Original researchUterine artery Doppler in predicting pregnancy outcome in women with antiphospholipid syndrome
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
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Cited by (46)
Antiphospholipid syndrome: An update on risk factors for pregnancy outcome
2018, Autoimmunity ReviewsCitation Excerpt :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.
Pregnancy and antiphospholipid syndrome
2012, Revue de Medecine InterneUterine artery Doppler and subendometrial blood flow in patients with unexplained recurrent miscarriage
2011, Middle East Fertility Society JournalCitation Excerpt :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.
Predictive value of uterine artery velocity waveforms in monitoring of pregnancies with high obstetrical risk antiphospholipid syndrome: The Rouen experience
2010, Gynecologie Obstetrique et FertiliteChapter 9 Obstetric Manifestations of the Antiphospholipid Syndrome
2009, Handbook of Systemic Autoimmune DiseasesCitation Excerpt :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.
Tests to Predict Preeclampsia
2009, Chesley's Hypertensive Disorders in Pregnancy