Perinatal Outcomes In Preeclampsia Research Articles

Estimation of Serum Uric Acid as an Indicator of Severity of Preeclampsia and Perinatal Outcome.

Uric acid is a marker of oxidative stress tissue injury and renal dysfunction, hence a correlation hypothesized. (1) To evaluate severity of preeclampsia with raised serum uric acid. (2) To evaluate perinatal outcome in preeclampsia with raised serum uric ccid. 50 pregnant women withsevere preeclampsia and 50 normotensive womenwere included in the study and maternal serum uric acid was estimated in both the groups. In the study group comprising of 50 cases of preeclampsia, there is a positive correlation (r=0.695 & +0.359) between the variables in study group, and as the SBP or DBP increases, the MSUA concentration also increases. In control group, there is a negative correlation (r=-0.083 & -0.095). Perinatal complication was more in study group, 54% were preterm compared to 4% in control group also as MSUA value increased average gestational age decreased. Mean birth weight in study group was 1.8kg study group of which 13 (26%) babies were VLBW, 28 (56%) were LBW, and 9 (18%) babies had normal birth weight, in control group mean birth weight was 2.99kg. There were 6 cases of ELBW babies in study group which were included in VLBW group for statistical calculation. The difference was found to be statistically significant (p<0.05). In the study group, the MSUA concentration is found higher in LBW and VLBW babies compared to normal birth weight babies. There is a positive correlation between SUA & severity of preeclampsia, and a significant adverse fetal outcome is observed with raised MSUA in preeclamptic patients.

112 Massive proteinuria in superimposed preeclampsia significantly increased the maternal organ involvements

Introduction It is recently recognized that the amount of proteinuria is not mainly contributed to the prognosis of preeclampsia or superimposed preeclampsia [1]. Thus the severity of proteinuria tends to be unimportant and unreliable criteria for the management of preeclamptic disease. On the other hand, it is reported that preeclampsia with greater proteinuria was easy to lead the complication of the adverse maternal outcomes [2]. We now studied how the amount of proteinuria is correlated to the maternal complications especially in superimposed preeclampsia. Methods The retrospective observational study according to the standard clinical management of preeclampsia was performed in 56 pregnant cases of superimposed preeclampsia. All cases were hospitalized for the management of preeclamptic conditions and should terminate the pregnancy in the state of uncontrollable severe high blood pressure, massive proteinuria (over 10 g/day), the complications of the maternal organ involvements such as HELLP syndrome or fetal jeopardy conditions. The urinary protein was evaluated by the daily urinary collection, or spot urine/creatinine ratio. Univariate and multivariate logistic regression analysis were conducted how the obstetric features such as the severity of blood pressure, proteinuria, or the onset of disease could correlate to these organ involvements. Statistical analysis was performed using with SPSS v21. Result 25 (43.9%) cases complicated with any maternal organ involvements were observed in 59 cases. The involvements of HELLP syndrome, thrombocytopenia, or elevated liver enzymes (HELLP related disorders) were observed in 19 cases (33.3%), and those of maternal CNS disorders such as eclampsia was 2 cases (3.5%). Proteinuria over 3 g/day were correlated to any of maternal organ involvements (adjusted Odds ratio 2.86, 95%CI 0.63–13.02, p = 0.18), and more the onset of diastolic high BP under 28 weeks gestation correlated significantly (aOR 4.57, 95%CI 0.86–24.22, p = 0.07) . No relations between the maternal organ involvements and high blood pressure in superimposed preeclampsia. HELLP related disorders tended more correlation to high proteinuria of 3–8 g/day (aOR 4.30 95%CI 0.93–19.80, p = 0.06), 8–12 g/day (aOR 3.74, 95%CI 0.63–22.32, p = 0.15), and showed significantly high correlation to proteinuria over 12 g/day (aOR 12.678, 95%CI 1.53–105.2, p = 0.02). Conclusion 59 cases of superimposed preeclampsia showed high rate of any of the maternal organ involvements in this observational study. These involvements were correlated to the early onset of hypertension under 28 weeks, and had more correlation to high amount of proteinuria than severe hypertension. Furthermore massive proteinuria over 12 g/day had significantly correlated to HELLP related disorders. Additionally not massive but large amount of proteinuria, that is under12 g/day did not show linear increase in complicating the maternal involvements. We then concluded the necessity of measuring the amount of proteinuria in the management of superimposed preeclampsia, and the massive proteinuria over 12 g/day might have the risk of complicating with the maternal organ involvements especially HELLP syndrome or its correlating disorders.

93 Maternal and perinatal outcomes in preeclampsia according to the magnitude of proteinuria: Results from a high risk referral center in Brazil

Preeclampsia (PE) is one of the leading causes of maternal and neonatal morbidity and mortality worldwide. It is defined as new onset hypertension developing ⩾20 weeks and proteinuria or evidence of maternal organ dysfunction. The magnitude of proteinuria was a marker for severity and when higher than 2 g/24 h indicated aggressive treatment. This was recently revised and no longer defines severity, but there are still gaps in understanding how different levels of increased proteinuria impact on maternal and perinatal outcomes and its long term consequences. To review all cases of PE with proteinuria ⩾2 g/24 h followed at the State University of Campinas (UNICAMP) in a 5 year period, and compare maternal and perinatal outcomes according to the magnitude of proteinuria. Retrospective cohort of all pregnant women with proteinuria ⩾2 g/24 h followed at UNICAMP from January 2009 to December 2013. Women with previous nephropathy, without diagnosis of PE or delivery elsewhere were excluded from the analysis. Data on demographic characteristics, onset of symptoms, laboratory findings, maternal and fetal/neonatal outcomes were recorded. Data were stored and analyzed using the Epi-Info 7; continuous variables were compared using ANOVA and categorical variables analyzed by x2 or Fisher exact tests. 269 women were screened for review, 19 were excluded for delivering elsewhere, 41 were excluded due to previous nephropathy, 8 due to absence of PE and 5 for post-partum PE (with normal proteinuria during gestation). The current analysis included 196 women. The median age was 28 (±7.1), majority white (69%) and nearly half primigravidas. The average overall magnitude of proteinuria was 5.1 g/24 h (±3.7). Cesarean delivery was the most frequent route of delivery (84%) and the mean gestational age at delivery 33 weeks (±3.8). The majority of cases presented severe PE (80%). Less then half of the women attended postpartum care and among those, most remained with abnormal proteinuria in early (80%) and late (76%) puerperium (followed up to 3 months postpartum). We considered 3 groups of cases according to the magnitude of proteinuria: ⩾2 and <5 g/24 h (n = 124), ⩾5 and <10 g/24 h (n = 43) and ⩾10 g/24 h (n = 18). A summarized comparison among these groups is in Table 1. Quantification of proteinuria remains an important tool in the diagnosis of PE but its magnitude alone, should not guide management. Massive proteinuria presented significantly more in primigravida and proteinuria ⩾5 g/24 h presented decreased gestational age at resolution. Future studies must address systematic follow-up of these women during pregnancy, latency from diagnosis to resolution, and the women’s perspective upon diagnosis of massive proteinuria. A postpartum follow-up is critical, to assess long term consequences of massive proteinuria during pregnancy.

Possible role of asymmetric dimethylarginine (ADMA) in prediction of perinatal outcome in preeclampsia and fetal growth retardation related to preeclampsia

Objective: The objective of this study is to investigate maternal serum and neonatal umbilical cord asymmetric dimethylarginine (ADMA) levels in prediction of perinatal prognosis in pregnancies with preeclampsia (PE) and fetal intrauterine growth retardation (IUGR) accompanying PE (PE + IUGR).Methods: Maternal serum ADMA (msADMA) and neonatal umbilical cord ADMA (ucADMA) levels were studied from 34 patients with PE, 25 patients with PE + IUGR, and 30 healthy pregnant controls in this prospective case–control study. Umbilical artery Doppler indices of fetuses, birth weights, Apgar scores, umbilical artery pH measurements of neonates, and admissions to neonatal intensive care unit (NICU) were recorded.Results: Median msADMA was significantly higher in PE and PE + IUGR groups (p = 0.024 and p = 0.011, respectively), and ucADMA was significantly higher in PE and PE + IUGR groups than the control group (p = 0.029 and p = 0.018, respectively). Median msADMA and ucADMA levels were significantly higher in the PE + IUGR group than the PE group (p = 0.019 and 0.021, respectively). ucADMA levels did not correlate with fetal umbilical arterial blood flow neither in the PE nor in the PE + IUGR group (p = 0.518 and p = 0.892, respectively). None was related with neonatal umbilical artery pH or NICU admission rates.Conclusions: msADMA and ucADMA correlated with severity of PE. msADMA and ucADMA failed to predict perinatal outcome in patients with PE and PE + IUGR.

Prediction of perinatal outcome in preeclampsia using middle cerebral artery and umbilical artery pulsatility and resistance indices

ABSTRACTObjective: In preeclampsia, changes in fetal hemodynamics can be detected 2–3 weeks earlier than any changes in cardiotocogram. Thus, these Doppler changes can be used to predict perinatal outcome. The present study is planned to assess the accuracy of the middle cerebral artery to umbilical artery (UA) pulsatility index (PI) and resistance index (RI) in predicting adverse perinatal outcome in pregnancies complicated by preeclampsia. Methods: Total of 115 and 108 pregnant women were included in preeclampsia and control group, respectively. Weekly Doppler study was done in both groups starting from 30 weeks till 36 weeks or delivery, whichever is later. Results: Mean gestational age at delivery was 250 ± 13 and 273 ± 8 days, respectively, in preeclampsia and control group (p < 0.01). Thirty-four babies in preeclampsia group had been admitted to nursery; out of which three died (p < 0.01). On receiver operating characteristic analysis, MCA /UmA PI ratio and MCA /UmA RI ratio had sensitivity of 9% and 9.7% and specificity of 98% and 96.6%, respectively, for predicting adverse perinatal outcome. Conclusion: Doppler indices of MCA and Um A are significantly abnormal in preeclampsia. But on diagnostic statistical analysis they have good specificity but low sensitivity for detecting adverse perinatal outcome.

Association of hypoproteinemia in preeclampsia with maternal and perinatal outcomes: A retrospective analysis of high-risk women.

Background:The aim of this study was to evaluate maternal and perinatal outcomes in preeclampsia (PE), according to the value of albumin.Materials and Methods:Preeclamptic women were retrospectively divided into mild hypoproteinemia (MHP, n = 220) and severe hypoproteinemia (SHP, n = 79) PE according to the value of albumin. The maternal and perinatal outcomes were evaluated in both groups.Results:Two hundred and ninety-nine single pregnancies complicated by PE were included in this study. Gestational age at delivery was earlier in SHP than MHP (P < 0.01). Severe hypertension, abnormal liver function, abnormal renal function, ascites, and abruption occurred more frequently in SHP than in MHP (P< 0.01, 0.03, <0.01, 0.01, and 0.04, respectively). Women in SHP had a higher rate of cesarean section than those in MHP (P = 0.04). Fetal growth restriction infants were more frequent in SHP than in MHP (P < 0.01). The occupancy rate of the Neonatal Intensive Care Unit was higher in SHP than in MHP (P < 0.01).Conclusion:SHP PE is associated with a higher risk of adverse pregnancy outcome than MHP PE, deserving closer surveillance during pregnancy.

THE ROLE OF CARDIOTOCOGRAPHY IN ASSESSING THE CONDITION OF A FETUS IN PREECLAMPSIA

The role of cardiotocography (CTG) in preeclampsia is still vaguely defined. The aim of this study was to investigate the possible role of CTG in assessing the condition of the fetus in preeclampsia with and without intrauterine growth retardation (IUGR) and to compare the CTG findings with Doppler parameters and perinatal outcome. The prospective study included 30 singleton pregnancies with preeclampsia completed by caesarean section. The study group was divided into subgroups based on the presence of IUGR in relation to the severity of preeclampsia. The control group consisted of 20 healthy women delivered by elective caesarean section. In 53.3% of preeclamptic cases, cardiotocographic findings differed from normal (p<0.001) and they were either warning or pathological. There were no significant differences in the presence of a pattern deviating from normal based on the severity of preeclampsia, and it was significantly more prevalent in preeclampsia with IUGR (p<0.01) than the one without it. The prevalence of CTG pattern types in the study group was significantly altered by presence of olygoamnion (p<0.05) as well as the parameters of the flow through the uterine arteries, umbilical artery and middle cerebral artery (p<0.05). Apgar score significantly depends on the CTG findings and decreases with the unfavourable CTG pattern. CTG and Doppler ultrasonography complement each other in order to improve perinatal outcome in preeclampsia. CTG is irreplaceable as a first measure of rapid assessment of the fetal condition in newly diagnosed cases of preeclampsia, aiming also to and in order to detect complications from umbilical cord during its follow-up.

May maternal anti-mullerian hormone levels predict adverse maternal and perinatal outcomes in preeclampsia?

Background: Prediction of preeclampsia and adverse maternal and perinatal outcomes with biomarkers has been proposed previously. Anti-mullerian hormone (AMH) is a growth factor, which is primarily responsible of the regression of the mullerian duct, but also used to predict ovarian reserve and decreases with age similar to the fertility. Aim: To evaluate the predictive role of maternal anti-mullerian hormone (mAMH) in adverse maternal and perinatal outcomes in preeclampsia. Methods: This prospective case-control study was conducted at current high-risk pregnancy department in a tertiary research hospital and 45 cases with preeclampsia classified as study group and 42 as control group. Data collected and evaluated were; age, body mass index (BMI), marriage duration (MD), gestational weeks (GW), gravidity, parity, mode of delivery, birth weight, newborn Apgar score, newborn gender, maternal complication, perinatal outcome, some laboratory parameters and mAMH. The association between mAMH levels and maternal and fetal outcomes were evaluated. Results: There were no statistically significant differences between groups in terms of age, BMI, MD, gravidity, parity and newborn gender (p > 0.05). GW, vaginal delivery, birth weight, newborn Apgar score, were statistically significantly lower in preeclamptic patients when compared with non-preeclamptic patients (p < 0.001). Adverse maternal and perinatal outcomes were statistically significantly higher in the study group (p < 0.001). The laboratory values [alanine transaminase (ALT), aspartate transaminase (AST), blood urea nitrogen (BUN), creatinine, lactic dehydrogenase (LDH), uric acid and fibrinogen) were statistically significantly lower in the control group (p < 0.001). The mAMH level was significantly lower in the preeclamptic group (p: 0.035). There was no correlation between mAMH levels and demographic and clinical parameters. The area under the ROC curve (AUC) was 0.590 and the cut-off value was 0.365 ng/ml with sensitivity of 67.4% and specificity of 47.1% for mAMH. Logistic regression analysis showed a statistically insignificance between mAMH and maternal complication and perinatal outcome (p: 0.149). Conclusion: According to this study, mAMH level was lower in preeclamptic patients than in normal pregnants, and is found to be a discriminative factor with low sensitivity and specificity. There was no relationship between mAMH and adverse maternal and perinatal outcomes. Further randomized controlled studies with more participants are needed to evaluate the accurate effects of mAMH levels on preeclampsia and should increase the power of mAMH levels in predicting the preeclampsia.

Pre-eclampsia part 2: prediction, prevention and management.

An antiangiogenic state might constitute a terminal pathway for the multiple aetiologies of pre-eclampsia, especially those resulting from placental abnormalities. The levels of angiogenic and antiangiogenic proteins in maternal blood change prior to a diagnosis of pre-eclampsia, correlate with disease severity and have prognostic value in identifying women who will develop maternal and/or perinatal complications. Potential interventions exist to ameliorate the imbalance of angiogenesis and, hence, might provide opportunities to improve maternal and/or perinatal outcomes in pre-eclampsia. Current strategies for managing pre-eclampsia consist of controlling hypertension, preventing seizures and timely delivery of the fetus. Prediction of pre-eclampsia in the first trimester is of great interest, as early administration of aspirin might reduce the risk of pre-eclampsia, albeit modestly. Combinations of biomarkers typically predict pre-eclampsia better than single biomarkers; however, the encouraging initial results of biomarker studies require external validation in other populations before they can be used to facilitate intervention in patients identified as at increased risk. Angiogenic and antiangiogenic factors might also be useful in triage of symptomatic patients with suspected pre-eclampsia, differentiating pre-eclampsia from exacerbations of pre-existing medical conditions and performing risk assessment in asymptomatic women. This Review article discusses the performance of predictive and prognostic biomarkers for pre-eclampsia, current strategies for preventing and managing the condition and its long-term consequences.

Perinatal outcome of pre-eclampsia in parous women

Women with a second and recurrent pre-eclampsia pregnancy have more adverse pregnancy outcomes compared with women with pre-eclampsia in the first pregnancy. A retrospective cohort study was performed to compare the clinical characteristics and perinatal outcomes of pre-eclampsia in parous women who had complicated pre-eclampsia in previous pregnancies (n = 69) and uncomplicated pre-eclampsia in previous pregnancies (n = 312) from 2006 to 2010, in the Fujian Maternity and Child Health Hospital. No statistical significant differences were observed between the two groups in terms of: maternal age, admission blood pressure and BMI; prenatal care times, hospitalisation time, laboratory results and incident rates of complications. The incident and delivery weeks were earlier and the renal injury, caesarean section and small for gestational age (SGA) incidence rates were higher in recurrent pre-eclampsia women. Women with recurrent pre-eclampsia had adverse perinatal outcomes when compared with parous women with pre-eclampsia who had not had pre-eclampsia in prior pregnancies.

The Ala-9Val (Mn-SOD) and Arg213Gly (EC-SOD) polymorphisms in the pathogenesis of preeclampsia in Romanian women: association with the severity and outcome of preeclampsia

Objective: To check whether individual or combined mutated genotypes for Ala-9Val (Mn-SOD) and Arg213Gly (EC-SOD) are associated with preeclampsia; to check the influence of the mutated genotypes on the degree of severity and perinatal outcome of preeclampsia. Methods: We genotyped 97 pregnant women (47 with preeclampsia and 50 normal pregnant women) using PCR-RFLP analysis. Results: The Val/Val (Mn-SOD) genotype (OR 5.99, p = 0.004) but not the Gly/Gly (EC-SOD) genotype (OR 4.23, p = 0.027) was significantly associated with preeclampsia. Higher frequency of both polymorphisms in women with preeclampsia (42.55%) compared to normal pregnant women (8%). Higher frequency of women diagnosed with PIH (27.27%, OR 4.31), mild (50%, OR 11.5) and severe preeclampsia (37.5%, OR 6.9) positive for both polymorphism compared to control women (8%). There was a statistically significant difference in gestational age at delivery according to Mn-SOD (Ala/Ala vs. Val/Val, 39 ± 1.41 weeks vs. 32.77 ± 3.7 weeks) and EC-SOD genotypes (Arg/Arg vs. Gly/Gly, 37.05 ± 3.18 weeks vs. 31.5 ± 3.84 weeks). There also was a statistically significant difference in birth weight according to Mn-SOD (grams, Ala/Ala vs. Val/Val, 3080 ± 481.66 vs. 2376.92 ± 916.88) and EC-SOD genotypes (grams, Arg/Arg vs. Gly/Gly, 2934.09 ± 662.14 vs. 2080 ± 721.19). Conclusions: Our study demonstrates a relationship between these two mutated genes, the clinical severity and the perinatal outcome of preeclampsia.

Clinical features of fetal growth restriction complicated later by preeclampsia

To assess the maternal and perinatal outcome of preeclampsia with fetal growth restriction (FGR) and to assess the risk factors of FGR complicated later by preeclampsia. A cohort of women with preeclampsia and/or FGR (n = 306) were retrospectively reviewed. First, the maternal and perinatal outcome were compared between preeclampsia with FGR (n = 37) and preeclampsia without FGR (n = 96). Second, the clinical findings of FGR followed later by preeclampsia (n = 24) were compared to FGR without preeclampsia (n = 149). The incidence of severe hypertension and critical maternal complications in women with preeclampsia with FGR was significantly higher than in those with preeclampsia without FGR. In women diagnosed with FGR, 13.8% (24/173) developed preeclampsia later. In this group, FGR was diagnosed at 28.8 gestational weeks, which was then complicated by preeclampsia at a mean of 32.6 gestational weeks, and delivered at 33.3 gestational weeks. The diagnosis of FGR was earlier and the incidence of proteinuria at entry was more common in women with FGR complicated later by preeclampsia than in those with FGR without preeclampsia (45.8% vs 4.7%; P < 0.001). Preeclampsia with FGR is severe condition which can possibly adversely affect the maternal condition. About 15% of all mothers diagnosed with FGR developed preeclampsia afterwards; therefore, those with FGR are considered to be candidates for close monitoring for the clinical manifestation of preeclampsia, and those with early-onset FGR with proteinuria may represent a high-risk group for preeclampsia.

Pregnancy outcome in women presenting with pre‐eclampsia at less than 25 weeks gestation

We aimed to (i) assess maternal and perinatal outcomes in pre-eclampsia at < 25(0) weeks; and (ii) determine if any antenatal factors were associated with adverse maternal and perinatal outcomes. A retrospective study. Tertiary referral hospital, Auckland, New Zealand. Data were extracted from the clinical record and hospital database. The study population involved women admitted with pre-eclampsia at < 25(0) weeks, with a live singleton pregnancy, from 1997 to 2004 and managed expectantly. Maternal morbidity, perinatal death, neurodevelopmental outcome at 18 months, small for gestational age assessed by population and customised birthweight centiles. Gestation at admission was the only antenatal variable associated with adverse perinatal outcome. Of 14 women admitted < 23 weeks, no babies survived, but eight (62%) babies of women admitted in the 24th week (24(0)-24(6)) survived. Neurodevelopmental outcome was assessed in eight of nine survivors; two (25%) had moderate and two (25%) had minor disability. All babies in this cohort had birthweights < 5th customised centile. Only one baby (10%) weighing < 500 g survived. Maternal morbidity was high in this expectantly managed cohort. As no babies survived when pre-eclampsia occurred before 23 weeks, induction of labour should be considered. In the 24th week two-thirds of babies survived and 25% had moderate handicap. This information may help clinicians and women in the future to make informed choices about management.

Maternal and perinatal outcome of preeclampsia with an onset before 24 weeks’ gestation: Audit in a tertiary referral center

Objective Preeclampsia, with an onset before 24 weeks’ gestation is a rare but severe condition in pregnancy with little data of maternal and perinatal outcome, particularly after expectant management. We therefore, evaluated pregnancy outcome in these women at our department where temporising management was introduced as the standard policy in early onset preeclampsia. Study design We analysed retrospectively all consecutive women with preeclampsia, with an onset before 24 weeks’ gestation, between 1 January 1993 and 31 December 2002 at a tertiary university referral center. Results Twenty-six pregnancies, of which two were twin pregnancies, resulted in 65% of the women in at least one major maternal complication: maternal death ( n = 1), HELLP syndrome ( n = 16), eclampsia ( n = 5) and pulmonary edema ( n = 4). Thirty percent of these women presented already with serious morbidity at admission. The median prolongation of the pregnancy was 24 days (range 3–46 days). The overall perinatal mortality was 82%: 19 fetal deaths and 4 neonatal deaths. Conclusion Early onset preeclampsia, with an onset before 24 weeks’ gestation, results in considerable maternal and perinatal morbidity and mortality. Therefore, expectant management should not be considered as a routine treatment option in these patients.

Umblical Doppler study and perinatal outcome in pre-eclampsia

We set out to test the value of routine Doppler study of the umbilical artery to predict the perinatal outcome in pre-eclamptic patients. Fetal wellbeing was assessed in 113 women with pre-eclampsia by weekly performed biophysical profile score (BPP) and Doppler study of the umbilical artery starting early in the third trimester until delivery. The last Doppler results before delivery were normal in 82 cases and abnormal in 31 cases. The group with abnormal Doppler had significantly higher blood pressure and serum uric acid level, and significantly lower platelet count than the group with normal Doppler. The incidence of IUGR, low apgar score at 5 minutes, perinatal deaths and operative delivery for fetal distress was significantly higher in the group with abnormal Doppler.

Perinatal outcomes in preeclampsia that is complicated by massive proteinuria

Objective: Current treatment of preeclampsia no longer mandates delivery for proteinuria of >5 g per 24 hours. We sought to determine whether delayed delivery of preeclampsia with massive proteinuria (>10 g/24 h) increased maternal or neonatal morbidity. Study Design: Records of all women with preeclampsia who were delivered at <37 weeks of gestation between January 1, 1997, and June 30, 2001, were reviewed. Patients with underlying renal disease or multiple gestation were excluded. Patients were characterized as having mild (<5 g/24 h), severe (5-9.9 g/24 h), or massive (>10 g/24 h) proteinuria. Outcomes were compared using the χ2 test, one-way analysis of variance, or Fisher exact test. Results: Two hundred nine patients met the inclusion criteria: 125 patients had mild proteinuria, 43 patients had severe proteinuria, and 41 patients had massive proteinuria. No significant differences in maternal morbidity were seen. Massive proteinuria was associated with earlier onset of preeclampsia, earlier gestational age at delivery, and higher rates of prematurity complications. After correction for prematurity, massive proteinuria has no significant effect on neonatal outcomes. Conclusion: Women with preeclampsia and massive proteinuria did not have increased maternal morbidity compared with women with severe or mild proteinuria. Massive proteinuria appears to be a marker for early-onset disease and progression to severe preeclampsia. Neonatal morbidity appears to be a function of prematurity rather than of massive proteinuria itself. (Am J Obstet Gynecol 2003;188:264-8.)

332 Perinatal outcomes in preeclampsia complicated by severe proteinuria admitted at

332 Perinatal outcomes in preeclampsia complicated by severe proteinuria admitted at <32 weeks gestation

Umbilical and middle cerebral artery Doppler indices in patients with preeclampsia

Objective: To compare changes in Doppler ultrasound studies of fetal circulation in normal pregnancies with those of a group of preeclamptic patients both with and without intrauterine growth retardation and to demonstrate the best index for predicting adverse perinatal outcome or IUGR. Study design: A cross-sectional study was performed on 125 normal pregnancies and 62 preeclamptic patients at 31–40 weeks of gestation. The umbilical artery systolic–diastolic ratio (UA S/D), UA pulsatility index (PI), the middle cerebral artery (MCA) PI, and the ratio of MCA PI to UA PI were measured. The mean values of the Doppler indices were compared. Different cut-off values (mean±2 S.D.) were used for the 31st–35th and the 36th–40th weeks. Results: Significant differences were found between normal pregnancies and preeclamptic patients without IUGR using the mean MCA PI and the MCA PI/UA PI ratio. In the preeclamptic patients with IUGR, all the mean Doppler indices were different from those of the normal pregnancies. In the preeclamptic patients with IUGR the values were different from the preeclamptic patients without IUGR, except for the MCA PI at 31–35 weeks. The UA S/D had the highest sensitivity (88%) and diagnostic accuracy (94%) in predicting the adverse perinatal outcome. The MCA PI/UA PI ratio showed the highest predictive value in determining IUGR by a sensitivity of 84% and a diagnostic accuracy of 87%. Conclusion: Both abnormal umbilical Doppler indices and cerebral–umbilical ratio are strong predictors of IUGR and of adverse perinatal outcome in preeclampsia. The MCA PI alone is not a reliable indicator. The combination of umbilical and fetal cerebral Doppler indices may increase the utility of Doppler ultrasound in preeclamptic subjects.