Urgert, M. (Merel) (2013) De waarde van Doppler onderzoek van de arteria uterina en arteria umbilicalis in het tweede trimester van de bedreigde zwangerschap. thesis, Medicine.
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Abstract
Objective: Smoking during pregnancy is a main cause of fetal growth restriction, mortality and morbidity. The effects of smoking during the second trimester of pregnancy on uterine and umbilical artery Doppler indices remain unclear. Aims of this study were (1) to determine the effect of maternal smoking on the uteroplacental circulation using uterine and umbilical Doppler indices during the second trimester of pregnancy, and (2) to investigate the usefulness of uterine and umbilical artery Doppler during the second trimester of pregnancy to predict intra-uterine growth restriction in women who smoke during pregnancy compared with non smokers, and (3) to assess repeatability and reproducibility of uterine and umbilical Doppler using transabdominal Doppler during second trimester of pregnancy. Methods: This is a prospective cohort study involving 156 women with high risk pregnancies. Participants were divided into three groups; non smokers, moderate smokers (1-9 cigarettes) and heavy smokers (≥ 10 cigarettes). Abdominal ultrasound Doppler was used to perform uterine PI and RI and umbilical Doppler PI indices during the second trimester of pregnancy. Information of birth weight, fetal sex and gestation at delivery was available in 97 of the participants. Statistical analysis was performed using logistic regression and linear regression. Intraobserver repeatability and interobserver reproducibility was assessed using intraclass correlation coefficients and the limits of agreement method of Bland and Altman. Main outcome measures: Mean umbilical PI and uterine artery PI and RI Doppler values. Proportion of abnormal uterine and umbilical Doppler values (> 95th centile). Birth weight and proportion of intra-uterine growth restriction (defined as birth weight < 10th centile). Intraclass correlation coefficient (ICC), limits of agreement method. Results: 72% (n=96) of the 156 participants reported they smoked during pregnancy. Among the smokers 55 women were moderate smokers, 41 were heavy smokers. (1) Significantly lower uterine PI Doppler values were found in moderate smokers compared to non smokers (0.90 (0.32) vs. 0.74 (1.52) p<0.05). Using linear regression significantly lower uterine PI and uterine RI values were found among moderate smokers compared with non smokers (-0.13 (-0.24, -0.02) p 0.024) and (-0.05 (-0.09, -0.01) p 0.026). (2) This study showed no significant predictive value of Doppler indices during the second trimester of pregnancy on birth weight. For women who had an abnormal umbilical PI during the second trimester of pregnancy there was a trend towards having a child with IUGR (OR 4.4, 95% CI 0.94-20.1, p 0.060). Also a trend was seen towards a decrease in birth weight and an increase in Doppler values during the second trimester of pregnancy. Of each increase in uterine PI, uterine RI and umbilical PI by 0.1 a reduction in birth weight was seen by 28.6, 49.9 and 27.9 gram respectively. (3) Intraobserver ICCs ranged from 0.788-0.959, indicating strong correlation. Interobserver ICCs ranged from 0.859-0.970. Limits of agreement ranged from -0.08 to 0.08 and -0.09 to 0.11 difference from the mean to -0.25 to 0.22. Uterine RI showed the highest agreement, followed by uterine PI and umbilical PI. Conclusion: (1) This study shows that smoking during pregnancy is not associated with higher umbilical and uterine Doppler values during the second trimester of pregnancy. Screening women who smoke during pregnancy for abnormal Doppler values in the second trimester of pregnancy is not indicated. Measuring fetal biometry in the third trimester of pregnancy may be more informative. (2) This study shows no significant predictive value of measuring Doppler indices in the second trimester of pregnancy to predict intra-uterine growth restriction. In retrospect this study was underpowered. There was a trend though towards having a child with IUGR in women who had an abnormal umbilical PI during the second trimester of pregnancy. Further research is needed to assess the usefulness of Doppler indices during the second trimester of pregnancy to predict IUGR. (3) This study demonstrates good repeatability and reproducibility of uterine RI Doppler when measured by an experienced investigator. Uterine PI and umbilical PI show wider limits of agreement, indicating poor repeatability and reproducibility. These results should be taken into account when using Doppler indices for clinical purpose. The limits of agreement method is shown to be more appropriate to assess inter- and intraobserver variability.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Stigter, Dr. R.H. and Deventer Ziekenhuis and Obstetrie & Gynaecologie |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:40 |
| Last Modified: | 25 Jun 2020 10:40 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/133 |
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