Araştırma Makalesi
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‘18-24 HAFTA UTERİN ARTER DOPPLER ULTRASONOGRAFİSİNDE PULSATİLİTE İNDEKSİNİN VE DİYASTOLİK ÇENTİK VARLIĞININ PREEKLAMPSİ ÖNGÖRÜSÜNDEKİ ÖNEMİ’

Yıl 2021, Cilt: 18 Sayı: 3, 933 - 937, 25.09.2021
https://doi.org/10.38136/jgon.941795

Öz

Amaç: İkinci trimester uterin arter pulsatilite indeksi (Pİ) değerinin ve diastolik çentik varlığının primigravid, düşük riskli gebe hastalarda preeklampsi öngörüsündeki önemini saptamaktır.
Gerekçeler ve Yöntem: Primipar, tekil, 18-24 haftalar arası olan ve bilinen sistemik hastalığı, fetal yapısal kromozomal anormalliği, uterin anomalisi olmayan 244 gebe hasta çalışmaya dâhil edildi. Doppler ölçümleri transabdominal olarak yapıldı. Uterin arter Pİ değeri ve diastolik çentik varlığı not edildi. Daha önce normotansif olan bir gebede, 20. gebelik haftası ve sonrasında yeni başlayan hipertansiyon (> 140/90 mmHg) ve proteinüri (24 saatlik idrarda 300 mg ve üzeri), proteinüri yokluğunda hipertansiyona eşlik eden sistemik bulguların bulunması preeklampsi olarak değerlendirildi. 32 gebelik haftası öncesi preeklampsi gelişmesi erken preeklampsi olarak tanımlandı.
Bulgular: Preeklampsi gözlenen 15 gebenin ortalama Pİ değeri (1,51), preeklampsi gözlenmeyen gebelerinkinden (0,89) anlamlı olarak yüksek bulundu (p<0,001). Preeklampsi için duyarlılığı ve özgüllüğü en yüksek olan eşik değer Pİ 1,13 olarak hesaplandı. Çentik gözlenen gebelerde preeklampsi ve erken preeklampsi gelişme oranı, çentik negatif olan gebelere göre anlamlı olarak artmıştı (p<0,001). Preeklampsi gözlenen 15 gebenin 13’ünde iki taraflı, ikisinde ise tek taraflı çentik pozitifti.
Sonuç: Çentik pozitifliği ile preeklampsi riski artmakla birlikte, tek taraflı çentik pozitifliği olan gebelerin sadece ikisinde preeklampsi gelişmiş olması ortalama Pİ’nin eşik değer olan 1,13’ten düşük olması ile ilişkili olabileceğini düşündürmüştür. İki taraflı çentik pozitifliği olan gebelerde ise ortalama Pİ değerinin 1,13 eşik değerinden yüksek olması, bu grup hastalarda preeklampsinin daha sık gözlenmesini açıklamaktadır. Sonuç olarak, iki taraflı çentik pozitifliği olan gebelerin Pİ değeri 1,13’ten yüksekse, preeklampsi açısından çok yakından takip edilmesi gerekmektedir.

Kaynakça

  • 1. Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol 2009;33(03):130–137.
  • 2. Rolnik DL, Wright D, Poon LC, O'Gorman N, Syngelaki A, de Paco Matallana C, et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med. 2017;377(7):613-22.
  • 3. Wallace AE,Whitley GS, Thilaganathan B, Cartwright JE. Decidual natural killer cell receptor expression is altered in pregnancies with impaired vascular remodeling and a higher risk of preeclampsia. J Leukoc Biol 2015;97(01):79–86.
  • 4. Brosens IA, Robertson WB, Dixon HG. The role of the spiral arteries in the pathogenesis of preeclampsia. Obstet Gynecol Annu 1972;1:177–191
  • 5. Cnossen, Jeltsje S et al. “Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis.” CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne vol. 2008; 178(6): 701-11.
  • 6. Gallo, Dahiana Marcela, et al. "Prediction of preeclampsia by uterine artery Doppler at 20-24 weeks' gestation." Fetal diagnosis and therapy 2013; 34.(4): 241-247.
  • 7. Adefisan, Adeyemi S., et al. "Role of second‐trimester uterine artery Doppler indices in the prediction of adverse pregnancy outcomes in a low‐risk population." International Journal of Gynecology & Obstetrics 2020; 151(2): 209-213.
  • 8. Papageorghiou, A. T., et al. "Second-trimester uterine artery Doppler screening in unselected populations: a review." The Journal of Maternal-Fetal & Neonatal Medicine 2002; 12(2): 78-88.
  • 9. Oloyede OA, Iketubosin F. Uterine artery Doppler study in second trimester of pregnancy. Pan African Med J 2013;15(1).
  • 10. Afrakhteh M, Moeini A, Taheri MS, Haghighatkhah HR, Fakhri M, Masoom N. Uterine Doppler velocimetry of the uterine arteries in the second and third trimesters for the prediction of gestational outcome. Rev Bras Ginecol Obstet 2014;36(1):35–39.
  • 11. Schwarze A, Nelles I, Krapp M, et al. Doppler ultrasound of the uterine artery in the prediction of severe complications during low-risk pregnancies. Archi Gynecol Obstet 2005;271(1):46–52.
  • 12. Bhattacharyya SK, Kundu S, Kabiraj SP. Prediction of preeclampsia by midtrimester uterine artery Doppler velocimetry in high-risk and low-risk women. J Obstet Gynecol India 2012;62(3):297–300.
  • 13. Espinoza J, Romero R, Nien JK, et al. Identification of patients at risk for early onset and/or severe preeclampsia with the use of uterine artery Doppler velocimetry and placental growth factor. Am J Obstet Gynecol 2007;196(4):326–e1.
  • 14. Espinoza J, Kusanovic JP, Bahado-Singh R, Gervasi MT, Romero R, Lee W, et. al. Should bilateral uterine artery notching be used in the risk assessment for preeclampsia, small-for-gestational-age, and gestational hypertension. J Ultrasound Med 2010; 29: 1103-1115,
  • 15. Brodszki J, Länne T, Stale H akan, Batra S and Maršál K: Altered vascular function in healthy normotensive pregnant women with bilateral uterine artery notches. BJOG 2002; 109: 546-552.
  • 16. Ratiu, Dominik, et al. "Doppler indices and notching assessment of uterine artery between the 19th and 22nd week of pregnancy in the prediction of pregnancy outcome." in vivo 2019; 33(6): 2199-2204.
  • 17. Cnossen, Jeltsje S., et al. "Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis." Cmaj 2008; 178(6): 701-711.
  • 18. Lesmes C, Gallo DM, Saiid Y, Poon LC and Nicolaides KH: Prediction of small-for-gestational-age neonates: screening by uterine artery Doppler and mean arterial pressure at 19-24 weeks. Ultrasound Obstet Gynecol 2015; 46: 332-340.
  • 19. Poon, Leona CY, et al. "Second-trimester uterine artery Doppler in the prediction of stillbirths." Fetal diagnosis and therapy 2013; 33(1): 28-35.
  • 20. Giordano R, Cacciatore A, Romano M, La Rosa B, Fonti I, Vigna R. Uterine artery Doppler flow studies in obstetric practice. J Prenat Med 2010;4(4):59.

THE UTILITY OF PULSATILITY INDEX AND DIASTOLIC NOTCH PRESENCE IN UTERINE ARTERY DOPPLER ULTRASOUND BETWEEN 18-24 WEEKS FOR PREEKLAMPSIA PREDICTION’

Yıl 2021, Cilt: 18 Sayı: 3, 933 - 937, 25.09.2021
https://doi.org/10.38136/jgon.941795

Öz

Aim: To determine second-trimester uterine artery pulsatility index (UA-PI) values and diastolic notch (DN) presences in primigravid, low-risk pregnant women for preeclampsia (PE) prediction.
Matherials and Methods: We studied prospectively primigravid, pregnant women between 18 and 24 weeks of gestation who were admitted for routine prenatal care. An ultrasound examination that included measurements of the UA-PI and DN presence was performed and pregnancy outcomes were evaluated.
Results: In total 244 primigravid pregnant women were included this study, and 15 (6,1 %) developed PE. When Preeclampsia positive (PEP) group and the preeclampsia negative (PEN) group compared, there was no difference in demographic data. PEP group mean UA-PI value was significantly higher (p< 0,01) when mean time of the delivery week (p< 0,01) and fetal birth weight (p< 0,01) were significantly lower than PEN group.
DN was negative (NN) in 163 (66,8 %) pregnant women, and found positive (NP) in 81 (33,2%) pregnant women. NP group had higher PE rates compared to NN group. Bilateral notch positivity increases both PE and early PE rates compared to notch negativity and unilateral notch positivity. The most sensitive and specific value of UA-PI for PE prediction was found 1,13.
Conclusion: Uterine artery Doppler is a non-invasive and simple tool to identify high-risk pregnancies and may improve patient-specific practice. Especially pregnant women with a bilateral uterine notch accompanying with abnormal UA-PI values resulted a higher prevalence to develop these severe adverse outcomes. Closer monitoring may help to reduce both maternal and fetal morbidity and mortality in high-risk groups.

Kaynakça

  • 1. Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol 2009;33(03):130–137.
  • 2. Rolnik DL, Wright D, Poon LC, O'Gorman N, Syngelaki A, de Paco Matallana C, et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med. 2017;377(7):613-22.
  • 3. Wallace AE,Whitley GS, Thilaganathan B, Cartwright JE. Decidual natural killer cell receptor expression is altered in pregnancies with impaired vascular remodeling and a higher risk of preeclampsia. J Leukoc Biol 2015;97(01):79–86.
  • 4. Brosens IA, Robertson WB, Dixon HG. The role of the spiral arteries in the pathogenesis of preeclampsia. Obstet Gynecol Annu 1972;1:177–191
  • 5. Cnossen, Jeltsje S et al. “Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis.” CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne vol. 2008; 178(6): 701-11.
  • 6. Gallo, Dahiana Marcela, et al. "Prediction of preeclampsia by uterine artery Doppler at 20-24 weeks' gestation." Fetal diagnosis and therapy 2013; 34.(4): 241-247.
  • 7. Adefisan, Adeyemi S., et al. "Role of second‐trimester uterine artery Doppler indices in the prediction of adverse pregnancy outcomes in a low‐risk population." International Journal of Gynecology & Obstetrics 2020; 151(2): 209-213.
  • 8. Papageorghiou, A. T., et al. "Second-trimester uterine artery Doppler screening in unselected populations: a review." The Journal of Maternal-Fetal & Neonatal Medicine 2002; 12(2): 78-88.
  • 9. Oloyede OA, Iketubosin F. Uterine artery Doppler study in second trimester of pregnancy. Pan African Med J 2013;15(1).
  • 10. Afrakhteh M, Moeini A, Taheri MS, Haghighatkhah HR, Fakhri M, Masoom N. Uterine Doppler velocimetry of the uterine arteries in the second and third trimesters for the prediction of gestational outcome. Rev Bras Ginecol Obstet 2014;36(1):35–39.
  • 11. Schwarze A, Nelles I, Krapp M, et al. Doppler ultrasound of the uterine artery in the prediction of severe complications during low-risk pregnancies. Archi Gynecol Obstet 2005;271(1):46–52.
  • 12. Bhattacharyya SK, Kundu S, Kabiraj SP. Prediction of preeclampsia by midtrimester uterine artery Doppler velocimetry in high-risk and low-risk women. J Obstet Gynecol India 2012;62(3):297–300.
  • 13. Espinoza J, Romero R, Nien JK, et al. Identification of patients at risk for early onset and/or severe preeclampsia with the use of uterine artery Doppler velocimetry and placental growth factor. Am J Obstet Gynecol 2007;196(4):326–e1.
  • 14. Espinoza J, Kusanovic JP, Bahado-Singh R, Gervasi MT, Romero R, Lee W, et. al. Should bilateral uterine artery notching be used in the risk assessment for preeclampsia, small-for-gestational-age, and gestational hypertension. J Ultrasound Med 2010; 29: 1103-1115,
  • 15. Brodszki J, Länne T, Stale H akan, Batra S and Maršál K: Altered vascular function in healthy normotensive pregnant women with bilateral uterine artery notches. BJOG 2002; 109: 546-552.
  • 16. Ratiu, Dominik, et al. "Doppler indices and notching assessment of uterine artery between the 19th and 22nd week of pregnancy in the prediction of pregnancy outcome." in vivo 2019; 33(6): 2199-2204.
  • 17. Cnossen, Jeltsje S., et al. "Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis." Cmaj 2008; 178(6): 701-711.
  • 18. Lesmes C, Gallo DM, Saiid Y, Poon LC and Nicolaides KH: Prediction of small-for-gestational-age neonates: screening by uterine artery Doppler and mean arterial pressure at 19-24 weeks. Ultrasound Obstet Gynecol 2015; 46: 332-340.
  • 19. Poon, Leona CY, et al. "Second-trimester uterine artery Doppler in the prediction of stillbirths." Fetal diagnosis and therapy 2013; 33(1): 28-35.
  • 20. Giordano R, Cacciatore A, Romano M, La Rosa B, Fonti I, Vigna R. Uterine artery Doppler flow studies in obstetric practice. J Prenat Med 2010;4(4):59.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Kadın Hastalıkları ve Doğum
Bölüm Araştırma Makaleleri
Yazarlar

Şule GÖNCÜ AYHAN 0000-0002-5770-7555

Resul ARISOY 0000-0003-1359-1674

Veli MİHMANLI 0000-0001-8701-8462

Yayımlanma Tarihi 25 Eylül 2021
Gönderilme Tarihi 24 Mayıs 2021
Kabul Tarihi 12 Ağustos 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 18 Sayı: 3

Kaynak Göster

Vancouver GÖNCÜ AYHAN Ş, ARISOY R, MİHMANLI V. THE UTILITY OF PULSATILITY INDEX AND DIASTOLIC NOTCH PRESENCE IN UTERINE ARTERY DOPPLER ULTRASOUND BETWEEN 18-24 WEEKS FOR PREEKLAMPSIA PREDICTION’. JGON. 2021;18(3):933-7.