UTERINE-UMBILICAL ARTERY DOPPLER VELOCIMETRY IN PREGNANT WOMEN WITH CONNECTIVE TISSUE DISORDERS

Background: Pregnancy in connective tissue disorders (CTD) can be at high risk to the mother and fetus. Prothrombotic risk factors and vascular damage can impair utero-placental perfusion affecting pregnancy outcome. Objectives: We prospectively evaluated continuous wave uterine-umbilical artery Doppler velocimetry in order to determine if some CTD patients (pts) have a higher prevalence of Doppler alterations with a higher risk of adverse pregnancy outcome. Methods: Blood flow velocity waveforms of the umbilical and uterine arteries were studied by transabdominal Doppler ultrasound in 40 women attending our high risk pregnancy clinic. Nine patients (pts) were affected from Systemic Lupus Erythematosus (SLE) [1 with secondary antiphospholipid syndrome and 4 with positive antiphospholipid antibodies (aPL) or Lupus anticoagulant (LA)], 12 from undifferentiated connective tissue disorder (UCTD) (2 with positive LA), 4 from primary antiphospholipid syndrome (APS), 4 from Systemic Sclerosis (Scl), 3 from Seronegative Spondyloarthritis (SpA), 3 from Sjogren Syndrome (SS), 3 from Behcet disease and 1 from Rheumatoid Arthritis (RA). Resistance index (RI) of umbilical and uterine arteries was measured every 4 weeks from week 21 (corresponding to morphological examination) to week 32. Results: Abnormal umbilical-uterine artery blood flow velocity was found in 13 pts, 4 affected from SLE of whom 1 with secondary APS and 2 with positive aPL (1 IgG aPL high title and positive LA and 2 IgG and IgM aPL high title), 2 affected from APS (with positive IgG aPL high title and 1 with positive LA and IgG aPL high title), 3 with Scl, 2 with Behcet, 1 with UCTD and 1 with SpA. All 13 pts delivered uneventfully. Nine out of 13 pts performed a caesarian section (CS) at a mean gestational age of 35.7 weeks; reasons for CS were 4 premature membrane ruptures, 1 intrauterine growth retardation, 1 preeclampsia and 2 SLE flares with nephritis. The mean birth weight was 2142 gram and the mean APGAR score at 5 and at 10 minutes was respectively 8 and 8. The 27 mothers with normal Doppler waves delivered uneventfully. Eighteen had a spontaneous delivery and 9 experienced CS (1 PROM). Mean gestational age was 39 weeks. Mean birth weight was 3200 gram and mean APGAR score at 5 and 10 minutes was respectively 9 and 10. Conclusion: This study confirm how pregnancy outcome of patients with abnormal waves (at maternal i.e.umbilical and at feto-maternal i.e. uterine level) is worse compared to woman with normal Doppler. Infact in this study, despite the aPL status (data not shown), abnormal Doppler velocimetry was related to an increased prevalence of PROM, IUGR, maternal and perinatal complications (low birth weight, low APGAR score). Not surprisingly due to the important role of vascular damage, pts at higher risks were those with SLE (50% had abnormal flow), APS (50% with abnormal flow), Scl (75% with abnormal flow) and Behcet disease (66%). We suggest that in these CTD pts besides the aPL status which is a well known factor associated with adverse pregnancy outcome, Doppler velocimetry must be performed in order to identify patients at higher risk and in order to start a proper therapy.