Ultrasound Obstet Gynecol 2010; 36: 69–75

Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.7591

Maternal renal interlobar vein impedance index is higher

in early- than in late-onset pre-eclampsia
W. GYSELAERS*†, T. MESENS*, K. TOMSIN*†, G. MOLENBERGHS‡ and L. PEETERS§
*Department of Obstetrics & Gynecology, Ziekenhuis Oost Limburg, Genk and †Department of Physiology and ‡Center for Statistics,
Universiteit Hasselt, Diepenbeek, Belgium and §Department of Obstetrics & Gynecology, Academisch Ziekenhuis Maastricht, Maastricht,
The Netherlands

K E Y W O R D S: Doppler; maternal Doppler; maternal hemodynamics; pre-eclampsia; renal interlobar veins; venous impedance
index

ABSTRACT P = 0.03) and higher proteinuria (4131 ± 3885 vs.

Objectives To test the hypothesis that Doppler character-
istics of maternal renal interlobar veins (RIV) are different
between pregnancies affected by early-onset pre-eclampsia
(EP) and those affected by late-onset pre-eclampsia (LP).
Methods A gestational age of 34 weeks was considered
to differentiate EP from LP. All women had a
renal duplex scan according to a standard protocol,
with known intraobserver correlation coefficient (0.88).
Maximum (Vmax) and minimum (Vmin) RIV velocities
were measured on two occasions (between 28 and 32
and between 34 and 37 weeks) in 18 women with
uncomplicated pregnancy (UP). In women with EP
(n = 32) or LP (n = 41), these variables were measured
once, within 3 days following hospital admission. Delta
velocity (DeltaV) was calculated as Vmax − Vmin and
the RIV impedance index (RIVI) was calculated as
DeltaV/Vmax. Data on neonatal outcome and maternal
renal function were obtained for UP and those with EP
and LP, and group-specific means ± SD were calculated
and compared.
Results Compared with UP, the RIVI of both left and
right kidneys was higher in those with EP (0.49 ±
0.13 vs. 0.36 ± 0.04, P = 0.0001, and 0.46 ± 0.15 vs.
0.33 ± 0.04, P = 0.0008) and in those with LP (0.41 ±
0.07 vs. 0.37 ± 0.06, P = 0.04, and 0.38 ± 0.12 vs.
0.30 ± 0.05, P = 0.009). RIVI was higher in pregnancies
with EP than in those with LP (P ≤ 0.01), and this
difference was associated with lower median birth-weight
percentiles (22.5 (interquartile range (IQR), 15–35) vs.
40.0 (IQR, 12–55), P = 0.01), higher maternal serum
uric acid concentrations (419 ± 84 vs. 374 ± 85 µmol/L,
1190 ± 1133 mg/24 h, P < 0.0001).
Conclusion Maternal vascular maladaption in pre-
eclampsia is associated with abnormal Doppler findings
in the venous compartment. RIVI is higher in EP than in
LP pregnancies and this is associated with lower birth-
weight percentiles and higher proteinuria. Copyright 
2010 ISUOG. Published by John Wiley & Sons, Ltd.
INTRODUCTION
Evidence is growing that early-onset (EP) and late-onset
(LP) pre-eclampsia, both characterized by gestation-
induced hypertension and proteinuria in the active phase,
present different hemodynamic background mechanisms
in the latent phase of the disease1 . Easterling et al.2
reported different types of pre-eclampsia depending on
the degree of peripheral resistance: in pre-eclampsia with
high total peripheral resistance, delivery was earlier and
birth-weight percentiles were lower than in pre-eclampsia
with low total peripheral resistance. They also reported
that low-resistance pre-eclampsia was associated with
high maternal cardiac output and delivery near term3 .
Vasoconstrictor agents have been noted to be active
much earlier in EP than in LP pregnancies4 . Doppler
studies of the uterine artery have shown that abnormal
notching of the Doppler waveform, suggestive of increased
arterial wall resistance, with or without the combination
of angiogenic factors5 , predicts EP pregnancy much better
than it does LP pregnancy6,7 .
Maternal cardiac function has also been reported to
differ between EP and LP pregnancies: at 24 weeks of
gestation, maternal cardiac output was lower and total

Correspondence to: Dr W. Gyselaers, Department of Obstetrics & Gynecology, Ziekenhuis Oost Limburg, Schiepse Bos 6, B-3600 Genk,
Belgium (e-mail: wilfried.gyselaers@zol.be)
Accepted: 9 July 2009

Copyright  2010 ISUOG. Published by John Wiley & Sons, Ltd. ORIGINAL PAPER
70
peripheral resistance was higher in the latent phase of EP
compared with LP pregnancies1 . In the first trimester of
pregnancy, the mean arterial pressure was increased in
women subsequently developing pre-eclampsia, as com-
pared to pregnancies with normal outcome, and this
was associated with increased cardiac output in the
group with normal fetal growth, and with increased total
peripheral resistance in the group with impaired fetal
growth8 .
It is still unclear whether EP and LP are also
accompanied by differences in Doppler blood flow
profiles in the maternal venous compartment. The
venous impedance index, defined as (maximum flow
velocity (Vmax) − minimum flow velocity (Vmin))/Vmax,
is considered the Doppler equivalent of the arterial
resistance index. A number of recent studies9 – 11 provide
evidence for the renal interlobar vein (RIV) impedance
index (RIVI) to be a reproducible Doppler-derived
parameter of intrarenal venous vascular function, both
during pregnancy and postpartum. RIVI was found to
be higher in pre-eclamptic than in normal pregnancies
and this was associated with fast decelerating forward
flow during the last hundred milliseconds of the venous
Doppler wave12 . This phenomenon, the so-called ‘venous
pre-acceleration nadir’ (VPAN), was linked to backflow
of blood from the heart into the venous circulation during
atrial contraction, due to lack of a valve mechanism13 .
This study aimed to compare RIV Doppler parameters
between uncomplicated pregnancies (UP) and those with
EP or LP in relation to parameters of neonatal outcome
and maternal renal function.
METHODS
Approval of the local ethics committee was obtained
before study commencement and all women gave
informed consent to participate. Only singleton preg-
nancies were included of women without known dis-
eases, such as chronic hypertension, thrombophilia, dia-
betes and glomerular or rheumatic disease. We eval-
uated 18 women with UP and term birth of an
infant with normal weight. These women were evalu-
ated twice during pregnancy (between 28 and 32, and
again between 34 and 37 weeks). We also included
73 women with pre-eclampsia, who were evaluated
once shortly after admission at the Maternal Fetal
Medicine Unit of Ziekenhuis Oost Limburg, Genk, Bel-
gium. Pre-eclampsia was defined as gestation-induced
hypertension ≥ 140/90 mmHg on at least two occa-
sions, combined with proteinuria > 300 mg/24h14,15 . We
defined EP as pre-eclampsia diagnosed at a gestational
age < 34 weeks and LP as pre-eclampsia diagnosed at
≥ 34 weeks.
All women were examined according to a standard
protocol10 with a known intraobserver correlation
coefficient of 0.88. All examinations were performed
by the same ultrasonographer (W.G.), using a 3.5–7-
MHz probe (Hitachi EUB 6500, Hitachi Medical Systems,
Heverlee, Belgium). The methodology is presented
Copyright  2010 ISUOG. Published by John Wiley & Sons, Ltd.
Gyselaers et al.
schematically in Figure 1. All women were placed in a
supine position and both kidneys were scanned in the
transverse plane just above the renal hilus. The interlobar
arteries and veins were identified using color Doppler
flow mapping11 . The impact of breathing movements on
the ultrasound image was demonstrated to every patient
and the relevance of breath-holding during Doppler
measurements was explained and demonstrated. Once
the patient was familiar with the instructions of the
ultrasonographer, the examination was performed as
follows. (1) A simultaneous Doppler signal of both
interlobar arteries and veins was obtained for unequivocal
identification of the examined vessels. (2) The real-time
ultrasound image in combined B-D mode was frozen after
visualization of at least two to three similar Doppler
flow patterns during interrupted breathing. (3) As the
direction of the Doppler beam was mostly parallel to
the examined vessels, adjustment of the beam was rarely
needed. If it was, the axis of adjustment was always within
± 30◦ . (4) Vmax and Vmin were plotted and printed out.
Throughout the course of the ultrasound examination,
the ultrasonographer was blinded to the results depicted
on-screen. (5) For every woman, three consecutive
measurements were printed out for each kidney. (6) After
the scan, delta velocity (DeltaV) and RIVI were calculated
as Vmax − Vmin and DeltaV/Vmax, respectively.
The mean of three values for each of Vmax, Vmin,
DeltaV and RIVI was considered the kidney-specific value,
and was recorded in the database. The reproducibility of
this methodology was evaluated by defining RIVI twice
for each kidney in a set of 24 women: the intraclass or
intraobserver correlation coefficient was calculated using
restricted maximum likelihood estimation for the linear
mixed model16,17 .
The following patient demographics and outcome
data were obtained from all women included in
the study: maternal age, parity, first-trimester body
mass index, smoking habits, history of fetal loss or
gestational hypertensive and/or fetal growth disorder,
current use of antihypertensives or anticoagulation, mode
of delivery, gestational age at delivery, birth weight,
population-specific birth weight percentile18 , maternal
serum concentrations of uric acid, 24 h proteinuria and
creatinine clearance. Data were categorized into groups:
UP, EP and LP. Because RIV blood flow is reported
to change in the third trimester10,11 , UP-RIV Doppler
parameters were also categorized into 30-week and
36-week measurements. Pre-eclamptic pregnancies were
categorized into those with and those without infants
born small-for-gestational age (≤ 10th percentile, SGA).
Student’s t-test was used for statistical comparison at the
nominal level α < 0.05.
A repeated-measures analysis of covariance (repeated
measures ANCOVA) was applied to compare the impact
of advancing gestation on RIVI values of both kidneys
between UP, EP pregnancies and LP pregnancies, using
the SAS procedure MIXED with restricted maximum
likelihood (SAS/STAT software, version 9.2 (2007), SAS
Inst. Inc., Cary, NC, USA)16,17 .
Ultrasound Obstet Gynecol 2010; 36: 69–75.
Maternal venous Doppler 71

(a)
Anterior
superior Superior
segmental segmental
vein vein

Anterior
inferior
segmental
vein
Renal
vein

Arcuate
veins
Inferior
segmental
vein

Interlobar
veins

Figure 1 Schematic illustration of the methodology used in this study. (a) Anatomy of the intrarenal venous system. The renal vein collects
blood from the segmental veins, which are located at the level of the renal pelvis. The renal arcuate veins are present in the cortex
underneath the renal surface and drain their blood into the renal interlobar veins, which are located between the renal pelvis and the cortex.
(Adapted from http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/8817.jpg). (b) Two-dimensional ultrasound image of the
kidney, scanned in the transverse plane as illustrated by the Doppler probe in (a). The white trapezium marks the area between renal pelvis
and cortex, where the interlobar veins are located. (c) Color Doppler image of the renal interlobar vessels. Renal interlobar arteries are red,
indicating blood flow towards the Doppler beam, while veins are blue. Note that the direction of the Doppler beam is parallel to the
examined vessels, reducing the need for Doppler angle correction. (d) Doppler waves obtained from both renal interlobar arteries (upper
waveform) and veins (lower waveform).

RESULTS the EP and LP groups than in the UP group. The

Table 1 lists the patient characteristics of women in
the three study groups. The women in the EP and
LP groups differed from those in the UP one, with
lower maternal age and gestational age at delivery, and
higher BMI, use of medication and Cesarean section
rate. The proportion of SGA neonates was higher in
proportion of infants with birth weight ≥ 90th percentile
did not differ between LP and UP groups, but none
was observed in the EP group. Compared to neonates
of women with LP, the median birth weight percentile
of those of women with EP was lower and both
maternal serum uric acid and 24 h proteinuria were
higher.

Copyright  2010 ISUOG. Published by John Wiley & Sons, Ltd. Ultrasound Obstet Gynecol 2010; 36: 69–75.
72 Gyselaers et al.

Table 1 Patient characteristics of the three study groups: uncomplicated pregnancy (UP), early-onset pre-eclampsia (EP) and late-onset
pre-eclampsia (LP)

Pre-eclampsia

Uncomplicated Early-onset (EP) Late-onset (LP)

pregnancy (UP)
(n = 18) P* (n = 32) P† (n = 41) P‡

Maternal age (years) 31.1 ± 3.5 0.02 28.1 ± 4.7 0.99 28.1 ± 4.8 0.02
Parity 0.7 ± 0.8 0.36 0.5 ± 0.7 0.07 0.3 ± 0.5 0.02
BMI (kg/m2 ) 21.2 ± 2.6 0.001 25.5 ± 4.8 0.75 25.8 ± 5.1 0.0006
Smoker 0 1 (3.1) 0.33 5 (12.2)
Obstetric history
Fetal loss 7 (38.9) 0.48 8 (25.0) 0.98 9 (22.0) 0.31
PE/IUGR 0 4 (12.5) 0.90 6 (14.3)
Medication during pregnancy
Antihypertensives 0 10 (32.3) 0.02 3 (7.3)
Anticoagulation 0 3 (9.7) 0
Cesarean section 2 (11) < 0.0001 26 (83.9) 0.001 18 (43.9) 0.03
GA at delivery (weeks) 39.6 ± 1.4 < 0.0001 31.3 ± 2.9 < 0.0001 37.2 ± 1.6 < 0.0001
Birth weight (g) 3515 ± 352 1456 ± 527 2861 ± 637
Birth weight (median (IQR)) 58 (50–74) < 0.0001 22.5 (15–35) 0.01 40 (12–55) 0.12
Birth weight
≥ 90th centile 3 (16.7) 0 3 (7.3) 0.53
≤ 10th centile 0 6 (18.8) 0.78 10 (24.4)
Renal function
Maternal serum uric acid (µmol/L) NA 419 ± 84 0.03 374 ± 85
Proteinuria (mg/24h) NA 4131 ± 3885 < 0.0001 1190 ± 1133
> 5g/24h 13 (40.6) 0
Creatinine clearance (mL/min) NA 114.0 ± 39.0 0.13 127.9 ± 36.9

Data are given as mean ± SD, n (%) or median (interquartile range (IQR). *UP vs. EP. †EP vs. LP. ‡LP vs. UP. BMI, body mass index, as
defined at the first antenatal visit; GA, gestational age; PE/IUGR, pre-eclampsia and/or intrauterine growth restriction.

Table 2 Comparison between uncomplicated pregnancies at 30 weeks (UP30w) and at 36 weeks (UP36w), early-onset pre-eclampsia (EP)
and late-onset pre-eclampsia (LP) of renal interlobar vein Doppler characteristics

UP30w EP LP UP36w
(n = 18) P* (n = 32) P† (n = 41) P‡ (n = 18)

GA (weeks) 30.0 ± 1.9 0.37 30.67 ± 2.81 < 0.0001 36.71 ± 1.57 0.07 36.0 ± 0.5
Left kidney
Vmax (cm/s) 9.20 ± 1.73 0.19 8.50 ± 1.85 0.01 7.42 ± 1.72 0.04 8.41 ± 1.38
Vmin (cm/s) 5.90 ± 1.24 0.0002 4.30 ± 1.38 0.68 4.42 ± 1.10 0.02 5.17 ± 1.01
DeltaV (cm/s) 3.30 ± 0.64 0.02 4.20 ± 1.45 < 0.0001 3.00 ± 0.81 0.70 3.08 ± 0.49
RIVI 0.36 ± 0.04 0.0001 0.49 ± 0.13 0.0006 0.41 ± 0.07 0.04 0.37 ± 0.06
Right kidney
Vmax (cm/s) 10.3 ± 2.39 0.31 9.63 ± 2.09 0.16 8.87 ± 2.47 0.44 9.38 ± 1.91
Vmin (cm/s) 6.93 ± 1.62 0.0009 5.10 ± 1.82 0.38 5.48 ± 1.81 0.03 6.58 ± 1.42
DeltaV (cm/s) 3.38 ± 0.87 0.02 4.53 ± 1.89 0.01 3.39 ± 1.79 0.19 2.80 ± 0.82
RIVI 0.33 ± 0.04 0.0008 0.46 ± 0.15 0.01 0.38 ± 0.12 0.009 0.30 ± 0.05

Data are given as mean ± SD. *UP30w vs. EP. †EP vs. LP. ‡LP vs. UP36w. DeltaV, delta velocity (Vmax − Vmin); GA, gestational age;
RIVI, renal interlobar vein impedance index; Vmax, maximum velocity; Vmin, minimum velocity.

In both EP and LP groups, RIVI values were not
different between pregnancies with and those without
infants born SGA (left kidney, EP group: 0.55 ± 0.14
vs. 0.48 ± 0.12, P = 0.17; right kidney, EP group:
0.53 ± 0.14 vs. 0.44 ± 0.15, P = 0.20; left kidney, LP
group: 0.40 ± 0.05 vs. 0.41 ± 0.07, P = 0.80; right
kidney, LP group: 0.35 ± 0.06 vs. 0.38 ± 0.14, P =
0.47).
Table 2 shows the intergroup comparison of RIV
Doppler parameters between UP (30 weeks), EP, LP
and UP (36 weeks) groups. RIVI in EP pregnan-
cies was approximately 30% higher than it was in
UP. This observation was mainly due to the signif-
icantly lower Vmin values and higher DeltaV val-
ues in EP pregnancies. In LP pregnancies, Vmin
was also significantly lower than it was in UP, and
RIVI was significantly higher; however, this was not
associated with a higher DeltaV. Both RIVI and
DeltaV were significantly higher in EP than in LP
pregnancies.

Copyright  2010 ISUOG. Published by John Wiley & Sons, Ltd. Ultrasound Obstet Gynecol 2010; 36: 69–75.
Maternal venous Doppler 73

Figure 2 Examples of Doppler waveforms from the renal interlobar veins in normal and pre-eclamptic pregnancies. Doppler waves are
presented together with the maternal electrocardiogram (ECG) signal, to illustrate the time-relation between the P-wave of the ECG,
initiating cardiac atrial contraction, and the sudden sharp deceleration of flow during the last hundred milliseconds of the Doppler wave
resulting from backflow of blood into the venous circulation following atrial contraction, which is the so-called venous pre-acceleration
nadir (VPAN)13 . (a) Uniform Doppler wave in a 28-week uncomplicated pregnancy, with absence of VPAN. (b) Doppler waveform with a
small but clearly visible VPAN, as observed frequently in late-onset pre-eclampsia but also in uncomplicated late third-trimester pregnancy.
(c) Doppler wave from a pregnancy with early-onset pre-eclampsia, with a deep VPAN.

The equations for linear regression curves of RIVI
evolution according to gestational age (GA) in the left
kidney were:
Y = 0.3059 + 0.0018 × GA for UP,
Y = 1.059 − 0.018 × GA for EP pregnancies,
Y = 0.2616 + 0.004 × GA for LP pregnancies and
Y = 0.8816 − 0.0128 × GA for pre-eclampsia (EP + LP).
For the right kidney, these equations were:
Y = 0.495 − 0.0055 × GA for UP,
Y = 1.3572 − 0.0292 × GA for EP pregnancies,
Y = 0.4988 − 0.0033 × GA for LP pregnancies and
Y = 0.9699 − 0.0163 × GA for pre-eclampsia (EP + LP).
As illustrated in Figure 3a, the evolution of RIVI was
significantly different between UP and pre-eclampsia for
both left (P < 0.0001) and right (P = 0.009) kidneys, due
mainly to the different evolution of RIVI in the EP group
compared with the UP group, which was significantly
different for both left (P = 0.0016) and right (P = 0.001)
kidneys. The differences between the LP group and the UP
group were not significant (P ≥ 0.725 for both kidneys).
This is illustrated graphically in Figure 3b.
DISCUSSION
Methods to study human venous hemodynamics are
complex and often difficult to perform in pregnancy19 .
Doppler measurement of RIVI seems to be a simple
non-invasive method to study renal venous blood flow
dynamics, both in the non-pregnant and pregnant
state9 – 11 . We reported previously a high intraobserver
correlation coefficient for RIVI measurement, supporting
its validity and reproducibility10 . Using this technique
we found increased RIVI in pre-eclamptic pregnancies
diagnosed before 34 weeks10 . In the present study, we
evaluated whether RIVIs in EP and LP were associated
with different neonatal outcome values and parameters of
maternal renal function.
Our results confirm former observations that RIVI is
higher in pre-eclampsia than in UP10,12 . This can be
explained by lower Vmin values in both EP and LP
(Table 2). Bateman et al.12 observed in pre-eclampsia a
sharp deceleration of forward flow at the end of the
RIV Doppler wave and suggested that this could result
from a selective increase of downstream resistance. As we
have reported elsewhere, there is a time relation between
VPAN and cardiac right atrial contraction13 , suggesting
that backflow of blood from the heart into the venous
circulation during atrial contraction is responsible for this
temporary increased resistance against forward venous
flow (Figure 2). Our current data show that this counter-
current phenomenon is more pronounced in EP than it is
in LP (Table 2): first, the differences between UP and EP
are more pronounced than are those between UP and LP
and second in EP, but not in LP, reduced Vmin values are
associated with increased DeltaV values, defined as Vmax
− Vmin. From our current observations, it is unclear
whether this reduction of Vmin in pre-eclampsia results
from the pre-eclampsia-related reduction of intravascular
volume20 , from venous distensibility21 or from both. Our
analysis also shows that the impact of gestational age on
RIVI measurements is significantly different between EP
pregnancies and UP, but not between LP pregnancies and
UP (Figure 3).
Our data on neonatal outcome agree with the
observations by Easterling et al.2 , who reported lower

Copyright  2010 ISUOG. Published by John Wiley & Sons, Ltd. Ultrasound Obstet Gynecol 2010; 36: 69–75.
74 Gyselaers et al.

(a) 0.90 Our observations also provide evidence for another

0.80
important aspect of gestational hypertensive disorders.
Parameters of maternal renal function, such as serum
0.70 uric acid and 24 h proteinuria but not creatinine clear-
0.60 ance, were significantly more abnormal in EP than in
LP pregnancies (Table 1). It has been reported that
RIVI

0.50
in formerly pre-eclamptic women, postpartum persis-
0.40 tence of cardiovascular abnormalities are accompanied
0.30 by impaired venous drainage of the conjunctival micro-
circulation, reflected in dilated venules and tortuous
0.20
capillaries22 . Our data provide evidence for impaired
0.10 drainage of venous blood from the kidneys during pre-
24 26 28 30 32 34 36 38 40 42
Gestational age (weeks)
eclamptic pregnancy. The elevated impedance of RIV and
the counter-current venous flow during atrial contraction
(b) 0.90 in pre-eclampsia provide indirect evidence for impeded
0.80 venous drainage from the kidneys. Impaired renal venous
drainage also occurs in clinical syndromes, such as renal
0.70
vein thrombosis23 , abdominal compartment syndrome24
0.60 and nutcracker syndrome25 . These syndromes present
RIVI

0.50 with proteinuria, with or without hypertension. Under

0.40 experimental conditions, a pressure rise in the renal vein
0.30
has been reported to provoke proteinuria26 . It is necessary
to further explore the role of increased venous impedance
0.20
and impaired drainage of blood from the kidneys in the
0.10 pathogenesis of pre-eclampsia-related proteinuria.
24 26 28 30 32 34 36 38 40 42
Gestational age (weeks) We conclude from the current study that Doppler
parameters of RIV differ between UP and pre-eclamptic
Figure 3 (a) Scatter diagram of measured values of the renal pregnancies, and that these differences are more pro-
interlobar vein impedance index (RIVI) relative to gestational age nounced in EP than in LP. We are aware that, because
for uncomplicated pregnancies in left ( ,
°
) kidneys and for pre-eclampsia (PE) in left (
,
ž
) and right ( ,
) and
several tests were carried out simultaneously, one must
be careful not to overinterpret differences found. How-
right (, ) kidneys. Lines show regression. Evolution of RIVI
in both left and right kidneys was significantly different between ever, our observation illustrates that the severity of pre-
uncomplicated pregnancies and those with PE (P < 0.01). (b) This eclampsia-related vascular abnormalities in pre-eclampsia
differing evolution of RIVI can be attributed mainly to its evolution is reflected in Doppler parameters of the venous com-
in early-onset PE (
), which was significantly different from that in partment, and relates to neonatal birth weight percentile
uncomplicated pregnancies in both left ( ) and right ( )
kidneys (P ≤ 0.001); the evolution of RIVI was not significantly and maternal renal function. Our data suggest impaired
different between uncomplicated pregnancies and those with drainage of venous blood from the kidneys during pre-
late-onset PE. As in (a), gray lines indicate normal left ( ) and eclampsia, suggesting a need for further exploration of
right ( ) kidney regression lines and black lines are those for PE the role of abnormal renal venous hemodynamics in the
left ( ) and right ( ) kidneys.
, early-onset PE; ,
pathogenesis of pre-eclampsia-related proteinuria.
late-onset PE.

birth weights in high-resistance pre-eclampsia than in ACKNOWLEDGMENTS

low-resistance pre-eclampsia, due to earlier delivery and
lower percentile birth weights for gestational age2 . As
shown in Table 1, we observed that gestational age at
delivery was approximately 6 weeks earlier in EP than
in LP, and that median neonatal birth-weight percentiles
in EP were significantly lower. Additionally, we found
infants with a birth-weight ≥ 90th percentile in UP and LP
pregnancies, but not in EP pregnancies. Contrary to Khaw
et al.8 , who reported different vascular characteristics
between pre-eclamptic pregnancies with and without
growth restriction, we found no difference in RIVI values
in pre-eclampsia pregnancies with and without infants
born SGA. It should be emphasized that in this study
our observations in pre-eclampsia were not made in the
latent phase of the disease but only when hypertension
and proteinuria were both manifest.
We acknowledge Professor M. Hanssens of the Catholic
University of Louvain, Belgium for her useful recommen-
dations towards the initiation of this study. We also thank
Mrs V. De Loenen for assisting in the administration and
data collection.
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