Doppler Velocimetry of Uterine and Umbilical Arteries Doesn't Predict the Anatomopathological Alterations of the Placenta in High Risk Pregnancies for Preeclampsia

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Abstract

Background

Preeclampsia (PE) frequently complicates pregnancy. Clinical and laboratory markers commonly used for diagnosis doesn't predict it with the desired anticipation, and most of them appearing late in pregnancy. Doppler velocimetry of uterine and umbilical arteries (Doppler) has been frequently used in the evaluation of patients with PE, how-ever its utility as a diagnostic and prognostic tool remains controversial.

Objectives

First, to evaluate if Doppler abnormalities predicts placenta pathological alterations and the development of hypertension. Second, to evaluate if low dose aspirin(ASA) improves the clinical evolution and the laboratory determinations used in the con-trol of these patients.

Material and method Sixty seven patients were included. Umbilical and uterine arteries Doppler was done in 63, between the 28 and 38weeks. The anatomopathological study of the placenta was carried out in 32 patients. When a diastolic pressure of 100 mm Hg or more was found, they were treated either with alphametildopa or atenolol. In 36 patients 50 mg of ASA per day and in 31patients a placebo was given, between 12 and 24 weeks, until one week before the estimated date of delivery. Patients with aspirin contraindications were excluded. Fisher test was used for statistical analysis. Results In 75% of patients with abnormal Doppler during weeks 28 to 38, hypertensive disorders appear, meanwhile this occur only in 34.5% with normal Doppler (p < 0.05). No differences were found in the hystopathological study of the placenta in patients with normal or abnormal Doppler (p= NS). When both groups (ASA and placebo) were compared, no significant differences appear in clinical parameters, except for the number of low weight babies: ASA =0 versus placebo=4 cases (p = 0.04). Conclusions Doppler velocimetry of uterine and umbilical arteries doesn't predict the pathological alterations of the placenta, but it turned out be a good predictor of future development of hypertension. Low dose aspirin generally didn't improve the clinical features used for patients control.