title: Microvascular remodelling in preeclampsia: quantifying capillary rarefaction accurately and independently predicts preeclampsia.
abstract: BACKGROUND
  Preeclampsia is a major cause of maternal and neonatal mortality and morbidity. The incidence of preeclampsia seems to be rising because of increased prevalence of predisposing disorders, such as essential hypertension, diabetes, and obesity, and there is increasing evidence to suggest widespread microcirculatory abnormalities before the onset of preeclampsia. We hypothesized that quantifying capillary rarefaction could be helpful in the clinical prediction of preeclampsia.
  
  
  METHODS
  We measured skin capillary density according to a well-validated protocol at 5 consecutive predetermined visits in 322 consecutive white women, of whom 16 subjects developed preeclampsia.
  
  
  RESULTS
  We found that structural capillary rarefaction at 20-24 weeks of gestation yielded a sensitivity of 0.87 with a specificity of 0.50 at the cutoff of 2 capillaries/field with the area under the curve of the receiver operating characteristic value of 0.70, whereas capillary rarefaction at 27-32 weeks of gestation yielded a sensitivity of 0.75 and a higher specificity of 0.77 at the cutoff of 8 capillaries/field with area under the curve of the receiver operating characteristic value of 0.82. Combining capillary rarefaction with uterine artery Doppler pulsatility index increased the sensitivity and specificity of the prediction. Multivariable analysis shows that the odds of preeclampsia are increased in women with previous history of preeclampsia or chronic hypertension and in those with increased uterine artery Doppler pulsatility index, but the most powerful and independent predictor of preeclampsia was capillary rarefaction at 27-32 weeks.
  
  
  CONCLUSIONS
  Quantifying structural rarefaction of skin capillaries in pregnancy is a potentially useful clinical marker for the prediction of preeclampsia.
authors.affiliation: Blood Pressure Unit & Division of Clinical Sciences, St George's, University of London, London, UK.
authors.forename: Tarek F T
authors.initials: TF
authors.lastname: Antonios
authors.forename: Vivek
authors.initials: V
authors.lastname: Nama
authors.forename: Duolao
authors.initials: D
authors.lastname: Wang
authors.forename: Isaac T
authors.initials: IT
authors.lastname: Manyonda
mesh_terms: D000328:Adult; D015415:Biomarkers; D002196:Capillaries / Q000473:pathology*; D005260:Female; D006801:Humans; D008833:Microcirculation / Q000502:physiology; D018715:Microscopy, Video; D011225:Pre-Eclampsia / Q000175:diagnosis* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D011379:Prognosis; D063177:Pulse Wave Analysis; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012867:Skin / Q000098:blood supply*; D014463:Ultrasonography; D055988:Uterine Artery / Q000000981:diagnostic imaging
chemical_list: D015415:Biomarkers
keywords: blood pressure; capillary rarefaction; hypertension; microcirculation; prediction; preeclampsia.