Prospective study of the hemodynamic behavior of ophthalmic arteries in postpartum preeclamptic women: A doppler evaluation

Abstract

The aim of this study was to evaluate the hemodynamic behavior of the ophthalmic artery by means of the Doppler ultrasound, in postpartum preeclamptic women. It was an observational prospective study with 44 postpartum preeclamptic women (group 1) and 49 postpartum normal women with normal blood pressure and with no previous illnesses known (group 2). All the pregnant women had a Doppler ultrasound exam of the ophthalmic artery in the immediate puerperium, that is, 10 days for the delivery (time 1). Group 1 was then followed prospectively, 26 patients of which returned to the last test in the remote puerperium in 45 days (time 2) and 29 patients returned to the last test in the remote puerperium in 90 days (time 3). All these women had preeclampsia before the delivery. The resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), end diastolic flow velocity (EDV), second peak of systolic velocity (P2), and the peak ratio (PR) were calculated. The data obtained are expressed in average and standard deviation, by using the Lilliefors test for normality. The average of the Doppler indexes in groups 1 and 2 was compared by means of test t of the student. Group 1 was analyzed separately, comparing the three times, using the test of ANOVA for repetitive measures and Tukey post-hoc range test. In the "Results" section, the statically meaningful differences in RI, PI, P2, RPV, and EDV (p < 0.0001, p < 0.0001, p < 0.0009, p < 0.0001, p < 0.0028) were found in the immediate puerperium of group 1 in relation to group 2, indicating the persistence of hyperperfusion and orbital vasodilatation in the immediate postpartum period in patients who had complicated pregnancies previously due to preeclampsia. In the evolutionary analysis of group 1, comparing the Doppler indexes between the immediate and late puerperium, statistically relevant differences between the rates of RI, P2, and PR (p < 0,01) were observed, showing a raise of RI and reduction of P2 and PR, and also a tendency of normalization of these rates in the late puerperium. When the same indexes were compared (PI, P2, and PR) now in times 2 and 3, the remote, and late puerperium, respectively, there were no significant differences, indicating the stabilization of these indexes since the 45th day of the puerperium. Within 90 days, RI, PI, and PR are not stabilized yet in relation to the control, even though there is a tendency of these indexes to reach the control. In conclusion, there was persistence of signs of vasodilatation and hyperperfusion of the orbital territory, represented by Doppler of the ophthalmic artery in the immediate puerperium of preeclamptic women. A tendency of normalization of the orbital hemodynamic standard in the pregnant women from the period of the late puerperium was observed, but there was no complete normalization of the vascular pattern on the remote postpartum.

Optic nerve sonography and ophthalmic artery Doppler velocimetry in healthy pregnant women: an Australian cohort study

“…The only changes of significance were a reduction in the end diastolic ophthalmic artery velocity, and consequently a reduced TAMaxV and increased PI and RI. This is a novel finding, as although other authors have compared postnatal ophthalmic artery Doppler variables in a cohort of previously preeclamptic women with normotensive controls, this is the first study to observe the impact of delivery within the same cohort. The apparent increase in vascular resistance may reflect a healthy cerebrovascular response to the normal changes in cardiac output after delivery, as homeostasis is reestablished through a rise in systemic vascular resistance to prepregnancy levels.…”

Plane-Wave Ultrasound Doppler of the Eye in Preeclampsia

“…Our findings are consistent with the observation of reduced vascular resistance in transcranial Doppler studies of the cerebral arteries of women with PE reported by Riskin‐Mashiah et al 18 and in the ophthalmic artery by Hata et al 19 , 20 and Diniz et al 21 Sato et al 22 reported declining vascular resistance and an inverse correlation with MAP in the retinal vessels in late pregnancy in normal subjects using laser Doppler flowmetry. Alves Borges et al 23 reported reduced resistance in the ophthalmic artery in post-partum PE versus control subjects. Belfort et al, 24 however, reported that whereas resistance was negatively correlated with MAP in normal pregnancies, it was positively correlated with MAP in the CRA and ophthalmic artery in PE.…”

Ophthalmic artery Doppler analysis: a window into the cerebrovasculature of women with pre‐eclampsia

“…After delivery, the changes in the ophthalmic artery Doppler parameters of pre‐eclamptic women may take time to resolve, with a recent study demonstrating persistent differences up to 3 months postpartum in comparison with women with normotensive pregnancy. This serves to reinforce our evolving understanding that many features of pre‐eclampsia may take much longer than the conventional 6 weeks to resolve.…”