Mean Velocity (MV) 5.7 ± 0.8 (P < .005 Control 8.5 ± 3.2). The correlations between the variables and gestational age in the two pregnant groups were studied and were compared with the control group and maternal treatment. The study revealed that the Doppler indices for right and left eyes differed significantly within the three trimesters for pregnant diabetic and pregnant non diabetic ladies and when compared with the control group at p-value ˂0.05. No significant difference was detected between the Doppler indices and the treatment taken as Diet Control, or insulin for type 1 diabetic pregnant ladies. Color Doppler Ultrasonography is useful for assessing blood flow. Ophthalmic arteries Doppler Indices were affected significantly in pregnant ladies with or without type 1diabetes.

OP02.03: Correlation of maternal ophthalmic artery Doppler indices with maternal‐fetal parameters in pregnancies with fetal growth restriction: preliminary results

<scp>OP02</scp>.03: Correlation of maternal ophthalmic artery Doppler indices with maternal‐fetal parameters in pregnancies with fetal growth restriction: preliminary results

21st World Congress on Ultrasound in Obstetrics and Gynecology, 18-22 September 2011, Los Angeles, USA: presentations and awards

21st World Congress on Ultrasound in Obstetrics and Gynecology, 18-22 September 2011, Los Angeles, USA: presentations and awards

OP09.04: Maternal ophthalmic artery Doppler: novel parameter to predict early‐onset pre‐eclampsia in the first trimester of pregnancy

Objectives: To evaluate the utility of sequential measurement of the uterine artery (UtA) resistances in both the 11–14 weeks scan (1T) and the 19–22 weeks scan (2T) for the prediction of preeclampsia (PE) in a high-risk population. Methods: Prospective observational study of 155 singleton pregnancies at high risk for PE (at least having one major risk factor: prior PE, chronic hypertension, pregestational diabetes mellitus, chronic renal disease, BMI >30, autoimmune disorders or thrombophilia). Pregnancies with abnormal karyotype or incomplete outcome were excluded. Measurement of mean UtA pulsatility index (UtA-PI) was performed at 1T and 2T and statistical comparisons were established between unaffected gestations and those who developed either late PE (gestational age at delivery ≥34 weeks) or early PE ( 1.8 in the 2T developed PE (2 late, 4 early) (OR 13.9; 95% CI 3.2–59.8), and 5/14 (36%) pregnancies with mean UtA-PI in the 2T > mean UtA-PI in the 1T developed PE (2 late, 3 early) (OR 8.2; 95% CI 2.1–33.0). Conclusions: When applied to high-risk women, UtA Doppler screening proved to be ineffective for the prediction of late PE and showed a modest performance for the prediction of early PE, especially in the 1T. However, very high UtA resistances in the 2T as well as the increase of the UtA resistances between 1T and 2T are associated with a highly increased risk of developing PE in high-risk women. OP09.04 Maternal ophthalmic artery Doppler: novel parameter to predict early-onset pre-eclampsia in the first trimester of pregnancy