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  • Title: PP110. The role of doppler to predict adverse pregnancy outcome in patients with pre-eclampsia.
    Author: Pagani G, Gerosa V, Gregorini ME, Rovida PL, Prefumo F, Valcamonico A, Frusca T, Andrea L.
    Journal: Pregnancy Hypertens; 2012 Jul; 2(3):298-9. PubMed ID: 26105432.
    Abstract:
    INTRODUCTION: Recently Middle Cerebral Artery (MCA) to uterine artery (UtA) Pulsatility Index (PI) ratio and MCA to Umblical Artery (UA) PI ratio have been described to be good predictors of neonatal outcome in pre-eclamptic patients in the third trimester and have been proposed to identify fetuses at risk of morbidity and mortality. OBJECTIVES: To investigate the value of doppler indexes such as MCA PI, UA PI; MCA to UtA PI ratio and MCA to UA PI ratio to predict adverse pregnancy outcome (APO) in patients affected by Pre-eclampsia (PE). METHODS: Cohort study on 100 consecutive singleton pregnancies complicated with pre-eclampsia referred to our Department from January 2010 and December 2011.Doppler evaluations were performed from diagnosis to delivery.UtA, UA and ACM PI were assessed at each scan, Measurements obtained within one week from delivery were analysed, and MCA/UA PI ratio and MCA/UtA PI ratio calculated.PE was defined according to ISSHP criteria.Clinical and perinatal outcomes were reviewed.APO was defined as Apgar score less than 7 at five minutes, pH<7.20; birth weight <5th percentile (SGA), stillbirth or neonatal death. Receiver-operating characteristics (ROC) curves were used to determine the predictive ability for subsequent development of APO. Logistic regression was run to assess the additional value to the routine indexes for both ratios. RESULTS: One case of stillbirth and four cases of neonatal death were observed.SGA was present in 56/100 neonates; 52/95 (55%) live births were admitted to Neonatal Intensive Care Unit.Maternal Age was 33years (mean, SD±5yy), mean maternal BMI was 23.6Kg/mq (SD±4.9Kg/mq), gestational age (GA at diagnosis of PE was 32+5w (mean, SD±3+6w), GA at delivery was 33+4w (mean, SD±3+4w), birth weight percentile was 13.33 (mean, SD±18.23), pH was 7.26 (mean, SD±0.11)Fifty-six pregnancies developed APO. Doppler findings assessed within one week from delivery are shown in Table 1, values are expressed as mean (±SD). The prediction of subsequent development of APO, expressed as the area under ROC curve, was 0.695 (95% CI 0.59-0.80) for UtA PI; 0.730 (95% CI 0.62-0.81) for UAPI; 0.677 (95% CI 0.55-0.78) for MCA PI; 0.785 (95% CI 0.66-0.87) for MCA/UA PI; 0.774 (95% CI 0.66-0.86) for MCA/UtA PI. Moreover, a MCA/UA PI=1.28 showed a sensitivity of 74.4% and a specificity of 76.0% in predicting APO. Logistic regression analysis showed that the better index combination is represented by MCA/UA PI and MCA/UtA PI. CONCLUSION: In addition to UtA and UAPI, MCA/UA PI ratio and MCA/UtA PI ratio are useful predictors of neonatal outcome in pregnancies complicated with PE.
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