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Arechvo A, Wright A, Nobile Recalde A, Liandro R, Charakida M, Nicolaides KH. Ophthalmic artery Doppler and biomarkers of impaired placentation at 36 weeks' gestation in pregnancies with small fetuses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:358-364. [PMID: 37902727 DOI: 10.1002/uog.27521] [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: 10/02/2023] [Revised: 10/15/2023] [Accepted: 10/19/2023] [Indexed: 10/31/2023]
Abstract
OBJECTIVES First, to compare ophthalmic artery peak systolic velocity (PSV) ratio and biomarkers of impaired placentation at 36 weeks' gestation in women who delivered a small-for-gestational-age (SGA) or growth-restricted (FGR) neonate, in the absence of hypertensive disorder, with those of women who developed pre-eclampsia (PE) or gestational hypertension (GH) and of women unaffected by SGA, FGR, PE or GH. Second, to examine the associations of PSV ratio, uterine artery pulsatility index (UtA-PI), placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) with birth-weight Z-score or percentile. METHODS This was a prospective observational study of women with a singleton pregnancy 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 of fetal anatomy and growth, and measurement of maternal ophthalmic artery PSV ratio, UtA-PI, PlGF and sFlt-1. Values of PSV ratio, UtA-PI, PlGF and sFlt-1 were converted to multiples of the median (MoM) or delta values. Median MoM or deltas of these biomarkers in the SGA, FGR, PE and GH groups were compared with those in the unaffected group. Regression analysis was used to examine the relationship of PSV ratio delta, UtA-PI MoM, PlGF MoM and sFlt-1 MoM with birth-weight Z-score, after exclusion of PE and GH cases. RESULTS The study population of 9033 pregnancies included 7696 (85.2%) that were not affected by FGR, SGA, PE or GH, 182 (2.0%) complicated by FGR in the absence of PE or GH, 698 (7.7%) with SGA in the absence of FGR, PE or GH, 236 (2.6%) with PE and 221 (2.4%) with GH. Compared with unaffected pregnancies, in the FGR and SGA groups, the PSV ratio delta and sFlt-1 MoM were increased and PlGF MoM was decreased; UtA-PI MoM was increased in the FGR group but not the SGA group. The magnitude of the changes in biomarker values relative to the unaffected group was smaller in the FGR and SGA groups than that in the PE and GH groups. In non-hypertensive pregnancies, there were significant inverse associations of PSV ratio delta and UtA-PI MoM with birth-weight Z-score, such that the values were increased in small babies and decreased in large babies. There was a quadratic relationship between PlGF MoM and birth-weight Z-score, with low PlGF levels in small babies and high PlGF levels in large babies. There was no significant association between sFlt-1 MoM and birth-weight Z-score. CONCLUSIONS Ophthalmic artery PSV ratio, reflective of peripheral vascular resistance, and UtA-PI, PlGF and sFlt-1, biomarkers of impaired placentation, are altered in pregnancies complicated by hypertensive disorder and, to a lesser extent, in non-hypertensive pregnancies delivering a SGA or FGR neonate. The associations between the biomarkers and birth-weight Z-score suggest the presence of a continuous physiological relationship between fetal size and peripheral vascular resistance and placentation, rather than a dichotomous relationship of high peripheral resistance and impaired placentation in small compared to non-small fetuses. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Arechvo
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - A Nobile Recalde
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - R Liandro
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - M Charakida
- Fetal Medicine Research Institute, King's College Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
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Springer S, Worda K, Franz M, Karner E, Krampl-Bettelheim E, Worda C. Fetal Growth Restriction Is Associated with Pregnancy Associated Plasma Protein A and Uterine Artery Doppler in First Trimester. J Clin Med 2023; 12:jcm12072502. [PMID: 37048586 PMCID: PMC10095370 DOI: 10.3390/jcm12072502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Fetal growth restriction (FGR) is a major cause of stillbirth and poor neurodevelopmental outcomes. The early prediction may be important to establish treatment options and improve neonatal outcomes. The aim of this study was to assess the association of parameters used in first-trimester screening, uterine artery Doppler pulsatility index and the development of FGR. In this retrospective cohort study, 1930 singleton pregnancies prenatally diagnosed with an estimated fetal weight under the third percentile were included. All women underwent first-trimester screening assessing maternal serum pregnancy-associated plasma protein A (PAPP-A), free beta-human chorionic gonadotrophin levels, fetal nuchal translucency and uterine artery Doppler pulsatility index (PI). We constructed a Receiver Operating Characteristics curve to calculate the sensitivity and specificity of early diagnosis of FGR. In pregnancies with FGR, PAPP-A was significantly lower, and uterine artery Doppler pulsatility index was significantly higher compared with the normal birth weight group (0.79 ± 0.38 vs. 1.15 ± 0.59, p < 0.001 and 1.82 ± 0.7 vs. 1.55 ± 0.47, p = 0.01). Multivariate logistic regression analyses demonstrated that PAPP-A levels and uterine artery Doppler pulsatility index were significantly associated with FGR (p = 0.009 and p = 0.01, respectively). To conclude, these two parameters can predict FGR < 3rd percentile.
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Affiliation(s)
- Stephanie Springer
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria
| | - Katharina Worda
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence: ; Tel.: +43-140-400-28210
| | - Marie Franz
- Department of Gynecology and Obstetrics, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Eva Karner
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Christof Worda
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria
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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: 2] [Impact Index Per Article: 2.0] [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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Abdel Azim S, Sarno M, Wright A, Vieira N, Charakida M, Nicolaides KH. Ophthalmic artery Doppler at 35-37 weeks' gestation in pregnancies with small or growth-restricted fetuses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:483-489. [PMID: 35000242 DOI: 10.1002/uog.24854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/22/2021] [Accepted: 12/29/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES First, to compare the ophthalmic artery peak systolic velocity (PSV) ratio at 35-37 weeks' gestation among women who delivered small-for-gestational-age (SGA) or growth-restricted (FGR) neonates in the absence of hypertensive disorders, women who developed pre-eclampsia (PE) or gestational hypertension (GH) and those without SGA, FGR, PE or GH. Second, to examine the association of PSV ratio with placental growth factor (PlGF) and mean arterial pressure (MAP). Third, to assess the associations of PSV ratio, PlGF and MAP with birth-weight Z-score and percentile. 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 of fetal anatomy and growth, and measurement of maternal ophthalmic artery PSV ratio, first (PSV1) and second (PSV2) peaks of systolic velocity, MAP and serum PlGF. The values of PSV ratio, MAP and PlGF were converted to multiples of the median (MoM) or delta values, and the median MoM or delta of these variables in the SGA, FGR, PE and GH groups were compared with those in the unaffected group. Regression analysis was used to examine the relationship of PSV ratio delta, PlGF MoM and MAP MoM with birth-weight Z-score after exclusion of PE and GH cases. Regression analysis was also used to examine the association of PSV ratio delta with log10 PlGF MoM and log10 MAP MoM. RESULTS The study population included 2287 pregnancies, of which 1954 (85.4%) were not affected by FGR, SGA, PE or GH, 49 (2.1%) were complicated by FGR in the absence of PE or GH, 160 (7.0%) had SGA in the absence of FGR, PE or GH, 60 (2.6%) had PE and 64 (2.8%) had GH. Compared with unaffected pregnancies, in both the FGR and SGA groups, the means of PSV ratio delta (0.042 (95% CI, 0.007-0.076) and 0.032 (95% CI, 0.016-0.049), respectively) and MAP MoM (1.028 (95% CI, 1.006-1.050) and 1.048 (95% CI, 1.035-1.060), respectively) were increased, while the mean of PlGF MoM was decreased (0.495 (95% CI, 0.393-0.622) and 0.648 (95% CI, 0.562-0.747), respectively). However, the magnitude of these changes was smaller than in the PE and GH groups. Ophthalmic artery waveform analysis revealed that the predominant feature of pregnancies complicated by SGA in the absence of hypertensive disorders was a reduction in PSV1, whereas, in those with hypertensive disorders, there was an increase in PSV2. In non-hypertensive pregnancies, there were linear inverse associations of PSV ratio delta and MAP MoM with birth-weight Z-score, with increased values in small neonates and decreased values in large neonates. There was a quadratic relationship between PlGF MoM and birth-weight Z-score, with low PlGF levels in small neonates and high PlGF levels in large neonates. There was a significant correlation of ophthalmic artery PSV ratio delta with both log10 MAP MoM (0.124 (95% CI, 0.069-0.178)) and log10 PlGF MoM (-0.238 (95% CI, -0.289 to -0.185)). CONCLUSION Assuming that the ophthalmic artery PSV ratio is a reflection of the interplay between cardiac output and peripheral vascular resistance, the linear association between PSV ratio and birth-weight Z-score in non-hypertensive pregnancies suggests the presence of a continuous physiological relationship between fetal size and cardiovascular response rather than a dichotomous relationship between high peripheral resistance and low cardiac output in small compared with non-small fetuses. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Abdel Azim
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- Department of Obstetrics and Gynaecology, Medical University of Innsbruck, Innsbruck, Austria
| | - 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
| | - M Charakida
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, 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 Hospital, London, UK
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Onwudiegwu C, Adekanmi A, Olusanya B, Lawal O, Adedokun B, Morhason-Bello I, Oladokun A. Case-control study on ocular changes and ophthalmic Doppler velocimetric indices among preeclamptic and normotensive pregnant women in Ibadan, Nigeria. BMJ Open Ophthalmol 2020; 5:e000550. [PMID: 32984544 PMCID: PMC7488785 DOI: 10.1136/bmjophth-2020-000550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/10/2020] [Accepted: 08/15/2020] [Indexed: 11/16/2022] Open
Abstract
Objective To compare the ocular changes and Doppler velocimetric indices in preeclamptic and normotensive pregnant women. Methods and analysis This was a case-control study of 71 preeclamptic women and 72 parity-matched normotensive pregnant women conducted at the University College Hospital, Ibadan, Nigeria. Demographic data were obtained using questionnaires. All participants had visual acuity assessment, funduscopy, intraocular pressure measurement and orbital Doppler ultrasonography. The differences in parameters between the two groups were tested using Student’s t-test for quantitative variables and χ2 tests for categorical variables. Results There were no significant differences between cases and controls with respect to sociodemographic variables. The mean pulsatility index was 1.35±0.46 in cases and 2.1±0.4 in controls (p<0.001); the resistivity index was 0.7±0.18 in cases and 0.83±0.27 among the controls (p=0.01). A similar pattern was observed in the peak systolic velocity (p<0.001) and the peak ratio (p<0.001). There was no significant difference between the groups concerning end-diastolic velocity (p=0.535). Three preeclampsia patients (5.2%) had abnormalities on funduscopy compared with none of the controls. Preeclamptic women had significantly higher intraocular pressures in both eyes at baseline and at 24 hours post delivery. Conclusion This study demonstrated lower Doppler velocimetry and impedance parameters and higher intraocular pressure among preeclampsia cases compared with controls. Abnormal funduscopic findings were observed in a few preeclamptic women and none among the controls. Ophthalmic artery Doppler parameters could be useful in identifying those women who are likely to suffer preeclampsia and its complications.
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Affiliation(s)
- Chiemelie Onwudiegwu
- Obstetrics and Gynaecology, University of Ibadan College of Medicine, Ibadan, Nigeria
| | - Ademola Adekanmi
- Radiology, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria
| | - Bolutife Olusanya
- Ophthalmology, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria
| | - Olatunji Lawal
- Obstetrics and Gynaecology, University of Ibadan College of Medicine, Ibadan, Nigeria
| | - Babatunde Adedokun
- Epidemiology and Medical Statistics, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria
| | - Imran Morhason-Bello
- Obstetrics and Gynaecology, University of Ibadan College of Medicine, Ibadan, Nigeria.,Institute of Advanced Medical and Research Training, University of Ibadan College of Medicine, Ibadan, Nigeria
| | - Adesina Oladokun
- Obstetrics and Gynaecology, University of Ibadan College of Medicine, Ibadan, Nigeria
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Ozdemir ME, Demirci O, Ozturkmen HA, Ulusoy NB, Ohanoglu K, Cilingir IU. What Is the Role of the Maternal Ophthalmic and Cervical Internal Carotid Arteries in Predicting Maternal Adverse Outcomes in Preeclampsia? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1527-1535. [PMID: 32049383 DOI: 10.1002/jum.15241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 05/27/2023]
Abstract
OBJECTIVES We aimed to investigate the efficacy of maternal ophthalmic artery (OA) and cervical internal carotid artery (CICA) in predicting adverse maternal outcomes and gestational age at birth in preeclampsia (PE). METHODS The study was performed at the Zeynep Kamil Women and Children's Diseases Training and Research Hospital. Measurements were made in 2 groups consisting of 50 pregnant women with PE and 50 healthy pregnant women. The peak systolic velocity (PSV), end-diastolic velocity, PI, RI, first diastolic peak velocity, systolic/diastolic (S/D) ratio, and peak ratio of the maternal OA were measured by a transorbital Doppler ultrasound (US) scan. The PSV, end-diastolic velocity, PI, RI, and S/D ratio of the CICA were measured. The differences of Doppler indices between groups with P < .05 were considered statistically significant. Cutoff values were calculated, which could be used to predict adverse maternal outcomes and gestational age at birth. RESULTS The RI and PI values of the OA were lower, and the first diastolic peak velocity, PSV, and peak ratio values were higher among the PE group. The RI and S/D values of the CICA were significantly lower in the PE group compared to the healthy group. The OA RI was determined to be the strongest US variable in predicting adverse maternal outcomes and gestational age at birth, with a cutoff value of 0.72, 76% sensitivity, and 76% specificity. CONCLUSIONS Maternal OA Doppler indices can be used as US markers to predict adverse maternal outcomes.
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Affiliation(s)
- Mucize Eric Ozdemir
- Departments of Perinatology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Oya Demirci
- Departments of Perinatology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Hatice Akay Ozturkmen
- Department of Radiology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Nuray Bakal Ulusoy
- Department of Radiology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Karolin Ohanoglu
- Health Science University, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Isil Uzun Cilingir
- Health Science University, Istanbul Training and Research Hospital, Istanbul, Turkey
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Kalayci M, Tahtabasi M. Assessment of Doppler flow parameters of the retrobulbar arteries and internal carotid artery in patients with glaucoma: the significance of ophthalmic artery peak ratio and the intima-media thickness of the internal carotid artery. Int Ophthalmol 2020; 40:3337-3348. [PMID: 32720168 DOI: 10.1007/s10792-020-01520-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/17/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The objective of this study was to analyze flow parameters of the central retinal artery (CRA), ophthalmic artery (OA), and internal carotid artery (ICA) assessed by color Doppler ultrasound. METHODS Thirty-five patients with primary open-angle glaucoma (PAAG), 65 patients with normal-tension glaucoma (NTG), and 45 healthy controls, a total of 145 patients were included in this study and study participants were divided into three groups. All study participants underwent color Doppler ultrasound to assess blood flow parameters of CRA, OA and ICA. RESULTS Comparisons among three groups revealed that pulsatility index and resistive index of the OA were significantly higher and peak ratio and end-systolic volume were significantly lower in patients with NTG or PAAG compared to healthy controls (p < 0.001 for all). As with OA, resistive index of the CRA was statistically significantly higher in patients with glaucoma (PAAG and NTG) compared to healthy controls (p < 0.001). The peak systolic volume and intima-media thickness of the ICA were statistically significantly higher in patients with PAAG compared to the other two groups (p < 0.001). ROC curve analysis of the CRA resistive index, OA resistive index and OA peak ratio in patients with glaucoma (PAAG and NTG) revealed that the sensitivity and specificity were 89% and 88%; 86% and 84%; 84% and 82%, respectively, at cutoff values of 0.64, 0.78 and 0.59, respectively. CONCLUSIONS Ophthalmic artery peak ratio and ICA intima-media thickness may be useful parameters in the diagnosis of patients with glaucoma.
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Affiliation(s)
- Mustafa Kalayci
- Department of Ophthalmology, Somalia Mogadishu-Turkey Education and Research Hospital, Mogadishu, Somalia.
- Department of Ophthalmology, Antalya Training and Research Hospital, Antalya, Turkey.
| | - Mehmet Tahtabasi
- Department of Radiology, Somalia Mogadishu-Turkey Education and Research Hospital, Mogadishu, Somalia
- Department of Radiology, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
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First trimester prediction and prevention of adverse pregnancy outcomes related to poor placentation. Curr Opin Obstet Gynecol 2018; 29:367-374. [PMID: 28984646 DOI: 10.1097/gco.0000000000000420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW To summarize recent research findings related to first trimester prediction and prevention of adverse pregnancy outcomes associated with poor placentation. Recent publications related to prediction and prevention of preeclampsia, intrauterine growth restriction (IUGR) and stillbirth were reviewed. RECENT FINDINGS Researchers continue to identify markers that will help predict pregnancies that go on to develop preeclampsia through screening at 11-13 weeks. A number of multivariate algorithms describing risks for preeclampsia have been published and some of these have been validated in independent populations. A large randomized controlled trial has proven the efficacy of a first trimester prediction - prevention programme for preeclampsia with an 80% reduction in prevalence of disease leading to delivery less than 34 weeks. Screening tools for IUGR and stillbirth are less advanced and require further validation in other populations. The value of these models in preventing disease still needs to be demonstrated. SUMMARY Significant progress has been made in developing predictive and preventive strategies which can affect the prevalence of severe early-onset preeclampsia. This approach could be adopted for population-based screening aiming to prevent this disease.
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Kalafat E, Laoreti A, Khalil A, Da Silva Costa F, Thilaganathan B. Ophthalmic artery Doppler for prediction of pre-eclampsia: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:731-737. [PMID: 29330892 DOI: 10.1002/uog.19002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine the accuracy of ophthalmic artery Doppler in pregnancy for the prediction of pre-eclampsia (PE). METHODS MEDLINE, EMBASE, CINAHL and The Cochrane Library were searched for relevant citations without language restrictions. Two reviewers independently selected studies that evaluated the accuracy of ophthalmic artery Doppler to predict the development of PE and extracted data to construct 2 × 2 tables. Individual patient data were obtained from the authors if available. A bivariate random-effects model was used for the quantitative synthesis of data. Logistic regression analysis was employed to generate receiver-operating characteristics (ROC) curves and obtain optimal cut-offs for each investigated parameter, and a bivariate analysis was employed using predetermined cut-offs to obtain sensitivity and specificity values and generate summary ROC curves. RESULTS A total of 87 citations matched the search criteria of which three studies, involving 1119 pregnancies, were included in the analysis. All included studies had clear description of the index and reference tests, avoidance of verification bias and adequate follow-up. Individual patient data were obtained for all three included studies. First diastolic peak velocity of ophthalmic artery Doppler at a cut-off of 23.3 cm/s showed modest sensitivity (61.0%; 95% CI, 44.2-76.1%) and specificity (73.2%; 95% CI, 66.9-78.7%) for the prediction of early-onset PE (area under the ROC curve (AUC), 0.68; 95% CI, 0.61-0.76). The first diastolic peak velocity had a much lower sensitivity (39.0%; 95% CI, 20.6-61.0%), a similar specificity (73.2%; 95% CI, 66.9-78.7%) and a lower AUC (0.58; CI, 0.52-0.65) for the prediction of late-onset PE. The pulsatility index of the ophthalmic artery did not show a clinically useful sensitivity or specificity at any cut-off for early- or late-onset PE. Peak ratio above 0.65 showed a similar diagnostic accuracy to that of the first diastolic peak velocity with an AUC of 0.67 (95% CI, 0.58-0.77) for early-onset PE and 0.57 (95% CI, 0.51-0.63) for late-onset disease. CONCLUSIONS Ophthalmic artery Doppler is a simple, accurate and objective technique with a standalone predictive value for the development of early-onset PE equivalent to that of uterine artery Doppler evaluation. The relationship between ophthalmic Doppler indices and PE cannot be a consequence of trophoblast invasion and may be related to maternal hemodynamic adaptation to pregnancy. The findings of this review justify efforts to elucidate the effectiveness and underlying mechanism whereby two seemingly unrelated maternal vessels can be used for the prediction of a disease considered a 'placental disorder'. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- E Kalafat
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Ankara University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
- Middle East Technical University, Department of Statistics, Ankara, Turkey
| | - A Laoreti
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Ankara University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
| | - F Da Silva Costa
- Department of Obstetrics and Gynaecology, Monash University and Monash Ultrasound for Women, Melbourne, Victoria, Australia
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
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