The value of uterine artery Doppler in the prediction of uteroplacental complications in multiparous women

Harrington, Kevin; Fayyad, Abdalla; Thakur, Vidya; Aquilina, J.

doi:10.1002/uog.932

Cited by 97 publications

(59 citation statements)

References 22 publications

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“…Uterine Doppler waveforms analysis has become a valuable tool in the evaluation of the placental circulation and in the prediction of pregnancy outcome. Increased placental vascular impedance is frequently related to FGR and pregnancy-induced hypertension, 1,3,6,[7][8][9][10][11][12] which are still unsolved severe clinical problems associated with an increased maternal and perinatal mortality and morbidity. Maternal uterine artery Doppler in the second trimester of pregnancy helps the obstetricians to select patients at high risk for these complications but with a too low positive predictive value.…”

Section: Discussionmentioning

confidence: 99%

“…xtensive research over the past 20 years has evaluated the use of uterine artery Doppler evaluation in the second [1][2][3][4][5][6] trimesters of pregnancy as a screening tool to predict the later development of preeclampsia, fetal growth restriction (FGR), placental abruption, and stillbirth. Since the introduction of uterine artery Doppler as an early screening test for complications in pregnancy in the mid-1980s, conflicting results on its value have been reported as discussed by Papageorghiou et al 4 The persistence of bilateral notches in uterine arteries associated with a quantitative resistance index cutoff at 24 weeks' gestation was reported to improve screening efficacy to identify patients at risk for complications in pregnancy.…”

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confidence: 99%

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Total Vascular Resistance and Left Ventricular Morphology as Screening Tools for Complications in Pregnancy

Vasapollo¹,

Novelli²,

Valensise³

2008

Hypertension

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Abstract-We evaluated the predictive value of elevated total vascular resistance on the outcome of pregnancy in normotensive high-risk primigravidas with bilateral notching of the uterine artery Doppler. A total of 526 high-risk primigravidas referred to the obstetrics outpatient clinic of Tor Vergata University with bilateral notching of the uterine artery at 20 to 22 weeks' gestation were submitted to a maternal echocardiographic examination and uterine artery Doppler evaluation at 24 weeks' gestation. Blood pressure was recorded at the time of the examination, total vascular resistance was calculated, and the geometric pattern of the left ventricle was assessed. Patients were followed until the end of pregnancy to detect fetal/maternal adverse outcomes (gestational hypertension, preeclampsia, abruptio placentae, fetal growth restriction, perinatal death, etc). A total of 111 of the 526 pregnancies showed a bilateral notch at 24 weeks' gestation, and 97 had an adverse outcome (18.44%). The best independent predictor for maternal and fetal complications was total vascular resistance (odds ratio: 91.25; 95% CI: 39.64 to 210.05; PϽ0.001). The cutoff value was 1400 dynes ⅐ s ⅐ cm Ϫ5, with a sensitivity and a specificity of 89% and 94%, respectively. A high relative wall thickness of the left ventricle (Ͼ0.37; odds ratio: 2.47; 95% CI: 1.12 to 5.44) and a hypertrophized ventricle (left ventricular mass Ͼ130 g; odds ratio: 2.52; 95% CI: 1.12 to 5.64) were also independent predictors (PϽ0.05). Echocardiography might identify at 24 weeks' gestation patients who subsequently develop maternal and fetal complications through the assessment of maternal hemodynamics and left ventricular geometry. (Hypertension. 2008;51:1020-1026.)

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Total Vascular Resistance and Left Ventricular Morphology as Screening Tools for Complications in Pregnancy

Vasapollo¹,

Novelli²,

Valensise³

2008

Hypertension

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“…Studies using first-trimester 9,35,36 or secondtrimester [37][38][39] Doppler sonography alone or combined with maternal serum markers 4,40-43 have had some success, but sensitivity and PPVs are low, or the tests were expensive or invasive. Accurate identification of women at risk, particularly those at risk of early-onset disease, would have real clinical benefits.…”

Section: Discussionmentioning

confidence: 99%

Pulse wave analysis: a preliminary study of a novel technique for the prediction of pre‐eclampsia

Khalil

Cooper

Harrington

2008

BJOG

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Objective To investigate whether first-trimester arterial pulse wave analysis (PWA) can predict pre-eclampsia.Design This was a prospective screening study.Setting The Homerton University Hospital, a London teaching hospital.Population Two hundred and ten low-risk women with a singleton pregnancy were analysed.Methods Radial artery pulse waveforms were measured between the 11 +0 and 13 +6 weeks of gestation and the aortic waveform derived by applying a generalised transfer function. Augmentation pressure (AP) and augmentation index at heart rate of 75 beats per minute (AIx-75), measures of arterial stiffness, were calculated. The multiple of the gestation-specific median in controls for AP and AIx-75 were calculated. Logistic regression models were developed and their predictive ability assessed using the area under the receiver operator curve.Main outcome measures Prediction of pre-eclampsia by AIx-75.Results Fourteen (6.7%) women developed pre-eclampsia, and 196 remained normotensive. Eight of the 14 women developed pre-eclampsia before 34 weeks of gestation (early-onset pre-eclampsia). For a false-positive rate of 11%, AIx-75 had a detection rate of 79% for all cases of pre-eclampsia and 88% for early-onset pre-eclampsia.Conclusion First-trimester arterial PWA can play a significant role in understanding the pathophysiology of pre-eclampsia and may play a role in early screening.

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“…Doppler ultrasound investigation of human FGR pregnancies exhibit increased impedance to umbilical arterial blood flows [75,76] and uterine blood flows [77,78]. Additionally, it has been shown during in vivo human study that the limitation in fetal oxygen delivery during FGR results from decreased placental transfer of oxygen as blood leaving the conceptus through the uterine veins has a higher PO 2 than control pregnancies and concomitantly, there is a lower uterine oxygen extraction rate [79].…”

Section: Placental Oxygen Transfer and Metabolismmentioning

confidence: 99%

The pregnant sheep as a model for human pregnancy

2008

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Successful outcome of human pregnancy not only impacts the quality of infant life and well-being, but considerable evidence now suggests that what happens during fetal development may well impact health and well-being into adulthood. Consequently, a thorough understanding of the developmental events that occur between conception and delivery is needed. For obvious ethical reasons, many of the questions remaining about the progression of human pregnancy can not be answered directly, necessitating the use of appropriate animal models. A variety of animal models exist for the study of both normal and compromised pregnancies, including laboratory rodents, non-human primates and domestic ruminants. While all of these animal models have merit, most suffer from the inability to repetitively sample from both the maternal and fetal side of the placenta, limiting their usefulness in the study of placental or fetal physiology under non-stressed in vivo conditions. No animal model truly recapitulates human pregnancy, yet the pregnant sheep has been used extensively to investigate maternal-fetal interactions. This is due in part to the ability to surgically place and maintain catheters in both the maternal and fetal vasculature, allowing repeated sampling from non-anesthetized pregnancies. Considerable insight has been gained on placental oxygen and nutrient transfer and utilization from use of pregnant sheep. These findings were often confirmed in human pregnancies once appropriate technologies became available. The purpose of this review is to provide an overview of human and sheep pregnancy, with emphasis placed on placental development and function as an organ of nutrient transfer.

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The value of uterine artery Doppler in the prediction of uteroplacental complications in multiparous women

Abstract: ABSTRACT

Cited by 97 publications

References 22 publications

Total Vascular Resistance and Left Ventricular Morphology as Screening Tools for Complications in Pregnancy

Total Vascular Resistance and Left Ventricular Morphology as Screening Tools for Complications in Pregnancy

Pulse wave analysis: a preliminary study of a novel technique for the prediction of pre‐eclampsia

The pregnant sheep as a model for human pregnancy

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