Inadequate maternal vascular response to placentation in pregnancies complicated by pre‐eclampsia and by small‐for‐gestational age infants

Khong, T. Y.; Wolf, Frank de; Robertson, W. B.; Brosens, Ivo

doi:10.1111/j.1471-0528.1986.tb07830.x

Cited by 1,523 publications

(724 citation statements)

References 25 publications

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“…35 The uterine artery PI was of no prognostic value in this cohort since 98.2% of the uterine artery waveforms were abnormal. This is in keeping with other studies showing a high incidence of Prognostic value of placental insufficiency indicators L Geerts and HJ Odendaal increased uterine artery PI before the onset of pre-eclampsia as well as in established disease, more so in severe early-onset pre-eclampsia (as in this cohort) compared to milder forms near term.…”

Section: Uterine Artery Waveformsmentioning

confidence: 73%

Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

Geerts

Odendaal

2007

J Perinatol

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Objective: Assess the prognostic value of ultrasound and Doppler parameters in severe preterm pre-eclampsia.Study design: Prospective cohort study in Cape Town, South Africa, involving 113 women with severe pre-eclampsia between 24 and 34 weeks of gestation and managed expectantly when suitable. Serial ultrasound and multivessel Doppler assessments were performed 2 to 3 times weekly. Observations included fetal weight estimation, growth pattern, amniotic fluid volume, appearance of the heart and bowel, pulsatility index of the uterine, umbilical and middle cerebral arteries and ductus venosus. Perinatal outcome (death or neurological compromise, n ¼ 12) and major morbidity (n ¼ 62) were related to findings at recruitment and on the last assessment preceding delivery.Results: In univariate analysis, fetal growth asymmetry and waveform analysis of all three fetal vessels significantly correlated with both end points. The initial fetal weight estimation with a cutoff weight of 1080 g had the highest sensitivity (83.3%) and negative predictive value (97.5%) for poor outcome (P<0.001) while the final ductus venosus pulsatility index had the highest specificity (92%) and positive predictive value (33%). The combination of a raised placentocerebral ratio and ductus venosus pulsatility index close to delivery had the highest (57.1%) positive predictive value. Logistic regression showed the best overall predictive model for poor outcome to be a combination of initial fetal weight estimation and final ductus venosus pulsatility index (overall accuracy 94.6%, RR 20.20 (7.36, 55.41)). The initial fetal weight estimation with a cutoff weight of 1283 g provided the best correct prediction of major morbidity (83.2% overall accuracy, sensitivity 79.0%, specificity 88.2%, positive and negative predictive values of 89.1 and 77.6% respectively). This was better than using the gestational age at recruitment or delivery, birth weight or any of the Doppler results. The prediction of morbidity was not improved by the addition of any other variable in logistic regression analysis. Conclusion:For the short-term outcome measures assessed in this study, the estimated fetal weight at the time of diagnosis is the most important prognostic factor in severe pre-eclampsia with some additional value of ductus venosus assessment.

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Section: Uterine Artery Waveformsmentioning

confidence: 73%

Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

Geerts

Odendaal

2007

J Perinatol

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“…1,2 The underlying mechanism for early-PE, requiring delivery before 34 weeks, is thought to be impaired placentation because of inadequate trophoblastic invasion of the maternal spiral arteries, which has been documented by the findings of both histologic and Doppler ultrasound studies of the uterine arteries, [3][4][5][6][7][8] reduced maternal serum concentration of the placental product pregnancy-associated plasma protein-A (PAPP-A) 9 and impaired fetal growth. 10 In contrast late-PE, which is usually associated with normal placentation and fetal growth, 11,12 is thought to be a manifestation of an underlying metabolic disorder with increased insulin resistance.…”

Section: Introductionmentioning

confidence: 99%

Maternal serum insulin-like growth factor-binding protein-3 (IGFBP-3) at 11–13 weeks in preeclampsia

et al. 2011

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“…Tissue biopsy and preparation for immunostaining were as described previously. 13,14 Placental villi (from Magee-Women's Hospital) and placental site curettings (from University of Tennessee Medical Center) for determining XDH/XO activity were obtained after separation of the placenta, immediately frozen in liquid nitrogen, and stored at Ϫ80°C until further processing. In this case, placental samples were obtained only from women delivered by cesarean section without prior contractions.…”

Section: Tissue Processingmentioning

confidence: 99%

Invasive Cytotrophoblasts Manifest Evidence of Oxidative Stress in Preeclampsia

Many

Hubel

Fisher

et al. 2000

The American Journal of Pathology

251

150

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In preeclampsia, poor placental perfusion may result in maternal endothelial dysfunction, but the pathways involved are largely unknown. Candidate placental mediators include products of oxidative stress released into the maternal circulation. Xanthine oxidase has been implicated in postischemic-reperfusion injury via the generation of superoxide anion radicals (superoxide; O 2 .؊ ) and hydrogen peroxide. We examined placentas and placental bed curettings and/or biopsies from preeclamptic control pregnant women to test the hypothesis that xanthine oxidase is a mediator of oxidative stress in placentas from women with preeclampsia. The expression of xanthine dehydrogenase/xanthine oxidase holoenzyme and the activity of xanthine oxidase, the isoform known to generate reactive oxygen species, were increased in a subpopulation of cytotrophoblasts of preeclamptic women. Additionally, the expression of superoxide dismutase, which would scavenge superoxide produced by xanthine oxidase, was reduced in the same cells. Preeclampsia, a pregnancy-specific disorder, is the leading cause of maternal mortality in the Western world and increases perinatal mortality fivefold. The clinical diagnosis is based on the new onset of hypertension and the appearance of proteinuria and edema during pregnancy. It is evident, however, that these findings are a small component of a multisystemic disease that reduces perfusion to virtually all of the organs in the body. 1 The hypothesis has been advanced that much of the disease could be explained by alterations in the function of vascular endothelium. Increasing data support this hypothesis. 2 The more complete hypothesis posits that the placenta, likely in response to reduced perfusion, produces a circulating factor(s) that alters endothelial cell function. 2 Among the candidate molecules are products resulting from oxidative stress. 3 Oxidative stress, the result of freeradical generation in excess of protective mechanisms, is suggested as an important component of other disorders that affect endothelial function, including diabetes and atherosclerosis. 4,5 Evidence for oxidative stress in preeclampsia includes elevated lipid hydroperoxides or their metabolites and reduced plasma antioxidant activity. 3,6 -8 Xanthine oxidase, which metabolizes xanthine and hypoxanthine to uric acid with production of superoxide and hydrogen peroxide, is an integral mediator of reactive oxygen species generation in many settings. Usually, this enzyme is present as the holoenzyme xanthine dehydrogenase/xanthine oxidase (XDH/XO). The dehydrogenase isoform (XDH) converts purines to uric acid with reducton of nicotinamide-adenine dinucleotide (NAD) to reduced NAD (NADH). With hypoxia and in response to several cytokines, XDH/XO synthesis increases, and the conversion of the enzyme to the XO form is enhanced. 9 Reduced organ perfusion and subsequent reperfusion are proposed to result in increased XO during reduced flow and in subsequent formation of reactive oxygen species with reperfusion. The inadequate pla...

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Inadequate maternal vascular response to placentation in pregnancies complicated by pre‐eclampsia and by small‐for‐gestational age infants

Cited by 1,523 publications

References 25 publications

Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

Maternal serum insulin-like growth factor-binding protein-3 (IGFBP-3) at 11–13 weeks in preeclampsia

Invasive Cytotrophoblasts Manifest Evidence of Oxidative Stress in Preeclampsia

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