Relationship between acute fetal distress and maternal‐placental‐fetal circulations in severe preeclampsia

Yang, Jenn‐Ming; Wang, Kuo-Gon

doi:10.3109/00016349509024402

Cited by 13 publications

(9 citation statements)

References 17 publications

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“…The initial umbilical artery PI had good sensitivity for poor outcome and major morbidity (75 and 58% respectively) in line with other publications reporting more adverse outcome in pre-eclampsia when umbilical artery waveforms are abnormal. [11][12][13]18,19 The current results, however, are in contrast to 18 Yoon (1994), who showed the umbilical artery waveform to be an independent predictor of poor outcome with an odds ratio of 14.2 after correcting for GA. The much narrower definition of adverse outcome in the current, larger cohort, may account for the lower relative risk as well as the lack of statistical significance in multivariate analysis including the fetal weight estimation.…”

Section: Placental Insufficiencycontrasting

confidence: 97%

“…2,5,6 The coexistence, temporal changes and prognostic implications of abnormal ultrasound and Doppler findings are now well described in placental insufficiency, [7][8][9] but while knowledge of umbilical artery Doppler results 10 is of clear clinical benefit, the use of other ultrasound and Doppler parameters has not yet been shown to improve perinatal outcome. In preterm pre-eclampsia, some studies have investigated the prognostic value of such parameters close to delivery, [11][12][13][14][15][16][17] but combinations of parameters, their inter-relations and the influence of confounding variables in this setting have not been investigated widely. [18][19][20] Before one can assume that assessment of fetoplacental blood flow patterns should affect the management of preterm pre-eclampsia, it needs to be established which findings contribute independently to the ultimate prognosis, either at the time of diagnosis or during serial reassessment.…”

Section: Introductionmentioning

confidence: 99%

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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: Placental Insufficiencycontrasting

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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

Geerts

Odendaal

2007

J Perinatol

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“…Cabe señalar, sin embargo, que un aumento de peso mayor de 12 kg no es normal y puede asociarse con preeclampsia. En esta situación se produce hemoconcentración, la cual eleva la concentración de hemoglobina y por lo tanto puede enmascarar una anemia verdadera (37). La anemia gestacional también se ha asociado con una mayor tasa de mortalidad perinatal en diversos estudios (24,38).…”

Section: Discussionunclassified

Prevalencia de anemia en gestantes, Hospital Regional de Pucallpa, Perú

Becerra¹,

Gonzáles²,

Villena³

et al. 1998

Rev Panam Salud Publica

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Las encuestas demográficas de salud y población del Perú indican que las tasas globales de fecundidad, la proporción de adolescentes embarazadas y la mortalidad maternoinfantil son más altas en la selva que en otras zonas del país. Las parasitosis intestinales endémicas agra nacidos. Ni esta tasa ni el peso de los recién nacidos resultaron asociados con el grado de anemia de la madre. El análisis de regresión multivariado muestra que el peso de la madre al inicio de la gestación (P = 0,0001), el peso ganado durante la gestación (P = 0,0001) y el número de gestaciones (P = 0,008) predicen el peso del recién nacido. Los resultados indican que la alta prevalencia de anemia en las gestantes de Pucallpa no se asocia con un bajo peso al nacer ni con una alta mortalidad perinatal. En estudios futuros deben investigarse las causas principales de la anemia que padecen las embarazadas de Pucallpa y sus efectos en el desarrollo psicomotor de sus hijos. RESUMENEn los países en desarrollo, las tasas globales de fecundidad, mortalidad infantil y mortalidad materna son elevadas. Asimismo, la prevalencia de malnutrición infantil es alta y a menudo se traduce en retraso del crecimiento y del desarrollo y en enfermedades de origen alimentario, tales como la anemia (1).En el Perú, la población muestra un crecimiento acelerado y la tasa de mortalidad maternoinfantil es alta. La situación representada por estos indicadores se torna más patente y alarmante cuando su análisis se estratifica por zonas geográficas. Según los resultados de la Encuesta Demográfica y de Salud Familiar, la tasa global de fecundidad es más alta en la selva que en otras zonas del país, al igual que la proporción de adolescentes embarazadas y la mortalidad maternoinfantil. En cambio, la proporción de niños escolarizados es menor en la selva (2),

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“…Early intervention in the three cases with severe preeclampsia who refused to be admitted and underwent cesarean delivery immediately after the diagnosis of REDFV, may have avoided the intrauterine death and improve perinatal outcome. Ethically, it is hard to force patients to make a decision between intrauterine death and prematurity with possible morbidity (1,16,18).…”

Section: Discussionmentioning

confidence: 99%

“…Elevation of the systolic-diastolic ratio (s.d. ratio) (8)(9)(10), absent end-diastolic flow velocity (AEDFV) (11)(12)(13)(14) or reverse end-diastolic flow velocity (REDFV) (15) were associated with higher perinatal morbidity and mortality rates (16,17) es-pecially in preeclampsia (18), intrauterine growth retardation (IUGR) fetuses (19,20), and the twinto-twin transfusion syndrome (21)(22)(23). However, REDFV may be encountered in fetuses with congenital malformations or chromosomal abnormalities (16,24).…”

mentioning

confidence: 99%

Impact of reverse end-diastolic flow velocity in umbilical artery on pregnancy outcome after the 28th gestational week

Wang¹,

Chen²,

Yang³

et al. 1998

Acta Obstet Gynecol Scand

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Relationship between acute fetal distress and maternal‐placental‐fetal circulations in severe preeclampsia

Abstract: In severe preeclampsia, early onset of disease superimposed with maternal hemoconcentration might initiate an acute insult and predispose the fetus to acute hypoxia.

Cited by 13 publications

References 17 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

Prevalencia de anemia en gestantes, Hospital Regional de Pucallpa, Perú

Impact of reverse end-diastolic flow velocity in umbilical artery on pregnancy outcome after the 28th gestational week

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