RESUMO
OBJECTIVES: The purpose of this study was to examine whether the maternal renal interlobar vein impedance index as assessed by first-trimester sonography is able to predict the later development of hypertensive disorders of pregnancy. METHODS: Venous Doppler parameters of both maternal kidneys were studied in 214 pregnant women at gestational ages of 11 weeks to 13 weeks 6 days. Patients were classified according to outcomes related to hypertensive disorders. Detection rates and areas under receiver operating characteristic curves were determined for the maternal renal interlobar vein impedance index as a first-trimester predictor of preeclampsia and gestational hypertension. RESULTS: Among the 214 patients, 22 (10.3%) developed preeclampsia; 10 (4.7%) developed gestational hypertension; and 182 were unaffected by hypertensive disorders (controls; 85.0%). In the overall study population, there was no difference in the impedance index between the right (0.44; 95% confidence interval, 0.35-0.50) and left (0.43; 95% confidence interval, 0.35-0.53) sides (P = .86). The average impedance index did not differ among women destined to develop preeclampsia (0.46; 95% confidence interval, 0.38-0.57), gestational hypertension (0.39; 95% confidence interval, 0.33-0.46), or pregnancies uncomplicated by hypertensive disease (0.42; 95% confidence interval, 0.37-0.50; P = .15). Low detection rates and the area under the curve analysis demonstrated that the impedance index was not predictive of hypertensive disorders of pregnancy. CONCLUSIONS: The maternal renal interlobar vein impedance index should not be considered a first-trimester marker of hypertensive disorders of pregnancy.
Assuntos
Hipertensão Induzida pela Gravidez/diagnóstico por imagem , Hipertensão Induzida pela Gravidez/fisiopatologia , Primeiro Trimestre da Gravidez , Veias Renais/diagnóstico por imagem , Veias Renais/fisiopatologia , Ultrassonografia Doppler/métodos , Adulto , Feminino , Humanos , Rim/irrigação sanguínea , Rim/diagnóstico por imagem , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes , Adulto JovemRESUMO
OBJECTIVE: To examine whether the maternal serum concentration of the soluble receptor-1 of tumor necrosis factor-α (TNF-R1) at 11-13 + 6 weeks of gestation is a predictor of development of pre-eclampsia (PE). METHODS: This is a nested case-control study in which the concentration of TNF-R1 at 11 + 0 to 13 + 6 weeks was measured in 426 pregnant women in the first trimester. TNF-R1 values were expressed as multiples of the median (MoM) adjusted for maternal factors. The distributions of log TNF-R1 MoM in the control group and hypertensive disorders (early-PE [ePE], late-PE [lPE] and gestational hypertension [GH]) groups were compared. Logistic regression analysis was used to determine whether maternal factors, TNF-R1 or their combination make a significant contribution to the prediction of PE. Screening performance was determined by analysis of receiver-operating characteristics curves. RESULTS: Median concentration of TNF-R1 (ng/ml) was higher in ePE (2.62 ± 0.67), lPE (2.12 ± 0.56) and GH (2.19 ± 0.45) compared to controls (2.04 ± 0.42), p = 0.001. Logistic regression analysis demonstrated that the addition of TNFR-1 to maternal factors did not make a significant contribution to the prediction of PE. CONCLUSIONS: The maternal serum TNF-R1 concentration at 11-13 + 6 weeks of gestation was increased in pregnancies which developed hypertensive disorders, however, the addition of TNFR-1 did not improve the detection rate of these conditions compared with maternal factors alone.
Assuntos
Pré-Eclâmpsia/sangue , Receptores Tipo I de Fatores de Necrose Tumoral/sangue , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Gravidez , Primeiro Trimestre da Gravidez/sangue , Adulto JovemRESUMO
BACKGROUND: The aim of this study was to establish normative data for ophthalmic artery Doppler variables in the first trimester of normal pregnancy. METHODS: Maternal ophthalmic artery Doppler signals were recorded in 409 singleton pregnancies at 11-14 weeks' gestation, in mothers presenting consecutively for routine antenatal care. Pulsatility and resistance indices (PI, RI), peak systolic velocity (PSV), first peak diastolic velocity (PD1), and peak ratio (PR) were measured. Quartile regression was used to estimate reference ranges in the late first trimester of pregnancy. RESULTS: Mean ± SD values for maternal ophthalmic artery Doppler parameters between 11 and 14 weeks' gestation were RI = 0.81 ± 0.12, PI = 2.06 ± 0.57, PSV = 36.41 ± 12.1, PD1 = 21.07 ± 7.62, and PR = 0.58 ± 0.11. All clinical and Doppler variables were normally distributed. PD1 values were higher in patients who smoked, and in those with diabetes or a history of pre-eclampsia. PR values were higher in patients with diabetes and chronic hypertension, and lower in the nulliparous; these values declined as gestation advanced from 11 to 14 weeks, whereas the other variables remained unchanged. CONCLUSIONS: We provide reference values for maternal ophthalmic artery Doppler variables in the first trimester of normal pregnancy.