Surányi Andrea, Altorjay Ábel, Kaiser László, Nyári Tibor, Németh Gábor
Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary.
Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary.
Pregnancy Hypertens. 2017 Apr;8:51-59. doi: 10.1016/j.preghy.2017.03.004. Epub 2017 Mar 19.
The purpose of this study was to assess three-dimensional placental power Doppler indices in second and third trimester of pregnancies complicated by chronic-, gestational hypertension or pre-eclampsia.
We analyzed 226 pregnancies prospectively measuring three-dimensional placental power Doppler indices (vascularization index, flow index, vascularization flow index) in cases of normal blood pressure (N=109), chronic hypertension (N=43), gestational hypertension (N=57) and pre-eclampsia (N=17). We evaluated the correlation among vascularization indices, flow characteristics of uterine arteries and perinatal outcome. We assessed the influence of maternal factors (pregestational body mass index, previous pregnancies/deliveries, maternal age) on vascularization indices, and analyzed histological findings of placenta from pregnancy hypertension groups.
Vascularization index was significantly higher (p=0.010) in pregnancies with chronic- and lower (p=0.152) in pregnancies with gestational hypertension and preeclampsia compared to the normal group. Flow index was significantly lower in all three pathological groups compared to normal group. Placental volume was significantly smaller (p<0.001) in all three pathological groups than in normal pregnancies at the time of delivery, and there was no significant difference between the three affected groups. The rate of adverse pregnancy outcomes showed no significant difference between the normal and chronic hypertension groups. We observed significantly lower 1', 5' and 10' APGAR scores (p<0.,001), and birth weight in preeclampsia compared to chronic-, gestational hypertension, and normal groups. Maternal factors had no influence on the development of the power Doppler indices.
Vascularization indices seem good markers for the prediction of risks and adverse outcomes in case of pregnancy hypertension.
本研究旨在评估妊娠中晚期合并慢性高血压、妊娠期高血压或子痫前期孕妇的三维胎盘能量多普勒指数。
我们前瞻性分析了226例妊娠病例，测量了血压正常组（N=109）、慢性高血压组（N=43）、妊娠期高血压组（N=57）和子痫前期组（N=17）的三维胎盘能量多普勒指数（血管化指数、血流指数、血管化血流指数）。我们评估了血管化指数、子宫动脉血流特征与围产期结局之间的相关性。我们评估了母体因素（孕前体重指数、既往妊娠/分娩史、产妇年龄）对血管化指数的影响，并分析了妊娠高血压组胎盘的组织学 findings。
与正常组相比，慢性高血压妊娠的血管化指数显著更高（p=0.010），妊娠期高血压和子痫前期妊娠的血管化指数更低（p=0.152）。与正常组相比，所有三个病理组的血流指数均显著更低。在分娩时，所有三个病理组的胎盘体积均显著小于正常妊娠组，且三个受影响组之间无显著差异。正常组和慢性高血压组的不良妊娠结局发生率无显著差异。与慢性高血压组、妊娠期高血压组和正常组相比，子痫前期组的1分钟、5分钟和10分钟阿氏评分（p<0.001）和出生体重显著更低。母体因素对能量多普勒指数的发展无影响。
血管化指数似乎是预测妊娠高血压风险和不良结局的良好指标。
