What Is the Role of the Maternal Ophthalmic and Cervical Internal Carotid Arteries in Predicting Maternal Adverse Outcomes in Preeclampsia?

Abstract

ObjectivesWe aimed to investigate the efficacy of maternal ophthalmic artery (OA) and cervical internal carotid artery (CICA) in predicting adverse maternal outcomes and gestational age at birth in preeclampsia (PE).MethodsThe study was performed at the Zeynep Kamil Women and Children's Diseases Training and Research Hospital. Measurements were made in 2 groups consisting of 50 pregnant women with PE and 50 healthy pregnant women. The peak systolic velocity (PSV), end‐diastolic velocity, PI, RI, first diastolic peak velocity, systolic/diastolic (S/D) ratio, and peak ratio of the maternal OA were measured by a transorbital Doppler ultrasound (US) scan. The PSV, end‐diastolic velocity, PI, RI, and S/D ratio of the CICA were measured. The differences of Doppler indices between groups with P < .05 were considered statistically significant. Cutoff values were calculated, which could be used to predict adverse maternal outcomes and gestational age at birth.ResultsThe RI and PI values of the OA were lower, and the first diastolic peak velocity, PSV, and peak ratio values were higher among the PE group. The RI and S/D values of the CICA were significantly lower in the PE group compared to the healthy group. The OA RI was determined to be the strongest US variable in predicting adverse maternal outcomes and gestational age at birth, with a cutoff value of 0.72, 76% sensitivity, and 76% specificity.ConclusionsMaternal OA Doppler indices can be used as US markers to predict adverse maternal outcomes.

Ophthalmic artery Doppler in the complementary diagnosis of preeclampsia: a systematic review and meta-analysis

“…In four studies evaluated, the mean PI difference between overall PE and controls was − 0.48 (95% CI -0.59; -0.37), I2 36% with cut-offs established by the primary studies of 1.17 15 , 1.28 12 , 1.29 30 , and 1.30 13 (Supplement 11). In the mild PE group, there were seven studies with a mean difference of -0.62 (95% CI difference was − 0.87 (95% CI -1.20; -0.55), I2 = 94% with cut-offs of 1.00 14 , 1.02 15 , 1.13 34 , 1.14 33 , 1.17 34 , and 1.61 11 (Supplement 12).…”

“…PVS showed low accuracy, and EDV demonstrated higher velocities in the PE group and good accuracy. The mean PSV difference for overall PE (four studies) was 1.71 (95% CI -2.88; 6.29), I2 = 76% with cut-offs of 28.96 15 , 37.60 13 , 40.35 30 , and 47.00 12 cm/s. In the mild PE group (four studies), the mean difference was − 0.36 (95% CI -3.32; 2.60), I2 = 48% with cut-offs of 28.44 15 , 30.60 32 , 34.35 14 , and 48.30 11 cm/s.…”

“…In seven studies evaluated, the mean RI difference for overall PE was − 0.07 (95% CI -0.09; -0.04), I2 = 81% with cut-offs established by the primary studies of 0.62 15 , 0.64 16 , 0.66 12,17 , 0.67 18 , and 0.68 13,30 (Supplement 8). In the mild PE group, there were seven studies with a mean difference of -0.02 (95% CI -0.14; 0.09), I2 = 99% with cut-offs of 0.63 31 , 0.641 4 , 0.66 15 , 0.73 32,33 , 0.77 11 , and 0.97 19 (Supplement 9).…”

“…This parameter was compared among cases and controls in three studies, and the mean difference was 0.24 (95% CI 0.15; 0.34). There was high heterogeneity, I2 = 90% (199 events), with cut-offs established by the primary studies of 0.75 12 , 0.81 13 , and 0.83 30 (Supplement 2). In the mild PE group, there were four studies with a mean difference of 0.21 (95% CI 0.11; 0.30), I2 = 92% (98 events) with cut-offs of 0.65 32 , 0.70 11 , 0.71 33 , 0.81 14, and in the severe PE group with four studies, the mean difference was 0.35 (95% CI 0.16; 0.38), I2 = 0% (90 events) with cut-offs of 0.81 11 , 0.84 14 , 0.85 33 , 0.89 32 (Supplement 3).…”

Ophthalmic artery Doppler in the complementary diagnosis of preeclampsia: a systematic review and meta-analysis

“…8 Several studies have described changes in the velocity wave pattern of the ophthalmic artery in women with PE, both prenatally and in the postpartum, with signs of decreased impedance and orbital hyperperfusion, represented by high values of peak ratio (PR), the second peak of systolic velocity (P2) and decreased resistance index (RI) and pulsatility index (PI). [9][10][11][12][13][14][15][16][17][18][19] However, there is no consensus in the literature about what is the best diagnostic parameter of OAD in pregnant women with PE. The aid of this ultrasound examination may be relevant if used in the hospital environment to diagnose patients with PE where this information is urgently needed, to optimize care and facilitate early treatment, especially in severe cases.…”