Hypertension in Pregnancy - Fetal and Infant Outcome a Cohort Study

Montán, Sven; Sjöberg, Nils‐Otto; Svenningsen, Nils W.

doi:10.3109/10641958709023484

Cited by 26 publications

(21 citation statements)

References 9 publications

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“…Pre‐eclampsia remains a major cause of maternal and perinatal morbidity and mortality 1,2 . Since it is uncommon for this disease to present in the first half of pregnancy and the natural progression of the established disease is unpredictable, a predictive test for this condition in early pregnancy would allow the possibility of vigilant antenatal surveillance and preventive measures to be taken to avoid serious sequelae.…”

Section: Introductionmentioning

confidence: 99%

The reliability of the detection of an early diastolic notch with uterine artery Doppler velocimetry

Farrell¹,

Chien²,

Mires³

1998

BJOG

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This study evaluates the ability of two reviewers to detect independently an early diastolic notch in 1371 uterine artery Doppler velocity waveform recordings. Agreement between the two reviewers for the detection of uterine artery notching was assessed by using the Kappa statistic. The inter-rater reliability for the detection of unilateral notching was 0.75 (95% CI 0.70-0.80), whereas that for the presence or absence of bilateral notching was 0.66 (95% CI 0.60-0.71). The results suggest that there was good reviewer agreement for the presence or absence of a notch on uterine artery Doppler velocimetry.

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Section: Introductionmentioning

confidence: 99%

The reliability of the detection of an early diastolic notch with uterine artery Doppler velocimetry

Farrell¹,

Chien²,

Mires³

1998

BJOG

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“…1 It is also responsible for 18% of fetal (more than 19 weeks of gestation) and infant mortality as well as 46% of infant born small for gestation age. 2 The primary pathology is the impairment of placental perfusion result from insufficient invasion of maternal spiral arterioles by the trophoblast early in gestation. This leads to increased vascular resistance and decreased utero placental perfusion.…”

Section: Introductionmentioning

confidence: 99%

Doppler interrogation of fetoplacental circulation in hypertensive disorder of pregnancy and their perinatal outcomes

et al. 2017

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Background: Hypertensive disorders of pregnancy are one of the major causes of maternal morbidity-mortality leading to 10-15% of maternal deaths especially in developing areas of the world. The Doppler examination makes it possible by providing a unique, non-invasive and safe method of studying blood flow characteristics in both the fetoplacental and uteroplacental circulations that is being used in clinical evaluation of high risk pregnancies. The aim was to study early detection of fetoplacental compromise in hypertensive disorder of pregnancy with Doppler indices and to know its role in predicting perinatal outcomes and interventional strategies in these patients.Methods: This prospective study was conducted on 100 subjects, 50 patients in study group with hypertensive disorders and 50 patients in control group with normotensive pregnancy. Doppler studies of umbilical and middle cerebral artery done and parameters recorded were systolic/diastolic ratio, pulsatility index and resistance index at 28-37 weeks of gestation. Perinatal outcomes of both groups compared, analyzed statistically. Multiple pregnancy, chronic hypertension, fetal congenital anomalies, systemic disease and those lost to follow up till delivery were excluded from study.Results: Statistically significant difference in the incidence of induction of labour (p=0.012) and caesarean delivery (p=0.049), preterm delivery (p=0.004), low birth weight (p=0.003), low apgar score (p=0.045) and NICU admission in the patients with abnormal umbilical artery doppler of hypertensive group were seen .66.66% and 100% perinatal mortality seen in absent end diastolic flow and reverse end diastolic flow of umbilical artery in hypertensive group respectively.Conclusions: Abnormal umbilical artery had highest sensitivity 76% and positive predictive value 84% in predicting adverse perinatal outcome and MCA Doppler having highest specificity 96% to exclude the false positive results of abnormal UA. The sequential study of both vessels useful in predicting interventional strategies and improving perinatal outcomes.

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“…[1][2][3] Maternal complications of pre-eclampsia include coagulopathy, renal and liver failure, and stroke.…”

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confidence: 99%

Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis

Cnossen¹,

Morris²,

Riet³

et al. 2008

Canadian Medical Association Journal

636

403

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Background: : Alterations in waveforms in the uterine artery are associated with the development of pre-eclampsia and intrauterine growth restriction. We investigated the predictive accuracy of all uterine artery Doppler indices for both conditions in the first and second trimesters. Methods: :We identified relevant studies through searches of MEDLINE, EMBASE, the Cochrane Library and Medion databases (all records to April 2006) and by checking bibliographies of identified studies and consulting with experts. Four of us independently selected studies, extracted data and assessed study validity. We performed a bivariable meta-analysis of sensitivity and specificity and calculated likelihood ratios. Results:We identified 74 studies of pre-eclampsia (total 79 547 patients) and 61 studies of intrauterine growth restriction (total 41 131 patients). Uterine artery Doppler ultrasonography provided a more accurate prediction when performed in the second trimester than in the first-trimester. Most Doppler indices had poor predictive characteristics, but this varied with patient risk and outcome severity. An increased pulsatility index with notching was the best predictor of pre-eclampsia (positive likelihood ratio 21.0 among high-risk patients and 7.5 among low-risk patients). It was also the best predictor of overall (positive likelihood ratio 9.1) and severe (positive likelihood ratio 14.6) intrauterine growth restriction among low-risk patients.Interpretation: Abnormal uterine artery waveforms are a better predictor of pre-eclampsia than of intrauterine growth restriction. A pulsatility index, alone or combined with notching, is the most predictive Doppler index. These indices should be used in clinical practice. Future research should also concentrate on combining uterine artery Doppler ultrasonography with other tests. Abstract CMAJ 2008;178(6):701-11From the Departments of General Practice (Cnossen, ter Riet, Bindels), of Obstetrics and Gynaecology (Cnossen, Mol, van der Post) and

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Hypertension in Pregnancy - Fetal and Infant Outcome a Cohort Study

Cited by 26 publications

References 9 publications

The reliability of the detection of an early diastolic notch with uterine artery Doppler velocimetry

The reliability of the detection of an early diastolic notch with uterine artery Doppler velocimetry

Doppler interrogation of fetoplacental circulation in hypertensive disorder of pregnancy and their perinatal outcomes

Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis

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