Bedside diagnosis of two major clinical phenotypes of hypertensive disorders of pregnancy.
OBJECTIVE
To investigate the hypothesis that fetal abdominal circumference (AC) and uterine artery (UtA) Doppler pulsatility index (PI) could be used to select two homogeneous subgroups of women affected by hypertensive disorders of pregnancy (HDP), characterized by the coexistence of maternal hypertension with and without intrauterine growth restriction (IUGR).


METHODS
This was a multicenter retrospective study of cases affected by HDP in whom fetal AC and UtA-PI had been measured at admission to fetomaternal medicine units. Maternal characteristics, pregnancy complications and outcome were recorded. These data allowed us to model the characteristics of fetal growth in cases affected by HDP, and to design composite indicators of risk factors for maternal metabolic syndrome and of severity for maternal functional organ damage.


RESULTS
Measurements of fetal AC and UtA-PI allowed us to define a group of HDP cases with appropriate-for-gestational-age (AGA) fetuses (HDP-AGA), diagnosed by normal fetal AC and UtA-PI (n = 205), and a group of HDP cases with IUGR fetuses (HDP-IUGR), diagnosed by fetal AC < 5(th) centile and UtA-PI > 95(th) centile (n = 124). Curves fitted to the birth weights of these two groups were significantly different, but gestational age at admission for HDP (< 34 or ≥ 34 weeks) did not show an independent association with birth weight. When birth weight was expressed as a Z-score with respect to local reference charts, the average corresponded to the 6(th) and 48(th) centiles, respectively. The occurrence of HDP-AGA (as compared with HDP-IUGR) was significantly associated with risk factors for maternal metabolic syndrome (odds ratio, 2.79 (95% CI, 1.57-4.97)), independent of gestational age. The same risk factors yielded non-significant odds ratios for the development of late-onset (vs early-onset) HDP. Women with HDP-IUGR had worse clinical outcomes.


CONCLUSIONS
This study provides new information based on simple prenatal bedside examinations that might help to differentiate HDP-IUGR from HDP-AGA fetuses. These groups are associated with different fetal growth patterns and risk factors, independent of gestational age at onset of the disease. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
Department of Woman, Mother and Neonate, Buzzi Hospital, Biomedical and Clinical Sciences School of Medicine, University of Milan, Milan, Italy.
E
E
Ferrazzi
Department of Woman, Mother and Neonate, Buzzi Hospital, Biomedical and Clinical Sciences School of Medicine, University of Milan, Milan, Italy.
S
S
Zullino
Unit of Prenatal Diagnosis, IRCCS Burlo Garofolo, Trieste, Italy.
T
T
Stampalija
Laboratory 'GA Maccacaro' Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
C
C
Vener
Obstetrics and Gynecology Unit, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
P
P
Cavoretto
Ob/Gyn Unit, Department for Health of Mothers and Children, Padua City Hospital, Padua, Italy.
M T
MT
Gervasi
Department of Obstetrics and Gynecology, University of Milano-Bicocca, Monza, Italy.
P
P
Vergani
High Risk Pregnancy Unit, University Hospital of Careggi, Florence, Italy.
F
F
Mecacci
Department of Surgical Sciences, Sant'Anna Hospital, University of Turin, Turin, Italy.
L
L
Marozio
Department of Surgical Sciences, Sant'Anna Hospital, University of Turin, Turin, Italy.
G
G
Oggè
Department of Obstetrics and Gynecology, University of Milano-Bicocca, Monza, Italy.
P
P
Algeri
Ob/Gyn Unit, Department for Health of Mothers and Children, Padua City Hospital, Padua, Italy.
A
A
Ruffatti
Laboratory 'GA Maccacaro' Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
S
S
Milani
Department of Surgical Sciences, Sant'Anna Hospital, University of Turin, Turin, Italy.
T
T
Todros
D000005:Abdomen / Q000000981:diagnostic imaging* / Q000196:embryology; D000328:Adult; D001724:Birth Weight; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging*; D005865:Gestational Age; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000000981:diagnostic imaging*; D007231:Infant, Newborn; D000067716:Point-of-Care Testing; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D018608:Ultrasonography, Doppler / Q000379:methods; D016216:Ultrasonography, Prenatal / Q000379:methods; D055988:Uterine Artery / Q000000981:diagnostic imaging* / Q000196:embryology
Doppler velocimetry; hypertension; intrauterine growth restriction; metabolic syndrome; pre-eclampsia; pregnancy