Uterine and umbilical artery velocimetry in pre‐eclampsia

Asselt, Kristel van; Gudmundsson, Sæmundur; Lindqvist, Pelle G.; Maršál, Karel

doi:10.1034/j.1600-0412.1998.770607.x

Cited by 30 publications

(21 citation statements)

References 32 publications

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“…Previous studies examining uterine artery PI [29,30,31,32,33] and serum PlGF or the sFlt-1 to PlGF ratio [34,35,36,37,38,39] in the late second or early third trimesters of pregnancy have essentially focused on the investigation of women presenting to specialist clinics with signs of hypertensive disorders with the aim of identifying the subgroup that will develop severe disease [29,30,31,32,33,34]. Our study examined the application of biomarkers in routine screening for subsequent development of PE as part of a strategy for a new approach to prenatal care [7].…”

Section: Discussionmentioning

confidence: 99%

Competing Risks Model in Screening for Preeclampsia by Biophysical and Biochemical Markers at 30-33 Weeks' Gestation

et al. 2014

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Objective: To assess the risk for preeclampsia (PE) by maternal characteristics, uterine artery pulsatility index (Ut-PI), mean arterial pressure (MAP), serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1)at 30-33 weeks' gestation. Methods: This was a screening study in singleton pregnancies including 2,140 that developed PE and 83,615 that were unaffected by PE. We developed a survival time model for the time of delivery for PE by combining maternal characteristics and history with Ut-PI, MAP, PlGF and sFlt-1 multiple of the median (MoM) values (combined test). Data on third-trimester MAP and Ut-PI were available in 350 cases of PE, and 13,878 unaffected pregnancies and data on PlGF and sFlt-1 were available in 118 cases of PE and 3,734 unaffected pregnancies. Modelled detection rate of all PE and PE requiring delivery within 4 and 6 weeks of the visit was estimated. Results: Screening by the combined test would detect 66, 98 and 86% of all PE and PE requiring delivery within 4 and 6 weeks of the visit, respectively, at a false positive rate of 5%. Interpretation: Screening by biophysical and biochemical testing at 30-33 weeks could identify most pregnancies developing PE and requiring delivery within the subsequent 4 weeks.

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Section: Discussionmentioning

confidence: 99%

Competing Risks Model in Screening for Preeclampsia by Biophysical and Biochemical Markers at 30-33 Weeks' Gestation

et al. 2014

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“…Essentially, Doppler studies were carried out in pregnancies presenting with PE or fetal growth restriction reported that the outcome was worse if there was increased, rather than normal, impedance to flow in the uterine arteries [16,17,18,19,20,21,22]. Similarly, studies investigating pregnancies with abnormal uterine artery Doppler at 20-24 weeks' gestation reported that outcome was worse in those with persistence of high impedance to flow during the third trimester compared to those with normalization in flow [23,24,25].…”

Section: Introductionmentioning

confidence: 99%

Uterine Artery Doppler at 30-33 Weeks' Gestation in the Prediction of Preeclampsia

Lai¹,

Poon²,

Pinas³

et al. 2013

Fetal Diagn Ther

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Objective: To investigate the potential value of measuring uterine artery pulsatility index (PI) at 30-33 weeks' gestation in the prediction of preeclampsia (PE) developing at or after 34 weeks. Methods: Screening study in singleton pregnancies at 30-33 weeks' gestation including 4,294 cases that were unaffected by PE, gestational hypertension (GH) or delivery of small for gestational age neonates (normal group), 145 that subsequently developed PE, with 37 cases requiring delivery at 34-37 weeks (intermediate-PE) and 108 delivering at or after 38 weeks (late-PE) and 161 that developed GH. The a priori risks for intermediate- and late-PE from maternal demographic characteristics and medical history were derived by logistic regression analysis. The a posteriori risks were calculated by combining the a priori risks with the likelihood ratios for uterine artery PI, which were calculated from fitted bivariate gaussian distributions. Results: In screening for PE by a combination of maternal characteristics and uterine artery PI, the estimated detection rates of intermediate- and late-PE, at a false-positive rate of 10%, were 70.3 and 54.6%, respectively. Conclusion: Combined testing by maternal characteristics and uterine artery PI at 30-33 weeks could effectively identify women at high risk for subsequent development of PE.

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“…Meanwhile it is well known that an elevation of the impedance of uterine blood flow as well as the presence of bilateral more than unilateral notch [4,5] are related to an increased frequency of APA. Several studies [6,7] showed a correlation between notch and birth weight according to the persistence or later disappearance of firsttrimester bilateral notch versus unilateral or no notch.…”

mentioning

confidence: 99%

Doppler Sonography of Uterine Arteries at 20–23 Weeks: Depth of Notch Gives Information on Probability of Adverse Pregnancy Outcome and Degree of Fetal Growth Restriction in a Low-Risk Population

Becker¹,

Vonk²

2010

Fetal Diagn Ther

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Objective: Our purpose was to assess the relation between the depth of notch in the uterine arteries at 20–23 weeks and the incidence and severity of subsequent pregnancy complications. Methods: The Notch Index (NI) was defined as (C – D)/C, with C = postsystolic zenith and D = postsystolic nadir. For evaluation, the mean NI of the two uterine arteries was determined. Adverse pregnancy outcome was defined as presence of SGA ≤5th percentile, pre-eclampsia, preterm delivery <33 weeks, placental abruption or intrauterine or neonatal death. Women who received preventive treatment (Aspirin or low-molecular heparin) were excluded. Results: A notch was present in 957 of 15,888 singleton pregnancies (6.0%; unilateral = 4.37%, bilateral = 1.66%). The incidence of adverse pregnancy outcome was 5.3%; it increased from 4.6% for women without notch to 41.8% for those with a mean NI ≧0.2 and higher. Moreover, higher mean NI values tended to be associated with lower birth weight. In addition to the maternal age, parity, mean Pulsatility Index and presence of notch, the depth of notch made an additional significant contribution to the assessment of the probability of adverse pregnancy outcome. Conclusion: Besides the classic parameters such as maternal age, history of adverse pregnancy outcome, parity, impedance and the presence of notch, also the depth of notch seems to be valuable in the assessment of adverse pregnancy outcome risk. Especially in cases where very high or very low values of NI are measured, quantification of the depth of notch may give more information than the description of the presence of notch alone. This might be of value for future multivariate models for risk assessment of adverse pregnancy outcome.

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Uterine and umbilical artery velocimetry in pre‐eclampsia

Abstract: Abnormal velocity waveforms in the uterine and umbilical arteries have clinical significance in pregnancies complicated by pre-eclampsia and predict adverse outcome of pregnancy, especially the fetal growth restriction and need for operative interventions during labor and delivery.

Cited by 30 publications

References 32 publications

Competing Risks Model in Screening for Preeclampsia by Biophysical and Biochemical Markers at 30-33 Weeks' Gestation

Competing Risks Model in Screening for Preeclampsia by Biophysical and Biochemical Markers at 30-33 Weeks' Gestation

Uterine Artery Doppler at 30-33 Weeks' Gestation in the Prediction of Preeclampsia

Doppler Sonography of Uterine Arteries at 20–23 Weeks: Depth of Notch Gives Information on Probability of Adverse Pregnancy Outcome and Degree of Fetal Growth Restriction in a Low-Risk Population

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