Doppler ultrasound evaluation in preeclampsia

BMC Research Notes

Margarita L Martinez-Fierro¹  Jose I Badillo-Almaraz¹  Monica I Martinez-Acuña¹  Idalia Garza-Veloz¹  Mauro A Ochoa-Torres²  Rene M Ramos-Gonzalez²  Raul Cortes-Flores²  Victoria Martinez-Gaytan²  Maria A Lopez-Mendez¹ 

[1] Molecular Medicine Laboratory, Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas, Carretera Zacatecas-Guadalajara Km. 6, C.P. 98160 Zacatecas, Mexico;Unidad Medica Materno-Fetal del Noreste, Unidad Medica de Alta Especialidad No. 23 Instituto Mexicano del Seguro Social, Monterrey, Mexico

关键词: Middle cerebral artery;    Umbilical artery;    Uterine artery;    Preeclampsia;    Doppler velocimetry;   

Others  :  1140743
DOI  :  10.1186/1756-0500-6-477

 received in 2013-08-02, accepted in 2013-11-15,  发布年份 2013

【 摘 要 】

Background

Worldwide preeclampsia (PE) is the leading cause of maternal death and affects 5 to 8% of pregnant women. PE is characterized by elevated blood pressure and proteinuria. Doppler Ultrasound (US) evaluation has been considered a useful method for prediction of PE; however, there is no complete data about the most frequently altered US parameters in the pathology. The aim of this study was to evaluate the uterine, umbilical, and the middle cerebral arteries using Doppler US parameters [resistance index (RI), pulsatility index (PI), notch (N), systolic peak (SP) and their combinations] in pregnant women, in order to make a global evaluation of hemodynamic repercussion caused by the established PE.

Results

A total of 102 pregnant Mexican women (65 PE women and 37 normotensive women) were recruited in a cases and controls study. Blood velocity waveforms from uterine, umbilical, and middle cerebral arteries, in pregnancies from 24 to 37 weeks of gestation were recorded by trans-abdominal examination with a Toshiba Ultrasound Power Vision 6000 SSA-370A, with a 3.5 MHz convex transducer. Abnormal general Doppler US profile showed a positive association with PE [odds ratio (OR) = 2.93, 95% confidence interval (CI) = 1.2 - 7.3, P = 0.021)], and a specificity and predictive positive value of 89.2% and 88.6%, respectively. Other parameters like N presence, RI and PI of umbilical artery, as well as the PI of middle cerebral artery, showed differences between groups (P values < 0.05).

Conclusion

General Doppler US result, as well as N from uterine vessel, RI from umbilical artery, and PI from umbilical and middle cerebral arteries in their individual form, may be considered as tools to determine hemodynamic repercussion caused by PE.

【 授权许可】

   
2013 Lopez-Mendez et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Crispi F: Predictive value of angiogenic factors and uterine artery doppler for early- versus late-onset pre-eclampsia and intrauterine growth restriction. Ultrasound Obstet Gynecol 2008, 31:303-309.
• [2]Diab AE, Manal ME-B, Moustafa AE, Amal ES: Angiogenic factors for the prediction of pre-eclampsia in women with abnormal midtrimester uterine artery doppler velocimetry. Int J Gynaecol Obstet 2008, 102:146-151.
• [3]Baumwell S: Pre-eclampsia: clinical manifestations and molecular mechanisms. Nephron Clinical practice 2007, 106:c72-c81.
• [4]Backes CH, Markham K, Moorehead P, Cordero L, Nankervis CA, Giannone PJ: Maternal preeclampsia and neonatal outcomes. J Pregnancy 2011, 2011:214365.
• [5]Szarka A, Rigo J Jr, Lazar L, Beko G, Molvarec A: Circulating cytokines, chemokines and adhesion molecules in normal pregnancy and preeclampsia determined by multiplex suspension array. BMC Immunol 2010, 11:59. BioMed Central Full Text
• [6]Molvarec A, Szarka A, Walentin S, Szucs E, Nagy B, Rigo J Jr: Circulating angiogenic factors determined by electrochemiluminescence immunoassay in relation to the clinical features and laboratory parameters in women with pre-eclampsia. Hypertens Res 2010, 33:892-898.
• [7]Davison JM, Homuth V, Jeyabalan A, Conrad KP, Karumanchi SA, Quaggin S, Dechend R, Luft FC: New aspects in the pathophysiology of preeclampsia. J Am Soc Nephrol 2004, 15:2440-2448.
• [8]Romero-Arauz JF R-LJ, Rivera-Velásquez P, Alvarez-Jimenez G, Molina-Pérez CJ: Velocimetría doppler de la arteria umbilical y resultado perinatal adverso en preeclampsia severa. Ginecologia y Obstetricia de Mexico 2008, 76:440-449.
• [9]Yu J, Shixia CZ, Wu Y, Duan T: Inhibin A, activin A, placental growth factor and uterine artery doppler pulsatility index in the prediction of pre-eclampsia. Ultrasound Obstet Gynecol 2011, 37:528-533.
• [10]Gomez O, Martinez JM, Figueras F, Del Rio M, Borobio V, Puerto B, Coll O, Cararach V, Vanrell JA: Uterine artery doppler at 11–14 weeks of gestation to screen for hypertensive disorders and associated complications in an unselected population. Ultrasound Obstet Gynecol 2005, 26:490-494.
• [11]Schwarze A, Nelles I, Krapp M, Friedrich M, Schmidt W, Diedrich K, Axt-Fliedner R: Doppler ultrasound of the uterine artery in the prediction of severe complications during low-risk pregnancies. Arch Gynecol Obstet 2005, 271:46-52.
• [12]Divon MY, Guidetti DA, Braverman JJ, Oberlander E, Langer O, Merkatz IR: Intrauterine growth retardation–a prospective study of the diagnostic value of real-time sonography combined with umbilical artery flow velocimetry. Obstet Gynecol 1988, 72:611-614.
• [13]Newnham JP, Patterson LL, James IR, Diepeveen DA, Reid SE: An evaluation of the efficacy of doppler flow velocity waveform analysis as a screening test in pregnancy. Am J Obstet Gynecol 1990, 162:403-410.
• [14]Cruz-Martinez R, Figueras F: The role of doppler and placental screening. Best Pract Res Clin Obstet Gynaecol 2009, 23:845-855.
• [15]Skotnicki MZ, Flig E, Urban J, Hermann T: Doppler examinations in the prognosis of birth status of the newborn. Med Sci Monit 2000, 6:611-615.
• [16]Brown MA, Lindheimer MD, Swiet M, Assche AV, Moutquin JM: The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the international society for the study of hypertension in pregnancy (ISSHP). Hypertens Pregnancy 2001, 20:9-14.
• [17]Sd S: Prevención, diagnóstico y manejo de la preeclampsia/eclampsia. 4th edition. Centro Nacional de Equidad de Género y Salud Reproductiva: México; 2007.
• [18]Detti L, Akiyama M, Mari G: Doppler blood flow in obstetrics. Curr Opin Obstet Gynecol 2002, 14:587-593.
• [19]Harman CR, Baschat AA: Comprehensive assessment of fetal wellbeing: which doppler tests should be performed? Curr Opin Obstet Gynecol 2003, 15:147-157.
• [20]Francesc F, Eva M, Gómez O: Vasos e índices de la exploración básica: arterias uterinas, umbilical y cerebral media. : Editorial Medica Panamericana; 2010:35-48. [Doppler en medicina fetal técnica y aplicación clínica: volume 1]
• [21]Gomez O, Figueras F, Fernandez S, Bennasar M, Martinez JM, Puerto B, Gratacos E: Reference ranges for uterine artery mean pulsatility index at 11–41 weeks of gestation. Ultrasound Obstet Gynecol 2008, 32:128-132.
• [22]Mukhopadhyay A, Sharma P, Dasgupta S, Sharma PP, Ghosh TK: Prediction of pre-eclampsia: comparative analysis of two screening tests. J Indian Med Assoc 2012, 110:546-547.
• [23]Papageorghiou AT, Yu CK, Cicero S, Bower S, Nicolaides KH: Second-trimester uterine artery doppler screening in unselected populations: a review. J Matern Fetal Neonatal Med 2002, 12:78-88.
• [24]North RA, Ferrier C, Long D, Townend K, Kincaid-Smith P: Uterine artery doppler flow velocity waveforms in the second trimester for the prediction of preeclampsia and fetal growth retardation. Obstet Gynecol 1994, 83:378-386.
• [25]Gomez O, Figueras F, Martinez JM, del Rio M, Palacio M, Eixarch E, Puerto B, Coll O, Cararach V, Vanrell JA: Sequential changes in uterine artery blood flow pattern between the first and second trimesters of gestation in relation to pregnancy outcome. Ultrasound Obstet Gynecol 2006, 28:802-808.
• [26]Bower S, Vyas S, Campbell S, Nicolaides KH: Color doppler imaging of the uterine artery in pregnancy: normal ranges of impedance to blood flow, mean velocity and volume of flow. Ultrasound Obstet Gynecol 1992, 2:261-265.
• [27]Konje JC, Kaufmann P, Bell SC, Taylor DJ: A longitudinal study of quantitative uterine blood flow with the use of color power angiography in appropriate for gestational age pregnancies. Am J Obstet Gynecol 2001, 185:608-613.
• [28]Trudinger BJ, Giles WB, Cook CM: Uteroplacental blood flow velocity-time waveforms in normal and complicated pregnancy. Br J Obstet Gynaecol 1985, 92:39-45.
• [29]Trudinger BJ, Giles WB, Cook CM, Bombardieri J, Collins L: Fetal umbilical artery flow velocity waveforms and placental resistance: clinical significance. Br J Obstet Gynaecol 1985, 92:23-30.
• [30]Aardema MW, Oosterhof H, Timmer A, van Rooy I, Aarnoudse JG: Uterine artery doppler flow and uteroplacental vascular pathology in normal pregnancies and pregnancies complicated by pre-eclampsia and small for gestational age fetuses. Placenta 2001, 22:405-411.
• [31]Myatt L, Clifton RG, Roberts JM, Spong CY, Hauth JC, Varner MW, Wapner RJ, Thorp JM Jr, Mercer BM, Grobman WA, et al.: The utility of uterine artery doppler velocimetry in prediction of preeclampsia in a low-risk population. Obstet Gynecol 2012, 120:815-822.
• [32]Meizner I, Katz M, Lunenfeld E, Insler V: Umbilical and uterine flow velocity waveforms in pregnancies complicated by major fetal anomalies. Prenat Diagn 1987, 7:491-496.
• [33]Viero S, Chaddha V, Alkazaleh F, Simchen MJ, Malik A, Kelly E, Windrim R, Kingdom JC: Prognostic value of placental ultrasound in pregnancies complicated by absent end-diastolic flow velocity in the umbilical arteries. Placenta 2004, 25:735-741.
• [34]Molvarec A, Gullai N, Stenczer B, Fugedi G, Nagy B, Rigo J Jr: Comparison of placental growth factor and fetal flow doppler ultrasonography to identify fetal adverse outcomes in women with hypertensive disorders of pregnancy: an observational study. BMC Pregnancy Childbirth 2013, 13:161. BioMed Central Full Text
• [35]Tannirandorn Y, Witoonpanich P, Phaosavasdi S: Doppler umbilical artery flow velocity waveforms in pregnancies complicated by major fetal malformations. J Med Assoc Thai 1993, 76:494-500.
• [36]Espinoza J, Romero R, Nien JK, Gomez R, Kusanovic JP, Goncalves LF, Medina L, Edwin S, Hassan S, Carstens M, Gonzalez R: Identification of patients at risk for early onset and/or severe preeclampsia with the use of uterine artery doppler velocimetry and placental growth factor. Am J Obstet Gynecol 2007, 196:326. e321-313
• [37]Sibai BM, Gordon T, Thom E, Caritis SN, Klebanoff M, McNellis D, Paul RH: Risk factors for preeclampsia in healthy nulliparous women: a prospective multicenter study: the national institute of child health and human development network of maternal-fetal medicine units. Am J Obstet Gynecol 1995, 172:642-648.
• [38]Duckitt K, Harrington D: Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ 2005, 330:565.
• [39]Kaaja R: Predictors and risk factors of pre-eclampsia. Minerva Ginecol 2008, 60:421-429.
• [40]Park YW, Cho JS, Choi HM, Kim TY, Lee SH, Yu JK, Kim JW: Clinical significance of early diastolic notch depth: uterine artery doppler velocimetry in the third trimester. Am J Obstet Gynecol 2000, 182:1204-1209.
• [41]Park YW, Lim JC, Kim YH, Kwon HS: Uterine artery doppler velocimetry during mid-second trimester to predict complications of pregnancy based on unilateral or bilateral abnormalities. Yonsei Med J 2005, 46:652-657.
• [42]Divon MY, Ferber A: Umbilical artery doppler velocimetry–an update. Semin Perinatol 2001, 25:44-47.
• [43]Westergaard HB, Langhoff-Roos J, Lingman G, Marsal K, Kreiner S: A critical appraisal of the use of umbilical artery doppler ultrasound in high-risk pregnancies: use of meta-analyses in evidence-based obstetrics. Ultrasound Obstet Gynecol 2001, 17:466-476.
• [44]Bahlmann F, Reinhard I, Krummenauer F, Neubert S, Macchiella D, Wellek S: Blood flow velocity waveforms of the fetal middle cerebral artery in a normal population: reference values from 18 weeks to 42 weeks of gestation. J Perinat Med 2002, 30:490-501.
• [45]Ebbing C, Rasmussen S, Kiserud T: Middle cerebral artery blood flow velocities and pulsatility index and the cerebroplacental pulsatility ratio: longitudinal reference ranges and terms for serial measurements. Ultrasound Obstet Gynecol 2007, 30:287-296.