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Uterine artery Doppler, birth weight and timing of onset of pre‐eclampsia: providing insights into the dual etiology of late‐onset pre‐eclampsia
Author(s) -
Verlohren S.,
Melchiorre K.,
Khalil A.,
Thilaganathan B.
Publication year - 2014
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.13310
Subject(s) - medicine , eclampsia , obstetrics , uterine artery , birth weight , gestational age , small for gestational age , pregnancy , retrospective cohort study , gestation , gynecology , genetics , biology
ABSTRACT Objective To investigate the relationship between uterine artery Doppler ultrasound indices and birth weight in women with early‐, intermediate‐ and late‐onset pre‐eclampsia as compared with women with uneventful pregnancy outcome. Methods In a retrospective, observational cohort study, uterine artery Doppler assessment was carried out at 18 + 0 to 23 + 6 weeks' gestation in 26 893 women attending for routine antenatal care in a tertiary care center. The mean resistance index ( RI ) and its relationship to the outcome of pregnancy and birth‐weight centiles were evaluated. Results Uterine artery RI showed a significant, negative correlation with birth weight ( r = −0.20, P < 0.0001). Patients with early‐onset pre‐eclampsia had an increased prevalence of high uterine artery mean RI , above the 90 th centile, corresponding to an increased proportion of small‐for‐gestational age ( SGA ) neonates with a birth weight below the 10 th centile. In late‐onset pre‐eclampsia, however, there was an unexpectedly higher proportion of large‐for‐gestational‐age ( LGA ) neonates with a birth weight above the 90 th centile without a concurrent increase in the prevalence of low uterine artery mean RI below the 10 th centile. Conclusions The finding of a bimodal skewed distribution of birth weight, with neonates exhibiting a higher prevalence of both LGA and SGA with late‐onset pre‐eclampsia, indicates that there are two types of late‐onset pre‐eclampsia. These findings explain the poor performance of mid‐trimester uterine artery Doppler in predicting pre‐eclampsia at term and provide insights into the placental origins of the early and late forms of pre‐eclampsia. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd