[Role of Doppler velocimetry of uterine arteries and ambulatory blood pressure monitoring in detecting pregnancies at risk for preeclampsia]. / Ruolo della Doppler flussimetria delle arterie uterine e del monitoraggio in continuo della pressione arteriosa nell'individuazione di soggetti a rischio per lo sviluppo di preeclampsia.

AIM: The aim of this study is to evaluate the performance of ambulatory blood pressure monitoring (ABPM) in association with Doppler velocimetry of uterine arteries in the detection of preeclampsia (PE). METHODS: In a prospective study, 22 patients at risk for the development of PE have been en-rolled: 17 were nulliparous women with increased resistances in uterine arteries at 24 weeks and 5 had an obstetric history of PE. All patients were tested with ABPM and uterine arteries Doppler velocimetry. A resistance index (RI) higher than 0.62 for the Doppler velocimetry and a diastolic midline estimating statistic of rhythm (MESOR) higher than 68 for the ABPM were considered abnormal. Patients were followed longitudinally until delivery. The occurrence of PE and low birth weight were considered as gestational outcomes endpoints. RESULTS: Overall, the mean gestational age at delivery was 36.3+/-3.4 weeks (range 29.4-41). Six out of 22 (27.2%) patients developed PE; 4 out of 22 (18%) newborns were small for gestational age (SGA) <5 degrees percentile. In the prediction of PE, ABPM in association with Doppler velocimetry showed a positive predictive value (PPV) of 42% and a negative predictive value (NPV) of 90%, for the development of low birth weight the PPV was 33% and the NPV 100%. CONCLUSION: This study shows that ABPM in association with Doppler velocimetry evaluation is a useful test to detect patients at high risk for the development of PE.

Prognostic role of umbilical artery Doppler velocimetry in growth-restricted fetuses.

OBJECTIVE: To correlate umbilical artery Doppler velocimetry with perinatal outcome in a group of growth-restricted fetuses. DESIGN: The study was a retrospective analysis of 578 singleton pregnancies with diagnosis of intrauterine growth restriction (IUGR), delivered in a single obstetric unit, at the Spedali Civili, Brescia, Italy, a university and teaching hospital with 3500 deliveries a year and neonatal intensive care unit (NICU). METHODS: During 1991-99 we studied 578 pregnancies with a diagnosis of IUGR referred for Doppler velocimetry. From this population, four subsets were formed: normal umbilical artery pulsatility index (NUAPI; 334 fetuses); increased pulsatility index but with telediastolic flow (abnormal umbilical artery pulsatility index AUAPI; 137 fetuses); absent end-diastolic flow (AEDF; 70 fetuses); reverse telediastolic flow (RF; 37 fetuses). Fetal biometry, amniotic fluid and fetal-maternal Doppler velocimetry were evaluated in all patients, with biophysical profile and routine non-stress test, when indicated. The following outcomes were examined: mean gestational age at delivery, number of preterm deliveries (< 34 weeks), mean neonatal weight, Apgar score at 5 min < 7, prenatal and neonatal deaths (within the first 28 days of life), admission to the NICU and number of days spent after birth in hospital. Neonatal morbidity was analyzed, including respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH, grade 2-3), necrotizing enterocolitis (NEC) and retinopathy of prematurity. Long-term neurological follow-up is still ongoing and will not be presented in this paper. RESULTS: Out of 578 fetuses with IUGR, 547 were born alive. There were 26 neonatal deaths. The mean gestational age at delivery was 35.6 +/- 4 weeks and mean birth weight 1844 +/- 612 g. There were 28 intrauterine deaths and three elective terminations of pregnancy. A total of 60 cases (11%) were complicated by RDS, 13 cases (2.4%) by retinopathy of prematurity, IVH was present in nine cases (1.6%) and NEC in seven cases (1.3%). Total perinatal mortality was 9.8%; in the 26 cases of neonatal death, the mean week at delivery was 29.6 +/- 4 with a mean weight of 840 +/- 425 g. Patients with NUAPI had a mean week at delivery of 37 +/- 3, those with AUAPI delivered at 34 +/- 3.2, those with AEDF delivered at 31 +/- 3 and those with RF delivered at 29 +/- 2 weeks. In progressively worsening umbilical velocimetry, we observed an increase of incidence of low Apgar score. Days of admission to the NICU and incidence of perinatal mortality increased with the worsening of Doppler velocimetry. CONCLUSIONS: Our study underlines the existence of a strict correlation between umbilical Doppler velocimetry and an increased incidence of perinatal complications in IUGR fetuses.

Effect of betamethasone on computerized cardiotocographic parameters in preterm growth-restricted fetuses with and without cerebral vasodilation.

OBJECTIVE: To verify the effects of maternal corticosteroid administration on fetal behavior and heart rate variation using computerized cardiotocography (cCTG) in a selected group of growth retarded fetuses. STUDY DESIGN: Fifty singleton pregnancies complicated by fetal growth restriction were enrolled in the study before 34 weeks of gestation. All of them received two intramuscular injections of 12 mg of betamethasone 24 h apart. Fetal heart rate was recorded by cCTG before the first injection, and every 24 h for the 3 days following the end of the treatment. After Doppler evaluation of cerebral circulation, fetuses were divided into a group with and a group without signs of cerebral vasodilation. Basal heart rate, short- and long-term variation, percentage of time spent in high variability, fetal movements and percentage of small accelerations were evaluated. RESULTS: Basal fetal heart rate did not show significant changes. Short-term variation and percentage of time spent in high variability significantly decreased in fetuses with but not in fetuses without vasodilation. Long-term variation and fetal movements significantly decreased in both groups. CONCLUSIONS: Maternal administration of betamethasone in growth-retarded fetuses with cerebral vasodilation is associated with significant but transitory modifications of fetal heart rate variation.