Elsevier

Obstetrics & Gynecology

Volume 98, Issue 2, August 2001, Pages 235-242
Obstetrics & Gynecology

Original research
Uterine artery Doppler in predicting pregnancy outcome in women with antiphospholipid syndrome

https://doi.org/10.1016/S0029-7844(01)01460-0Get rights and content

Abstract

OBJECTIVE:

To assess midtrimester uterine artery Doppler in the prediction of preeclampsia and small for gestational age (SGA) infants in women with primary antiphospholipid syndrome.

METHODS:

One hundred seventy pregnant women with histories of recurrent miscarriage in association with antiphospholipid antibodies (32 lupus anticoagulant positive, 47 IgG anticardiolipin positive, 78 IgM anticardiolipin positive, and 13 lupus anticoagulant and anticardiolipin antibodies positive) treated with low-dose aspirin and heparin were recruited prospectively. Doppler assessment of the uterine arteries (presence or absence of notches and pulsatility index) were performed at 16–18 and 22–24 weeks. The main outcome measures were the delivery of a SGA infant and the development of preeclampsia.

RESULTS:

There were 164 live births and six midtrimester losses. The prevalence of preeclampsia and SGA was similar at 10%. In predicting preeclampsia or SGA, uterine artery pulsatility index at either interval was of no value, and the diagnostic accuracy of the Doppler was limited to bilateral uterine artery notches at 22–24 weeks in the subgroup of women with positive lupus anticoagulant. In this subgroup, bilateral uterine artery notches at 22–24 weeks in predicting preeclampsia generated a high likelihood ratio for positive test (12.8, 95% confidence interval 2.2, 75), sensitivity (75%), specificity (94%), positive (75%) and negative (94%) predictive value. In predicting SGA, the corresponding figures were respectively 13.6 (95% confidence interval 1.9, 96), 80%, 94%, 80%, 94%. Uterine artery Doppler was of limited value in pregnancies associated with anticardiolipin antibodies in isolation.

CONCLUSION:

In pregnancies associated with lupus anticoagulant, uterine artery Doppler at 22–24 weeks is a useful screening test in predicting preeclampsia and SGA infants.

Section snippets

Subjects and methods

From October 1997 to September 2000, 170 pregnant women (median age 33 years; range 21–43) with histories of recurrent miscarriage were recruited for the study. Each tested persistently positive (on at least two occasions more than 6 weeks apart) for antiphospholipid antibodies before pregnancy. None had systemic lupus erythematosus or previous thromboembolic disease. Screening for antiphospholipid antibodies was performed as previously described.2 In brief, the dilute Russell’s viper venom

Results

There were 164 live births and six midtrimester fetal losses (four fetal deaths between 17 and 23 weeks’ gestation and two miscarriages at 17 and 19 weeks, preceded by spontaneous rupture of membranes). Pregnancy complications in relation to antiphospholipid antibody subtypes are listed in Table 2. Pregnancies associated with lupus anticoagulant and IgG anticardiolipin antibodies had the highest prevalence of complications and those associated with IgM anticardiolipin antibodies in isolation

Discussion

Antiphospholipid antibodies are associated with a wide spectrum of obstetric complications including recurrent miscarriage, preeclampsia, fetal growth restriction, and placental abruption. Although thromboprophylaxis significantly improves the live birth rate,13 successful pregnancies remain at high risk of complications (preeclampsia and SGA).2, 14 Despite the widespread belief that the presence of antiphospholipid antibodies results in abnormal placentation, only three small studies have to

References (22)

  • H.J Out et al.

    Histopathological findings in placentae from patients with intra-uterine fetal death and anti-phospholipid antibodies

    Eur J Obstet Gynecol Reprod Biol

    (1991)
  • R Pijnenborg et al.

    Trophoblastic invasion of human decidua from 8 to 18 weeks of pregnancy

    Placenta

    (1980)
  • A.K Mandal et al.

    Heparin lowers blood pressureBiological and clinical perspectives

    Kidney Int

    (1995)
  • M Birdsall et al.

    Antiphospholipid antibodies in pregnancy

    Aust N Z J Obstet Gynaecol

    (1992)
  • M Backos et al.

    Pregnancy complications in women with recurrent miscarriage associated with antiphospholipid antibodies treated with low dose aspirin and heparin

    Br J Obstet Gynaecol

    (1999)
  • R Shurtz-Swirski et al.

    In vitro effect of anticardiolipin autoantibodies upon total and pulsatile placental hCG secretion during early pregnancy

    Am J Reprod Immunol

    (1993)
  • P.F Chien et al.

    How useful is uterine artery Doppler flow velocimetry in the prediction of pre-eclampsia, intrauterine growth retardation and perinatal death? An overview

    Br J Obstet Gynaecol

    (2000)
  • A Caruso et al.

    Pregnancy outcome in relation to uterine artery flow velocity waveforms and clinical characteristics in women with antiphospholipid syndrome

    Obstet Gynecol

    (1993)
  • J.L Benifla et al.

    Predictive value of uterine artery velocity waveforms in pregnancies complicated by systemic lupus erythematosus and the antiphospholipid syndrome

    Fetal Diagn Ther

    (1992)
  • Z Blumenfeld et al.

    Anticardiolipin antibodies in patients with recurrent pregnancy wastageTreatment and uterine blood flow

    Obstet Gynecol

    (1991)
  • S Campbell et al.

    Investigation of the uteroplacental circulation by Doppler ultrasound

    Semin Perinatol

    (1987)
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      Conversely, no cases of preterm delivery or preeclampsia was reported among the APS pregnancies with normal uterine artery Doppler velocimetry [43]. Other authors [19,31] tested further Doppler index as uterine arteries' PI and umbilical artery end-diastolic flow in order to find out a possible role in predicting adverse pregnancy outcome, in terms of IUGR, preeclampsia, and preterm delivery. Unexpectedly, multivariate analysis revealed that only the persistence of uterine artery notches during the second trimester is associated with a 13-fold higher (OR of 13.84 (95% CI 3.41–56.16, p = 0.001) risk of developing these complications.This diagnostic test has a good likelihood ratio for prediction of both preeclampsia (12.8; CI 2.2–75) and IUGR (13.6 CI 1.9–96), the authors recommend to perform it to all APS pregnant women.

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      In the control group, nine patients got pregnant only one patient had aborted in the first trimester; eight patients had reached the third trimester and delivered at full term. Many studies have been conducted to study uterine artery blood flow in patients with recurrent pregnancy loss (10,18,19,28), and it was found that elevated uterine arterial impedance is associated with recurrent pregnancy loss, also based on studies from IVF-embryo transfer programmes, impedance of blood flow through the uterine arteries is an indicator of the probability of subsequent pregnancy outcome (16,29,30). The PI of the uterine arteries have been known to diminish progressively during the luteal phase (7,31,32) during which implantation occurs.

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      The increase in flow resistance results in an abnormal waveform pattern, comprising an increased bilateral resistance index or the persistence of the uni–bilateral protodiastolic notch (Figs. 2 and 3). Several studies have been performed to detect the predictive role of uterine artery Doppler velocimetry and pregnancy outcome in APS patients: all of them underlined the need for intensified surveillance and monitoring of pregnancy in the case of Doppler abnormalities (Blumenfeld et al., 1991; Benifla et al., 1992; Caruso et al., 1993; Meizner et al., 1988; Bar et al., 2001; Farrel and Dawson, 2001; Venkat-Raman et al., 2001; Bats et al., 2004; Le Thi Huong et al., 2006; De Carolis et al., 2007). Moreover, the normal uterine artery resistence index (RI) had good negative predictive value and could give early prediction of a good pregnancy outcome, allowing a reduction of antenatal care in terms of visits and obstetric surveillance and giving these APS pregnant patients reassuring counseling.

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