De-novo abnormal uteroplacental circulation in third trimester: pregnancy outcome and pathological implications

J Binder; C Monaghan; B Thilaganathan; S Carta; A Khalil

doi:10.1002/uog.17564

De-novo abnormal uteroplacental circulation in third trimester: pregnancy outcome and pathological implications

Ultrasound Obstet Gynecol. 2018 Jul;52(1):60-65. doi: 10.1002/uog.17564. Epub 2018 Jun 11.

Authors

J Binder^{1

2}, C Monaghan¹, B Thilaganathan^{1

3}, S Carta¹, A Khalil^{1

3}

Affiliations

¹ Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK.
² Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Vienna, Austria.
³ Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.

PMID: 28640514
DOI: 10.1002/uog.17564

Abstract

Objective: Hypertensive disorders of pregnancy (HDP) are associated with impaired placentation, as evidenced by abnormal uterine artery (UtA) Doppler. In normal pregnancy, mean UtA pulsatility index (PI) shows a progressive decline with gestational age (GA). However, previous studies have reported that a proportion of pregnancies demonstrate worsening UtA Doppler in later pregnancy. The aim of this study was to investigate the incidence of HDP according to the change in mean UtA-PI between the second and third trimesters.

Methods: This was a retrospective cohort study of singleton pregnancies between March 1997 and March 2016 that underwent longitudinal UtA Doppler assessment in the second and third trimesters. All parameters were converted into centiles or multiples of the median (MoM), adjusting for GA. The study cohort was divided into two groups, according to change in mean UtA-PI between the second and third trimesters (those with a decrease or no change and those with an increase). HDP included women who developed pre-eclampsia and/or gestational hypertension. Logistic regression analysis was used to adjust for potential confounders.

Results: The analysis included 5887 pregnancies. The incidence of HDP was significantly higher in the group with increasing mean UtA-PI compared with those without (7.9% vs 5.8%; P = 0.002). Logistic regression analysis demonstrated that both third-trimester UtA-PI MoM (odds ratio (OR), 7.35; 95% CI, 4.66-11.6; P < 0.001) and stable or decrease in UtA-PI MoM between the second and third trimesters (OR, 0.43; 95% CI, 0.31-0.60; P < 0.001) were significant independent predictors for the development of HDP.

Keywords: de-novo abnormal uterine artery Doppler; pregnancy hypertension; uterine artery Doppler; uterine artery Doppler worsening; uteroplacental circulation.

MeSH terms

Adult
Female
Fetal Distress / diagnostic imaging*
Humans
Hypertension, Pregnancy-Induced / diagnostic imaging
Hypertension, Pregnancy-Induced / physiopathology*
Placental Circulation / physiology*
Placental Insufficiency / diagnostic imaging
Placental Insufficiency / physiopathology*
Placentation / physiology*
Pre-Eclampsia / diagnostic imaging
Pre-Eclampsia / physiopathology*
Predictive Value of Tests
Pregnancy
Pregnancy Outcome
Pregnancy Trimester, Third
Pulsatile Flow / physiology
Retrospective Studies
Ultrasonography, Doppler
Ultrasonography, Prenatal
Uterine Artery / diagnostic imaging