Downloaded from journal.bums.ac.ir at 15:59 IRST on Friday February 1st 2019!"#!" # $

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Downloaded from journal.bums.ac.ir at 15:59 IRST on Friday February 1st 2019!"#!" # $"

Transcription

1 ()*+ #$ %&'(!"! )!"# #$ "! : 6 &% 41 2%! 5% 3 2 1% * +&!, * -./' 0!&)%.&'% -. =>.&'% < %./' 6; -!796 4' 7-8 &' B CDE "5% ;! A4 (Resistance Index=RI) 7 5% 3;! 5, ' RI I&1 J FGH%. +&AA #.&' 3;!.%K%, 7>% %. ' (Velocimetry) ;A6 "L&1' - % FGH%. : 8 => &' >R RI.& 5!!.%K%, 7>% % & # &' B 5% +&' &&,, "+&!' J S)%7+ ; $ #Z K; % P0/05 L AF% UH, V$ L %8 %T8 SPSS L %8 K3! T +.&A +&!'J S)%7+ &' F>* RI 46 F>* RI 21 5% [ 6 : %71 # &' B %24 5% +&'&&,, "%6/5 %43.&' +&1,% %4/3 7>% 5% [ 6 # &' B?E,!' ;A6 :.&A%.%K%, 5% _, ' : ()*0 #$ %&'(!/!-. ) )*+/)/* :>3? -<=0////; :37 89: )*6/*/ :123!" # $ )*+,!" # %&'( )( 67, /(4) , /)*+, :- :+?( =>;/$$$;<<; :,1 =>;/$$$;<<;/ )*+,!" # 1!" AB+C D"

2 % H I C$3 &J C %D 2 9&E F %G F 1B $ g'k 36 +5,! S (i) J 3%.&' 3;! 1384/5/6 1382/3/1 j T &,% ->$.%K% L L L%!T 3 L ;A1!.A L, K $6 $ &Ak g!b L13 &A %T%! S LT % L ;A1! L!T &! FGH% T ">!?E,% '5% 3;!!8.%K%, 7>% % L! 3 T.&!&' Il 3;! J "5%! L +&AAF%.&' l./',, h e K!.%K% S!)1 T #>$ +&' +?E, 140/90 mm/hg LS% T 0 1 +T 1 S T #>$ 5% 7 L *> &! $ 5% of " '&! L An &' '&! 5%.(17) &' -; T GS p& -; I7 2% T RI >Z% GS p& -; G.& 5% T #>$ e c 3 qh$ K.G "&!%, T,!8 G, e _& D% L _&' i' r&;% " 100 mm/hg T 35% K%.)&! %. L!'. -s 3 S,!! FJ!.&' 3;! SbG! d +5 Hitachi /5 Convex s RI.&' 3;! t 2!S./'. G% u% L.5!% ' 1.&%8 # &' B h e 5%! 3;!!! 0!&)%.&'% #$ " 3 2 1% * +&!, * -./' &% 41 F>* 5%./' 6; -!796 4' 7 L15% LbG.(1) &'% < % 5!,! " # &' B S)%7+ +1 L c6 %./' F>* A' FGH%.(3"2) &'%. E! - %!T T +&%8 L1 L &' & "2 1% 5% d - c6 &e fgf% * (RI) * GBS%. T "FGH%..(4) d>% 7 #$ 5% # RI 7 -. => A4.g% Ag.,! # &' B CDE "5%! ;! hfgh%.&a% "&' +&AA L&F #%./' ;A6 L&F% L S)%7+ [ 6 5, 3 1% G (10-5) +&' 3;! H L15%.A./' % L&Z% hfgh% +& 3;!.%K%, 7>% %.(13-11) ' RI I&1 J FGH%, 7>% 5% 3;! 5,.&' 3;!.%K% "!# $ 7>% % -! 67 L "L&1' - % FGH%.! & +&AAF%.%K%, * Resistance Index (RI) $=

3 ()*+ #$ %&'(!"! ) =.> /$, 0/001 0/016 0/001 RI $& ' ()* $+% $ %,-. /) 012 / $,+6 RI (12 46) (%6/5) 3 (%4/3) 2 (%4/3) 1 RI $,+67 (12 21) (%43) 9 (%24) 5 (%71) ! 5% +&!'&&,, +&!'J S)%7+ # &' B %& 7>%!T +&!'J S)%7+ i' i' (16-14) %20 G %5..%K% S!)1 L An h e %10/7.%K% S!)1 SGA.(17) +&' x %23 ".%K% S!)1 3w # &' B i' * "FGH%. +&'&&,, K% %10 SEP K% "%25. 5A11 >$ L1 %18 5% " g1 Frusca d +&' 3;! FGH% 8. %3/8 +&!'J S)%7+ K% Z. T.)8 ID% 6 &!%.(14) &' l% FGH%, "SEP. AF% L %8 h # &' B 5% +&'&&, K! J FGH% "F>* RI F>* RI ;A6 g!. T 'l hfgh% &A!% 5% [ 6 H A' ' "&A%.%K%, 7>%!T.&A% g1 Caruso d +&' 3;! FGH% "&' 3;!.%K%, 7>% % -! 42 L # &' B "S)%7+ y! 5% [ 6 K% RI % + G % 2!L K%.& F>* RI &1' + F>* 2! L G % # &' B "S)%7+ &&,, "(SEP) +&!'J S)%7+ ".& >R 5% +&', &&, h e 5% +&'&&,, G, 15 mm/hg T, LS% S)%7+ 5% -S 1 T &F L An & ; S!)1 &'& h e +&!'J % 300 LS%, L An -g' dz% +T&! h e # &' B %T.&' of d% T F% IZ! T.A s8g.& >R K! &G 35A1.A T 5% -, 3& &' 3;! T T 0 +%.& h>r T T 0!8 %T8 SPSS L %8 K3! T + 1+ K; % P0/05 L AF% UH, V$ L %8.&A $ #Z 46 F>* (%31) 21 F>* (%69), "(%10) 7 +&!'J S)%7+ # &' B (%18) 12 5% +&'&&, RI.&' +&1,% (%25) 17, "+&!'J S)%7+ K% F>* v # &' B 5% +&' &&, K% F>* RI %71 %43 "%24 5% +&' &&,, "+&!'J S)%7+ %4/3 %6/5 "%4/3 v # &' B.' AF% I7 % 1 F>* RI V>* Perinatal Outcome "1 2& 2!L [ 6.&1%,!./' F>* F' F>* RI %!T #$ *.&'% $

4 % H I C$3 &J C %D 2 9&E F %G F 1B $ 28 1 T 0 ' Diastolic Notch.&' % L T + +&' 3;! hfgh% $ vh%. +&AAA, Diastolic Notch A' A RI T RI +1 Notching Unilateral 5% [ 6!T i;% &'! 5% 3;! 5! Notch H ' F>* RI,1 Bilateral Notch.!8 5% [ 6 T L{ %, &F L, hfgh% L RI 4K K% R.%K%, RI Diastolic Notch 3w K! 5% >$6 S 4K }6 + { FGH% $ H o, >p% 5, h &$.&' &1 5% [ 6 %46 %26 "%60 v F>* RI +.(6) e % 1 &1' + &' B K% "K! g1 Frucca FGH% + +&!'J S)%7+ # %52 %12 F>* RI.%K%, 7>% % #$ I7 %1 e 2%! RI +.(14) &1%,! ) '( 5! ",% hfgh% J FGH% L1 i;% '!G vh%..%k% S!)1 7>% RI L +T&! F>* z! &A% 5% [ 6 A'.&'% &&' L5 2A T! 5! L va% L1 F% T 5 g 3&.%K%, 7>% % :*&+ 1- Pijnenbory R, Dixon G, Robertson WB, Brosens I. Trophoblastic invasion of human deciduas from 8-18 weeks of pregnancy. Placena. 1980; 1: Pijnenborg R, Anthony J, Davey DA, Rees A, Tiltman A, Vercruysse L, et al. Placental bed spiral arteries in the hypertensive disorders of pregnancy. Br J Obstet Gynaecol. 1991; 98 (7): Aardema MW, Osterhof H, Timmer A, van Rooy I, Aarnoudse JG. Uterine artery Doppler flow and uteroplacental vascular pathology in normal pregnancies and pregnancies complicated by pre-eclampsia and small for gestational age fetuses. Placenta. 200; 22 (5): Prefumo F, Sebire NJ, Thilaganathan B. Decreased endovascular trophoblast invasion in first trimester pregnancies with high-resistance uterine artery Doppler indices. Hum Reprod. 2004; 19 (1): Arduini D, Rizzo G, Romani C, Mancuso S. Utero-placentalmblood flow velocity waveform as a predictor of pregnancy-induced hypertension. Eur J Obstet Gynecol Reprod Bilo 1987; 26: Caruso A, Ferrazzani S, De Carolis S. Prediction of preeclampsia by Doppler uterine flow waveforms. Am J Obstet Gynecol. 1992; 166: Jacobson L, Imhof R, Manning N. The value of Doppler assessment of the uteroplacental circulation in predicting preeclapsia or intrauterine growth retardation. Am J Obset Gynecolo. 1990; 162: Campbell S, Diaz-Recasens J, Griffin DR, Cohen-Overbeek TE, Pearce JM, Willson K, et al. New doppler technique for assessing uteroplacental blood flow. Lancet. 1983; 1 (8326 Pt 1): Hutter W, Grab D, Schneider D, Terinde R, Wolf A. Continuous wave Doppler investigation of uteroplacental vessels in high risk pregnancies as predictor of fetal growth retardation and pregnancy induced hypertention. Gyencol Obstet Invest. 1994; 38: $$

5 ()*+ #$ %&'(!"! ) 10- Trudinger B, Giles W, Cook C. Flow velocity waveform in the maternal unteroplacental and fetal umbilical placental circulations. Am J Obstet Gynecol. 1985; 152: Fleischer A, Schulman H, Farmakides G, Bracero L, Grunfeld L, Rochelson B, et al. Erine artery doppler velocimetry in pregnant women with hypertension. Am J Obstet Gynecol. 1986; 154 (4): Ducey J, Schulman H, Farmakides G, Rochelson B, Bracero L, Fleischer A, et al. A classification of hypertension in pregnancy based on Doppler velocimetry. Am J Obstet Gynecol. 1987; 157 (3): Clode N, Nunes J, Cardozo C, Graca LM. The clinical implications of the characteristics of ureroplacental flow in pregnanciesvcomplicated by ypertention. Acta Med Port. 1994; 7: Frusca T, Soregaroli M, Zanelli S, Danti L, Guandalini F, Valcamonico A. Role of uterine artery doppler investigation in pregnant women with chronic hypertension. Eur J Obstet Gynecol Reprod Biol. 1998; 79 (1): Rey E, Couturier A. The prognosis of pregnancy in women with chronic hypertention. Am J Obstet Gynecol. 1994; 171: McCown LME, Bruist RG, North RA, Gamble G. Perinatal morbidity in chronic hypertention. Br J Obstet Gynacol. 1996; 103: Cunniogham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap LC, Wenstrom KD. Williams s obstetrics. 12 th ed. US: McGraw Hill;

6 % H I C$3 &J C %D 2 9&E F %G F 1B $ Title: Evaluation of the uterine artery resistance index by Doppler ultrasonography in pregnant women with chronic hypertension Authors: Y. Davoudi 1, M. Mohammadi Fard 2, F. Madarshahian 3 Abstract: Background and Aim: Uterine placental bloodstream pressure can be measured by Doppler ultrasonography, which is a non-invasive technique. Uterine arteries velocimetry progressively decreases during the first and second trimesters in normal gestation; due to trophoblastic invasion of musculoelastic membrane of uterine spiral arteries. The relationship between trophoblastic invasion and placental resistance index can be helpful in predicting gestation outcome; intrauterine growth retardation in particular. The aim of this study was to measure the significance of uterine artery resistance index in predicting maternal and fetal complications in pregnant women with chronic hypertension. Materials and Methods: Uterine artery velocimetry was investigated between 28 and 32 weeks after gestation in 67 chronic hypertensive pregnant women by means of colour Doppler sonograph. Resistance index (RI) was recorded and its relationship to the development of superimposed pre-eclampsia (SPE), pregnancy aggravated hypertension (PAH), and intrauterine growth retardation (IUGR) was surveyed. The obtained data was analysed employing SPSS using Fisher accurate test; and P0.05 was considered as the significant level. Results: There were more pregnancy complications in 21 patients with abnormal RI compared with 46 patients with normal RI (SPE 43% vs.6.5%, PAH 24% vs. 4.3%, and IUGR 71% vs. 4.3%). Conclusion: Uterine artery Doppler velocimetry helps to identify a subgroup of chronic hypertensive patients with a high frequency of pregnancy complications. Key words: Uterine artery, Doppler ultrasonography, hypertension, Pregnancy 1 Assistant Professor, Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences. Mashhad, Iran 2 Corresponding Author; Assistant Professor, Department of Radiology, Faculty of Medicine, Birjand University of Medical Sciences. Birjand, Iran 3 Instructor, Faculty of Nursing and Midwifery, Birjand University of Medical Sciences. Birjand, Iran $E