Uteroplacental blood flow and placental vascular endothelial growth factor in normotensive and pre-eclamptic pregnancy.
OBJECTIVE
To determine whether placental vascular endothelial growth factor (VEGF) is increased in pre-eclampsia.


METHODS
Prospective cohort study.


METHODS
Royal Prince Alfred Hospital, Sydney, Australia.


METHODS
Eleven normotensive women and eight women with pre-eclampsia matched for age and gestation.


METHODS
Uterine artery Doppler ultrasound flow velocity profiles were recorded in the third trimester and resistance index calculated as (Vs-Vd)/Vs (Vs = peak systolic flow velocity, Vd = end diastolic flow velocity). Placental tissue at delivery was examined for VEGF distribution with avidin-biotin-peroxidase immunohistochemistry.


RESULTS
Uterine resistance index [median (range)] was significantly increased in pre-eclamptic women (normotensive: 0.42 (0.36-0.51); pre-eclampsia: 0.59 (0.40-0.75); P = 0.005). Notching of the uterine artery waveform, consistent with a high resistance circulation, was evident in early diastole in five women with pre-eclampsia but only one normotensive woman (P = 0.013). Placental VEGF was increased in women with pre-eclampsia in the decidual trophoblast (normotensive: 34% (4-59) cells stained for VEGF; pre-eclampsia: 58% (15-95); P = 0.033) and in the villous syncytiotrophoblast (normotensive: VEGF count 1.4 arbitrary units (1.1-2.1); pre-eclampsia: 1.8 arbitrary units (1.4-2.2); P = 0.041). Analysis indicated that uterine artery resistance index was directly correlated with placental VEGF staining, mean arterial pressure and birthweight.


CONCLUSIONS
Abnormal uterine artery Doppler ultrasound flow velocity profiles in pre-eclampsia indicate increased uteroplacental resistance. The associated increase in placental VEGF may represent a compensatory mechanism attempting to restore blood flow towards normal.
Simmons
L A
LA
Department of Cardiology, Royal Prince Alfred Hospital, University of Sydney, Australia.
Hennessy
A
A
Gillin
A G
AG
Jeremy
R W
RW
D000328:Adult; D001783:Blood Flow Velocity; D001794:Blood Pressure; D015331:Cohort Studies; D016228:Endothelial Growth Factors / Q000378:metabolism*; D005260:Female; D006801:Humans; D008222:Lymphokines / Q000378:metabolism*; D008875:Middle Aged; D021041:Placental Circulation / Q000502:physiology*; D011225:Pre-Eclampsia / Q000378:metabolism / Q000503:physiopathology*; D011247:Pregnancy; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal; D014599:Uterus / Q000000981:diagnostic imaging; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors
D016228:Endothelial Growth Factors; D008222:Lymphokines; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors