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KMID : 0382619850050010241
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Hanyang Journal of Medicine
1985 Volume.5 No. 1 p.241 ~ p.251
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Comparison of Uteroplacental Blood Flow in Normal and Pre-eclamptic Patients Measurement with Technetium-99m and a Computer-linked Gamma Camera
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Abstract
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Uteroplacental blood flow studies in preeclampsia are of special interest since the vascular changes reported in this disease might constitute a structural basis for a reduc-tion of blood flow. Evidence has also been given for a decreased uteroplacental blood flow in preeclampsia.
Among the various methods to estimate the maternal placental blood flow, the one most frequently reported in the literature during the last years has been the time ac-tivity analysis of short lived radiotracer such as technetium-99m or indium-113m in-jected intravenously. Only few studies with the above mentioned technique compar-ing normal and preeclampsia cases have been undertaken.
In clinical practice we frequently experience difficulty in finding the optimal time to get the delivery in preeclampsia patients.
The aim of this study was first to measure uteroplacental blood flow in preeclamp-tic pregnancies using a computer-linked gamma camera method for the time-activity analysis of technetium-99m and second to discuss the the possibility of clinical ap-plication of these measurements for determination of fetal well-being and the timing of the delivery in these patients.
Uteroplacental blood flow was measured from 13 preeclamptic patients and 19 pregnancies without any complication after 35 completed weeks of gestation from Jan. 1983 to Sep. 1983 at Obstetrics department of Hanyang University Hospital.
The results were as follows;
1. In the preeclamptic women a significantly prolonged median rise time(107sec VS 67sec) was observed (p < 0.05). The maximum activity in the group of preeclamp-sia was also decreased(3406 VS 5100 counts/10sec) (p < 0.05). These values taken together resulted in a median blood flow index in the normal group of 73.4m1/sec and in the preeclamptic group of 33.6m1/sec. The uteroplacental blood flow was reduced with more than 50% in preeclampsia (p < 0.05).
2. Uteroplacental blood flow was compared according to severity of disease. The rise time (103sec) and maximum activity (2518counts/lOsec) in mild from of preeclamp-sia were seemed to be more shortened and higher in activity than those in severe form (158sec, 4003counts/lOsec) respectively, and blood flow index in mild form(46.4m1/sec) was seemed to be more increased than that in severe form (26.2ml/sec). But not so significant difference was noticed.
3. Corresponding calculations were performed with regard to the presence of in-trauterine growth retardation (IUGR) or absence in preeclamptic patients. There was tendency of more reduced placental blood flow in the group with IUGR than that in the group without IUGR(26.5 ml/sec VS 42.2 ml/sec). However, the dif-ference was not significant statistically(p>0.05).
4. Even in preeclamptic patients without IUGR, placental blood flow was reduced than that in the normal group(42.2ml/sec VS 73.4m1/sec) (p<0.05).
5. There was no correlation between the uteroplacental blood flow and 1min. And 5min. of Apgar score.
6. From the above results analysis of time-activity curve of Tc-99m using computer-linked gamma camera could be an useful method to determine the degree of reduc-tion of uteroplacental blood flow in patients with preeclampsia. It is not appropriate to determine the optimal time for delivery by this method alone. However, it might be used as an auxillary terms to evaluate the fetal well-being.
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