Uterine Artery Doppler Screening in 2nd Trimester of Pregnancy for Prediction of Pre-eclampsia and Fetal Growth Restriction

Background: Pre-eclampsia is a pregnancy specific disorder characterized by hypertension and proteinuria after 20 weeks of gestation. Uterine artery Doppler velocimetry analysis has been extensively studied in the second trimester of pregnancy as a predictive investigation for the future development of pre-eclampsia and Fetal Growth Restriction.Aims: To predict the probability of developing pre-eclampsia of pregnant women and Fetal Growth Restriction in relation with normal and abnormal Doppler velocimetry of uterine artery at 2nd trimester of pregnancy.Methods:A total of 97 pregnant women of 2nd trimester of pregnancy were included in this study After taking informed written consent of the participants, all they underwent uterine artery Doppler velocimetry at 22ndand 24thweek of pregnancy. They again examined clinically during delivery at different gestational age. Pre-eclampsia (PE) was diagnosed on the basis of measurement of blood pressure as well as urine routine and microscopic examination. Fetal Growth Restriction (FGR) was determined by measuring birth weight and gestational age at the time of delivery. Development of PE and FGR was observed in relation to severity of Uterine Artery Doppler Velocimetry findings. A pre-structured data collection sheet was used as a research tool for data collection. Statistical analyses of the results were obtained by using windows-based computer software devised with Statistical Packages for Social Sciences (SPSS-23).Results: More than half (52.6%) of the subjects belonged to age 21-25 years and 52(53.6%) subjects were nulliparous. More than half (56.7%) of the subjects came from low income group family. Pre-eclampsia developed 11(11.3%) of the patients, 15(15.5%) had FGR and 12(12.4%) had notching in 2ndUADV at 24thweek. Presence of Pre-diastolic notch in 2ndUADV study at 24thweek to predict pre-eclampsia has sensitivity 72.7%, specificity 95.4%, accuracy 92.8% and positive predictive values 66.7% and negative predictive value 96.5%. Presence of Pre-diastolic notch in 2ndUADV study at 24thweek to predict FGR has sensitivity 20.0%, specificity 89.0%, accuracy 78.4% and positive predictive values 25.0% and negative predictive value 85.9%. The mean age was 28.69±7.81 years who had per-diastolic notch in 2ndUADV at 24thweek and 24.13±6.11 years who had normal UADV and the p value is 0.022 which is significant. The mean para was 1.29±0.33 who had per-diastolic notch in 2ndUADV at 24thweek and 1.77±0.29 who had normal UADV together with remarkable p value which is 0.001. The mean BMI was 23.59±1.09 Kg/m2who had per-diastolic notch in 2ndUADV at 24thweek and 21.57±0.47 Kg/m2who had normal UADV with notable p value 0.001 in this study.Conclusion:Uterine artery Doppler velocimetry in early pregnancy can be a good investigating tool for prediction of subsequent development of pre-eclampsia and Fetal Growth Restriction

Uterine artery Doppler velocimetry in the prediction of adverse obstetric outcomes in unexplained MSAFP elevations

Unexplained maternal serum-fetoprotein (MSAFP) elevation has been known to be associated with adverse obstetric outcomes, however it is not sufficiently useful as a screening test. This study was undertaken to determine whether uterine artery Doppler velocimetry could define a subset of patients with an elevated MSAFP level in whom complications of pregnancy might develop. The subjects included 179 women between 26 and 28 weeks' gestation with MSAFP > or = 2.5 multiples of the median, in whom either the presence of an early diastolic notch or a resistance index 0.6 was considered as an abnormal Doppler velocimetry finding. Those subjects who displayed abnormal Doppler velocimetry findings showed an increased incidence of preeclampsia, preterm birth, IUGR, and IUFD compared to those subjects with only elevated MSAFP (p < 0.05). No differences were observed in the incidence of LBW. Positive predictive values of adverse obstetric outcomes were significantly higher in the group having both elevated MSAFP and abnormal Doppler velocimetry compared to the group with only elevated MSAFP (p < 0.05). Uterine artery Doppler velocimetry in the second trimester can improve the value of unexplained MSAFP elevation in the prediction of adverse obstetric outcomes.

Expression of Adhesion Molecules in Placenta and Correlation with Uterine Artery Doppler Velocimetry in Pregnancy-induced Hypertension / 대한산부인과학회잡지

INTRODUCTION: The pathophysiology of PIH remains unclear. Recently, placental abnormalitiesare stressed as a possible cause of PIH. Abnormal shallow invasion of trophoblasts, confinedto decidua, without involving myometrium is believed to result in reduced uteroplacentalperfusion, endothelial injury, and activation of coagulation cascade system. Integrin, one of theadhesive membrane proteins, is expected to be related to the regulation of trophoblasts invasion. PURPOSE: The purpose of this study is to investigate the expression of adhesion moleculesin placenta and the correlation between uterine artery Doppler findings and integrinexpressions in the placentas of PIH patients. SUBJECTS: Thirty-six cases of severe PIH patients were enrolled in the study with 10number of normal control pregnant women. The integrin subunit expressions withimmunohistochemical staining were observed in floating villi, maternal-side cytotropholbasts, andfetal-side cytotrophoblasts. Uterine artery Doppler study was also performed, and the S/Dratio was evaluated. Abnormal Doppler findings was defined as S/D ratio>or=2.6. RESULTS: Cytoplasmic staining of villi and placental bed cytotrophoblast for theintegrin alpha1 subunit in PIH specimen was weaker than those in normal controls. Theexpression of integrin beta1 subunit was negative for both controls and PIH group. Thepositive cytoplasmic stain was observed among PIH placenta in contrast to normal control inwhich the expression of integrin beta4 subunit was not detected. The expression of alpha v beta3 introphoblast with PIH was positive staining, but not in control group. Uterine artery Dopplervelocimetry was performed in 25 cases with PIH. Trace(+/-) or - staining of integrin alpha1 subunit were observed in 60.0% of abnormal S/D(>or=2.6) group, 20.0% of normal S/Dratio group patients, respectively. Trace or + staining of integrin beta4 subunit were observedin 50.0% of abnormal S/D group and 6.7% of normal S/D group and this is in statisticallysignificant. Trace or + staining of integrin alpha v beta3 subunit were observed 70.0% ofabnormal S/D group and 26.7% of normal S/D group, and this statistically significant. CONCLUSION: In PIH the abnormality in the invasion of cytotrophoblats results inabnormal integrin subunit expression, but it is also correlated to the abnormal uterine arteryDoppler velocimetry which shows a S/D ratio of greater than 2.6. Thus, the uterine arteryDoppler velocimetry reflects abnormal placentation.