P15.04: Ductus venosus Doppler waveform analysis: a new tool for the early prediction of preeclampsia

P15.04: Ductus venosus Doppler waveform analysis: a new tool for the early prediction of preeclampsia
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  15 th World Congress on Ultrasound in Obstetrics and Gynecology Poster abstracts P15.02Ophthalmic and central retinal arteries Doppler inpreeclamptic women with visual disturbance and headache A. L. D. Diniz 1 , A. F. Moron 1 , M. C. Santos 2 , N. Sass 1 ,C. R. Pires 1 1 Federal University of S˜ ao Paulo, Brazil,  2 Federal Universityof Uberl ˆ andia, Brazil  Objective:  To compare ophthalmic and central retinal arteriesDopplerinpreeclampticwomenwithandwithoutvisualdisturbanceand headache. Methods:  Transversal study that compared the ophthalmic andretinal central arteries Doppler indices of 40 preeclamptic womenwith no symptoms compared to 7 preeclamptic women with visualdisturbance and headache. Right and left eyes averages Dopplerindices were evaluates and resistance index (RI), pulsatility index(PI), peak systolic velocity (PSV), end diastolic velocity (EDV) andpeak ratio (PR) were calculated. Wilcoxon test was performed tocompare the two groups, with significance level of 5%. Results: The mainvisual disturbance wasphotophobia. Allthesevenwomen referred headache associated with photophobia, and theywere not using any medication. There was no statistical significantdifference in RI, PI, PSV, EDV, PR (  p = 0 . 99 ; 0.23; 0.84; 0.85; 0.08)ophthalmic artery and RI, PI, PSV, EDV (  p = 0 . 34 ; 0.35; 0.87; 0.57)central retinal artery, comparing women with and without visualdisturbance and headache. Conclusion:  Preeclamptic women with visual disturbance andheadache do not show any worse in the orbital vascularvasodilatation or hyperperfusion. This is a preliminary analysis,and furthers studies will be necessary to clarify this question. P15.03Ocular hyperperfusion in preeclamptic women demonstrated by ophthalmic and central retinal arteries Doppler A. L. D. Diniz 1 , A. F. Moron 1 , M. C. Santos 2 , N. Sass 1 ,C. R. Pires 1 1 Federal University of S˜ ao Paulo, Brazil,  2 Federal Universityof Uberl ˆ andia, Brazil  Objective:  To analyse the preeclampsia influence on the ophthalmicand central retinal arteries Doppler indices. Methods:  Case-control study that compared the ophthalmic andcentral retinal arteries Doppler indices of 40 preeclamptic women(study group) and 51 normotensive pregnant women (controlgroup). The study group was selected using National High BloodPressure Education Program 2000 criteria. Right and left eyesindices averages were evaluated and the resistance index (RI),pulsatility index (PI), peak systolic velocity (PSV), end systolicvelocity(ESV)andpeakratio(PR)werecalculated.Varianceanalysiswasperformed tocomparethegroups, withsignificance levelof 5%. Results:  The ophthalmic and central retinal arteries RI ( 0 . 64 ± 0 . 13 ; 0 . 61 ± 0 . 11 ) and PI averages ( 1 . 08 ± 0 . 27 ;  0 . 82 ± 0 . 21 ) weresignificantly lower (  p < 0 . 0001 ) in the preeclamptic women whencompared to the normotensive pregnant women. The PSV averagesof both arteries ( 37 . 68 ± 6 . 31 ;  10 . 53 ± 2 . 91 ), ESV ( 13 . 99 ± 4 . 09 ; 4 . 32 ± 1 . 73 ) and PR ( 0 . 82 ± 0 . 08 ) were significantly higher (  p < 0 . 0001 ) in preeclamptic women. Conclusion:  Preeclampsia was associated with a significant decreasein orbital vascular impedance, observed by the fall in the pulsatilityand resistance indices, and elevation of peak systolic velocity, endsystolic velocity and peak ratio, indicating orbital hyperperfusion. P15.04Ductus venosus Doppler waveform analysis: a new tool forthe early prediction of preeclampsia? H. F. Yazicioglu, R. Demirbas Ersu, ¨O. D ¨ulger ¸Cetin,A. ¸Cankaya, M. Ayg¨un, O. N. ¨Ozyurt, Z. ¸Cebi, L. Yabar,S. S ¨onmez S¨ uleymaniye Maternity Hospital, Turkey Objective:  To test the efficiency of first trimester fetal ductusvenosus Doppler waveform analysis as a test for early prediction of preeclampsia. Materials methods:  For this retrospective cohort analysis thedatabase of the perinatology unit of the S ¨uleymaniye MaternityHospital was searched for women with known pregnancy outcomesand a satisfactory ductus venosus Doppler tracing during the firsttrimester screen. Mean peak velocity index for veins (PVIV)((S-a)/D)and mean pulsatility index for veins (PIV)((S-a)/TAMX) and thefrequencies of abnormal values ( > 95.percentile for gestational ageand/or presence of a reverse ‘‘a’’ wave) were compared betweenthe women with a normal outcome versus those with provenpreeclampsia. Odds ratios of abnormal results for the occurenceof preeclampsia were calculated. Findings:  Mean ductal PIV values were significantly higher inpreeclamptic patients. ( 0 . 831 ± 0 . 208  versus  0 . 959 ± 0 . 271 ;  p < 0 . 04 ). The frequency of patients with an abnormal ductus venosusDopplerweresignificantlyhigherinthepreeclampticgroup.(21% vs4.4% (  p = 0 . 02 ); 21.1% vs 3.6% (  p = 0 . 008 ) and 15.8% vs 3.1%(  p = 0 . 03 ) for PIV, PVIV and the presence of a reverse ‘‘a’’ waverespectively).Similarly odds ratio (5–95 CI) of an abnormal result forthe prediction of preeclampsia were 5.21 (1.48–18.35); 7.23(1.95–26.79) and5.86(1.38–24.88) forPIV,PVIVandthepresenceof a reverse a wave respectively. Conclusion:  Pregnant women with an abnormal ductus venosusDoppler result during the first trimester screen might have a greaterprobability of developing preeclampsia later in the same gestation. P15.05The application of logistic regression risk modelling to secondtrimester uterine artery Doppler screening for pre-eclampsia A. Khaw 1 , O. Turan 1 , A. Lynch 2 1 King’s College Hospital, UK,  2 Centre for Applied Medical Statistics, University of Cambridge, UK Objective:  To construct a locally-derived risk-adjusted model forprediction of pre-eclampsia (PET) based on patient demographicsand individual patient assessment of blood pressure, total peripheralresistance and uterine artery Doppler waveform analysis at23 weeks. Method:  Our study population of 1902 patients were recruitedfrom first trimester. Between 21 to 23 weeks, blood pressure andechocardiographic assessments were performed on each patient andtotal peripheral resistance (TPR) calculated. Uterine artery Dopplerwaveforms were assessed. Pulsatility index (PI) and diastolic flowindex (DFI : a novel index presented in separate abstract) werecalculated and notch status (none/bilateral/unilateral) was recorded.PI, DFI and TPR were log-transformed for analysis. The covariateswere tested with stepwise multiple logistic regression to determinethe significance of each for risk modelling. Results:  The ethnic breakdown consisted of 56% whites, 33%blacks and 11% classified as ‘other’ for this analysis (Asians,Orientals,mixed),ofwhich41%wereparous,2.1%hadahistoryof previous PET, 1.2% a background of essential hypertension, 0.6%were diabetic and 6.6% were ‘current smokers’. The prevalence of bilateral notching was 10.1% and 5.2% for unilateral notching. Theincidence of PET in this cohort was 3.3% (62 cases). Preliminaryanalysis of the first 1000 patients showed that 4 covariates weresignificant after logistic regression analysis: log PI ( P = 0 . 004 ), 462  Ultrasound in Obstetrics & Gynecology  2005;  26 : 376–471
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