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Dall'Asta A, Frusca T, Rizzo G, Ramirez Zegarra R, Lees C, Figueras F, Ghi T. Assessment of the cerebroplacental ratio and uterine arteries in low-risk pregnancies in early labour for the prediction of obstetric and neonatal outcomes. Eur J Obstet Gynecol Reprod Biol 2024; 295:18-24. [PMID: 38325239 DOI: 10.1016/j.ejogrb.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/28/2024] [Accepted: 02/02/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND The evidence-based management of human labor includes the antepartum identification of patients at risk for intrapartum hypoxia. However, available evidence has shown that most of the hypoxic-related complications occur among pregnancies classified at low-risk for intrapartum hypoxia, thus suggesting that the current strategy to identify the pregnancies at risk for intrapartum fetal hypoxia has limited accuracy. OBJECTIVE To evaluate the role of the combined assessment of the cerebroplacental ratio (CPR) and uterine arteries (UtA) Doppler in the prediction of obstetric intervention (OI) for suspected intrapartum fetal compromise (IFC) within a cohort of low-risk singleton term pregnancies in early labor. METHODS Prospective multicentre observational study conducted across four tertiary Maternity Units between January 2016 and September 2019. Low-risk term pregnancies with spontaneous onset of labor were included. A two-step multivariable model was developed to assess the risk of OI for suspected IFC. The baseline model included antenatal and intrapartum characteristics, while the combined model included antenatal and intrapartum characteristics plus Doppler anomalies such as CPR MoM < 10th percentile and mean UtA Doppler PI MoM ≥ 95th percentile. Predictive performance was determined by receiver-operating characteristics curve analysis. RESULTS 804 women were included. At logistic regression analysis, CPR MoM < 10th percentile (aOR 1.269, 95 % CI 1.188-1.356, P < 0.001), mean UtA PI MoM ≥ 95th percentile (aOR 1.012, 95 % CI 1.001-1.022, P = 0.04) were independently associated with OI for suspected IFC. At ROC curve analysis, the combined model including antenatal characteristics plus abnormal CPR and mean UtA PI yielded an AUC of 0.78, 95 %CI(0.71-0.85), p < 0.001, which was significantly higher than the baseline model (AUC 0.61, 95 %CI(0.54-0.69), p = 0.007) (p < 0.001). The combined model was associated with a 0.78 (95 % CI 0.67-0.89) sensitivity, 0.68 (95 % CI 0.65-0.72) specificity, 0.15 (95 % CI 0.11-0.19) PPV, and 0.98 (0.96-0.99) NPV, 2.48 (95 % CI 2.07-2.97) LR + and 0.32 (95 % CI 0.19-0.53) LR- for OI due to suspected IFC. CONCLUSIONS A predictive model including antenatal and intrapartum characteristics combined with abnormal CPR and mean UtA PI has a good capacity to rule out and a moderate capacity to rule in OI due to IFC, albeit with poor predictive value.
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Affiliation(s)
- Andrea Dall'Asta
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy; Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom.
| | - Tiziana Frusca
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynaecology, Fondazione Policlinico di Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Ruben Ramirez Zegarra
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Christoph Lees
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom; Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Francesc Figueras
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Spain
| | - Tullio Ghi
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
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de Ganzo Suárez T, de Paco Matallana C, Plasencia W. Spiral, uterine artery doppler and placental ultrasound in relation to preeclampsia. Best Pract Res Clin Obstet Gynaecol 2024; 92:102426. [PMID: 38039843 DOI: 10.1016/j.bpobgyn.2023.102426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/18/2023] [Accepted: 08/06/2023] [Indexed: 12/03/2023]
Abstract
Preeclampsia (PE) is a multiorgan disorder that complicates around 2-8% of pregnancies and is a major cause of perinatal and maternal morbidity and mortality. PE is a clinical syndrome characterized by hypertension secondary to systemic inflammation, endothelial dysfunction, and syncytiotrophoblast stress leading to hypertension and multiorgan dysfunction. The uterine arteries are the main blood vessels that supply blood to the uterus. They give off branches and plays an important role in maintaining blood supply during pregnancy. The arcuate artery originates from the uterine artery and runs medially through the myometrium. The arcuate arteries divide almost directly into anterior and posterior branches, from which the radial artery leads directly to the uterine cavity during their course. Near the endometrium-myometrium junction, the radial artery generates spiral arteries within the basal layer and functional endometrium. The walls of radial and spiral arteries are rich in smooth muscle, which is lost when trophoblast cells invade and become large-caliber vessels. This physiological transformation of uteroplacental spiral arteries is critical for successful placental implantation and normal placental function. In normal pregnancy, the luminal diameter of the spiral arteries is greatly increased, and the vascular smooth muscle is replaced by trophoblast cells. This process and changes in the spiral arteries are called spiral artery remodeling. In PE, this genetically and immunologically governed process is deficient and therefore there is decreased vascular capacitance and increased resistance in the uteroplacental circulation. Furthermore, this defect in uteroplacental spiral artery remodeling is not only associated with early onset PE, but also with fetal growth restriction, placental abruption, and spontaneous premature rupture of membranes. Doppler ultrasound allows non-invasive assessment of placentation, while the flow impedance decreases as the pregnancy progresses in normal pregnancies, in those destined to develop preeclampsia the impedance is increased.
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Affiliation(s)
- Tania de Ganzo Suárez
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Nuestra Señora de la Candelaria, Tenerife, Canary Islands, Spain.
| | - Catalina de Paco Matallana
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar, Murcia, Spain; Faculty of Medicine, Universidad de Murcia, Murcia, Spain.
| | - Walter Plasencia
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario de Canarias, Tenerife. Canary Islands, Spain.
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Paiboonborirak C, Phupong V. Serum fatty acid binding protein 4 and Doppler of uterine artery ultrasound in the first trimester for the prediction of preeclampsia. Hypertens Res 2024:10.1038/s41440-023-01553-y. [PMID: 38182901 DOI: 10.1038/s41440-023-01553-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/27/2023] [Accepted: 12/02/2023] [Indexed: 01/07/2024]
Abstract
The objective of this study was to determine the predictive value of serum fatty acid binding protein 4 (FABP4) combined with Doppler of the uterine artery in singleton pregnancy at gestational age (GA) 11-13+6 weeks for prediction of preeclampsia. A prospective observational study included singleton pregnant women at GA 11-13+6 weeks and was conducted at the Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, between December 2020 and April 2022. Serum FABP4 levels and Doppler of the uterine artery were performed. Pregnancy outcomes were recorded. The predictive values of these combined tests at the optimal cut-off values were determined to predict preeclampsia. A total of 330 participants with 15 cases of preeclampsia (4.5%) and 6 cases of them had preterm preeclampsia (GA < 37 weeks) (1.8%) were analyzed. Women with preeclampsia had significantly higher serum FABP4 levels than normal pregnant women (12.9 ± 6.5 ng/ml vs 10.1 ± 4.8 ng/ml, p = 0.034) but no difference in the mean pulsatility index (PI) of the uterine artery and the presence of an early diastolic notch. When using serum FABP4 levels greater than 1.0 multiple of the median of GA as a cut-off value to predict preeclampsia, combined with abnormal Doppler PI of the uterine artery, the sensitivity, specificity, positive predictive value, and negative predictive value were 73.3%, 47.3%, 6.2%, and 97.4%, respectively. This study demonstrated that serum FABP4 levels combined with Doppler of the uterine artery at GA 11-13+6 weeks were effective in predicting preeclampsia.
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Affiliation(s)
- Chaiyawut Paiboonborirak
- Placental Related Diseases Research Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
| | - Vorapong Phupong
- Placental Related Diseases Research Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.
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Jie M, Jaufuraully S, Lambert J, Napolitano R, Siassakos D. Second trimester abnormal uterine artery Dopplers and adverse obstetric and neonatal outcomes when PAPP-a is normal. J Matern Fetal Neonatal Med 2023; 36:2230515. [PMID: 37401032 DOI: 10.1080/14767058.2023.2230515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVES To explore the association between abnormal uterine artery Dopplers (combined PI > 2.5) - with normal PAPP-A - and adverse obstetric/neonatal outcomes. METHODS This was a retrospective cohort study of 800 patients between 1 March 2019 - 23 November 2021 in a tertiary UK hospital, where it is routine to measure uterine artery Dopplers of all pregnancies during their anomaly scans. 400 nulliparous women/birthing people with complete data were included. 400 nulliparous controls scanned in the same time frame (1.5 years) with normal PAPP-A and uterine artery Dopplers were matched for age and BMI. Outcomes included: mode of birth, postpartum complications, birth weight/centile, Apgar score, gestational age at delivery, neonatal unit admission, and clinical neonatal hypoglycemia. Multivariable analysis was used. RESULTS Compared to controls, pregnancies with abnormal uterine artery Dopplers and normal PAPP-A were at increased risk of induction (46.5% vs 35.5%, p = .042), cesarean section (46.0% vs 38.0%, p = .002), emergency cesarean section (35.0% vs 26.5%, p = .009), and pre-eclampsia 5.8% vs 2.5%, p = .021). Their babies were more likely to be admitted to the neonatal unit - mostly for prematurity (15.3% vs 6.3%, p = .0004), hypoglycemia (4.0% vs 1.0%, p = .007), be small for gestational age (26.5% vs 11.5%, p = .0001), had intrauterine growth restriction (10.8% vs 1.3%, p = .0001), and be born prematurely (10.0% vs 3.5%, p = .002). Routine measurement of uterine artery Dopplers increased the detection rate of small for gestational age fetuses by 15.1%. Over half of the babies admitted with neonatal hypoglycemia in pregnancies with abnormal uterine artery Dopplers had an unexplained cause. CONCLUSIONS Pregnancies with abnormal uterine Dopplers are not only at increased risk of pre-eclampsia and small for gestational age fetuses/intrauterine growth restriction, but are also at increased risk of emergency cesarean section and adverse neonatal outcomes. The increased incidence of neonatal hypoglycemia is likely driven to some degree by prematurity and placental complications, but possibly also by undiagnosed glucose dysmetabolism. This may warrant routine measurement of uterine artery Dopplers in all pregnancies (regardless of risk), where feasible, to aid antenatal management and counseling.
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Affiliation(s)
- Michelle Jie
- Ultrasound Screening Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Shireen Jaufuraully
- UCL EGA Institute for Women's Health, UCL, London, United Kingdom of Great Britain and Northern Ireland
- Wellcome/EPSRC Centre for Intperventional and Surgical Sciences, London, United Kingdom of Great Britain and Northern Ireland
| | - James Lambert
- School of Economics and Finance, Queen Mary University of London, London, United Kingdom of Great Britain and Northern Ireland
| | - Raffaele Napolitano
- Ultrasound Screening Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, London, United Kingdom of Great Britain and Northern Ireland
- UCL EGA Institute for Women's Health, UCL, London, United Kingdom of Great Britain and Northern Ireland
| | - Dimitrios Siassakos
- UCL EGA Institute for Women's Health, UCL, London, United Kingdom of Great Britain and Northern Ireland
- Wellcome/EPSRC Centre for Intperventional and Surgical Sciences, London, United Kingdom of Great Britain and Northern Ireland
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Álvarez SC, Zurita AR, Del Carmen De Ganzo Suárez T, De Luis Escudero JF, Medina NS, Pérez CC, de Basoa CMF, Montesino JLT, Masip MTC, Bello MÁG. Is a sFlt-1/PlGF cutoff of 38 suitable to predict adverse outcomes in pregnancies with abnormal uterine artery Doppler velocimetry in the second trimester? Pregnancy Hypertens 2023; 34:13-18. [PMID: 37778280 DOI: 10.1016/j.preghy.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 07/03/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE To determine the optimal cutoff value for the soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) ratio to predict maternal and fetal adverse events in pregnancies with uterine artery Doppler scans results above the 95th percentile in the late second trimester. STUDY DESIGN Retrospective, observational cohort study on 116 asyntomatic patients with abnormal uterine artery Doppler scans at gestational week 25. The sFlt-1/PlGF ratio was determined within the weeks 25 to 29 of gestation and ROC curve analysis performed. The diagnostic validity of different cutoff values to predict severe maternal and fetal complications, i.e. preeclampsia, fetal growth restriction, placental abruption, and fetal death, was analyzed. MAIN OUTCOME MEASURES An ideal cutoff for sFlt-1/PlGF ratios in pregnancies with abnormal uterine artery Doppler in the second trimester. RESULTS Applying a cutoff point of 38, the area under the ROC curve was 0.89, generally considered low risk in fetal and maternal complication prediction. The sensitivity was 32.1%, the specificity 98.4%, the positive predictive value (PPV) 94.4%, and the negative predictive value (NPV) 63.3%. A cutoff value of 10, leading to the highest Youden index, performed best at detecting overall complications, increasing sensitivity to 69.8% and the NPV to 76.8%. at the cost of a reduced specificity and PPV. CONCLUSIONS In pregnancies with abnormal uterine artery Doppler in the second trimester, an sFlt-1/PlGF cutoff value greater than equal to 38 improves its predictive power for adverse events.
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Affiliation(s)
- Sara Caamiña Álvarez
- Department of Obstetrics and Gynecology, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.
| | - Alicia Rodríguez Zurita
- Department of Obstetrics and Gynecology, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - José Fernando De Luis Escudero
- Department of Obstetrics and Gynecology, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Nieves Sierra Medina
- Department of Obstetrics and Gynecology, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Carolina Chulilla Pérez
- Department of Obstetrics and Gynecology, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Cecilia Martín Fernández de Basoa
- Prenatal Screening and Preeclampsia Unit, Clinical Analysis Service, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - José Luis Trabado Montesino
- Department of Obstetrics and Gynecology, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - María Teresa Concepción Masip
- Prenatal Screening and Preeclampsia Unit, Clinical Analysis Service, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Miguel Ángel García Bello
- Department of Clinical Psychology-Psychobiology and Methodology, University of La Laguna, Santa Cruz de Tenerife, Spain
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Fan J, Zhang J, Xu S, Liu H, Lv W, Bi X, Liu Y, Shi W, Zhang Y, Wu X. The predictive value of uterine artery Doppler in the success rate of pregnancy from the first frozen embryo transfer during the implantation window. BMC Pregnancy Childbirth 2023; 23:825. [PMID: 38037011 PMCID: PMC10688035 DOI: 10.1186/s12884-023-06150-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Worldwide, frozen embryo transfer (FET) has become a new strategy for the treatment of infertility. The success of FET is closely related to endometrial receptivity. Does uterine artery Doppler during the implantation window predict pregnancy outcome from the first FET? METHODS A total of 115 retrospectively collected cycles were included in the study, with 64 cycles of clinical pregnancy and 51 cycles of nonclinical pregnancy; There were 99 nonabsent end-diastolic flow (NAEDF) cycles and 16 absent end-diastolic flow (AEDF) cycles. The differences in uterine artery Doppler findings between different pregnancy outcomes were investigated. The clinical pregnancy rate and spontaneous abortion rate in the NAEDF and AEDF groups were compared. The predictive value of uterine artery Doppler during the implantation window in the success rate of pregnancy from the first FET was also investigated. RESULTS Between the clinical pregnancy group and the nonclinical pregnancy group, there were no significant differences in the mean resistance index (mRI) (Z = -1.065, p = 0.287), mean pulsatility index (mPI) (Z = -0.340, p = 0.734), and mean peak systolic/end-diastolic velocity(mS/D) (Z = -0.953, p = 0.341); there were significant differences in the mean peak systolic velocity (mPSV) (Z = -1.982, p = 0.048) and mean end-diastolic velocity (mEDV) (Z = -2.767, p = 0.006). Between the NAEDF and AEDF groups, there was no significant difference in the clinical pregnancy rate (χ2 = 0.003, p = 0.959), and there was a significant difference in the spontaneous abortion rate (χ2 = 3.465, p = 0.019). Compared with uterine artery Doppler alone, its combination with artificial abortion history, waist-to-hip ratio, LH (Luteinizing hormone) of P (Progesterone) administration day, mPSV and mEDV had a higher predictive value regarding clinical pregnancy from the first FET [ROC-AUC 0.782, 95% CI (0.680-0.883) vs. 0.692, 95% CI (0.587-0.797)]. CONCLUSIONS Uterine artery Doppler, particularly mPSV and mEDV during the implantation window, was useful for predicting clinical pregnancy, and AEDF was related to spontaneous abortion in the first trimester. Uterine artery Doppler combined with artificial abortion history, waist-to-hip ratio, LH of P administration day, mPSV and mEDV have a higher predictive value than uterine artery Doppler alone regarding the pregnancy from the first FET.
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Affiliation(s)
- Junmei Fan
- Department of Reproductive Medicine Center, Children's Hospital of Shanxi and Women Health Center of Shanxi, Affiliated of Shanxi Medical University, Taiyuan, Shanxi, China.
| | - Junkun Zhang
- Department of Intensive Care Unit, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, China
| | - Suming Xu
- Department of Reproductive Medicine Center, Children's Hospital of Shanxi and Women Health Center of Shanxi, Affiliated of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Huiping Liu
- Department of Reproductive Medicine Center, Children's Hospital of Shanxi and Women Health Center of Shanxi, Affiliated of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Weigang Lv
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xingyu Bi
- Department of Reproductive Medicine Center, Children's Hospital of Shanxi and Women Health Center of Shanxi, Affiliated of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yanling Liu
- Department of Reproductive Medicine Center, Children's Hospital of Shanxi and Women Health Center of Shanxi, Affiliated of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Wenjing Shi
- Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yuxia Zhang
- Department of Reproductive Medicine Center, Children's Hospital of Shanxi and Women Health Center of Shanxi, Affiliated of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xueqing Wu
- Department of Reproductive Medicine Center, Children's Hospital of Shanxi and Women Health Center of Shanxi, Affiliated of Shanxi Medical University, Taiyuan, Shanxi, China.
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Wu JN, Li MQ, Xie F, Zhang B. Gestational week-specific of uterine artery Doppler indices in predicting preeclampsia: a hospital-based retrospective cohort study. BMC Pregnancy Childbirth 2021; 21:843. [PMID: 34952577 PMCID: PMC8705461 DOI: 10.1186/s12884-021-04329-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/23/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Plenty of studies explored the relationship between uterine artery (UtA) Doppler indices and the onset of preeclampsia at different trimesters. However, few studies test the gestational week-specific predictive value of the UtA indices for subsequent preeclampsia and compare the difference of right or left UtA indices (e.g., pulsatility or resistance index [PI or RI]). METHODS Hospital-based retrospective cohort study of singleton pregnant women who received the Doppler test between 2012 and 2016 was conducted in 2018. The predictive performance of the UtA indices for preeclampsia and its variants, including early-onset preeclampsia (< 34 weeks) and preterm preeclampsia (< 37 weeks), was estimated. RESULTS The UtA indices, with a cutoff value of 1.11 for the right and left UtA-PI, and 0.66 and 0.63 for the right and left UtA-RI, respectively, were effective predictors for subsequent preeclampsia. The prediction was satisfactory at the 9th week of the Doppler scan: areas under the curve ≥ 0.80, the Youden index ranging from 0.54 to 0.58, the sensitivity of 63.2 ~ 73.7%, and the specificity 84.2 ~ 91.3%, respectively. The UtA indices had comparable performance in screening for early-onset and preterm preeclampsia but showed lower predictive value for late-onset cases. Among these indices, the right UtA-RI had the highest specificity (all P < 0.01), while the left UtA-PI showed good authenticity (higher Youden index) in predicting the disorder. CONCLUSIONS The second-trimester measured UtA indices had a satisfactory performance at the 9th week in predicting subsequent preeclampsia. The right UtA-RI was the first choice in ruling out preeclampsia, while the left UtA-PI showed the best authenticity of the prediction.
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Affiliation(s)
- Jiang-Nan Wu
- Obstetrics and Gynecology Hospital of Fudan University, 566 Fangxie Rd, Shanghai, 200011, China.
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.
| | - Ming-Qing Li
- Obstetrics and Gynecology Hospital of Fudan University, 566 Fangxie Rd, Shanghai, 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Feng Xie
- Obstetrics and Gynecology Hospital of Fudan University, 566 Fangxie Rd, Shanghai, 200011, China.
| | - Bin Zhang
- Obstetrics and Gynecology Hospital of Fudan University, 566 Fangxie Rd, Shanghai, 200011, China
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Nicolaides KH, Papastefanou I, Syngelaki A, Ashoor G, Akolekar R. Predictive performance for placental dysfunction related stillbirth of the competing risks model for small for gestational age fetuses. BJOG 2021; 129:1530-1537. [PMID: 34919332 DOI: 10.1111/1471-0528.17066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/26/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES First, to examine the predictive performance for placental dysfunction related stillbirths of the competing risks model for small for gestational age (SGA) fetuses based on a combination of maternal risk factors, estimated fetal weight (EFW) and uterine artery pulsatility index (UtA-PI); and second, to compare the performance of this model to that of stillbirth-specific model utilizing the same biomarkers and to the Royal College of Obstetricians and Gynecologists (RCOG) guideline for the investigation and management of the SGA fetus. DESIGN Prospective observational study. SETTING Two UK maternity hospitals. POPULATION 131,514 women with singleton pregnancies attending for routine ultrasound examination at 19-24 weeks' gestation. METHODS The predictive performance for stillbirth achieved by three models was compared. Main outcome measure Placental dysfunction related stillbirth. RESULTS At 10% false positive rate, the competing risks model predicted 59%, 66% and 71% of placental dysfunction related stillbirths, at any gestation, at <37 weeks and at <32 weeks, respectively, which were similar to the respective figures of 62%, 70% and 73% for the stillbirth-specific model. At a screen positive rate of 21.8 %, as defined by the RCOG guideline, the competing risks model predicted 71%, 76% and 79% of placental dysfunction related stillbirths at any gestation, at <37 weeks and at <32 weeks, respectively, and the respective figures for the RCOG guideline were 40%, 44% and 42%. CONCLUSION The predictive performance for placental dysfunction related stillbirths by the competing risks model for SGA was similar to the stillbirth-specific model and superior to the RCOG guideline.
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Affiliation(s)
| | | | - Argyro Syngelaki
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Ghalia Ashoor
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Ranjit Akolekar
- Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK.,Institute of Medical Sciences, Canterbury Christ Church University, Chatham, UK
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Molina Pérez CJ, Nolasco Leaños AG, Carrillo Juárez RI, Berumen Lechuga MG, Isordia Salas I, Leaños Miranda A. Soluble Endoglin and Uterine Artery Flow Doppler Ultrasonography as Markers of Progression to Preeclampsia in Women with Gestational Hypertension. Gynecol Obstet Invest 2021; 86:445-453. [PMID: 34662881 DOI: 10.1159/000519371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/29/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Gestational hypertension (GH) pregnancies are at a high risk of developing adverse outcomes, including progression to preeclampsia. Prediction of GH-related adverse outcomes is challenging because there are no available clinical tests that may predict their occurrence. OBJECTIVE The aim of the study was to determine the clinical usefulness of the soluble endoglin (sEng) and parameters of uterine artery flow (UtAF) measured by Doppler ultrasonography as markers of progression to preeclampsia in women with GH. SETTING Mexico City, Mexico. MATERIAL AND METHODS We included 77 singleton pregnant women with GH in a nested case-control study. Cases were women who progressed to preeclampsia (n = 36), and controls were those who did not (n = 41). Serum sEng and UtAF measurements were performed at enrollment. The main outcomes measured were progression to preeclampsia and occurrence of preterm delivery (PD) <37 and <34 weeks of gestation, small for gestational age infant (SGA), and fetal growth restriction (FGR). RESULTS Women with sEng values in the highest tertile had higher risk of progression to preeclampsia, preterm delivery <34 weeks of gestation, and fetal growth restriction, odds ratios (ORs) ≥3.7. Patients with abnormal UtAF Dopp-ler-pulsatility index had higher risk of progression to preeclampsia, preterm delivery <34 weeks of gestation, small for gestational age infant, and fetal growth restriction (ORs ≥3.3). The presence of notch was associated with higher risk of progression to preeclampsia, preterm delivery <37 and <34 weeks of gestation, SGA infant, and fetal growth restriction (ORs ≥2.9). However, logistic regression analysis revealed that only serum sEng was a significant and independent risk factor for progression of GH to preeclampsia, preterm delivery <34 weeks of gestation, and fetal growth restriction (ORs ≥3.1). CONCLUSIONS In GH pregnancies, UtAF Doppler ultrasonography is associated with increased risk of adverse outcomes and progression to preeclampsia. However, serum sEng concentration appears to be a better predictor to assess the risk of adverse maternal and perinatal outcomes and progression to preeclampsia.
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Affiliation(s)
- Carlos José Molina Pérez
- Instituto Mexicano del Seguro Social (IMSS), Medical Research Unit in Reproductive Medicine, UMAE-Hospital de Ginecología y Obstetricia "Luis Castelazo Ayala", Ciudad de México, Mexico
| | - Ana Graciela Nolasco Leaños
- Instituto Mexicano del Seguro Social (IMSS), Medical Research Unit in Reproductive Medicine, UMAE-Hospital de Ginecología y Obstetricia "Luis Castelazo Ayala", Ciudad de México, Mexico.,Instituto Politécnico Nacional, Posgrado e Investigación Biomedicina y Biotecnología Molecular, Ciudad de México, Mexico
| | - Reyes Ismael Carrillo Juárez
- Instituto Mexicano del Seguro Social (IMSS), Medical Research Unit in Reproductive Medicine, UMAE-Hospital de Ginecología y Obstetricia "Luis Castelazo Ayala", Ciudad de México, Mexico
| | | | - Irma Isordia Salas
- Research Unit in Thrombosis, Hemostasia and Atherogenesis, HGR No.1 "Dr. Carlos Mac Gregor," IMSS, Ciudad de México, Mexico
| | - Alfredo Leaños Miranda
- Instituto Mexicano del Seguro Social (IMSS), Medical Research Unit in Reproductive Medicine, UMAE-Hospital de Ginecología y Obstetricia "Luis Castelazo Ayala", Ciudad de México, Mexico
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Loardi C, Fratelli N, Mazzoni G, Orabona R, Valcamonico A, Fichera A, Sartori E, Prefumo F. Uterine artery Doppler for the prediction of outcome in pregnancies complicated by hypertensive disorders of pregnancy. Pregnancy Hypertens 2021; 26:69-74. [PMID: 34555699 DOI: 10.1016/j.preghy.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/21/2021] [Accepted: 09/09/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To evaluate, in pregnancies complicated by hypertensive disorders of pregnancy (HDP), the predictive role of uterine artery (UtA) Doppler for pregnancy outcome compared to the definition of preeclampsia (PE) established by ISSHP recommendations. STUDY DESIGN Retrospective cohort study including singleton pregnancies diagnosed with HDP, who underwent UtA Doppler assessment at admission in 2011-2017. The study population was classified considering the presence or absence of PE and according to the presence or absence of abnormal UtA Doppler (mean pulsatility index > 95th percentile). MAIN OUTCOME MEASURES Pregnancy outcome, maternal and fetal complications, evaluated as composite outcomes (CO), and duration of pregnancy (from admission to delivery). RESULTS A total of 311 mother-infant couples was included.The diagnostic ability of the two classifications was analysed comparing the relative likelihood ratio in the Biggerstaff graph. ISSHP definition turned out to be more efficient in detecting maternal adverse CO in comparison to UtA Doppler, relative positive likelihood ratio 1.50 (1.35-1.66) and 1.31 (1.07-1.60). UtA Doppler classification resulted more efficient in predicting adverse neonatal CO than PE definition, relative positive likelihood ratio 2.21 (1.77-2.75) and 1.61 (1.37-1.90). UtA Doppler was significantly associated with delivery at earlier gestational ages both for patients affected by PE and for women affected by HDP without superimposed PE (respectively p = 0.009 and p = 0.037). CONCLUSIONS UtA Doppler at HDP diagnosis is a useful bedside marker of fetal/neonatal complications, and is associated with pregnancy duration.
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Nasheeha N, Gk P. Diagnostic accuracy of uterine artery and spiral artery Doppler for evaluation of endometrial pathology in postmenopausal bleeding. J Gynecol Obstet Hum Reprod 2021; 50:102209. [PMID: 34418593 DOI: 10.1016/j.jogoh.2021.102209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/06/2021] [Accepted: 08/16/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Traditional diagnostic workup for Endometrial carcinoma in women with post-menopausal bleeding (PMB) involves endometrial biopsy. Addition of colour and power Doppler ultrasound to transvaginal ultrasonography (TVS) might help in differentiating subset of women who are at high risk of carcinoma. The aim of this study was to determine the diagnostic value of Pulsatility Index (PI) and Resistance Index (RI) of uterine and spiral artery in PMB and to determine the diagnostic value of power Doppler flow mapping in them. MATERIAL AND METHODS A prospective study was done amongst 50 women with PMB. All women were subjected to TVS including uterine artery and spiral artery Doppler velocimetry, power Doppler flow mapping of spiral artery, hysteroscopy and endometrial biopsy. RESULTS Uterine artery PI and RI values were overlapping between benign and malignant endometrial pathologies. Whereas spiral artery PI ≤ 0.33 and RI ≤ 0.5 helps in differentiating malignant frombenign pathology. Power Doppler multiple vessel pattern is also found to have a better diagnostic ability in picking endometrial cancer. CONCLUSION Addition of spiral artery velocimetry and power Doppler flow mapping to those with thickened endometrium, aids in differentiating endometrial malignancy from benign pathology. This might be helpful in counselling the women for endometrial biopsy, as histopathological analysis is the gold standard diagnostic modality.
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Affiliation(s)
- Noorul Nasheeha
- Senior Resident, Department of Obstetrics and Gynecology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Poomalar Gk
- Professor, Department of Obstetrics and Gynecology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India.
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Wu JN, Ren YY, Zhu C, Peng T, Zhang B, Li MQ. Abnormal placental perfusion and the risk of stillbirth: a hospital-based retrospective cohort study. BMC Pregnancy Childbirth 2021; 21:308. [PMID: 33865362 PMCID: PMC8052678 DOI: 10.1186/s12884-021-03776-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 04/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background A lack of information on specific and interventional factors for stillbirth has made designing preventive strategies difficult, and the stillbirth rate has declined more slowly than the neonatal death rate. We compared the prevalence of stillbirth among the offspring of women with or without abnormal placental perfusion (APP). Methods We conducted a hospital-based retrospective cohort study involving women with a singleton pregnancy between 2012 and 2016 (N = 41,632). Multivariate analysis was performed to compare the prevalence of stillbirth in infants exposed to APP (defined as any abnormality in right or left uterine artery pulsatility index or resistance index [UtA-PI, −RI] [e.g., > 95th percentile] or presence of early diastolic notching) with that in those not exposed to APP. Results Stillbirths were more common among women with APP than among those with normal placental perfusion (stillbirth rate, 4.3 ‰ vs 0.9 ‰; odds ratio (OR), 4.2; 95% confidence interval (CI), 2.2 to 8.0). The association strengths were consistent across groups of infants exposed to APP that separately defined by abnormality in right or left UtA-PI or -RI (OR ranged from 3.2 to 5.3; all P ≤ 0.008). The associations were slightly stronger for the unexplained stillbirths. Most of the unexplained stillbirth risk was attributed to APP (59.0%), while a foetal sex disparity existed (94.5% for males and 58.0% for females). Women with normal placental perfusion and a male foetus had higher credibility (e.g., higher specificities) in excluding stillbirths than those with APP and a female foetus at any given false negative rate from 1 to 10% (93.4% ~ 94.1% vs. 12.3% ~ 14.0%). Conclusions APP is associated with and accounts for most of the unexplained stillbirth risk. Different mechanisms exist between the sexes. The performance of screening for stillbirth may be improved by stratification according to sex and placental perfusion. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03776-8.
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Affiliation(s)
- Jiang-Nan Wu
- Department of Clinical Epidemiology, Obstetrics and Gynecology Hospital of Fudan University, 566 Fangxie Rd, Shanghai, 200011, China.
| | - Yun-Yun Ren
- Department of Ultrasound, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Chen Zhu
- Department of Ultrasound, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Ting Peng
- Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Bin Zhang
- Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Ming-Qing Li
- Research Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
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Yue CY, Gao JP, Zhang CY, Ni YH, Ying CM. Development and validation of a nomogram for the early prediction of preeclampsia in pregnant Chinese women. Hypertens Res 2021; 44:417-425. [PMID: 33060833 DOI: 10.1038/s41440-020-00558-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/31/2020] [Accepted: 09/11/2020] [Indexed: 02/06/2023]
Abstract
To make early predictions of preeclampsia before diagnosis, we developed and validated a new nomogram for the early prediction of preeclampsia in pregnant Chinese women. A stepwise regression model was used for feature selection. Multivariable logistic regression analysis was used to develop the prediction model. We incorporated BMI, blood pressure, uterine artery ultrasound parameters, and serological indicator risk factors, and this was presented with a nomogram. The performance of the nomogram was assessed with respect to its calibration, discrimination, and clinical usefulness. Internal validation was assessed. The signature, which consisted of 11 selected features, was associated with preeclampsia status (P < 0.1) for the development dataset. Predictors contained in the individualized prediction nomogram included BMI, blood pressure, uterine artery ultrasound parameters, and serological indicator levels. The model showed good discrimination, with an area under the ROC curve of 0.8563 (95% CI: 0.8364-0.8761) and good calibration. The nomogram still had good discrimination and good calibration when applied to the validation dataset (area under ROC curve of 0.8324, 95% CI: 0.7873-0.8775). Decision curve analysis demonstrated that the nomogram was clinically useful. The nomogram presented in this study incorporates BMI, blood pressure, uterine artery ultrasound parameters, and serological indicators and can be conveniently used to facilitate the individualized prediction of preeclampsia.
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Affiliation(s)
- Chao-Yan Yue
- Department of Laboratory Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jiang-Ping Gao
- College of Engineering and Computer Science, Australian National University, Canberra, ACT, Australia
| | - Chun-Yi Zhang
- Department of Laboratory Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Ying-Hua Ni
- Department of Laboratory Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Chun-Mei Ying
- Department of Laboratory Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
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Hasija A, Balyan K, Debnath E, V R, Kumar M. Prediction of hypertension in pregnancy in high risk women using maternal factors and serial placental profile in second and third trimester. Placenta 2021; 104:236-242. [PMID: 33450643 DOI: 10.1016/j.placenta.2021.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/11/2020] [Accepted: 01/05/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION To evaluate the role of placental profile markers in second and third trimester of pregnancy in predicting hypertensive disorders of pregnancy (HDP) in women at high risk of preeclampsia. METHOD Women who were at high risk of preeclampsia underwent βhCG, ultrasound assessment of placental length, thickness and its ratio, uterine artery Doppler at 20-24 weeks and 28-32 weeks of gestation, the outcome at delivery was noted. Those who developed HDP were cases and those with normal outcome were controls. The placental profile markers among cases and controls were compared. RESULTS Hypertensive disorders of pregnancy was seen in 72/160 (45%) high risk women The serum β hCG levels at 20-24 weeks (p = 0.001) and 28-32 weeks (p = 0.018) was significantly high in women who had preeclampsia. Placental thickness was found to be less in among all subgroups of HDP, for preeclampsia, it was significantly low at 20-24 weeks (AUC- 0.743; sensitivity- 75%, specificity- 66.3%) and 28 weeks (AUC -0.764, sensitivity - 75.0% specificity - 78.7%). Uterine artery S/D ratio was considerable high in women with chronic hypertension (AUC -0.765), gestational hypertension (AUC -0.771) and preeclampsia (AUC -0.726) at 20-24 weeks. In preeclampsia group, uterine artery PI was highest and the best marker at 20-24 weeks (AUC -0.935, sensitivity - 100.0%, specificity - 87.6%). DISCUSSION The placental profile markers may be used to provide closer follow up in high risk pregnancies with abnormal placental profile levels, while less intense follow up in those with normal levels, thus channelizing the resources.
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Affiliation(s)
- Aayushi Hasija
- Department of Obstetrics and Gynecology, LHMC, New Delhi, India
| | - Kirti Balyan
- Department of Obstetrics and Gynecology, LHMC, New Delhi, India
| | - Ekta Debnath
- Department of Biochemistry, LHMC, New Delhi, India
| | - Ravi V
- Department of Statistics, LSR, New Delhi, India
| | - Manisha Kumar
- Department of Obstetrics and Gynecology, LHMC, New Delhi, India.
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Karge A, Beckert L, Moog P, Haller B, Ortiz JU, Lobmaier SM, Abel K, Flechsenhar S, Kuschel B, Graupner O. Role of sFlt-1/PIGF ratio and uterine Doppler in pregnancies with chronic kidney disease suspected with Pre-eclampsia or HELLP syndrome. Pregnancy Hypertens 2020; 22:160-166. [PMID: 32992124 DOI: 10.1016/j.preghy.2020.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/01/2020] [Accepted: 09/11/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Pregnancies of women with chronic kidney disease (CKD) are at higher risk of experiencing adverse perinatal (APO) and maternal outcome (AMO). Mean uterine artery pulsatility index (mUtA-PI) as well as the ratio of soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) are helpful tools in diagnosing pre-eclampsia (PE) in women with CKD. The aim of the study was to evaluate the role of sFlt-1/PIGF ratio and mUtA-PI as predictors for APO, AMO, preterm delivery and decline of kidney function in CKD pregnancies. METHODS A total of 28 CKD pregnancies with suspected PE/HELLP syndrome were retrospectively included, in whom both sFlt-1/PIGF and mUtA-PI were determined during the third trimester. APO was defined as fetal growth restriction, respiratory distress syndrome, intubation, admission to NICU, 5 min Apgar <7 and intracerebral hemorrhage. AMO was defined as the development of PE, HELLP syndrome or resistant hypertension. Decline of kidney function was defined as a 25% increase of creatinine level after delivery. RESULTS Of all included women, eight (28.6%) developed a PE/HELLP syndrome. AMO (28.6%) and APO (32.1%) were frequently observed. ROC analyses revealed a predictive value for AMO and sFlt-1/PIGF or mUtA-PI. Neither sFlt-1/PIGF nor mUtA-PI could predict APO or decline of postnatal kidney function. mUtA-PI was a predictor for preterm delivery. CONCLUSION Uterine Doppler and sFlt-1/PIGF are predictors of AMO in CKD pregnancies. Therefore, both markers might be helpful for an improved risk assessment. However, neither sFlt-1/PIGF nor mUtA-PI were able to predict a decline of postnatal kidney function or APO.
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Affiliation(s)
- Anne Karge
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Lina Beckert
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Philipp Moog
- Department of Nephrology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute for Medical Informatics, Statistics and Epidemiology (IMedIS), University Hospital rechts der Isar, Technical University of Munich, Germany
| | - Javier U Ortiz
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Silvia M Lobmaier
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kathrin Abel
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sarah Flechsenhar
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bettina Kuschel
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Oliver Graupner
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
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Chilumula K, Saha PK, Muthyala T, Saha SC, Sundaram V, Suri V. Prognostic role of uterine artery Doppler in early- and late-onset preeclampsia with severe features. J Ultrasound 2020; 24:303-310. [PMID: 32797405 DOI: 10.1007/s40477-020-00524-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To correlate uterine artery Doppler findings with maternal and neonatal outcomes in early- and late-onset preeclampsia with severe features. METHODOLOGY Doppler scan was done in both uterine arteries. Maternal and neonatal outcomes in women with abnormal and normal Doppler results were compared. RESULTS Abnormal Doppler results were present in 45 women (75%). Thirty-four (56.7%) women had abnormal RI, 19 (31.6%) had abnormal PI, and 36 (60%) had diastolic notch. Of the women who participated in the study, 21.6% developed maternal complications, and the majority belonged to the early-onset severe preeclampsia group. Diastolic notch was twofold more frequent in the early group. RI was abnormal in 63% of the early-onset and 50% of the late-onset group. CONCLUSION Pregnancies with early-onset preeclampsia who had abnormal uterine artery Doppler findings were at high risk for both maternal and neonatal complications, whereas those who had late-onset preeclampsia with abnormal Doppler findings only had an increased risk of perinatal complications.
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Affiliation(s)
- Keerthi Chilumula
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Pradip Kumar Saha
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Tanuja Muthyala
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Subhas Chandra Saha
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Venkataseshan Sundaram
- Department of Neonatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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Malah N, Hofstaetter C, Raio L, Surbek D. Effects of early aspirin therapy on utero-placental hemodynamics in patients at risk of preeclampsia. J Matern Fetal Neonatal Med 2020; 35:2304-2310. [PMID: 32731776 DOI: 10.1080/14767058.2020.1786048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the effects of early aspirin therapy on the mean pulsatility index of both uterine arteries (utA PI) at 1st and 2nd trimester in women at risk of preeclampsia (PE). METHODS Uterine artery (utA) blood flow characteristics were obtained in 315 women, 73 women at risk for PE and early aspirin treatment (group 1), 124 without specific risk factors and no aspirin treatment (group 2) and 118 women with manifest PE (group 3). Mean utA PI of group 1 and group 2 were compared within and between the groups at the 1st and 2nd trimester time points. Furthermore, values at 2nd trimester were compared with those of group 3. Observed to expected mean utA PI ratio (O/E ratio) were calculated for comparison between the groups. RESULTS Mean utA PI of group 1 was significantly higher in the 1st trimester compared to group 2 (1.74 vs. 1.47, p = .0117). In the 2nd trimester mean PI decreased significantly in both groups from 1.74 to 1.16 in group 1 and from 1.47 to 0.90 in group 2 (p < .0001). Nevertheless, the difference between the groups was significantly higher in the 2nd trimester than in the 1st trimester (0.29 vs. 0.27, p < .001). Correction for gestational age by analyzing mean utA O/E ratios showed a comparable pattern with a significantly decrease in both groups (1.40 to 1.10 in group 1 and 1.18 to 0.78 in group 2, p < .0001), but a significant higher decrease in the 2nd trimester in group 2 (0.31 vs.0.22, p < 0001). The prevalence of PE was 15.1% (11/73) in group 1 (4 early/7 late onset PE) and 4.7% (6/124) in group 2 (1 early/5 late onset). Mean utA PI and O/E ratio obtained in the 2nd trimester were higher in all PE cases with no significant difference between early and late onset PE (1.49/1.57 and 1.25/1.36 in group 1 and 0.80/0.97 and 0.77/0.99 in group 2). However, mean utA PI and O/E ratio decreased in all cases without PE in both groups, whereas mean utA PI was 1,37 and O/E-ratio was 1,29 in patients with manifest PE at admission, with significantly higher values in early onset than in late onset PE (1.45/1.31 vs. 1.07/1.02, p < .0001). CONCLUSIONS Our results show that early aspirin treatment leads to a decrease of elevated mean utA PI between 1st and 2nd trimester in patients at elevated risk for PE which is inferior to the decrease observed in women at standard risk for PE. While aspirin improves trophoblast invasion during early second trimester, vascular resistance remains well above average levels. Limited vascular remodeling capacity in the utero-placental perfusion area seems to be the explanation why aspirin does not abrogate PE in all women and has little effect on birth weight. Another explanation might be that a dose of 100 mg aspirin was used as compared to the 150 mg which is recommended today. Our findings underscore the need to study the effects of intervention already during the early stages of trophoblast invasion in the first trimester.
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Affiliation(s)
- Nicole Malah
- Department of Obstetrics and Gynecology, Inselspital, University of Bern, Bern, Switzerland
| | - Cornelia Hofstaetter
- Department of Obstetrics and Gynecology, Inselspital, University of Bern, Bern, Switzerland
| | - Luigi Raio
- Department of Obstetrics and Gynecology, Inselspital, University of Bern, Bern, Switzerland
| | - Daniel Surbek
- Department of Obstetrics and Gynecology, Inselspital, University of Bern, Bern, Switzerland
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Abstract
Pre-eclampsia complicating 2-5% of pregnancies is an obstetrical syndrome associated with deleterious short-and long-term consequences to the gravid women, the fetus and the neonate. Majority of the obstetrical complications occur in early pre-eclampsia (requiring delivery <34 weeks). The risk factor based approach recommended by the professional organizations for pre-eclampsia screening has shown suboptimal clinical performance. The combined multimarker screening for pre-eclampsia encompassing documentation of maternal medical history, measurement of mean arterial pressure, estimation of the maternal serum levels of placental growth factor, pregnancy associated plasma protein-A, and recording the Uterine artery mean pulsatility index, performed in the first trimester between 11 and 13 + 6 weeks has proven to be an effective screening strategy. The a-priori risk is determined by multivariate analysis of the factors from history, while the other parameters are converted to log 10 transformed multiple of median values. Bayes' theorem is used to calculate the final risk. The above model has shown to detect 77% of preterm pre-eclampsia (<37 weeks), 96% of early preterm pre-eclampsia (<34 weeks), 38% of term pre-eclampsia and 54% of all pre-eclampsia, at a false positive rate of 10%. Uterine artery Doppler is key to pre-eclampsia screening. Currently a risk of >1:100 for pre-eclampsia developing before 37 weeks (preterm pre-eclampsia) is regarded as screen positive. Aspirin at a dose of 150 mg at bedtime given to screen positive subjects is associated with a significant reduction of preterm pre-eclampsia and early pre-eclampsia. The intervention is now supported by a well conducted randomized trial and metanalysis data. Aspirin acts by diminishing stores of constitutive cyclooxygenase enzyme in the non-nucleated platelets without disturbing systemic prostaglandin production. Selective use of aspirin in screen positive women is associated with a very low incidence of adverse maternal, fetal and neonatal side effects. The screening protocol can be applied to twin pregnancies albeit minor differences. Hence, screening for pre-eclampsia in first trimester, which is now endorsed by the federation of international obstetrical and gynecological societies, should be offered universally to all women at 11 to 13 + 6 weeks of gestation, followed by the administration of aspirin and serial maternal-fetal surveillance in the screen positive woman.
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Affiliation(s)
- Seneesh Kumar Vikraman
- Center for Prenatal diagnosis and Fetal therapy, ARMC AEGIS Hospital, Perinthalmana, Kerala, India.,Department of Fetal Medicine, Almas Hospital, Malappuram, Kerala, India
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Graupner O, Karge A, Flechsenhar S, Seiler A, Haller B, Ortiz JU, Lobmaier SM, Axt-Fliedner R, Enzensberger C, Abel K, Kuschel B. Role of sFlt-1/PlGF ratio and feto-maternal Doppler for the prediction of adverse perinatal outcome in late-onset pre-eclampsia. Arch Gynecol Obstet 2019; 301:375-385. [PMID: 31734756 DOI: 10.1007/s00404-019-05365-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 10/30/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The sFlt-1 (soluble fms-like tyrosine kinase-1)/PlGF (placental growth factor) ratio and uterine artery Doppler have shown to be helpful in the diagnosis of pre-eclampsia (PE). The predictive value of the cerebroplacental ratio (CPR) regarding adverse perinatal outcome (APO) in low-risk pregnancies is intensively discussed. We evaluated the extent to which sFlt-1/PlGF ratio and feto-maternal Doppler may be useful in predicting APO in singleton pregnancies complicated by late-onset PE and/or HELLP syndrome. METHODS This is a retrospective study from 2010 to 2018 consisting of singleton pregnancies with confirmed diagnosis of late-onset (lo ≥ 34 weeks) PE/HELLP syndrome in which sFlt-1/PlGF ratio and feto-maternal Doppler (mUtA-PI: mean uterine artery pulsatility index and CPR) were determined. The ability of sFlt-1/PlGF ratio, mUtA-PI, CPR and their combination to predict APO or SGA was evaluated using receiver operating characteristic (ROC) curves. RESULTS 67 patients were included in the final analysis. Of these, sFlt-1/PlGF was > 110 (defining angiogenic lo PE) in 40.3% (27/67), mUtA-PI was above the 95th centile in 34.3% (23/67) patients and CPR was lower than the 5th centile in 10.4% (7/67). Abnormal sFlt-1/PlGF and mUtA-PI as well as CPR were associated with a lower birth weight (BW). Late-preterm birth (< 37 weeks) as well as postnatal diagnosis of small for gestational age (SGA: BW < 3rd centile) was significantly more often in angiogenic lo PE cases. Neither sFlt-1/PIGF nor CPR or mUtA-PI were APO predictors. Only for sFlt-1/PlGF, ROC analysis revealed a significant predictive value for postnatal SGA (AUC = 0.856, p = 0.001, 95% CI 0.75-0.97). There was no statistical added value of combined SGA predictors as compared to sFlt-1/PlGF alone. CONCLUSIONS In patients with lo PE, adding sFlt-1/PlGF ratio to routine antepartum fetal surveillance may be useful to identify cases of postnatal SGA. However, further prospective studies are warranted to define the role of feto-maternal Doppler and sFlt-1/PlGF ratio as outcome predictors.
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Affiliation(s)
- Oliver Graupner
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Anne Karge
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sarah Flechsenhar
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Alina Seiler
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Haller
- Institute for Medical Informatics, Statistics and Epidemiology (IMedIS), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Javier U Ortiz
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Silvia M Lobmaier
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Roland Axt-Fliedner
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital UKGM, Justus-Liebig University, Giessen, Germany
| | - Christian Enzensberger
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital UKGM, Justus-Liebig University, Giessen, Germany
| | - Kathrin Abel
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bettina Kuschel
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Leite JF, Lobo GAR, Nowak PM, Antunes IR, Araujo Júnior E, Pares DBDS. Prediction of preeclampsia in the first trimester of pregnancy using maternal characteristics, mean arterial pressure, and uterine artery Doppler data in a Brazilian population. Obstet Gynecol Sci 2019; 62:391-6. [PMID: 31777734 DOI: 10.5468/ogs.2019.62.6.391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/03/2019] [Accepted: 04/17/2019] [Indexed: 11/08/2022] Open
Abstract
Objective To evaluate the performance of the preeclampsia (PE) screening algorithm of the Fetal Medicine Foundation (FMF) during the first trimester in a Brazilian population using maternal characteristics, mean arterial pressure (MAP), and uterine artery Doppler data. Methods This is a prospective cohort study that evaluated 701 pregnant women during the first trimester ultrasound screening for chromosomal abnormalities (11-13+6 weeks). All patients provided information regarding clinical and obstetric history, MAP, and mean uterine artery pulsatility index (mean PI). Patients were assigned to four groups based on the presence of PE and gestational age at delivery: group 1 (control), patients without hypertensive disorders (n=571); group 2, PE and delivery before 34 weeks of gestation (n=7); group 3, PE and delivery before 37 weeks of gestation, including patients from group 2 and patients that presented PE with delivery between 34 and 37 weeks (n=17); and group 4, PE and delivery before 42 weeks of gestation, including patients from both groups 2 and 3 and patients that presented PE with delivery between 37 and 42 weeks of gestation (n=34). Results After the exclusion of 96 patients, we evaluated the data of 605 patients. By combining maternal characteristics, MAP, and the mean uterine artery PI for the detection of PE, we found a sensitivity of 71.4% in group 2, 50% in group 3, and 41.2% in group 4 (false positive rate=10%). Conclusion Using maternal characteristics, MAP, and uterine artery Doppler data, we were able to identify a significant proportion of patients who developed preterm PE.
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Taylor TJ, Quinton AE, de Vries BS, Hyett JA. Uterine Artery Pulsatility Index Assessment at <11 Weeks' Gestation: A Prospective Study. Fetal Diagn Ther 2019; 47:129-137. [PMID: 31280268 DOI: 10.1159/000500776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/06/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Mean uterine artery pulsatility index (meanUAPI) is commonly measured at 11-13+6 weeks to predict adverse pregnancy outcomes including hypertensive disorders and small-for-gestational age. The aims of this study were to establish a population-specific reference range for meanUAPI at <11 weeks, to determine if an abnormal meanUAPI at <11 weeks was associated with adverse pregnancy outcome, and to assess changes in meanUAPI between <11 weeks and 11-13+6 weeks. METHODS A prospective cohort was examined at <11 weeks and at 11-13+6 weeks to develop reference ranges for meanUAPI. Based on these regression models, meanUAPI Z-scores were compared between outcome groups using a two-sample t test. Longitudinal changes in the meanUAPI between <11 and 11-13+6 weeks were assessed by two-way mixed ANOVA. RESULTS Prior to 11 weeks, there was no significant difference in meanUAPI between normal (n = 622) and adverse (n = 80) outcomes (mean [95% CI]: 2.62 [2.57-2.67] and 2.67 [2.50-2.84], respectively; p = 0.807). At 11-13+6 weeks, meanUAPI was significantly higher in the adverse (n = 66) compared with the normal (n = 535) outcome group (mean [95% CI]: 1.87 [1.70-2.03] and 1.67 [1.63-1.72], respectively; p = 0.040). There was a statistically significant decrease (p < 0.0001) in meanUAPI between the two time points. CONCLUSION MeanUAPI measured at <11 weeks' gestation does not appear to be a useful marker for the prediction of placental-related adverse pregnancy outcomes, supporting an argument for the prediction of risk at 11-13+6 weeks' gestation.
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Affiliation(s)
- Tracey J Taylor
- South Coast Ultrasound for Women, Wollongong, New South Wales, Australia, .,Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia,
| | - Ann E Quinton
- Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.,School of Health, Medical and Applied Science, Central Queensland University, Sydney, New South Wales, Australia
| | - Bradley S de Vries
- Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.,RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Jonathon A Hyett
- Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.,RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Sebastian A, Raj TJS, Yenuberi H, Job V, Varuhghese S, L J, Regi A. Angiogenic factors and uterine artery Doppler in predicting preeclampsia and associated adverse outcomes in a tertiary hospital in south India. Pregnancy Hypertens 2019; 16:26-30. [PMID: 31056155 DOI: 10.1016/j.preghy.2019.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/22/2019] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Ajit Sebastian
- Department of Gynecologic Oncology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - T J Simi Raj
- Department of Obstetrics and Gynecology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Hilda Yenuberi
- Department of Obstetrics and Gynecology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
| | - Victoria Job
- Department of Clinical Biochemistry, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Santosh Varuhghese
- Department of Nephrology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Jayaseelan L
- Department of Biostatistics, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Annie Regi
- Department of Obstetrics and Gynecology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Orosz L, Orosz G, Veress L, Dosa D, Orosz L, Arany I, Fabian A, Medve L, Pap K, Karanyi Z, Toth Z, Poka R, Than NG, Torok O. Screening for preeclampsia in the first trimester of pregnancy in routine clinical practice in Hungary. J Biotechnol 2019; 300:11-19. [PMID: 31055145 DOI: 10.1016/j.jbiotec.2019.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/18/2019] [Accepted: 04/20/2019] [Indexed: 12/01/2022]
Abstract
We aimed to evaluate the contribution of different factors in the Fetal Medicine Foundation algorithms for preeclampsia (PE) risk calculation during first-trimester screening in Hungary. We selected subjects for the nested case-control study from a prospective cohort of 2545 low-risk pregnancies. Eighty-two patients with PE and 82 gestational age-matched controls were included. Individual PE risk was calculated using two risk-assessing softwares. Using Astraia 2.3.1, considering maternal characteristics and biophysical parameters only, detection rates (DR) were 63.6% for early-PE and 67.6% for late-PE. When we added placenta associated plasma protein A (PAPP-A) to the risk calculation, DRs decreased to 54.5% and 64.8% respectively. Using Astraia 2.8.2 with maternal characteristics and biophysical parameters resulted in the DRs of 63.6% (early-PE) and 56.3% (late-PE). If we added PAPP-A to the risk calculation, DRs improved to 72.7% and 54.9%. The addition of placental growth factor (PlGF) did not increase detection rates in either calculation. In conclusion, using maternal characteristics, biophysical parameters, and PAPP-A, an acceptable screening efficacy could be achieved for early-PE during first-trimester screening. Since PlGF did not improve efficacy in our study, we suggest setting new standard curves for PlGF in Eastern European pregnant women, and the evaluation of novel biochemical markers.
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Affiliation(s)
- Laszlo Orosz
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Debrecen Medical and Health Science Centre, Nagyerdei korut 98, 4032, Debrecen, Hungary
| | - Gergo Orosz
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Debrecen Medical and Health Science Centre, Nagyerdei korut 98, 4032, Debrecen, Hungary
| | - Lajos Veress
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen Medical and Health Science Centre, Nagyerdei korut 98, 4032, Debrecen, Hungary
| | - Diana Dosa
- Department of Family and Occupational Medicine, Faculty of Public Health and Faculty of Medicine, University of Debrecen Medical and Health Science Centre, Moricz Zsigmond krt. 22, 4032, Debrecen, Hungary
| | - Laszlo Orosz
- Departement of Obststrics and Gynaecology, Andras Josa County and Teaching Hospital, Szent Istvan ut. 68, 4400, Nyiregyhaza, Hungary.
| | - Ibolya Arany
- Departement of Neonatology, Andras Josa County and Teaching Hospital, Szent Istvan ut. 68, 4400, Nyiregyhaza, Hungary
| | - Antal Fabian
- Departement of Obststrics and Gynaecology, Andras Josa County and Teaching Hospital, Szent Istvan ut. 68, 4400, Nyiregyhaza, Hungary
| | - Laszlo Medve
- Departement of Obststrics and Gynaecology, Andras Josa County and Teaching Hospital, Szent Istvan ut. 68, 4400, Nyiregyhaza, Hungary
| | - Karoly Pap
- Departement of Obststrics and Gynaecology, Andras Josa County and Teaching Hospital, Szent Istvan ut. 68, 4400, Nyiregyhaza, Hungary
| | - Zsolt Karanyi
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen Medical and Health Science Centre, Nagyerdei korut 98, 4032, Debrecen, Hungary
| | - Zoltan Toth
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Debrecen Medical and Health Science Centre, Nagyerdei korut 98, 4032, Debrecen, Hungary
| | - Robert Poka
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Debrecen Medical and Health Science Centre, Nagyerdei korut 98, 4032, Debrecen, Hungary
| | - Nandor Gabor Than
- Systems Biology of Reproduction Lendulet Research Group, Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Magyar Tudosok krt. 2, 1117, Budapest, Hungary; Maternity Private Clinic of Obstetrics and Gynecology, Kiralyhago ter 8, 1126, Budapest, Hungary; First Department of Pathology and Experimental Cancer Research, Semmelweis University, Ulloi ut 26, 1085, Budapest, Hungary.
| | - Olga Torok
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Debrecen Medical and Health Science Centre, Nagyerdei korut 98, 4032, Debrecen, Hungary.
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Li J, Cai A, Yuan Q, Ding H, Zhao D. Relationships of serum placental growth factor and soluble fms-like tyrosine kinase-1 with fetal and uterine artery Doppler indices in pre-eclampsia. Int J Gynaecol Obstet 2019; 145:176-181. [PMID: 30801711 DOI: 10.1002/ijgo.12796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 10/30/2018] [Accepted: 02/21/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) concentrations among women with pre-eclampsia and healthy control women and to evaluate the associations of serum PlGF and sFlt-1 with fetal and uterine artery Doppler indices in pre-eclampsia. METHODS A prospective cross-sectional study of 33 women with pre-eclampsia and 33 normotensive pregnant women attending a university hospital in China between January and November 2014. Serum PlGF and sFlt-1 were assayed by enzyme linked immunosorbent assays. Doppler indices of the uterine artery, umbilical artery, fetal middle cerebral artery, and ductus venosus were measured. RESULTS The pulsatility index of the uterine artery was negatively correlated with PlGF (r, -0.487; P=0.004) and positively correlated with sFlt-1 (r, 0.420; P=0.015). Gestational age at birth was positively correlated with PlGF (r, 0.601, P<0.001) and negatively correlated with sFlt-1 (r, -0.568; P=0.001). Birth weight was positively correlated with PlGF (r, 0.555; P=0.001) and negatively correlated with sFlt-1 (r, -0.552; P=0.001). Apgar score was negatively correlated with sFlt-1 (r, -0.427; P=0.017). CONCLUSION Lower PlGF and higher sFlt-1 levels in maternal serum were significantly associated with increased uterine arterial impedance in pre-eclampsia.
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Affiliation(s)
- Jingyu Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ailu Cai
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Qian Yuan
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hao Ding
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Dan Zhao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Clark AR, James JL, Stevenson GN, Collins SL. Understanding abnormal uterine artery Doppler waveforms: A novel computational model to explore potential causes within the utero-placental vasculature. Placenta 2018; 66:74-81. [PMID: 29884305 PMCID: PMC6511649 DOI: 10.1016/j.placenta.2018.05.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/19/2018] [Accepted: 05/02/2018] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Uterine artery (UtA) Doppler indices are one of the most commonly employed screening tests for pre-eclampsia worldwide. Abnormal indices appear to result from increased uterine vascular resistance, but anatomical complexity and lack of appropriate animal models mean that little is known about the relative contribution of each of the components of the uterine vasculature to the overall UtA Doppler waveform. Previous computational models suggested that trophoblast-mediated spiral artery remodeling has a dominant effect on the UtA Doppler waveform. However, these models did not incorporate the myometrial arterio-venous anastomoses, which have significant potential to affect utero-placental haemodynamics. METHODS We present a more anatomically complete computational model, explicitly incorporating a structural description of each component of the uterine vasculature, and crucially including myometrial arterio-venous anastomoses as parallel pathways for blood-flow away from the placental bed. Wave transmission theory was applied to the network to predict UtA waveforms. RESULTS Our model shows that high UtA resistance indices, combined with notching, reflect an abnormal remodeling of the entire uterine vasculature. Incomplete spiral artery remodeling alone is unlikely to cause abnormal UtA Doppler waveforms as increased resistance in these arteries can be 'buffered' by upstream anastomoses. Critically, our results indicate that the radial arteries, may have a more important effect on utero-placental flow dynamics, and the UtA Doppler waveform than previously thought. CONCLUSIONS This model suggests that to appropriately interpret UtA Doppler waveforms they must be considered to be reflecting changes in the entire system, rather than just the spiral arteries.
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Affiliation(s)
- Alys R Clark
- Auckland Bioengineering Institute, University of Auckland, New Zealand.
| | - Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Gordon N Stevenson
- School of Women's & Children's Health, University of New South Wales, Sydney, Australia
| | - Sally L Collins
- Nuffield Department of Women's and Reproductive Health, University of Oxford, The Fetal Medicine Unit, John Radcliffe Hospital, Oxford, United Kingdom
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Rodríguez-Almaraz ME, Herraiz I, Gómez-Arriaga PI, Vallejo P, Gonzalo-Gil E, Usategui A, López-Jiménez EA, Galindo A, Galindo M. The role of angiogenic biomarkers and uterine artery Doppler in pregnant women with systemic lupus erythematosus or antiphospholipid syndrome. Pregnancy Hypertens 2018. [PMID: 29523283 DOI: 10.1016/j.preghy.2018.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To evaluate the usefulness of the uterine artery mean pulsatility index (mPI-UtA) and the sFlt-1/PlGF ratio in women with systemic lupus erythematosus (SLE) or antiphospholipid syndrome (APS) for the prediction of placental dysfunction-related adverse outcomes (AO), namely pre-eclampsia (PE) and intrauterine growth restriction (IUGR), and for differential diagnosis between PE and SLE flares. STUDY DESIGN Observational prospective cohort study of 57 pregnant women with SLE or APS. MAIN OUTCOME MEASURES mPI-UtA and sFlt-1/PlGF ratio in maternal serum were obtained at four gestational age periods (11-14, 19-22, 24-29 and 32-34 weeks). Comparisons among pregnancies with normal outcome, SLE flare and AO were performed. RESULTS Overall, we had 44 ongoing pregnancies (36 with SLE and 8 with APS) of which most (n = 35, 80%) were uncomplicated. The overall rate of AO was 9% (n = 4), that was diagnosed at a mean (SD) gestational age of 34.1 (7.5) weeks. Five SLE patients (14%) suffered a SLE flare. No differences for these markers were found between normal pregnancies and those affected by SLE flare. mUtA-PI values were significantly higher in the AO group when compared with normal and SLE flare groups, at 19-22 weeks (1.52, 0.95 and 0.76) and 32-34 weeks (1.13, 0.68 and 0.65), respectively. The sFlt-1/PlGF ratio was significantly higher in the AO group at 24-29 weeks (191.1, 3.1 and 9.2), respectively. CONCLUSION Our preliminary results indicate that mPI-UtA and sFlt1/PlGF ratio may be useful to predict AO in women with SLE, and to make the differential diagnosis with a lupus flare.
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Affiliation(s)
- M E Rodríguez-Almaraz
- Department of Rheumatology, Hospital Universitario 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Universidad Complutense, Madrid, Spain
| | - I Herraiz
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Universidad Complutense, Madrid, Spain.
| | - P I Gómez-Arriaga
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Universidad Complutense, Madrid, Spain
| | - P Vallejo
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Universidad Complutense, Madrid, Spain
| | - E Gonzalo-Gil
- Department of Rheumatology, Hospital Universitario 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Universidad Complutense, Madrid, Spain
| | - A Usategui
- Department of Rheumatology, Hospital Universitario 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Universidad Complutense, Madrid, Spain
| | - E A López-Jiménez
- Department of Biochemistry, Hospital Universitario 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Universidad Complutense, Madrid, Spain
| | - A Galindo
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Universidad Complutense, Madrid, Spain
| | - M Galindo
- Department of Rheumatology, Hospital Universitario 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Universidad Complutense, Madrid, Spain
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Maged AM, Saad H, Meshaal H, Salah E, Abdelaziz S, Omran E, Deeb WS, Katta M. Maternal serum homocysteine and uterine artery Doppler as predictors of preeclampsia and poor placentation. Arch Gynecol Obstet 2017; 296:475-482. [PMID: 28689278 DOI: 10.1007/s00404-017-4457-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/05/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to evaluate the role of maternal serum total Homocysteine (tHcy) and uterine artery (Ut-A) Doppler as predictors of preeclampsia (PE), intrauterine growth restriction (IUGR), and other complications related to poor placentation. PATIENTS AND METHODS A prospective cohort study was conducted on 500 women with spontaneous pregnancies. tHcy was measured at 15-19 weeks, and then, Ut-A Doppler was performed at 18-22 weeks of pregnancy. RESULTS 453 pregnant women completed the follow-up of the study. The tHcy and Ut-A resistance index were significantly higher in women who developed PE, IUGR, and other complications when compared to controls (tHcy: 7.033 ± 2.744, 6.321 ± 3.645, and 6.602 ± 2.469 vs 4.701 ± 2.082 μmol/L, respectively, p value <0.001 and Ut-A resistance index: 0.587 ± 0.072, 0.587 ± 0.053, and 0.597 ± 0.069 vs 0.524 ± 0.025, respectively, p value <0.001). The use of both tHcy assessment and Ut-A Doppler improved the sensitivity of prediction of PE relative to the use of each one alone (85.2 relative to 73.33 and 60%, respectively). CONCLUSION The use of elevated homocysteine and uterine artery Doppler screening are valuable in prediction of preeclampsia, IUGR, and poor placentation disorders. CLINCALTRIAL. GOV ID NCT02854501.
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Affiliation(s)
- Ahmed M Maged
- Obstetrics and Gynecology Department, Cairo University, 135 King Faisal St. Haram, Giza, 12151, Egypt.
| | - Hany Saad
- Obstetrics and Gynecology Department, Cairo University, 135 King Faisal St. Haram, Giza, 12151, Egypt
| | - Hadeer Meshaal
- Obstetrics and Gynecology Department, Cairo University, 135 King Faisal St. Haram, Giza, 12151, Egypt
| | - Emad Salah
- Obstetrics and Gynecology Department, Cairo University, 135 King Faisal St. Haram, Giza, 12151, Egypt
| | - Suzy Abdelaziz
- Obstetrics and Gynecology Department, Cairo University, 135 King Faisal St. Haram, Giza, 12151, Egypt
| | - Eman Omran
- Obstetrics and Gynecology Department, Cairo University, 135 King Faisal St. Haram, Giza, 12151, Egypt
| | - Wesam S Deeb
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Maha Katta
- Department of Obstetrics and Gynecology, Faculty of Medicine, BeniSuef University, Beni Suef, Egypt
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Guizani M, Valsamis J, Dutemeyer V, Kang X, Ceccotti V, Khalife J, Duiella SF, Blavier F, Faraca A, Cos T, Jani JC. First-Trimester Combined Multimarker Prospective Study for the Detection of Pregnancies at a High Risk of Developing Preeclampsia Using the Fetal Medicine Foundation-Algorithm. Fetal Diagn Ther 2017; 43:266-273. [PMID: 28715818 DOI: 10.1159/000477934] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/29/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the Fetal Medicine Foundation (FMF) algorithm prospectively at 11-13 weeks' gestation in the prediction of preeclampsia (PE). METHODS Single-center prospective screening study for PE of singleton pregnancies at 11-13 weeks. The FMF algorithm takes into account maternal characteristics and biomarkers. Detection rate (DR) for a 10% false-positive rate (FPR) for delivery with preterm and term PE was estimated. RESULTS Between January 2011 and December 2013, of 3,239 patients available for final analysis, 36 (1.1%) subsequently developed preterm and 44 (1.4%) term PE. In combined screening by maternal factors, mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor, the DR was 80.6% (95% CI 64.0-91.8) for PE at <37 weeks and 31.8% (95% CI 18.6-47.6) for PE at ≥37 weeks, at a 10% FPR. CONCLUSION Our data suggest that the FMF algorithm provides effective first-trimester screening for preterm PE.
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Affiliation(s)
- Meriem Guizani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Tarasevičienė V, Grybauskienė R, Mačiulevičienė R. sFlt-1, PlGF, sFlt-1/PlGF ratio and uterine artery Doppler for preeclampsia diagnostics. Medicina (Kaunas) 2016; 52:349-353. [PMID: 27940029 DOI: 10.1016/j.medici.2016.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/18/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Angiogenic factors such as soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) play a key role in the pathogenesis of preeclampsia. Uterine artery (UA) blood flow is important for preeclamptic pregnancy outcome, but small amount of evidence suggests UA dopplerometry for preeclampsia diagnostics and management. The aim of our study was to compare the value of angiogenic factors and UA dopplerometry in preeclampsia diagnosis and determine cut-off values to obtain the highest sensitivity and specificity of the parameter. MATERIALS AND METHODS We performed a case controlled study of 72 pregnant women with preeclampsia and 72 healthy matched controls. SFlt-1 and PlGF were measured in serum samples, the sFlt-1/PlGF ratio was calculated and UA pulsatility (PI) and resistance (RI) indexes were registered. RESULTS Significantly higher levels of sFlt-1, sFlt-1/PlGF ratio and mean UAPI and UARI and lower levels of PlGF were found in preeclampsia group when compared to controls. The highest sensitivity and specificity for preeclampsia had SFlt-1/PlGF and PlGF with the cut-off values of ≥35 (sensitivity of 95.8% and specificity of 96.2%, respectively) and ≤138.6pg/mL (sensitivity of 95.8% and specificity of 93.7%, respectively). For diagnostics of early-onset preeclampsia, all factors sFlt-1, PlGF and sFlt-1/PlGF had equal significance with the cut-off values of ≥7572pg/mL (specificity of 97.5%, sensitivity 92.3%), ≤100.5pg/mL (specificity 96.2%, sensitivity of 100%) and ≥54.6 (specificity 97.5%, sensitivity 97.5%) respectively. CONCLUSIONS The sFlt-1/PlGF ratio and PlGF are superior to sFlt-1, UAPI and UARI for preeclampsia diagnosis. For early-onset preeclampsia diagnostics either sFlt-1 or PlGF is sufficient.
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Affiliation(s)
- Viktorija Tarasevičienė
- Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Regina Grybauskienė
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Regina Mačiulevičienė
- Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Fouad Gomaa M, Elkholy AG, Farid LA, Elkady OS, Eldin MS. Serum C3 and uterine artery Doppler indices at 14-20 weeks gestation for preeclampsia screening in low-risk primigravidas: A prospective observational study. J Reprod Immunol 2016; 117:4-9. [PMID: 27343872 DOI: 10.1016/j.jri.2016.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 05/29/2016] [Accepted: 06/16/2016] [Indexed: 11/24/2022]
Abstract
PROBLEM Preeclampsia affects 2-10% of human pregnancies with poor screening tests. In order to intervene preventively, high risk population should be identified before the 20th week of pregnancy and by a method not subjected to operator efficiency. METHODOLOGY Prospective observational study recruiting 825 low risk primigravidas. Serum C3 and uterine artery Doppler indices were measured at 14-20 weeks. RESULTS Serum C3 levels at 14-20 weeks of gestation had a sensitivity 83.3%, specificity 100%, PPV 100% and NPV 98.3% when the cut-off value was 53.1mg/. For the mean RI, the best cut off value found was 0.72 with 100% sensitivity, 99.1% specificity, 92.3% PPV and 100% NPV. For the mean PI the best cut off value was 1.35 with 100% sensitivity, 94.1% specificity, 63.2% PPV and 100% NPV. The combination of serum C3 level and mean uterine artery PI showed 100% sensitivity, 97.4% specificity, 80% PPV and 100% NPV in prediction of PE. CONCLUSION Serum C3 levels at 14-20 weeks can be used for prediction of PE with comparable results to uterine artery Doppler indices but has the superiority of being operator independent.
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Verma D, Gupta S. Prediction of adverse pregnancy outcomes using uterine artery Doppler imaging at 22-24 weeks of pregnancy: A North Indian experience. Turk J Obstet Gynecol 2016; 13:80-84. [PMID: 28913097 PMCID: PMC5558343 DOI: 10.4274/tjod.55632] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/26/2016] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the predictive value of uterine artery Doppler imaging at 22-24 weeks of gestation for adverse pregnancy outcomes. MATERIALS AND METHODS This was a prospective study in which uterine artery Doppler was performed at 22-24 weeks of gestation in 165 pregnant women with singleton pregnancies. A pulsatility index (PI) more than 1.45 or bilateral uterine notching was labeled as abnormal Doppler. The pregnancy outcome was assessed in terms of normal outcome, preeclampsia, fetal growth restriction (FGR), low birth weight, spontaneous preterm delivery, oligohydramnios, fetal loss or at least one adverse outcome. RESULTS Out of 165 patients, 35 (21.2%) had abnormal second trimester uterine artery Doppler. In pregnancies that resulted in preeclampsia (PE), (n=21), FGR, (n=21), and low birth weight (n=39), the median uterine artery PI was higher (1.52, 1.41, and 1.27 respectively). In the presence of abnormal Doppler, the risk of PE [OR=10.7, 95% confidence interval (CI): (3.91-29.1); p<0.001], FGR [OR=4.34, 95% CI: (1.62-11.6); p=0.002], low birth weight [OR=6.39, 95% CI: (3.16-12.9); p<0.001] and the risk of at least one obstetric complication [OR=8.73, 95% CI: (3.5-21.3); p<0.001] was significantly high. The positive predictive value of abnormal uterine artery Doppler was highest for preeclampsia (36.84%) among all adverse pregnancy outcomes assessed. CONCLUSION Uterine artery Doppler ultrasonography at 22-24 weeks of gestation is a significant predictor of at least one adverse pregnancy outcome, with the highest prediction for preeclampsia.
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Affiliation(s)
- Deepti Verma
- Maulana Azad Medical College, Department of Obstetrics and Gynecology, New Delhi, India
| | - Sangeeta Gupta
- Maulana Azad Medical College, Department of Obstetrics and Gynecology, New Delhi, India
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Bahlmann F, Al Naimi A. Using the angiogenic factors sFlt-1 and PlGF with Doppler ultrasound of the uterine artery for confirming preeclampsia. Arch Gynecol Obstet 2016; 294:1133-9. [PMID: 27256338 DOI: 10.1007/s00404-016-4128-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 05/27/2016] [Indexed: 01/13/2023]
Abstract
PURPOSE The aim of this study is to assess the value of the angiogenic factors for diagnosing preeclampsia and predicting the severity of manifestation. A secondary aim is assessing the combination of the uterine artery Doppler with the angiogenic factors for improving the diagnostic power. METHODS This is a prospective single center study in a tertiary referral hospital. This study includes 728 individual patients. Inclusion criteria were singleton pregnancies, a referral to the hospital with suspicion of preeclampsia and any one or combination of the following symptoms: headache, upper abdominal pain, edema, and hypertension. Patients with complications that would affect the course of the pregnancy, such as placenta praevia, premature preterm rupture of membranes, breech presentation, and fetal chromosomal or structural anomalies, were excluded from the study. Blood samples collection and uterine artery Doppler ultrasound were performed at time of recruitment. The differences in sFlt-1, PlGF, and their quotient among normal collective and patients with preeclampsia were analyzed. Doppler ultrasound was performed by one of four highly qualified sonographers. Wilcoxon-Mann-Whitney U test, Spearman's rank correlation, receiver operating characteristic curves, Chi-square test, and logistic regression were used in the analysis. RESULTS A total of 1003 individual samples for the angiogenic factors were included in the analysis. 584 out of the recruited 728 patients had follow-up data with delivery information at the study hospital. Patients with preeclampsia show a significant increase in sFlt-1, which directly correlate with the increased severity of manifestation (Spearman's ρ 0.49). The sFlt-1 cut-off value of 5424 pg/ml confirms preeclampsia with 83.7 % sensitivity, 68.1 % specificity, and 24 % misclassification rate. Preeclampsia patients also show a significant decrease in PlGF, which negatively correlates with the increased severity of manifestation (Spearman's ρ -0.39). A PlGF cut-off value of 118 pg/ml confirms preeclampsia with 47.6 % sensitivity, 71.4 % specificity, and 27 % misclassification rate. Logistic regression shows that a combination of the quotient from sFlt-1/PlGF with notching and uterine artery PI provides a valid model for diagnosing preeclampsia with a diagnostic power of 74.4 %. CONCLUSIONS The study confirms the use of the sFlt-1 and PlGF for diagnosing preeclampsia. It also shows their significance in differentiating between different categories of preeclampsia according to severity. This study shows that the use of angiogenic factors in combination with ultrasound findings provides valid models for confirming preeclampsia.
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Hawkes RA, Patterson AJ, Priest AN, Harrison G, Hunter S, Pinney J, Set P, Hilliard N, Graves MJ, Smith GCS, Lomas DJ. Uterine artery pulsatility and resistivity indices in pregnancy: Comparison of MRI and Doppler US. Placenta 2016; 43:35-40. [PMID: 27324097 DOI: 10.1016/j.placenta.2016.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 03/20/2016] [Accepted: 04/04/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this work was to evaluate whether the uterine arteries (UtA) could be identified and their flow profiles measured during a fetal MRI examination. A comparison was performed against same day sonographic Doppler assessment. METHODS 35 normal, healthy, singleton pregnancies at 28-32 weeks gestation underwent routine Doppler examination, followed by MRI examination. The resistivity index (RI) and pulsatility index (PI) of the left and right UtA were measured using phase contrast MRI. Bland Altman statistics were used to compare MRI and ultrasound results. RESULTS Sixty-nine comparable vessels were analysed. Six vessels were excluded due to artefact or technical error. Bland-Altman analysis demonstrated the ultrasound indices were comparable, although systematically lower than the MRI indices; Right UtA RI bias -0.03 (95% limits of agreement (LOA) -0.27 to +0.20), and left UtA RI bias -0.06 (95% LOA -0.26 to +0.14); Right UtA PI bias -0.06 (95% LOA -0.50 to +0.38), Left UtA PI bias -0.11 (95% LOA -0.54 to +0.32). The inter-rater agreement for the MRI derived PI and RI analysis was good. CONCLUSION This study demonstrates that in the majority of early third trimester pregnancies, the uterine arteries can be identified, and their flow profiles measured using MRI, and that the derived PI and RI values are comparable with Doppler ultrasound values.
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Affiliation(s)
- R A Hawkes
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom.
| | - A J Patterson
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - A N Priest
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | | | - S Hunter
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - J Pinney
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - P Set
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - N Hilliard
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - M J Graves
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - G C S Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, United Kingdom
| | - D J Lomas
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
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Abstract
Introduction The uterine artery Doppler has potentials for screening for complications of impaired placentation. This study examines the indices of uterine artery impedance at 22-23 weeks gestation and their relationship with maternal age and parity. Methods Uterine artery colour imaging and pulsed wave Doppler ultrasound was conducted between 22nd and 23rd weeks in 430 pregnancies. The pregnancies were classified into 2 groups: normal and abnormal outcomes. The indices of impedance recorded were pulsatility index, resistance index and the systolic/diastolic ratio. Relevant obstetric information was retrieved from the antenatal records. The student t- test and Pearson's product moment were used for statistical analysis. Results Fifty eight (13.5%) out of 430 pregnancies had complications of impaired placentation, mainly intrauterine growth restriction and preterm birth (24 or 41.4% each). The indices in normal pregnancies were similar to presently used values. There was no statistically significant difference in the 2 pregnancies groups. The Pulsatility Index (PI) in the right uterine artery was statistically different from the left (t-test 32.8, p < 0.05). Maternal age and parity demonstrate statistically significant positive correlation with PI (r =0.9, p < 0.05; r =0.8, p < 0.05). Conclusion The indices in normal pregnancies were similar to values from previous studies. The values are however not significantly different in pregnancies with abnormal outcome.
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Affiliation(s)
- Olufemi Adebari Oloyede
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
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Prajapati SR, Maitra N. Prediction of pre-eclampsia by a combination of maternal history, uterine artery Doppler, and mean arterial pressure (a prospective study of 200 cases). J Obstet Gynaecol India 2013; 63:32-6. [PMID: 24431597 DOI: 10.1007/s13224-012-0239-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 06/14/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To determine the clinical value of uterine artery Doppler Pulsatility index (PI) at 22-24 + 6 weeks scan and importance of maternal history and mean arterial pressure (MAP) in the prediction of pre-eclampsia. MATERIALS AND METHODS This was a prospective screening study of 200 women with singleton pregnancy. Maternal history and blood pressure were recorded, and MAP was calculated. Transabdominal Doppler ultrasound of uterine artery was performed. Mean PI was calculated, and the presence or the absence of bilateral early diastolic notch was noted. Women were then followed up through pregnancy and delivery for the development of pre-eclampsia, gestational hypertension, and SGA. RESULTS The mean ± SD PI value for subjects who had an adverse pregnancy outcome was significantly higher (0.84 ± 0.28) than mean ± SD PI value for subjects who had normal pregnancy outcome (0.71 ± 0.16) with P value <0.000. CONCLUSION Second trimester uterine artery Doppler is a useful screening method for identification of high risk pregnancy in women who can be kept under close surveillance for better maternal and neonatal outcome. This test works better when combined with previous history of pre-eclampsia and MAP.
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