Journal of Ultrasound in Medicine, Vol 11, Issue 6 275-281, Copyright © 1992 by American Institute of Ultrasound in Medicine
Uterine-umbilical artery Doppler velocimetry in pregnant women with systemic lupus erythematosus
E. Guzman, H. Schulman, L. Bracero, B. Rochelson, G. Farmakides and A. Coury
Department of Obstetrics and Gynecology, Newark Beth Israel Medical Center, New Jersey.
We evaluated continuous wave uterine-umbilical artery Doppler velocimetry
for predicting pregnancy outcome in women with systemic lupus erythematosus
(SLE). Lupus anticoagulant (LAC) and anticardiolipin (ACL) antibody status
also were correlated with Doppler results and outcome. Three Doppler
vascular patterns were identified in 27 pregnancies of 26 women with SLE.
Patients with normal flow velocity in both vessels had normal outcomes (n =
18). Reduced flow velocity of the umbilical artery only was present in five
women, whose newborn infants were of lesser gestational age and
birthweight, two being small for gestational age. In four pregnancies
reduced flow velocity was noted in both vessels. These cases had the
poorest outcome, with three perinatal losses and all fetuses being small
for gestational age. Doppler velocimetry showed 100% sensitivity and
negative predictive value in the detection of the small for gestational age
fetus and abnormal antepartum fetal heart rate tracing. Fourteen of 18
women with normal Doppler studies did not have preeclampsia or SLE
flare-ups, whereas all nine women with abnormal Doppler studies had such
complications. In all 27 pregnancies the women were screened for LAC, and
21 women also were tested for the ACL antibody. Poor correlation was found
between antiphospholipid antibody status and Doppler results in three of
the six pregnancies with positive antibody testing the patients had normal
Doppler studies and outcomes. Thus, Doppler velocimetry may help determine
when these substances will affect the outcome adversely. In this study the
umbilical-placental vascular system was affected more often.
Uterine-umbilical arterial Doppler velocimetry uniquely identified the
fetus at risk for adverse perinatal outcome in pregnancies complicated by
SLE. Thus, it is a potentially valuable tool in clarifying the
pathophysiology and in the management of SLE in pregnancy.
