27th World Congress on Ultrasound in Obstetrics and Gynecology Short oral presentation abstracts
Objectives: To assess quality of measurements of mean arterial
pressure (MAP), mean uterine artery pulsatility index (UtPI),
pregnancy-associated plasma protein A (PAPP-A) and placental
growth factor (PlGF) in first trimester screening for pre-eclampsia
program.
Methods: Consecutive patients attending first trimester screening
for aneuploidies in a large practice in Sydney, Australia, from
May 2014 to February 2017 also had combined screening for
pre-eclampsia based on the Fetal Medicine Foundation (FMF)
algorithm. Distributions of MAP, UtPI, PAPP-A and PlGF, expressed
as multiples of the median (MoM) were plotted in relation to the
previously published UK median. Temporal analyses were produced
by cumulative sum charts (CUSUM) and monthly distributions.
Central tendency and dispersion charts were also produced for each
individual UtPI operator.
Results: 26,543 women attended for first trimester assessment and
21,010 had screening for pre-eclampsia with all four markers
measured. Median MAP (n=26,450) UtPI (n=25,672), PAPP-A
(n=23,471) and PlGF (n=21,723) MoM were 0.959, 1.031, 1.137
and 0.977, respectively. Of those, MAP and PAPP-A measurements
were outside the expected range (±0.2 SD Log
10
[MoM]), and PlGF
had a negative bias after March 2016. Most sonographers (40/46)
measured UtPI within the acceptable range. The screen positive
rate (SPR) for preterm pre-eclampsia, using a cut-off of 1:100, was
11.8%, similar with previous validation studies.
Conclusions: While slight variations on biomarkers could be
due to population characteristics and are unlikely to have
major consequences on detection rate, bigger biases might affect
significantly the SPR. Therefore, quality assurance process is essential
in a first trimester screening program.
OP17.07
Worsening of the uterine artery Doppler is associated with the
development of hypertensive disorders of pregnancy
J. Binder
3,2
, C.A. Monaghan
3,1
, S. Carta
3
, B. Thilaganathan
3
,
A. Khalil
3
1
Fetal Medicine Department, Royal Maternity Hospital,
Belfast, Co Down, United Kingdom;
2
Department of
Obstetrics and Fetomaternal Medicine, Medical University of
Vienna, Vienna, Austria;
3
Fetal Medicine Unit, St George’s
Hospital Medical School, University of London, London,
United Kingdom
Objectives: Hypertensive disorders of pregnancy (HDP) are associ-
ated with impaired placentation, as evidenced by abnormal uterine
artery (UtA) Doppler. UtA mean pulsatility index (PI) shows a
progressive decline with gestational age (GA). However, previous
studies have reported that a proportion of pregnancies demonstrate
worsening of the UtA Doppler. The aim of this study was to investi-
gate the incidence of HDP according to the change in the UtA mean
PI between the second and third trimester.
Methods: This cohort study included singleton pregnancies under-
going longitudinal UtA Doppler assessment in the second and third
trimester. All the parameters were converted into centiles and multi-
ples of the median (MoM) adjusting for GA. The study cohort was
divided into 2 groups according to the change in the UtA Doppler
between the second and third trimesters (decline or no change vs
increase in the mean PI MoM). HDP included women who developed
pre-eclampsia and gestational hypertension. Regression analysis was
used to adjust for potential confounders.
Results: The analysis included 5887 pregnancies. The incidence
of HDP was significantly higher in the group with worsening of
the UtA mean PI compared to those without (7.9% vs 5.8%;
p<0.002). Logistic regression analysis demonstrated that both the
second trimester UtA PI MoM (OR 8.12, 95% CI 5.07-13.00;
p<0.001) and the difference between the 2 trimesters (OR 3.41, 95%
CI 2.434-4.768; p<0.001) were significant independent predictors
for the development of HDP.
Conclusions: Worsening of the UtA Doppler, independent of the
value recorded in the second trimester, is associated with HDP.
OP17.08
Echocardiography and heart rate variability in pregnant
women with essential arterial hypertension and pre-eclampsia
V. Makukhina
Kuban State Medical University, Krasnodar, Russian
Federation
Objectives: Pre-eclampsia is associated with pregnancy in 2-8% of
cases. Arterial hypertension presents danger for the mother and fetus
and provokes pre-eclampsia.
Our research represents a comparative evaluation of echocardiog-
raphy and heart rate variability (HRV) data of pregnant women with
essential arterial hypertension, gravidas suffering from pre-eclampsia
and healthy carriers.
Methods: Three groups of pregnant women were examined: 11
had essential arterial hypertension (group 1, average age 35,3±1,0),
10 had pre-eclampsia (group 2, average age – 30,1±1,7) and 5
were healthy (group 3, 33±1,7 age). An echocardiography and
daily ECG-monitoring with HRV evaluation were conducted for all
patients.
Results: The study has revealed a statistically significant increase in
the interventricular septum thickness in the group 1, when compared
to the group 2 (p<0.05). At the same time left ventricle (LV)
ejection fraction was significantly higher in the group 2 than in
other groups (p<0.05). There was no difference in the end-diastolic
size and LV myocardium masse index between the groups. Results
showed a statistically significant decrease of standard deviation
normal to normal beat (SDNN) (p<0,01), SDNNi (SDNN index)
and SDANNi (p<0,05) in group 1 compared with group 3. A strong
negative correlation was found between the age of patients in the
group 1 and their SDNN (correlation coefficient -0,8) and rMSSD
data values (correlation coefficient -0,85). All pregnant women with
obesity in groups 1 and 2 had different grade of uterine-placental
hemodynamics disorders (odds ratio – 3,75).
Conclusions: Carriers with pre-eclampsia have increased left
ventricle ejection fraction, which is not accompanied with the
decline of HRV measures. Pregnant women with essential arterial
hypertension have deterioration of HRV measures. Obesity
is associated with more frequent cases of uterine-placental
hemodynamics disorders.
OP17.09
Flow mediated dilation and peripheral arterial tonometry are
disturbed in pre-eclampsia and reflect different aspects of
endothelial function
D. Mannaerts
1,2
, E. Faes
1,2
, E. Van Craenenbroeck
3,4
,
C. De Bruyn
2
, M. Spaanderman
5
, W. Gyselaers
6
,
Y. Jacquemyn
1,2
1
Research Group ASTARC, Antwerp Surgical Training,
Anatomy and Research Centre, University of Antwerp,
Antwerp, Belgium;
2
Obstetrics and Gynecology, Antwerp
University Hospital, Antwerp, Belgium;
3
Laboratory for
Cellular and Molecular Cardiology and Department of
Cardiology, Antwerp University Hospital, Antwerp, Belgium;
4
Research Group Cardiovascular Diseases, Translational
Pathophysiological Research, Antwerp University Hospital,
Antwerp, Belgium;
5
Obstetrics and Gynecology, MUMC
Maastricht University, Maastricht, Netherlands;
6
Obstetrics
and Gynecology, Hasselt University, Genk, Belgium
Objectives: Endothelial function and arterial stiffness are known to
be altered in pre-eclamptic pregnancies. Previous studies have shown
conflicting results regarding the best technique for assessing vascular
© The Authors 2017
104 © Ultrasound in Obstetrics & Gynecology 2017; 50 (Suppl. 1): 48–153.