MATERNAL BRAIN BLOOD FLOW IN NORMAL PREGNANCY AND PREECLAMPSIS

妊娠与生理性血管扩张有关。 我们定义了， 在脑动脉中使用多普勒超声， 正常妊娠期间血流速度和阻力的变化。 先兆子痫是一种普遍存在的内皮疾病，可引起血管痉挛， 动脉阻力增加 血管反应性增加 早于临床综合征（高血压/蛋白尿）数周，或 个月 在此基础上，研究了一些测试， 预测先兆子痫的能力，但目前还没有临床 有用的. 我们已经确定了大脑/眼眶多普勒的明显差异 先兆子痫和正常血压孕妇之间的参数。 此外，我们还开发了3个多普勒分析模型， 用于可靠地区分长期血压正常和 先兆子痫妇女使用脑动脉阻力指数和 估计的脑灌注压。 这些模型可以适用于 其他血管床，包括肾、子宫胎盘和外周血管床 动脉循环 我们在本提案中的目标是表明， 多个血管中小动脉同时多普勒研究 床可以（i）在临床前和亚临床中识别先兆子痫 阶段，和（ii）组患者已建立的早产先兆子痫 那些会失败或对保守派的拖延做出反应的人 管理 我们将使用标准的多普勒方法， 眶、肾、子宫胎盘和外周动脉床， 确定导出的阻力、流速和灌注指数。 在 此外，血管反应性的动态试验将用于 区分应力分布。 计划了两个纵向方案： A：一项对320名低风险的孕妇进行的门诊研究， 从16周或更短时间开始每月一次，直至足月/分娩，然后在第6、12和 产后24周; B：30例早产先兆子痫患者的内部方案 接受临时管理，每日评估 最初，每隔一天稳定一次，直到分娩。 早期 异常动脉功能的检测可以允许识别 先兆子痫出现前的临床体征。 常设 先兆子痫，血管痉挛恶化的证据将提供信息 疾病的进程和治疗的有效性 就业。

Pregnancy is associated with physiologic vasodilation. We have defined, using Doppler ultrasound in cerebral arteries, some of the physiologic changes in blood velocity and resistance during normal pregnancy. Preeclampsia, an ubiquitous endothelial disease, causes vasospasm and an increase in arterial resistance. Increased vascular reactivity predates the clinical syndrome (hypertension/proteinuria) by weeks or months. Based on this, a number of tests have been studied for their ability to predict preeclampsia, but currently none that are clinically useful. We have identified distinct differences in cerebral/orbital Doppler parameters between preeclamptic and normotensive pregnant women. Furthermore, we have developed 3 Doppler analytical models which can be used to reliably differentiate between term normotensive and preeclamptic women using cerebral arterial resistance indices and estimated cerebral perfusion pressure. These models can be adapted to other vascular beds including the renal, uteroplacental and peripheral arterial circulations. Our objectives in this proposal are to show that simultaneous Doppler studies of small arteries in a number of vascular beds can (i) identify preeclampsia in its preclinical and subclinical phases, and (ii) group patients with established preterm preeclampsia into those who will fail or respond to conservative temporizing management. We will use standard Doppler methods in the cerebral, orbital, renal, uteroplacental and peripheral arterial beds to determine derived resistance, flow-velocity, and perfusion indices. In addition dynamic tests of vascular reactivity will be used to differentiate stress profiles. Two longitudinal protocols are planned: A: an outpatient study of 320 low-risk, primigravid women, evaluated monthly from 16 weeks or less until term/delivery, and then at 6, 12 and 24 weeks postpartum; B: an in-house protocol of 30 preterm preeclamptics undergoing temporizing management, evaluated on a daily basis initially, and once stable every other day, until delivery. Early detection of abnormal arterial function may allow identification of preeclampsia before emergence of clinical signs. In established preeclampsia, evidence of worsening vasospasm will provide information on the course of the disease and the effectiveness of the therapy being employed.