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OP 34 Systolic notch in severe preeclampsie – A Doppler marker of maternal hemodynamic dysfunction?
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 9 (2017) 9–35
Management OP 34 Systolic notch in severe preeclampsie – A Doppler marker of maternal hemodynamic dysfunction? Markus Gonser, Karin Wessler, Andreas Klee (HELIOS-HSKKliniken, Obstetrics and Prenatal Medicine, Wiesbaden, Germany Introduction: A systolic notch in the uterine artery (UtA) is an ominous sign in severe preeclampsia (PE) and is scarcely referenced in the literature (Thaler, 1992; Polat, 2015). Timing and hemodynamic conditions for its appearance remain unclear. Objectives: As PW velocity (PWV) is times faster than blood flow velocity, signs of PW reflection should be present in the blood flow velocity waveform (FVW), but is not easily visible. In PE maternal condition is impaired by cardiac dysfunction (Melchiorre, 2011) and arterial PW reflection is increased (Khalil, 2014). We speculate that a systolic notch coincides with the earlier arrival of a stronger reflected PW. Patients and methods: The entire transit time of an outgoing and reflected PW is given by the time to inflection, T-infl, in the pressure waveform (Phan 2016). Half of this time corresponds to the 1-way travel time T from the aortic valve to the prodominant sites of reflection (Curtis 2007) and approximately to the UtA: T = (T-infl)/2 = t (AoV-UtA). UtA Doppler was performed in patients with PE. When a systolic notch was present, the time to inflection was assessed. A rough estimate of PWV was calculated dividing the 1-way travel distance D by the 1-way travel time T: PWV = D/T. The 1-way travel distance D = d (AoV-UtA), corresponds approximately to the sum of the lengths of aorta, common and internal iliac artery. Vessel lengths were taken from the literature and yield D = 56 cm (Matthys, 2007, Sherwin, 2003). Results: In 6 singleton pregnancies with severe PE we found a systolic notch. Mean gestational age at the time of Doppler sampling was 29 ± 3wks and delivery by cesarean section was indicated within 1 week in all patients. Mean time to inflection, T-infl (±SD) was 123 ± 9 ms. Thus mean 1-way travel time T is 61 ms and mean maternal PWV = D/T = 560 mm/61 ms = 9.16 m/s. Conclusion: The observed timing of the systolic notch in severe PE is considerably shorter than PW travel time in normal pregancy
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(Macedo 2008) and inicates the arrival of the reflected PW at the site of Doppler sampling. In addition, PWV was found to be abnormally increased, in accordance with reported PWV in PE (Khalil 2014, Katsipi 2014). Thus a systolic notch may be explained by increased PW reflection and may indicate maternal hemodynamic dysfunction. doi:10.1016/j.preghy.2017.07.057
Management OP 35 Incidence of pre-eclampsia in the UK in 2016–17 Eleanor Hendy, Nicola Vousden, Andrew Shennan, Lucy Chappell (King’s College London, Women’s Health Academic Centre, London, United Kingdom Introduction: Accurate contemporaneous data on the incidence of pre-eclampsia in high-income settings are sparse and often limited by coding inaccuracies. Recent work has reported the incidence of pre-eclampsia in the US (1980–2010) to be 3.4% (Ananth et al., BMJ 2013). Objectives: To obtain data on the incidence of pre-eclampsia. Materials and methods: An audit was undertaken in 16 NHS sites around England and Wales, participating in the PHOENIX study (www.isrctn.com/ISRCTN01879376). Data collection was designed to capture the incidence and duration of care for women diagnosed with pre-eclampsia across the gestational ranges. Data were expressed as a percentage of deliveries for that unit for the time period of data collection. Results: The incidence of pre-eclampsia is shown in Fig. 1 below. The mean diagnosis to delivery interval was 11.6 (range 0.0–36.3) days in women presenting prior to 34 weeks gestation, 7.6 (1.3– 32.7) days in women between 34 and 37 weeks gestation and 2.6 days (0.0–10.7) in those after 37 weeks gestation. Conclusion: The overall incidence of preeclampsia was found to be 1.92% of deliveries, lower than previously described; the reasons behind the lower incidence are unclear. These data have important implications for planning future research studies. doi:10.1016/j.preghy.2017.07.058
Management OP 34 Systolic notch in severe preeclampsie – A Doppler marker of maternal hemodynamic dysfunction? Markus Gonser, Karin Wessler, Andreas Klee (HELIOS-HSKKliniken, Obstetrics and Prenatal Medicine, Wiesbaden, Germany Introduction: A systolic notch in the uterine artery (UtA) is an ominous sign in severe preeclampsia (PE) and is scarcely referenced in the literature (Thaler, 1992; Polat, 2015). Timing and hemodynamic conditions for its appearance remain unclear. Objectives: As PW velocity (PWV) is times faster than blood flow velocity, signs of PW reflection should be present in the blood flow velocity waveform (FVW), but is not easily visible. In PE maternal condition is impaired by cardiac dysfunction (Melchiorre, 2011) and arterial PW reflection is increased (Khalil, 2014). We speculate that a systolic notch coincides with the earlier arrival of a stronger reflected PW. Patients and methods: The entire transit time of an outgoing and reflected PW is given by the time to inflection, T-infl, in the pressure waveform (Phan 2016). Half of this time corresponds to the 1-way travel time T from the aortic valve to the prodominant sites of reflection (Curtis 2007) and approximately to the UtA: T = (T-infl)/2 = t (AoV-UtA). UtA Doppler was performed in patients with PE. When a systolic notch was present, the time to inflection was assessed. A rough estimate of PWV was calculated dividing the 1-way travel distance D by the 1-way travel time T: PWV = D/T. The 1-way travel distance D = d (AoV-UtA), corresponds approximately to the sum of the lengths of aorta, common and internal iliac artery. Vessel lengths were taken from the literature and yield D = 56 cm (Matthys, 2007, Sherwin, 2003). Results: In 6 singleton pregnancies with severe PE we found a systolic notch. Mean gestational age at the time of Doppler sampling was 29 ± 3wks and delivery by cesarean section was indicated within 1 week in all patients. Mean time to inflection, T-infl (±SD) was 123 ± 9 ms. Thus mean 1-way travel time T is 61 ms and mean maternal PWV = D/T = 560 mm/61 ms = 9.16 m/s. Conclusion: The observed timing of the systolic notch in severe PE is considerably shorter than PW travel time in normal pregancy
25
(Macedo 2008) and inicates the arrival of the reflected PW at the site of Doppler sampling. In addition, PWV was found to be abnormally increased, in accordance with reported PWV in PE (Khalil 2014, Katsipi 2014). Thus a systolic notch may be explained by increased PW reflection and may indicate maternal hemodynamic dysfunction. doi:10.1016/j.preghy.2017.07.057
Management OP 35 Incidence of pre-eclampsia in the UK in 2016–17 Eleanor Hendy, Nicola Vousden, Andrew Shennan, Lucy Chappell (King’s College London, Women’s Health Academic Centre, London, United Kingdom Introduction: Accurate contemporaneous data on the incidence of pre-eclampsia in high-income settings are sparse and often limited by coding inaccuracies. Recent work has reported the incidence of pre-eclampsia in the US (1980–2010) to be 3.4% (Ananth et al., BMJ 2013). Objectives: To obtain data on the incidence of pre-eclampsia. Materials and methods: An audit was undertaken in 16 NHS sites around England and Wales, participating in the PHOENIX study (www.isrctn.com/ISRCTN01879376). Data collection was designed to capture the incidence and duration of care for women diagnosed with pre-eclampsia across the gestational ranges. Data were expressed as a percentage of deliveries for that unit for the time period of data collection. Results: The incidence of pre-eclampsia is shown in Fig. 1 below. The mean diagnosis to delivery interval was 11.6 (range 0.0–36.3) days in women presenting prior to 34 weeks gestation, 7.6 (1.3– 32.7) days in women between 34 and 37 weeks gestation and 2.6 days (0.0–10.7) in those after 37 weeks gestation. Conclusion: The overall incidence of preeclampsia was found to be 1.92% of deliveries, lower than previously described; the reasons behind the lower incidence are unclear. These data have important implications for planning future research studies. doi:10.1016/j.preghy.2017.07.058