Amaç: İkinci trimesterde uterin arter Doppler bulguları ve maternal serum homosistein düzeyi ile kötü gebelik sonuçları arasındaki ilişkinin araştırılması. Gereç ve yöntem: 185 gebe üzerinde yapılan prospektif olgu-kontrol çalışmasında 20-24. gebelik haftaları arasında uterin arter Doppler incelemesi yapıldı ve serum homosistein düzeyi ölçüldü.Bulgular: Gebeler uterin arter Doppler bulgularına göre bilateral erken diyastolik çentiklenmesi olanlar olgu grubu (n=97); çentik bulunmayan veya unilateral çentiklenmesi olan olgular kontrol grubu (n=88) olmak üzere iki gruba ayrıldı. Gebeliğe bağlı hipertansiyon (p
Purpose: The aim of the study is to investigate uterine artery Doppler findings and maternal homocysteine levels in relation with adverse pregnancy outcomes during the second trimester of pregnancy. Materials and methods: A prospective case-control study was performed with 185 healthy pregnant women. Uterine artery Doppler velocimetry was performed between 20 and 24 weeks of gestation. Maternal serum homocysteine concentrations were measured. Doppler results and homocysteine levels were used in prediction of adverse pregnancy outcome.Results: According to the uterine artery Doppler findings, pregnant women were divided into two groups. The first group composed of women with bilateral diastolic notches (case group, n=85), the second group composed of the women with unilateral notches, and the women with no diastolic notch (control group, n=88) formed the third group. Pregnancy-induced hypertension (p<0.0001), small for gestational age infants (p<0.0001), and preterm delivery (p=0.02) were found to be higher in the case group in comparison with the control group 2. Although no significant differences were observed in homocysteine levels between the groups, mean pulsatility index or resistance index were significantly higher in case group compared with control group (p<0.0001). Receiver operating characteristic analysis showed that using serum homocysteine, at a 4.3 µmol/L cut off, predicted the delivery of small-for-gestational-age infants with a sensitivity of 48%, and a specificity of 76% rate [AUC (Area under the ROC Curve) =0.64; p=0.02)]. Conclusion: Presence of bilateral uterine arterial notch in second trimester was associated with adverse pregnancy outcome. Mid-trimester maternal homocysteine concentration had no role in predicting obstetric complications, but it seems to be predictive for small for gestational age infants
Bower S, Bewley S, Campbell S. Improved prediction of preeclampsia by two-stage screening of uterine arteries using the early diastolic notch and color Doppler imaging. Obstet Gynecol 1993;82:78-83.
Martin AM, Bindra R, Curcio P, Cicero S, Nicolaides KH. Screening for pre-eclampsia and fetal growth restriction by uterine artery Doppler at 11-14 weeks of gestation. Ultrasound Obstet Gynecol 2001;18:583-586.
Harrington K, Cooper D, Lees C, Hecher K, Campbell S. Doppler ultrasound of the uterine arteries: the importance of bilateral notching in the prediction of pre- eclampsia, placental abruption or delivery of a small- for-gestational-age baby. Ultrasound Obstet Gynecol 1996;7:182-188.
Yu CK, Papageorghiou AT, Boli A, Cacho AM, Nicolaides KH. Screening for pre-eclampsia and fetal growth restriction in twin pregnancies at 23 weeks of gestation by transvaginal uterine artery Doppler. Ultrasound Obstet Gynecol 2002;20:535-540.
Espinoza J, Romero R, Nien JK, et al. Identification of patients at risk for early onset and/or severe preeclampsia with the use of uterine artery Doppler velocimetry and placental growth factor. Am J Obstet Gynecol 2007;196:326.e1-13.
Kupferminc MJ, Eldor A, Steinman N, et al. Increased frequency of genetic thrombophilia in women with complications of pregnancy. N Engl J Med 1999;340:9- 13.
Dekker GA, de Vries JI, Doelitzsch PM, et al. Underlying disorders associated with severe early-onset preeclampsia. Am J Obstet Gynecol 1995;173:1042- 1048.
López-Quesada E, Vilaseca MA, Vela A, Lailla JM. Perinatal outcome prediction by maternal homocysteine and uterine artery Doppler velocimetry. Eur J Obstet Gynecol Reprod Biol 2004;113:61-66.
ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. ACOG Committee on Practice Bulletinsin Obstetrics. Obstet Gynecol 2002;99:159-167.
Zhang J, Merialdi M, Platt LD, Kramer MS. Defining normal and abnormal fetal growth: promises and challenges. Am J Obstet Gynecol 2010;202:522-528.
Onalan R, Onalan G, Gunenc Z, Karabulut E. Combining 2nd-trimester maternalserum homocysteine levels and uterine artery Doppler for prediction of preeclampsia and isolated intrauterine growth restriction. Gynecol Obstet Invest 2006;61:142-148.
Reddy UM, Ko CW, Willinger M. Maternal age and the risk of stillbirth throughout pregnancy in the United States. Am J Obstet Gynecol 2006;195:764-770.
Campbell S, Diaz-Recasens J, Griffin DR, et al. New doppler technique for assessing uteroplacental blood flow. Lancet 1983;1:675-677.
Hofstaetter C, Dubiel M, Gudmundsson S, Marsal K. Uterine artery color Doppler assisted velocimetry and perinatal outcome. Acta Obstet Gynecol Scand 1996;75:612-619.
Florio P, Reis FM, Pezzani I, Luisi S, Severi FM, Petraglia F. The addition of activin A and inhibin A measurement to uterine artery Doppler velocimetry to improve the early prediction of pre-eclampsia. Ultrasound Obstet Gynecol 2003;21:165-169.
Chien PF, Arnott N, Gordon A, Owen P, Khan KS. How useful is uterine artery Doppler flow velocimetry in the prediction of pre-eclampsia, intrauterine growth retardation and perinatal death? An overview. BJOG 2000;107:196-208.
Clarke R, Daly L, Robinson K, et al. Hyperhomocysteinemia: an independent risk factor for vascular disease. N Engl J Med 1991;324:1149-1155.
Hogeveen M, Blom HJ, den Heijer M. Maternal homocysteine and small-for-gestational-age offspring: systematic review and meta-analysis. Am J Clin Nutr 2012;95:130-136.
Yeter A, Topcu HO, Guzel AI, Ozgu E, Danisman N. Maternal plasma homocysteine levels in intrauterine growth retardation. J Matern Fetal Neonatal Med 2014;26:1-4.