Document Detail

Second trimester Doppler ultrasound screening of the uterine arteries differentiates between subsequent normal and poor outcomes of hypertensive pregnancy: two different pathophysiological entities?
MedLine Citation:
PMID:  14636154     Owner:  NLM     Status:  MEDLINE    
The 'classical' concept that pregnancy-induced hypertension (PIH) and pre-eclampsia (PE) primarily originate from defective placentation in early pregnancy has been challenged recently. There is growing evidence that other factors, including maternal predisposing conditions, also play a significant role in the pathophysiology of PIH and PE. The aim of the present study was to test the hypothesis that PIH and PE with an early onset and poor pregnancy outcome is associated with defective placentation, e.g. inadequate spiral artery dilatation and subsequent reduced uteroplacental perfusion, whereas PIH and PE with normal pregnancy outcome is not. Using Doppler ultrasound, we measured the uterine artery pulsatility index (PI) in a population of 531 nulliparous women in the 22nd week of gestation. Uterine artery PI was used as an index of resistance to blood flow in the uteroplacental circulation. Outcome measures were PIH/PE with or without poor pregnancy outcome, preterm birth and intra-uterine growth restriction (IUGR). The results revealed a striking difference between PI values for PIH/PE with and without poor pregnancy outcome. Uterine artery PI in the 22nd week was increased significantly in pregnancies which developed early-onset (before 35 weeks) PIH/PE with a poor pregnancy outcome. In contrast, uterine artery PI values were normal in women who developed PIH/PE, but had a good pregnancy outcome. There was a significant correlation between 22nd week uterine artery PI and subsequent preterm birth or IUGR. Our results indicate that only PIH/PE with poor pregnancy outcome is associated with defective placentation, whereas PIH/PE with good outcome is not. These findings support the concept of heterogeneous causes of hypertensive disorders of pregnancy.
M W Aardema; M C S Saro; M Lander; B T H M De Wolf; H Oosterhof; J G Aarnoudse
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical science (London, England : 1979)     Volume:  106     ISSN:  0143-5221     ISO Abbreviation:  Clin. Sci.     Publication Date:  2004 Apr 
Date Detail:
Created Date:  2004-03-22     Completed Date:  2004-06-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7905731     Medline TA:  Clin Sci (Lond)     Country:  England    
Other Details:
Languages:  eng     Pagination:  377-82     Citation Subset:  IM    
Department of Obstetrics and Gynaecology, Division of Obstetrics and Perinatal Medicine, University Medical Centre Groningen, Postbox 30.001, 9700 RB Groningen, The Netherlands.
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MeSH Terms
Arteries / ultrasonography
Hypertension / physiopathology,  ultrasonography*
Placental Circulation
Pre-Eclampsia / physiopathology,  ultrasonography
Pregnancy Complications, Cardiovascular / physiopathology,  ultrasonography*
Pregnancy Trimester, Second
Ultrasonography, Doppler, Color
Uterus / ultrasonography*

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