4 years ago

De-Novo Abnormal Uteroplacental Circulation in the Third Trimester: Pregnancy Outcome and Pathological Implications

Asma Khalil, Julia Binder, Silvia Carta, Caitriona Monaghan, Baskaran Thilaganathan
Objective Hypertensive disorders of pregnancy (HDP) are associated with impaired placentation, as evidenced by abnormal uterine artery (UtA) Doppler. UtA mean pulsatility index (PI) shows a progressive decline with gestational age (GA). However, previous studies have reported that a proportion of pregnancies demonstrate worsening of the UtA Doppler. The aim of this study was to investigate the incidence of HDP according to the change in the UtA mean PI between the second and third trimester. Methods This cohort study included singleton pregnancies undergoing longitudinal UtA Doppler assessment in the second and third trimester. All the parameters were converted into centiles and multiples of the median (MoM) adjusting for GA. The study cohort was divided into 2 groups according to the change in the UtA Doppler between the second and third trimesters (decline or no change vs increase in the mean PI MoM). HDP included women who developed pre-eclampsia and gestational hypertension. 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 worsening of the UtA mean PI compared to those without (7.9% vs 5.8%; p < 0.002). Logistic regression analysis demonstrated that both the second trimester UtA PI MoM (OR 8.12, 95% CI 5.07-13.00; p < 0.001) and the difference between the 2 trimesters (OR 3.41, 95% CI 2.434-4.768; p < 0.001) were significant independent predictors for the development of HDP. Conclusion Worsening of the UtA Doppler, independent of the value recorded in the second trimester, is associated with HDP.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/uog.17564

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