The second trimester Doppler ultrasound examination is the best predictor of late pregnancy outcome in systemic lupus erythematosus and/or the antiphospholipid syndrome

• Published in: Rheumatology (Oxford, England) Vol. 45; no. 3; pp. 332 - 338
• Main Authors: Le Thi Huong, D., Wechsler, B., Vauthier-Brouzes, D., Duhaut, P., Costedoat, N., Andreu, M. R., Lefebvre, G., Piette, J.-C.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.03.2006; Oxford Publishing Limited (England)
• Subjects: Antiphospholipid syndrome; Antiphospholipid Syndrome - diagnostic imaging; Biological and medical sciences; Cardiovascular system; Diseases of the osteoarticular system; Doppler ultrasound; Female; Fetal Death - etiology; Humans; Investigative techniques, diagnostic techniques (general aspects); Lupus Erythematosus, Systemic - diagnostic imaging; Medical sciences; Pregnancy; Pregnancy Complications - diagnostic imaging; Pregnancy Outcome; Pregnancy Trimester, Second; Prognosis; Prospective Studies; Risk Factors; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Systemic lupus erythematosus; Thrombophlebitis - complications; Ultrasonic investigative techniques; Ultrasonography, Doppler; Ultrasonography, Prenatal; Umbilical Arteries - diagnostic imaging; Umbilical Arteries - physiopathology; Sonography; Doppler ultrasound study; Connective tissue disease; Skin disease; Antiphospholipid antibody syndrome; Prognosis; Rheumatology; Cardiovascular disease; Autoimmune disease; Hemopathy; Doppler ultrasound; Vascular disease; Pregnancy; Platelet; Systemic lupus erythematosus; Systemic disease; Ultrasound; Antiphospholipid syndrome
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/kei159

Objective. To examine the predictive value of clinical examination, laboratory tests and Doppler ultrasound examination in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS) pregnancies. Methods. A prospective study of 116 pregnancies followed in a single tertiary referral centre. Outcomes analysed were fetal/neonatal death and adverse pregnancy outcome. Univariate analysis was performed for: (i) medical and obstetric history; (ii) medical and obstetric clinical examination; (iii) biological data; (iv) Doppler ultrasound examination. Variables significantly associated with the outcomes in the univariate analysis were entered into a logistic regression model. Results. Sixteen out of 116 pregnancies ended in 12 fetal deaths and 4 embryonic losses. Hence, data for 100 pregnancies were analysed. Seven fetal deaths and one neonatal death occurred, associated with abnormal end-diastolic umbilical artery Doppler flow at the second trimester (P<0.006), a history of thrombophlebitis (P<0.001) or notched uterine artery and growth restriction at the second trimester (P<0.002). Multivariate analysis retained abnormal end-diastolic umbilical artery Doppler flow (P = 0.047) and history of thrombophlebitis (P = 0.018) as significant predictors. Thirty-one adverse pregnancy outcomes occurred, associated with notched uterine artery (P<0.00003), abnormal end-diastolic umbilical artery Doppler flow (P<0.0006) and fetal growth restriction at the second trimester (P<0.008), growth restriction (P<0.00001) and notched uterine artery at the third trimester (P<0.0008), use of heparin (P<0.05) and history of thrombophlebitis (P<0.04). Notched uterine artery at the second trimester remained the only predictor in multivariate analysis (P = 0.001). Conclusions. Results of the second trimester Doppler ultrasound examination are the best predictors for late pregnancy outcome in SLE and/or APS.