Search

Objective To investigate whether first-trimester arterial pulse wave analysis (PWA) can predict pre-eclampsia. Design This was a prospective screening study. Setting The Homerton University Hospital, a London teaching hospital. Population Two hundred and ten low-risk women with a singleton pregnancy were analysed. Methods Radial artery pulse waveforms were measured between the 11+0 and 13+6 weeks of gestation and the aortic waveform derived by applying a generalised transfer function. Augmentation pressure (AP) and augmentation index at heart rate of 75 beats per minute (AIx-75), measures of arterial stiffness, were calculated. The multiple of the gestation-specific median in controls for AP and AIx-75 were calculated. Logistic regression models were developed and their predictive ability assessed using the area under the receiver operator curve. Main outcome measures Prediction of pre-eclampsia by AIx-75. Results Fourteen (6.7%) women developed pre-eclampsia, and 196 remained normotensive. Eight of the 14 women developed pre-eclampsia before 34 weeks of gestation (early-onset pre-eclampsia). For a false-positive rate of 11%, AIx-75 had a detection rate of 79% for all cases of pre-eclampsia and 88% for early-onset pre-eclampsia. Conclusion First-trimester arterial PWA can play a significant role in understanding the pathophysiology of pre-eclampsia and may play a role in early screening. [ABSTRACT FROM AUTHOR]

Discusses the significance of the appropriate use of fetal biophysical and Doppler ultrasound in the management of the growth restricted fetus. Difficulties involved in using the advanced applications of Doppler ultrasound; Relationship between hypoxemia and redistribution of the fetal arterial circulation.

An abstract of the research paper "Hemodynamic and Placental Markers to Predict Pre-Eclampsia," by A.A. Khalil and colleagues is presented.

An abstract of the research paper "First Trimester Markers for Prediction of Pre-Eclampsia," by A.A. Khalil and colleagues is presented.

Study objectives: To evaluate the three commonly used indices of Doppler blood flow resistance in clinical practice for the uterine artery. By assessing the measures of central tendency, dispersion, and variation, to determine the most appropriate index for clinical use transabdominally in the second half of pregnancy. Methods: A prospective study of uterine artery Doppler measurement in singleton pregnancies between 18 and 32 weeks gestation. Using previously described methods, two independent measurements were obtained transabdominally from each side in all subjects. The systolic/diastolic ratio (SD ratio), pulsatility index (PI), and resistance index (RI) were recorded from both the right and left uterine artery in turn. All measurements were obtained by a single operator (MOT) using the same machine (Philips SD 800). The results were analyzed statistically for the measures of dispersion, distribution, and the variation explained. Results: There were 1796 observations from 449 subjects in total, with the SD ratio showing the widest dispersion. The PI measurements were intermediate with respect to both, while the RI showed the least dispersion. The RI distribution was the closest to a naturally distributed (Gaussian) pattern, followed by the PI. The SD ratio did not appear to conform to a normal distribution. The interquartile ranges (IRQ) for the SD ratio were 0.71, 0.73 (left- and right-uterine artery, respectively); PI: 0.42, 0.41; and RI: 0.15, 0.17. The mean of three derived measurements of the RI was sufficient to account for over 99% of the observed variation. Conclusions: Differences reported between the different resistance and pulsatility Doppler indices could be due to either random or systematic error, or a combination of both. The observations from this study suggest that when the RI is used, these are kept to a minimum. These findings may be helpful in selecting the appropriate index for uterine artery Doppler screening and clinical applications... [ABSTRACT FROM AUTHOR]

Superovulation therapy during assisted conception may result in a hypercoagulable state. Five cases of upper extremity venous thrombosis were identified in women who conceived after ovarian stimulation for in vitro fertilization (IVF). They presented between 7 and 10 weeks' gestation with neck pain and swelling. Three had been treated for ovarian hyperstimulation syndrome and two had evidence of inherited thrombophilia. Four patients received thromboprophylaxis before presentation. Although thrombosis is an uncommon complication of IVF, patients should be counselled before treatment. Thrombophilia screening may be considered for 'high-risk' patients, although current regimes for thromboprophylaxis remain suboptimal.