Italy: Study on Hypertensive Disorders of Pregnancy

In a new study, it was found that at the time of hypertensive disorders of pregnancy (HDP) diagnosis, uterine artery (UtA) Doppler is a good bedside measure of fetal/neonatal problems and is linked to pregnancy duration. This study was conducted by Chiara Loardi and team, results of which were published in the journal Pregnancy Hypertension.

The trophoblastic invasion of the spiral arteries is shown by UtA Doppler. The incomplete spiral artery remodeling that causes PE is shown in abnormal UtA velocimetry. Insufficient trophoblast invasion and spiral artery remodeling are more common in women with early-onset pre-eclampsia, while only a tiny percentage of placentas demonstrate under perfusion lesions in late-onset preeclampsia.

The objective of this study was to compare the prognostic effect of uterine artery Doppler for pregnancy outcomes in pregnancies complicated by hypertensive disorders of pregnancy to the ISSHP-recommended diagnosis of preeclampsia (PE).

This was a retrospective cohort analysis of singleton pregnancies diagnosed with HDP who were assessed with UtA Doppler upon admission between 2011 and 2017. The study population was divided into two groups based on whether or not they had PE and whether or not they had abnormal UtA Doppler (mean pulsatility index > 95th percentile). Pregnancy outcome, maternal and fetal problems, and pregnancy length were all evaluated as composite outcomes (CO) (from admission to delivery).

Results of the Study

• A total of 311 mother-infant pairs were enrolled in the study.
• The relative probability ratio in the Biggerstaff graph was used to compare the diagnostic capabilities of the two classes.
• In comparison to UtA Doppler, the ISSHP definition proved to be more effective in identifying maternal unfavorable CO, with relative positive likelihood ratios of 1.50 and 1.31.
• UtA Doppler categorization was more effective than PE definition in predicting bad neonatal CO, with relative positive likelihood ratios of 2.21 and 1.61 respectively.
• For both patients with PE and women with HDP without superimposed PE, UtA Doppler was linked with birth at a younger gestational age.

Reference

Chiara Loardi, Nicola Fratelli, Giorgia Mazzoni, Rossana Orabona, Adriana Valcamonico, Anna Fichera, Enrico Sartori, Federico Prefumo. Uterine artery Doppler for the prediction of outcome in pregnancies complicated by hypertensive disorders of pregnancy, https://doi.org/10.1016/j.preghy.2021.09.004.