Prediction of preeclampsia by means of Doppler flowmetry of uterine artery and flow-mediated dilation of brachial artery

Abstract

Predição de pré-eclâmpsia por meio da dopplerfluxometria das artérias uterinas e da dilatação fluxo-mediada da artéria braquial Calixto AC, Brandão AHF, Toledo LL, Leite HV, Cabral ACV. Prediction of preeclampsia by means of Doppler flowmetry of uterine artery and flow-mediated dilation of brachial artery. Radiol Bras. 2014 Jan/Fev;47(1):14-17. Abstract ResumoObjective: To evaluate the association of Doppler of uterine artery and flow-mediated dilation of brachial artery (FMD) in the assessment of placental perfusion and endothelial function to predict preeclampsia. Materials and Methods: A total of 91 patients considered as at risk for developing preeclampsia were recruited at the prenatal unit of the authors' institution. All the patients underwent FMD and Doppler of uterine arteries between their 24th and 28th gestational weeks. Calculations of sensitivity and specificity for both isolated and associated methods were performed. Results: Nineteen out of the 91 patients developed preeclampsia, while the rest remained normotensive. Doppler flowmetry of uterine arteries with presence of bilateral protodiastolic notch had sensitivity of 63.1% and specificity of 87.5% for the prediction of preeclampsia. Considering a cutoff value of 6.5%, FMD showed sensitivity of 84.2% and specificity of 73.6%. In a parallel analysis, as the two methods were associated, sensitivity was 94.2% and specificity, 64.4%. Conclusion: The association of Doppler study of uterine arteries and FMD has proved to be an interesting clinical strategy for the prediction of preeclampsia, which may represent a positive impact on prenatal care of patients considered as at high-risk for developing such a condition.

Ultrasonographic study and Doppler flow velocimetry of maternal kidneys and liver in low-risk pregnancy

“…Ultrasonography, particularly with the utilization of Doppler, has been increasingly studied and utilized in several clinical conditions, especially in pregnant patients. In some situations as in gestational trophoblastic disease ( 14 ) in the prediction of pre-eclampsia ( 15 ) , such method of evaluation has demonstrated its positive impact on pre-natal follow-up. Several other studies have been undertaken, demonstrating that obstetric ultrasonography presents good sensitivity in the screening fetal malformations of the central nervous system, in special with the continuous improvement and mastery of the utilization of specialized methods such as Doppler and volumetric (3D/4D) ultrasonography, contributing to make it the method of choice in such a routine ( 16 ) .…”

“…The second cause is hormonal due to increased progesterone levels causing relaxation of the ureteral musculature, with a decrease in ureteral peristalsis and consequential ureteral dilation ( 2 , 3 , 21 ) . Such physio-anatomical changes lead to urinary stasis with pyelocaliceal dilatation ( 15 , 22 ) , more common at right, in the end of the second gestational trimester and beginning of the third trimester, and may be similar to pathological conditions such as hydronephrosis.…”

Comparison of flow-mediated dilation (FMD) of the brachial artery in normotensive versus preeclamptic pregnant females

“…Their range of FMD was found nearer to our study [ Table 7 ]. The lower cutoff value of FMD% in other studies, such as Negin Rezavand et al ,[ 6 ] Calixto A.C. et al ,[ 12 ] and Oliveira OP et al ,[ 13 ] can be explained by the fact that they included only high-risk population, such as chronic arterial hypertension, pregestational diabetes mellitus (DM), personal history of preeclampsia in previous gestation, and family history of preeclampsia (mother or sister), while in recent study cases who had history of chronic hypertension, prepregnancy diabetes and previous history of preeclampsia were excluded because abovementioned high-risk conditions are associated with preexisting endothelial dysfunction, which leads to lesser vasodilation of blood vessels in response to reactive hyperemia so they have lesser FMD% cutoff values.…”