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Aris T Papageorghiou

Publications and source records attributed to Aris T Papageorghiou.

10 recordsLinked to original sources
PubMed2007

Maternal uterine artery Doppler flow velocimetry and the risk of stillbirth.

OBJECTIVE: We sought to relate the risk of antepartum stillbirth to uterine artery Doppler flow velocimetry at 22-24 weeks. METHODS: Data were available from 30,519 unselected women from seven units in the UK who had uterine artery Doppler performed between 22 and 24 weeks of gestation. The risk of stillbirth (n=109) was assessed using time to event and logistic regression analysis. Stillbirths were subdivided into placental (due to abruption, preeclampsia, or growth restriction) or unexplained. RESULTS: The risk of placental stillbirth was increased among women with a mean pulsatility index in the top decile (adjusted hazard ratio [HR] 5.5, 95% confidence interval [CI] 2.8-10.6) and those with a bilateral notch (adjusted HR 3.9, 95% CI 2.0-7.8). The relationship between a mean pulsatility index in the top decile and the risk of unexplained stillbirth was weaker (adjusted HR 2.5, 95% CI 1.1-5.6) and there was no association with a bilateral notch. Placental stillbirths occurred at earlier gestations than unexplained stillbirths (median [interquartile range] 30 [26-36] compared with 38 [36-40], P<.001). Consequently, being in the top 5% of predicted risk of stillbirth on the basis of the combination of mean pulsatility index and notching was a good predictor (sensitivity, specificity, and positive likelihood ratio) of all cause stillbirth up to 32 weeks (58%, 95%, and 12.1, respectively) but a poor predictor of stillbirth at later gestations (7%, 95%, and 1.3, respectively). CONCLUSION: Abnormal uterine artery Doppler was a better predictor of the risk of stillbirth due to placental causes than unexplained stillbirth. Consequently, abnormal uterine artery Doppler was a good predictor of stillbirth at extreme preterm gestations but a poor predictor of stillbirth at term. LEVEL OF EVIDENCE: II.

Adult↗
PubMed2006

Hyperemesis gravidarum: is an ultrasound scan necessary?

BACKGROUND: Traditionally, in cases of hyperemesis gravidarum (HG), an ultrasound evaluation is recommended to confirm viability and to exclude multiple pregnancies and gestational trophoblastic disease (GTD). Our aim was to perform a case-control study to evaluate the incidence of these findings. METHODS: Each case of HG was matched for gestational age with the next ultrasound examination performed in an asymptomatic pregnancy. The findings were compared between the two groups. RESULTS: Two hundred and eighty-six cases of HG were matched with 286 asymptomatic women. The total number of viable pregnancies was higher in the HG group (280/286, 97.9%) than that in the control group (265/286, 92.6%; P = 0.006). The incidence of twins was 3.1% in each group (P > 0.999). The incidence of early pregnancy failure was 0.7% in women with HG compared to 7.0% in asymptomatic women (odds ratio 0.09, 95% CI 0.01-0.04, P < 0.0001). The one case of GTD was in the HG group; however, this case also presented with vaginal bleeding. CONCLUSIONS: Pregnancies complicated by HG had a similar risk of twin pregnancy, and a lower risk of early pregnancy failure compared to controls. In the absence of vaginal bleeding, there was no increase in GTD in women with HG. We conclude that an ultrasound scan is not clinically necessary in women presenting with HG, other than for maternal reassurance.

Case-Control Studies↗
PubMed2006

Sonographic screening for trisomy 13 at 11 to 13(+6) weeks of gestation.

OBJECTIVE: The purpose of this study was to examine the sonographic features of trisomy 13 at 11 to 13(+6) weeks of gestation. STUDY DESIGN: This was a retrospective study that examined the features of trisomy 13 at the ultrasound scan at 11 to 13(+6) weeks of gestation, which in our center is performed for the measurement of crown-rump length, nuchal translucency thickness, and fetal heart rate and the examination for major defects. RESULTS: In the 181 fetuses with trisomy 13, there were holoprosencephaly, exomphalos, and/or megacystis in 92 fetuses (50.2%), fetal heart rate above the 95th percentile in 129 fetuses (71.3%), and nuchal translucency above the 95th percentile in 141 fetuses (77.9%). There was no significant association between nuchal translucency and fetal heart rate, and it was estimated that inclusion of fetal heart rate in nuchal translucency screening can improve the detection rate of trisomy 13 by approximately 5%. CONCLUSION: At the 11 to 13(+6)-week scan, the measurement of fetal nuchal translucency and fetal heart rate and fetal examination for holoprosencephaly, exomphalos, and megacystis can identify >90% of fetuses with trisomy 13.

Adult↗
PubMed2006

First trimester screening for preeclampsia.

PURPOSE OF REVIEW: Aspirin therapy from the first trimester of pregnancy may benefit women at high risk for preeclampsia. We review publications from the past year that examine first-trimester screening studies for preeclampsia. RECENT FINDINGS: For a false positive rate of 5%, first-trimester uterine artery Doppler studies will detect 50-65% of women who will develop severe preeclampsia (i.e. needing delivery before 35 weeks). Measurement of placental volume with three-dimensional ultrasound at 11-14 weeks detected 20% for a false positive rate of 10% in one study and further evaluation of this technique is needed. Maternal serum placental growth factor, vascular endothelial growth factor and soluble fms-like tyrosine kinase-1 have shown initial promise, but recent studies have shown no improvement in screening compared with using uterine artery Doppler alone. Placental protein 13 is the most promising serum marker and in combination with uterine Doppler may predict up to 90% of cases of severe preeclampsia for a false positive rate of 9%. SUMMARY: First-trimester uterine artery Doppler can identify over half of women who will develop preeclampsia. Detection rates may be increased by a combination of uterine artery Doppler with first-trimester maternal serum markers, especially placental protein 13. Such high-risk women may be the most likely to benefit from pharmacological intervention in future trials.

Biomarkers↗
PubMed2005

An integrated model for the prediction of preeclampsia using maternal factors and uterine artery Doppler velocimetry in unselected low-risk women.

OBJECTIVE: The purpose of this study was to develop a predictive model for preeclampsia. STUDY DESIGN: This was a prospective screening study for preeclampsia using uterine artery Doppler ultrasound in unselected low-risk singleton pregnancies at community hospitals in the UK (n = 32,157). Logistic regression models were developed and their predictive ability assessed using the area under the receiver operator curve (AROC). RESULTS: Six hundred twelve (2.0%) women developed preeclampsia, and 144 (0.5%) required early delivery (<34 weeks). A model using both maternal and ultrasound factors had an AROC of 0.798, which was higher than ultrasound alone (0.729, P < .0001) or maternal factors alone (0.712, P < .0001). In early onset disease, the ROC of ultrasound alone (0.922) was not significantly improved by adding maternal predictors (0.945, P = .27). In contrast, late onset disease was better predicted by the combined model (AROC 0.798) than ultrasound alone (AROC 0.729, P < .0001) or maternal factors alone (AROC 0.712, P < .0001). CONCLUSION: The combination of uterine artery Doppler ultrasound and maternal factors provided the best estimate of risk.

Adult↗
PubMed2005

Uterine artery Doppler screening for adverse pregnancy outcome.

PURPOSE OF REVIEW: This article reviews publications in the area of uterine artery Doppler screening that were published during the past year. RECENT FINDINGS: Studies have shown that assessment of a woman's level of risk for pre-eclampsia by uterine artery Doppler performs better than maternal history alone. Combination of maternal history and uterine artery Doppler findings leads to even more accurate assessment of risk, and allows calculation of patient-specific risk. Combining screening with uterine artery Doppler and maternal serum biochemical markers has been explored in some studies, but data remain limited and larger prospective longitudinal studies are needed to asses the effectiveness of these techniques. A number of promising markers for development of the disease have been identified, however, including pregnancy associated plasma protein-A, inhibin-A, activin-A and fibronectin, as well as placental growth factor, vascular endothelial growth factor and soluble fms-like tyrosine kinase 1. SUMMARY: Uterine artery Doppler has proved useful in identifying women at high and low risk for developing complications of uteroplacental insufficiency and may aid in stratifying antenatal care. In addition, it can identify women in whom biochemical markers should be measured in order to develop screening tests and aid in evaluation of the pathophysiology of impaired placentation and pre-eclampsia. Whether pharmacological intervention in women identified to be at high risk for pre-eclampsia on the basis of Doppler is effective in reducing the incidence of the disease remains to be established.

Arteries↗
PubMed2005

Assessment of risk for the development of pre-eclampsia by maternal characteristics and uterine artery Doppler.

OBJECTIVE: To develop a method for the estimation of patient-specific risk for the development of pre-eclampsia by combining maternal history and uterine artery Doppler. DESIGN: Prospective multicentre observational study. SETTING: Antenatal clinics in seven hospitals in the UK and three overseas centres. POPULATION: Unselected women with singleton pregnancies attending for routine antenatal care. METHODS: Doppler studies of the uterine arteries were performed using colour flow mapping and pulsed wave Doppler at 23 weeks of gestation. The mean pulsatility index (PI) of the two uterine arteries was calculated. Doppler and maternal history variables were combined to develop a model for risk assessment. The incidence of pre-eclampsia was used to derive the prior risk for this complication. The posterior risk was derived by multiplying the prior odds with likelihood ratios (LRs) derived from independent risk factors identified from the maternal history, and the LR estimated from the heights of the frequency distributions of mean PI in affected and unaffected pregnancies. MAIN OUTCOME MEASURE: Pre-eclampsia. RESULTS: There were 17,480 women recruited to the study, in which 17,319 (99.1%) of these Doppler examination of both uterine arteries were completed, and outcome data were available in 16,806 (97.0%). Pre-eclampsia occurred in 369 (2.20%) cases. Significant independent prediction of pre-eclampsia was provided by mean PI, ethnic origin, body mass index (BMI), parity, cigarette smoking, history of hypertension and family or personal history of pre-eclampsia. Models were derived allowing calculation of patient-specific risk for development of pre-eclampsia. For a false-positive rate of 25%, the detection rate of pre-eclampsia by screening using maternal history was 45.3%, with uterine artery Doppler it was 63.1% and with combined assessment it was 67.5%. CONCLUSIONS: Combining risk factors in the mother's history with Doppler of the uterine arteries allows calculation of patient-specific risk for the development of pre-eclampsia.

Arteries↗
PubMed2004

The role of uterine artery Doppler in predicting adverse pregnancy outcome.

The complications of placental insufficiency, pre-eclampsia and fetal growth restriction (FGR) are major causes of perinatal as well as maternal morbidity and mortality. In normal pregnancy, impedance to flow in the uterine arteries decreases with gestation, and histopathological studies suggest that this is due to trophoblastic invasion of the spiral arteries and their conversion into low-resistance vessels. Failure of trophoblastic invasion is associated with complications of uteroplacental insufficiency. Several Doppler screening studies, both in the second and more recently in the first trimester of pregnancy, have demonstrated an association between increased impedance to flow in the uterine arteries and subsequent development of pre-eclampsia, FGR and perinatal death.

Arteries↗