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Stoilov B, Uchikova E, Kirovakov Z, Zaharieva-Dinkova P. Therapeutic Value of Low-Dose Acetylsalicylic Acid for the Prevention of Preeclampsia in High-Risk Bulgarian Women. Cureus 2024; 16:e66298. [PMID: 39113818 PMCID: PMC11304363 DOI: 10.7759/cureus.66298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction Preeclampsia (PE) is a syndrome that affects pregnant women after 20 weeks of gestation and involves numerous organ systems. Screening for PE is essential to prevent complications and guide management. Some existing guidelines for screening have limitations in terms of detection rates and false positives. The aim of this study is to assess the therapeutic value of low-dose acetylsalicylic acid (ASA) for the prevention of PE in high-risk Bulgarian women. Methodology A prospective cohort research was carried out, encompassing women who were recruited from several routine consultations, such as booking, scanning, and regular prenatal visits. We utilized the purposive sampling technique to carefully choose potential participants. The study was conducted by a maternal-fetal medicine center located in Plovdiv, Bulgaria. The data-gathering period spanned from January 2018 to November 2020. At the appointment, the following procedures were conducted: 1) recording history; 2) assessing height, weight, and blood pressure; 3) collecting blood specimens for biochemical markers; and 4) ultrasound examination. Results A total sample size of 1,383 individuals was categorized into two distinct groups: high-risk patients (n = 506) and low-risk patients (n = 877). The mean uterine artery pulsatility index (UtA-PI) and mean arterial pressure (MAP) ratios were all greater in high-risk group women (p < 0.05). The data revealed that a significant number of high-risk women failed to adhere to the prescribed dosage or regular use of ASA as recommended by their doctor. There were only 384 (75.9%) high-risk women who took low-dose ASA regularly. Conclusion The findings emphasize the importance of personalized prenatal care and early risk assessment to improve maternal and fetal outcomes. Therefore, it is crucial to educate pregnant women, considering the benefits and risks of low-dose ASA when appropriately indicated.
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Affiliation(s)
- Boris Stoilov
- Obstetrics and Gynaecology, Medical University Plovdiv, Plovdiv, BGR
| | | | - Zlatko Kirovakov
- Midwifery Care, Faculty of Health Care, Medical University Pleven, Pleven, BGR
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Sivakumaran P, Khare M, Kumar P. A Case Report of Bilateral Exudative Retinal Detachment in Severe Pre-eclampsia. Cureus 2024; 16:e56791. [PMID: 38650803 PMCID: PMC11034995 DOI: 10.7759/cureus.56791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 04/25/2024] Open
Abstract
We report a case of a 31-year-old gravida 2 para 1 female presenting to the optician with a two-week history of blurred vision and persistent headaches at 29 weeks gestation. Visual acuity on presentation was 6/100 in the right eye and 6/24 in the left eye. Fundoscopy of both eyes revealed serous retinal detachment in the absence of background retinal changes. On urgent admission to the maternity assessment unit, blood pressure was 189/126 mmHg and urine dipstick revealed 4+ proteinuria. Due to recurrent poor foetal heart rate variability on cardiotocography monitoring, an emergency caesarean was conducted. Sixteen hours following delivery, visual symptoms had improved, and clinical examination revealed normal blood pressure. An optical coherence tomography scan performed three months later was dry bilaterally with minor retinal pigment epithelium clumping. Serous retinal detachment involves the separation of the neurosensory retinal layer from the underlying retinal pigment epithelium. It is rare in pre-eclampsia but can be seen in patients with severe disease. The presentation of serous retinal detachment includes acute visual loss, reduced visual acuity, floaters, and flashing lights appearing in the vision. Although alarming on initial presentation, resolution is commonly seen within a couple of days postpartum. The pathogenic mechanism for serous retinal detachment development is widely discussed and thought to include changes to the choroidal circulation. Overall, although often self-resolving, a move to thorough antenatal care and vigilant monitoring in pre-eclamptic women is vital to prevent complications like this from occurring.
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Affiliation(s)
| | - Manjiri Khare
- Maternal-Fetal Medicine, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Periyasamy Kumar
- Ophthalmology, University Hospitals of Leicester NHS Trust, Leicester, GBR
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Gyokova E, Hristova-Atanasova E, Iskrov G. Preeclampsia Management and Maternal Ophthalmic Artery Doppler Measurements between 19 and 23 Weeks of Gestation. J Clin Med 2024; 13:950. [PMID: 38398264 PMCID: PMC10889272 DOI: 10.3390/jcm13040950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/19/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
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.
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Affiliation(s)
- Elitsa Gyokova
- Department of Obstetrics and Gynecology, Faculty of Medicine, Medical University-Pleven, 5800 Pleven, Bulgaria;
- Obstetrics Clinic, UMHAT “Saint Marina” Pleven, 5800 Pleven, Bulgaria
| | - Eleonora Hristova-Atanasova
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria;
| | - Georgi Iskrov
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria;
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Silverman RH, Urs R, Wapner RJ, Valenzuela IA, Coleman HR, Bearelly S. Correlation of Ocular Plane-Wave Doppler With Optical Coherence Tomography Angiography in Preeclampsia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2815-2824. [PMID: 37605863 PMCID: PMC10840834 DOI: 10.1002/jum.16320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/02/2023] [Accepted: 08/06/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Preeclampsia (PE) is a severe complication of pregnancy characterized by hypertension, proteinuria and compromised fetal blood supply. The eye, like other end organs, is affected by this systemic condition, but unlike in other organs, ocular media transparency allows high-resolution optical visualization of the vascular structure of the retina. Our aim was to assess how ultrasound-determined ocular blood-flow correlates with vascular structure of the retina and choriocapillaris determined by optical coherence tomography angiography (OCTA). METHODS Plane-wave ultrasound and OCTA were performed on both eyes of 40 consecutive subjects consisting of normal controls (n = 11), mild PE (n = 5), severe PE (n = 17) and chronic or gestational hypertension (n = 7) within 72 hours following delivery. From ultrasound, we measured pulsatile flow velocity and resistance indices in the central retinal artery (CRA) and vein, the short posterior ciliary arteries (SPCAs) and choroid. From OCTA, we measured vascular density (VD) in the superficial, deep retina and choriocapillaris. We determined differences in Doppler and OCTA parameters among groups and correlations between ultrasound and OCTA. RESULTS In severe PE, flow resistance was reduced with respect to controls. Flow velocity and resistance in the and SPCA were moderately correlated with VD in the choriocapillaris and peripapillary retina, but VD in PE did not differ significantly from controls. CONCLUSIONS Although OCTA parameters were moderately correlated with Doppler ultrasound, OCTA did not demonstrate significant differences between PE and controls postpartum.
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Affiliation(s)
| | - Raksha Urs
- Department of Ophthalmology, Columbia University Irving Medical Center
| | - Ronald J. Wapner
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center
| | | | - Hanna R. Coleman
- Department of Ophthalmology, Columbia University Irving Medical Center
| | - Srilaxmi Bearelly
- Department of Ophthalmology, Columbia University Irving Medical Center
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de Melo PFMV, Roever L, Mendonça TMS, da Silva Costa F, Rolnik DL, Diniz ALD. Ophthalmic artery Doppler in the complementary diagnosis of preeclampsia: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:343. [PMID: 37173625 PMCID: PMC10176747 DOI: 10.1186/s12884-023-05656-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVE To evaluate the accuracy of different parameters of the ophthalmic artery Doppler (OAD) in the complementary diagnosis of preeclampsia (PE). METHODS This meta-analysis adhered to the PRISMA guidelines. To investigate the mean difference in OAD values, peak systolic velocity (PSV), end-diastolic velocity (EDV), second systolic velocity peak (P2), resistance index (RI), pulsatility index (PI), and peak ratio (PR), between PE cases (overall and according to severity) and controls, random-effects meta-analyses were conducted for each Doppler parameter, with overall PE and mild and severe PE subgroups. Diagnostic performance and heterogeneity were evaluated with summary receiver operating characteristic (sROC) curves and 95% confidence intervals obtained with bivariate models. RESULTS Eight studies stratified the results into mild and severe or late and early PE, involving 1,425 pregnant women. PR and P2 had better diagnostic performance than the other indexes, with the PR of AUsROC at 0.885, the sensitivity of 84%, and specificity of 92%, with a low false-positive rate of 0.08 and the P2 with AUsROC of 0.926, the sensitivity of 85% and specificity of 88%. RI, PI, and EDV showed good performance and consistency across studies but lower AUsROC values of 0.833, 0.794, and 0.772, respectively. CONCLUSION Ophthalmic artery Doppler is a complementary tool with good performance for the diagnosis of overall and severe preeclampsia, with high and best sensitivity and specificity when using PR and P2 parameters.
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Affiliation(s)
- Pollyanna F M Vaz de Melo
- Department of Obstetrics and Gynaecology, Federal University of Uberlândia - UFU, Avenida Pará, 1720, Uberlândia, 38504-320, Minas Gerais, Brasil
| | - Leonardo Roever
- Clinical Research, Federal University of Uberlândia-UFU, Uberlândia, Brazil
| | - Tânia M S Mendonça
- Medical School of Federal, University of Uberlândia-UFU, Uberlândia, Brazil
| | - Fabrício da Silva Costa
- Maternal Fetal Medicine Unit, Gold Coast University Hospital and School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Daniel Lorber Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Angélica L D Diniz
- Clinical Research, Federal University of Uberlândia-UFU, Uberlândia, Brazil.
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Mansukhani T, Arechvo A, Cecchini F, Breim M, Wright A, Nicolaides KH, Charakida M. Vascular phenotype at 35-37 weeks' gestation in women with gestational diabetes mellitus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:386-391. [PMID: 36173400 DOI: 10.1002/uog.26077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To examine the vascular phenotype at 35-37 weeks' gestation of women with gestational diabetes mellitus (GDM) and compare it to that in women without GDM, using ophthalmic artery Doppler and carotid-femoral pulse-wave velocity. METHODS This was a prospective observational study of women attending for a routine hospital visit at 35 + 0 to 37 + 6 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, ophthalmic artery Doppler for calculation of the peak systolic velocity (PSV) ratio and assessment of cardiac output, stroke volume, total peripheral resistance, central systolic and diastolic blood pressure, carotid-femoral pulse-wave velocity and augmentation index. All measurements were standardized to remove the effects of maternal characteristics and elements from the medical history, and the adjusted values in the GDM group were compared with those in the non-GDM group. RESULTS The study population of 2018 pregnancies contained 218 (10.8%) that developed GDM, including 78 (35.8%) that were treated with diet alone, 81 (37.2%) treated with metformin and 59 (27.1%) treated with insulin with or without metformin. In the GDM group, compared with the non-GDM group, there were significantly higher ophthalmic artery PSV ratio, carotid-femoral pulse-wave velocity and central systolic blood pressure, but there was no significant difference in cardiac output, stroke volume, total peripheral resistance, central diastolic blood pressure or augmentation index. In the GDM group, women treated with metformin or insulin had a higher ophthalmic artery PSV ratio compared with those treated with diet alone. Additionally, compared with the diet group, the metformin group had higher central systolic blood pressure and the insulin group had a higher carotid-femoral pulse-wave velocity. CONCLUSION Women with GDM have evidence of early vascular disease, and this may contribute to their long-term cardiovascular risk. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T Mansukhani
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
| | - A Arechvo
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
| | - F Cecchini
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
| | - M Breim
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
| | - M Charakida
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Kusuma RA, Nurdiati DS, Al Fattah AN, Danukusumo D, Abdullah S, Sini I. Ophthalmic artery Doppler for pre-eclampsia prediction at the first trimester: a Bayesian survival-time model. J Ultrasound 2023; 26:155-162. [PMID: 35917093 PMCID: PMC10063770 DOI: 10.1007/s40477-022-00697-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To develop a Bayesian survival-time model for the prediction of pre-eclampsia (PE) at the first trimester using a combination of established biomarkers including maternal characteristics and history, mean arterial pressure (MAP), uterine artery Doppler pulsatility index (UtA-PI), and Placental Growth Factor (PlGF)) with an ophthalmic artery Doppler peak ratio (PR) analysis. METHODS The receiving operator curve (ROC) analysis was used to determine the area under the curve (AUC), detection rate (DR), and positive screening cut-off value of the model in predicting the occurrence of early-onset PE (< 34 weeks' gestation) and preterm PE (< 37 weeks' gestation). RESULTS Of the 946 eligible participants, 71 (7.49%) subjects were affected by PE. The incidences of early-onset and preterm PE were 1% and 2.2%, respectively. At a 10% false-positive rate, using the high-risk cut-off 1:49, with AUC 0.981 and 95%CI 0.965-0.998, this model had an 100% of DR in predicting early-onset PE. The DR of this model in predicting preterm PE is 71% when using 1:13 as the cut-off, with AUC 0.919 and 95%CI 0.875-0.963. CONCLUSION Combination ophthalmic artery Doppler PR with the previously established biomarkers could improve the accuracy of early and preterm PE prediction at the first trimester screening.
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Affiliation(s)
- Raden Aditya Kusuma
- Department of Obstetrics and Gynecology, Harapan Kita National Women and Children Hospital, Letjen S. Parman Street, Number Kav 87, Palmerah, West Jakarta, 11420 Jakarta, Indonesia
- Indonesian Prenatal Institute, Jakarta, Indonesia
| | - Detty Siti Nurdiati
- Department of Obstetrics and Gynecology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Adly Nanda Al Fattah
- Indonesian Prenatal Institute, Jakarta, Indonesia
- Kosambi Maternal and Children Center, Jakarta, Indonesia
| | - Didi Danukusumo
- Department of Obstetrics and Gynecology, Harapan Kita National Women and Children Hospital, Letjen S. Parman Street, Number Kav 87, Palmerah, West Jakarta, 11420 Jakarta, Indonesia
| | - Sarini Abdullah
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, Universitas Indonesia, Jakarta, Indonesia
| | - Ivan Sini
- Morula IVF Jakarta Clinic, Jakarta, Indonesia
- IRSI Research and Training Centre, Jakarta, Indonesia
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Dai X, Kang L, Ge H. Doppler parameters of ophthalmic artery in women with preeclampsia: A meta-analysis. J Clin Hypertens (Greenwich) 2022; 25:5-12. [PMID: 36495167 PMCID: PMC9832230 DOI: 10.1111/jch.14611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022]
Abstract
Preeclampsia is a progressive and severe cardiovascular disorder in pregnant women. To determine the potential significance of ophthalmic Doppler parameters in preeclamptic women and to provide evidence-based hints for clinical practice and scientific investigation. We searched PubMed, Embase, Web of Science, and the Cochrane Library till July 31, 2022. Pooled standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated using the random effects model. Heterogeneity across included studies was evaluated utilizing the Q test and I2 statistic. We identified 8 observational studies that met the inclusion criteria. The pooled SMD for peak systolic velocities (PSV) was .12 (95% CI: -.82, 1.06, p = .8071; I2 = 94%, p < .0001). The overall SMD for time-averaged mean peak velocities (MV) was 1.79 (95% CI: .87, 2.71, p = .0001; I2 = 60%, p = .1152). Regarding the pulsatility index (PI), the pooled SMD was -2.05 (95% CI: -3.12, -.98, p = .0002; I2 = 92%, p < .0001). Overall SMD for end-diastolic velocities (EDV) was 1.11 (95% CI: .23, 1.98, p = .0136; I2 = 92%, p < .0001). The pooled SMDs for resistance index (RI) and peak ratio (PR) was -.18 (95% CI: -1.90, 1.53, p = .8333; I2 = 96%, p < .0001) and 1.46 (95% CI: -1.30, 4.22, p = .2994; I2 = 99%, p < .0001), respectively. Publication bias was not identified. MV, PI, and EDV showed significant differences between patients with preeclampsia and non-hypertensive pregnant participants. Studies on the predictive performance of ophthalmic artery Doppler parameters are warranted.
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Affiliation(s)
- Xinxin Dai
- Department of Ultrasound MedicineBeijing Chaoyang HospitalCapital Medical UniversityBeijingChina
| | - Li Kang
- Department of Ultrasound MedicineBeijing Chaoyang HospitalCapital Medical UniversityBeijingChina
| | - Huiyu Ge
- Department of Ultrasound MedicineBeijing Chaoyang HospitalCapital Medical UniversityBeijingChina
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Kusuma RA, Nurdiati DS, Wilopo SA. Alternatives of Risk Prediction Models for Preeclampsia in a Low Middle-Income Setting. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
Objectives: To develop prediction models for the first-trimester prediction of PE (PE) using the established biomarkers including maternal characteristics and history, mean arterial pressure (MAP), uterine artery Doppler pulsatility index (UtA-PI ), and Placental Growth Factor (PlGF)) in combination with Ophthalmic artery Doppler peak ratio (PR).
Methods: This was a prospective observational study in women attending a first-trimester screening at 11-14 weeks’ gestation. Maternal characteristics and history, measurement of MAP, ultrasound examination for UtA-PI measurement, maternal ophthalmic PR Doppler measurement, and serum PlGF collection were performed during the visit. Logistic regression analysis was used to determine if the maternal factor had a significant contribution in predicting PE. The Receiving Operator Curve (ROC) analysis was used to determine the area under the curve (AUC), positive predictive value (PPV), negative prefictive value (NPV) and positive screening cut-off in predicting the occurrence of PE at any gestational age.
Results: Of the 946 eligible participants, 71 (7,49%) subjects were affected by PE. Based on the ROC curves, optimal high-risk cutoff value for prediction of preeclampsia at any gestational age for model 2 (primary care model) in this Indonesia study population were 63% with the sensitivity and specificity of 71.8% and 71.2%, respectively. Both sensitivity and specificity for model 3 (complete model) were 70.4% and 74.9%, respectively for the cutoff value 58%. The area under the curve of model 2, model 3 was 0.7651 (95% CI: 0.7023-0.8279)) and 0.7911 (95% CI: 0.7312-0.8511), respectively, for predicting PE. In addition, PPV and NPV for model 2 were 16.8% and 96.9%, respectively. PPV and NPV for model 3 were 18.55 and 96.9%, respectively.
Conclusion: The prediction models of preeclampsia vary depending upon healthcare resource. Complete model is clinically superior to primary care model but it is not statistically significant. Prognostic models should be easy to use, informative and low cost with great potential to improve maternal and neonatal health in Low Middle Income Country settings.
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Reddy M, Palmer K, Rolnik DL, Wallace EM, Mol BW, Da Silva Costa F. Role of placental, fetal and maternal cardiovascular markers in predicting adverse outcome in women with suspected or confirmed pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:596-605. [PMID: 34985800 DOI: 10.1002/uog.24851] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/14/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To assess the performance of placental, fetal and maternal cardiovascular markers in the prediction of adverse perinatal and maternal outcomes in women with suspected or confirmed pre-eclampsia. METHODS This was a prospective prognostic accuracy study of women with suspected or confirmed pre-eclampsia who underwent a series of investigations to measure maternal hemodynamic indices, mean arterial pressure, augmentation index, ophthalmic artery peak systolic velocity (PSV) ratio, uterine artery pulsatility index (UtA-PI), fetal biometric and Doppler parameters, soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF). The performance of these markers, individually or in combination, in predicting adverse perinatal and maternal outcomes was then assessed using receiver-operating-characteristics (ROC)-curve analysis. Adverse maternal outcome was defined as one or more of severe hypertension, admission to the intensive care unit, eclampsia, placental abruption, HELLP syndrome, disseminated intravascular coagulation, platelets < 100 × 109 /L, creatinine > 90 μmol/L and alanine aminotransferase > 100 U/L. Adverse perinatal outcome was defined as one or more of preterm birth at or before 34 + 0 weeks, neonatal intensive care unit admission for > 48 h, respiratory distress syndrome, intraventricular hemorrhage, hypoxic ischemic encephalopathy, necrotizing enterocolitis, retinopathy of prematurity and confirmed fetal infection. RESULTS We recruited 126 women with suspected (n = 31) or confirmed (n = 95) pre-eclampsia at a median gestational age of 33.9 weeks (interquartile range, 30.9-36.3 weeks). Pregnancies with adverse perinatal outcome compared to those without had a higher median UtA-PI (1.3 vs 0.8; P < 0.001), ophthalmic artery PSV ratio (0.8 vs 0.7; P = 0.01) and umbilical artery PI percentile (82.0 vs 68.5; P < 0.01) and lower median estimated fetal weight percentile (4.0 vs 43.0; P < 0.001), abdominal circumference percentile (4.0 vs 63.0; P < 0.001), middle cerebral artery PI percentile (28.0 vs 58.5; P < 0.001) and cerebroplacental ratio percentile (18.0 vs 46.5; P < 0.001). Pregnancies with adverse perinatal outcome also had a higher median sFlt-1 (8208.0 pg/mL vs 4508.0 pg/mL; P < 0.001), lower PlGF (27.2 pg/mL vs 76.3 pg/mL; P < 0.001) and a higher sFlt-1/PlGF ratio (445.4 vs 74.4; P < 0.001). The best performing individual marker for predicting adverse perinatal outcome was the sFlt-1/PlGF ratio (area under the ROC curve (AUC), 0.87 (95% CI, 0.81-0.93)), followed by estimated fetal weight (AUC, 0.81 (95% CI, 0.73-0.89)). Women who experienced adverse maternal outcome had a higher median sFlt-1 level (7471.0 pg/mL vs 5131.0 pg/mL; P < 0.001) and sFlt-1/PlGF ratio (204.3 vs 93.3; P < 0.001) and a lower PlGF level (37.0 pg/mL vs 66.1 pg/mL; P = 0.01) and estimated fetal weight percentile (16.5 vs 37.0; P = 0.04). All markers performed poorly in predicting adverse maternal outcome, with sFlt-1 (AUC, 0.69 (95% CI, 0.60-0.79)) and sFlt-1/PlGF ratio (AUC, 0.69 (95% CI, 0.59-0.78)) demonstrating the best individual performance. The addition of cardiovascular, fetal or other placental indices to the sFlt-1/PlGF ratio did not improve the prediction of adverse maternal or perinatal outcomes. CONCLUSIONS The sFlt-1/PlGF ratio performs well in predicting adverse perinatal outcomes but is a poor predictor of adverse maternal outcomes in women with suspected or diagnosed pre-eclampsia. The addition of cardiovascular or fetal indices to the model is unlikely to improve the prognostic performance of the sFlt-1/PlGF ratio. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Reddy
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Monash Women's, Monash Health, Clayton, Victoria, Australia
| | - K Palmer
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Monash Women's, Monash Health, Clayton, Victoria, Australia
| | - D L Rolnik
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Monash Women's, Monash Health, Clayton, Victoria, Australia
| | - E M Wallace
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - B W Mol
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - F Da Silva Costa
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Maternal Fetal Medicine Unit, Gold Coast University Hospital and School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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11
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Lau KG, Baloi M, Dumitrascu-Biris D, Nicolaides KH, Kametas NA. Changes in ophthalmic artery Doppler during acute blood-pressure control in hypertensive pregnant women. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:185-191. [PMID: 34358385 DOI: 10.1002/uog.23755] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To examine the changes in ophthalmic artery Doppler indices and their association with changes in mean arterial blood pressure (MAP) and systolic (SBP) and diastolic (DBP) blood pressure, following acute antihypertensive treatment in women with hypertensive disorders of pregnancy presenting with high blood pressure. METHODS This was a prospective cohort study of 31 pregnant women presenting at 30 + 0 to 39 + 6 weeks' gestation for management of their hypertension. Paired maternal blood-pressure and ophthalmic-artery-Doppler measurements were performed prior to and at 30 min and 60 min after starting antihypertensive medication. In patients who did not achieve blood-pressure control (i.e. when blood pressure was < 140/90 mmHg) by 60 min, paired readings were continued up to 120 min. If blood-pressure control was still not achieved at that point, patients were admitted to hospital. Univariate linear regression was performed to determine the association of ophthalmic artery peak systolic velocity (PSV) ratio with SBP, DBP and MAP before treatment and after blood-pressure control. The longitudinal changes in MAP, SBP, DBP and PSV ratio from pretreatment to 30 min and 60 min after commencement of antihypertensives were examined by repeated measure, multilevel, linear mixed-effects analysis. RESULTS Antihypertensive treatment was associated with a decrease in SBP, DBP, MAP and PSV ratio. At 60 min following antihypertensive treatment, the decrease in SBP, DBP, MAP and PSV ratio was 12.1 mmHg (95% CI, 9.0-15.1 mmHg; P < 0.0001), 9.1 mmHg (95% CI, 6.5-11.5 mmHg; P < 0.0001), 10.0 mmHg (95% CI, 7.6-12.4 mmHg; P < 0.0001) and 0.07 (95% CI, 0.03-0.11 mmHg; P < 0.001), respectively. From the total cohort, 20 (64.5%) women had achieved blood-pressure control at 60 min and another seven (22.6%) by 120 min from commencement of antihypertensive treatment. Four (12.9%) women did not achieve blood-pressure control during this period and were admitted to hospital. The relationship between PSV ratio and SBP, DBP and MAP was assessed before treatment (n = 31) and at the point of blood-pressure control in women in whom this was achieved by 120 min (n = 27). Prior to treatment, there was a significant association between PSV ratio and MAP (P < 0.0001, R2 = 0.39). This was primarily due to the association of PSV ratio with DBP (P < 0.0001, R2 = 0.39) and less so due to its association with SBP (P = 0.02, R2 = 0.16). At the point of achieving blood-pressure control, there was no significant association between PSV ratio and MAP (P = 0.7), DBP (P = 0.5) or SBP (P = 0.7). CONCLUSIONS Acute blood-pressure control in pregnancy is associated with a concomitant reduction in blood pressure and ophthalmic artery PSV ratio. In hypertensive pregnant women, there is a significant association of PSV ratio with MAP, SBP and DBP, which disappears after blood pressure is reduced to < 140/90 mmHg following antihypertensive treatment. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- K G Lau
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- Antenatal Hypertension Clinic, King's College Hospital, London, UK
| | - M Baloi
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- Antenatal Hypertension Clinic, King's College Hospital, London, UK
| | - D Dumitrascu-Biris
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- Antenatal Hypertension Clinic, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - N A Kametas
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- Antenatal Hypertension Clinic, King's College Hospital, London, UK
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12
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Diniz ALD, Menêses VFSDC, Freitas MARD, Paes MMBM, Naves WU, Sass N. Performance of ophthalmic artery Doppler velocimetry in the complementary diagnosis of preeclampsia. J Matern Fetal Neonatal Med 2022; 35:9078-9085. [PMID: 35099350 DOI: 10.1080/14767058.2021.2014452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To calculate the accuracy (A) and establish the best cutoff value for ophthalmic artery (OA) Doppler velocimetry indexes in patients diagnosed with preeclampsia (PE), compared with healthy pregnant women. METHODS This prospective experimental study enrolled 268 women: 133 with PE and 135 healthy pregnant women. All patients were evaluated by OA Doppler sonography, bilaterally, to assess their pulsatility index (PI), resistance index (RI), peak systolic velocity (PVS), second peak systolic velocity (P2), end-diastolic velocity (EDV), and peak ratio (PR). Means were compared using Student's T-test. Receiver Operating Characteristics (ROC) curve was used to establish the cutoff value and estimate the sensitivity (S), specificity (Sp), accuracy (A) of all variables, and a significance of 95% was adopted. RESULTS ROC curve analysis showed that P2 and PR were superior to the other parameters for PE diagnosis. We tested two cutoff values: (1) using PR ≥0.70, obtained A: 88.72%, S: 81.95%, and Sp: 95.48% and (2) using PR ≥0.75, and A: 86.24%, S: 74.43%, and Sp: 99.24%. By adopting P2 ≥ 21.5 cm/s, we obtained A: 87.59%, S: 84.96%, and Sp: 90.22% and when the cutoff point was P2 ≥ 22 cm/s, there was a slight decrease in A to 86.46% and S to 81.20%, with Sp: 91.89.3%. CONCLUSION Ophthalmic artery Doppler demonstrated to be an effective and high-performance imaging method for the diagnosis of PE and the indexes P2 and PR demonstrated superior accuracy to the other Doppler parameters assessed. Higher performance occurred when the cutoff values with greater specificity were adopted, PR ≥ 0.75 and P2 ≥ 22 cm/s, considering that the proposed OA Doppler is to be a complementary method for preeclampsia.
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Affiliation(s)
- Angélica Lemos Debs Diniz
- Department of Gynecology and Obstetrics at Federal, University of Uberlândia-UFU, Uberlândia, Brazil
| | | | | | | | - Welington Ued Naves
- Department of Obstetrics at Federal, University of São Paulo-UNIFESP, Rua Napoleão de Barros, São Paulo, Brazil
| | - Nelson Sass
- Department of Obstetrics at Federal, University of São Paulo-UNIFESP, Rua Napoleão de Barros, São Paulo, Brazil
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13
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Paes MMBM, Martins LMM, Diniz ALD. A sex specific approach of ophthalmic and middle cerebral arteries Doppler in smokers. Sci Rep 2021; 11:21719. [PMID: 34741061 PMCID: PMC8571273 DOI: 10.1038/s41598-021-00503-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/11/2021] [Indexed: 11/09/2022] Open
Abstract
Vascular dysfunctions can progress and lead to stroke and cardiovascular disease, especially in smokers. The presence of particular vascular changes according to sex has been described and they can be identified by the Doppler method. This study evaluated Doppler velocimetry parameters of the Ophthalmic Artery (OA) and the Middle Cerebral Artery (MCA) according to sex in smokers regarding a non-smoker group. This cross-sectional observational study included 178 subjects: 93 women and 85 men. Doppler parameters were assessed in OA and MCA. Student's t-test was used, with p < 0.05. There were no significant differences in OA and MCA Doppler velocimetry data between male non-smokers and smokers. However, female smokers presented several differences compared with non-smokers: lower pulsatility index (PI) and higher peak ratio in OA, and higher PI and resistance index and lower end diastolic velocity in MCA. There were different brain vascular waveforms in the group of female smokers compared with non-smokers. Cigarette smoking also led to opposite arterial patterns in OA and MCA in the female group, with signs of falling impedance in OA and increased impedance in MCA. An individualized approach regarding arterial changes according to sex is desirable.
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Affiliation(s)
- Maria Marta B M Paes
- Department of Ultrasound, Clinical Hospital of the Federal University of Uberlândia, State of Minas Gerais, Brazil
| | | | - Angélica L D Diniz
- Department of Gynecology and Obstetrics, Clinical Hospital of the Federal University of Uberlândia, Av. Pará, SN - Umuarama, Uberlândia - MG, State of Minas Gerais, 38405-320, Brazil.
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14
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Sarno M, Wright A, Vieira N, Sapantzoglou I, Charakida M, Nicolaides KH. Ophthalmic artery Doppler in combination with other biomarkers in prediction of pre-eclampsia at 35-37 weeks' gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:600-606. [PMID: 33073902 DOI: 10.1002/uog.23517] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/01/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- M Sarno
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- Department of Obstetrics and Gynecology, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - N Vieira
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - I Sapantzoglou
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - M Charakida
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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15
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Sapantzoglou I, Wright A, Arozena MG, Campos RV, Charakida M, Nicolaides KH. Ophthalmic artery Doppler in combination with other biomarkers in prediction of pre-eclampsia at 19-23 weeks' gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:75-83. [PMID: 33142353 DOI: 10.1002/uog.23528] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/18/2020] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- I Sapantzoglou
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - M Gallardo Arozena
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - R Vallenas Campos
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - M Charakida
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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16
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Sarno M, Wright A, Vieira N, Sapantzoglou I, Charakida M, Nicolaides KH. Ophthalmic artery Doppler in prediction of pre-eclampsia at 35-37 weeks' gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:717-724. [PMID: 32857890 DOI: 10.1002/uog.22184] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- M Sarno
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
- Department of Obstetrics and Gynecology, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - N Vieira
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
| | - I Sapantzoglou
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
| | - M Charakida
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
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17
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Kane SC, Dennis AT, Da Silva Costa F, Kornman LH, Cade TJ, Brennecke SP. Optic nerve sonography and ophthalmic artery Doppler velocimetry in healthy pregnant women: an Australian cohort study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:531-539. [PMID: 31087684 DOI: 10.1002/jcu.22735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/11/2019] [Accepted: 05/04/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE Maternal ocular sonography offers a window into cerebrovascular and intracranial pressure changes in pregnancy. This study aimed to determine the Doppler velocimetric variables of the ophthalmic artery, and the mean diameter of the optic nerve sheath (ONSD), in an Australian cohort of healthy pregnant women. METHODS A prospective observational cohort study of healthy women with uncomplicated singleton pregnancies in the third trimester was undertaken in a tertiary maternity service. A single prenatal ultrasonographic examination was performed on all participants, with a postnatal examination performed on a subgroup with uncomplicated deliveries. RESULTS Fifty women were examined at a mean gestation of 35 weeks. The mean ± SD Doppler variables in the ophthalmic artery were peak systolic velocity (PSV) 41.89 ± 13.13 cm/s, second peak velocity 20.63 ± 8.97 cm/s, end diastolic velocity 9.29 ± 5.13 cm/s, pulsatility index 1.97 ± 0.53, resistive index 0.78 ± 0.07, peak ratio (second peak velocity/PSV) 0.49 ± 0.12, while the mean ONSD was 4.34 ± 0.4 mm. None of these variables had a demonstrable relationship with gestation or mean arterial pressure (MAP), nor did the sheath diameter have a relationship with any of the Doppler variables. CONCLUSIONS The ocular sonographic variables observed in this population are similar to those reported in other cohorts. No clear relationship could be identified in this cohort between ophthalmic artery Doppler variables and the ONSD, and between each of these variables and gestation or MAP.
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Affiliation(s)
- Stefan C Kane
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Department of Maternal Fetal Medicine, Pregnancy Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
- Ultrasound Service, Pauline Gandel Women's Imaging Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Alicia T Dennis
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Department of Anaesthesia, The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Medicine and Radiology, The University of Melbourne, Parkville, Victoria, Australia
- Department of Pharmacology and Therapeutics, The University of Melbourne, Parkville, Victoria, Australia
| | - Fabrício Da Silva Costa
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Departamento de Ginecologia e Obstetricia, Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Estado de São Paulo, Brazil
| | - Louise H Kornman
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Department of Maternal Fetal Medicine, Pregnancy Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
- Ultrasound Service, Pauline Gandel Women's Imaging Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Thomas J Cade
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Department of Maternal Fetal Medicine, Pregnancy Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Shaun P Brennecke
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Department of Maternal Fetal Medicine, Pregnancy Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
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Are There Differences in the Anthropometric, Hemodynamic, Hematologic, and Biochemical Profiles between Late- and Early-Onset Preeclampsia? Obstet Gynecol Int 2018; 2018:9628726. [PMID: 29686709 PMCID: PMC5852893 DOI: 10.1155/2018/9628726] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/13/2017] [Accepted: 01/04/2018] [Indexed: 12/19/2022] Open
Abstract
Preeclampsia (PE) is classified as early-onset PE (EOPE) and late-onset PE (LOPE) when present before or after 34 weeks of gestation, respectively. This transversal study aimed to investigate the differences and possible associations existing in the anthropometric, hemodynamic, hematologic, and biochemical profiles of late- and early-onset preeclampsia. The study included 65 volunteers admitted to a tertiary hospital in Brazil: 29 normotensive and 36 with preeclampsia (13 with EOPE and 23 with LOPE). Pregnant women with LOPE presented greater weight gain and borderline increase in body mass index at the end of gestation in relation to the other groups, which is compatible with the metabolic origin, associated with obesity, attributed to this form of the disease. Pregnant women with EOPE presented a borderline reduction in the number of erythrocytes and a significant decrease in the number of platelets, in addition to a significant increase in reticulocytes, serum iron, and ferritin when compared to normotensive pregnant women and pregnant women with LOPE. A significant increase in osmotic stability of erythrocytes was observed in the EOPE group in relation to other groups. Hemodynamic analysis by Doppler ultrasonography of the ophthalmic artery showed that both groups of pregnant women with PE presented alterations compatible with the occurrence of hyperflow in the orbital territory. These hemodynamic changes were associated with changes in hematimetric indices.
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Ferhi F, Khlifi A, Hachani F, Tarmiz K, Benjazia K. Ultrasound assessment of visual loss during severe preeclampsia: a case report. Crit Ultrasound J 2018; 10:6. [PMID: 29435677 PMCID: PMC5809623 DOI: 10.1186/s13089-018-0087-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 01/27/2018] [Indexed: 01/04/2023] Open
Abstract
Bilateral retinal detachments and cortical blindness are rare complications of preeclampsia and the association of the two pathologies is exceptional. We report the case of a preeclamptic patient who presented with an acute bilateral vision loss. Besides, her ocular ultrasound revealed bilateral retinal detachments and an elevated optic nerve sheath diameter. The patient underwent an urgent cesarean section. Subsequently, magnetic resonance imaging and ocular fundus examination confirmed the diagnosis.
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Affiliation(s)
- Fehmi Ferhi
- Department of Anaesthesiology and Critical Care Medicine, Farhat Hached University Hospital Center, 4002, Sousse, Tunisia. .,The Research Unit on Maternal Morbidity and Mortality UR17SP08, Sousse, Tunisia. .,Ibn Jazzar Medical School Sousse, Avenue Mohamed El Karoui, 4002, Sousse, Tunisia.
| | - Abdeljalil Khlifi
- Ibn Jazzar Medical School Sousse, Avenue Mohamed El Karoui, 4002, Sousse, Tunisia.,Department of Obstetrics and Gynaecology, Farhat Hached University Hospital Center, 4002, Sousse, Tunisia
| | - Feten Hachani
- Ibn Jazzar Medical School Sousse, Avenue Mohamed El Karoui, 4002, Sousse, Tunisia.,Department of Obstetrics and Gynaecology, Farhat Hached University Hospital Center, 4002, Sousse, Tunisia
| | - Khalil Tarmiz
- Department of Anaesthesiology and Critical Care Medicine, Farhat Hached University Hospital Center, 4002, Sousse, Tunisia.,The Research Unit on Maternal Morbidity and Mortality UR17SP08, Sousse, Tunisia.,Ibn Jazzar Medical School Sousse, Avenue Mohamed El Karoui, 4002, Sousse, Tunisia
| | - Khaled Benjazia
- Department of Anaesthesiology and Critical Care Medicine, Farhat Hached University Hospital Center, 4002, Sousse, Tunisia.,The Research Unit on Maternal Morbidity and Mortality UR17SP08, Sousse, Tunisia.,Ibn Jazzar Medical School Sousse, Avenue Mohamed El Karoui, 4002, Sousse, Tunisia
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20
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Choroidal Thickness in Women with Uncomplicated Pregnancy: Literature Review. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5694235. [PMID: 29250544 PMCID: PMC5700513 DOI: 10.1155/2017/5694235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/09/2017] [Indexed: 11/24/2022]
Abstract
Pregnancy is a time when many changes occur in a woman's body. The goal of these changes is the provision of optimum conditions for the development of the foetus. Pregnancy also affects eye physiology. Well recognized physiological changes include a reduced corneal sensitivity, an increase in its central thickness and curvature, and a decrease in intraocular pressure. The association between choroidal thickness and pregnancy is not clear. Haemodynamic and hormonal changes taking place during pregnancy and the question of whether these changes are reflected by choroidal thickness are especially important. It is assumed that the choroid, which is one of the most highly vascularized tissues characterized by the highest blood flow to tissue volume ratio in the whole body, should respond by an increase in its thickness to an increase in blood flow and drop in the value of peripheral resistance. Measurement of choroidal thickness using enhanced depth imaging optical coherence tomography (EDI-OCT) in women with uncomplicated pregnancy provides important information concerning the effects of physiological changes in the eye.
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21
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Maternal ophthalmic artery Doppler ultrasonography in preeclampsia and pregnancy outcomes. Pregnancy Hypertens 2017; 10:242-246. [DOI: 10.1016/j.preghy.2017.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 09/16/2017] [Accepted: 10/14/2017] [Indexed: 01/19/2023]
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22
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Arabin B, Baschat AA. Pregnancy: An Underutilized Window of Opportunity to Improve Long-term Maternal and Infant Health-An Appeal for Continuous Family Care and Interdisciplinary Communication. Front Pediatr 2017; 5:69. [PMID: 28451583 PMCID: PMC5389980 DOI: 10.3389/fped.2017.00069] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/20/2017] [Indexed: 12/21/2022] Open
Abstract
Physiologic adaptations during pregnancy unmask a woman's predisposition to diseases. Complications are increasingly predicted by first-trimester algorithms, amplify a pre-existing maternal phenotype and accelerate risks for chronic diseases in the offspring up to adulthood (Barker hypothesis). Recent evidence suggests that vice versa, pregnancy diseases also indicate maternal and even grandparent's risks for chronic diseases (reverse Barker hypothesis). Pub-Med and Embase were reviewed for Mesh terms "fetal programming" and "pregnancy complications combined with maternal disease" until January 2017. Studies linking pregnancy complications to future cardiovascular, metabolic, and thrombotic risks for mother and offspring were reviewed. Women with a history of miscarriage, fetal growth restriction, preeclampsia, preterm delivery, obesity, excessive gestational weight gain, gestational diabetes, subfertility, and thrombophilia more frequently demonstrate with echocardiographic abnormalities, higher fasting insulin, deviating lipids or clotting factors and show defective endothelial function. Thrombophilia hints to thrombotic risks in later life. Pregnancy abnormalities correlate with future cardiovascular and metabolic complications and earlier mortality. Conversely, women with a normal pregnancy have lower rates of subsequent diseases than the general female population creating the term: "Pregnancy as a window for future health." Although the placenta works as a gatekeeper, many pregnancy complications may lead to sickness and earlier death in later life when the child becomes an adult. The epigenetic mechanisms and the mismatch between pre- and postnatal life have created the term "fetal origin of adult disease." Up to now, the impact of cardiovascular, metabolic, or thrombotic risk profiles has been investigated separately for mother and child. In this manuscript, we strive to illustrate the consequences for both, fetus and mother within a cohesive perspective and thus try to demonstrate the complex interrelationship of genetics and epigenetics for long-term health of societies and future generations. Maternal-fetal medicine specialists should have a key role in the prevention of non-communicable diseases by implementing a framework for patient consultation and interdisciplinary networks. Health-care providers and policy makers should increasingly invest in a stratified primary prevention and follow-up to reduce the increasing number of manifest cardiovascular and metabolic diseases and to prevent waste of health-care resources.
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Affiliation(s)
- Birgit Arabin
- Center for Mother and Child, Philipps University, Marburg, Germany
- Clara Angela Foundation, Witten, Germany
| | - Ahmet A. Baschat
- Clara Angela Foundation, Witten, Germany
- Center for Fetal Therapy, Johns Hopkins University, Baltimore, MD, USA
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23
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Ghossein-Doha C, Khalil A, Lees CC. Maternal hemodynamics: a 2017 update. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:10-14. [PMID: 28058786 DOI: 10.1002/uog.17377] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- C Ghossein-Doha
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre (MUMC) & Cardiology Department, Zuyderland Medisch Centrum Heerlen, Maastricht, The Netherlands
| | - A Khalil
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University of London, London, UK
| | - C C Lees
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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24
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Thilaganathan B. Placental syndromes: getting to the heart of the matter. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:7-9. [PMID: 28067440 DOI: 10.1002/uog.17378] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- B Thilaganathan
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London and St George's University Hospitals NHS Foundation Trust, London, UK
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