Evaluation of Relevance of Sonographic Findings with Prognosis and Outcomes of Pregnancy in Preeclampsia Patients in Comparison with Control Group

Document Type : Original Article(s)

Authors

1 Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran

2 Professor, Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Radiology, Iran University of Medical Sciences, Iran, Iran

4 Associate Professor of Obstetrics and Gynecology, Department of Obstetrics & Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran

10.48305/jims.v43.i809.0264

Abstract

Background: Preeclampsia is a multisystem disorder during pregnancy, affecting approximately 5–7% of pregnancies and leading to several complications in the mother, fetus and neonate. To date, no precise method has been discovered for the prevention and accurate screening of preeclampsia.
Methods: One proposed method for predicting the occurrence of preeclampsia is placental sonography and color Doppler and spectral Doppler and assessment of Pulsatility Index (PI) of uterine and umbilical arteries. This study aimed to evaluate the relevance of grayscale sonography, color Doppler and spectral Doppler findings of the placenta and the associated vessels with prognosis and unpleasant outcomes of pregnancy in the mother, fetus and neonate, in two groups, pregnant women with preeclampsia and a healthy control group.
Findings: The PI of uterine arteries (on each side, and the mean PI of bilateral uterine arteries), umbilical artery PI, and also presence of bilateral early diastolic uterine arteries notching on spectral Doppler study, had significantly higher incidence in the preeclampsia group. The Incidence of Preterm Birth, low fetal weight percentage, low fetal Abdominal Circumference, Low Birth Weight, rate of cesarean section, fetal and neonatal brain injuries, NICU admission and maternal ICU admission were significantly higher in the preeclampsia group. In addition, PI of uterine and umbilical arteries showed independent relevance with an increased rate of preterm birth.
Conclusion: The findings of this study suggest the prognostic usage of sonographic findings, particularly color and spectral Doppler studies, in predicting preeclampsia adverse outcomes of pregnancy in this setting.

Highlights

Mahshid Bahrami: Google Scholar, PubMed

Pooya Kiani: Google Scholar, PubMed

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References

  1. Predoi CG, Grigoriu C, Vladescu R, Mihart AE. Placental damages in preeclampsia - from ultrasound images to histopathological findings. J Med Life 2015; 8 Spec Issue (Spec Issue): 62-5.
  2. Kleinrouweler CE, Bossuyt PM, Thilaganathan B, et al. Value of adding second-trimester uterine artery Doppler to patient characteristics in identification of nulliparous women at increased risk for pre-eclampsia: an individual patient data meta-analysis. Ultrasound Obstet Gynecol 2013; 42(3): 257-67.
  3. Guzin K, Tomruk S, Tuncay YA, et al. The relation of increased uterine artery blood flow resistance and impaired trophoblast invasion in pre-eclamptic pregnancies. Arch Gynecol Obstet 2005; 272(4): 283-8.
  4. Tabatabaeian M, Kordi M, Dadgar S, Irani M. Evaluation of the role of serum markers and Doppler ultrasonography of uterine artery in predicting preeclampsia at the second trimester of pregnancy: A systematic review [in Persian]. Iranian Journal of Obstetrics, Gynecology and Infertility 2018; 21(Suppl): 76-85.
  5. Messerschmidt A, Baschat A, Linduska N, Kasprian G, Brugger PC, Bauer A, et al. Magnetic resonance imaging of the placenta identifies placental vascular abnormalities independently of Doppler ultrasound. Ultrasound Obstet Gynecol 2011; 37(6): 717-22
  6. Vinnars MT, Nasiell J, Ghazi S, Westgren M, Papadogiannakis N. The severity of clinical manifestations in preeclampsia correlates with the amount of placental infarction. Acta Obstet Gynecol Scand 2011; 90(1): 19-25.
  7. Viero S, Chaddha V, Alkazaleh F, Simchen MJ, Malik A, Kelly E, et al. Prognostic value of placental ultrasound in pregnancies complicated by absent end-diastolic flow velocity in the umbilical arteries. Placenta 2004; 25(8-9): 735-41.
  8. Papageorghiou AT, Yu CK, Cicero S, Bower S, Nicolaides KH. Second-trimester uterine artery Doppler screening in unselected populations: a review. J Matern Fetal Neonatal Med 2002; 12(2): 78-88.
  9. von Dadelszen P, Magee LA, Roberts JM. Subclassification of preeclampsia. Hypertens Pregnancy 2003; 22(2): 143-8.
  10. Gaugler-Senden IP, Huijssoon AG, Visser W, Steegers EA, de Groot CJ. Maternal and perinatal outcome of preeclampsia with an onset before 24 weeks' gestation. Audit in a tertiary referral center. Eur J Obstet Gynecol Reprod Biol 2006; 128(1-2): 216-21.
  11. Reister F, Heyl W, Kaufmann P, Rath W. [Trophoblast invasion in pre-eclampsia] [in German]. Zentralbl Gynakol 1999; 121(12): 587-90.
  12. Guzin K, Tomruk S, Tuncay YA, Naki M, Sezginsoy S, Zemheri E, et al. The relation of increased uterine artery blood flow resistance and impaired trophoblast invasion in pre-eclamptic pregnancies. Arch Gynecol Obstet 2005; 272(4): 283-8.
  13. Li H, Gudnason H, Olofsson P, Dubiel M, Gudmundsson S. Increased uterine artery vascular impedance is related to adverse outcome of pregnancy but is present in only one-third of late third-trimester pre-eclamptic women. Ultrasound Obstet Gynecol 2005; 25(5): 459-63.
  14. Kurdi W, Campbell S, Aquilina J, England P, Harrington K. The role of color Doppler imaging of the uterine arteries at 20 weeks' gestation in stratifying antenatal care. Ultrasound Obstet Gynecol 1998; 12(5): 339-45.
  15. Papageorghiou AT, Yu CK, Bindra R, Pandis G, Nicolaides KH; Fetal Medicine Foundation Second Trimester Screening Group. Multicenter screening for pre-eclampsia and fetal growth restriction by transvaginal uterine artery Doppler at 23 weeks of gestation. Ultrasound Obstet Gynecol 2001; 18(5): 441-9. 
  16. Papageorghiou AT, Yu CK, Nicolaides KH. The role of uterine artery Doppler in predicting adverse pregnancy outcome. Best Pract Res Clin Obstet Gynaecol 2004; 18(3): 383-96.
  17. Borgheei N.S., Rabeiei Mandajin Mohammad reza. Study of the relationship between ethnicity and incidence of Preeclampsia [in Persian]. J Sabzevar Univ Med Sci 2008; 15(2 (48)): 110-15.
  18. Mesdaghinia E, Talari H, Abedzadeh-Kalahroudi M. Effect of aspirin for prevention of preeclampsia in women with abnormal ultrasonic findings in uterine artery [in Persian]. Feyz 2011; 15(2): 98-104.
  19. Movahed F, Lalooha F, Moinodin R, Dabbaghi Ghale T, Rezaee Majd Z, Yazdi Z. The effect of aspirin in the prevention of preeclampsia in women with abnormal uterine artery doppler ultrasonography findings [in Persian]. J Adv Med Biomed Res 2017; 25(108): 11-9.
  20. Layegh P, Afiat M, Farrokh D, Salehi M, Rezvani Mahmouee Z, Mardani R. Evaluation of Uterine artery indexes in Doppler sonography for predicting neonatal outcomes in preeclamptic pregnancies [in Persian]. The Iranian Journal of Obstetrics, Gynecology and Infertility 2016; 19(9): 11-6.
  21. Ali Zarad C, Mohamed MH, Shanab WSA. Role of uterine artery Doppler in assessment of unexplained infertility. Egypt J Radiol Nucl Med 2021; 52: 59.
  22. Ashorn P, Ashorn U, Muthiani Y, Aboubaker S, Askari S, Bahl R, et al. Small vulnerable newborns-big potential for impact. Lancet 2023; 401(10389): 1692-706.
  23. Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371(9606): 75-84.
  24. Prelabor Rupture of Membranes: ACOG Practice Bulletin, Number 217. Obstet Gynecol 2020; 135(3): e80-e97.
  25. Novak CM, Ozen M, Burd I. Perinatal Brain Injury: Mechanisms, Prevention, and Outcomes. Clin Perinatol 2018; 45(2): 357-75.
  26. Gu S, Zhou C, Pei J, Wu Y, Wan S, Zhao X, et al. Esomeprazole inhibits hypoxia/endothelial dysfunction-induced autophagy in preeclampsia. Cell Tissue Res 2022; 388(1): 181-94.
  27. Ashwal E, Ali-Gami J, Aviram A, Ronzoni S, Mei-Dan E, Kingdom J, et al. Contribution of Second Trimester Sonographic Placental Morphology to Uterine Artery Doppler in the Prediction of Placenta-Mediated Pregnancy Complications. J Clin Med 2022; 11(22): 6759.
  28. Herzog EM, Eggink AJ, Reijnierse A, Kerkhof MAM, de Krijger RR, Roks AJM, et al. Impact of early- and late-onset preeclampsia on features of placental and newborn vascular health. Placenta 2017; 49: 72-79.
  29. Paules C, Dantas AP, Miranda J, Crovetto F, Eixarch E, Rodriguez-Sureda V, et al. Premature placental aging in term small-for-gestational-age and growth-restricted fetuses. Ultrasound Obstet Gynecol 2019; 53(5): 615-22.
  30. Lisonkova S, Joseph KS. Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset disease. Am J Obstet Gynecol 2013; 209(6): 544.e1-544.e12.
  31. Ying H, Lu Y, Dong YN, Wang DF. Effect of placenta Previa on preeclampsia. PLoS One 2016; 11(1): e0146126.
  32. Ziegler KA, Paul DA, Hoffman M, Locke R. Variation in NICU Admission Rates Without Identifiable Cause. Hosp Pediatr 2016; 6(5): 255-60.
  33. Lam MTC, Dierking E. Intensive Care Unit issues in eclampsia and HELLP syndrome. Int J Crit Illn Inj Sci 2017; 7(3): 136-41.
  34. Dimitriadis E, Rolnik DL, Zhou W, Estrada-Gutierre G, Koga K, Francisco RPV, et al. Pre-eclampsia Nat Rev Dis Primers 2023; 9(1): 8.
  35. Pietro L, Daher S, Rudge MV, Calderon IMP, Damasceno DC, Sinzato YK, et al. Vascular endothelial growth factor (VEGF) and VEGF-receptor expression in placenta of hyperglycemic pregnant women. Placenta. 2010; 31(9): 770-80.
  36. Mammaro A, Carrara S, Cavaliere A, Ermito S, Dinatale A, Pappalardo EM, et al. Hypertensive disorders of pregnancy. J Prenat Med 2009; 3(1): 1-5.
  37. Richards EMF, Giorgione V, Stevens O, Thilaganathan B. Low-dose aspirin for the prevention of superimposed preeclampsia in women with chronic hypertension: a systematic review and meta-analysis. Am J Obstet Gynecol 2023; 228(4): 395-408.
  38. Sandall J, Tribe RM, Avery L, Mola G, Visser GH, Homer CS, et al. Short-term and long-term effects of caesarean section on the health of women and children. Lancet 2018; 392(10155): 1349-57.
Journal of Isfahan Medical School
Volume 43, Issue 809
1st Week, June
May and June 2025
Pages 264-274

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History

  • Receive Date: 01 June 2024
  • Revise Date: 28 June 2025
  • Accept Date: 28 June 2025

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