Document Type : Original Article

Authors

1 Associate Professor, Department of Ob. & Gyn., Afzalipoor School of Medicine & Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran

2 Gynecologist, Department of Ob. & Gyn, NikNafs Hospital , Rafsanjan University of Medical Sciences, Rafsanjan , Iran

3 Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Abstract

Background: Epidemiologic studies have shown the relationship of maternal hemoglobin level and abnormal findings in uterine Doppler sonography with pregnancy- related complications. In this study, we evaluated the relationship of uterine artery Doppler velocimetry findings and hemoglobin level with the outcomes of pregnancy in women with preeclampsia and healthy women.
Methods: In this prospective study performed from September 2013 to September 2014, 50 patients with Preeclampsia in the third trimester (more than 28 weeks) referred to Afzalipour Hospital, Kerman/ Iran and 50 healthy pregnant women who attended the perinatology clinic for prenatal care, were randomly selected. The results of uterine artery Doppler, hemoglobin concentration and outcome of pregnancy were compared between the two groups.
Results:Twenty nine patients (51%) with preeclampsia and 17 patients (34%) in the control group had abnormal Doppler findings. In both groups, birth weight was lower in women with abnormal Dopller findings compared to the women who had normal sonography findings (p=0.024 and p=0.008, respectively); furthermore, in both groups, gestational age at birth time was lower in women with abnormal sonography findings (p=0.044 and p=0.012, respectively). The average hemoglobin concentration was not statistically different between the two groups and abnormal Doppler findings showed no significant relationship with the mean concentration of hemoglobin in none of the two groups.
Conclusion: This study showed that abnormal findings in Doppler of the uterine artery are associated with adverse pregnancy outcomes such as low birth weight and premature births and the coexistence of preeclampsia is associated with worse pregnancy outcomes.
 

Keywords

  1. Shahabi A, Wilson ML, Lewinger JP, Goodwin TM, Stern MC, Ingles SA. Genetic admixture and risk of hypertensive disorders of pregnancy among Latinas in Los Angeles County. Epidemiology 2013; 24(2): 285-94.
  2. Ghi T, Youssef A, Piva M, Contro E, Segata M, Guasina F, et al. The prognostic role of uterine artery Doppler studies in patients with late-onset preeclampsia. AmJ Obstet Gynecol 2009; 201(1): 36. e1-. e5.
  3. Hladunewich M, Karumanchi SA, Lafayette R. Pathophysiology of the clinical manifestations of preeclampsia. Clinical journal of the American Society of Nephrology : CJASN 2007; 2(3): 543-9.
  4. Maged AM, Elnassery N, Fouad M, Abdelhafiz A, Al Mostafa W. Third -trimester uterine artery Doppler measurement and maternal postpartum outcome among patients with severe pre-eclampsia. Int J Gyn Obtet 2015; 131(1): 49-53.
  5. Shwarzman P, Waintraub A, Frieger M, Bashiri A, Mazor M , Hershkovitz R.Third trimester abnormal uterine artery Doppler findings are associated with adverse pregnancy outcomes.J Ultrasound Med 2013 ; 32 (12):2107-2113.
  6. Hwang HS, Kim YH, Kwon JY, Park YW. Uterine and umbilical artery Doppler velocimetry as a predictor for adverse pregnancy outcomes in pregnant women with anemia. J perinat Med 2010; 38(5): 467-71.             
  7. Gonzales GF, Tapia V, Gasco M,Carrillo CE.Maternal hemoglobin concentration and adverse pregnancy outcomes at low and moderate altitudes in Peru.J Matern Fetal Neonatal Med ; 2012; 25 (7): 1105-1110.
  8. Cordina M, Bhatti S, Fernandez M, Syngelakki A, Kypros H, Nicolaides KH, Kametas NA.Maternal .hemoglobin at 27-29 weeks gestation and severity of prreclampsia. JMatern Fetal Neonatal Med2015; 28 (13): 1-6.
  9. Gomez O, Figueras F, Fernandez S, Bennaser M, Martinez JM, Puerto B, et al. Reference ranges for uterine artery mean pulsality index at 11-14 weeks of gestation. Ultrasound Obstet Gynecol 2008; 32 (2): 126-32.
  10. Eser A, Zulfikaroglu E, Eserdag S, Kilic S, Danisman N. Predictive value of middle cerebral artery to uterine artery pulsatility index ratio in preeclampsia. Arch Gynecol Obstet 2011; 284(2): 307-11.
  11. Herraiz I, Escribano D, Gómez‐Arriaga P, Herníndez‐García J, Herraiz MA, Galindo A. Predictive value of sequential models of uterine artery Doppler in pregnancies at high risk for pre‐eclampsia. Ultrasound Obstet Gynecol 2012; 40(1): 68-74.
  12. Myatt L, Clifton RG, Roberts JM, Spong CY, Hauth JC, Varner MW, et al. The utility of uterine artery Doppler velocimetry in prediction of preeclampsia in a low-risk population. Obstet gynecol 2012; 120(4): 815-22.
  13. Pinto de Melo BC, Ramos de Amorim MM, Katz L, Coutinho I, Veríssimo G. Uterine artery Doppler in the third trimester of pregnancy and postnatal outcome of patients with severe preeclampsia. Hypertens pregnancy 2010; 29(2): 135-47.
  14. Guzin K, Tomruk S, Tuncay YA, Naki M, Sezginsoy S, Zemheri E, et al. The relation of increased uterine artery blood flow resistance and impaired trophoblast invasion in pre-eclamptic pregnancies. ArchGynecolObstet 2005; 272(4): 283-8.
  15. Hunkapiller NM, Gasperowicz M, Kapidzic M, Plaks V, Maltepe E, Kitajewski J, et al. A role for Notch signaling in trophoblast endovascular invasion and in the pathogenesis of pre-eclampsia. Development  2011; 138(14): 2987-98.
  16. Vergani P, Roncaglia N, Andreotti C, Arreghini A, Teruzzi M, Pezzullo JC, et al. Prognostic value of uterine artery Doppler velocimetry in growth-restricted fetuses delivered near term. Am J Obstet Gynecol 2002; 187(4): 932-6.
  17. Yip R. Significance of an abnormally low or high hemoglobin concentration during pregnancy: special consideration of iron nutrition. Am J Clin Nut 2000; 72(1 Suppl): 272s-9s.
  18. Makuyana D, Mahomed K, Shukusho FD, Majoko F. Liver and kidney function tests in normal and pre-eclamptic gestation--a comparison with non-gestational reference values. Cent Afr J Med 2002; 48(5-6): 55-9.
  19. Hershkovitz R, Ohel I, Sheizaf B, Nathan I, Erez O, Sheiner E, et al. Erythropoietin concentration among patients with and without preeclampsia. Arch Gynecol Obstet 2005; 273(3): 140-3.
  20. Ventura SJ, Martin JA, Curtin SC, Matthews T, Park MM. Births: final data for 1998: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 2000.