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Do maternal cerebral vascular changes assessed by transcranial Doppler antedate pre‐eclampsia?
Author(s) -
Williams K. P.,
Moutquin J. M.
Publication year - 2004
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.955
Subject(s) - medicine , middle cerebral artery , eclampsia , transcranial doppler , gestational age , cardiology , doppler effect , prospective cohort study , hemodynamics , cerebral arteries , pregnancy , obstetrics , physics , ischemia , astronomy , biology , genetics
Objective To determine whether maternal transcranial Doppler (TCD) evaluation of the middle cerebral artery identifies changes in the cerebral circulation prior to the development of pre‐eclampsia. Methods In a nested, case‐controlled study developed from a previous prospective cohort study, 20 pre‐eclamptic and 40 normotensive pregnancies, matched for maternal age, were assessed with the traditional middle cerebrovascular Doppler parameters (pulsatility index, mean cerebral blood flow velocity), together with non‐traditional Doppler parameters including time taken to achieve end systole (EST) and percentage time to achieve end systole (% EST). Assessments done at 20–24 and 28–32 weeks' gestational age were compared using Student's t ‐tests. Significance was set at the P < 0.05 level. Results In the second trimester (20–24 weeks) there were no significant differences in any of the Doppler waveform characteristics in either group. In the third trimester (28–32 weeks) there was a significant increase in the % EST in the group who subsequently developed pre‐eclampsia (45.2 ± 4.2 vs. 42.3 ± 4.1; P < 0.01). Conclusions Patients who subsequently develop pre‐eclampsia show a significant lengthening in the EST in the third trimester as a late finding, which indicates an increase in the cerebrovascular resistance. Earlier prediction of pre‐eclampsia using TCD waveform analysis will require more provocative testing (i.e. hand grip and CO 2 reactivity). Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.