Background. Poor placentation and systemic endothelial dysfunction have been identified as main events in Preeclampsia (PE). The relationship and chronology of these phenomena are important if we are to understand the pathophysiological mechanisms underlying this major clinical problem. Objectives. To compare the evolution of placentation and endothelial function in normotensive and preeclamptic pregnancies. Patients and methods. In a prospective cohort study, 59 pregnant women with a high risk of developing PE were subjected to flow-mediated dilation (FMD) and to Doppler velocimetry of uterine arteries in order to obtain their Pulsatility Index (UtA-PI). The variations in the FMD and UtA-PI values, between 16+0 and 19+6 and 24+0 and 27+6 weeks of gestation, were compared, taking PE development into consideration. Results. Nine patients developed PE and the other 50 women remained normotensive. At 16+0 to 19+6 weeks of pregnancy, patients that developed PE presented higher values of UtA-PI than the normotensive group, but there was no difference in FMD results between them. At 24+0 to 27+6 weeks, the patients that developed PE presented higher values of UtA-PI and lower values of FMD than the women that remained normotensive. Conclusions. These results corroborate the evidence that endothelial injury is secondary to poor placentation.

Introduction: Hypertensive disorders represent the most frequent and serious complications of pregnancy and childbirth. Abnormal findings upon uterine artery Doppler, including altered values of pulsatility index and average persistence of bilateral diastolic notch, have been proposed as suitable predictors of preeclampsia in screening tests. Objectives: To evaluate the usefulness of uterine artery Doppler in predicting the occurrence of preeclampsia in a group of women at clinical and epidemiological risk for its development. Patients and methods: 81 pregnant women, all of which with risk factors for developing preeclampsia were selected. The average pulsatility index exams were performed on gestational intervals of 16+0 and 19+6 weeks and 24+0 and 27+6 weeks. In the latter range, the persistence of bilateral diastolic notch was also assessed. Results: Bilateral diastolic notch between 24+0 and 27+6 weeks of gestation could predict the diagnosis of preeclampsia with 75% sensitivity, 82% specificity, positive predictive value of 50% and negative predictive value of 93%. The analysis of data obtained between 16+0 and 19+6 weeks and between 24+0 and 27+6 weeks demonstrated that high values of mean pulsatility index were found in patients affected by preeclampsia compared with those found in the group of normotensive patients. Conclusion: pregnancies complicated by preeclampsia had significantly higher prevalence of bilateral notches and higher mean pulsatility indexes in each of the ranges studied. Since no specific treatment is currently available, the ability to predict the disease at its onset, in the first half of pregnancy, can facilitate early monitoring, increased support, and the ability to intervene at the appropriate time so as to reduce the maternal-fetal morbidity and mortality observed in preeclampsia.

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