Uterine Artery Doppler in the Second Trimester as a Predictor of Preeclampsia in High Risk Pregnancy

Abstract

Preeclampsia is a multisystem disorder of pregnancy which is a major cause of maternal and fetal morbidity and mortality worldwide. The cardinal clinical features of the condition are hypertension and proteinuria occurring after 20 weeks gestation in women who were not previously known to be hypertensive and the symptoms include (a) Proteinuria (b) Dysfunctions of maternal organs which can be renal insufficiency, hepatic impairment, And neurological Complications. (c) Uteroplacental dysfunctions: fetal growth restriction; changes in the Doppler velocimetry studies of the umbilical artery, especially if combined with alterations in uterine arteries. The etiology of preeclampsia is still unknown, although an excessive maternal systemic inflammatory response and an imbalance between circulating angiogenic and anti-angiogenic factors have been described. The pathophysiology of preeclampsia is based on the incapability of the trophoblast to invade properly the myometrium causing a limited remodeling of spiral arteries. The impaired placental perfusion caused by vascular abnormalities precedes clinical manifestations of preeclampsia and it can be detected by Doppler ultrasound. Doppler ultrasound provides a non-invasive way to examine placental blood flow and placental vascular resistance on the maternal and fetal sides of the placenta, enabling information about the maternal – fetal circulation. The normal course of pregnancy is characterized by increased diastolic blood flow velocity and diastolic notch loss in the second trimester of pregnancy, around the gestational age of 22 weeks. Pregnancy with persistent notch and increased blood flow resistance may have a high risk of preeclampsia, premature birth, and intrauterine growth restriction. This investigation allows the identification of pregnancies that are at high risk for developing preeclampsia and occurance of maternal and fetal complications. Maternal Complications of preeclampsia include: Eclampsia, stroke, Abruptio placenta, DIC, Hemolysis, Pulmonary edema and death. Fetal complications include fetal growth restriction, Preterm delivery, hypoxia/acidosis and perinatal death. The aim of the work was to evaluate the role of uterine artery Doppler in the second trimester as a predictor of preeclampsia in high risk pregnancy. We included 80 pregnant females in the second trimester at high risk pregnancy in our study, uterine artery Doppler ultrasound was done in the second trimester and the patients were followed up in the third trimester for blood pressure measurement and diagnosis of PE. Our results revealed correlation between high indices of uterine arteries and development of PE. On conclusion, our study revealed that we can use uterine artery Doppler as a reliable method to predict preeclampsia.