Artery Doppler Flow Research Articles

504 Fetal growth restriction and latency from diagnosis to delivery in early onset preeclampsia

Early onset preeclampsia (PE) is associated with increased maternal and neonatal morbidity, including fetal growth restriction (FGR). Data on the benefit of expectant management in women with early onset PE with severe features (SF) in the setting of FGR are limited. Therefore, we aimed to determine whether FGR shortens the latency from PE diagnosis till delivery, in women undergoing expectant management of early onset PE with SF. Retrospective chart review of women with early onset PE with SF that developed < 34 weeks of gestation, who delivered at a single tertiary care center between 2011-2020. Women were excluded if delivery was planned after completion of antenatal corticosteroids, fetal demise at time of PE diagnosis or fetal anomaly. Our primary outcome was latency from diagnosis of PE to delivery. Sub-analysis was performed to further evaluate the FGR group based on estimated fetal weight (EFW) ≤3% or abnormal Doppler studies defined as >95% systolic/diastolic umbilical artery Doppler (UAD) flow, absent or reversed UAD. Of 261 patients identified, 236 patients met criteria for analysis, with 80 (33.6%) FGR and 156 (66.4%) appropriately grown for gestational age (AGA) fetuses. There were no differences in maternal age, BMI at time of delivery, ethnicity/race, nulliparity, chronic hypertension or need for acute anti-hypertensive therapy. Patients with FGR were more likely to use tobacco and be delivered via cesarean compared with those with AGA fetuses. Pregnancies complicated by FGR were diagnosed with PE and delivered at earlier GA compared with those with AGA fetuses. (Table 1) There were no differences in latency between the two groups with median of 3 [IQR 1-5] vs 2 [1-4] days. There were no differences in the composites of maternal or neonatal outcomes. Similar patterns were observed in sub-analysis of FGR by EFW ≤3% and abnormal UAD studies. (Table 2) In patients with early onset PE with SF, FGR did not impact latency or worsen short term maternal and neonatal outcomes. Further research is needed to determine long term maternal and child outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

896 The effect of maternal hyper-oxygenation on vascular resistance of growth restricted fetuses

To study the effects of maternal hyper-oxygenation on fetal circulation as measured by Doppler ultrasonography in the growth restricted fetus. This is prospective observational study. Patients were positioned in low-fowlers position with the head of the bed elevated between 15 and 30 degrees for approximately 15 minutes. 100% oxygen was delivered at a flow rate of 8 l/min through a close-fitting facemask (with a reservoir and non-rebreathing valve) for a duration of 10 minutes. Fetal doppler ultrasonography was performed 20 minutes prior and after administration of supplemental oxygen. Doppler values for umbilical artery, middle cerebral artery, ductus venosus, were obtained during a period of fetal apnea, preferably fetal quiet sleep as flow waveforms and cardiac output have been shown to vary with behavioral states. At least three consecutive waveforms were gathered. Six patients with growth restricted fetuses were enrolled. We found no statistically signficant differences in umbilical artery peak systolic flow, end diastolic flow, resistance index, pulsatility index. or systolic to diastolic ratio before and after maternal hyper-oxygenation. We also found no difference in middle cerebral artery peak systolic flow, end diastolic flow, resistance index, and pulsatility index before and after maternal hyper-oxygenation. We were unable to measure fetal ductus venosus doppler flow due to hyperactivity of the fetus within the 20 minutes following maternal oxygen administration. Maternal hyper-oxygenation caused a noted increase in fetal movements in the growth restricted fetus, and precluded aquisition of fetal ductus venosus assessement following oxygen administration. We found no significant differences in umbilical artery and middle cerebral artery doppler flow measurements following maternal hyper-oxygenation.

Universal late pregnancy ultrasound screening to predict adverse outcomes in nulliparous women: a systematic review and cost-effectiveness analysis.

Currently, pregnant women are screened using ultrasound to perform gestational aging, typically at around 12 weeks' gestation, and around the middle of pregnancy. Ultrasound scans thereafter are performed for clinical indications only. We sought to assess the case for offering universal late pregnancy ultrasound to all nulliparous women in the UK. The main questions addressed were the diagnostic effectiveness of universal late pregnancy ultrasound to predict adverse outcomes and the cost-effectiveness of either implementing universal ultrasound or conducting further research in this area. We performed diagnostic test accuracy reviews of five ultrasonic measurements in late pregnancy. We conducted cost-effectiveness and value-of-information analyses of screening for fetal presentation, screening for small for gestational age fetuses and screening for large for gestational age fetuses. Finally, we conducted a survey and a focus group to determine the willingness of women to participate in a future randomised controlled trial. We searched MEDLINE, EMBASE and the Cochrane Library from inception to June 2019. The protocol for the review was designed a priori and registered. Eligible studies were identified using keywords, with no restrictions for language or location. The risk of bias in studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Health economic modelling employed a decision tree analysed via Monte Carlo simulation. Health outcomes were from the fetal perspective and presented as quality-adjusted life-years. Costs were from the perspective of the public sector, defined as NHS England, and the costs of special educational needs. All costs and quality-adjusted life-years were discounted by 3.5% per annum and the reference case time horizon was 20 years. Umbilical artery Doppler flow velocimetry, cerebroplacental ratio, severe oligohydramnios and borderline oligohydramnios were all either non-predictive or weakly predictive of the risk of neonatal morbidity (summary positive likelihood ratios between 1 and 2) and were all weakly predictive of the risk of delivering a small for gestational age infant (summary positive likelihood ratios between 2 and 4). Suspicion of fetal macrosomia is strongly predictive of the risk of delivering a large infant, but it is only weakly, albeit statistically significantly, predictive of the risk of shoulder dystocia. Very few studies blinded the result of the ultrasound scan and most studies were rated as being at a high risk of bias as a result of treatment paradox, ascertainment bias or iatrogenic harm. Health economic analysis indicated that universal ultrasound for fetal presentation only may be both clinically and economically justified on the basis of existing evidence. Universal ultrasound including fetal biometry was of borderline cost-effectiveness and was sensitive to assumptions. Value-of-information analysis indicated that the parameter that had the largest impact on decision uncertainty was the net difference in cost between an induced delivery and expectant management. The primary literature on the diagnostic effectiveness of ultrasound in late pregnancy is weak. Value-of-information analysis may have underestimated the uncertainty in the literature as it was focused on the internal validity of parameters, which is quantified, whereas the greatest uncertainty may be in the external validity to the research question, which is unquantified. Universal screening for presentation at term may be justified on the basis of current knowledge. The current literature does not support universal ultrasonic screening for fetal growth disorders. We describe proof-of-principle randomised controlled trials that could better inform the case for screening using ultrasound in late pregnancy. This study is registered as PROSPERO CRD42017064093. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 15. See the NIHR Journals Library website for further project information.

Pravastatin suppresses inflammatory cytokines and endothelial activation in patients at risk of developing preeclampsia: INOVASIA study

Introduction The Indonesian INOVASIA study is an ongoing multicentre randomized, open controlled trial of pravastatin for the prevention of preeclampsia in patients deemed to be high risk. Here we evaluate the effects of pravastatin on circulating inflammatory and endothelial markers, i.e. Vascular Endothelial Growth Factor (VEGF), Interleukin-6 (IL-6), Endothelin-1 (ET-1), and Nitric Oxide (NO). Methods Pregnant women deemed to be at a high risk of developing preeclampsia women were recruited based on the Fetal Medicine Foundation preeclampsia screening test or a history of preterm preeclampsia, or clinical risk factors in combination with an abnormal uterine artery Doppler flow pattern at 11–20 week's gestation. This is a nested cohort study within the larger trial (INOVASIA); 38 patients were consecutively recruited and assigned to the pravastatin group and the control group. Participants in the pravastatin group received pravastatin (2 × 20 mg p.o) in addition to a standard regimen of aspirin (80 mg p.o) and calcium (1 g p.o), from 14 to 20 weeks until delivery. Blood samples to measure the various biomarkers were obtained in consecutive patients before starting the research medication and just before delivery (pre and post-test examination). Result The number of samples on the 2 time points for the various biomarkers was: VEGF: 38, IL-6: 30, ET-1: 38, and NO: 35. IL-6 levels decreased significantly in the pravastatin group (mean ± SD): (191.87 ± 82.99 vs. 151.85 + 48.46, p = .013), while levels in the control group did not change significantly (median (interquartile range)) (144.17 (53.91) vs. 140.82 (16.18), p = .177). ET-1 levels decreased significantly in the pravastatin group (3.64 ± 0.85 vs. 3.01 ± 0.74, p = .006) while the control group had more or less stable levels (3.57 ± 1.12 vs. 3.78 ± 0.73 p = .594). NO was the only serum marker that showed significant changes in both groups. NO levels increased in pravastatin group (11.30 (17.43) vs. 41.90 (53.18), p = .044) and decreased in control group (38.70 (34.80) vs. 10.03 (26.96), p = .002). VEGF levels appeared to follow opposite trends in the 2 groups (NS) (Pravastatin: 3.22 (0.62) vs. 3.28 (0.75), p = .402. Control: 3.38 (0.83) vs. 3.06 (0.74), p = .287). Conclusion Administration of 40 mg pravastatin resulted in an improvement in NO levels, and a decrease in IL-6 and endothelin (ET-1) levels. The direction of the effect of pravastatin on these biomarkers appears to underpin the potential for a beneficial effect of pravastatin in the prevention of preeclampsia.

VP43.22: Longitudinal changes of umbilical artery Doppler flow patterns in monochorionic twins with selective fetal growth restriction

VP43.22: Longitudinal changes of umbilical artery Doppler flow patterns in monochorionic twins with selective fetal growth restriction

Venous Flow Coupler in Head and Neck Free Flap Reconstruction.

To describe the utility of venous flow couplers in monitoring free tissue flaps in the immediate postoperative setting. Retrospective case series. Otolaryngology department at a single tertiary care institution. A retrospective case series of free flap reconstructions in which venous flow couplers were employed to supplement flap monitoring. All free flap cases performed over the past 4 years were reviewed. Inclusion criteria were venous flow coupler and arterial flow Doppler monitored for 5 days postoperatively. From July 2014 through May 2018, the venous flow coupler was used with the arterial flow Doppler and clinical monitoring in 228 cases. Eleven cases did not meet criteria for inclusion; thus, 217 cases were analyzed. Twenty cases (9.2%) returned to the operating room with concern for flap compromise, and 16 were salvaged. The combination of venous flow coupler and arterial flow Doppler identified 19 of these flaps. Venous flow couplers identified 5 compromised flaps before there was an arterial signal change, and all were salvaged. Additionally, there was a 24.1% false-positive rate when 2 venous flow couplers were used in parallel. For the venous flow coupler, the positive predictive value was 64.3% and the negative predictive value, 98.9%. The false-positive rate in the series was 5.1%. The sensitivity was 90% and the specificity, 94.9%. The venous flow coupler is able to detect venous thrombosis in the absence of arterial thrombosis and may contribute to improved flap salvage rates.

PREDICTIVE VALUE OF DOPPLER ANALYSIS IN UTERINE TRANSPLANTATION

Successful pregnancy with uterine transplantation is contingent on numerous factors. Our study of uterus donors prior to transplant and uterus recipients after transplant explored whether uterine artery Doppler blood flow indices (UAQI) could predict successful implantation.

Perinatal outcome of growth restricted fetuses with abnormal umbilical artery Doppler waveforms compared to growth restricted fetuses with normal umbilical artery Doppler waveforms at a tertiary referral hospital in urban Ethiopia.

Intrauterine growth restriction is defined as a fetal weight below the 10th percentile for a given gestational age and can be identified using umbilical artery Doppler velocimetry which is a non-invasive technique. The objective of this study was to determine the perinatal outcome of growth-restricted fetuses with abnormal umbilical artery Doppler study compared to those with normal umbilical artery Doppler waveforms at a tertiary referral hospital in Ethiopia. A prospective cohort study was conducted among pregnant mothers with fetal growth restriction admitted for labour and delivery from September 2018-February 2019. The data were entered and analyzed using SPSS version 23. After conducting descriptive analysis, exploring the entire data, and checking for, statistical associations between abnormal umbilical artery Doppler and outcome variables, multiple logistic regression was conducted to control for confounders. A total of 170 pregnant mothers complicated with growth-restricted fetuses were included in the study, among which 133 were with normal umbilical artery Doppler studies and 37 were with abnormal umbilical artery Doppler studies. Four (3%) of normal and 9(24.3%) of abnormal umbilical artery Doppler studies ended in perinatal death-value = 0.001. Twenty (15%) of normal and 24(64.9%) of abnormal umbilical artery Doppler study neonates required neonatal intensive care admission-value = 0.002. Growth restricted fetuses complicated with abnormal Doppler were two times more likely to require neonatal intensive care unit admissions compared to growth-restricted fetuses with normal umbilical artery Doppler flow, P-value 0.002, (OR = 2.059,95%CI 1.449-2.926). Growth restricted fetuses complicated with abnormal Doppler were four times more likely to end in early neonatal death compared to growth-restricted fetuses with normal umbilical artery Doppler flow, P-value 0.001, (OR = 4.136, 95%CI 3.423-4.998). However, the study is unmatched and there is a possibility of gestational age confounding the result and should be seen with the context of preterm morbidity and mortality. The abnormal umbilical artery Doppler waveform is associated with cesarean section delivery, neonatal intensive care unit admission, respiratory distress syndrome, neonatal sepsis, neonatal hyperbilirubinemia, and early neonatal death compared to normal umbilical artery Doppler flow.

Assessment of the carotid artery Doppler flow time in patients with acute upper gastrointestinal bleeding.

INTRODUCTION:Because of the subjectivity and ambiguity of the noninvasive measurements and limited use of invasive ones, there is an impending need for a real-time, fast, inexpensive, and reproducible noninvasive measurement method in acute upper gastrointestinal (GI) bleeding with active bleeding in emergency services.AIMS:In this study, we aimed to evaluate the effect of bedside carotid artery flow time (CFT) measurement before and after the passive leg raising (PLR) maneuver on the determination of active bleeding in patients admitted to the emergency department (ED) with upper GI bleeding.MATERIALS AND METHODS:This prospective case–control study was conducted in the ED of a training and research hospital with upper GI bleeding. Patients were placed in the supine position to perform bedside carotid Doppler ultrasonography before starting treatment. CFT, corrected CFT (CFTc), and carotid artery Doppler flow velocity were measured. After then performed PLR, the same parameters were measured again.RESULTS:A total of 94 patients, including 50 patients with GI bleeding and 44 healthy volunteers as control group were included in the study. CFT and CFTc were shorter in the patient group than the control group (P < 0.001, P = 0.004, respectively). After PLR, there were statistically significant differences in change in the CFT (ΔCFT) and change in the corrected CFT (ΔCFTc) between the groups (P = 0.001, P < 0.001). There were also statistically significant differences in ΔCFT and ΔCFT between the patients with active bleeding and the nonbleeding ones (P = 0.01, P = 0.005, respectively). Area under curve to detect active bleeding for ΔCFT and ΔCFTc were calculated as 0.801 (95% confidence interval [CI]: 0.65–0.95) and 0.778 (95% CI: 0.63–0.91), respectively.CONCLUSION:The corrected carotid Doppler flow time measurements in patients with GI bleeding at the time of presenting to the emergency department can be helpful to interpret the active bleeding.

The role of clinical and laboratory tests along with uterine artery Doppler indices in the prediction of pre-eclampsia and pregnancy outcome in Egypt

Background and aim As the ideal test to predict pregnancy-induced hypertension and preeclampsia should be inexpensive, reproducible, easy to do early in pregnancy, and noninvasive and have high sensitivity, the aim of this study was to evaluate clinical parameters, laboratory tests, and uterine artery doppler indices in prediction of preeclampsia and pregnancy outcome.Patients and methods This study was carried out in the antenatal care clinic of Obstetrics and Gynecology Department of Al Azhar University Hospital. The study included 177 pregnant women booked for antenatal care before 18 weeks of gestation, who were considered to be at increased risk of developing preeclampsia.Results Doppler flow velocimetry of the uterine artery at 18–20 and 22–24 weeks of gestation represents a useful predictive test in high-risk pregnancy and in predicting preeclampsia, when used as a single test. Microalbuminuria between 24 and 34 weeks of gestation, in the first morning urine specimen, is a good predictor for the subsequent development of preeclampsia.Conclusion When three tests were combined to test their ability to predict preeclampsia, the best triple tests were microalbuminuria, uterine artery doppler flow velocimetry study at 24–26 weeks of gestation, and mean platelet volume, which gave the highest value when κ test of agreement was used.

Doppler ultrasound evaluation of blood flow patterns of the uterine arteries in pre- and postmenopausal women with cervical cancer and controls in Zaria

Background: Cervical cancer remains an important health issue, especially in the developing countries that account for about 85% of the world burden of cervical cancer. Finding a role for Doppler ultrasound in the evaluation of these patients may reduce the cost and improve access to management. Aim: The study aimed at evaluating the Doppler flow parameters in pre- and postmenopausal patients with cervical cancer when compared to normal controls in a teaching hospital in Nigeria. Methodology: This is a prospective case–control observational study conducted over a period of 7 months (August 2016–February 2017) in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Eighty-one patients with cervical cancer and 81 age-matched controls had a transabdominal Doppler ultrasound examination of the main uterine arteries. The data were analyzed using SPSS version 20.0, Chicago, Illinois, USA. Statistical differences in the uterine artery indices between two groups were tested, andP Results: The mean resistive index (RI) and pulsatility index (PI) of the patients were 0.64 ± 0.12 and 1.26 ± 0.31, respectively, and of controls were 0.88 ± 0.08 and 2.60 ± 0.56, respectively. These showed significantly lower values in patients than the controls (P Conclusion: The findings showed that significant differences exist in the uterine artery Doppler flow parameters in patients with cervical cancer compared to the healthy controls and that these parameters are influenced by menopausal status of the women and the size of the cervical mass. Hence, Doppler helps in staging, prognosticating, and posttreatment evaluation of patients with cervical cancer.

Early Onset Fetal Growth Restriction: Does Path to Diagnosis Impact Outcomes and Pathology?

Objective:To evaluate demographics and outcomes of maternal-fetal pairs in early onset fetal growth restriction (FGR) requiring delivery prior to 34 weeks’ gestation based on ultrasound indication leading to diagnosis.Study Design:This is a descriptive study of maternal-fetal pairs with early FGR diagnosed prior to 30 weeks’ gestation and delivering between 22w0d and 34w0d under the care of Wake Forest University Perinatology 01/2012–12/2016. Serial ultrasounds to assess fetal growth and umbilical artery flow Doppler velocimetry were evaluated. Pairs were dichotomized into those with maternal comorbidities leading to ultrasound diagnosis, and those with ultrasound indicated only by appreciation of uterine size less than dates on exam. Patient characteristics and outcomes were tracked. Univariate and multivariate analyses were performed as appropriate.Results:56 pregnancies were identified with FGR prior to 30 weeks and subsequent delivery prior to 34 weeks. Common comorbidities present in the group with maternal comorbidities included chronic hypertension (30.5%), hypertensive disorders of pregnancy (36.1%), preexisting diabetes (13.9%), gestational diabetes (5.6%). None of the women in the S<D group developed hypertensive disorders of pregnancy or GDM. Other background characteristics were similar. Pregnancies evaluated for size less than dates were diagnosed on average 3 weeks later in gestation, had higher incidence of reverse end diastolic flow on Doppler evaluation both at diagnosis (80% vs. 22.9%, p=0.01, OR 0.08 (<0.01,0.74) and were more likely to be delivered for an urgent indication. Both groups of babies had similar survival to discharge rates and length of stay in the NICU. A subanalysis evaluating only babies with abnormal Doppler studies showed a shorter diagnosis to delivery interval and continued to show increased risk of urgent delivery due to fetal status in those pregnancies diagnosed based on size<dates.Conclusion:Women measuring size less than dates in the mid-trimester should be evaluated by ultrasound without delays. Early FGR carries a high mortality rate in all cases and in our pilot data, women measuring small were diagnosed later with fetal growth restriction and may represent a severe phenotype with poor fetal-placental circulation. These pregnancies often met criteria for urgent delivery in a short time frame, especially if abnormal umbilical artery Doppler velocimetry was noted.

480: Umbilical artery Doppler discordance in fetal growth restriction

Contemporary antepartum surveillance for fetal growth restriction (FGR) consists of serial umbilical artery Doppler waveform assessments from a “free loop” (FL) of cord without regard to the specific artery being sampled. The primary objective of this study was to establish the frequency of discordant blood flow patterns between right and left umbilical arteries at the abdominal wall insertion site (AWI). Secondary aims included determining the frequency of discordance between FL and AWI patterns, and whether deterioration of Doppler waveforms occurred in a synchronous pattern. A descriptive prospective cohort study of patients diagnosed with IUGR between 23 0/7 -36 6/7 weeks gestation. Umbilical artery FL Doppler was obtained per routine clinical practice, with additional study waveforms acquired of both right and left umbilical arteries at the AWI. Doppler patterns were assigned 1 of 6 classifications. Baseline maternal demographics, obstetrical complications, gestational age at delivery, and neonatal birthweights were abstracted from medical records. Median gestational age at IUGR diagnosis was 31.4 weeks. Among the 70 participants, 50 (71.4%) had more than 1 Doppler measurement recorded, for a total of 238 examinations. At the initial study measurement, 14 patients (20%) had discordant AWI waveforms. When comparing AWI to FL measurements, discordance was found in 23 cases (33%). Progression of at least 1 AWI Doppler occurred in 23 patients (33%), and progression was discordant in 20 cases (29%; Table1). Frequent variability exists between arterial umbilical Doppler flow patterns in growth restricted fetuses, both at time of diagnosis and during subsequent measurements. The current study was descriptive, thus the clinical significance of this finding is indeterminate at present. Further investigations are needed to determine if umbilical artery Doppler discordance could conceivably represent an additional parameter for antepartum monitoring in fetal growth restriction.

A prospective, longitudinal monocentric study on laser Doppler imaging of microcirculation: comparison with macrovascular pathophysiology and effect of adalimumab treatment in early rheumatoid arthritis

Increased cardiovascular (CV) morbidity and mortality have been found in rheumatoid arthritis (RA). Tumour necrosis factor α (TNF-α) inhibitors may improve vascular function. In the first part of this study, we determined microcirculation during postoocclusive reactive hyperemia (PORH) representing endothelial function. In a nonselected population (n = 46) we measured flow-mediated vasodilation (FMD) of the brachial artery and laser Doppler flow (LDF) by ultrasound. Among LDF parameters, we determined TH1 (time to half before hyperemia), TH2 (time to half after hyperemia), Tmax (time to maximum) and total hyperemic area (AH). We measured von Willebrand antigen (vWF:Ag) by ELISA. In the second part of the study, we assessed the effects of adalimumab treatment on microcirculatory parameters in 8 early RA patients at 0, 2, 4, 8 and 12 weeks. We found significant positive correlations between FMD and LDF Tmax (R = 0.456, p = 0.002), FMD and TH2 (R = 0.435, p = 0.004), and negative correlation between vWF:Ag and Tmax (R = − 0.4, p = 0.009) and between vWF:Ag and TH2 (R = − 0.446, p = 0.003). Upon adalimumab therapy in early RA, TH2 times improved in comparison to baseline (TH2baseline = 26.9 s vs. TH24weeks = 34.7 s, p = 0,032), and this effect prolonged until the end of treatment (TH28weeks = 40.5, p = 0.026; TH212weeks = 32.1, p = 0.013). After 8 weeks of treatment, significant improvement was found in AHa (AHbaseline = 1599 Perfusion Units [PU] vs. AH8weeks = 2724 PU, p = 0.045). The PORH test carried out with LDF is a sensitive option to measure endothelial dysfunction. TH1 and TH2 may be acceptable and reproducible markers. In our pilot study, treatment with adalimumab exerted favorable effects on disease activity, endothelial dysfunction and microcirculation in early RA patients.

EP10.13: Novel screening method of fetal premature contraction evaluated from simple arterial Doppler flow image

EP10.13: Novel screening method of fetal premature contraction evaluated from simple arterial Doppler flow image

Transabdominal Doppler ultrasound evaluation of blood flow patterns of the uterine arteries in cervical cancer patients in Zaria, North-Western Nigeria

Cervical cancer remains an important health issue especially in the developing countries that account for about 85% of the world burden of cervical cancer. Finding a role for Doppler ultrasound in the evaluation of these patients, may reduce the cost and improve access to management. This study was aimed at evaluating the Doppler flow parameters in patients with cervical cancer when compared to normal subjects. This was a prospective case control, descriptive and observational study conducted in radiology department, ABU Teaching Hospital, Zaria, Nigeria. Eighty-one patients with cervical cancer and 81 age-matched controls had transabdominal Doppler ultrasound examination of the main uterine arteries. The data was analyzed using SPSS version 20.0 Chicago Illinois USA. Difference between two groups was tested using student ttest and P&lt;0.05 considered as statistically significant. The mean Resistivity Index (RI) and Pulsatility Index (PI) were significantly lower in patients with cervical cancer than the control (P&lt;0.0001). The mean end diastolic velocity was significantly higher in patients than the control (P&lt;0.0001). There was however no significant difference in the mean peak systolic velocity in patients and control (P=0.97). The findings have demonstrated that significant differences exist in the uterine artery Doppler flow parameters in patients with cervical cancer compared to the healthy controls. This emphasizes the role of Doppler scan in the evaluation and management of patients with cervical cancer.

The Effect of Antenatal Vaginal Progesterone Administration on Uterine, Umbilical, and Fetal Middle Cerebral Artery Doppler Flow: A Cohort Study.

This study aimed to evaluate the effect of vaginal progesterone (P) administration during the second and third trimesters of pregnancy on Doppler velocimetry of uterine, umbilical, and middle cerebral vessels. A prospective cohort study conducted on 80 women at risk for preterm labor. Uterine artery, umbilical artery, and middle cerebral artery (MCA) Doppler indices were measured before and after 1 week of administration of 200 mg twice daily vaginal P. The primary outcome parameter was the change of MCA pulsatility index (PI) after P administration. Secondary outcomes included changes in uterine artery and umbilical artery Doppler measurement. There was no significant changes of umbilical artery resistance index (RI) (0.69 ± 0.049 vs. 0.68 ± 0.041), umbilical artery PI (1.14 ± 0.118 vs. 1.11 ± 0.116), uterine artery RI (0.66 ± 0.12 vs. 0.66 ± 0.107), uterine artery PI (1.00 ± 0.26 vs. 1.016 ± 0.24), and MCA PI (1.27 ± 0.18 vs. 1.26 ± 0.23) measurements before and after 1 week of P administration, respectively. Administration of vaginal P has no significant effects on uterine artery, umbilical artery, and MCA Doppler indices.

Uterine artery Doppler flow indices in pregnant women during the 11 weeks + 0 days and 13 weeks + 6 days gestational ages: A study of 258 patients

Uterine artery Doppler flow indices in pregnant women during the 11 weeks + 0 days and 13 weeks + 6 days gestational ages: A study of 258 patients

Blood flow differences in cun-kou (radial) artery and anterior tibial artery: normal people vs patients with chronic gastritis

OBJECTIVETo explore the blood flow differences in cun-kou (radial) artery and anterior tibial artery between normal people and patients with chronic gastritis METHODSUsing doppler ultrasonography, blood flow charts [peak systolic velocity (VP), maximum blood flow velocity in diastole (VD), mean blood flow velocity (VM), pulse index (PI), resistance index (RI), blood vessel diameter (D), vessel volume (SV), circulation blood flow periodic time (ET)] measured by at cun-kou (radial) artery and anterior tibial artery in normal group (n = 30) and chronic gastritis group (n = 30) in department of ultrasound, Beijing Anzhen hospital, capital medical university. RESULTSIn the doppler flow charts of the normal group, there were statistically significant differences in VD, VM, D, RI, SV, ET between cun-kou artery and anterior tibial artery (P < 0.05), and there were more statistically significant differences in PI between cun-kou artery and anterior tibial artery (P < 0.01). In the comparison of doppler flow charts in the chronic gastritis group, there were statistically significant differences in VD, VM, D, RI, SV, ET between cun-kou artery and anterior tibial artery (P < 0.05), and there were more statistically significant differences in PI between cun-kou artery and anterior tibial artery (P < 0.01). In the comparison of doppler flow charts between normal group and chronic gastritis group, there were statistically significant differences in SV, ET between normal group and chronic gastritis group (P < 0.05), and there were more statistically significant differences in PI between normal group and chronic gastritis group (P <0.01). CONCLUSIONBased on the differences in doppler flow charts between the normal group and the chronic gastritis group, the doppler flow charts of cun-kou artery and anterior tibial artery were not only proved to be significantly different, but also provided quantitative objective indexes for the study of cun-kou artery and anterior tibial artery doppler flow charts of normal people and chronic gastritis patients. This study also proves that the doppler flow chart of the anterior tibial pulse is of great significance for the diagnosis of chronic gastritis.

The Impact of Aspirin on Ultrasound Markers of Uteroplacental Flow in Low-Risk Pregnancy: Secondary Analysis of a Multicenter RCT.

This article evaluates the effect of low-dose aspirin on uterine artery (UtA) Doppler, placental volume, and vascularization flow indices in low-risk pregnancy. In this secondary analysis of the TEST randomized controlled trial, low-risk nulliparous women were originally randomized at 11 weeks to: (1) routine aspirin 75 mg; (2) no aspirin; and (3) aspirin based upon the preeclampsia Fetal Medicine Foundation screening test. UtA Doppler, three-dimensional (3D) placental volume, and vascularization flow indices were assessed prior to and 6 weeks postaspirin commencement. A total of 546 women were included (aspirin n = 192, no aspirin n = 354). Between first and second trimesters, aspirin use was not associated with a change in UtA Doppler, placental volume, or vascular flow indices. There was no significant difference in the change in UtA Doppler pulsatility index (PI) Z-scores or notching (PI Z-score -0.2 vs. -0.2, p = 0.17), nor was there a significant change in placental volume Z-score and vascular flow indices (volume Z-score change: 0.74 vs. 0.62, p = 0.34). Low-dose aspirin commenced at 11 weeks in low-risk women does not appear to improve uterine and placental perfusion or placental volume. Any perceived effect on uteroplacental vasculature is not reflected in changes in placental volume nor uteroplacental flow as assessed by two-dimensional and 3D ultrasound.