Doppler ultrasound and hemostasis parameters for diagnosis and prevention of preeclampsia

Purpose 

The possibility of early diagnosis and prevention of preeclampsia with the use of Doppler ultrasound and hemostasis parameters including hereditary thrombophilia and antiphospholipid antibodies was investigated.
 

Materials and methods

The study included 76 pregnant women: with normal pregnancy n=27 – control group and 49 women with a pregnancy complicated by preeclampsia (n=15), intrauterine growth restriction (IUGR) (n=12), preeclampsia and IUGR (n=22). All women have been examined with the use of Doppler ultrasound in terms of pregnancy from 23 until 26 weeks, from 26 until 32 weeks, from 32 until 37 weeks and after 37 weeks of pregnancy. Blood flow velocity waveforms were recorded from the uterine arteries, umbilical, basilar and vertebral arteries of a fetus. Hemostasis research included evaluation of plasma levels of coagulation and fibrinolysis parameters (íÄí, D-dimer), determination of circulation of antiphospholipid antibodies (APA) and genetic forms of thrombophilia.

Bulgular

Thrombophilia has been revealed at 31 (63.3%) pregnant women with the complications of pregnancy. Genetic forms (55.1%) and circulation of antiphospholipid antibodies (22.4%) were the most frequent at patients with IUGR and preeclampsia. Overall, there were 6.1% heterozygotes for FVL, homozygous – 4.1%, MTHFR C677T heterozygous – 30.6%, homozygous – 14.3%, PAI-1 gene polymorphism 4G/4G – 14.3%, 4G/5G – 20.4%, fibrinogen polymorphism “455G/A” homozygous – 4.1%, heterozygous – 8.2%, polymorphism of platelet receptor GpIa homozygous – 6.1%, heterozygous – 8.2%, polymorphism of platelet receptor GpIIIa – homozygous-2.0%, heterozygous – 8.2%, ACE polymorphism heterozygotes (I/D) – 10.2%, angiotensin II receptor polymorphism 1166 A/C heterozygous – 4.1%, isolated APA – 8.2%. Abnormal uteroplacental hemodynamics was observed in all pregnancies complicated by IUGR. The fetoplacental circulation was abnormal in 21 (61.8%) pregnancies with IUGR, in 50.0% with preeclampsia, and in 83.3% without preeclampsia. Among women with preeclampsia without IUGR there were 6 cases (40.0%) of abnormal uteroplacental hemodynamics. All patients with IUGR had high values of the plasma levels of coagulation and fibrinolysis parameters (íÄí, D-dimer). Changes of values of the plasma levels of coagulation and fibrinolysis parameters were more expressed in pregnancies with abnormal uteroplacental circulation compared to the control group.

Sonuç

Widespread use of Doppler ultrasound and investigation of thrombophilias might assist early diagnosis of pregnancy complications such as preeclampsia and IUGR and might provide effective preventive strategies.
Key words: Doppler, preeclampsia, IUGR, thrombophilia

Anahtar Kelimeler

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