scholarly journals P08.07: Maternal uterine artery Doppler changes in pre-eclampsia and fetal growth restriction

2018 ◽  
Vol 52 ◽  
pp. 160-160
Author(s):  
J. Tay ◽  
G. Masini ◽  
C. Lees ◽  
I.B. Wilkinson ◽  
C.M. McEniery
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Uterine Artery ◽  
Growth Restriction ◽  
Uterine Artery Doppler

scholarly journals Does Pentaerytrithyltetranitrate reduce fetal growth restriction in pregnancies complicated by uterine mal-perfusion? Study protocol of the PETN-study: a randomized controlled multicenter-trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
T. Groten ◽  
◽  
T. Lehmann ◽  
E. Schleußner
Keyword(s):  
Birth Weight ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Uterine Artery ◽  
Therapeutic Option ◽  
Multicenter Trial ◽  
Growth Restriction ◽  
Organic Nitrate ◽  
Phosphodiesterase Type 5 Inhibitors ◽  
Uterine Artery Doppler

Abstract Background Affecting approximately 10% of pregnancies, fetal growth restriction (FGR), is the most important cause of perinatal mortality and morbidity. Impaired placental function and consequent mal-perfusion of the placenta is the leading cause of FGR. Although, screening for placental insufficiency based on uterine artery Doppler measurement is well established, there is no treatment option for pregnancies threatened by FGR. The organic nitrate pentaerithrityl tetranitrate (PETN) is widely used for the treatment of cardiovascular disease and has been shown to have protective effects on human endothelial cells. In a randomized placebo controlled pilot-study our group could demonstrate a risk reduction of 39% for the development of FGR, and FGR or death, by administering PETN to patients with impaired uterine artery Doppler at mid gestation. To confirm these results a prospective randomized placebo controlled double-blinded multicentre trial was now initiated. Method The trial has been initiated in 14 centres in Germany. Inclusion criteria are abnormal uterine artery Doppler, defined by mean PI > 1.6, at 190 to 226 weeks of gestation in singleton pregnancies. Included patients will be monitored in 4-week intervals. Primary outcome measures are development of FGR (birth weight < 10th percentile), severe FGR (birth weight < 3rd centile) and perinatal death. Placental abruption, birth weight below the 3rd, 5th and 10th centile, development of FGR requiring delivery before 34 weeks` gestation, neonatal intensive care unit admission, and spontaneous preterm delivery < 34 weeks` and 37 weeks` gestation will be assessed as secondary endpoints. Patient enrolment was started in August 2017. Results are expected in 2020. Discussion During the past decade therapeutic agents with possible perfusion optimizing potential have been evaluated in clinical trials to treat FGR. Meta-analysis and sub-analysis of trials targeting preeclampsia revealed ASS to have a potential in reducing FGR. Phosphodiesterase-type-5 inhibitors have recently been tested in a worldwide RCT for therapy of established FGR, failing to show an effect on neonatal outcome. The ongoing multicenter trial will, by confirming our previous results, finally provide a therapeutic option in cases at risk for FGR. Trial registration DRKS00011374 registered at September 29th, 2017 and NCT03669185, registered September 13th, 2018.

scholarly journals Uterine Artery Doppler in Screening for Preeclampsia and Fetal Growth Restriction

2018 ◽  
Vol 40 (05) ◽  
pp. 287-293 ◽  
Author(s):  
Marianna Pedroso ◽  
Kirsten Palmer ◽  
Ryan Hodges ◽  
Fabricio Costa ◽  
Daniel Rolnik
Keyword(s):  
Fetal Growth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Fetal Growth Restriction ◽  
Uterine Artery ◽  
Growth Restriction ◽  
Current Evidence ◽  
Individual Risk ◽  
Predictive Test ◽  
Uterine Artery Doppler

Objective To perform a comprehensive review of the current evidence on the role of uterine artery Doppler, isolated or in combination with other markers, in screening for preeclampsia (PE) and fetal growth restriction (FGR) in the general population. The review included recently published large cohort studies and randomized trials. Methods A search of the literature was conducted using Medline, PubMed, MeSH and ScienceDirect. Combinations of the search terms “preeclampsia,” “screening,” “prediction,” “Doppler,” “Doppler velocimetry,” “fetal growth restriction,” “small for gestational age” and “uterine artery” were used. Articles in English (excluding reviews) reporting the use of uterine artery Doppler in screening for PE and FGR were included. Results Thirty articles were included. As a single predictor, uterine artery Doppler detects less than 50% of the cases of PE and no more than 40% of the pregnancies affected by FGR. Logistic regression-based models that allow calculation of individual risk based on the combination of multiple markers, in turn, is able to detect ∼ 75% of the cases of preterm PE and 55% of the pregnancies resulting in small for gestational age infants. Conclusion The use of uterine artery Doppler as a single predictive test for PE and FGR has poor accuracy. However, its combined use in predictive models is promising, being more accurate in detecting preterm PE than FGR.

scholarly journals First-Trimester Uterine Artery Doppler Analysis in the Prediction of Later Pregnancy Complications

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Su Lynn Khong ◽  
Stefan C. Kane ◽  
Shaun P. Brennecke ◽  
Fabrício da Silva Costa
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Early Onset ◽  
Uterine Artery ◽  
Measurement Techniques ◽  
First Trimester ◽  
Growth Restriction ◽  
Waveform Analysis ◽  
Future Research ◽  
Uterine Artery Doppler

Uterine artery Doppler waveform analysis has been extensively studied in the second trimester of pregnancy as a predictive marker for the later development of preeclampsia and fetal growth restriction. The use of Doppler interrogation of this vessel in the first trimester has gained momentum in recent years. Various measurement techniques and impedance indices have been used to evaluate the relationship between uterine artery Doppler velocimetry and adverse pregnancy outcomes. Overall, first-trimester Doppler interrogation of the uterine artery performs better in the prediction of early-onset than late-onset preeclampsia. As an isolated marker of future disease, its sensitivity in predicting preeclampsia and fetal growth restriction in low risk pregnant women is moderate, at 40–70%. Multiparametric predictive models, combining first-trimester uterine artery pulsatility index with maternal characteristics and biochemical markers, can achieve a detection rate for early-onset preeclampsia of over 90%. The ideal combination of these tests and validation of them in various patient populations will be the focus of future research.

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