Increased uterine artery vascular impedance is related to adverse outcome of pregnancy but is present in only one‐third of late third‐trimester pre‐eclamptic women

Li, Haiyan; Gudnason, H; Olofsson, Per; Dubiel, Mariusz; Gudmundsson, Sæmundur

doi:10.1002/uog.1895

Cited by 66 publications

(56 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Caesarean section was reportedly less in number in comparison with vaginal delivery and fetal distress eas the main indication for caesarean section. These findings are comparable with the findings of study done by Rai L et al and Garcia B et al 12,13 Mean birth weight in present study was 2150 gm but these findings are not comparable with similar study done by Wald RM et al, Garcia B at al, Peixoto et al and Li H et al 6,11,12,14 Oligohydramnios, SFGR, Pre-eclamsia, Anemia are the most common pregnancy complications respectively.…”

Section: Discussionsupporting

confidence: 69%

“…15 This is in contrast to the findings of Ghosh et al where RI and PI were considered better indicators of vascular impedance in predicting adverse perinatal outcomes. 16 B/L notch in uterine artery Doppler was present in 25.4% participants and this findings are quit comparable with the similar study done by Wald RM et al, Rai L et al but not consistent with study done by Maria AL et al and Li H et al 11,13,14,17 Study found acceptable sensitivity, specificity, PPV and NPV of Doppler ultrasound during third trimester to predict obstetrical and perinatal outcome and this findings are comparable with study done by Rai L et al 13 Limitations of this study was number of cases has been small and study not included Patients who came in labor or with a complication like abruptio placenta.…”

Section: Discussioncontrasting

confidence: 53%

See 1 more Smart Citation

Third trimester Doppler ultrasound as prediction of obstetric outcome in high-risk pregnancy, Gujarat, India

Ghosh

Oza

Meel

2017

Int J Reprod Contracept Obstet Gynecol

View full text Add to dashboard Cite

Background: Doppler ultrasound has emerged as beneficial tool in the assessment of the fetal and placental circulation and in the prediction of adverse pregnancy outcome. Umbilical artery Doppler has proved helpful to supervise the growth restricted fetuses and compromised vasculature as in hypertensive disorders high risk pregnancies. Objective of present study was to investigate the association between third-trimester uterine artery Doppler assessment and adverse obstetric outcome.Methods: This prospective study was done among 110 high risk pregnancies. Vessel like uterine artery, umbilical artery, middle cerebral artery and ductus venosus were studied in present study. Indices calculated: Peak systolic velocity, End diastolic velocity, Mean velocity, Systolic/diastolic ratio, Pulsatility index (PI) and resistance index (RI) of middle cerebral artery (MCA), Ductus venosus S/A ratio.Results: bilateral notch was present statistically significant (p<0.05) in 18.1% and absent in 28.2% among cases of adverse perinatal outcome. UA S/D ratio was >3 in 22.7% and <3 in 11.8% among cases of adverse perinatal outcome and findings were statistically significant (p<0.05). End diastolic velocity was reduced in statistically significant (p<0.05) in 9.1% and normal in 20.1% among cases of adverse perinatal outcome. MCA PI was <lower limit statistically significant (p<0.05) in 24.5% and >lower limit in 18.2% among cases of adverse perinatal outcome. MCA PI/UA PI ratio was <1 statistically significant (p<0.05) in 25.5% and absent in 17.3% among cases of adverse perinatal outcome.Conclusions: Increase in UA PI and decrease in MCA PI are early marker for detection of fetal compromise. Ratio of indices between MCA PI and UA PI reflects brain sparing effect as well as placental insufficiency and these are more specific in detection of IUGR than individual artery indices.

show abstract

Section: Discussionsupporting

confidence: 69%

Section: Discussioncontrasting

confidence: 53%

Third trimester Doppler ultrasound as prediction of obstetric outcome in high-risk pregnancy, Gujarat, India

Ghosh

Oza

Meel

2017

Int J Reprod Contracept Obstet Gynecol

View full text Add to dashboard Cite

show abstract

“…Previous studies examining uterine artery PI [29,30,31,32,33] and serum PlGF or the sFlt-1 to PlGF ratio [34,35,36,37,38,39] in the late second or early third trimesters of pregnancy have essentially focused on the investigation of women presenting to specialist clinics with signs of hypertensive disorders with the aim of identifying the subgroup that will develop severe disease [29,30,31,32,33,34]. Our study examined the application of biomarkers in routine screening for subsequent development of PE as part of a strategy for a new approach to prenatal care [7].…”

Section: Discussionmentioning

confidence: 99%

Competing Risks Model in Screening for Preeclampsia by Biophysical and Biochemical Markers at 30-33 Weeks' Gestation

et al. 2014

View full text Add to dashboard Cite

Objective: To assess the risk for preeclampsia (PE) by maternal characteristics, uterine artery pulsatility index (Ut-PI), mean arterial pressure (MAP), serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1)at 30-33 weeks' gestation. Methods: This was a screening study in singleton pregnancies including 2,140 that developed PE and 83,615 that were unaffected by PE. We developed a survival time model for the time of delivery for PE by combining maternal characteristics and history with Ut-PI, MAP, PlGF and sFlt-1 multiple of the median (MoM) values (combined test). Data on third-trimester MAP and Ut-PI were available in 350 cases of PE, and 13,878 unaffected pregnancies and data on PlGF and sFlt-1 were available in 118 cases of PE and 3,734 unaffected pregnancies. Modelled detection rate of all PE and PE requiring delivery within 4 and 6 weeks of the visit was estimated. Results: Screening by the combined test would detect 66, 98 and 86% of all PE and PE requiring delivery within 4 and 6 weeks of the visit, respectively, at a false positive rate of 5%. Interpretation: Screening by biophysical and biochemical testing at 30-33 weeks could identify most pregnancies developing PE and requiring delivery within the subsequent 4 weeks.

show abstract

“…This is in keeping with other studies showing a high incidence of Prognostic value of placental insufficiency indicators L Geerts and HJ Odendaal increased uterine artery PI before the onset of pre-eclampsia as well as in established disease, more so in severe early-onset pre-eclampsia (as in this cohort) compared to milder forms near term. 36,37 Abnormal uterine artery waveforms are strongly associated with histological abnormalities in the placenta 23,38 (that is decidual vasculopathy, accelerated villous maturation, ischemic-thrombotic lesions and infarctions) that correlate with ultrasound characteristics 23 and occur more frequently at earlier GA. 29 This is in keeping with the current findings: only 49% of placentas had a normal appearance on ultrasound and with a jelly-like placenta the pregnancies were approximately 1 week less advanced (207.3±9.9 versus 215.5±13.2 days).…”

Section: Uterine Artery Waveformsmentioning

confidence: 99%

Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

Geerts

Odendaal

2007

J Perinatol

View full text Add to dashboard Cite

Objective: Assess the prognostic value of ultrasound and Doppler parameters in severe preterm pre-eclampsia.Study design: Prospective cohort study in Cape Town, South Africa, involving 113 women with severe pre-eclampsia between 24 and 34 weeks of gestation and managed expectantly when suitable. Serial ultrasound and multivessel Doppler assessments were performed 2 to 3 times weekly. Observations included fetal weight estimation, growth pattern, amniotic fluid volume, appearance of the heart and bowel, pulsatility index of the uterine, umbilical and middle cerebral arteries and ductus venosus. Perinatal outcome (death or neurological compromise, n ¼ 12) and major morbidity (n ¼ 62) were related to findings at recruitment and on the last assessment preceding delivery.Results: In univariate analysis, fetal growth asymmetry and waveform analysis of all three fetal vessels significantly correlated with both end points. The initial fetal weight estimation with a cutoff weight of 1080 g had the highest sensitivity (83.3%) and negative predictive value (97.5%) for poor outcome (P<0.001) while the final ductus venosus pulsatility index had the highest specificity (92%) and positive predictive value (33%). The combination of a raised placentocerebral ratio and ductus venosus pulsatility index close to delivery had the highest (57.1%) positive predictive value. Logistic regression showed the best overall predictive model for poor outcome to be a combination of initial fetal weight estimation and final ductus venosus pulsatility index (overall accuracy 94.6%, RR 20.20 (7.36, 55.41)). The initial fetal weight estimation with a cutoff weight of 1283 g provided the best correct prediction of major morbidity (83.2% overall accuracy, sensitivity 79.0%, specificity 88.2%, positive and negative predictive values of 89.1 and 77.6% respectively). This was better than using the gestational age at recruitment or delivery, birth weight or any of the Doppler results. The prediction of morbidity was not improved by the addition of any other variable in logistic regression analysis. Conclusion:For the short-term outcome measures assessed in this study, the estimated fetal weight at the time of diagnosis is the most important prognostic factor in severe pre-eclampsia with some additional value of ductus venosus assessment.

show abstract

Increased uterine artery vascular impedance is related to adverse outcome of pregnancy but is present in only one‐third of late third‐trimester pre‐eclamptic women

Abstract: ABSTRACT

Cited by 66 publications

References 23 publications

Third trimester Doppler ultrasound as prediction of obstetric outcome in high-risk pregnancy, Gujarat, India

Third trimester Doppler ultrasound as prediction of obstetric outcome in high-risk pregnancy, Gujarat, India

Competing Risks Model in Screening for Preeclampsia by Biophysical and Biochemical Markers at 30-33 Weeks' Gestation

Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

Contact Info

Product

Resources

About