Preeclampsia – abnormal uterine artery Doppler is related to recurrence of symptoms during the next pregnancy
-
Haraldur M. Gudnasson
Abstract
Background: Impaired trophoblast invasion is suggested as the main cause of reduced placental perfusion, which results in fetal growth restriction and preeclampsia. Immunological response against the invading tissue has been given as the explanation. Preeclampsia frequently recurs during the next pregnancy. Doppler ultrasound can predict increased vascular impedance in the uteroplacental circulation. Whether signs of increased vascular resistance in pregnancies complicated by preeclampsia are predictive of recurrence during the next pregnancy is unknown.
Methods and material: Uterine artery Doppler was performed in 570 pregnant women with preeclampsia. Of these, 139 became pregnant again. The uterine artery Doppler results during the first pregnancy were related to symptoms of preeclampsia in the succeeding pregnancy.
Results: Preeclampsia developed again in 43 of the 139 women. Pregnancies with signs of increased uterine artery vascular impedance during the first pregnancy were 3.4 times more likely to develop preeclampsia again (CI 1.58–7.6). Similar results for a small for gestational age newborn were 9.7 (CI 1.1–90).
Conclusion: Increased uterine artery vascular impedance in pregnancies complicated by preeclampsia increases the likelihood of recurrence and growth restriction during the next pregnancy. The Doppler information gathered during the first pregnancy might thus select cases for special surveillance and possibly prophylactic anti-platelet treatment in the next pregnancy.
References
1 Campbell S, J Diaz-Recasens, DR Griffin, TE Cohen-Overbeek, JM Pearce, K Willson, MJ Teague: New Doppler technique for assessing uteroplacental blood flow. Lancet154 (1983) 675Search in Google Scholar
2 Hofstaetter C, M Dubiel, S Gudmundsson, K Marsál: Uterine artery color Doppler assisted velocimetry and perinatal out-come. Acta Obstet Gynecol Scand75 (1996) 612Search in Google Scholar
3 Mogren I, U Hogberg, A Winkvist, H Stenlund: Familial occurrence of preeclampsia. Epidemiology10 (1999) 518Search in Google Scholar
4 Trogstad LI, A Eskild, P Magnus, SO Samuelsen, BI Nesheim: Changing paternity and time since last pregnancy; the impact on preeclampsia risk. A study of 547 238 women with and without previous preeclampsia. Int J Epidemiol30 (2001) 1317Search in Google Scholar
5 Chien PF, N Arnott, A Gordon, P Owen, KS Khan: How useful is uterine artery Doppler flow velocimetry in the prediction of preeclampsia, intrauterine growth retardation and perinatal death? An overview. Br J Obstet Gynaecol107 (2000) 196Search in Google Scholar
6 Gosling RG, G Dunbar, DH King, DL Newman, CD Side, JP Woodcock, DE Fitzgerald, JS Keates, D MacMillan: The quantitative analysis of occlusive peripheral arterial disease by a non-intrusive ultrasonic technique. Angiology22 (1971) 52Search in Google Scholar
7 Gudmundsson S, K Marsál: Umbilical artery and uteroplacental blood flow velocity waveforms in normal pregnancy – a cross-sectional study. Acta Obstet Gynecol Scand67 (1988) 347Search in Google Scholar
8 Laurin J, G Lingman, K Marsal, PH Persson: Fetal blood flow in pregnancies complicated by intrauterine growth retardation. Obstet Gynecol69 (1987) 895Search in Google Scholar
9 Gudmundsson S, P Korszun, P Olofsson, M Dubiel: A new score indicating placental vascular resistance. Acta Obstet Gynecol Scand82 (2003) 807Search in Google Scholar
10 Marsál K, PH Persson, T Larsen, H Lilja, A Selbing, B Sultan: Intrauterine growth curves based on ultrasonically estimated foetal weights. Acta Paediatr85 (1996) 843Search in Google Scholar
11 Brosens I, WB Robertson, HG Dixon: The physiological response of the vessels of the placental bed to normal pregnancy. J Pathol Bacteriol93 (1967) 569Search in Google Scholar
12 Sebire NJ: Early trophoblast invasion and fetal loss in chromosomally abnormal conceptions. Ultrasound Obstet Gynecol19 (2002) 52910.1046/j.1469-0705.2002.00677.xSearch in Google Scholar PubMed
13 Assali NS, L Rauramo, T Peltonen: Measurement of uterine blood flow and uterine metabolism. Am J Obstet Gynecol79 (1960) 86Search in Google Scholar
14 Goldman-Wohl D, S Yagel: Regulation of trophoblast invasion: from normal implantation to preeclampsia. Mol Cell Endocrinol187 (2002) 233Search in Google Scholar
15 Kitzmiller JL, K Benirschke: Immunofluorescent study of placental bed vessels in pre-eclampsia of pregnancy. Am J Obstet Gynecol115 (1973) 248Search in Google Scholar
16 Harrington K, D Cooper, C Lees, K Hecher, S Campbell. Doppler ultrasound of the uterine arteries: the importance of bilateral notching in the prediction of preeclampsia, placental abruption or delivery of a small-for-gestational-age baby. Ultrasound Obstet Gynecol7 (1996) 182Search in Google Scholar
17 Levine RJ, JC Hauth, LB Curet, BM Sibai, PM Catalano, CD Morris, R DerSimonian, JR Esterlitz, EG Raymond, DE Bild, JD Clemens, JA Cutler: Trial of calcium to prevent preeclampsia. N Engl J Med337 (1997) 69Search in Google Scholar
18 Coomarasamy A, S Papaioannou, H Gee, KS Khan: Aspirin for the prevention of preeclampsia in women with abnormal uterine artery Doppler: a meta-analysis. Obstet Gynecol98 (2001) 861Search in Google Scholar
© Walter de Gruyter
Articles in the same Issue
- Fetal membrane inflammatory cytokines: a switching mechanism between the preterm premature rupture of the membranes and preterm labor pathways
- Preeclampsia – abnormal uterine artery Doppler is related to recurrence of symptoms during the next pregnancy
- Mother-to-infant vertical transmission of transfusion transmitted virus in South China
- Evaluation of second trimester maternal serum screening for Down’s Syndrome using the Spiegelhalter-Knill-Jones (S-KJ) approach
- β2-adrenergic receptor gene polymorphisms and pregnancy outcome
- Maternal and fetal insulin-like growth factors 1 and 2 (IGF-1, IGF-2) and IGF BP-3, and their relationship to fetal acidosis at delivery
- Comparison of intrapartum fetal heart rate tracings in patients with neonatal seizures vs. no seizures: what are the differences?
- Computerized cardiotocography parameters in pregnant women affected by pregestational diabetes mellitus
- The effect of processing and cryopreservation on nucleated umbilical cord blood cells
- Etiology of cerebral palsy
- Characterisation of the cytokine inflammatory response in LPS stimulated full-term cord blood
- Amniotic cavity cultures, blood cultures, and surface swabs in preterm infants – useful tools for the management of early-onset sepsis?
- Massive hepatic infarction in preeclampsia: successful treatment with continuous hemodiafiltration and corticosteroid therapy
- The use of recombinant factor VIIa in a primigravida with Glanzmann’s thrombasthenia during delivery
- Potential harm from puncture resistant surgical gloves
Articles in the same Issue
- Fetal membrane inflammatory cytokines: a switching mechanism between the preterm premature rupture of the membranes and preterm labor pathways
- Preeclampsia – abnormal uterine artery Doppler is related to recurrence of symptoms during the next pregnancy
- Mother-to-infant vertical transmission of transfusion transmitted virus in South China
- Evaluation of second trimester maternal serum screening for Down’s Syndrome using the Spiegelhalter-Knill-Jones (S-KJ) approach
- β2-adrenergic receptor gene polymorphisms and pregnancy outcome
- Maternal and fetal insulin-like growth factors 1 and 2 (IGF-1, IGF-2) and IGF BP-3, and their relationship to fetal acidosis at delivery
- Comparison of intrapartum fetal heart rate tracings in patients with neonatal seizures vs. no seizures: what are the differences?
- Computerized cardiotocography parameters in pregnant women affected by pregestational diabetes mellitus
- The effect of processing and cryopreservation on nucleated umbilical cord blood cells
- Etiology of cerebral palsy
- Characterisation of the cytokine inflammatory response in LPS stimulated full-term cord blood
- Amniotic cavity cultures, blood cultures, and surface swabs in preterm infants – useful tools for the management of early-onset sepsis?
- Massive hepatic infarction in preeclampsia: successful treatment with continuous hemodiafiltration and corticosteroid therapy
- The use of recombinant factor VIIa in a primigravida with Glanzmann’s thrombasthenia during delivery
- Potential harm from puncture resistant surgical gloves
