The value of Doppler assessment of the uteroplacental circulation in predicting preeclampsia or intrauterine growth retardation

Jacobson, Sig Linda; Imhof, Regine; Manning, Nicki; Mannion, Vibeke; Little, D; Rey, É.; Redman, Christopher W.G.

doi:10.1016/0002-9378(90)90832-r

Cited by 114 publications

(37 citation statements)

References 9 publications

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“…Hyperuricemia was defined as serum or plasma uric acid concentrations Ն1 SD above normal for gestational age, 11 a value that corresponds with what is considered hyperuricemia at term in most studies. 8,12,13 We chose 1 SD rather than a fixed value as abnormal, because uric acid increases strikingly 11 with advancing gestation. For the same reason, the analysis of uric acid as a continuous variable is presented as z scores to account for gestationspecific changes in uric acid.…”

Section: Methodsmentioning

confidence: 99%

Uric Acid Is as Important as Proteinuria in Identifying Fetal Risk in Women With Gestational Hypertension

et al. 2005

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Abstract-Gestational hypertension is differentiated into higher and lower risk by the presence or absence of proteinuria.We asked if hyperuricemia, a common finding in pregnancy hypertension, might also be an indicator of increased risk. We examined fetal outcome data from 972 pregnancies collected from 1997 to 2002 in a nested case-control study. Participants were nulliparous with no known medical complications. The frequency of preterm birth, the duration of pregnancy, frequency of small-for-gestational-age infants, and birth weight centile were determined for pregnancies assigned to 8 categories by the presence or absence of combinations of hypertension, hyperuricemia, and proteinuria. In women with gestational hypertension, hyperuricemia was associated with shorter gestations and smaller birth weight centiles and increased risk of preterm birth and small-for-gestational-age infants. Hyperuricemia increased the risk of these outcomes in the presence or absence of proteinuria. Risk was also increased in a small group of women with hyperuricemia and proteinuria without hypertension. Women with only hypertension and hyperuricemia have similar or greater risk as women with only hypertension and proteinuria. Those with hypertension, proteinuria, and hyperuricemia have greater risk than those with hypertension and proteinuria alone. The risk of these outcomes increased with increasing uric acid. Hyperuricemia is at least as effective as proteinuria at identifying gestational hypertensive pregnancies at increased risk. Uric acid should be reexamined for clinical and research utility. Key Words: gestational hypertension Ⅲ preeclampsia Ⅲ pregnancy Ⅲ uric acid Ⅲ intrauterine growth restriction Ⅲ preterm birth Ⅲ risk assessment H ypertensive disorders during pregnancy increase maternal and infant risk. The greatest impact is associated with the pregnancy-specific syndrome, preeclampsia. 1 Preeclampsia, conventionally diagnosed by the gestational onset of hypertension and proteinuria, increases perinatal mortality 5-fold 1 and kills 50,000 women yearly worldwide. 2 Its management, delivery to halt the progression of the pathophysiology, is responsible for 15% of preterm births in developed countries. 3 Gestational hypertension without proteinuria has much less of an adverse effect on maternal or fetal outcome, whereas the major risk from hypertension that antedates pregnancy is the superimposition of preeclampsia. 4 The importance of differentiating these conditions is reflected in several classification schemes in which gestational hypertension with proteinuria is separated from gestational hypertension without proteinuria and hypertension that antedates pregnancy. 4 -6 These diagnostic criteria currently used to discriminate high-risk from lower risk women with gestational hypertension are arbitrary. The term "preeclampsia" was coined in the early 20th century when it was recognized that hypertension and proteinuria could be precursors to a pregnancy-specific seizure disorder, eclampsia, which had been recognized for...

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Section: Methodsmentioning

confidence: 99%

Uric Acid Is as Important as Proteinuria in Identifying Fetal Risk in Women With Gestational Hypertension

et al. 2005

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“…In fetal growth retardation, enhanced cortisol availability is present due to reduced 11␤-HSD2 activity, 6 accompanied by elevated blood flow resistance and increased shear stress (ss) in the uteroplacental circulation. 7,8 An increased cortisol availability within the vascular wall, a known target for glucocorticoids and mineralocorticoids, could be essential for the response to vasoactive mediators, such as the pressor hormones angiotensin II (Ang II) and ␣-adrenergic agonists. 9 Glucocorticoids, such as dexamethasone, have been shown (1) to stimulate Ang II type 1A (AT 1A ) receptor expression via glucocorticoid responsive elements in the gene promotor, 10,11 (2) to enhance AT 1 receptor binding of Ang II in vascular smooth muscle cells, 12 and (3) to reduce AT 2 receptor expression, 13 all of which could also explain the sensitization to Ang II in PE.…”

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confidence: 99%

Fluid Shear Stress Reduces 11β-Hydroxysteroid Dehydrogenase Type 2

et al. 2001

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Abstract-In pregnancy, invading trophoblasts represent the inner vascular border of maternal spiral arteries and are exposed to elevated shear stress (ss) in hypertensive disorders. Intracellular cortisol availability is regulated by 11␤-hydroxysteroid dehydrogenases (11␤-HSDs), thus determining body fluid volume and vascular responses. The impact of ss on 11␤-HSD2 activity was studied in the human JEG-3 cell line, a model for trophoblasts. JEG-3 cells do not express 11␤-HSD1; however, 11␤-HSD2 message and activity are measured via cortisol/cortisone conversion in cell lysates, and both are reduced by ss. The reduction in 11␤-HSD2 activity via ss is dose dependent and completely reversible after the discontinuation of ss. cAMP-dependent protein kinase A activation increased the 11␤-HSD2 activity yet did not prevent the ss response. The ss response was completely protein kinase C independent. The mitogen-activated protein kinase kinase inhibitor PD-098059 enhanced 11␤-HSD2 activity in static conditions yet only ameliorated the ss effect. Cytochalasin D disrupts focal adhesion (FA)-cytoskeleton interactions and abolished the ss-induced tyrosine phosphorylation of FA kinase dose-dependently, thus maintaining 11␤-HSD2 activity. The 11␤-HSD2 activity was only partially restored by the tyrosine kinase inhibitor genistein; however, herbimycin A almost completely abolished the ss effect on 11␤-HSD2 activity. In conclusion, JEG-3 cells express 11␤-HSD2, which is downregulated by ss. Regulatory mechanisms involve transcriptional control and require intact FA-cytoskeleton signaling and phosphorylation of FA kinase. Thus, ss adds to an enhanced intracellular availability of cortisol, which may ultimately support a vasoconstrictive vascular response. (Hypertension. 2001;37:160-169.)

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“…The literature includes studies propounding that increased uterine artery RI and uterine notch can predict preeclampsia and SGA (19,20). In these studies, which were performed in large population groups and usually in the 18 th -24 th weeks of pregnancy, the sensitivity reached 63-95% when RI was above the 95 th percentile or when the limit values of 0.56-0.58 were used for RI (21,22). The RI found in the present study is close to those determined in earlier studies, although the cutoff value 0.582 was measured in a different gestational age period of pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Predictive values of maternal serum PAPP-A level, uterine artery Doppler velocimetry, and fetal biometric measurements for poor pregnancy and poor neonatal outcomes in pregnant women

Balcı

2016

J Turkish German Gynecol Assoc

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The value of Doppler assessment of the uteroplacental circulation in predicting preeclampsia or intrauterine growth retardation

Cited by 114 publications

References 9 publications

Uric Acid Is as Important as Proteinuria in Identifying Fetal Risk in Women With Gestational Hypertension

Uric Acid Is as Important as Proteinuria in Identifying Fetal Risk in Women With Gestational Hypertension

Fluid Shear Stress Reduces 11β-Hydroxysteroid Dehydrogenase Type 2

Predictive values of maternal serum PAPP-A level, uterine artery Doppler velocimetry, and fetal biometric measurements for poor pregnancy and poor neonatal outcomes in pregnant women

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