Subscribe to RSS
DOI: 10.1055/s-0032-1329181
Emergence of Late-Onset Placental Dysfunction: Relationship to the Change in Uterine Artery Blood Flow Resistance between the First and Third Trimesters
Publication History
13 February 2012
27 July 2012
Publication Date:
19 December 2012 (online)
Abstract
Objectives To test if emergence of third-trimester (T3) placental dysfunction is related to the impedance change in uterine artery blood flow resistance between the first trimester (T1) and T3.
Study Design Mean T1 and T3 uterine artery (mUtA) pulsatility index (PI) was measured in 1098 singletons. Each patient's individual mUtA-PI change was calculated ([(T3 PI − T1 PI/interval in days)] × 100; ΔmUtA-PI). This parameter and T1 and T3 mUtA-PI z-scores were related to placenta-related disease (PRD) and to constitutionally small neonates (CS).
Results Forty-seven (5%) women had PRD and 83 (8.7%) delivered a CS neonate. T1 and T3 mUtA-PI z-scores were higher with PRD (0.418 versus −0.097 and 1.06 versus −0.13, p < 0.001 for all). Change in mUtA-PI (ΔmUtA PI) was similar for patients with PRD. However, the prevalence of PRD doubled with rising ΔmUtA-PI (11.1% versus 5.2%, p = 0.041).
Conclusion T3 uterine artery Doppler performs significantly better in detecting patients at risk for late-onset PRD than T1 or the gestational age change in uterine artery Doppler resistance This suggests that a proportion of late emerging PRD is not amenable to early screening by uterine artery Doppler. Further research is essential to identify the optimal screening strategy for late-onset placental dysfunction.
-
References
- 1 McLaurin KK, Hall CB, Jackson EA, Owens OV, Mahadevia PJ. Persistence of morbidity and cost differences between late-preterm and term infants during the first year of life. Pediatrics 2009; 123: 653-659
- 2 Flenady V, Koopmans L, Middleton P , et al. Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet 2011; 377: 1331-1340
- 3 De Wolf F, De Wolf-Peeters C, Brosens I, Robertson WB. The human placental bed: electron microscopic study of trophoblastic invasion of spiral arteries. Am J Obstet Gynecol 1980; 137: 58-70
- 4 Meekins JW, Pijnenborg R, Hanssens M, McFadyen IR, van Asshe A. A study of placental bed spiral arteries and trophoblast invasion in normal and severe pre-eclamptic pregnancies. Br J Obstet Gynaecol 1994; 101: 669-674
- 5 Campbell S, Diaz-Recasens J, Griffin DR , et al. New Doppler technique for assessing uteroplacental blood flow. Lancet 1983; 1 (8326 Pt 1) 675-677
- 6 Papageorghiou AT, Yu CKH, Nicolaides KH. The role of uterine artery Doppler in predicting adverse pregnancy outcome. Best Pract Res Clin Obstet Gynaecol 2004; 18: 383-396
- 7 Yu CK, 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: 429-436
- 8 Llurba E, Carreras E, Gratacós E , et al. Maternal history and uterine artery Doppler in the assessment of risk for development of early- and late-onset preeclampsia and intrauterine growth restriction. Obstet Gynecol Int 2009; 275613
- 9 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: 742-749
- 10 Espinoza J, Romero R, Nien JK , et al. 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 , e1–e13
- 11 Audibert F, Boucoiran I, An N , et al. Screening for preeclampsia using first-trimester serum markers and uterine artery Doppler in nulliparous women. Am J Obstet Gynecol 2010; 203: 383 , e1–e8
- 12 Plasencia W, Maiz N, Poon L, Yu C, Nicolaides KH. Uterine artery Doppler at 11 + 0 to 13 + 6 weeks and 21 + 0 to 24 + 6 weeks in the prediction of pre-eclampsia. Ultrasound Obstet Gynecol 2008; 32: 138-146
- 13 Robinson HP, Fleming JE. A critical evaluation of sonar “crown-rump length” measurements. Br J Obstet Gynaecol 1975; 82: 702-710
- 14 Turan S, Miller J, Baschat AA. Integrated testing and management in fetal growth restriction. Semin Perinatol 2008; 32: 194-200
- 15 Vainio M, Kujansuu E, Iso-Mustajärvi M, Mäenpää J. Low dose acetylsalicylic acid in prevention of pregnancy-induced hypertension and intrauterine growth retardation in women with bilateral uterine artery notches. BJOG 2002; 109: 161-167
- 16 Bujold E, Roberge S, Lacasse Y , et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol 2010; 116 (2 Pt 1) 402-414
- 17 Baschat AA, Gembruch U. The cerebroplacental Doppler ratio revisited. Ultrasound Obstet Gynecol 2003; 21: 124-127
- 18 Soothill PW, Bobrow CS, Holmes R. Small for gestational age is not a diagnosis. Ultrasound Obstet Gynecol 1999; 13: 225-228
- 19 Brown MA, Lindheimer MD, de Swiet M, Van Assche A, 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: IX-XIV
- 20 Gómez O, Figueras F, Fernández S , et al. Reference ranges for uterine artery mean pulsatility index at 11–41 weeks of gestation. Ultrasound Obstet Gynecol 2008; 32: 128-132
- 21 Melchiorre K, Leslie K, Prefumo F, Bhide A, Thilaganathan B. First-trimester uterine artery Doppler indices in the prediction of small-for-gestational age pregnancy and intrauterine growth restriction. Ultrasound Obstet Gynecol 2009; 33: 524-529
- 22 Hepburn M, Rosenberg K. An audit of the detection and management of small-for-gestational age babies. Br J Obstet Gynaecol 1986; 93: 212-216
- 23 Boyle JD, Boyle EM. Born just a few weeks early: does it matter?. Arch Dis Child Fetal Neonatal Ed 2011; Aug 24. [Epub ahead of print]
- 24 Zhong Y, Tuuli M, Odibo AO. First-trimester assessment of placenta function and the prediction of preeclampsia and intrauterine growth restriction. Prenat Diagn 2010; 30: 293-308
- 25 Gómez O, Martínez JM, Figueras F , et al. 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
- 26 Schuchter K, Metzenbauer M, Hafner E, Philipp K. Uterine artery Doppler and placental volume in the first trimester in the prediction of pregnancy complications. Ultrasound Obstet Gynecol 2001; 18: 590-592
- 27 Poon LC, Kametas NA, Valencia C, Chelemen T, Nicolaides KH. Hypertensive disorders in pregnancy: screening by systolic diastolic and mean arterial pressure at 11–13 weeks. Hypertens Pregnancy 2011; 30: 93-107
- 28 Maroni E, Youssef A, Arcangeli T , et al. Increased uterine artery pulsatility index at 34 weeks and outcome of pregnancy. Ultrasound Obstet Gynecol 2011; 38: 395-399
- 29 Ghi T, Youssef A, Piva M , et al. The prognostic role of uterine artery Doppler studies in patients with late-onset preeclampsia. Am J Obstet Gynecol 2009; 201: 36 , e1–e5
- 30 Pijnenborg R, Bland JM, Robertson WB, Brosens I. Uteroplacental arterial changes related to interstitial trophoblast migration in early human pregnancy. Placenta 1983; 4: 397-413
- 31 Askie LM, Duley L, Henderson-Smart DJ, Stewart LA. PARIS Collaborative Group. Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data. Lancet 2007; 369: 1791-1798
- 32 Yu CK, Papageorghiou AT, Parra M, Palma Dias R, Nicolaides KH. Fetal Medicine Foundation Second Trimester Screening Group. Randomized controlled trial using low-dose aspirin in the prevention of pre-eclampsia in women with abnormal uterine artery Doppler at 23 weeks' gestation. Ultrasound Obstet Gynecol 2003; 22: 233-239