The role of maternal echocardiography and uterine artery Doppler at 11-14 weeks in the prediction of pre-eclampsia in nulliparous women
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20215072Keywords:
Pregnancies, Echocardiography, Uterine artery Doppler, Pre-eclampsia, NulliparousAbstract
Background: Pre-eclampsia (PE) complicates 2% of pregnancies and may have serious effects on mother and child, which makes it an important threat to public health in both developed and developing countries. Once high-risk women are identified, they can be targeted for more intense prenatal surveillance and preventative measures. Predicting PE in the first trimester requires the use of maternal echocardiography and the uterine artery pulsatility index (UAPI). Objective of the study was to see whether maternal echocardiography and uterine artery Doppler at 11-14 weeks can predict subsequent development of PE in nulliparous women.
Methods: This prospective observational cohort study was carried out in outdoor patients of obstetrics and gynecology of Bangabandhu Sheikh Mujib Medical University (BSMMU), with collaboration with department of cardiology, National Institute of Nuclear Medicine and Allied Sciences (NINMAS), BSMMU, Dhaka, during 01 December 2013 to July 2015. A total of 135 healthy nulliparous women at 11-14 weeks of gestation were included in this study. Data was processed and analyzed by statistical package for the social sciences (SPSS) version 24.0.
Results: Among 135 patients, two (1.5%) patients developed preeclampsia during 1st follow-up (20-28 weeks) and four (2.9%) patients developed preeclampsia during (29-36 weeks). Mean total peripheral resistance was found to be 1332.0±75.2 dynes/sec/cm5 in preeclampsia and 1157.0±139.2 dynes/sec/cm5 in non preeclamptic pregnancy. The difference between two groups was statistically significant. MAP and total peripheral resistance were statistically significant (p<0.05) between two groups.
Conclusions: In first trimester of pregnancy UAPI is the best predictor for detection of PE.
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References
Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. The Lancet. 2005;365(9461):785-99.
Pettit F, Brown MA. The management of pre-eclampsia: what we think we know. Eur J Obstet Gynecol Reprod Biol. 2012;160(1):6-12.
World Health Organization. Make every mother and child count: World Health Day, 7 April 2005: a toolkit for organizers of activities. 2005. Available at: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwihooGwu_n0AhXJldgFHXuzD8YQFnoECAoQAQ&url=https%3A%2F%2Fapps.who.int%2Firis%2Fhandle%2F10665%2F68863&usg=AOvVaw3T9x_T24Eruq8Cy-FbpXdI. Accessed on 03 August 2021.
Begum A. Study on clinical profile and outcome of preeclampsia. Dissertation, Bangladesh College of physician and surgeon. 2004.
Bhattacharyya SK, Kundu S, Kabiraj SP. Prediction of preeclampsia by midtrimester uterine artery Doppler velocimetry in high-risk and low-risk women. J Obstet Gynecol India. 2012;62(3):297-300.
McDonald SD, Lutsiv O, Dzaja N, Duley L. A systematic review of maternal and infant outcomes following magnesium sulfate for pre-eclampsia/eclampsia in real-world use. Int J Gynecol Obstet. 2012;118(2):90-6.
Ck Y, Smith GC, Papageorghiou AT, Cacho AM, Nicolaides KH, Fetal Medicine Foundation Second Trimester screening Group. An integrated model for the prediction of preeclampsia using maternal factors and uterine artery Doppler velocimetry in unselected low-risk women. Am J Obstet Gynecol. 2005;193(2):429-36.
Plasencia W, Maiz N, Bonino S, Kaihura C, Nicolaides KH. Uterine artery Doppler at 11+ 0 to 13+ 6 weeks in the prediction of pre‐eclampsia. Ultrasound Obstet Gynecol. 2007;30(5):742-9.
Lewis G. Confidential Enquiry Into Maternal and Child Health: Saving Mother's Lives: Reviewing Maternal Deaths to Make Motherhood Safer-2003-2005: Executive Summary and Key Recommendations: December 2007. CEMACH. 2007.
Schlembach D. Pre-eclampsia-still a disease of theories. Fukushima J Med Sci. 2003;49(2):69-115.
Luo ZC, An N, Xu HR, Larante A, Audibert F, Fraser WD. The effects and mechanisms of primiparity on the risk of pre‐eclampsia: a systematic review. Paediatric Perinatal Epidemiol. 2007;21:36-45.
Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ. 2007;335(7627):974.
Bosio PM, McKenna PJ, Conroy R, O’Herlihy C. Maternal central hemodynamics in hypertensive disorders of pregnancy. Obstet Gynecol. 1999;94(6):978-84.
Easterling TR, Benedetti TJ, Schmucker BC, Millard SP. Maternal hemodynamics in normal and preeclamptic pregnancies: a longitudinal study. Obstet Gynecol. 1990;76(6):1061-9.
Xiong X, Demianczuk NN, Saunders LD, Wang FL, Fraser WD. Impact of preeclampsia and gestational hypertension on birth weight by gestational age. Am J Epidemiol. 2002;155(3):203-9.
Solanki R, Maitra N. Echocardiographic assessment of cardiovascular hemodynamics in preeclampsia. J Obstet Gynecol India. 2011;61(5):519-22.
Khong TY, De Wolf F, Robertson WB, Brosens I. Inadequate maternal vascular response to placentation in pregnancies complicated by pre‐eclampsia and by small‐for‐gestational age infants. BJOG. 1986;93(10):1049-59.
Steel SA, Pearce JM, Chamberlain GV. Doppler ultrasound of the uteroplacental circulation as a screening test for severe pre-eclampsia with intra-uterine growth retardation. Eur J Obstet Gynecol Reprod Biol. 1988;28(4):279-87.
Bolte AC, Dekker GA. Uterine artery Doppler as screening tool for preeclampsia. When to screen in obstetrics and gynecology. Philadelphia: Saunders Elsevier. 2006;408-19.
Poon LC, Kametas NA, Maiz N, Akolekar R, Nicolaides KH. First-trimester prediction of hypertensive disorders in pregnancy. Hypertension. 2009;53(5):812-8.
Visser W, Wallenburg HC. Central hemodynamic observations in untreated preeclamptic patients. Hypertension. 1991;17(6):1072-7.
Mabie WC, Ratts TE, Sibai BM. The central hemodynamics of severe preeclampsia. Am J Obstet Gynecol. 1989;161(6):1443-8.
Phelan JP, Yurth DA. Severe preeclampsia: I. Peripartum hemodynamic observations. Am J Obstet Gynecol. 1982;144(1):17-22.
Martin PY. Mobilizing masculinities': women's experiences of men at. Organization. 2001;8(4):587-618.
Turan JM, Miller S, Bukusi EA, Sande J, Cohen CR. HIV/AIDS and maternity care in Kenya: how fears of stigma and discrimination affect uptake and provision of labor and delivery services. AIDS Care. 2008;20(8):938-45.
Salako BL, Olayemi O, Odukogbe AT, Adedapo KS, Aimakhu CO, Alu FE, Ola B. Microalbuminuria in pregnancy as a predictor of preeclampsia and eclampsia. West Af J Med. 2003;22(4):295-300.
Khaw KT, Wareham N, Bingham S, Welch A, Luben R, Day N. Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study. PLoS Med. 2008;5(1):12.
Hunter S, Robson SC. Adaptation of the maternal heart in pregnancy. Br Heart J. 1992;68(6):540.
