Background Pregnancies in women with SLE resulted in an increase of adverse pregnancy outcomes (APOs). The predictive value of fetal umbilical artery Doppler examinations for APOs has been reported, while not widely be assessed in SLE pregnant women.
Objectives To ascertain the predictive value of fetal umbilical artery Doppler for fetal APOs in SLE pregnancies.
Methods A fetal Doppler ultrasound examination was performed on all fetuses during the third trimester (28∼36 weeks of gestation) and the term pregnancy (37∼42 weeks of gestation). The Doppler flow parameters of umbilical arteries were recorded, including pulsatility parameter (PI), resistance index (RI), the peak value of umbilical arteries at end-systole (Vmax, also abbreviate as S) and the peak value of umbilical arteries at end-diastole (Vmin, also abbreviate as D). The value of S/D was automatically calculated. Clinical data and pregnancy outcomes were also analyzed retrospectively.
Results In total, 109 cases of pregnant SLE women performed fetal umbilical artery Doppler at the third trimester and 82 at the term pregnancy. Among the 109 cases, 65 resulted in one or more APOs, including 45 with premature delivery, 23 with intrauterine growth restriction (IUGR), 16 with fetal distress, 8 with neonatal lupus (NLE) and 3 with congenital malformation. Fetus with APOs had higher S/D values compared with fetus without APOs (2.9±0.9 VS. 2.4±0.5, P=0.001). In addition, other Doppler indexes did not differ significantly across groups. The area under the receiver operating characteristic curve was 0.7 (P=0.003) for S/D values, with the optimal cutoff of 2.8. At this cutoff, sensitivity (46.2%) and specificity (90.9%) had the best combination, whereas the positive and negative predictive values were 83.3% and 52.1%, respectively. Among the 82 cases with term pregnancy, 23 resulted in APOs, including 11 with IUGR, 15 with fetal distress, 4 with NLE and 1 with congenital malformation. All of the Doppler indexes (S/D, PI, RI, Vmax and Vmin) in fetus with APOs were higher than those without APOs, but no statistical significance were found between the 2 groups.
Conclusions Umbilical artery Doppler was a good monitor method for APOs in the third trimester. S/D values were sensitive and specific predictors for APOs in pregnancies complicated by SLE. Women with more than 2.8 S/D could start strict monitoring to rapidly identify and treat obstetric complications.
Disclosure of Interest None declared