title: Emergence of late-onset placental dysfunction: relationship to the change in uterine artery blood flow resistance between the first and third trimesters.
abstract: OBJECTIVE
  To test if emergence of third-trimester (T3) placental dysfunction is related to the impedance change in uterine artery blood flow resistance between the first trimester (T1) and T3.
  
  
  METHODS
  Mean T1 and T3 uterine artery (mUtA) pulsatility index (PI) was measured in 1098 singletons. Each patient's individual mUtA-PI change was calculated ([(T3 PI - T1 PI/interval in days)] × 100; ΔmUtA-PI). This parameter and T1 and T3 mUtA-PI z-scores were related to placenta-related disease (PRD) and to constitutionally small neonates (CS).
  
  
  RESULTS
  Forty-seven (5%) women had PRD and 83 (8.7%) delivered a CS neonate. T1 and T3 mUtA-PI z-scores were higher with PRD (0.418 versus -0.097 and 1.06 versus -0.13, p < 0.001 for all). Change in mUtA-PI (ΔmUtA PI) was similar for patients with PRD. However, the prevalence of PRD doubled with rising ΔmUtA-PI (11.1% versus 5.2%, p = 0.041).
  
  
  CONCLUSIONS
  T3 uterine artery Doppler performs significantly better in detecting patients at risk for late-onset PRD than T1 or the gestational age change in uterine artery Doppler resistance This suggests that a proportion of late emerging PRD is not amenable to early screening by uterine artery Doppler. Further research is essential to identify the optimal screening strategy for late-onset placental dysfunction.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Center for Advanced Fetal Care, University of Maryland School of Medicine, Baltimore, MD 21201, USA. abaschat@umm.edu
authors.forename: Elisa
authors.initials: E
authors.lastname: Llurba
authors.forename: Ozhan
authors.initials: O
authors.lastname: Turan
authors.forename: Tania
authors.initials: T
authors.lastname: Kasdaglis
authors.forename: Chris R
authors.initials: CR
authors.lastname: Harman
authors.forename: Ahmet A
authors.initials: AA
authors.lastname: Baschat
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D010922:Placenta Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011673:Pulsatile Flow; D012039:Regional Blood Flow; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler; D055988:Uterine Artery / Q000000981:diagnostic imaging / Q000502:physiology*; D014655:Vascular Resistance / Q000502:physiology*; D055815:Young Adult