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Title: Dopplervelocimetria da artéria oftálmica em gestantes com hipertensão arterial
Keywords: Ultra-Sonografia Doppler;  Artéria oftálmica;  Pré-Eclâmpsi;  Hipertensão;  Ultrasonography, Doppler;  Ophthalmic Artery;  Pre-Eclampsia;  Hypertension;  MEDICINA;  CIÊNCIAS MÉDICAS;  Gestante;  Artéria oftálmica
Issue Date: 12-Nov-2012
Abstract: The identification of high risk pregnancies allows adoption of preventive strategies to reduce the morbidity and fetal and maternal mortality. Preeclampsia (PE) is the leading cause of maternal death in Brazil and worldwide. The ocular ecodoppler has been proposed and studied as a complementary method in the evaluation and management of pregnant women, especially those with hypertension. The aim of this study was to compare the ophthalmic artery Doppler indices observed in singleton pregnant women complicated by hypertension (mild PE, severe PE or chronic hypertension) and to correlate the indices observed in hypertensive pregnant women with those observed in normal pregnant women. In a preliminary study the interobserver reproducibility of the method was evaluated. Ophthalmic artery Doppler indices of 30 mild and 30 severe preeclamptic women and 30 pregnant women with chronic hypertension at 20 to 40 weeks of gestational age (GA) were compared. The control group consisted of 289 healthy pregnant women. Resistance index (RI), pulsatility index (PI), and peak ratio (PR) were determined for the right eye. All data were submitted to statistical analysis (S-Plus version 8.0). The mean and standard deviation (SD) were calculated for each group. Kolmogorov-Smirnov test was used to evaluate if data obtained in hypertensive pregnant women had normal distribution. Analysis of variance (ANOVA) was used to compare mean values of the Doppler indices between groups. As significant differences were determined by ANOVA analysis, each group was compared by Tukey method. A receiver operating characteristic (ROC) curves was used to determine the predictive power of ophthalmic artery Doppler indexes for identification of severe pre-eclamptic women. P < 0.05 was considered statistically significant. Significant differences were found between the values obtained for RI, PI, and PR in severe PE women compared to those observed in pregnant women with mild PE, CH and control group. The mean and SD for RI, PI and PR in mild PE, severe PE and CH groups were respectively 0.73 &#61617; 0.06, 1.63 0.35 and 0.65 0.10; 0.63 0.09, 1.13 0.31 and 0.89 0.12; and 0.73 0.07, 1.66 0.49 and 0.66 0.14. The mean and SD for RI, PI and PR in normotensive pregnant women were 0.75 0.05, 1.88 0.43, 0.52 0.10. The optimal cut-off values for RI, PI and PR for identification of severe pre-eclamptic women as determinate by roc curves were 0.657, 1.318 and 0.784 (sensitivity and specificity were 0.633 and 0.919, 0.733 and 0.888, and 0.833 and 0.974, respectively). The area under the ROC curve for RI was 0.787 (95% CI: 0.68-0.89), for PI was 0.797 (95% CI: 0.69-0.90) and for PR was 0.886 (95% CI: 0.80-0.96). In pregnant women with severe PE was observed central overperfusion by Doppler ophthalmic artery. PR was the best ophthalmic Doppler index at discriminating between severe PE and pregnant women with mild PE or chronic hypertension as determined by ROC curve
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