OC204: Placental Doppler velocimetry in pregnancies complicated by pre-gestation diabetes mellitus

31 August–4 September 2003, Paris, France was − 0.64 ± 0.77, − 0.58 ± 0.91 and − 0.18 ± 0.90 in Group 1, 2 and 3, respectively. One-way analysis of variance (ANOVA) showed that the difference in birthweight between the groups was statistically significant (F = 10.884; p < 0.005). Conclusion: The timing of trophoblast invasion, as reflected by uterine artery waveforms, has a significant effect on birthweight.

OC203 Carotid artery blood volume flow and elevated blood pressure in high-risk pregnancy M. O. Thompson*, N. C. Wathen† and K. Harrington† *University College Hospital, London, UK and †Homerton Hospital, London, UK Introduction: Cerebral hypoxic and ischaemic changes have been implicated in the aetiology of the characteristic seizures that signify the end-progression of pre-eclampsia. Until recently, neuronal dysfunction secondary to ischaemic causes or functional impairment has been difficult to study in adult humans due to the relative inaccessibility of the cerebral circulation. Doppler ultrasound now provides a means of assessing the normalcy of blood flow velocity, and has demonstrated consistency in the evaluation of severe vascular stenosis 1. Differences in systemic peripheral resistance between normotensive and preeclamptic pregnant women have also been demonstrated using calibrated carotid pulse tracings 2. Objective: To measure peak Carotid blood volume flow in a group of prospective mothers at high-risk of pregnancy hypertension and preeclampsia following uterine artery Doppler screening. Methods: Carotid artery velocimetric and blood volume flow profiles were evaluated using standardised techniques in 31 pregnant women at 24–28 weeks gestation. Results: Blood volume flow measurement showed a 75% sensitivity for elevated blood pressure in later pregnancy, 60% sensitivity for the development of preeclampsia and 100% sensitivity for preterm preeclampsia. Conclusion: The measurement of blood volume flow in the Carotid circulation in high-risk pregnant women merits further investigation as a second-tier screening test for pregnancy hypertension and preeclampsia.

Oral communication abstracts

Material and methods: A multicenter retrospective study of 155 pregestation diabetic women (PGDM) between 22nd and 40th week of pregnancy, categorized in White classification as: B: 49; C: 40; D: 22; R: 20; F: 5; and R/F: 19. Class R, F and R/F were defined as cases with vasculopathy. Doppler velocimetry of umbilical and uterine arteries were evaluated for vascular impedance, both in terms of pulsatility index (PI) for both arteries and a notch in early diastole in the uterine arteries. The last examination before delivery was used for analysis. The average HbA1c concentrations in the White classes were between 6.1% and 6.9%. Results: Increased umbilical artery PI was seen in 19 and a uterine artery abnormality in 45 cases. There was no correlation between serum HbA1c and either umbilical or uterine artery Doppler or White classification. There was no correlation between umbilical artery Doppler and White classification. A strong correlation was however seen between the classification and uterine artery Doppler velocimetry. Abnormal uterine artery Doppler was also strongly related to adverse outcome of pregnancy including preterm birth, small for gestational age newborns, lower placental weight, low Apgar score at 5 minutes, low umbilical venous pH and pregnancy induced hypertension. Conclusions: Abnormal uterine artery Doppler was strongly related to vasculopathy and adverse outcome of pregnancy in cases of pre-pregnancy diabetes mellitus. This finding might be of value for clinical surveillance of these high-risk pregnancies.

OC205 Sonographic atypical vascular coiling of the umbilical cord: incidence and clinical significance ¨ Duwe*, E. Di Naro*, L. Raio*, F. Ghezzi†, D. Gunter A. Cromi†, V. Bergamni‡, P. Duerig* and H. Schneider* *University of Berne, Switzerland; †University of Insubria – Varese, Italy and ‡University of Verona, Italy

Objective: The aim of the study was to evaluate the relationship between placental Doppler velocimetry and levels of the maternal glucose and signs of organ damage in pregnancy complicated by pre-gestational diabetes mellitus.

Objective: Usually, the umbilical cord (UC) vascular coiling is a periodic phenomenon that repeats itself through the entire UC length. Variation in the number of coils at delivery have been found to be associated with adverse pregnancy outcome. Although hypo- or hypercoiling can be present, the angioarchitecture of these UCs preserves a repetitive (typical) pattern through the UC length. The aim of this study was to investigate whether a non-repetitive UC coiling pattern (uncoordinated coiling) or an excessive coiling (supercoiling) at prenatal sonography is associated with adverse pregnancy outcome. Methods: A target sonographic evaluation of the UC was performed in 356 consecutive pregnant women. Color flow mapping was used to enhance the definition of the UC vascular coils. Atypical coiling was defined as the presence of a spring-shape UC (supercoiling) or a bizarre, aperiodic, coiling pattern. Umbilical artery Doppler assessment was conducted in cases with atypical coiling. Fetal and neonatal outcome was investigated. Results: Of the 356 cases, 14 (3.9%) were found to have an atypical UC coiling pattern (7 uncoordinated coiling pattern and 7 supercoiled). Ten (71.4%) had an adverse pregnancy outcome. Seven delivered preterm and 7 were small for gestational age at delivery. Three fetuses had a meconium peritonitis with ascites, all with supercoiled UCs. One fetus had trisomy 18. Three umbilical cords had a single umbilical artery. Umbilical artery Doppler waveforms presented a postsystolic notch in 5 (35.7%) cases. Conclusions: The presence of an atypical UC vascular coiling is associated with an elevated risk of unfavourable pregnancy outcome. The detection of an atypical coiling pattern should prompt the sonographer to perform a comprehensive evaluation of the fetal anatomy and well-being. The identification of an umbilical artery postsystolic notch at Doppler sonography is frequently associated with an atypical UC coiling pattern.

Ultrasound in Obstetrics & Gynecology 2003; 22 (Suppl. 1): 1–69

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REFERENCES 1. Colon EJ, de Weerd JP, Notermans SL, Vingerhoets HM. Reliability of Doppler sonography in extracranial vascular stenosis. Clinical Neurology & Neurosurgery 1979; 81(2): 108–113. 2. Lang Rm, Pridjian G, Feldman T, Neumann A, Lindheimer M, Borow KM. Left ventricular mechanics in preeclampsia. American Heart Journal 1991; 121(6): 1768–1775.

OC204 Placental Doppler velocimetry in pregnancies complicated by pre-gestation diabetes mellitus M. Pietryga*, J. Brazert*, E. Wender-Ozegowska*, R. Biczysko*, M. Dubiel* and S. Gudmundsson† *University of Medical Sciences, Poznan, ˜ Poland and †University of Lund, Sweden