FIRST TRIMESTER SCREENING FOR HYPERTENSIVE DISORDER OF PLACENTAL AND MATERNOGENIC ORIGIN
Tesi di Dottorato
Data di Pubblicazione:
2015
Citazione:
FIRST TRIMESTER SCREENING FOR HYPERTENSIVE DISORDER OF PLACENTAL AND MATERNOGENIC ORIGIN / M. Quadrifoglio ; tutor: E. M. Ferrazzi : coordinator: R. L. Weinstein. DIPARTIMENTO DI SCIENZE BIOMEDICHE E CLINICHE "L. SACCO", 2015 Mar 04. 26. ciclo, Anno Accademico 2013. [10.13130/quadrifoglio-mariachiara_phd2015-03-04].
Abstract:
FIRST TRIMESTER SCREENING OF HYPERTENSIVE DISORDERS OF PLACENTAL AND MATERNOGENIC ORIGIN
Background:
Hypertensive disorders (HD) constitute a heterogeneous group of conditions. They complicate around 10% of pregnancies, and are a major cause of maternal and perinatal morbidity and mortality. The most used classification is based on temporal criteria: diagnosis (or delivery) before/after 34 weeks’ of gestation. Early-onset HD (before 34 weeks) is commonly associated with abnormal uterine artery Doppler, fetal growth restriction, evidence of ischemic lesions on placental examination and adverse maternal and neonatal outcomes. In contrast, late-onset HD (after 34 weeks) is mostly associated with normal or slightly increased uterine resistance index, a low rate of fetal involvement, and more favourable perinatal outcomes. Nevertheless, the phenotypes of HD do not fit entirely into the temporal classification. Thus, it has been hypothesized that phenotypes of HD, rather than temporal classification, reflect the underlying aetiology of HD: 1) HD of placental origin, when the defect in placentation causes an altered remodelling of the spiral arteries leading to reduced placental flow, activation of coagulation cascade, organ damage and intrauterine fetal growth restriction (IUGR); and 2) HD of maternogenic origin, associated with normal feto-placental perfusion and normal fetal growth, probably related to chronic inflammation and insuline resistance, typical aspects of metabolic syndrome.
The early identification of pregnancies at risk of HD is a major challenge. Extensive research has identified a series of 1st trimester biophysical and biochemical markers of impaired placentation. The combination of these markers and maternal history have been used by clinicians as a 1st trimester screening for the recognition of pregnancies at risk of early/late onset HD.
The aim of the study is to evaluate a new classification of hypertensive disease based on physiopathology, and not on temporary factors and to evaluate the effectiveness of 1st trimester screening for HD of placental and maternal origin by Doppler velocimetry of uterine arteries (UtA).
Material and Methods:
This is a prospective longitudinal cohort study of pregnant women followed in two hospital: prenatal diagnosis and gynaecologic Unit of the Institute for Maternal and Child Health – IRCCS “Burlo Garofolo” in Trieste and Obstetrics and Gynecologic Unit of Children’s Hospital – ICP “Vittore Buzzi” in Milan, Italy. This study was offered to pregnant women at the time of first trimester ultrasound aneuploidy screening. All women were recruited consecutively from October 2007 to April 2009 in Triest and from October 2009 to December 2012 in Milan. We enrolled singleton pregnancies between 11+0 and 13+6 weeks of gestation. The inclusion criteria were: single pregnancy, gestational age between 11+0 and 13+6 weeks confirmed by scan measurements, and signed informed consent. Multiple pregnancies or pregnancies complicated by fetal malformation or aneuploidy, spontaneous abortion, intrauterine fetal death, maternal neurodevelopment delay or psychiatric disorders were excluded.
The following data were collected at the time of the scan: maternal history, previous disease, age, body mass index (BMI), parity, mode of conception (spontaneous or IVF), and gestational age. Doppler velocimetry of both UtA was added to routine ultrasound measurements. Doppler study was performed trans-abdominally, after identifying with the Color Doppler each uterine artery along the side of the cervix and uterus at the level of the internal os. Pulsed wave Doppler was used with the sampling gate set at 2 mm to cover the whole vessel ensuring the angle of insonation <30°. When thre
Tipologia IRIS:
Tesi di dottorato
Keywords:
screening first trimester; uterine arteries; pregnancy induced hypertensive diseases; placental hypertensive disorder; maternal hypertensive disorder
Elenco autori:
M. Quadrifoglio
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