V. Cararach

Uterine artery Doppler at 11–14 weeks of gestation to screen for hypertensive disorders and associated complications in an unselected population

To establish reference values for the first‐trimester uterine artery (UtA) pulsatility index (PI) and to investigate the role of UtA Doppler in the early prediction of hypertensive disorders and their associated complications in an unselected Mediterranean population.

Variations in policies for management of the third stage of labour and the immediate management of postpartum haemorrhage in Europe

Background  The EUropean Project on obstetric Haemorrhage Reduction: Attitudes, Trial, and Early warning System (EUPHRATES) is a set of five linked projects, the first component of which was a survey of policies for management of the third stage of labour and immediate management of postpartum haemorrhage following vaginal birth in Europe.

Sequential changes in uterine artery blood flow pattern between the first and second trimesters of gestation in relation to pregnancy outcome.

To describe sequential changes in uterine artery waveform between the first and second trimesters of gestation and to analyze their association with the subsequent risk of hypertensive disorders and fetal growth restriction (IUGR).

Variation in lipid levels during pregnancy in women with different types of hypertension

Objectives. To evaluate the levels of serum lipids (cholesterol and triglycerides) in pregnant women with different types of hypertension, at the first, second and third trimesters of pregnancy.

Lipid peroxide and vitamin E patterns in pregnant women with different types of hypertension in pregnancy

OBJECTIVES We sought to evaluate the circulating levels of lipid peroxides and vitamin E and the placental levels of lipid peroxides in pregnant women with different types of hypertension. STUDY DESIGN Lipid peroxides were measured in serum and placental tissue by the thiobarbituric acid method and high-pressure liquid chromatography, and vitamin E was measured by high-pressure liquid chromatography. The patients studied were 36 healthy pregnant women and 92 women with hypertension classified as having mild gestational hypertension (n = 28), severe gestational hypertension (n = 10), preeclampsia (n = 34), and chronic hypertension (n = 20). RESULTS Lipid peroxides in serum and placental tissue were significantly increased, and vitamin E levels in serum were significantly decreased in women with severe gestational hypertension and preeclampsia compared with controls. The groups of mild gestational hypertension or chronic hypertension had similar values of lipid peroxides or vitamin E as controls. CONCLUSIONS Our results suggest that the category of gestational hypertension may be composed of at least two entities with different pathophysiology and support the concept of nonproteinuric preeclampsia.

Increased susceptibility to low density lipoprotein oxidation in women with a history of pre-eclampsia

Objectives To evaluate the susceptibility to oxidation of low density lipoprotein (LDL) in women with a history of pre‐eclampsia.

Visual analysis of antepartum fetal heart rate tracings: inter- and intra-observer agreement and impact of knowledge of neonatal outcome

Abstract Objective: To evaluate the inter- and intra-observer agreement of visual analysis of fetal heart rate tracing and to evaluate the bias introduced by knowledge of perinatal outcome in this interpretation. Methods: One hundred tracings were independently analyzed by four observers. In a second study period, two observers re-analysed the 100 tracings in order to evaluate intra-observer agreement. The other two observers re-analyzed the tracings, which were labelled with fictitious perinatal outcome to evaluate the impact of this information on reliability. Agreement was analyzed by means of the proportion of agreement for qualitative parameters and the inter- and intra-class correlation coefficient for quantitative data. Results: Poor agreement was found for quantitative variability, low variability category and number of decelerations. Moderate agreement was observed for baseline, normal variability category and number of accelerations. Fetal heart rate variability and number of accelerations and decelerations were found to be significantly influenced by clinical information of perinatal outcome. Biased observers showed lower reliability than unbiased ones. Conclusion: Visual assessment of fetal heart rate tracings is unreliable due to low rates of agreement between and within observers. Only qualitative classification such as normal baseline and normal variability showed good agreement. Knowledge of clinical information introduces subjectivity to the visual analysis, leading to a negative impact on reliability.

Cardiac function monitoring of fetuses with growth restriction

OBJECTIVE To describe the time sequence of changes in cardiac function in intrauterine growth restriction. STUDY DESIGN This was a prospective longitudinal study on 22 singleton pregnancies with growth-restricted fetuses. Pulsatility indices of fetal arterial and venous Doppler waveforms, systolic peak velocity in the aorta and pulmonary artery, right and left ventricular shortening fraction and atrioventricular flow E/A ratio were assessed at each monitoring session. Logistic regression was used for modeling the probability of abnormality of a variable in relation to the time interval before delivery. Trends over time were analyzed by Mann-Withney U-test. RESULTS Umbilical artery pulsatility index was the first variable to become abnormal, followed by the middle cerebral artery, right diastolic indices (right E/A, ductus venosus), right systolic indices and, finally, both diastolic and systolic left cardiac indices. CONCLUSION We have found an earlier and more pronounced right than left and diastolic than systolic fetal cardiac function deterioration in growth restricted fetuses monitored longitudinally.

Interleukin-4, interleukin-10, and granulocyte-macrophage colony stimulating factor in second-trimester serum from women with preeclampsia ☆

Objective To evaluate the serum levels of interleukin-4, interleukin-10, and granulocyte-macrophage colony-stimulating factor at the moment of diagnosis and in early second-trimester serum from women with preeclampsia and from gestational age-matched controls. Methods Serum from 14 women with preeclampsia at the moment of diagnosis and 14 gestational age-matched controls was analyzed. In 10 cases and 10 controls, second-trimester serum also was studied. Cytokines were measured by specific enzyme-linked immunosorbent assay. Results Serum levels of granulocyte-macrophage colony-stimulating factor at the moment of diagnosis were detected less frequently (21 compared with 71%, P < .01) and in lower concentrations (0 pg/mL [range 0–56] compared with 55.5 pg/mL [range 0–105], P = .01) in women with preeclampsia as compared with controls. In second-trimester serum, granulocyte-macrophage colony-stimulating factor detection rates (20 and 70% respectively, P = .06) and concentrations (0 pg/mL [range 0–32] and 2.5 pg/mL [range 0–37], respectively, P = .08) were lower in the group of preeclampsia, but the differences do not reach statistical significance. Measurements regarding interleukin-4 and interleukin-10 were similar between both study groups. Conclusion Differences in granulocyte-macrophage colony-stimulating factor support the concept of the existence of an immunologic imbalance as part of the etiologic mechanisms leading to preeclampsia.

Doppler assessment of fetal aortic isthmus blood flow in two different sonographic planes during the second half of gestation.

To compare the reliability of Doppler blood flow measurements of the fetal aortic isthmus (AoI) according to whether the sampling plane is obtained from the traditional longitudinal aortic arch (LAA) view or the more recently described three vessels and trachea (3VT) view of the fetal upper mediastinum.