To assess the ability of non-invasive cardiac output monitoring (NICOM), a novel method of non-invasive maternal hemodynamic assessment using bioreactance, in combination with first trimester biomarkers to predict the evolution of gestational hypertension (GH), pre-eclampsia (PE) and normotensive fetal growth restriction (FGR)

Breathnach, Colm R.

Byrne, Greg

Campbell, Sharon

Dicker, Patrick

Doherty, Ann

EL-Khuffash, Afif

Kent, Etaoin

Malone, Fergal

McSweeney, Lisa

Monteith, Kathy

O\u27Loughlin, John

Sherrin, Lucy

Tully, Elizabeth C.

English

Arrow@TUDublin

Technological University Dublin ARROW@TU Dublin Articles School of Biological Sciences 2018 First Trimester Prediction of Uteroplacental Disease- Results of the Prospective Handle Study Kathy Monteith RCSI Dublin, Ireland Lisa McSweeney RCSI Dublin, Ireland Colm R. Breathnach RCSI Dublin, Ireland Lucy Sherrin RCSI Dublin, Ireland Patrick Dicker RCSI Dublin, Ireland See next page for additional authors Follow this and additional works at: https://arrow.tudublin.ie/scschbioart Recommended Citation Monteith, C., McSweeney, L. & Breathnach, C.R. (2018). First Trimester Prediction of Uteroplacental Disease- Results of the Prospective Handle Study. American Journal of Obstetrics and Gynecology, col. 218, no. 1, pp. S207-S207. doi:10.21427/09py-bc22 This Article is brought to you for free and open access by the School of Biological Sciences at ARROW@TU Dublin. It has been accepted for inclusion in Articles by an authorized administrator of ARROW@TU Dublin. For more information, please contact yvonne.desmond@tudublin.ie, arrow.admin@tudublin.ie, brian.widdis@tudublin.ie. This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 License Authors Kathy Monteith, Lisa McSweeney, Colm R. Breathnach, Lucy Sherrin, Patrick Dicker, Elizabeth C. Tully, John O'Loughlin, Sharon Campbell, Greg Byrne, Fergal Malone, Afif EL-Khuffash, Etaoin Kent, and Ann Doherty This article is available at ARROW@TU Dublin: https://arrow.tudublin.ie/scschbioart/165 331 First trimester prediction of uteroplacentaldisease- results of the prospective handle studyCathy Monteith1, Lisa McSweeney1, Colm R. Breathnach1,Lucy Shirren1, Patrick Dicker1, Elizabeth C. Tully1,John O’Loughlin2, Sharon Campbell2, Greg Byrne3,Fergal D. Malone1, Afif EL-Khuffash2, Etaoin Kent2, Ann Doherty21RCSI, Dublin, Ireland, 2Rotunda Hospital, Dublin, Ireland, 3Dublin Instituteof Technology, Dublin, IrelandOBJECTIVE: To assess the ability of non-invasive cardiac outputmonitoring (NICOM), a novel method of non-invasive maternalhemodynamic assessment using bioreactance, in combination withfirst trimester biomarkers to predict the evolution of gestationalhypertension (GH), pre-eclampsia (PE) and normotensive fetalgrowth restriction (FGR).STUDY DESIGN: Low risk nulliparous women were enrolled in a singlecenter prospective observational study. NICOM assessments wereperformed at 14 weeks’ gestation and data obtained on cardiacoutput (CO), indexed CO (adjusted for maternal body surface area;COI), total peripheral resistance (TPR), indexed TPR (adjusted formaternal body surface area; TPRi), stroke volume (SV), indexed SV(adjusted for maternal body surface area; SVi) and heart rate (HR).Maternal serum samples were obtained in the first trimester and thefollowing markers were analysed: placental growth factor (PLGF;Cobas Roche); soluble fms-like tyrosine-1 (s-flt-1; Elecsys) Apelin13 (Nori ELISA) and mean platelet volume (MPV). Corrleationbetween cardiac variables and biomarkers was assessed usingSpearman coefficient. Discriminant analysis was employed to modelGH, PE and FGR with NICOM and biomarker measurements aspredictors. Logistic regression was performed on variables of interestvia SAS version 9.0.RESULTS: The haemodynamic profile of pregnancies complicated byuteroplacental disease- GH (n¼13), PE (n¼5) and FGR (n¼18)were compared to 61 healthy unaffected pregnant controls.Apelin 13demonstrated a negative correlation with TPRi (r¼-0.29, p¼0.004),and a positive correlation with COi (r¼0.29, p¼0.005). In the pre-diction of PE s-flt-1 and MPV had a combined prediction modelAUC 0.88 (p¼0.01). Whereas in the prediction of FGR s-flt-1, SVand TPRI had a combined prediction model AUC 0.76 (p¼0.007).CONCLUSION: Apelin 13 is an inodilator produced by the normalplacenta in pregnancy. This study shows the hemodynamic effects ofApelin 13 are present as early as 14 weeks’ gestation. Down regu-lation of placental Apelin 13 has been linked with PE and lowerserum Apelin with FGR, from 20 weeks’ gestation onwards. How-ever, this association was not present at 14 weeks’ gestation. Inaddition to its known use in PE, first trimester s-flt-1 may have anrole in the prediction of FGR which is strengthened by the additionof hemodynamic variables.332 Can a point-of-care hemoglobin device replacecomplete blood count for fetal blood samplingduring intrauterine transfusion?Cathy Monteith1, Jahan Jadauji1, Hala Abu1, Ann M. McHugh1,Jennifer C. Donnelly2, Ciaran Mooney2, Siobhan Enright2,Niamh Hayes2, Fergal D. Malone11RCSI, Dublin, Ireland, 2Rotunda Hospital, Dublin, IrelandOBJECTIVE: Our objective was to prospectively validate a Point-of-Care (POC) hemoglobin device (Hemocue 201 DM system) as analternative to a laboratory based complete blood count (CBC) in thesetting of hemoglobin evaluation during cordocentesis and intra-uterine fetal transfusion.STUDY DESIGN: This prospective study was performed in a tertiarylevel maternity hospital. Fifteen consecutive cases of fetal anemiaattending the hospital for cordocentesis and intrauterine fetaltransfusion over an 18 month period were included. At the time ofcordocentesis all participants had at least two episodes of dual fetalblood sampling with both a POC Test and a laboratory-based CBC.Statistical analysis was performed via Pearson’s test.RESULTS: Fifteen cordocentesis procedures were performed duringthe 18 month period yielding a total of 35 paired samples. There wasstrong correlation between the POC hemoglobin and a CBC he-moglobin with r¼0.976 (95% CI 0.952-0.988) and a p value<0.0001. This study demonstrated a linear fit between both methodsof hemoglobin quantification enabling the prediction of the antici-pated CBC hemoglobin from CBC hemoglobin via the equationHemocue Hemoglobin ¼ 2.902 + 0.9617 Laboratory Hemoglobin.CONCLUSION: Overall there is good agreement between the POC fetalhemoglobin and the CBC fetal hemoglobin. This suggests that theHemocue 201 DM system is a viable and reproducible alternativeform of measurement of fetal hemoglobin, with the importantadvantage of providing expedited results at the bedside. This ulti-mately may reduce fetal morbidity associated with cordocentesis andintrauterine transfusion, minimizing the time required to completethe procedure.ajog.org Poster Session IISupplement to JANUARY 2018 American Journal of Obstetrics & Gynecology S207333 Potential preeclampsia therapy testedAsif Ahmed, Keqing Wang, Shakil Ahmad, Homira RezaiAston Medical School of Aston University, Birmingham,United KingdomOBJECTIVE: Low circulating levels of placenta growth factor (PlGF) isstrongly associated with the onset of preeclampsia. Although, PlGF-deficient mice are born healthy and fertile at a Mendelian ratio, thephysiological importance of PlGF in the pathogenesis of pre-eclampsia is unclear. We hypothesised that decreased levels of PlGFin pregnancy exacerbates the fetal growth restriction associated withpreeclampsia in the presence of high soluble Flt-1 (sFlt-1). Earlierstudies showed that heme oxygenase-1 (HO-1) pathway inhibitssFlt-1 and as hydrogen sulfide (H2S) stimulates HO-1, we arguedH2S donors will recuse the defects.STUDY DESIGN: Pregnant PlGF-/- mice were injected with adenovirusencoding sFlt-1 (Ad-sFlt-1) at high (i) 1.5x109 pfu/ml and low (ii)0.5x109 pfu/ml doses. Mean arterial blood pressure (MBP),biochemical and histological assessments of maternal kidney,placenta and embryos were performed.RESULTS: Ad-sFlt-1 significantly increased MBP and induced se-vere glomerular endotheliosis in PlGF-/- mice at E10.5 gestationcompared to wild-type animals. High sFlt-1 also significantlyelevated albumin-creatinine ratio and increased levels of urinarykidney injury molecule-1, a marker for proximal tubule injury. Ata high dose of sFlt-1, there was complete fetal resorption in thepregnant PlGF-/- mice, and even the lower dose of sFlt-1 inducedsevere fetal resorption and abnormal placental vascularization.H2S-releasing agent, GYY4137, significantly reduced resorption,hypertension and proteinuria in Ad-sFlt-1 treated pregnantPlGF-/- mice. To determine if placental PlGF is critical for pre-venting fetal growth restriction associated with preeclampsia, wegenerated haploinsufficient PlGF+/- placentas and embryos weregenerated in wild-time dams and exposed to high sFlt-1 envi-ronment. This resulted in reduced fetal resorption, gestationalhypertension and proteinuria when compared to pregnant PlGF-/-mice.CONCLUSION: Placental PlGF is a critical protective factor againstthe damaging effects of high sFlt-1 associated with preeclampsiaand activation of the H2S pathway appears to rescue pre-eclampsia phenotype even under low PlGF environment possiblyby upregulating other protective pathways such as the HO-1/COsystem.334 Preeclampsia with severe features: IsIbuprofen dose associated with elevated bloodpressures postpartum?Jonathan S. Hirshberg, Shahroz Fatima, Julia D. Lo´pez,Methodius G. Tuuli, George A. Macones, Alison G. CahillWashington University School of Medicine in St. Louis, St. Louis, MOOBJECTIVE: The American College of Obstetricians and Gynecolo-gists (ACOG) Task Force statement on Hypertension in Pregnancyrecommends that clinicians withhold nonsteroidal anti-inflamma-tory medications in patients with postpartum hypertension. Wesought to determine if there was a dose dependent association be-tween Ibuprofen dose and blood pressures postpartum in those withpreeclampsia with severe features.STUDY DESIGN: This was a planned secondary analysis of a pro-spective cohort study of consecutive term patients meeting diag-nostic criteria for preeclampsia with severe features delivered at asingle academic medical center. Ibuprofen dose, frequency and timeof administration were collected during the postpartum course.Noninvasive measurements of systolic and diastolic blood pressures(NIBP) were used to calculate daily mean arterial pressure (MAP).Association between Ibuprofen dose and MAPs were estimated usingparametric T-tests.RESULTS: Of the 335 patients in our analysis, 94% received Ibuprofenpostpartum. For those that received Ibuprofen, there was no asso-ciation between daily Ibuprofen dose and mean postpartum MAP(Figure). The median total dose of ibuprofen was 3g during thepostpartum hospitalization. Patients who received more than 3g ofibuprofen had an average MAP of 100.59.1 mmHg, which did notdiffer significantly from those who received less than 3g (99.49.4mmHg, p¼ 0.28). This relationship persisted across modes of de-livery (Table).CONCLUSION: There is no association between postpartum ibuprofenuse with standard dosing and mean arterial blood pressure in pa-tients with preeclampsia with severe features.Poster Session II ajog.orgS208 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2018View publication stats

First Trimester Prediction of Uteroplacental Disease- Results of the Prospective Handle Study

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First Trimester Prediction of Uteroplacental Disease- Results of the Prospective Handle Study

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