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Li Z, Zhu J, Chen Y, Wei F, Yang J, Tan X. Preeclampsia/eclampsia impacts the structure and function of neonatal hearts probably by reducing myocardial compaction. Eur J Radiol 2024; 173:111382. [PMID: 38382423 DOI: 10.1016/j.ejrad.2024.111382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/18/2023] [Accepted: 02/16/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Preeclampsia/Eclampsia (PE/E) poses significant risks to neonatal cardiac health. Traditional echocardiographic methods have limitations in detailing these impacts. This study hypothesized that echocardiographic radiomics could provide a more comprehensive assessment of the cardiac changes in neonates affected by PE/E. METHOD In a comprehensive analysis, 2594 neonates underwent echocardiographic screening. From these, 556 were selected for detailed radiomics analysis, focusing on cardiac shape, movement, and texture features. A multiblock sparse partial least squares (sPLS) model integrated these features to assess their association with PE/E. RESULTS Newborns from PE/E-affected pregnancies displayed lower left ventricular ejection fractions compared to the control group (61.1 % vs. 66.2 %). Our radiomics approach extracted 15,494 features per neonate, with the sPLS model identifying 17 features significantly correlated with PE/E. Among these, texture features representing myocardial non-compaction were most strongly correlated with PE/E (correlation coefficient r = 0.63). Detailed visualization of these texture features suggested that PE/E might lead to more pronounced myocardial non-compaction, characterized by a thicker non-compaction layer and increased cardiac trabeculation. CONCLUSIONS Our findings demonstrate the potential of echocardiographic radiomics as a tool for assessing the impact of PE/E on neonatal cardiac function. The correlation between PE/E and myocardial non-compaction underlines the need for enhanced cardiac monitoring in neonates born to PE/E-affected mothers. This study contributes to a better understanding of PE/E's cardiac implications, potentially guiding future clinical practices.
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Affiliation(s)
- Zexin Li
- Clinical Research Center, First Affiliated Hospital of Shantou University Medical College, No. 57, Changping Road, Shantou, Guangdong 515041, China; Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital), No. 6, Ailong Road, Shenzhen 518172, China
| | - Jinxiu Zhu
- Institute of Clinical Electrocardiology, First Affiliated Hospital of Shantou University Medical College, No. 57, Changping Road, Shantou, Guangdong 515041, China; Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital), No. 6, Ailong Road, Shenzhen 518172, China
| | - Yequn Chen
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, No. 57, Changping Road, Shantou, Guangdong 515041, China
| | - Fengxiang Wei
- Central Laboratory, Longgang District Maternity & Child Healthcare Hospital (Longgang Maternity and Child Institute of Shantou University Medical College), No. 6, Ailong Road, Shenzhen 518172, China
| | - Jinying Yang
- Department of Obstetrics, Longgang District Maternity & Child Healthcare Hospital (Longgang Maternity and Child Institute of Shantou University Medical College), No. 6, Ailong Road, Shenzhen, Guangdong 518172, China
| | - Xuerui Tan
- Clinical Research Center, First Affiliated Hospital of Shantou University Medical College, No. 57, Changping Road, Shantou, Guangdong 515041, China.
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Zheng W, Yan G, Jiang Y, Bao Z, Li K, Deng M, Li B, Zou Y. Diffusion-Weighted MRI of the Fetal Brain in Fetal Growth Restriction With Maternal Preeclampsia or Gestational Hypertension. J Magn Reson Imaging 2024; 59:1384-1393. [PMID: 37315155 DOI: 10.1002/jmri.28861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/28/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The fetal neurodevelopmental microstructural alterations of intrauterine exposure to preeclampsia (PE) or gestational hypertension (GH) remain unknown. PURPOSE To evaluate the differences in diffusion-weighted imaging (DWI) of the fetal brain between normotensive pregnancies and PE/GH pregnancies, with a focus on PE/GH pregnancies with fetal growth restriction (FGR). STUDY TYPE Retrospective matched case-control study. POPULATION 40 singleton pregnancies with PE/GH complicated by FGR, and 3 paired control groups (PE/GH without FGR, normotensive FGR, normotensive pregnancies) (28-38 gestational weeks). FIELD STRENGTH/SEQUENCE DWI with single-shot echo-planar imaging at 1.5 Tesla. ASSESSMENT The apparent diffusion coefficient (ADC) values were calculated in the centrum semi-ovale (CSO), parietal white matter (PWM), frontal white matter (FWM), occipital white matter (OWM), temporal white matter (TWM), basal ganglia, thalamus (THAL), pons, and cerebellar hemisphere. STATISTICAL TESTS Student t test or Wilcoxon matched test was used to reveal the difference of ADC values among the investigated brain regions. A correlation between gestational age (GA) and ADC values was determined by linear regression analysis. RESULTS Compared with fetuses in PE/GH without FGR and those with normotensive pregnancies, fetuses in the PE/GH with FGR group had significantly lower average ADC measurements of supratentorial regions (1.65 ± 0.09 vs. 1.71 ± 0.10 10-3 mm2 /sec; vs. 1.73 ± 0.11 10-3 mm2 /sec, respectively). Regions of significantly decreased ADC values in the fetal brain included CSO, FWM, PWM, OWM, TWM and THAL in cases of PE/GH with FGR. ADC values from supratentorial regions in PE/GH pregnancies were not significantly correlated with GA (P = 0.12, 0.26); however, this trend was statistically significant in the normotensive groups. DATA CONCLUSION ADC values may indicate fetal brain developmental alterations in PE/GH with FGR fetuses but more microscopic and morphological studies are necessary to provide additional evidence to offer a different interpretation of this trend in fetal brain. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Weizeng Zheng
- Department of Radiology, Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Guohui Yan
- Department of Radiology, Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Ying Jiang
- Department of Obstetrics, Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Zhongkun Bao
- Department of Radiology, Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Kui Li
- Department of Radiology, Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Meixiang Deng
- Department of Radiology, Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Baohua Li
- Department of Obstetrics, Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Yu Zou
- Department of Radiology, Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
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Zhou T, Gu S, Shao F, Li P, Wu Y, Xiong J, Wang B, Zhou C, Gao P, Hua X. Prediction of preeclampsia from retinal fundus images via deep learning in singleton pregnancies: a prospective cohort study. J Hypertens 2024; 42:701-710. [PMID: 38230614 PMCID: PMC10906188 DOI: 10.1097/hjh.0000000000003658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/01/2023] [Accepted: 12/30/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Early prediction of preeclampsia (PE) is of universal importance in controlling the disease process. Our study aimed to assess the feasibility of using retinal fundus images to predict preeclampsia via deep learning in singleton pregnancies. METHODS This prospective cohort study was conducted at Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine. Eligible participants included singleton pregnancies who presented for prenatal visits before 14 weeks of gestation from September 1, 2020, to February 1, 2022. Retinal fundus images were obtained using a nonmydriatic digital retinal camera during their initial prenatal visit upon admission before 20 weeks of gestation. In addition, we generated fundus scores, which indicated the predictive value of hypertension, using a hypertension detection model. To evaluate the predictive value of the retinal fundus image-based deep learning algorithm for preeclampsia, we conducted stratified analyses and measured the area under the curve (AUC), sensitivity, and specificity. We then conducted sensitivity analyses for validation. RESULTS Our study analyzed a total of 1138 women, 92 pregnancies developed into hypertension disorders of pregnancy (HDP), including 26 cases of gestational hypertension and 66 cases of preeclampsia. The adjusted odds ratio (aOR) of the fundus scores was 2.582 (95% CI, 1.883-3.616; P < 0.001). Otherwise, in the categories of prepregnancy BMI less than 28.0 and at least 28.0, the aORs were 3.073 (95%CI, 2.265-4.244; P < 0.001) and 5.866 (95% CI, 3.292-11.531; P < 0.001). In the categories of maternal age less than 35.0 and at least 35.0, the aORs were 2.845 (95% CI, 1.854-4.463; P < 0.001) and 2.884 (95% CI, 1.794-4.942; P < 0.001). The AUC of the fundus score combined with risk factors was 0.883 (sensitivity, 0.722; specificity, 0.934; 95% CI, 0.834-0.932) for predicting preeclampsia. CONCLUSION Our study demonstrates that the use of deep learning algorithm-based retinal fundus images offers promising predictive value for the early detection of preeclampsia.
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Affiliation(s)
- Tianfan Zhou
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University
| | - Shengyi Gu
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University
| | - Feixue Shao
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University
| | - Ping Li
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University
| | - Yuelin Wu
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University
| | | | - Bin Wang
- Beijing Airdoc Technology Co., Ltd., Beijing, China
| | - Chenchen Zhou
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University
| | - Peng Gao
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University
| | - Xiaolin Hua
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University
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Tian F, Dou LF, Tang LW, Gao QM, Li BW. Predictive value of placental real-time shear wave elastography combined with 3-dimensional power Doppler index for preeclampsia. Medicine (Baltimore) 2024; 103:e37372. [PMID: 38457566 PMCID: PMC10919515 DOI: 10.1097/md.0000000000037372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 03/10/2024] Open
Abstract
This study aimed to investigate the value of placental real-time shear wave elastography combined with three-dimensional power Doppler index (3D-PDI) in the prediction of preeclampsia. We conducted a retrospective study selecting 60 pregnant women diagnosed with preeclampsia as the experimental group and 60 normal pregnant women as the control group from January 2021 to December 2022. The elastic modulus values of different regions of the placenta and placental 3D-PDI were detected and compared between the two groups. The ROC curve was used to evaluate the diagnostic value of each parameter, alone or in combination, for preeclampsia. The study findings demonstrated that the elastic modulus values of different regions of the placenta and 3D-PDI of the two groups have statistical significance. The values of SWE, VI, FI, and VFI are different in prediction of preeclampsia, and the combination of various parameters can improve the prediction value. Overall, our study provides a valuable method for the prediction of preeclampsia with the advantages of non-invasiveness, efficiency, and simplicity.
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Affiliation(s)
- Fei Tian
- Ultrasound Department, Binzhou Medical University Hospital, Binzhou, Shandong Province, China
| | - Lian-feng Dou
- Emergency Department, Binzhou Medical University Hospital, Binzhou, Shandong Province, China
| | - Li-wei Tang
- Ultrasound Department, Binzhou Medical University Hospital, Binzhou, Shandong Province, China
| | - Qi-min Gao
- Ultrasound Department, Binzhou Medical University Hospital, Binzhou, Shandong Province, China
| | - Bao-wei Li
- Ultrasound Department, Binzhou Medical University Hospital, Binzhou, Shandong Province, China
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Arechvo A, Wright A, Nobile Recalde A, Liandro R, Charakida M, Nicolaides KH. Ophthalmic artery Doppler and biomarkers of impaired placentation at 36 weeks' gestation in pregnancies with small fetuses. Ultrasound Obstet Gynecol 2024; 63:358-364. [PMID: 37902727 DOI: 10.1002/uog.27521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/15/2023] [Accepted: 10/19/2023] [Indexed: 10/31/2023]
Abstract
OBJECTIVES First, to compare ophthalmic artery peak systolic velocity (PSV) ratio and biomarkers of impaired placentation at 36 weeks' gestation in women who delivered a small-for-gestational-age (SGA) or growth-restricted (FGR) neonate, in the absence of hypertensive disorder, with those of women who developed pre-eclampsia (PE) or gestational hypertension (GH) and of women unaffected by SGA, FGR, PE or GH. Second, to examine the associations of PSV ratio, uterine artery pulsatility index (UtA-PI), placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) with birth-weight Z-score or percentile. METHODS This was a prospective observational study of women with a singleton pregnancy attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, ultrasound examination of fetal anatomy and growth, and measurement of maternal ophthalmic artery PSV ratio, UtA-PI, PlGF and sFlt-1. Values of PSV ratio, UtA-PI, PlGF and sFlt-1 were converted to multiples of the median (MoM) or delta values. Median MoM or deltas of these biomarkers in the SGA, FGR, PE and GH groups were compared with those in the unaffected group. Regression analysis was used to examine the relationship of PSV ratio delta, UtA-PI MoM, PlGF MoM and sFlt-1 MoM with birth-weight Z-score, after exclusion of PE and GH cases. RESULTS The study population of 9033 pregnancies included 7696 (85.2%) that were not affected by FGR, SGA, PE or GH, 182 (2.0%) complicated by FGR in the absence of PE or GH, 698 (7.7%) with SGA in the absence of FGR, PE or GH, 236 (2.6%) with PE and 221 (2.4%) with GH. Compared with unaffected pregnancies, in the FGR and SGA groups, the PSV ratio delta and sFlt-1 MoM were increased and PlGF MoM was decreased; UtA-PI MoM was increased in the FGR group but not the SGA group. The magnitude of the changes in biomarker values relative to the unaffected group was smaller in the FGR and SGA groups than that in the PE and GH groups. In non-hypertensive pregnancies, there were significant inverse associations of PSV ratio delta and UtA-PI MoM with birth-weight Z-score, such that the values were increased in small babies and decreased in large babies. There was a quadratic relationship between PlGF MoM and birth-weight Z-score, with low PlGF levels in small babies and high PlGF levels in large babies. There was no significant association between sFlt-1 MoM and birth-weight Z-score. CONCLUSIONS Ophthalmic artery PSV ratio, reflective of peripheral vascular resistance, and UtA-PI, PlGF and sFlt-1, biomarkers of impaired placentation, are altered in pregnancies complicated by hypertensive disorder and, to a lesser extent, in non-hypertensive pregnancies delivering a SGA or FGR neonate. The associations between the biomarkers and birth-weight Z-score suggest the presence of a continuous physiological relationship between fetal size and peripheral vascular resistance and placentation, rather than a dichotomous relationship of high peripheral resistance and impaired placentation in small compared to non-small fetuses. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Arechvo
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - A Nobile Recalde
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - R Liandro
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - M Charakida
- Fetal Medicine Research Institute, King's College Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
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Shinohara S, Yoshihara T, Mochizuki K, Yasuda G, Kasai M, Sunami R. Preeclampsia prediction model using demographic, clinical, and sonographic data in the second trimester of Japanese nulliparous women. J Obstet Gynaecol Res 2024; 50:395-402. [PMID: 38109933 DOI: 10.1111/jog.15861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023]
Abstract
AIM This study aimed to clarify the factors influencing preeclampsia (PE) development in nulliparous Japanese women and to develop a PE prediction model using second trimester sonographic and clinical data readily available to obstetricians. METHODS This historical cohort study examined the obstetric records of nulliparous women who delivered at Yamanashi Prefectural Central Hospital from January 2019 to May 2023. A model was constructed to predict the PE development rate, with a focus on 796 nulliparous women. The assessed outcome was PE, excluding superimposed PE. Data on maternal age, assisted reproductive technology, mean arterial pressure, uterine artery notching, and umbilical artery resistance index were extracted. Multivariable logistic regression analysis was conducted on these five factors. RESULTS The incidence of PE was 4.3% (34/796). Multivariable analysis indicated significant odds ratios for the association of PE with mean arterial pressure (adjusted odds ratio: 1.06, 95% confidence interval: 1.03-1.10) and uterine artery notching (adjusted odds ratio: 6.28, 95% confidence interval: 2.82-14.0) in nulliparous women. The PE prediction formula was established as follows: Probability of PE development (%) = (odds/1 + odds) × 100, odds = ex and x = -11.3 + 0.039 × maternal age (years) + 0.91 × assisted reproductive technology + 0.061 × mean arterial pressure (mmHg) + 1.84 × uterine artery notching + 1.84 × umbilical artery resistance index. The sensitivity and specificity of this model were 58.8% and 84.5%, respectively (area under the curve: 0.79). CONCLUSIONS This study is the first to provide a prediction formula targeting the Japanese population. Our specialized model for nulliparous women could guide obstetricians to educate women regarding the precise prospect of PE development.
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Affiliation(s)
- Satoshi Shinohara
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
| | - Tatsuya Yoshihara
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
| | - Kana Mochizuki
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
| | - Genki Yasuda
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
| | - Mayuko Kasai
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
| | - Rei Sunami
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
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Mansukhani T, Wright A, Arechvo A, Laich A, Iglesias M, Charakida M, Nicolaides KH. Ophthalmic artery Doppler at 36 weeks' gestation in prediction of pre-eclampsia: validation and update of previous model. Ultrasound Obstet Gynecol 2024; 63:230-236. [PMID: 37616530 DOI: 10.1002/uog.27464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To validate and extend a model incorporating maternal ophthalmic artery Doppler at 35-37 weeks' gestation in the prediction of subsequent development of pre-eclampsia (PE). METHODS This was a prospective validation study of screening for PE (defined according to the 2019 American College of Obstetricians and Gynecologists criteria) by maternal ophthalmic artery peak systolic velocity (PSV) ratio in 6746 singleton pregnancies undergoing routine care at 35 + 0 to 36 + 6 weeks' gestation (validation dataset). Additionally, the data from the validation dataset were combined with those of 2287 pregnancies that were previously used for development of the model (training dataset), and the combined data were used to update the original model parameters. The competing-risks model was used to estimate the individual patient-specific risk of delivery with PE at any time and within 3 weeks from assessment by a combination of maternal demographic characteristics and medical history with PSV ratio alone and in combination with the established PE biomarkers of mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), serum placental growth factor (PlGF) and serum soluble fms-like tyrosine kinase-1 (sFlt-1). We evaluated the predictive performance of the model by examining, first, the ability to discriminate between the PE and non-PE groups using the area under the receiver-operating-characteristics curve and the detection rate (DR) at fixed screen-positive (SPR) and false-positive rates of 10% and, second, calibration by measuring the calibration slope and calibration-in-the-large. McNemar's test was used to compare the performance of screening by a biophysical test (maternal factors, MAP, UtA-PI and PSV ratio) vs a biochemical test (maternal factors, PlGF and sFlt-1), low PlGF concentration (< 10th percentile) or high sFlt-1/PlGF concentration ratio (> 90th percentile). RESULTS In the validation dataset, the performance of screening by maternal factors and PSV ratio for delivery with PE within 3 weeks and at any time after assessment was consistent with that in the training dataset, and there was good agreement between the predicted and observed incidence of PE. In the combined data from the training and validation datasets, good prediction for PE was achieved in screening by a combination of maternal factors, MAP, UtA-PI, PlGF, sFlt-1 and PSV ratio, with a DR, at a 10% SPR, of 85.0% (95% CI, 76.5-91.4%) for delivery with PE within 3 weeks and 65.7% (95% CI, 59.2-71.7%) for delivery with PE at any time after assessment. The performance of a biophysical test was superior to that of screening by low PlGF concentration or high sFlt-1/PlGF concentration ratio but not significantly different from the performance of a biochemical test combining maternal factors with PlGF and sFlt-1 for both PE within 3 weeks and PE at any time after assessment. CONCLUSION Maternal ophthalmic artery PSV ratio at 35-37 weeks' gestation in combination with other biomarkers provides effective prediction of subsequent development of PE. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T Mansukhani
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - A Arechvo
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - A Laich
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - M Iglesias
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - M Charakida
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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de Ganzo Suárez T, de Paco Matallana C, Plasencia W. Spiral, uterine artery doppler and placental ultrasound in relation to preeclampsia. Best Pract Res Clin Obstet Gynaecol 2024; 92:102426. [PMID: 38039843 DOI: 10.1016/j.bpobgyn.2023.102426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/18/2023] [Accepted: 08/06/2023] [Indexed: 12/03/2023]
Abstract
Preeclampsia (PE) is a multiorgan disorder that complicates around 2-8% of pregnancies and is a major cause of perinatal and maternal morbidity and mortality. PE is a clinical syndrome characterized by hypertension secondary to systemic inflammation, endothelial dysfunction, and syncytiotrophoblast stress leading to hypertension and multiorgan dysfunction. The uterine arteries are the main blood vessels that supply blood to the uterus. They give off branches and plays an important role in maintaining blood supply during pregnancy. The arcuate artery originates from the uterine artery and runs medially through the myometrium. The arcuate arteries divide almost directly into anterior and posterior branches, from which the radial artery leads directly to the uterine cavity during their course. Near the endometrium-myometrium junction, the radial artery generates spiral arteries within the basal layer and functional endometrium. The walls of radial and spiral arteries are rich in smooth muscle, which is lost when trophoblast cells invade and become large-caliber vessels. This physiological transformation of uteroplacental spiral arteries is critical for successful placental implantation and normal placental function. In normal pregnancy, the luminal diameter of the spiral arteries is greatly increased, and the vascular smooth muscle is replaced by trophoblast cells. This process and changes in the spiral arteries are called spiral artery remodeling. In PE, this genetically and immunologically governed process is deficient and therefore there is decreased vascular capacitance and increased resistance in the uteroplacental circulation. Furthermore, this defect in uteroplacental spiral artery remodeling is not only associated with early onset PE, but also with fetal growth restriction, placental abruption, and spontaneous premature rupture of membranes. Doppler ultrasound allows non-invasive assessment of placentation, while the flow impedance decreases as the pregnancy progresses in normal pregnancies, in those destined to develop preeclampsia the impedance is increased.
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Affiliation(s)
- Tania de Ganzo Suárez
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Nuestra Señora de la Candelaria, Tenerife, Canary Islands, Spain.
| | - Catalina de Paco Matallana
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar, Murcia, Spain; Faculty of Medicine, Universidad de Murcia, Murcia, Spain.
| | - Walter Plasencia
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario de Canarias, Tenerife. Canary Islands, Spain.
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Liu Y, Xie Z, Huang Y, Lu X, Yin F. Uterine arteries pulsatility index by Doppler ultrasound in the prediction of preeclampsia: an updated systematic review and meta-analysis. Arch Gynecol Obstet 2024; 309:427-437. [PMID: 37217697 DOI: 10.1007/s00404-023-07044-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/09/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Preeclampsia is a common pregnancy complication with serious potential risks for maternal and neonatal health. Early prediction of preeclampsia is crucial for timely prevention, surveillance, and treatment to improve maternal and neonatal outcomes. This systematic review aimed to summarize the available evidence on the prediction of preeclampsia based on Doppler ultrasound of uterine arteries at different gestational ages. METHODS A systematic literature search and meta-analysis were conducted to evaluate the sensitivity and specificity of the pulsatility index of Doppler ultrasound of uterine arteries for predicting preeclampsia. The timing of ultrasound scans within and beyond 20 weeks of gestational age was compared to assess its effect on the sensitivity and specificity of the pulsatility index. RESULTS This meta-analysis included 27 studies and 81,673 subjects (3309 preeclampsia patients and 78,364 controls). The pulsatility index had moderate sensitivity (0.586) and high specificity for predicting preeclampsia (0.879) (summary point: sensitivity 0.59; 1-specificity 0.12). Subgroup analysis revealed that ultrasound scans performed within 20 weeks of gestational age did not significantly affect the sensitivity and specificity for predicting preeclampsia. The summary receiver operator characteristic curve showed the pulsatility index's optimal range of sensitivity and specificity. CONCLUSIONS The uterine arteries pulsatility index measured by Doppler ultrasound is useful and effective for predicting preeclampsia and should be implemented in the clinical practice. The timing of ultrasound scans at different gestational age ranges does not significantly affect the sensitivity and specificity.
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Affiliation(s)
- Yan Liu
- B Ultrasonic room, The First People's Hospital of Lianyungang, Lianyungang City, 222006, Jiangsu Province, China
| | - Zilu Xie
- Department of Ultrasound Medicine, Jing men no. 2 People's Hospital, Jingmen City, 448000, Hubei Province, China
| | - Yong Huang
- Department of Ultrasound Medicine, Jiangjin Central Hospital, Chongqing, 402260, China
| | - Xin Lu
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an City, 721000, Shaanxi Province, China
| | - Fengling Yin
- Department of Obstetrics and Gynecology, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, No. 199 Jiefang South Road, Quanshan District, Xuzhou City, 221000, Jiangsu Province, China.
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Xie C, Man Q, Wan X, Ding Y, Li M. The clinical value of combining shear wave elastography, VOCAL technique, and T2* MRI of early gestation placenta to predict pre-eclampsia. J Clin Ultrasound 2024; 52:13-19. [PMID: 37883126 DOI: 10.1002/jcu.23575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To investigate the clinical value of combining shear wave elastography (SWE) with the Volumetric Organ Computer-Aided AnaLysis (VOCAL) technique and T2* magnetic resonance imaging (MRI) to predict pre-eclampsia (PE). METHODS From December 2022 to March 2023, we recruited 31 pregnant women diagnosed with PE at our hospital as the observation group and 85 normal pregnant women as the control group. Differences in placental elasticity, vascularization index (VI), flow index (FI), vascularization flow index (VFI), and T2* MRI perfusion fraction (f) were compared between the two groups. Received operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic value of placental elasticity, VI, FI, VFI, f, and their combination for predicting PE. RESULTS Placental elasticity was higher in the observation group than in the control group, while VI, FI, VFI, and f were lower in the observation group (all p < 0.05). The area under the curve (AUC) for placental elasticity, VI, FI, VFI, f, and their combination for predicting PE were 0.85, 0.77, 0.78, 0.84, 0.65, and 0.94, respectively. The sensitivity was 71%, 55%, 94%, 65%, 55%, and 81%. The specificity was 92%, 91%, 60%, 92%, 79%, and 98%. The combined prediction model had a higher AUC than the individual predictors (p < 0.05). CONCLUSION SWE combined with VOCAL technique and T2* MRI has high value for predicting PE and can provide reference information for clinical diagnosis.
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Affiliation(s)
- Chuanbo Xie
- Ultrasound Medicine Department, Zigong Hospital of Woman and Children Healthcare, Zigong, Sichuan, China
| | - Qin Man
- Prenatal Diagnosis Center, Zigong Hospital of Woman and Children Healthcare, Zigong, Sichuan, China
| | - Xiaomei Wan
- Ultrasound Medicine Department, Zigong Hospital of Woman and Children Healthcare, Zigong, Sichuan, China
| | - Yanyun Ding
- Ultrasound Medicine Department, Zigong Hospital of Woman and Children Healthcare, Zigong, Sichuan, China
| | - Min Li
- Imaging Department, Zigong Hospital of Woman and Children Healthcare, Zigong, Sichuan, China
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Haggai MC. Preeclampsia or nonalcoholic fatty liver disease: is it only overlap which explains the increased liver stiffness, observed in ante- and postpartum elastography? Am J Obstet Gynecol 2024; 230:105-106. [PMID: 37633579 DOI: 10.1016/j.ajog.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Michal Carmiel Haggai
- Liver Unit, Galilee Medical Center, Nahariya 20107000, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
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12
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Ridder A, O'Driscoll J, Khalil A, Thilaganathan B. Routine first-trimester pre-eclampsia screening and maternal left ventricular geometry. Ultrasound Obstet Gynecol 2024; 63:75-80. [PMID: 37448160 DOI: 10.1002/uog.26306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE Pre-eclampsia (PE) is a pregnancy complication associated with premature cardiovascular disease morbidity and mortality (i.e. before 60 years of age or in the first year postpartum). PE is associated with adverse left ventricular (LV) remodeling in the peri- and postpartum periods, an independent risk factor for cardiovascular disease. This study aimed to compare LV geometry by LV mass (LVM) and LVM index (LVMI) between participants with a high vs low screening risk for preterm PE in the first trimester. METHODS This was a prospective cohort study of singleton pregnancies between 11 + 0 and 13 + 6 weeks' gestation that underwent screening for preterm PE as part of their routine first-trimester ultrasound assessment at a tertiary center in London, UK, from February 2019 until March 2020. Screening for preterm PE was performed using the Fetal Medicine Foundation algorithm. Participants with a screening risk of ≥ 1 in 50 for preterm PE were classified as high risk and those with a screening risk of ≤ 1 in 500 were classified as low risk. All participants underwent two-dimensional and M-mode transthoracic echocardiography. RESULTS A total of 128 participants in the first trimester of pregnancy were included in the analysis, with 57 (44.5%) participants screened as low risk and 71 (55.5%) participants as high risk for PE. The risk groups did not vary in maternal age and gestational age at assessment. Maternal body surface area and body mass index were significantly higher in the high-risk group (all P < 0.05). The high-risk participants were significantly more likely to be Afro-Caribbean, nulliparous and have a family history of hypertensive disease in pregnancy as well as other cardiovascular disease (all P < 0.05). In addition, mean arterial blood pressure (P < 0.001), mean heart rate (P < 0.001), median LVM (130.06 (interquartile range, 113.62-150.50) g vs 97.44 (81.68-114.16) g; P < 0.001) and mean LVMI (72.87 ± 12.2 g/m2 vs 57.54 ± 12.72 g/m2 ; P < 0.001) were significantly higher in the high-risk group. Consequently, those in the high-risk group were more likely to have abnormal LV geometry (37.1% vs 7.0%; P < 0.001). CONCLUSIONS Early echocardiographic assessment in participants at high risk of preterm PE may unmask clinically healthy individuals who are at increased risk for future cardiovascular disease. Adverse cardiac remodeling in the first trimester of pregnancy may be an indicator of decreased cardiovascular reserve and subsequent dysfunctional cardiovascular adaptation in pregnancy. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Ridder
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - J O'Driscoll
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Lin X, Lu C, Ma G. The value of TDI combined with myocardial strain parameters in quantitative evaluation of left heart function in parturient with pregnancy-induced hypertension. Sci Rep 2023; 13:21315. [PMID: 38044364 PMCID: PMC10694130 DOI: 10.1038/s41598-023-48599-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023] Open
Abstract
This study aimed to investigate the value of tissue doppler imaging (TDI) and 4D myocardial strain parameters in evaluating left heart function of pregnant women with hypertension and the association between these parameters and relevant factors. Forty-five pregnant women with hypertensive disorder, including 20 with hypertension, 15 with mild preeclampsia, and 10 with severe preeclampsia, were recruited, and their cardiac functions were compared with those of 30 healthy pregnant women as controls. High Left ventricular end-systolic volume (LVESV), Left atrial volume index (LAVI), E/e were observed in hypertensive disorder, while Mitral peak diastolic velocity(E), Early diastolic peak velocity(e), E/A, Left ventricularglobal longitudinal strain (LVGLS), Left ventricularglobal area strain (LVGAS), and Left atrialglobal longitudinal strain (LAGLS) were decreased; for pre-eclampsia, Left ventricular end-systolic diameter (LVESD), Left atrial anteroposterior diameter (LAD-ap), LVESV, LAVI were significantly increased, LVGLS, LAGLS were significantly decreased, Left ventricular end-diastolic diameter (LVEDD), Left ventricular end-diastolic volume (LVEDV), A peak, E/e were increased, while E peak, E/A, e, Left ventricle global radial strain (LVGRS), Left ventricle global circumferential strain (LVGCS), LVGAS were decreased but not significantly; for severe preeclampsia, Left ventricular end diastolic diameter (LVEDD), LVESD, LAD-ap, Left ventricular end-diastolic volume (LVEDV), LVESV, LAVI, A, and E/e were significantly increased, while LVGLS, LVGRS, LVGCS, LVGAS, LAGLS, E peak, E/A, and e were significantly reduced. TDI combined with 4D myocardial strain parameters can detect early changes in cardiac function of hypertensive disorders in pregnancy, with LVGLS, LVGAS, and LAGLS being the most sensitive indicators for early changes. Such findings provide a basis for effective clinical treatment of these symptoms.
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Affiliation(s)
- Xiumei Lin
- Department of Ultrasound, The Affiliated Hospital of Weifang Medical University, 2428 Yuhe Road, Weifang, 261031, Shandong, China
| | - Chengwei Lu
- Liutuan Town Central Health Center, Weifang, Shandong, China
| | - Guifeng Ma
- Department of Ultrasound, The Affiliated Hospital of Weifang Medical University, 2428 Yuhe Road, Weifang, 261031, Shandong, China.
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Yagani S, Jain K, Bhatia N, Singla K, Bagga R, Bahl A. Incidence of Interstitial Alveolar Syndrome on Point-of-Care Lung Ultrasonography in Pre-eclamptic Women With Severe Features: A Prospective Observational Study. Anesth Analg 2023; 137:1158-1166. [PMID: 36727867 DOI: 10.1213/ane.0000000000006367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Lung interstitial edema is a clinically silent pathology that develops before overt pulmonary edema among pre-eclamptic women with severe features. Point-of-care lung ultrasonography (LUS) has been suggested as an accessible bedside tool that may identify lung interstitial edema before developing clinical signs and symptoms. Thus, we planned to use bedside LUS as a diagnostic tool in admitted pre-eclamptic women with severe features, with the aim of identifying alveolar-interstitial fluid, seen as B-lines. Our primary objective was to assess the incidence of interstitial alveolar syndrome on lung ultrasonography. METHODS We conducted a prospective, single-center, observational study on parturients with pre-eclampsia with severe features over a period of 15 months. LUS in 4 intercostal spaces (ICS) was performed on all eligible patients. The number of single or confluent B-lines in each space was recorded by an independent observer. A scoring system was used to grade the lung fluid content based on the number of single and confluent B-lines per ICS, with scores ranging from 0 to 32 (low, 0-10; moderate, 11-20; and high, 21+). The incidence of B-lines at admission and before and after delivery was calculated. In addition, bedside 2D echocardiography was performed to assess left ventricular systolic and diastolic function. Any correlation between presence of B-lines on LUS and blood pressure, clinical symptoms, or echocardiography findings was assessed. RESULTS Seventy patients were enrolled in the study. On LUS, B-lines were seen in 64.3% patients at admission (45/70 vs 25/70 without B-lines; P = .02), 65.7% patients before delivery (46/70 vs 24/70 without B-lines; P = .01), and 58.6% patients 24 hours postpartum (41/70 versus 29/70 without B-lines; P = .15). Nearly all patients (94.3%) exhibited low to moderate severity of pulmonary fluid burden at admission. Echocardiography revealed diastolic dysfunction in 47.1% (n = 33/70) patients with associated B-lines in the majority (n = 32/33). The total B-line score and E/e' ratio among patients with diastolic dysfunction was found to be strongly correlated (r = 0.848; P < .001). All pre-eclamptic women with presence of breathlessness (11/11; 100%) and facial puffiness (16/16; 100%) on admission had B-lines on LUS. CONCLUSIONS We conclude that ultrasonographic pulmonary interstitial syndrome is present in more than half of the women with pre-eclampsia with severe features and correlates with diastolic dysfunction, high blood pressure records, and acute-onset breathlessness.
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Affiliation(s)
| | - Kajal Jain
- From the Departments of Anaesthesia and Intensive Care
| | - Nidhi Bhatia
- From the Departments of Anaesthesia and Intensive Care
| | - Karan Singla
- From the Departments of Anaesthesia and Intensive Care
| | | | - Ajay Bahl
- Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Lau KGY, Kountouris E, Salazar-Rios L, Nicolaides KH, Kametas NA. Prediction of adverse outcome by ophthalmic artery Doppler and angiogenic markers in pregnancies with new onset hypertension. Pregnancy Hypertens 2023; 34:110-115. [PMID: 37925874 DOI: 10.1016/j.preghy.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 07/31/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To compare the ophthalmic artery Doppler peak systolic velocity ratio (OA PSV-ratio) and soluble fms-like tyrosine kinase-1/placental growth factor ratio (sFlt-1/PlGF ratio) in predicting adverse maternal and perinatal outcomes in women presenting with new onset hypertension. STUDY DESIGN Prospective cohort study in a specialist hypertension clinic, within a tertiary referral centre. MAIN OUTCOME MEASURES Comparison between the OA PSV-ratio and sFlt-1/PlGF ratio in predicting delivery within one week from presentation and adverse maternal and perinatal outcomes e.g. severe hypertension, neonatal unit admission, small for gestational age. RESULTS Women who delivered within one week, compared to those who did not, had a higher OA PSV-ratio (0.82 vs 0.71, p < 0.01) and sFlt-1/PlGF ratio (93.3 vs 40.5, p = 0.08). Independent predictors of the OA PSV-ratio included mean arterial pressure and maternal weight and predictors of the sFlt-1/PlGF ratio included diastolic blood pressure and use of antihypertensive medications. Prediction of adverse outcomes with both ratios were similar and only modest e.g. AUROC for predicting delivery within one week for OA PSV-ratio was 0.57 (95% CI 0.47-0.67) and for sFlt-1/PlGF ratio was 0.61 (95% CI 0.52-0.70) (p = 0.53). CONCLUSIONS In women presenting with new onset hypertension, the OA PSV-ratio and sFlt-1/PlGF ratio have similar and modest performance in predicting adverse outcomes.
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Affiliation(s)
- Katherine G Y Lau
- Antenatal Hypertension Clinic, King's College Hospital, London, UK; Harris Birthright, Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | | | | | - Kypros H Nicolaides
- Harris Birthright, Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - Nikos A Kametas
- Antenatal Hypertension Clinic, King's College Hospital, London, UK; Harris Birthright, Research Centre for Fetal Medicine, King's College Hospital, London, UK.
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Vincely VD, Bayer CL. Functional Photoacoustic Imaging for Placental Monitoring: A Mini Review. IEEE Trans Ultrason Ferroelectr Freq Control 2023; 70:1642-1650. [PMID: 37030823 PMCID: PMC10539485 DOI: 10.1109/tuffc.2023.3263361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The placenta, a highly vascularized interface between the mother and fetus, undergoes dramatic anatomical and functional changes during pregnancy. These changes occur both during healthy development and adverse pathologies of pregnancy, such as preeclampsia (PE). Abnormal placental development can lead to life-long health impacts on both the mother and child. Photoacoustic (PA) imaging, extensively developed for preclinical imaging applications in oncology and cardiovascular disease, uses optical energy to generate acoustic waves through thermoelastic expansion of light-absorbing chromophores within tissue. Recently, PA imaging has been used to study preclinical placental anatomy and function. If clinical translation of PA imaging of the placenta is achieved, the impact on maternal-fetal health could be expansive. This perspective highlights the recent progress in PA imaging for placental monitoring and discusses the progress needed for human clinical translation.
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Álvarez SC, Zurita AR, Del Carmen De Ganzo Suárez T, De Luis Escudero JF, Medina NS, Pérez CC, de Basoa CMF, Montesino JLT, Masip MTC, Bello MÁG. Is a sFlt-1/PlGF cutoff of 38 suitable to predict adverse outcomes in pregnancies with abnormal uterine artery Doppler velocimetry in the second trimester? Pregnancy Hypertens 2023; 34:13-18. [PMID: 37778280 DOI: 10.1016/j.preghy.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 07/03/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE To determine the optimal cutoff value for the soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) ratio to predict maternal and fetal adverse events in pregnancies with uterine artery Doppler scans results above the 95th percentile in the late second trimester. STUDY DESIGN Retrospective, observational cohort study on 116 asyntomatic patients with abnormal uterine artery Doppler scans at gestational week 25. The sFlt-1/PlGF ratio was determined within the weeks 25 to 29 of gestation and ROC curve analysis performed. The diagnostic validity of different cutoff values to predict severe maternal and fetal complications, i.e. preeclampsia, fetal growth restriction, placental abruption, and fetal death, was analyzed. MAIN OUTCOME MEASURES An ideal cutoff for sFlt-1/PlGF ratios in pregnancies with abnormal uterine artery Doppler in the second trimester. RESULTS Applying a cutoff point of 38, the area under the ROC curve was 0.89, generally considered low risk in fetal and maternal complication prediction. The sensitivity was 32.1%, the specificity 98.4%, the positive predictive value (PPV) 94.4%, and the negative predictive value (NPV) 63.3%. A cutoff value of 10, leading to the highest Youden index, performed best at detecting overall complications, increasing sensitivity to 69.8% and the NPV to 76.8%. at the cost of a reduced specificity and PPV. CONCLUSIONS In pregnancies with abnormal uterine artery Doppler in the second trimester, an sFlt-1/PlGF cutoff value greater than equal to 38 improves its predictive power for adverse events.
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Affiliation(s)
- Sara Caamiña Álvarez
- Department of Obstetrics and Gynecology, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.
| | - Alicia Rodríguez Zurita
- Department of Obstetrics and Gynecology, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - José Fernando De Luis Escudero
- Department of Obstetrics and Gynecology, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Nieves Sierra Medina
- Department of Obstetrics and Gynecology, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Carolina Chulilla Pérez
- Department of Obstetrics and Gynecology, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Cecilia Martín Fernández de Basoa
- Prenatal Screening and Preeclampsia Unit, Clinical Analysis Service, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - José Luis Trabado Montesino
- Department of Obstetrics and Gynecology, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - María Teresa Concepción Masip
- Prenatal Screening and Preeclampsia Unit, Clinical Analysis Service, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Miguel Ángel García Bello
- Department of Clinical Psychology-Psychobiology and Methodology, University of La Laguna, Santa Cruz de Tenerife, Spain
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Silverman RH, Urs R, Wapner RJ, Valenzuela IA, Coleman HR, Bearelly S. Correlation of Ocular Plane-Wave Doppler With Optical Coherence Tomography Angiography in Preeclampsia. J Ultrasound Med 2023; 42:2815-2824. [PMID: 37605863 PMCID: PMC10840834 DOI: 10.1002/jum.16320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/02/2023] [Accepted: 08/06/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Preeclampsia (PE) is a severe complication of pregnancy characterized by hypertension, proteinuria and compromised fetal blood supply. The eye, like other end organs, is affected by this systemic condition, but unlike in other organs, ocular media transparency allows high-resolution optical visualization of the vascular structure of the retina. Our aim was to assess how ultrasound-determined ocular blood-flow correlates with vascular structure of the retina and choriocapillaris determined by optical coherence tomography angiography (OCTA). METHODS Plane-wave ultrasound and OCTA were performed on both eyes of 40 consecutive subjects consisting of normal controls (n = 11), mild PE (n = 5), severe PE (n = 17) and chronic or gestational hypertension (n = 7) within 72 hours following delivery. From ultrasound, we measured pulsatile flow velocity and resistance indices in the central retinal artery (CRA) and vein, the short posterior ciliary arteries (SPCAs) and choroid. From OCTA, we measured vascular density (VD) in the superficial, deep retina and choriocapillaris. We determined differences in Doppler and OCTA parameters among groups and correlations between ultrasound and OCTA. RESULTS In severe PE, flow resistance was reduced with respect to controls. Flow velocity and resistance in the and SPCA were moderately correlated with VD in the choriocapillaris and peripapillary retina, but VD in PE did not differ significantly from controls. CONCLUSIONS Although OCTA parameters were moderately correlated with Doppler ultrasound, OCTA did not demonstrate significant differences between PE and controls postpartum.
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Affiliation(s)
| | - Raksha Urs
- Department of Ophthalmology, Columbia University Irving Medical Center
| | - Ronald J. Wapner
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center
| | | | - Hanna R. Coleman
- Department of Ophthalmology, Columbia University Irving Medical Center
| | - Srilaxmi Bearelly
- Department of Ophthalmology, Columbia University Irving Medical Center
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Ortner CM, Lucovnik M, Zieleskiewicz L. Will Point-of-Care Ultrasound Be the New Standard of Care in the Management of Women Diagnosed With Preeclampsia? Anesth Analg 2023; 137:1154-1157. [PMID: 37973130 DOI: 10.1213/ane.0000000000006551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- Clemens M Ortner
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Miha Lucovnik
- Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Laurent Zieleskiewicz
- Department of Anesthesiology and Intensive Care, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
- Center for Cardiovascular and Nutrition Research (C2VN), Aix Marseille Université, INSERM, INRA, Marseille, France
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Hussain FN, Rosenbluth E, Feldman KM, Strauss TS, Schneider E, Schmidt-Beauchat E, Rodriguez-Rivas C, Brustman L, Kushner T. Transient elastography and controlled attenuation parameter to evaluate hepatic steatosis and liver stiffness in postpartum patients. J Matern Fetal Neonatal Med 2023; 36:2190838. [PMID: 36935368 DOI: 10.1080/14767058.2023.2190838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 03/21/2023]
Abstract
INTRODUCTION Nonalcoholic fatty liver disease (NAFLD) affects 30% of adults in the United States. Transient elastography (TE) (Fibroscan, Echosens, Paris, France) with controlled attenuation parameter (CAP) is a noninvasive way to evaluate liver steatosis and liver stiffness. The primary objective of this study was to assess prevalence of elevated liver stiffness and steatosis immediately postpartum. Furthermore, we sought to evaluate whether there were differences in rates of metabolic disorders of pregnancy (gestational diabetes mellitus (GDM), gestational hypertension, and preeclampsia) and pre-pregnancy conditions (type 2 diabetes mellitus (DM), chronic hypertension, and obesity) in those with elevated postpartum liver steatosis/liver stiffness. METHODS IRB approved prospective cross-sectional study in which TE and liver function tests were performed 1-2 days postpartum. CAP ≥300 dB/m was classified as significant steatosis. Increased liver stiffness was defined as ≥7 kPa. Prevalence was determined by proportion of individuals undergoing TE/CAP who met criteria. Chi-square analysis was used to compare differences between groups. RESULTS Eighty-nine patients were included: 20 (22%) had GDM, 13 (15%) had gestational hypertension, and 15 (17%) had preeclampsia. Women with kPa ≥7 were more likely to have ALT ≥25, type 2 diabetes, and preeclampsia (p < .05). Pre-gravid BMI, BMI at delivery, and GDM were not associated with increased kPa. Pregravid BMI ≥25 and chronic hypertension were associated with CAP ≥ 300 dB/m (p < .05). GDM, preeclampsia, and gestational hypertension were not associated with CAP ≥300 dB/m. CONCLUSIONS Patients with preeclampsia, type 2 diabetes, and elevated ALT were more likely to have elevated postpartum liver stiffness. Pregravid BMI ≥25 and ≥30 were associated with increased liver steatosis, although did not impact liver stiffness. GDM was not associated with increased liver stiffness or steatosis. Consideration should be made for screening pregnant patients with preeclampsia, type 2 DM and overweight or obese BMI for liver disease in the postpartum period with potential for lifestyle intervention.
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Affiliation(s)
- Farrah Naz Hussain
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Maternal Fetal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emma Rosenbluth
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kristina Martimucci Feldman
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Maternal Fetal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tirtza Spiegel Strauss
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Maternal Fetal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily Schneider
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Maternal Fetal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily Schmidt-Beauchat
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Maternal Fetal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Clara Rodriguez-Rivas
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lois Brustman
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Maternal Fetal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tatyana Kushner
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Maternal Fetal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Erjongmanee S, Phupong V. First trimester SHARP1 and second-trimester uterine artery Doppler to predict preeclampsia. J Matern Fetal Neonatal Med 2023; 36:2253348. [PMID: 37654106 DOI: 10.1080/14767058.2023.2253348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVES The objective of this study was to identify the predictive value of the first-trimester serum SHARP1 level and the second-trimester uterine artery Doppler in singleton pregnancy for the prediction of preeclampsia. METHODS A prospective study including singleton pregnancy presenting at an antenatal clinic, King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University from 2019-March 2020 was conducted. Serum SHARP1 was collected at the gestational age (GA) of 11-13+6 weeks, and transabdominal uterine artery Doppler ultrasound was performed at GA of 18-24 weeks. Serum SHARP1 level and uterine artery pulsatility index (PI) were combined to calculate the predictive value for preeclampsia detection. RESULTS 288 pregnant women were enrolled in the first trimester, but only 249 participants completed the study. Thirteen patients had preeclampsia (5.2%), which three cases (1.2%) had early-onset preeclampsia. The median serum SHARP1 level in the first trimester of pregnant women with preeclampsia was lower than the normal pregnancy group (1392 pg/ml vs. 1941 pg/ml, p = 0.046). The second-trimester uterine artery PI and prevalence of early diastolic notching were higher in the preeclampsia group than in the normal pregnancy group (p = 0.029 and p = 0.001, respectively). When the first-trimester serum SHARP1 level is combined with the second-trimester uterine artery PI, the sensitivity, specificity, PPV, and NPV for preeclampsia prediction were 84.6%, 47.5%, 8.2%, and 98.3%, respectively. CONCLUSIONS This study demonstrated that serum SHARP1 level in the first trimester combined with the uterine artery PI in the second trimester had good sensitivity to predict preeclampsia.
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Affiliation(s)
- Suchada Erjongmanee
- Placental Related Diseases Research Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vorapong Phupong
- Placental Related Diseases Research Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Xiang Q, Wei Y, Feng X, Chen S, Zhao Y. Initial establishment and validation of a predictive model for preeclampsia in twin pregnancies based on maternal characteristics and echocardiographic parameters. Acta Obstet Gynecol Scand 2023; 102:1566-1574. [PMID: 37533238 PMCID: PMC10577616 DOI: 10.1111/aogs.14651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/22/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION The primary objective of this study was to evaluate the association between maternal echocardiographic changes and the occurrence of preeclampsia (PE) in twin pregnancies. Additionally, we established and validated a prediction model for PE in twin pregnancies. MATERIAL AND METHODS The first part of this study was retrospective and included data from 854 twin pregnancies that received antenatal care at Peking University Third Hospital from April 2017 to April 2021 (training cohort). Overall, 159 women who underwent transthoracic echocardiography were included in the analysis. To build a predictive model, cardiac findings were compared between normotensive women and those with PE. The model was then validated in a prospective longitudinal cohort (test cohort) that included 109 women with twin pregnancies who underwent two consecutive transthoracic echocardiography examinations during the second and third trimesters. RESULTS Fifty-four normotensive women and 105 women with PE were analyzed in the retrospective cohort that was used to build the model in which later preeclampsia was associated with higher left ventricular mass index (>61 g/m2 ), interventricular septal thickness (>7.87 mm), left atrial anteroposterior diameter (>33.5 mm), mitral inflow late diastolic velocity (A) (>0.685 m/s), ratio of early diastolic velocity (E) and peak early diastolic myocardial velocity of the lateral mitral annulus (>6.5), and lower peak early diastolic myocardial velocity (<13.1 cm/s). The optimized PE prediction model based on the interventricular septal thickness, left atrial anteroposterior diameter, A, peak early diastolic myocardial velocity and pre-pregnancy bodyweight index was then established (area under the curve [AUC] = 0.840, 95% CI 0.778-0.903, P < 0.001). The model was tested in the prospective cohort including 87 normotensive women and 22 women with PE; the validation test showed that the prediction model in the second (AUC = 0.801) and third (AUC = 0.811) trimesters had high discriminative ability and calibration. CONCLUSIONS Maternal echocardiographic changes in twin pregnancies are associated with the development of preeclampsia. The model constructed, based on the echocardiographic parameters and body mass index, provides novel ideas for the prediction of PE.
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Affiliation(s)
- Qianqian Xiang
- Department of Obstetrics and GynecologyPeking University Third HospitalBeijingChina
- National Clinical Research Center of Obstetrics and GynecologyPeking University Third HospitalBeijingChina
- National Center for Healthcare Quality Management in ObstetricsBeijingChina
| | - Yuan Wei
- Department of Obstetrics and GynecologyPeking University Third HospitalBeijingChina
- National Clinical Research Center of Obstetrics and GynecologyPeking University Third HospitalBeijingChina
- National Center for Healthcare Quality Management in ObstetricsBeijingChina
| | - Xinheng Feng
- Department of CardiologyPeking University Third HospitalBeijingChina
| | - Shaomin Chen
- Department of CardiologyPeking University Third HospitalBeijingChina
| | - Yangyu Zhao
- Department of Obstetrics and GynecologyPeking University Third HospitalBeijingChina
- National Clinical Research Center of Obstetrics and GynecologyPeking University Third HospitalBeijingChina
- National Center for Healthcare Quality Management in ObstetricsBeijingChina
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Su S, Zhong H, Wang X, Huang Y, Su Q. Shear wave elastography combined with two-dimensional ultrasonography for detecting optic nerve sheath: An effective tool for assessing preeclampsia. J Clin Ultrasound 2023; 51:1412-1418. [PMID: 37643987 DOI: 10.1002/jcu.23551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE/OBJECTIVE This study aimed to investigate two-dimensional ultrasound and shear-wave elastography (SWE) in evaluating optic neuropathy in preeclampsia. METHODS Ninety-one singleton pregnant women (51 with preeclampsia [observation group]; 40 without complications [control group]) admitted between January 2022 and April 2022 participated in this study. Optic nerve sheath diameter (ONSD) and optic nerve stiffness measurement (ONSM) were measured using two-dimensional ultrasound and SWE, respectively, and compared between the two groups. Receiver operating characteristic curves were employed to evaluate the performance of ONSD, ONSM, and combination (ONSD + ONSM) for diagnosing preeclampsia. RESULTS The observation (preeclampsia) group ONSD and ONSM were significantly higher than those in the control group (p < 0.05). Optimal diagnostic values for ONSD and ONSM were 4.10 mm and 11.20 kPa, respectively. Areas under the curve for diagnosing preeclampsia were 0.958 (95% confidence interval [CI], 0.926-0.990) for ONSD, 0.939 (95% CI, 0.894-0.985) for ONSM, and 0.982 (95% CI, 0.962-1.000) for ONSD + ONSM. There was no significant difference between ONSD and ONSM in diagnosing preeclampsia (p = 0.436). However, ONSD + ONSM was significantly advantageous over ONSD or ONSM alone in diagnosing preeclampsia (p = 0.033; p = 0.014). CONCLUSIONS Ultrasonic evaluation of the optic nerve can quantitatively assess optic nerve changes in pregnant women with preeclampsia.
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Affiliation(s)
- Shanshan Su
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Huohu Zhong
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Xiaohua Wang
- Department of Anesthesiology, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yanyan Huang
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Reproductive in Medicine, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Qichen Su
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
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Bakre AFK, Morhe ESK, Ofori EK, Donkor E, Okeji MC, Kwadjo S, Cornelius IV, Musa HM, Yakubu C, Ogolodom MP. Sonographic evaluation of maternal uterine artery from 11 - 30 weeks 6 days of gestational age in a Nigerian population: A predictive index for pre-eclampsia and intrauterine growth restriction. Radiography (Lond) 2023; 29:1035-1040. [PMID: 37714067 DOI: 10.1016/j.radi.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/06/2023] [Accepted: 08/30/2023] [Indexed: 09/17/2023]
Abstract
INTRODUCTION Uterine artery (UtA) Doppler sonography is a potential screening tool for pregnancy complications in placental insufficiency. Evaluation of the maternal and fetal vessels in pregnancy ensures accurate identification and prediction of pregnancy complications, such as preeclampsia (PE) and intrauterine growth restrictions (IUGR). The study aims to establish local reference values for UtA in a Nigerian population. METHODS This prospective longitudinal study was conducted among 230 pregnant women. All participants had their left (Lt) and right (RT) UtAs evaluated with a Doppler ultrasound from 11 to 30 weeks 6 days of gestational age. Peak systolic velocity (PSV), End diastolic Velocity (EDV), Systolic/Diastolic ratio (S/D), Pulsatility Index (PI), and Resistivity Index (RI) were measured and documented. RESULTS The mean values of UtA at 11-30 weeks 6 days of GA ranged as follows: 0.79-0.53 (RI), 1.83-0.79 (PI), 5.16-2.23 (S/D), 96.37-98.00 (PSV) & 26.07-44.14 (EDV). While the mean values of the Rt. & Lt. UtA 's ranged as follows: 0.79-0.50 (RI. Rt), 0.78-0.56 (RI. Lt), 2.05-0.80 (PI. Rt), 1.61-0.78 (PI. Lt), 6.03-2.13 (S/D. Rt), 4.29-2.33 (S/D. Lt), 89.79-99.23 (PSV. Rt), 102.76-96.71 (PSV. Lt) & 23.31-45.25 (EDV. Rt), 28.83-43.02 (EDV. Lt) respectively. CONCLUSION UtA Doppler reference range was established in the study population. These reference ranges will be of clinical value in daily obstetric practice. IMPLICATION FOR PRACTICE Obstetricians and sonographers will apply these values for early prediction of pregnancies at risk of complications in the locality.
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Affiliation(s)
- A F K Bakre
- Department of Medical Imaging and Allied Sciences Ho, Ghana.
| | - E S K Morhe
- School of Medicine, The University of Health and Allied Sciences Ho. Ghana
| | - E K Ofori
- Department of Medical Imaging and Allied Sciences Ho, Ghana
| | - E Donkor
- Department of Medical Imaging and Allied Sciences Ho, Ghana
| | - M C Okeji
- Department of Radiography and Radiological Sciences. University of Nigeria, Enugu Campus, Nigeria
| | - S Kwadjo
- Department of Medical Imaging and Allied Sciences Ho, Ghana
| | - I V Cornelius
- Department of Radiography& Radiological Science, Faculty of Allied Medical Sciences College of Medical Sciences. University of Calabar, Calabar, Nigeria
| | - H M Musa
- Esteem Diagnostic Medical Services Limited, Lagos Nigeria
| | - C Yakubu
- Lagos University Teaching Hospital, Idi-Araba (LUTH) Lagos Nigeria
| | - M P Ogolodom
- Department of Radiography, Faculty of Basic Medical Sciences, Rivers State University, Port Harcourt, Nigeria
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Hendem DU, Oluklu D, Beser DM, Yildirim M, Turgut E, Tanacan A, Sahin D. Evaluation of Fetal Cardiac Functions in Preeclampsia: Does the Severity or Proteinuria Affect Fetal Cardiac Functions? J Ultrasound Med 2023; 42:2415-2424. [PMID: 37310112 DOI: 10.1002/jum.16268] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/24/2023] [Accepted: 05/08/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To compare the fetal cardiac functions in preeclampsia and control group, and determine whether the severity or amount of proteinuria affects fetal cardiac functions. METHODS This prospective case-control study involves 48 pregnant women with preeclampsia and 48 healthy women. Pulsed wave Doppler, M-mode, and tissue Doppler imaging were used to measure the cardiac function between the 32 and 34 gestational weeks in each group. All Doppler indices and cardiac function parameters were also compared in subgroups with mild and severe preeclampsia and between subgroups with proteinuria >3 g/24 hours and <3 g/24 hours. RESULTS Decreased diastolic function (decreased E, A, E', and A' values in mitral/tricuspid valves and increased isovolumetric relaxation time) and decreased systolic functions (decreased mitral and tricuspid annular plane systolic excursion and S' value in mitral/tricuspid valves) were detected in the preeclampsia group. Decreased tricuspid E value in severe preeclampsia compared with mild preeclampsia was shown in the present study. CONCLUSION Preeclampsia may cause changes in systolic and diastolic functions in the fetal heart. Subclinical functional changes of these fetuses can be detected earlier and more sensitively with the help of tissue Doppler imaging. Biventricular diastolic functional changes are more prominent in preeclamptic cases with proteinuria >3 g/24 hours.
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Affiliation(s)
- Derya Uyan Hendem
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Deniz Oluklu
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Menekse Beser
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Muradiye Yildirim
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ezgi Turgut
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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Piao SF, Cong J, Li R, Song GH, Li Y, Xu L. Evaluating the characteristics of myocardial work by two-dimensional echocardiography during pre-eclampsia pregnancy. Int J Cardiovasc Imaging 2023; 39:1621-1629. [PMID: 37318675 DOI: 10.1007/s10554-023-02844-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/22/2023] [Indexed: 06/16/2023]
Abstract
This study aimed to analyze the changes in myocardial work (MyW) properties and the correlation of MyW with cardiovascular and clinical indices during the pre-eclampsia (PE) pregnancy. Standard two-dimensional and speckle-tracking echocardiography were sequentially performed on 77 women with PE and 89 with normal pregnancy. Four components of MyW: global myocardial work index (GWI), constructive work (GCW), wasted work (GWW), and work efficiency (GWE) were measured. The significant increased GWI, GCW and GWW were observed, while GWW elevated more than GCW with consequently resulting the decline in GWE among PE cases. Although there was a diverse relationship between MyW components and LV morphological as well as functional indices, MyW parameters were significantly correlated with the grades of arterial hypertension and the incidence of adverse outcome of PE. With the hypertension stages, GWI, GCW and GWW gradually increased but GWE decreased. Meanwhile, the higher GWI and GCW and the lower GWE, the more adverse events occurred in PE group. In conclusion, during the PE pregnancy, GWI, GCW and GWW increase, while GWW elevates more than GCW, which leads to the decrease in GWE. Moreover, the changes in MyW are associated with the hypertension grades and the poor prognosis in PE. The non-invasive manner for MyW assessment provides a new perspective on the myocardial biomechanics, cardio-metabolic conditions and pathophysiological changes in the condition of PE.
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Affiliation(s)
- Shun-Fu Piao
- Department of Obstetrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
| | - Juan Cong
- Department of Ultrasound, Henan Provincial People's Hospital Heart Center, Fuwai Central China Cardiovascular Hospital, Fuwai Central China Hospital of Zhengzhou University, the People's Hospital of Zhengzhou University, Zhengzhou, China.
| | - Rong Li
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Guang-Hui Song
- Clinical laboratory, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Yong Li
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Lin Xu
- Department of Obstetrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
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Kim IK, Shin JE, Kim MJ, Ra H, Baek J. Quantitative analysis of choroidal morphology in preeclampsia during pregnancy according to retinal change. Sci Rep 2023; 13:13171. [PMID: 37580383 PMCID: PMC10425443 DOI: 10.1038/s41598-023-40144-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/05/2023] [Indexed: 08/16/2023] Open
Abstract
We sought to investigate changes in choroidal hemodynamics in preeclampsia according to presence of retinal change by quantitatively assessing choroidal vessels using optical coherence tomography (OCT). This retrospective study included 106 eyes (of 53 patients) with preeclampsia, including 70 eyes without retinal change in patients with preeclampsia (Group A), 22 eyes with retinal change in patients with preeclampsia (Group B), and 14 eyes of normal pregnant women (controls). Subfoveal choroidal thickness (SFCT) was measured on OCT B-scan images, and choroidal vessel densities (CVDs) were calculated using binarized OCT B-scan and en face images. Their values were then correlated with clinical parameters associated with preeclampsia. SFCT was greater in Group B compared to Group A or controls (354.32 ± 65.13 vs. 288 ± 55.68 or 277.21 ± 50.08, both P < 0.001). CVD on B-scan images was greater in Group B compared to Group A or controls (76.4 ± 4.9 vs. 73.7 ± 5.3 or 71.5 ± 5.1; both P ≤ 0.046). CVD on en face images was also greater in Group B compared to Group A or controls (64.7 ± 0.8 vs. 63.6 ± 1.5 or 63.3 ± 1.3; both P ≤ 0.001). SFCT and CVD positively correlated with each other (P ≤ 0.009) and were greater in patients with blurred vision and vaginal bleeding (P ≤ 0.020 for blurred vision and P ≤ 0.024 for vaginal bleeding). SFCT and CVDs were higher in preeclampsia patients with retinal change compared to those without retinal change or controls. Both SFCT and CVD showed association with blurred vision and vaginal bleeding.
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Affiliation(s)
- In Kee Kim
- Department of Ophthalmology, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, #327 Sosa-Ro, Wonmi-Gu, Bucheon, Gyeonggi-Do, 14647, Republic of Korea
| | - Jae Eun Shin
- Department of Obstetrics and Gynecology, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Gyeonggi-Do, Republic of Korea
- College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Jeong Kim
- Department of Obstetrics and Gynecology, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Gyeonggi-Do, Republic of Korea
- College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho Ra
- Department of Ophthalmology, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, #327 Sosa-Ro, Wonmi-Gu, Bucheon, Gyeonggi-Do, 14647, Republic of Korea
- College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jiwon Baek
- Department of Ophthalmology, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, #327 Sosa-Ro, Wonmi-Gu, Bucheon, Gyeonggi-Do, 14647, Republic of Korea.
- College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Siricharoenthai P, Phupong V. The first-trimester serum high-temperature requirement protease A4 and uterine artery Doppler for the prediction of preeclampsia. Sci Rep 2023; 13:8295. [PMID: 37217518 PMCID: PMC10202921 DOI: 10.1038/s41598-023-35243-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023] Open
Abstract
The objective of this study was to investigate the predictive value of serum high-temperature requirement protease A4 (HtrA4) and the first-trimester uterine artery in predicting preeclampsia in singleton pregnancy. Pregnant women at gestational age 11-13+6 weeks, who visited the antenatal clinic at King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University during April 2020-July 2021 were included. Serum HtrA4 levels and transabdominal uterine artery Doppler ultrasound were performed to evaluate this combination for calculating the predictive value of preeclampsia. While 371 singleton pregnant women enrolled in this study, 366 completed it. Thirty-four (9.3%) women had preeclampsia. Mean serum HtrA4 levels were higher in the preeclampsia group than in the control group (9.4 ± 3.9 vs 4.6 ± 2.2 ng/ml, p < 0.001). The mean uterine artery pulsatility index (UtA-PI) was higher in the group with early onset preeclampsia than in the control group (2.3 ± 0.5 vs 1.7 ± 0.5, p = 0.002). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 76.5%, 90.7%, 45.6%, and 97.4%, respectively, when using serum HtrA4 levels above 1.8 multiples of the median for the gestational age as a cut-off value for predicting preeclampsia. A combination of serum HtrA4 levels and UtA-PI > 95th percentile yielded sensitivity, specificity, PPV, and NPV of 79.4%, 86.1%, 37% and 97.6%, respectively, for the prediction of preeclampsia. A combination of serum HtrA4 levels and uterine artery Doppler in the first trimester had good sensitivity for predicting preeclampsia.
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Affiliation(s)
- Patcharaporn Siricharoenthai
- Placental Related Diseases Research Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
| | - Vorapong Phupong
- Placental Related Diseases Research Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.
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Bala R, Budhwar D, Kumar V, Singhal S, Kaushik P, Sharma J. Clinical and ultrasonographic assessment of airway indices among non-pregnant, normotensive pregnant and pre-eclamptic patients: a prospective observational study. Int J Obstet Anesth 2023; 54:103637. [PMID: 36827944 DOI: 10.1016/j.ijoa.2023.103637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/05/2023] [Accepted: 01/25/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Prediction of a difficult airway is of paramount importance for an anaesthesiologist. Various anatomical and physiological factors contribute to a difficult airway in pregnant females, especially those with pre-eclampsia. The aim of the study was to assess airway indices using both routinely used clinical methods and ultrasound. METHODS Fifty-five non-pregnant females, 55 normotensive pregnant females and 55 females with pre-eclampsia were included in this prospective study. Clinical airway assessment was the modified Mallampati score, thyromental distance, hyomental distance, hyomental distance ratio, chest circumference, neck circumference and chest-to-neck circumference ratio. Sonographic assessment included tongue width, tongue volume, anterior neck soft tissue thickness at the level of hyoid, epiglottis and vocal cords, subglottic diameter, ratio of pre-epiglottic space to anterior, posterior and midpoint of anterior and posterior vocal folds. RESULTS Several significant differences were observed between pregnant and non-pregnant females, with additional changes in pre-eclamptic females. These included clinical parameters such as the modified Mallampati score and sonographic measurements of tongue width, tongue volume, subglottic diameter, anterior neck soft tissue thickness at the level of hyoid, epiglottis and vocal cords, and the ratio of pre-epiglottic space to anterior, posterior and midpoint of anterior and posterior vocal folds. CONCLUSION Routinely used clinical methods of airway assessment lack sensitivity and specificity. Ultrasound can visualise anatomical structures in the supraglottic and subglottic views and is encouraging as an airway assessment tool.
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Affiliation(s)
- R Bala
- Department of Anesthesia, Pt. B.D. Sharma PGIMS, Rohtak, Haryana 124001, India
| | - D Budhwar
- Department of Anesthesia, Pt. B.D. Sharma PGIMS, Rohtak, Haryana 124001, India
| | - V Kumar
- Department of Anesthesia, Pt. B.D. Sharma PGIMS, Rohtak, Haryana 124001, India.
| | - S Singhal
- Department of Obstetrics and Gynaecology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana 124001, India
| | - P Kaushik
- Department of Radiology, PT. B.D. Sharma PGIMS, Rohtak, Haryana 124001, India
| | - J Sharma
- Department of Anesthesia, AIIMS Bhatinda, Punjab 151001, India
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Kusuma RA, Nurdiati DS, Al Fattah AN, Danukusumo D, Abdullah S, Sini I. Ophthalmic artery Doppler for pre-eclampsia prediction at the first trimester: a Bayesian survival-time model. J Ultrasound 2023; 26:155-162. [PMID: 35917093 PMCID: PMC10063770 DOI: 10.1007/s40477-022-00697-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To develop a Bayesian survival-time model for the prediction of pre-eclampsia (PE) at the first trimester using a combination of established biomarkers including maternal characteristics and history, mean arterial pressure (MAP), uterine artery Doppler pulsatility index (UtA-PI), and Placental Growth Factor (PlGF)) with an ophthalmic artery Doppler peak ratio (PR) analysis. METHODS The receiving operator curve (ROC) analysis was used to determine the area under the curve (AUC), detection rate (DR), and positive screening cut-off value of the model in predicting the occurrence of early-onset PE (< 34 weeks' gestation) and preterm PE (< 37 weeks' gestation). RESULTS Of the 946 eligible participants, 71 (7.49%) subjects were affected by PE. The incidences of early-onset and preterm PE were 1% and 2.2%, respectively. At a 10% false-positive rate, using the high-risk cut-off 1:49, with AUC 0.981 and 95%CI 0.965-0.998, this model had an 100% of DR in predicting early-onset PE. The DR of this model in predicting preterm PE is 71% when using 1:13 as the cut-off, with AUC 0.919 and 95%CI 0.875-0.963. CONCLUSION Combination ophthalmic artery Doppler PR with the previously established biomarkers could improve the accuracy of early and preterm PE prediction at the first trimester screening.
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Affiliation(s)
- Raden Aditya Kusuma
- Department of Obstetrics and Gynecology, Harapan Kita National Women and Children Hospital, Letjen S. Parman Street, Number Kav 87, Palmerah, West Jakarta, 11420 Jakarta, Indonesia
- Indonesian Prenatal Institute, Jakarta, Indonesia
| | - Detty Siti Nurdiati
- Department of Obstetrics and Gynecology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Adly Nanda Al Fattah
- Indonesian Prenatal Institute, Jakarta, Indonesia
- Kosambi Maternal and Children Center, Jakarta, Indonesia
| | - Didi Danukusumo
- Department of Obstetrics and Gynecology, Harapan Kita National Women and Children Hospital, Letjen S. Parman Street, Number Kav 87, Palmerah, West Jakarta, 11420 Jakarta, Indonesia
| | - Sarini Abdullah
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, Universitas Indonesia, Jakarta, Indonesia
| | - Ivan Sini
- Morula IVF Jakarta Clinic, Jakarta, Indonesia
- IRSI Research and Training Centre, Jakarta, Indonesia
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Kissas G, Hwuang E, Thompson EW, Schwartz N, Detre JA, Witschey WR, Perdikaris P. Feasibility of Vascular Parameter Estimation for Assessing Hypertensive Pregnancy Disorders. J Biomech Eng 2022; 144:121011. [PMID: 36128759 PMCID: PMC9836050 DOI: 10.1115/1.4055679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 08/23/2022] [Indexed: 01/19/2023]
Abstract
Hypertensive pregnancy disorders (HPDs), such as pre-eclampsia, are leading sources of both maternal and fetal morbidity in pregnancy. Noninvasive imaging, such as ultrasound (US) and magnetic resonance imaging (MRI), is an important tool for predicting and monitoring these high risk pregnancies. While imaging can measure hemodynamic parameters, such as uterine artery pulsatility and resistivity indices (PI and RI), the interpretation of such metrics for disease assessment relies on ad hoc standards, which provide limited insight to the physical mechanisms underlying the emergence of hypertensive pregnancy disorders. To provide meaningful interpretation of measured hemodynamic data in patients, advances in computational fluid dynamics can be brought to bear. In this work, we develop a patient-specific computational framework that combines Bayesian inference with a reduced-order fluid dynamics model to infer parameters, such as vascular resistance, compliance, and vessel cross-sectional area, known to be related to the development of hypertension. The proposed framework enables the prediction of hemodynamic quantities of interest, such as pressure and velocity, directly from sparse and noisy MRI measurements. We illustrate the effectiveness of this approach in two systemic arterial network geometries: an aorta with branching carotid artery and a maternal pelvic arterial network. For both cases, the model can reconstruct the provided measurements and infer parameters of interest. In the case of the maternal pelvic arteries, the model can make a distinction between the pregnancies destined to develop hypertension and those that remain normotensive, expressed through the value range of the predicted absolute pressure.
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Affiliation(s)
- Georgios Kissas
- Department of Mechanical Engineering Applied Mechanics,
University of Pennsylvania, Philadelphia, PA
19104
| | - Eileen Hwuang
- Department of Bioengineering, University of
Pennsylvania, Philadelphia, PA 19104
| | | | - Nadav Schwartz
- Maternal Fetal Medicine, Department of Obstetrics and
Gynecology, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, PA 19104
| | - John A. Detre
- Department of Radiology, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, PA
19104; Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, PA
19104
| | - Walter R. Witschey
- Department of Radiology, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, PA
19104
| | - Paris Perdikaris
- Department of Mechanical Engineering and Applied Mechanics,
University of Pennsylvania, Philadelphia, PA
19104
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Rubin JM, Fowlkes JB, Pinter SZ, Treadwell MC, Kripfgans OD. Umbilical Vein Pulse Wave Spectral Analysis: A Possible Method for Placental Assessment Through Evaluation of Maternal and Fetal Flow Components. J Ultrasound Med 2022; 41:2445-2457. [PMID: 34935157 PMCID: PMC10204125 DOI: 10.1002/jum.15927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Placental blood flow analysis is complicated by having both maternal and fetal flow components. Using the Fast Fourier Transform (FFT) of the umbilical venous pulse wave spectra (PW) envelope, we could simultaneously assess maternal/fetal blood flow in the placenta and investigate if normal and intrauterine growth restriction (IUGR)/pre-eclamptic pregnancies could be distinguished. METHODS This retrospective study included normal gestations (N = 11) and gestations with IUGR, pre-eclampsia, or both (N = 13). Umbilical vein PW were acquired and spectral envelopes were identified as a function of time and analyzed by FFT. Base-10 logarithms of the ratios of the maternal/fetal spectral peaks (LRSP) were compared in normal and IUGR/pre-eclamptic populations (two-tailed t-test). Body mass index (BMI), gestational age at scan time, placental position, and weight-normalized umbilical vein blood volume flow (two-tailed t-test, analysis of variance [ANOVA] analysis) were tested. P < .05 was considered significant. RESULTS The LRSP for normal and IUGR/pre-eclamptic pregnancies were 0.141 ± 0.180 and -0.072 ± 0.262 (mean ± standard deviation), respectively (P = .033). We detected differences between normal gestations and combinations of LRSP and weight-normalized umbilical venous blood flows. Placental effects based on LRSPs and blood flow may act synergistically in cases with both pre-eclampsia and IUGR (P = .014). No other significant associations were seen. CONCLUSIONS In this preliminary study, we showed that umbilical venous flow contains markers related to placental maternal/fetal blood flow, which can be used to assess IUGR and pre-eclampsia. When coupled with umbilical cord blood flow, this new marker may potentially identify the primary causes of the two conditions.
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Affiliation(s)
- Jonathan M Rubin
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - J Brian Fowlkes
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Stephen Z Pinter
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Marjorie C Treadwell
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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Liu Y, Hou X, Yu M, Zhou J. Clinical Analysis of Echocardiography and Serum IL-6 and TNF- α Changes in Pregnant Women with Hypertension. Scanning 2022; 2022:9299746. [PMID: 36111265 PMCID: PMC9448602 DOI: 10.1155/2022/9299746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/09/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
In order to explore the changes and clinical significance of serum TNF-α and IL-6 and ET levels in the pathogenesis of hypertensive disorders of pregnancy (HDIP), echocardiography, and serum IL-6 and TNF-α changes in pregnant women with a hypertensive disorder, a clinical analysis method was proposed. A retrospective analysis of 59 pregnant women who visited the obstetrics department of a provincial hospital was divided into 2 groups. The normal control group consisted of 32 normal, uncomplicated pregnant women; the preeclampsia group included 27 patients with systolic blood pressure > 140 mmHg and/or diastolic blood pressure > 90 mmHg who developed proteinuria after 20 weeks of gestation. The levels of TNF-α and IL-6 in serum of normal pregnant women and pregnant women with preeclampsia were detected by enzyme-linked immunosorbent assay (ELISA). The results showed that compared with normal pregnant women, the serum levels of TNF-α and IL-6 in the early pregnant women of Zizhi were significantly increased, and the trend of increased TNF-α and IL-6 levels was related to the severity of complications. With the mean pulmonary arterypressure > 50 mmHg, the serum TNF-α level of pregnant women was significantly higher than that of pregnant women with mean pulmonary arterypressure < 50 mmHg. The analysis found that the serum levels of TNF-α and IL-6 in patients with hypoxic gestational hypertension were significantly increased, and the results of lung tissue immunohistochemistry also showed that serum TNF-α and IL-6 levels in patients with hypoxic gestational hypertension were significantly increased. And serum TNF-α and IL-6 levels were positively correlated with right ventricular systolic blood pressure (RVSP). Conclusion. This study revealed that the elevated levels of serum TNF-α and IL-6 are closely related to the pathophysiological process of gestational hypertension. Serum levels of TNF-α and IL-6 and ET were significantly increased, and the changes of serum TNF-α and IL-6 and ET levels had important clinical value for closely monitoring the severity of the disease and the development of the disease.
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Affiliation(s)
- Ying Liu
- Obstetrical Department VIII, The Fourth Hospital of Shijiazhuang (The Obstetrics and Gynecology Hospital of Hebei Medical University), Shijiazhuang, Hebei 050000, China
| | - Xiaolin Hou
- Prenatal Diagnosis Center, The Fourth Hospital of Shijiazhuang (The Obstetrics and Gynecology Hospital of Hebei Medical University), Shijiazhuang, Hebei 050000, China
| | - Mei Yu
- Prenatal Diagnosis Center, The Fourth Hospital of Shijiazhuang (The Obstetrics and Gynecology Hospital of Hebei Medical University), Shijiazhuang, Hebei 050000, China
| | - Jin Zhou
- Health Care Center, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
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Tsakiridis I, Dagklis T, Athanasiadis A, Dinas K, Sotiriadis A. Impact of Marginal and Velamentous Cord Insertion on Uterine Artery Doppler Indices, Fetal Growth, and Preeclampsia. J Ultrasound Med 2022; 41:2011-2018. [PMID: 34787339 DOI: 10.1002/jum.15883] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/12/2021] [Accepted: 10/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To assess the impact of marginal (MCI) or velamentous (VCI) cord insertion on uterine artery pulsatility index (UtA PI), preeclampsia (PE), and offspring's birthweight (BW). METHODS A retrospective cohort study of singleton pregnancies, undergoing routine anomaly scan at 20+0 -23+6 gestational weeks, was conducted between 2016 and 2020. The effect of placental cord insertion on BW and UtA mean PI z-scores was assessed using the t test or analysis of variance and post-hoc tests; their association with PE was evaluated with the chi-square test. A multivariate logistic regression model was employed to assess the independent association of placental cord insertion and UtA PI z-score with PE, BW <10th, <5th centile, and intrauterine death (IUD), using specific confounders. RESULTS The study population included 4453 pregnancies. Conception via assisted reproductive technology (ART) was associated with increased risk of abnormal cord insertion (odds ratio [OR]: 2.237; 95% confidence interval [CI]: 1.561-3.206; P < .001). Women with MCI/VCI had higher mean UtA PI z-score than those with central/eccentric (0.29 vs 0.01; mean difference: -0.28; 95% CI: -0.399 to -0.165; P < .001). MCI/VCI were associated with higher rates of BW <10th centile (central/eccentric: 16.2% vs MCI: 21.9% vs VCI: 35.7%; P < .001) and BW <5th centile (9.8 vs 15.1 vs 23.2%, respectively; P < .001). No association was identified between MCI/VCI and PE (P = .968). Finally, VCI (aOR: 13.717; 95% CI: 1.576-119.379; P = .018) and increased BMI (aOR: 1.167; 95% CI: 1.071-1.271; P < .001) significantly correlated with IUD. CONCLUSIONS Abnormal cord insertion is more common in ART pregnancies. MCI/VCI are associated with higher mean UtA PI and lower BW centile, but not with increased risk of PE.
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Affiliation(s)
- Ioannis Tsakiridis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Dinas
- Second Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandros Sotiriadis
- Second Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Montaguti E, Di Donna G, Youssef A, Pilu G. Hypertensive disorders and maternal hemodynamic changes in pregnancy: monitoring by USCOM ® device. J Med Ultrason (2001) 2022; 49:405-413. [PMID: 35705778 DOI: 10.1007/s10396-022-01225-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/13/2022] [Indexed: 11/25/2022]
Abstract
Hypertensive disorders are quite common, complicating about 10% of pregnancies, while preeclampsia occurs in 2-8% of cases. The most recognized etiopathogenetic factor for the development of preeclampsia is deficient remodeling of the spiral arteries during trophoblastic invasion. Recently, some authors speculated about the "cardiovascular origin of preeclampsia"; in particular, they postulate that placental dysfunction is not the primum movens of preeclampsia, but it could be caused by a failure of the maternal cardiovascular system to adapt to the pregnancy itself. Moreover, several studies have also shown that developing preeclampsia in pregnancy is associated with an increased risk of cardiovascular disease later in life. Due to the importance of this pathology, it would be crucial to have an effective screening in order to implement a prophylaxis; for this purpose, it could be useful to have an accurate and noninvasive device for the assessment of maternal hemodynamic variables. USCOM® (Ultrasonic Cardiac Output Monitor) is a noninvasive Doppler ultrasonic technology which combines accuracy, reproducibility, noninvasiveness, and a fast learning curve. Maternal hemodynamic evaluation is important in order to monitor the changes that the maternal organism encounters, in particular a reduction in blood pressure, a decrease in total peripheral resistances, and an increase in cardiac output, resulting in a hyperdynamic circle. These hemodynamic modifications are lacking in pregnancies complicated by preeclampsia. For these reasons, it is crucial to have a tool that allows these parameters to be easily evaluated in order to identify those women at higher risk of hypertensive complications and more severe outcomes.
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Affiliation(s)
- Elisa Montaguti
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 13, 40138, Bologna, Italy.
| | - Gaetana Di Donna
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 13, 40138, Bologna, Italy
| | - Aly Youssef
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 13, 40138, Bologna, Italy
| | - Gianluigi Pilu
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 13, 40138, Bologna, Italy
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Gana N, Sarno M, Vieira N, Wright A, Charakida M, Nicolaides KH. Ophthalmic artery Doppler at 11-13 weeks' gestation in prediction of pre-eclampsia. Ultrasound Obstet Gynecol 2022; 59:731-736. [PMID: 35642909 DOI: 10.1002/uog.24914] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To examine the potential value of maternal ophthalmic artery Doppler at 11-13 weeks' gestation, alone and in combination with the established first-trimester biomarkers of pre-eclampsia (PE), including uterine artery pulsatility index (UtA-PI), mean arterial pressure (MAP), serum placental growth factor (PlGF) and serum pregnancy-associated plasma protein-A (PAPP-A), in the prediction of subsequent development of PE. METHODS This was a prospective observational study in women attending for a routine hospital visit at 11 + 0 to 13 + 6 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, ultrasound examination for fetal anatomy and growth, assessment of flow velocity waveforms from the maternal ophthalmic arteries and calculation of the second-to-first peak systolic velocity (PSV) ratio, and measurement of MAP and serum PAPP-A. In addition, a case-control study was carried out for measurement of PlGF in stored samples from cases that developed PE and unaffected controls. The values of PSV ratio, UtA-PI, MAP, PAPP-A and PlGF were converted to multiples of the median or deltas to remove the effects of maternal characteristics and medical history. The competing-risks model was used to estimate the individual patient-specific risk of delivery with PE at < 37 and < 41 + 3 weeks' gestation for various combinations of markers. Performance was assessed using detection rates, at a fixed false-positive rate (FPR), and areas under the receiver-operating-characteristics curves. Modeled performance was also assessed. RESULTS The study population of 4066 pregnancies contained 114 (2.8%) that developed PE, including 25 (0.6%) that delivered with PE at < 37 weeks' gestation. The PSV ratio was significantly increased in PE pregnancies, and the effect of PE depended on gestational age at delivery, with the deviation from normal being greater for early than for late PE. Modeling demonstrated that the addition of PSV ratio improved the detection rate, at a 10% FPR, of preterm PE provided by maternal risk factors alone (from 46.3% to 58.4%), maternal factors, MAP and UtA-PI (65.9% to 70.6%), and maternal factors, MAP, UtA-PI and PlGF (74.6% to 76.7%). The PSV ratio did not improve the prediction of term PE provided by any combination of biomarkers. CONCLUSION Ophthalmic artery PSV ratio at 11-13 weeks' gestation is a potentially useful biomarker for prediction of subsequent development of preterm PE, but larger studies are needed to validate this finding. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N Gana
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - M Sarno
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - N Vieira
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - M Charakida
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Basso A, Youssef L, Nakaki A, Paules C, Miranda J, Casu G, Salazar L, Gratacos E, Eixarch E, Crispi F, Crovetto F. Fetal neurosonography at 31-35 weeks reveals altered cortical development in pre-eclampsia with and without small-for-gestational-age fetus. Ultrasound Obstet Gynecol 2022; 59:737-746. [PMID: 35015926 DOI: 10.1002/uog.24853] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the pattern of fetal cortical development in pregnancies complicated by pre-eclampsia (PE), with and without a small-for-gestational-age (SGA) fetus, compared to uncomplicated pregnancies. METHODS This was a prospective observational study including singleton pregnancies complicated by normotensive SGA (birth weight < 10th centile) (n = 77), PE with an appropriate-for-gestational-age (AGA) fetus (n = 76) or PE with a SGA fetus (n = 67), and 128 uncomplicated pregnancies (normotensive AGA) matched by gestational age at ultrasound. All pregnancies underwent detailed neurosonography, using a transabdominal and transvaginal approach, at 31-35 weeks' gestation to assess the depth of the insula, Sylvian fissure, parieto-occipital sulcus, cingulate sulcus and calcarine sulcus. All measurements were adjusted for biparietal diameter (BPD). In addition, a grading score of cortical development was assigned to each brain structure, ranging from Grade 0 (no development) to Grade 5 (maximum development). Univariate and multiple regression analyses were conducted. RESULTS Similar to findings in previous studies, normotensive pregnancies with a SGA fetus showed significant differences in cortical development compared with controls, with reduced Sylvian fissure depth adjusted for BPD (14.5 ± 2.4 vs 16.6 ± 2.3; P < 0.001) and increased insula depth adjusted for BPD (33.2 ± 2.0 vs 31.8 ± 2.0; P < 0.001). Interestingly, a similar cortical development pattern was observed in PE pregnancies with a SGA fetus and in PE pregnancies with an AGA fetus, manifested by reduced Sylvian fissure depth adjusted for BPD (14.2 ± 2.3 and 14.3 ± 2.3 vs 16.6 ± 2.3; P < 0.001 for both) and greater insula depth adjusted for BPD (33.2 ± 2.1 and 32.8 ± 1.7 vs 31.8 ± 2.0; P < 0.001 for both) compared with controls. No significant differences were observed in parieto-occipital, cingulate sulcus or calcarine sulcus depth across the study groups. The Sylvian fissure was scored as Grade 4 in significantly more (93.2% vs 59.5%) and as Grade 5 in significantly fewer (2.7% vs 37.3%) PE pregnancies with an AGA fetus compared with controls (P < 0.05 for both). These differences remained significant even after statistical adjustment for potential confounders, including ethnicity, low socioeconomic status, nulliparity, chronic hypertension, pregestational diabetes, assisted reproductive technologies, smoking and fetal gender, with the application of Benjamini-Hochberg procedure for multiple comparisons. CONCLUSIONS PE with or without SGA is associated with a differential fetal cortical development pattern which is similar to that described previously in small fetuses. Future research is warranted to elucidate better the mechanism(s) underlying these changes. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Basso
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - L Youssef
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - A Nakaki
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - C Paules
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - J Miranda
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - G Casu
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - L Salazar
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - E Gratacos
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - E Eixarch
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - F Crispi
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - F Crovetto
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
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Lau K, Wright A, Sarno M, Kametas NA, Nicolaides KH. Comparison of ophthalmic artery Doppler with PlGF and sFlt-1/PlGF ratio at 35-37 weeks' gestation in prediction of imminent pre-eclampsia. Ultrasound Obstet Gynecol 2022; 59:606-612. [PMID: 35132725 DOI: 10.1002/uog.24874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/28/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To compare the predictive performance for delivery with pre-eclampsia (PE) at < 3 weeks and at any stage after assessment at 35 + 0 to 36 + 6 weeks' gestation of serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1)/PlGF ratio with that of a competing-risks model utilizing maternal risk factors, mean arterial pressure (MAP) and ophthalmic artery peak systolic velocity (PSV) ratio. METHODS This was a prospective observational study of women attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, ultrasound examination of fetal anatomy and growth, assessment of flow velocity waveforms from the maternal ophthalmic arteries and measurement of MAP, serum PlGF and serum sFlt-1. The performance of screening for delivery with PE at < 3 weeks and at any time after the examination was assessed using areas under the receiver-operating-characteristics curves and detection rates (DRs), at a 10% false-positive rate (FPR). McNemar's test was used to compare DRs, at a 10% FPR, between screening by PlGF concentration, the sFlt-1/PlGF concentration ratio and the competing-risks model utilizing maternal risk factors, MAP and ophthalmic artery PSV ratio. Model-based estimates of screening performance for different methods of screening were also produced. RESULTS The study population of 2338 pregnancies contained 75 (3.2%) cases that developed PE, including 30 (1.3%) that delivered with PE at < 3 weeks from assessment, and 2263 cases unaffected by PE. The DR of PE at < 3 weeks from assessment, at a 10% FPR, of sFlt-1/PlGF ratio (70.0% (95% CI, 50.6-85.3%)) was superior to that of PlGF (50.0% (95% CI, 31.3-68.7%)) or PSV ratio (56.7% (95% CI, 37.4-74.5%)) but inferior to that of the combination of maternal risk factors, MAP multiples of the median (MoM) and PSV ratio delta (96.7% (95% CI, 82.8-99.9%)). Similarly, the DR of PE at any stage after assessment of sFlt-1/PlGF ratio (62.7% (95% CI, 50.7-73.6%)) was superior to that of PlGF (52.0% (95% CI, 40.2-63.7%)) or PSV ratio (41.3% (95% CI, 30.1-53.3%)) but inferior to that of the combination of maternal risk factors, MAP MoM and PSV ratio delta (78.7% (95% CI, 67.7-87.3%)). The empirical results for DR at a 10% FPR were consistent with the modeled results, both for delivery with PE at < 3 weeks and at any time after assessment. CONCLUSION Ophthalmic artery Doppler in combination with maternal risk factors and blood pressure could potentially replace measurement of PlGF and sFlt-1/PlGF ratio in the prediction of imminent PE. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- K Lau
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- Antenatal Hypertension Clinic, King's College Hospital, London, UK
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - M Sarno
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- Department of Obstetrics and Gynecology, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - N A Kametas
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- Antenatal Hypertension Clinic, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Gutierrez Henares J, Gutierrez Henares R, Perry H, Khalil A, Thilaganathan B. Maternal cardiovascular potential and kinetic energy indices in pre-eclamptic and small-for-gestational-age pregnancies. Ultrasound Obstet Gynecol 2022; 59:613-618. [PMID: 34529288 DOI: 10.1002/uog.24768] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Non-invasive assessment of maternal cardiovascular potential and kinetic energy can be used to derive potential-to-kinetic-energy ratio (PKR) and Smith-Madigan inotropic index (SMII), which reflect the balance between blood pressure and blood flow. The aim of this study was to evaluate PKR and SMII in pregnancies complicated by hypertensive disorders of pregnancy (HDP) and/or small-for-gestational-age (SGA) birth. METHODS This was a prospective study that enrolled women with a singleton pregnancy between 5 and 41 weeks' gestation. Women who developed HDP and/or SGA underwent cardiovascular profiling from 20 weeks. To establish reference ranges for PKR and SMII, women without any pre-existing medical problems at the time of booking who did not develop HDP, SGA or other complications during pregnancy were also recruited for cardiovascular profiling. Measurements of cardiovascular parameters were obtained using a non-imaging ultrasound cardiac output monitor. RESULTS A total of 688 women completed the study, including 626 controls, 21 cases with HDP, 19 cases with SGA and 22 cases with HDP and SGA. PKR was significantly elevated in pregnancies with placental dysfunction compared with controls (HDP only, 29.81 ± 9.5; HDP and SGA, 44.33 ± 24.27; SGA only, 31.05 ± 13.14; vs controls, 22.30 ± 7.93; all P < 0.05). SMII values were significantly lower only in cases affected by SGA alone when compared with controls (1.47 ± 0.23 W/m2 vs 1.75 ± 0.40 W/m2 ; P < 0.005). These differences remained statistically significant when the analysis was undertaken using multiples of the median values corrected for gestational age. CONCLUSIONS The findings of this study suggest that point-of-care non-invasive cardiovascular profiling using PKR and SMII may help distinguish between pregnancies affected by specific placental disorders and those exhibiting healthy cardiovascular adaptation to pregnancy. Women with HDP and/or SGA appear to have distinctive PKR and SMII profiles that reflect low kinetic energy in pregnancies with SGA and high potential energy in pregnancies affected by HDP. Finally, non-invasive assessment of potential and kinetic cardiovascular energy demonstrates physiological high-flow and low-resistance adaptation in uncomplicated pregnancies. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J Gutierrez Henares
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - R Gutierrez Henares
- Electronic Engineering, Malaga University, Campus de Teatinos, Málaga, Spain
| | - H Perry
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Whelan AR, Lambert-Messerlian GM, Kloza EM, Palomaki GE. First-trimester screening for pre-eclampsia: estimated vs measured mean arterial pressure. Ultrasound Obstet Gynecol 2022; 59:692-693. [PMID: 34985821 DOI: 10.1002/uog.24850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 06/14/2023]
Affiliation(s)
- A R Whelan
- Department of Obstetrics and Gynecology, Women & Infants Hospital, Providence, RI, USA
| | - G M Lambert-Messerlian
- Department of Obstetrics and Gynecology, Women & Infants Hospital, Providence, RI, USA
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital, Providence, RI, USA
- Department of Pathology and Laboratory Medicine, Alpert Medical School, Brown University, Providence, RI, USA
| | - E M Kloza
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital, Providence, RI, USA
| | - G E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital, Providence, RI, USA
- Department of Pathology and Laboratory Medicine, Alpert Medical School, Brown University, Providence, RI, USA
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Giorgione V, Melchiorre K, O'Driscoll J, Khalil A, Sharma R, Thilaganathan B. Maternal echocardiographic changes in twin pregnancies with and without pre-eclampsia. Ultrasound Obstet Gynecol 2022; 59:619-626. [PMID: 35000243 DOI: 10.1002/uog.24852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/23/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Twin pregnancies are at increased risk of developing hypertensive disorders of pregnancy (HDP) compared with singleton pregnancies, resulting in a substantially higher rate of maternal and perinatal complications. The strain caused by twin pregnancy on the maternal cardiovascular system has not been studied extensively. The objective of this study was to evaluate the changes in maternal cardiac morphology and diastolic function in a cohort of women with normotensive and those with hypertensive twin pregnancies. METHODS This was a cross-sectional study conducted at a tertiary referral university center. Women with singleton or twin pregnancy were enrolled prospectively to undergo maternal transthoracic echocardiography throughout pregnancy. Multiples of the median (MoM) were calculated for each index using a reference group of uncomplicated singleton pregnancies (n = 411) in order to adjust for changes associated with gestational age. Cardiac findings were indexed for body surface area and compared among normotensive twin pregnancies, singleton pregnancies complicated by HDP and twin pregnancies complicated by HDP. RESULTS The total cohort included 119 HDP singleton pregnancies, 52 normotensive twin pregnancies and 24 HDP twin pregnancies. Left ventricular mass index (LVMi) MoM (median (interquartile range)) did not differ between singleton pregnancies complicated by HDP and normotensive twin pregnancies, but was significantly higher in HDP twin compared with HDP singleton pregnancies (1.31 (1.08-1.53) vs 1.17 (0.98-1.35), P = 0.032). Two diastolic indices, left atrial volume index MoM (1.12 (0.66-1.38) vs 0.65 (0.55-0.84), P = 0.003) and E/e' MoM (1.29 (1.09-1.54) vs 0.99 (0.99-1.02), P = 0.036), were significantly higher in HDP twin compared with normotensive twin pregnancies. In normotensive twin compared with HDP singleton pregnancies, stroke volume index (SVi) MoM was higher (1.20 (1.03-1.36) vs 1.00 (0.81-1.15), P = 0.004) and total vascular resistance index (TVRi) was lower (0.73 (0.70-0.86) vs 1.29 (1.04-1.56), P < 0.0001). In contrast, SVi MoM was lower (1.10 (1.02-1.35) vs 1.20 (1.03-1.36), P = 0.018) and TVRi was higher (1.00 (0.88-1.31) vs 0.73 (0.70-0.86), P = 0.029) in HDP twin compared with normotensive twin pregnancies. CONCLUSION The maternal cardiovascular system is altered severely in twin pregnancy with or without HDP. Despite the low total vascular resistance, cardiac changes in normotensive twin pregnancies are comparable to those seen in singleton pregnancies complicated by HDP, reflecting the high cardiovascular demand imposed by twin pregnancy. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- V Giorgione
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - K Melchiorre
- Department of Obstetrics and Gynaecology, Spirito Santo Tertiary Level Hospital of Pescara, Pescara, Italy
| | - J O'Driscoll
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - R Sharma
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Gonser M, Vonzun L, Ochsenbein-Kölble N. Association of ophthalmic artery Doppler and maternal cardiac changes in preclinical stage of pre-eclampsia: hemodynamic relationship. Ultrasound Obstet Gynecol 2022; 59:402-404. [PMID: 34985792 DOI: 10.1002/uog.24845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Affiliation(s)
- M Gonser
- Prenatal Medicine and Sonography, Wiesbaden, Germany
- Department of Obstetrics and Prenatal Medicine, Helios-HSK Kliniken Wiesbaden, Wiesbaden, Germany
| | - L Vonzun
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - N Ochsenbein-Kölble
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
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Odibo AO, Kayisli U, Lu Y, Kayisli O, Schatz F, Odibo L, Chen H, Bronsteen R, Lockwood CJ. Longitudinal assessment of spiral artery and intravillous arteriole blood flow and adverse pregnancy outcome. Ultrasound Obstet Gynecol 2022; 59:350-357. [PMID: 34396628 PMCID: PMC9435956 DOI: 10.1002/uog.23760] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/23/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Superb microvascular imaging (SMI) has been shown to improve visualization of small vessels by suppressing global motions while preserving low-flow components, such as the microvessels in the placenta. We sought to determine if SMI-aided visualization of flow velocity waveforms in the spiral arteries (SA) and intravillous fetal arterioles (IVA) could predict fetal growth restriction (FGR), gestational hypertension (GH) and/or pre-eclampsia (PE). METHODS This was a prospective longitudinal study of singleton pregnancies without fetal anomaly, receiving prenatal care in one of two medical centers over a 5-year period. Using SMI-aided color Doppler, SA and IVA flow velocity was measured at three timepoints: 11 + 0 to 14 + 0, 18 + 0 to 22 + 6 and 28 + 0 to 34 + 6 weeks of gestation. SA and IVA flow velocity waveforms were reported as resistance indices (RI). RI values were analyzed using multilevel modeling; individual regression curves were estimated and combined to obtain the reference intervals for SA-RI and IVA-RI in uncomplicated pregnancies. The primary clinical outcome was FGR and secondary outcomes were PE and GH. FGR was defined as estimated fetal weight < 10th percentile. Student's t-test was used to compare deviation from expected RI between normal and complicated pregnancies. RESULTS Among 540 pregnancies included in the analysis, 18 (3.3%) had FGR, 31 (5.7%) PE and 61 (11.3%) GH. In uncomplicated pregnancies, the SA-RI decreased progressively with advancing gestation, whereas the IVA-RI increased with gestational age. In the third trimester, the mean SA-RI and IVA-RI values were significantly higher in the FGR group compared with pregnancies that did not develop FGR, while the mean SA-RI was significantly higher in PE compared with non-PE pregnancies. There was no significant difference in mean SA-RI or IVA-RI between pregnancies with vs those without GH at any gestational age. When all three adverse outcomes were combined, SA-RI was significantly higher in pregnancies with these outcomes when compared to uncomplicated pregnancies in the third trimester (mean ± SD, 0.29 ± 0.12 vs 0.26 ± 0.12; P = 0.02). In screening for FGR using SA-RI, the areas under the receiver-operating-characteristics curves (AUC) were 0.68, 0.73 and 0.73 in the first, second and third trimesters, respectively. The respective AUCs for IVA-RI were 0.72, 0.72 and 0.73 for each trimester. CONCLUSIONS SA-RI and IVA-RI, measured using SMI technology, were significantly higher in pregnancies at risk for FGR in late gestation. Larger studies are needed to determine if SA and IVA flow are reliable predictors of adverse pregnancy outcome. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A O Odibo
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Morsani College of Medicine, Tampa, FL, USA
| | - U Kayisli
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Morsani College of Medicine, Tampa, FL, USA
| | - Y Lu
- Study Design and Data Analysis Center, College of Public Health, University of South Florida, Tampa, FL, USA
| | - O Kayisli
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Morsani College of Medicine, Tampa, FL, USA
| | - F Schatz
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Morsani College of Medicine, Tampa, FL, USA
| | - L Odibo
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Morsani College of Medicine, Tampa, FL, USA
| | - H Chen
- Study Design and Data Analysis Center, College of Public Health, University of South Florida, Tampa, FL, USA
| | - R Bronsteen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - C J Lockwood
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Morsani College of Medicine, Tampa, FL, USA
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Frei L, Wright A, Syngelaki A, Akolekar R, Nicolaides KH. Estimated fetal weight at mid-gestation in prediction of pre-eclampsia in singleton pregnancy. Ultrasound Obstet Gynecol 2022; 59:335-341. [PMID: 34860455 DOI: 10.1002/uog.24829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To examine the distribution of birth weight according to gestational age in pregnancies complicated by pre-eclampsia (PE) and assess the potential value of sonographic estimated fetal weight (EFW) at mid-gestation as a predictor of PE. METHODS The data for this study were derived from prospective screening for adverse obstetric outcome in 93 911 women with a singleton pregnancy attending for routine pregnancy care at 19 + 0 to 24 + 6 weeks' gestation in two UK maternity hospitals. This visit included recording of maternal demographic characteristics and medical history, sonographic EFW and measurement of mean arterial pressure (MAP) and uterine artery pulsatility index (UtA-PI). The distribution of birth weight of pregnancies with and those without PE was assessed. The competing-risks model was used to estimate the individual, patient-specific risk of delivery with PE at < 32 and < 37 weeks' gestation and at any gestational age. The areas under the receiver-operating-characteristics curves and detection rates (DRs) of delivery with PE, at a 10% false-positive rate (FPR), were assessed for various combinations of maternal risk factors, EFW, MAP and UtA-PI. McNemar's test was used to determine the significance of difference in DR at a 10% FPR between screening with vs without EFW. RESULTS The study population contained 2843 (3.0%) pregnancies that subsequently developed PE, including 148 (0.2%) that delivered with PE at < 32 weeks' gestation and 654 (0.7%) that delivered with PE at < 37 weeks. Birth weight was < 10th percentile in 82% of pregnancies with PE delivering at < 32 weeks' gestation and this decreased to 21% of those with PE delivering at ≥ 37 weeks. In screening for delivery with PE at < 32 and < 37 weeks' gestation, the DR, at a 10% FPR, achieved by maternal risk factors (51% and 46%, respectively) was improved by addition of EFW (69% and 51%, respectively). Similarly, addition of EFW improved the performance of screening by a combination of maternal risk factors and MAP from 72% to 80% for PE < 32 weeks and from 57% to 60% for PE < 37 weeks. EFW did not improve the predictive performance of screening by a combination of maternal risk factors, MAP and UtA-PI. CONCLUSIONS In pregnancies complicated by preterm PE, a high proportion of neonates are small-for-gestational age, and sonographic EFW at mid-gestation can improve the prediction of early and preterm PE provided by maternal risk factors and MAP but not the prediction provided by a combination of maternal risk factors, MAP and UtA-PI. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L Frei
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - A Syngelaki
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - R Akolekar
- Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK
- Institute of Medical Sciences, Canterbury Christ Church University, Chatham, UK
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
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Wang Q, Liu D, Liu G. Value of Ultrasonic Image Features in Diagnosis of Perinatal Outcomes of Severe Preeclampsia on account of Deep Learning Algorithm. Comput Math Methods Med 2022; 2022:4010339. [PMID: 35035520 PMCID: PMC8759876 DOI: 10.1155/2022/4010339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/28/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Abstract
This study is aimed at discussing the value of ultrasonic image features in diagnosis of perinatal outcomes of severe preeclampsia on account of deep learning algorithm. 140 pregnant women singleton with severe preeclampsia were selected as the observation group. At the same time, 140 normal singleton pregnant women were selected as the control group. The hemodynamic indexes were detected by color Doppler ultrasound. The CNN algorithm was used to classify ultrasound images of two groups of pregnant women. The differential scanning calorimetry (DSC), mean pixel accuracy (MPA), and mean intersection of union (MIOU) values of CNN algorithm were 0.9410, 0.9228, and 0.8968, respectively. Accuracy, precision, recall, and F1-score were 93.44%, 95.13%, 95.09%, and 94.87%, respectively. The differences were statistically significant (P < 0.05). Compared with the normal control group, the umbilical artery (UA), uterine artery-systolic/diastolic (UTA-S/D), uterine artery (UTA), and digital video (DV) of pregnant women in the observation group were remarkably increased; the minimum alveolar effective concentration (MCA) of the observation group was obviously lower than the MCA of the control group, and the differences between groups were statistically valid (P < 0.05). Logistic regression analysis showed that UA-S/D, UA-resistance index (UA-RI), UTA-S/D, UTA-pulsatility index (UTA-PI), DV-peak velocity index for veins (DV-PVIV), and MCA-S/D were independent risk factors for the outcome of perinatal children with severe preeclampsia. In the perinatal management of severe epilepsy, the combination of the above blood flow indexes to select the appropriate delivery time had positive significance to improve the pregnancy outcome and reduce the perinatal mortality.
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Affiliation(s)
- Qiang Wang
- Department of Ultrasonography, Yidu Central Hospital of Weifang, Qingzhou, 262500 Shandong, China
| | - Dong Liu
- Department of Ultrasonography, Yidu Central Hospital of Weifang, Qingzhou, 262500 Shandong, China
| | - Guangheng Liu
- Department of Ultrasonography, Weifang People's Hospital, Weifang, 261041 Shandong, China
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Medjedovic E, Kurjak A. The Importance of Doppler Analysis of Uterine Circulation in Pregnancy for a Better Understanding of Preeclampsia. Med Arch 2021; 75:424-430. [PMID: 35169369 PMCID: PMC8802687 DOI: 10.5455/medarh.2021.75.424-430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The etiology of preeclampsia has still not been completely explained. Early identification of women with the risk of developing preeclampsia is a key goal of antenatal care. OBJECTIVE To investigate risk factors for preeclampsia from the history, laboratory and ultrasound findings (Doppler). METHODS Pregnant women with normal Doppler sonography in the second trimester of pregnancy were classified as a control group, while pregnant women with impaired Doppler in the second trimester were considered as the investigated group with presumably increased risk for preeclampsia. A total number of 80 patients was included in the study (40 patients in each group). RESULTS The difference of urea, uric acid and lactate dehydrogenase (LDH) in the serum of the control and investigated group was statistically significant, while the differences were not statistically significant for creatinine, aspartate aminotransferase (AST) and alanine aminotransferase (ALT). The presence of a notch sign during assessment of blood flow in uterine arteries in subjects in the investigated group with the diagnosis of preeclampsia had the specificity of 47.62%, and sensitivity of 88.89%. The positive predictive value of a notch sign during assessment of blood flow in uterine arteries as a marker for diagnosis of preeclampsia in the second trimester of pregnancy was 90.91%, and its negative. Systolic and diastolic blood pressure are dependent variables which are predicting preeclampsia, whilst a notch sign in uterine arteries was designated as an independent variable predicting preeclampsia. CONCLUSION From the laboratory tests the following parameters were considered as the risk factors for preeclampsia: increasing levels of urea, uric acid, and LDH. Notch sign was considered to be a very strong predictor of preeclampsia, especially if present bilaterally. Doppler sonography in the second trimester of pregnancy is a good predictor for early diagnosis of preeclampsia.
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Affiliation(s)
- Edin Medjedovic
- Clinic of Gynecology and Obstetrics, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
- Department of Gynecology, Obstetrics and Reproductive medicine, School of Medicine, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Asim Kurjak
- Department of Gynecology, Obstetrics and Reproductive medicine, School of Medicine, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
- Department of Obstetrics and Gynecology, Medical School University of Zagreb, Zagreb, Croatia
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Li R, Sun F, Piao S, He X, Li R, Xu L, Song G, Cong J. Left Atrial Strain and Compliance Correlate with Diastolic Dysfunction Grades and Complications during Pre-eclampsia: A Speckle-Tracking Echocardiography Study. Ultrasound Med Biol 2021; 47:3411-3419. [PMID: 34456083 DOI: 10.1016/j.ultrasmedbio.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/09/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
This study aimed to investigate left atrium (LA) strain components in the assessment of cardiac function and its clinical correlates in pre-eclampsia (PE). With the use of speckle tracking echocardiography, phasic LA strain and (LASr)/(E/e'), the surrogate of LA compliance, were compared between healthy pregnant women (n = 70) and those with PE (n = 146) and among different diastolic dysfunction (DD) grades in PE. Receiver operating characteristic curves and logistic regression analysis were used to identify the role of strain components in distinguishing DD grades and predicting cardiac complications. LA reservoir strain, conduit strain and LA compliance reduced significantly in PE (p < 0.01). LASr/(E/e') gradually decreased with worsening DD and LASr/(E/e') <3.40 was the independent risk factor for cardiac events in PE (p < 0.01). This study observed significantly decreased LA strain and compliance in PE. Notably, LA compliance decreased progressively with the severity of DD, and LASr/(E/e') <3.40 is the independent risk factor for cardiac complications during PE pregnancy.
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Affiliation(s)
- Rui Li
- Health Management Center, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Fei Sun
- Department of Echocardiography, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Shunfu Piao
- Department of Obstetrics, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Xiangqin He
- Department of Echocardiography, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Rong Li
- Department of Echocardiography, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Lin Xu
- Department of Obstetrics, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Guanghui Song
- Department of Clinical Laboratory, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Juan Cong
- Department of Geriatrics, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China; Systems Biology and Medicine Center for Complex Diseases, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
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Assu SM, Bhatia N, Jain K, Gainder S, Sikka P, Aditya AS. Sonographic Optic Nerve Sheath Diameter Following Seizure Prophylaxis in Pre-Eclamptic Parturients With Severe Features: A Prospective, Observational Study. J Ultrasound Med 2021; 40:2451-2457. [PMID: 33448448 DOI: 10.1002/jum.15632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Neurological manifestations, including raised intracranial pressures, are a hallmark of worsening pre-eclampsia. Invasive methods for measuring intracranial pressure, though a gold standard, are not always a viable option. Maternal ocular sonography is a promising bedside tool, which serves as a noninvasive, cost-effective means for measuring optic nerve sheath diameter (ONSD), a surrogate marker of raised intracranial pressures. We studied the ultrasonographically measured ONSD in severely pre-eclamptic women, and the effect of magnesium sulfate therapy on its values. METHODS Thirty severely pre-eclamptic women at ≥28 weeks gestation were included. We recorded baseline ONSD values, serum magnesium levels, neurological symptoms, vitals, and repeated them at 4 and 12 hours following magnesium sulfate therapy, and then at 24 hours postpartum. An ONSD value >5.8 mm was suggestive of raised intracranial pressure. Primary outcome measure was to evaluate changes in ultrasonographically measured ONSD following seizure prophylaxis with magnesium sulfate. RESULTS Women, 73.3%, had baseline ONSD >5.8 mm, with mean diameter being significantly high (6.02 ± 0.77 mm). There was a statistically nonsignificant decline in mean ONSD values at 4 and 12 hours, as well as at 24 hours postpartum. Patients with neurological symptoms declined significantly (from 70 to 10%; p value <.001) following magnesium sulfate therapy. CONCLUSIONS Majority of severely pre-eclamptic parturients had high ONSD value suggestive of raised intracranial pressures, which persisted in the postpartum period and was unaffected by magnesium sulfate therapy. Ultrasound can thus serve as a point-of-care, cost-effective, easily available bedside tool for indirectly measuring intracranial pressures in this high-risk population.
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Affiliation(s)
- Shiraz Mohammed Assu
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
- Department of Critical Care, Max Hospital, Mohali, India
| | - Nidhi Bhatia
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kajal Jain
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shalini Gainder
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pooja Sikka
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashish Singh Aditya
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Hwuang E, Wu PH, Rodriguez-Soto A, Langham M, Wehrli FW, Vidorreta M, Moon B, Kochar K, Parameshwaran S, Koelper N, Tisdall MD, Detre JA, Witschey W, Schwartz N. Cross-modality and in-vivo validation of 4D flow MRI evaluation of uterine artery blood flow in human pregnancy. Ultrasound Obstet Gynecol 2021; 58:722-731. [PMID: 32898295 PMCID: PMC8072518 DOI: 10.1002/uog.23112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/06/2020] [Accepted: 08/23/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Clinical assessment of uterine artery (UtA) hemodynamics is currently limited to Doppler ultrasound (US) velocimetry. We have demonstrated previously the feasibility of applying four-dimensional (4D) flow magnetic resonance imaging (MRI) to evaluate UtA hemodynamics during pregnancy, allowing flow quantification of the entire course of the vessel. In this study, we sought to further validate the physiological relevance of 4D flow MRI measurement of UtA blood flow by exploring its association with pregnancy outcome relative to US-based metrics. METHODS Recruited into this prospective, cross-sectional study were 87 women with a singleton pregnancy who underwent 4D flow MRI between May 2016 and April 2019 to measure the UtA pulsatility index (MRI-PI) and blood flow rate (MRI-flow, in mL/min). UtA-PI was also measured using US (US-PI). The primary outcome was a composite (COMP) of pre-eclampsia (PE) and/or small-for-gestational-age (SGA) neonate, and secondary outcomes were PE and SGA neonate individually. We assessed the ability of MRI-flow, MRI-PI and US-PI to distinguish between outcomes, and evaluated whether MRI-flow changed as gestation progressed. RESULTS Following 4D flow postprocessing and exclusions from the analysis, 74 women had 4D flow MRI data analyzed for both UtAs. Of these, 18 developed a COMP outcome: three developed PE only, 11 had a SGA neonate only and four had both. A comparison of the COMP group vs the no-COMP group found no differences in maternal age, body mass index, nulliparity, gravidity or race. For 66 of the 74 subjects, US data were also available. In these subjects, both median MRI-PI (0.95 vs 0.70; P < 0.01) and median US-PI (0.95 vs 0.73; P < 0.01) were significantly increased in subjects in the COMP group compared with those in the no-COMP group. The UtA blood-flow rate, as measured by MRI, did not increase significantly from the second to the third trimester (median flow (interquartile range (IQR)), 543 (419-698) vs 575 (440-746) mL/min; P = 0.77), but it was significantly lower overall in the COMP compared with the no-COMP group (median flow (IQR), 486 (366-598) vs 624 (457-749) mL/min; P = 0.04). The areas under the receiver-operating-characteristics curves for MRI-flow, MRI-PI and US-PI in predicting COMP were not significantly different (0.694, 0.737 and 0.731, respectively; P = 0.87). CONCLUSIONS 4D flow MRI can yield physiological measures of UtA blood-flow rate and PI that are associated with adverse pregnancy outcome. This may open up new avenues in the future to expand the potential of this technique as a robust tool with which to evaluate UtA hemodynamics in pregnancy. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Hwuang
- Department of Biomedical Engineering, University of Pennsylvania, Philadelphia, PA, USA
| | - P H Wu
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - A Rodriguez-Soto
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - M Langham
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - F W Wehrli
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - B Moon
- Department of Biomedical Engineering, University of Pennsylvania, Philadelphia, PA, USA
| | - K Kochar
- Drexel School of Medicine, Philadelphia, PA, USA
| | - S Parameshwaran
- Maternal and Child Health Research Center, University of Pennsylvania, Philadelphia, PA, USA
| | - N Koelper
- Center for Research on Reproduction and Women's Health, University of Pennsylvania, Philadelphia, PA, USA
| | - M D Tisdall
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - J A Detre
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - W Witschey
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - N Schwartz
- Maternal and Child Health Research Center, University of Pennsylvania, Philadelphia, PA, USA
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Abstract
Ultrasound imaging is a vital tool for exploring in vivo the placental function which is essential to understand pathological phenomena such as preeclampsia or intrauterine growth restriction. As technology advances including ready availability of three-dimensional (3D) probes and novel software, new markers of placental function become possible. The objective of this review was to provide an overview of the new ultrasound markers of placental function with a focus on the potential clinical application of three-dimensional power Doppler (3DPD). A broad-free text literature search was undertaken based on human placental studies and sixty full-text studies were included in this review. Three-dimensional power Doppler is a promising technique to predict preeclampsia in the first trimester. However, the influence of external factors such as body mass index, parameter standardisation and machine settings still need to be addressed. Contrast-enhanced ultrasound is currently reserved for research, because the required injected contrast mediums are not currently approved for use in pregnancy, although the safety data is reassuring.
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Affiliation(s)
- C Bertholdt
- Université de Lorraine, CHRU-Nancy, Pôle de Gynécologie-Obstétrique, F-54000 Nancy, France; Université de Lorraine, Inserm, IADI, F-54000 Nancy, France.
| | - M Dap
- Université de Lorraine, CHRU-Nancy, Pôle de Gynécologie-Obstétrique, F-54000 Nancy, France
| | - M Beaumont
- CHRU-Nancy, Inserm, Université de Lorraine, CIC, Innovation Technologique, F-54000 Nancy, France
| | - J Duan
- Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Hubei, 430071, China; Gynecology and Obstetrical Service, Zhongnan Hospital of Wuhan University, Hubei, 430071, China
| | - O Morel
- Université de Lorraine, CHRU-Nancy, Pôle de Gynécologie-Obstétrique, F-54000 Nancy, France; Université de Lorraine, Inserm, IADI, F-54000 Nancy, France
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