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Uterine artery Doppler ultrasonography and pregnancy outcome in women with a history of early onset pre‐eclampsia and thrombophilia
Author(s) -
Van Eyck J.,
Arabin B.,
Wibbens B.
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.abs27-22.x
Subject(s) - medicine , thrombophilia , gestation , obstetrics , pregnancy , eclampsia , aspirin , gynecology , uterine artery , thrombosis , surgery , biology , genetics
Purpose: To assess the relationship between persistence after 22 weeks' gestation of the notch in the uterine artery and pregnancy outcome in pregnant women with a history of early onset (<32 weeks) pre‐eclampsia, were tested for thrombophilia and subsequently received medication according to the disorder. Methods: Between 1995 and 2000, Doppler ultrasonography of both uterine arteries was performed between 18 and 24 weeks, in 80 pregnant women with a history of early onset pre‐eclampsia, were tested for thrombophilia. A total of 34 women had no thrombophilia and had received only low‐dose aspirin as from 12 weeks' gestation. Forty‐six women had thrombophilic disorders like: protein S deficiency ( N = 10), APC‐resistance ( N = 11), anticardiolipin antibodies ( N = 15) and had received low‐dose aspirin as from 12 weeks gestation in combination with low‐molecular heparin as from 7 weeks' gestation. Seventeen women from this group of 46 women also suffered from hyperhomocysteinemia. Next to their treatment with folic acid and pyridoxin, they had received low‐dose aspirin as from 12 week gestation. Five women had a combination of two disorders and one woman had three disorders. Results: In 29 women with single hit thrombophilia (protein S deficiency, APC‐resistance or anticardiolipin antibodies), notches persisted in only one woman, who subsequently developed pre‐eclampsia (PE) at 31 weeks. Of the remaining 28 women, four developed PE at 31, 31, 35 and 39 weeks despite disappearance of notches. In 12 women with single hit hyperhomocysteinemia, notches persisted in three women, one of them developing PE at 33 weeks. From the remaining nine women, two developed PE at 31 and 35 weeks. In 34 women without thrombophilia, notches persisted in four, one of them developing PE at 36 weeks. From the remaining 30 women, 3 developed PE at 29, 29 and 38 weeks. Conclusions: The percentage of persistence of uterine notch in women with ‘treated’ thrombophilia is comparable to women without thrombophilia (11 vs. 12%), whereas recurrence rate of PE is, respectively, 19 and 12%. In both groups averaged gestational age at which PE developed was 3 weeks later than in the index pregnancy. Whether these observations can be contributed to the described medication is currently evaluated in a large prospective, randomized, multicenter study in The Netherlands (FRUIT study).