Doppler sonographic findings for hypertension in pregnancy and HELLP syndrome

• Published in: Journal of perinatal medicine Vol. 27; no. 5; pp. 388 - 394
• Main Authors: Joern, Hendrik, Funk, Andreas, Rath, Werner
• Format: Journal Article
• Language: English
• Published: Berlin Walter de Gruyter 01.01.1999; New York, NY De Gruyter
• Subjects: Adolescent; Adult; Arteries - diagnostic imaging; Biological and medical sciences; Cerebral Arteries - diagnostic imaging; Cerebral Arteries - embryology; Diseases of mother, fetus and pregnancy; Female; Gynecology. Andrology. Obstetrics; HELLP Syndrome - diagnostic imaging; Humans; Hypertension - diagnostic imaging; Medical sciences; Middle Aged; Pre-Eclampsia - diagnostic imaging; Pregnancy; Pregnancy Complications, Cardiovascular - diagnostic imaging; Pregnancy Outcome; Pregnancy. Fetus. Placenta; Ultrasonography, Doppler, Color; Umbilical Arteries - diagnostic imaging; Uterus - blood supply; Sonography; Human; Statistical analysis; Prognosis; Pregnancy disorders; Preeclampsia; HELLP syndrome; Medical imagery; Female; Duplex ultrasonography; Pregnancy toxemia
• ISSN: 0300-5577
• DOI: 10.1515/JPM.1999.053

Doppler examinations of the umbilical artery, both uterine arteries, and the fetal middle cerebral artery were performed in the third trimester in 18 patients with pregnancy induced hypertension, 52 patients with preeclampsia, and 32 patients with HELLP syndrome and the results were correlated with the parameters fetal outcome. For 74% of the patients this was the first pregnancy, in 93% of the cases a cesarean section was necessary; 66% of the newborn babies were dystrophic and 90% of them were born prematurely. The blood flow in one uterine artery was restricted in 95% of all 102 pregnant women, only 5% did not show any pathological findings. A pathological blood flow was observed on Doppler sonography in the umbilical artery in 70% of the group and 39% showed a pathologically increased perfusion of the fetal middle cerebral artery. The average birth weights and gestational ages in the study group were markedly reduced in comparison with healthy pregnant women (pregnancy induced hypertension: 1620 g/35 weeks; preeclampsia: 1660 g/34 weeks; HELLP syndrome: 1160 g/31 weeks, respectively). The lowest values for average birth weight and gestational age occurred when all four investigated blood vessels showed pathological Doppler findings: 1180 g/31 weeks (0 to 1 pathological vascular findings: 2780 g/38 weeks; 2 pathological vascular findings: 1845 g/34.5 weeks; 3 pathological vascular findings: 1330 g/31 weeks). This Doppler study underlines the importance of examining four blood vessels: the uterine, the umbilical, and the fetal middle cerebral arteries for a complete analysis of the fetoplacental hemodynamics. On account of the severely impaired hemodynamics observed in the placentas of our patients with hypertensive diseases in pregnancy or HELLP syndrome, we believe the early diagnosis of these disorders by Doppler sonography and an early start of therapy to be essential.