First trimester NRBC count in maternal circulation Correlation with Doppler ultrasound studies

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Slide 1 : First trimester NRBC count in maternal circulation: Correlation with Doppler ultrasound studies ?avrou, A.,1 Kolialexi, A.1, Souka, A.2, Pilalis,A.2, Kavalakis,Y.2, Antsaklis,P.2,Kanavakis,E.1,Antsaklis A.21 Medical Genetics, 2 1st Dept. of Obstetrics & Gynecology, Athens University School of Medicine, Athens, Greece
Slide 2 : Pre-eclampsia is a consequence of abnormal trophoblast invasion of the maternal spiral arteries, leading to impaired placental perfusion and insufficiency. Doppler ultrasound studies have shown that impaired placental perfusion at 22-24 weeks of gestation is associated with high impedance to flow in the uterine arteries.
Slide 3 : In pregnancies that subsequently developed PET/IUGR there was an increase in fetal NRBCs in the 2nd trimester of pregnancy in maternal circulation
Slide 4 : Aim To determine whether the No. of NRBCs in maternal circulation in women with an anomalous 1st trimester Doppler could identify pregnancies that will continue to have an anomalous Doppler in the 2nd trimester.
Slide 5 : 20ml peripheral blood were obtained from 85 pregnant women in the 1st trimester of pregnancy with increased impedance to both uterine arteries (mean uterine arteries PI>1.6) . 10 women with normal flow velocity waveforms were used as controls
Slide 6 : Isolated by density gradient centrifugation with Histopaque 1083 Magnitically labelled with CD71 antibody to the transferrin receptor Positively selected by MACS Stained with May Grunwald Giemsa Mononuclear cells were
Slide 7 : 1st Trimester Doppler Ultrasound Studies Abnormal 39 Not tested 2nd trimester 39 Normalized 2nd trimester 7 Remained abnormal 85
Slide 8 : Pregnancy outcome in 7 cases with abnormal Doppler ultrasound findings in both 1st and 2nd trimesters 1 IUGR 1 Preeclamsia 5 Normal 7
Slide 9 : No. of NRBCs isolated from maternal blood in the 1st trimester from pregnancies with abnormal Doppler & from controls
Slide 10 :
Slide 11 : The present study indicates that the No. of NRBCs in maternal circulation in the 1st trimester cannot be used as a second line screening to identify pregnancies at high risk for PET/IUGR. There was only one case with high NRBC count which presented IUGR, but this is not enough to establish a possible correlation.
Slide 12 : No attempt was made to discriminate between fetal and maternal erythroblasts. However women carriers of ß-thalassemia trait were excluded from the study.
Slide 13 : High impedance blood flow in the uterine arteries in the 1st trimester may be due to unfinished process of trophoblastic invasion, most likely to be completed successfully by 22-24 weeks.
Slide 14 : First trimester NRBC count in maternal circulation: Correlation with Doppler ultrasound studies ?avrou, A.,1 Kolialexi, A.1, Souka, A.2, Pilalis,A.2, Kavalakis,Y.2, Antsaklis,P.2,Kanavakis,E.1,Antsaklis A.21 Medical Genetics, 2 1st Dept. of Obstetrics & Gynecology, Athens University School of Medicine, Athens, Greece
Slide 15 : All pregnancies were singleton and at the time of examination the women were healthy, normotensive and on no medication All fetuses had no obvious defects and normal fetal growth All women gave consent to participate in the study
Slide 16 : Therefore Doppler ultrasound examination of the uterine arteries can be used to identify a group of pregnancies at high risk of subsequent development of PET/IUGR.
Slide 17 : Since preeclampsia is a major cause of fetal and maternal morbidity and mortality, it is important to develop a predictive screening test early in pregnancy, so as to anticipate pregnancies at high risk for this complication.
Slide 18 : Follow up scans in the 22-23 week of pregnancy were obtained in 46/85 original cases. Details of the pregnancy outcomes were obtained from the patients’ files
Slide 19 : Preeclampsia was diagnosed as maternal blood pressure >140/90mm Hg , with + protein on reagent strip urinalysis of urine protein collection >300mg/24hThe diagnosis of IUGR was made if the birth weight was below the 5th centile of the normal range of gestation

 


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