Low maternal middle cerebral artery Doppler resistance indices can predict future development of pre‐eclampsia

Abstract-Preeclampsia may affect severely the cerebral circulation leading to impairment of cerebral autoregulation, edema, and ischemia. It is not known whether impaired autoregulation occurs before the clinical onset of preeclampsia, and whether this can predict the occurrence of preeclampsia. Seventy-two women at 25 to 28 weeks of gestation were studied. Control values were derived from 26 nonpregnant women. Dynamic properties of cerebral autoregulation (DCA) were measured in the middle and posterior cerebral artery using transcranial Doppler and transfer function analysis (phase and gain) of respiratory-induced 0.1 Hz hemodynamic oscillations. Uterine artery ultrasound was performed to search for a notch sign as an early marker of general endothelial dysfunction. All women were followed up until 6 weeks after delivery for the occurrence of preeclampsia. The autoregulation parameter gain did not differ between pregnant and nonpregnant women. Phase was slightly but significantly higher in pregnant women, indicating better DCA. Women with a notch sign did not show altered DCA. A history of preeclampsia during a previous pregnancy was associated with lower phase in middle cerebral artery and posterior cerebral artery (P<0.05 each). During follow-up, 9 women developed preeclampsia. None of the DCA parameters were associated with the occurrence of preeclampsia. In conclusion, DCA is well preserved during late midterm pregnancy, even in women with disturbed uterine blood flow. Yet, pregnant women with preeclampsia in a previous pregnancy seem to have poorer DCA. Although limited in statistical power, this study does not support DCA as a strong early risk marker of preeclampsia. (Hypertension. 2014;63:161-166.)

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“…17,21 However, we could not find an association of pulsatility or resistance indices with subsequent preeclampsia in our study.…”

Section: Discussioncontrasting

confidence: 87%

Dynamic Cerebral Autoregulation in Pregnancy and the Risk of Preeclampsia

et al. 2014

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“…Low middle cerebral artery Doppler resistance indices can predict future development of pre-eclampsia. [47] Also, ultrasound can be used to determine the amniotic fluid index and Manning's score. [67] www.wjpps.com Vol 6, Issue 6, 2017.…”

Section: Diagnosis Of Pre-eclampsiamentioning

confidence: 99%

Adjunctive Use of Esomeprazole in the Treatment of Pre-Eclampsia: A Case Report and Literature Review

Oriaifo¹

2017

WJPPS

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Faced with the absence of suitable assays and/or kits for predictive biomarkers, medical practitioners in poor resource settings may be emasculated by the unrelenting upwards prevalence of and uncertain forecast associated with the pre-eclampsia/eclampsia and fetal growth restriction disease spectrum. Low-birth weight and pre-eclampsia due to placental malaria, multiple pregnancy and malnutrition may be reactive oxygen species -and anti-angiogenic factors -dependent.Adjunctive esomeprazole promises to be a treatment regimen that may lead to cure for it has been found to attenuate the known pathophysiologic mechanisms responsible for pre-eclampsia and IUGR which may be imbalance between pro-angiogenic and anti-angiogenic factors. The proton pump inhibitor, esomeprazole, decreases the excessive secretion of the anti-angiogenic factors soluble fmslike tyrosine kinase-I (sFlt-I) and soluble endoglin from the placenta responsible for the hypertension, endothelial dysfunction, multiorgan injury and foetal growth restriction in preeclampsia. sFlt-I binds the pro-angiogenic placenta growth factor (PIGF) and vascular endothelial growth factor (VEGF), the circulating free forms of which are low in preeclampsia. Case report is of a 32-year old Nigerian housewife who showed significant reduction in blood pressure, proteinuria and pedal oedema with esomeprazole add-on to a regimen of methyl-dopa for severe preeclampsia. The combination significantly (P < 0.05) This report corroborates the accumulating pre-clinical data on the safety and efficacy of esomeprazole in the treatment of preeclampsia, a precursor of eclampsia.

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“…Several studies have reported lower ophthalmic artery PI values and higher PR values in women with hypertensive diseases of pregnancy . Other cerebral arteries, embryologically and functionally related to the ophthalmic artery, also demonstrated lower flow resistance in the second trimester of pregnancy among women who were to develop pre‐eclampsia …”

Section: Discussionmentioning

confidence: 99%

Reference values of maternal ophthalmic artery doppler variables in the first trimester of normal pregnancy

Alves

Yang

Sousa

et al. 2014

J of Clinical Ultrasound

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Low maternal middle cerebral artery Doppler resistance indices can predict future development of pre‐eclampsia

Abstract: Objective To determine if decreased resistance (vasodilatation) RI and PI were 0.93 and 0.93, respectively, with optimal sensitivity and specificity of 86% and 93% for both variables. Positive and negative likelihood ratios were 11.8/0.15 (RI) and 12.3/0.15 (PI). Conclusion

Cited by 23 publications

References 32 publications

Dynamic Cerebral Autoregulation in Pregnancy and the Risk of Preeclampsia

Dynamic Cerebral Autoregulation in Pregnancy and the Risk of Preeclampsia

Adjunctive Use of Esomeprazole in the Treatment of Pre-Eclampsia: A Case Report and Literature Review

Reference values of maternal ophthalmic artery doppler variables in the first trimester of normal pregnancy

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