Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Carlos Van Buren, Valparaíso, Chile.
Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile.
Ultrasound Obstet Gynecol. 2018 Jun;51(6):775-782. doi: 10.1002/uog.17515.
To determine the rate of placental apoptosis and adverse perinatal outcome in patients with late-onset pre-eclampsia (PE) and abnormal uterine artery (UtA) Doppler at diagnosis.
This was a prospective cohort study of women with singleton pregnancy diagnosed with late PE, performed between August 2011 and January 2014 at the Maternal-Fetal Medicine Unit of Hospital Carlos Van Buren. Patients were stratified according to UtA Doppler status at diagnosis (pulsatility index (PI) ≤ or > 95 percentile). Logistic regression analysis was performed to identify associations between abnormal UtA Doppler and adverse maternal and perinatal outcomes. In a subset of this cohort for whom placental samples were available, immunohistochemical analysis of the placenta was performed to identify the rate of apoptosis and its association with UtA Doppler by comparing samples from those with normal and those with abnormal UtA Doppler and normotensive controls. Non-parametric linear trend analysis was performed for assessment of the apoptotic index.
Eighty-six patients were included in the final analysis. Of these, UtA-PI was above the 95 percentile in 33 (38.4%) patients. Gestational age at diagnosis and delivery were significantly lower in this group compared with patients with normal UtA Doppler. Abnormal UtA Doppler was associated with increased risk of severe PE (odds ratio (OR) = 7.5; 95% CI, 2.76-20.46; P < 0.001), late preterm delivery (OR = 13.7; 95% CI, 4.53-41.46; P < 0.001), small-for-gestational age at birth (OR = 12.3; 95% CI, 3.17-47.57; P < 0.001) and admission to the neonatal intensive care unit (OR = 12.8; 95% CI, 2.61-62.36; P = 0.002). Moreover, UtA Z-score demonstrated a significant inverse correlation with birth-weight Z-score (r = -0.34; P = 0.0013). Mean placental apoptotic index demonstrated an ascending linear trend according to UtA Doppler status (P = 0.04).
In patients with late PE, UtA Doppler was useful for clinical classification and as an indicator of placental histological findings. Correlation between UtA Doppler and the apoptotic index provides new evidence of a subgroup of late PE with a placental origin. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
确定在诊断时出现晚期先兆子痫（PE）和子宫动脉（UtA）多普勒异常的患者胎盘凋亡率和不良围产结局。
这是一项前瞻性队列研究，纳入 2011 年 8 月至 2014 年 1 月在卡洛斯·范伯伦医院妇产科就诊的单胎妊娠被诊断为晚期 PE 的女性。根据 UtA 多普勒在诊断时的状态（搏动指数（PI）≤或>95 百分位数）将患者分层。Logistic 回归分析用于识别异常 UtA 多普勒与不良母体和围产儿结局之间的关联。在该队列的一部分患者中，可获得胎盘样本，对胎盘进行免疫组织化学分析，通过比较正常 UtA 多普勒和正常 UtA 多普勒及正常血压对照组的样本，识别胎盘凋亡率及其与 UtA 多普勒的关系。采用非参数线性趋势分析评估凋亡指数。
最终分析共纳入 86 例患者。其中，33 例（38.4%）患者的 UtA-PI 超过 95 百分位数。与 UtA 多普勒正常的患者相比，该组患者的诊断和分娩时的胎龄明显更低。异常 UtA 多普勒与严重 PE（比值比（OR）=7.5；95%置信区间，2.76-20.46；P<0.001）、晚期早产（OR=13.7；95%置信区间，4.53-41.46；P<0.001）、出生体重小于胎龄（OR=12.3；95%置信区间，3.17-47.57；P<0.001）和新生儿重症监护病房入院（OR=12.8；95%置信区间，2.61-62.36；P=0.002）的风险增加相关。此外，UtA Z 评分与出生体重 Z 评分呈显著负相关（r=-0.34；P=0.0013）。根据 UtA 多普勒状态，胎盘凋亡指数呈上升线性趋势（P=0.04）。
在晚期 PE 患者中，UtA 多普勒有助于临床分类，并可作为胎盘组织学发现的指标。UtA 多普勒与凋亡指数之间的相关性为胎盘起源的晚期 PE 亚组提供了新的证据。版权所有 © 2017 ISUOG。由 John Wiley & Sons Ltd 出版。
