Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK.
Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Vienna, Austria.
Ultrasound Obstet Gynecol. 2018 Jul;52(1):60-65. doi: 10.1002/uog.17564. Epub 2018 Jun 11.
Hypertensive disorders of pregnancy (HDP) are associated with impaired placentation, as evidenced by abnormal uterine artery (UtA) Doppler. In normal pregnancy, mean UtA pulsatility index (PI) shows a progressive decline with gestational age (GA). However, previous studies have reported that a proportion of pregnancies demonstrate worsening UtA Doppler in later pregnancy. The aim of this study was to investigate the incidence of HDP according to the change in mean UtA-PI between the second and third trimesters.
This was a retrospective cohort study of singleton pregnancies between March 1997 and March 2016 that underwent longitudinal UtA Doppler assessment in the second and third trimesters. All parameters were converted into centiles or multiples of the median (MoM), adjusting for GA. The study cohort was divided into two groups, according to change in mean UtA-PI between the second and third trimesters (those with a decrease or no change and those with an increase). HDP included women who developed pre-eclampsia and/or gestational hypertension. Logistic regression analysis was used to adjust for potential confounders.
The analysis included 5887 pregnancies. The incidence of HDP was significantly higher in the group with increasing mean UtA-PI compared with those without (7.9% vs 5.8%; P = 0.002). Logistic regression analysis demonstrated that both third-trimester UtA-PI MoM (odds ratio (OR), 7.35; 95% CI, 4.66-11.6; P < 0.001) and stable or decrease in UtA-PI MoM between the second and third trimesters (OR, 0.43; 95% CI, 0.31-0.60; P < 0.001) were significant independent predictors for the development of HDP.
Worsening of UtA Doppler is associated with HDP, independent of the value recorded in the second trimester. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
妊娠高血压疾病（HDP）与胎盘功能不全有关，这可通过子宫动脉（UtA）多普勒异常来证明。在正常妊娠中，平均 UtA 搏动指数（PI）随妊娠周数（GA）的增加而逐渐下降。然而，先前的研究报告称，一部分妊娠在妊娠后期出现 UtA 多普勒恶化。本研究旨在根据第二和第三孕期平均 UtA-PI 的变化来调查 HDP 的发生率。
这是一项回顾性队列研究，纳入了 1997 年 3 月至 2016 年 3 月期间进行过第二和第三孕期纵向 UtA 多普勒评估的单胎妊娠。所有参数均转换为百分位数或中位数倍数（MoM），以适应 GA。根据第二和第三孕期平均 UtA-PI 的变化，将研究队列分为两组（下降或不变组和增加组）。HDP 包括发生子痫前期和/或妊娠期高血压的女性。使用逻辑回归分析调整潜在混杂因素。
该分析纳入了 5887 例妊娠。与没有 UtA-PI 增加的组相比，UtA-PI 增加的组发生 HDP 的发生率明显更高（7.9% vs 5.8%；P=0.002）。逻辑回归分析表明，第三孕期 UtA-PI MoM（比值比（OR），7.35；95%置信区间，4.66-11.6；P<0.001）和第二至第三孕期 UtA-PI MoM 稳定或降低（OR，0.43；95%置信区间，0.31-0.60；P<0.001）均是 HDP 发生的独立显著预测因素。
UtA 多普勒恶化与 HDP 相关，与第二孕期记录的值无关。版权所有 © 2017 ISUOG。由 John Wiley & Sons Ltd 出版。
