Uterine-umbilical artery doppler velocimetry and pregnancy outcome in SLE patients: relation to disease manifestations and activity

ABSTRACT

To evaluate the uterine-umbilical artery Doppler velocimetry and determine its relation to pregnancy outcome and disease manifestations in SLE patients. Blood flow velocity waveforms of the umbilical and uterine arteries were studied by color Doppler ultrasound in 36 pregnant SLE patients referred from the Rheumatology Department for follow up and delivery in the Obstetrics Department. Resistance index [RI] and pulsality index [PI] were measured at the 1st week and then every 4 weeks from the 20th and 30th weeks till delivery. The mean age was 27.33 +/- 4.03 years and disease duration of 5.72 +/- 2.57 years. The nulliparity rate and history of previous abortions were higher in those with poor fetal outcome [50% and 62.5%, respectively]. Lupus anticoagulants and anticardiolipin were obviously higher in those with a poor outcome [25% and 37.5%, respectively] with a higher association with APS in spite of anticoagulation. The SLEDAI was higher in those with a poor fetal outcome and the difference reached significance at the 24th week gestation [12.13]. Eight [22.22%] of the patients had abnormal fetal outcome: 5 IUGR [13.89%], 1 IUFD [2.78%] and 2 [5.55%] with missed abortion. Uterine and umbilical artery Doppler abnormalities were higher in those with poor obstetric outcomes and were earlier revealed by the uterine. Uterine artery Doppler seems to be an earlier prognostic factor for adverse outcomes compared to umbilical in SLE patients at high risk, allowing antepartum intensive care and optimal timing of delivery to early confirm a good pregnancy outcome: