Fetal And Placental Doppler Velocimetry In Hypertensive Pregnant Women And Perinatal Outcomes According To Gestational Age [dopplervelocimetria Fetoplacentária Em Gestantes Hipertensas E Resultados Perinatais Segundo A Idade Gestacional]

Abstract

To evaluate the pulsatility index of umbilical artery (UAPI) and middle cerebral artery (MCAPI), as well as the umbilical-cerebral pulsatility (UAPI/MCAPI) ratio in fetuses of hypertensive pregnant women and associated adverse perinatal outcomes. MATERIALS AND METHODS: The authors have analyzed UAPI, MCAPI and UAPI/MCAPI ratio in 289 fetuses of hypertensive women, correlating the results with the presence of adverse perinatal outcomes. Results were compared with and without adjustment for gestational age. RESULTS: Apgar score < 7 at the 5th minute was associated with altered outcomes after adjustment for gestational age. The risk for small-for-gestational-age infant increased three times after such adjustment, with statistical significance for all the Doppler parameters. The increase in risk for neonatal hypoxia after adjustment for gestational age was statistically significant for UAPI and UAPI/MCAPI ratio. No increase was observed in the risk for respiratory distress syndrome in the adjusted analysis. A three-time higher risk for perinatal mortality and altered UAPI with statistical significance was observed after adjustment. CONCLUSION: In fetuses of hypertensive pregnant women, UAPI demonstrated better correlations with perinatal outcomes than MCAPI and UAPI/MCAPI ratio. The risk for adverse gestational outcome should be evaluated taking the gestational age into consideration. © Colégio Brasileiro de Radiologia e Diagnóstico por Imagem.433155160Sebire, N.J., Umbilical artery Doppler revisited: Pathophysiology of changes in intrauterine growth restriction revealed (2003) Ultrasound Obstet Gynecol, 21, pp. 419-422Campbell, S., Pearce, J.M., Hackett, G., Qualitative assessment of uteroplacental blood flow: Early screening for high-risk pregnancies (1986) Obstet Gynecol, 68, pp. 649-653Ozcan, T., Sbracia, M., D'ancona, R.L., Arterial and venous Doppler velocimetry in the severely growth-restricted fetus and associations with adverse perinatal outcome (1998) Ultrasound Obstet Gynecol, 12, pp. 39-44Nomura, R.M.Y., Francisco, R.P.V., Sakamoto, K., Centralização da circulação fetal em gestações de alto risco: Avaliação da vitalidade fetal e resultados perinatais (2001) Rev Bras Ginecol Obstet, 23, pp. 137-143Sebire, N.J., Goldin, R.D., Regan, L., Histomorpho-logical evidence for chronic vasoconstriction of placental stem vessels in pregnancies with intrau-terine growth restriction and abnormal umbilical artery Doppler velocimetry indices (2001) J Pathol, 19, p. 195Baschat, A.A., Gembruch, U., Weiner, C.P., Qualitative venous Doppler waveform analysis improves prediction of critical perinatal outcomes in premature growth-restricted fetuses (2003) Ultrasound Obstet Gynecol, 22, pp. 240-245Baschat, A.A., Galan, H.L., Bhide, A., Doppler and biophysical assessment in growth restricted fetuses: Distribution of test results (2006) Ultrasound Obstet Gynecol, 27, pp. 41-47Soothill, P.W., Ajayi, R.A., Campbell, S., Relationship between fetal acidemia at cordocentesis and subsequent neurodevelopment (1992) Ultrasound Obstet Gynecol, 2, pp. 80-83Bilardo, C.M., Wolf, H., Stigter, R.H., Relationship between monitoring parameters and perinatal outcome in severe, early intrauterine growth restriction (2004) Ultrasound Obstet Gynecol, 23, pp. 119-125Hartung, J., Kalache, K.D., Heyna, C., Outcome of 60 neonates who had ARED flow prenatally compared with a matched control group of appropriate-for-gestational age preterm neonates (2005) Ultrasound Obstet Gynecol, 25, pp. 566-572Hecher, K., Bilardo, C.M., Stigter, R.H., Monitoring of fetuses with intrauterine growth restriction: A longitudinal study (2001) Ultrasound Obstet Gynecol, 18, pp. 564-570Harman, C.R., Baschat, A.A., Gembruch, U., Venous Doppler in IUGR. Which vessel? Which parameter? (2001) Am J Obstet Gynecol, 185, p. 53Ferrazzi, E., Bozzo, M., Rigano, S., Temporal sequence of abnormal Doppler changes in the peripheral and central circulatory systems of the severely growth-restricted fetus (2002) Ultrasound Obstet Gynecol, 19, pp. 140-146Schreuder, A.M., McDonnell, M., Gaffney, G., Outcome at school age following antenatal detection of absent or reversed end diastolic flow velocity in the umbilical artery (2002) Arch Dis Child Fetal Neonatal Ed, 86, pp. 108-114Baschat, A.A., Harman, C.R., Antenatal assessment of the growth restricted fetus (2001) Curr Opin Obstet Gynecol, 13, pp. 161-168Bernstein, I.M., Horbar, J.D., Badger, G.J., Morbidity and mortality among very-low-birth-weight neonates with intrauterine growth restriction. The Vermont Oxford Network (2000) Am J Obstet Gynecol, 182 (1 PART 1), pp. 198-206Zeitlin, J., Ancel, P.Y., Saurel-Cubizolles, M.J., The relationship between intrauterine growth restriction and preterm delivery: An empirical approach using data from a European case-control study (2000) BJOG, 107, pp. 750-758Yamamoto, R.M., Francisco, R.P.V., Miyadahira, S., Fatores prognósticos para o óbito perinatal em gestações com diástole zero ou reversa na dop-plervelocimetria das artérias umbilicais (2000) Rev Bras Ginecol Obstet, 22, pp. 353-363A randomised trial of timed delivery for the compromised preterm fetus: Short term outcomes and Bayesian interpretation (2003) BJOG, 110, pp. 27-32. , GRIT Study GroupFrancisco, R.P.V., Nomura, R.M.Y., Miyadahira, S., Diástole zero ou reversa na dopplervelocime-tria das artérias umbilicais (2001) Rev Assoc Med Bras, 47, pp. 30-36Andrade, J.Q., Miyadahira, S., Nomura, R.M.Y., Dopplervelocimetria dos compartimentos arterial e venoso da circulação fetal e umbilical em ges-tação de alto-risco: Análise dos resultados perina-tais (2002) Rev Bras Ginecol Obstet, 24, pp. 153-160Romero, R., Kalache, K.D., Kadar, N., Timing the delivery of the preterm severely growth-restricted fetus: Venous Doppler, cardiotocography or the biophysical profile? (2002) Ultrasound Obstet Ginecol, 19, pp. 118-121Pires, P., Aplicações da dopplervelocimetria em gestação de alto risco (2006) Doppler No 2 o E 3 o Trimestres Da Gestação &ampHemodinâmica Feto-placentária, pp. 67-82. , 1 a ed. Recife: EdupePires, P., Faundes, A., Dopplervelocimetria na ava-liação hemodinâmica materno-fetal (2007) Femina, 35, pp. 383-390Arduini, D., Rizzo, G., Normal values of pulsatility index from fetal vessels: A cross-sectional study on 1556 healthy fetuses (1990) J Perinat Med, 18, pp. 165-172Schwarze, A., Gembruch, U., Krapp, M., Qualitative venous Doppler flow waveform analysis in preterm intrauterine growth-restricted fetuses with ARED flow in the umbilical artery-correlation with short-term outcome (2005) Ultrasound Obstet Gynecol, 25, pp. 573-579Baschat, A.A., Gembruch, U., Reiss, I., Relationship between arterial and venous Doppler and perinatal outcome in fetal growth restriction (2000) Ultrasound Obstet Gynecol, 16, pp. 407-413Müller, T., Nanan, R., Rehn, M., Arterial and ductus venosus Doppler in fetuses with absent or reverse end-diastolic flow in the umbilical artery: Correlation with short-term perinatal outcome (2002) Acta Obstet Gynecol Scand, 22, pp. 786-791Meyberg, G.C., Solomayer, E.F., Grischke, E.M., Does the measurement of four fetal arteries provide more information than the measurement of just two arteries in prenatal Doppler sonography? (1999) Ultrasound Obstet Gynecol, 13, pp. 407-414Zelop, C.M., Richardson, D.K., Heffner, L.J., Outcomes of severely abnormal umbilical artery doppler velocimetry in structurally normal singleton fetuses (1996) ObstetGynecol, 87, pp. 434-43