Premium
The role of thromboelastography in conjunction with second trimester uterine artery Doppler velocimetry in the prediction of adverse pregnancy outcome
Author(s) -
Karidas C.,
Anastassopoulos P.,
Perry D.,
Economides D. L.
Publication year - 2001
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 - 10.1046/j.1469-0705.2001.0180s1044.x
Subject(s) - medicine , thromboelastography , velocimetry , obstetrics , eclampsia , uterine artery , umbilical artery , gestational age , pregnancy , laser doppler velocimetry , gestation , prospective cohort study , cardiology , blood flow , physics , genetics , biology , optics , coagulation
Purpose: A pilot, prospective study to evaluate the use of thromboelastography in conjunction with uterine artery Doppler in the second trimester as predictors of pre‐eclampsia and IUGR (intrauterine growth restriction defined as birth weight below the 5th centile for gestational age). Methods: Two‐hundred and forty‐nine (249) unselected pregnant women were recruited at their booking appointment in the Royal Free Hospital. They underwent thromboelastography assessment and color flow/pulsed Doppler imaging of both uterine arteries at 20–24 weeks gestation. Standard parameters were measured from each thromboelastography tracing ( R , reaction time; K , clot formation time; A , angle; MA , maximum amplitude). The presence or absence of notches in the flow velocity waveform was noted and the resistance index measured. The main outcome measures were pre‐eclampsia and IUGR. Results: Twenty‐three pregnancies (9.2%) were complicated by IUGR and 10 (4%) by pre‐eclampsia. Assessment using abnormal Doppler velocimetry, defined as bilateral notches/mean RI ≥ 0.55 (27 cases) or unilateral notch/mean RI ≥ 0.65 (5 cases), demonstrated 52% (95% CI 33–71%) sensitivity for IUGR and 40% (CI 17–69%) for pre‐eclampsia with positive predictive values 37.5% (23–55%) and 12.5% (5–28%), respectively. Furthermore, in the pregnancies complicated by an adverse outcome, the groups with normal (14 cases) and abnormal (15 cases) Doppler velocimetry did not differ significantly in any of the thromboelastography parameters (Mann–Whitney test for comparisons). Conclusion: Pulsed Doppler velocimetry of the uterine arteries in the second trimester is an established predictor of adverse pregnancy outcome. The additional use of thromboelastography assessment does not appear to contribute significantly in providing further information. As this is a pilot study, larger trials are required to delineate its role.