First-trimester uteroplacental and fetal blood flow velocity waveforms in normally developing fetuses: a longitudinal study.

Abstract

Our objectives were to obtain a complete overview of uteroplacental and fetal hemodynamics early in pregnancy and to record flow velocity waveforms in the vitelline artery using color Doppler equipment. Flow velocity waveforms were recorded in 18 uneventful pregnancies between 6 and 16 weeks of gestation. Doppler recordings were made of the left and right uterine and spiral arteries from 6 weeks of gestation onwards. Recordings of c the umbilical artery, fetal aorta and fetal cerebral arteries started in weeks 7, 8 and 9, respectively. Where possible, the vitelline arteries were also recorded. The resistance and pulsatility indices and 95% confidence intervals for predictions were calculated.For the uterine and spiral arteries, characteristics of the waveforms were assessed. The resistance index of both uterine and spiral arteries gradually decreased with advancing pregnancy. For the umbilical artery, aorta and cerebral artery, the earliest possible Doppler recordings and characteristics of the waveforms were established. The pulsatility index of the umbilical arteries and fetal aorta showed a sharp decrease towards the 16th week. The pulsatility index of the fetal cerebral artery showed only a mild decrease towards week 16. In a longitudinal analysis, there were significant changes of the resistance and pulsatility indices for each patient. In the vitelline artery, recordings were possible in eight out of 18 fetuses, and only in weeks 7 and 8 of gestation. The pulsatility index showed a wide range and was not dependent on menstrual age.Knowledge of the normal flow velocity waveforms in the maternal uteroplacental and fetal circulations early in pregnancy may lead to a better understanding of physiological mechanisms.