Seyfettin Uludağ, Rıza Madazlı, Ali Benian, Vildan Ocak, Selçuk Erez

THE RELATIONSHIP BETWEEN MATERNAL SERUM a- FETOPROTEIN AND UTERINE ARTERY DOPPLER FINDINGS AT 20-24 WEEKS' GESTATION FOR PREDICTION OF PREECLAMPSIA AND INTRAUTERINE GROWTH RETARDATION

Objective: To estimate the relationship between maternal serum a- fetoprotein (MSAFP) levels and uterine artery Doppler findings at 20th week of pregnancy for prediction of preeclampsia and intrauterine growth retardation (IUGR).Methods: Eighty pregnant women were followed as a study group prospectively. MSAFP levels at the 15-18th week of gestation and bilateral uterine artery Doppler findings at the 20th week of gestation were obtained.Results: Bilateral early diastolic notch of the uterine artery was detected in 17 cases (21,75%) at the 20th week of gestation. In 9 of them early diastolic notch was persistent at the 24th week while in 8 cases, it had disappeared. Uterine artery diastolic notch was found to be a significant predictive factor for preeclampsia, as well as for IUGR (p< 0.001, OR: 69.74; p<0.02, OR: 10.11, respectively). MSAFP levels of 17 cases that showed early diastolic notch in uterine artery Doppler were significantly higher than in the notch negative cases (p<0.05). The levels of MSAFP in 9 cases which demonstrated the persistence of diastolic notch, were significantly higher than the 8 cases where the notch had disappeared, at the 24th week of gestation (p<0.05).Conclusion: Our findings suggest that abnormal uterine artery Doppler findings at 20th week of gestation correlate with elevated MSAFP levels, and bilateral diastolic notch in uterine artery at 20 weeks’ gestation together with elevated MSAFP, is associated with poor obstetric outcome.Key Words: IUGR, Preeclampsia, MSAFP, Diastolic notch

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Evans NI, Dvorin E, O'Brien JE, Moody JL, Drugan A. Alpha-Eetoprotein and biochemical screening. In: Evans Ml, ed. Reproductive Risks and Prenatal Diagnosis. California; AppletonßCLange, 1992:223-235.
Aristidou A, Van den flof MC, Campeil S, rticolaides R. Uterine artery Doppler in the investigation of pregnancies with raised maternal serum alpha-fetoprotein. Br J Obstet Gynaecol 1990:97:431-435.
Ronchak PS, Bernstein IM, Capeless EL. Uterine artery Doppler velocimetty in the detection of adverse obstetric outcomes in women with unexplained elevated maternal serum a-fetoprotein levels. Am J Obstet Gynecol 1995; I 73:1 I 15-1 I 19.
Wenstrom RD, Sipes SL, Williamson RA,Grant SS, Trawick DC, Esrle LC. Prediction of
7 3
S e y fe ttin U lu d a ğ , e t a l
pregnancy outcome with single versus serial maternal serum a-fetoprotein tests. Am J Obstet Gynecol 1992; 167:1529-1553.
Haddad B, Uzan S. Uterine Doppler waveform: prediction and management of pregnancy complications. In: Chervenah FA, Rurjak A, eds. The fetus as a Patient. The Parthenon Publishing Group, London, 1996:405-413.
Hicolaides fill, Rizzo G, Heclter R. In fetal medicine series; Plasental ve fetal Doppler. London: The Parthenon Publishing Group, 1999:71-104.
Wilkins-Haug L. Unexplained elevated maternal serum a-fetoprotein: What is the appropriate follow-up?. Curr Opin Obstet Gynecol 1998; 10:469-474.
Myatt L, Miodovnik M. Prediction of preeclamsia. Semin Perinatoloqy 1999; 23:45-57.
Carrera JM, Mallafre J. Intrauterine growth
retardation. In: Chervenak FA, Rurjak A, eds. The fetus as a patient; Advences in diagnosis and therapy. London: The Parthenon
Publishing Group, London, 1994:251-287.
Waller DR, Lustig LS, Cunningham GC, Feuchtbaum LB, Hook EB. The association
between maternal serum alpha-protein and preterm birth, small for gestational age infants, preeclampsia, and placental complications. Obstet Gynecol 1996;88:816- 822.
I 1. Sheppard BL, Bonnar J. An ultrastructural study of the uteroplacental spiral arteries in hypertensive and normotensive pregnancy and fetal growth retardation. Br J Obstet Gynaecol 1981 -,88:695-705.
Campbell S, Diaz-Recasens J, Griffen D, Cohen-Overbeek TE, Pearse JM, Willson R, Teague MJ. Hew Doppler technique for assessing uteroplacental blood flow. Lancet 1983,4:675-677.
Chung JE, Cho JS, Han SS, Park YW, Rim JW. Uterine artery Doppler velocimetry in the prediction of adverse obstetric outcomes in explained MSAFP elevations. Yonsei Med J 2000:41:17-21.
Bower S, Schlichter R, Campbell S. Doppler ultrasound screening as part of routine antenatal scannning: prediction of preeclampsia and intauterine growth retardation. Br J Obstet Gynaecol 1993; 100:989-994.