Doppler Indices of the Ophthalmic Artery in Pregnant Women With Pregestational Diabetes Mellitus With and Without Retinopathy.

OBJECTIVES: To evaluate ophthalmic Doppler velocimetry patterns in pregnant women with pregestational diabetes mellitus with and without retinopathy in comparison to pregnant women without gestational intercurrences. METHODS: This cross-sectional observational study analyzed Doppler indices of the ophthalmic arteries, including the resistive index (RI), pulsatility index, peak systolic velocity, second peak systolic velocity, peak ratio, and end-diastolic velocity (EDV), in 3 groups of pregnant women: diabetic with retinopathy (n = 12); diabetic without retinopathy (n = 85); and nondiabetic controls (n = 122). The Kruskal-Wallis test was used for the statistical analysis with a probability of 95%. RESULTS: The mean gestational ages ± SDs of pregnant women with and without retinopathy and nondiabetic controls were 29.1 ± 2.2, 29.7 ± 2.7, and 31 ± 1.0 weeks, respectively, with no significant differences between the groups (P > .099). The mean RI in the group with retinopathy was significantly higher (P = .030) than in the control group, but it did not significantly differ compared to the group without retinopathy (P = .204). The RI in the control group did not differ from that in the group without retinopathy (P = .079). The EDV was significantly lower in the group with retinopathy (P = .015) in relation to the control group, but there were no differences compared to the group without retinopathy (P = .217). CONCLUSIONS: Pregnant women with pregestational diabetes mellitus and retinopathy had increased vascular impedance in the ophthalmic artery together with a reduction in the EDV, which was probably related to ischemia, thrombosis, and neovascularization of retinal vessels.

The role of the erythrocyte in the outcome of pregnancy with preeclampsia.

The objective of this study was to analyze the relationships of osmotic and mechanical stability of erythrocytes with anthropometric, biochemical, hematologic and hemodynamic variables in pregnant women with preeclampsia (PE). The studied population consisted of 20 normotensive patients and 16 patients with PE. Patients with PE presented worse gestational outcome, greater hematologic impairment, erythrocytes osmotically more stable in vitro, but in conditions of isotonicity with the in vivo medium, in addition to hyperflow in orbital territory, when compared to normotensive patients. The correlation analysis between anthropometric, hematologic and hemodynamic variables in patients with PE indicated that erythrocytes with lower volumes and lower levels of hemoglobin favor the occurrence of a better gestational outcome, because they are more stable and because they are associated with a decrease in the hemodynamic changes present in the disease. This should mean that the tendency to microcytosis, probably due to a mechanism of compensatory mechanical selection, is a desirable characteristic in the disease.

[Orbital territory hyperperfusion in pregnant women with systemic lupus erythematosus]. / Hiperperfusão no território orbital de gestantes portadoras de lúpus eritematoso sistêmico.

PURPOSE: to analyze the ophthalmic artery functioning in pregnant women with systemic lupus erythematosus (PL) without active renal disease as compared to non-pregnant women with lupus (NPL) without active renal disease, and to normal pregnant women (PN). METHODS: observational study that analyzed ophthalmic artery dopplervelocimetric variables of 20 PN, 10 PL and 17 NPL women. The variables analyzed were: pulsatility index (PI), final diastolic velocity (FDV) and velocity peak ratio (VPR). Mean and standard deviation of these indexes were calculated. For group mean comparison, analysis of variance (ANOVA) and the post-hoc Tukey test have been used, with confidence interval of 95% (p<0.05). RESULTS: the PN group showed the following means and standard deviations of ophthalmic artery parameters: PI=2,4+/-0,3; VPR=0,5+/-0,1 e FDV=5,1+/-2,1 cm/s. The PL and NPL groups showed the following values, respectively: PI=2,0+/-0,4 and 1,9+/-0,4; VPR=0,6+/-0,1 and 0,6+/-0,1; FDV=9,7+/-3,9 cm/s and 8,1+/-4,3 cm/s. There was not significant mean difference between the PL and NPL groups for PI, VPR or FDV. However, statistically significant mean differences were observed between PN and PL for PI, VPR and FDV, with higher values of FDV and VPR in the PL group. CONCLUSIONS: there was a reduction of ophthalmic artery vascular impedance with orbital hyperfusion in the two groups of women with lupus erythematosus as compared to normal pregnant women. These results may help to improve the understanding on pathophysiology of systemic lupus erythematosus. In addition, the present method may be applied in future studies as a complementary procedure for the differential diagnosis between pre-eclampsia and renal failure due to lupus.