uterine dopplers scan, HELLP? Pre-ecalmpisa?

[BeckyBarker]

i had a uterine doppler scan receintly and they found "notches" on it. has anyone else had this scan with notches, what was the outcome? i'm about 5 and half months pregnant. I had pre-eclampsia and developed HELLP syndrone shortly after giving birth last time. Very lucky to be here, just a little worried about it all happening again. i'm concerned that i should have more check ups with midwifes although they were useless last time. I'm just getting parinoid with every little head ache etc at the moment.

Do they think it may be linked to pre-eclampsia. I thought you were only slightly more at risk of pre-eclampsia with a subsequent pregnancy, most women never experience it again. My sister had pe with her first but never had any problems with her second and third. Try to relax, go for a facial/massage. XX

Hi Becky
I also have had a doppler that showed notches at 21 week scan. I was taking part in research looking at pre-eclampsia risk and was just pleased to be having the extra scans. I'm an IVF, 40 year old, 3 previous miscarriages paranoid first time mum to be.
Why did they do the scan - because of the previous episode? Now what are they planning? I've been put on baby asprin (75mg) and they are rescanning next Tues at 26 (+6) weeks. My understanding is that the time to worry is during 3rd trimester and things should be OK at present. Where is your antenatal care? I'm being seen at hospital due to everything and it's where I actually work, so it's convenient. I can also measure my own blood pressure, which has been fine.
I've loads of medical info about notches if you want any other info. So not much help with outcome but happy to share the journey.
Take care.

Katyjo yes the link is an increased risk of developing pre-eclampsia - 30-70% increased risk depending on which study you read.

I had severe pre ecampsia 1st time around at 27 weeks, and developed HELLP syndrome too. 2nd time around I was given baby asprin as a precaution from 13 weeks and vitamin therapy. This was 5 1/2 years ago when there were a lot of stuides on this. Look at the APEC website which should give you good advice.

Yes the nothces ARE linked to pre-eclampsia, BUT they alone aren't the only thing. What should happen is that you have more scans and closer monitoring. I had scans at 20 weeks/24 weeks/28 weeks/32 weeks and 36 weeks to keep an eye on evrything. Midwives cannot do much, but hospital care will. You can also ask yor GP for urine sticks to test for protein (again I did this from 28 weeks) However 1st time around I went from no protein to +4 in less than 8 hrs.

may i ask what are notches and what is a doppler scan?i had pre-eclampsia with my first child and have been induced at 38 weeks with subsequent 3 babies due to high bp and protein in wee from 34 weeks onwards.i am expecting number 5 in march.

there is only a 10% risk of developing pre-eclampsia in subsequent pgs with the same biological father,but if it is with a new partner the risk is the same as for a first pg.

I'm reading this thread with interest as I too had severe pre-eclampsia with HELLP syndrome in my pregnancy. I'm keen to have more children, though not just yet , so I'm after info on how it can be prevented/better detected.

Dear all
This is a good explanation I found on www.apec.org.uk/Pre-Empt%20Issue%202.pdf
If people are worried due to previous problems I would suggest requesting such a scan but it may not be done where you are currently being seen.

No idea if it will let me post such a huge amount but here goes:

Chris Redman is Professor of Obstetric Medicine at the University of Oxford.He is Action on Pre-Eclampsia?s honorary Medical Advisor

Dear Professor Redman,
I would like to know more about uterine- artery Doppler scanning which shows the blood flow between mother and baby and I believe can be an early indicator for pre- eclampsia. We lost our first baby, Daniel who only survived for one week when he had to be delivered at 25 weeks gestation after I developed pre-eclampsia and HELLP syndrome 5 years ago. In my next pregnancy I requested that I have a Doppler ultrasound scan to see if I may be at risk again of pre-eclampsia. Thankfully the
scan showed a regular blood flow to the placenta and I did not encounter the same problems as in my first pregnancy. Despite
being 5 weeks early,Alfie is now a thriving four year old. I am now 21 weeks pregnant and have again requested a Doppler ultrasound scan which once again is thankfully normal.
My main queries are these:

1. How much of a definitive test is the Doppler analysis as an indicator for potential pre-eclampsia?
2. If it is a good indicator then why is this ultrasound not offered routinely to all pregnant women or at least to those with a history of pre-eclampsia? I was the one to instigate this test on both occasions, it had not been suggested to me by either of my consultants at the time. Thank you for any information that you can give on this subject. Sara Bricusse Dear Sara, Thank you for your letter and questions. A uterine artery Doppler scan is an ultrasound investigation which determines the pattern (but not the volume) of the blood flow through the two arteries that enter the womb on each side. During pregnancy these arteries are part of the blood supply to the afterbirth. A totally normal pattern indicates that blood is moving quickly and without difficulty, reflecting a vigorous circulation in the placenta. The speed of the flow peaks during each heart beat and declines afterwards but is always brisk even between heart beats. There are various ways of identifying a flow that is not optimal. They reflect what is happening between heart beats. There are two patterns. The first shows that the flow drops too quickly and becomes sluggish. This is measured as a high resistance index or as another index called a pulsatility index. The second pattern simply describes what is seen, namely a ?notch?in the velocity profile between heart beats which shows that the speed of flow drops too suddenly then picks up a little before the next beat. Most ultrasonographers are not yet trained to do this investigation. It is not difficult, but not simple either. The results are not straightforward to interpret, mainly because it often happens that the measurement in one artery is normal and in the other is not. Notches are not always clear and one observer may think that they are alright and another the opposite. Finally it is sometimes technically impossible to measure both arteries. A result is less reliable if it is based on assessment of only one artery. A very abnormal result, which is rare, reliably predicts trouble. However there is no agreement that any treatment can prevent the problems. Possibly all that can be done is to be prepared to ensure that at least the best is made of a very bad situation. Where there are difficulties with the test is where the result is not totally right but not very abnormal either. Most women with this pattern end up with completely normal pregnancies but the incidence of problems is modestly increased relative to normal. Several studies demonstrate that this sort of testing should not be carried out for all pregnant women. However there is reason to believe that it is useful where pregnant women are known to be "High Risk" because of previous problems in pregnancy, medical factors or other reasons. Then such a test is useful at least to determine how often a woman needs to be checked. In our Silver Star unit for High Risk women this is in fact what we do. We believe it focuses the checks where they are most needed. The procedure should be more widely available but is not, for reasons of cost. There is a grave shortage of funding for this type of work. You and all APEC members should know that the government has no priority for women who have problem pregnancies. The priority is for healthy women to maximise their choices (about place of delivery, community versus specialised care, mode of delivery etc). Yours sincerely,Chris Redman

BeckyBarker - how is your GP? I would be more inclined to see him/her and Im sure he will give you more advice/help than the midwives.
LaDIEDaDIE - If it helps APEC - action on pre-eclampsia are very helpful. www.apec.org or something.

thank you for posting that,pab5.

Hi just an update.
Recent doppler scan showed notches still on right uterine artery but not left. Babies growth is fine and BP fine. They'll rescan in 6 weeks. Happy for me to check my own BP weekly and just shout if I'm worried.

BeckyBarker hope all is well

Just to update and finish off our story. BP was a bit dodgy from about 7 months. At 36+1 had a growth scan which was fine but BP high and increased proteinurea so induced next day. DS born at 36+4 on Xmas eve by ventouse delivery (yes induction took a while) . He was fine but I had 2 fits just after delivery, lost blood from 2nd degree tear and needed transfusion. He's now 4 weeks old and great (had jaundice and phototherapy at 4 days old). Main problems now are my BP still increased (on meds) if I do anything vaguely taxing and BF not fully established though slowly increasing (mixed feeding). The fits were really scary for all concerned especially DP. Good things that came out of it all was because I was so ill DP and DS really bonded and it has all meant so much to us. Have DP home for another week than hope I can cope.
Take care all - hope those who had PE previously do not have it again - it was pretty scary. xxx