Rheumatology Advance Access originally published online on October 25, 2005
Rheumatology 2006 45(3):332-338; doi:10.1093/rheumatology/kei159
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The second trimester Doppler ultrasound examination is the best predictor of late pregnancy outcome in systemic lupus erythematosus and/or the antiphospholipid syndrome
Department of Internal Medicine and 1 Department of Gynecology-Obstetrics, Groupe Hospitalier Pitié-Salpêtrière, 83 bd de l’Hôpital, 75013 Paris, France.
Correspondence to: D. Le Thi Huong, Department of Internal Medicine, Groupe Hospitalier Pitié-Salpêtrière, 83 bd de l’Hôpital, 75013 Paris, France. E-mail: du.boutin{at}psl.ap-hop-paris.fr
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.
KEY WORDS: Antiphospholipid syndrome, Systemic lupus erythematosus, Pregnancy, Doppler ultrasound
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