Bilateral Notches Research Articles

70: Low-dose aspirin reduces uteroplacental vascular impedance during the first half of pregnancy in IVF/ICSI patients: A randomized placebo-controlled study

We hypothesized that low-dose aspirin improves uteroplacental hemodynamics in unselected IVF/ICSI subjects when medication is started concomitantly with controlled ovarian hyperstimulation. Thirty-five pregnant women who had undergone IVF/ICSI and had been randomized to receive 100 mg aspirin (n = 15) or placebo (n = 20) daily starting on the first day of controlled ovarian hyperstimulation were included in this study. There were 4 twin pregnancies in aspirin group and 3 in placebo group. Altogether, 19 fetuses were exposed to aspirin and 23 fetuses to placebo. Doppler ultrasonography was performed at 6+, 10+, 13+ and 18+ gestational weeks. Uterine (UtA) and spiral artery pulsatility index (PI) values were calculated and bilateral UtA notch was noted. Subplacental arcuate artery PI values were obtained at 6+ and 10+ weeks. Umbilical artery PI values and mean velocity were calculated at 10+, 13+ and 18+ weeks. At 6+ weeks, arcuate artery PIs were lower (p = 0.02) in aspirin group (1.71±0.43) compared to placebo group (2.34±0.61). At 18+ weeks, right (p = 0.026) and left (p = 0.044) UtA PIs were lower in aspirin group (0.79±0.37 and 0.87±0.35) than in placebo group (1.14±0.43 and 1.20±0.49). At 18+ weeks, bilateral UtA notch tended (p = 0.06) to be more common in placebo group (40%) than in aspirin group (13%). Umbilical artery PIs and mean velocity did not differ significantly between the groups. Low-dose aspirin reduced uteroplacental vascular impedance in early and mid pregnancy in unselected IVF/ICSI patients when medication was started concomitantly with controlled ovarian hyperstimulation. This may reflect improved throphoblastic invasion and remodeling of spiral arteries. Aspirin did not affect umbilicoplacental circulation during the first half of pregnancy.

Longitudinal study of Doppler flow resistance indices of the uterine arteries after normal vaginal delivery

To measure Doppler flow resistance indices in the uterine arteries, and to observe when the early diastolic notches appear during the normal puerperium. Some 45 women took part in this prospective longitudinal study after normal, vaginal delivery. Ultrasound examinations were scheduled for days 1, 3, 7, 14, 28 and 56 postpartum. A transabdominal probe was used during the first two postpartum weeks, and a transvaginal probe for the later examinations. The pulsatility (PI) and resistance (RI) indices in the uterine arteries were measured, and the presence or absence of early diastolic notches was recorded. Compared to day one, the resistance indices did not change markedly until day 28 postpartum. The mean PI was 1.23 at day 1, 1.22 at day 3, 1.22 at day 7, 1.33 at day 14, 1.81 at day 28, and 2.25 at day 56. The mean RI was 0.65 at day 1, 0.65 at day 3, 0.66 at day 7, 0.65 at day 14, 0.77 at day 28, and 0.84 at day 56. The presence of at least 1 uterine artery notch was found in 13.3% of the women at day 1, and in 90.6% at day 56 postpartum. Bilateral notches were recorded in 6.7% of the women at day 1, and in 84.4% at day 56 postpartum. Reference values of the resistance indices from uncomplicated puerperium are needed when the diagnostic efficacy of Doppler ultrasound for pathological conditions is to be tested. This study confirms that the time needed for the vascular physiology to revert from a pregnant to a non-pregnant state appears to be longer than previously assumed.

OP08.11: Placental volume measurement by 3D ultrasound in the first trimester and prediction of fetal growth restriction

Fetal growth restriction (IUGR) is associated with increased morbidity and mortality of the newborn. Reduced placental function because of impaired trophoblast invasion in the first trimester is an important pathogenetic factor. In this context increase in uterine blood flow resistance and reduction of placental size may be of clinical relevance. It is on this background that we investigated whether placental volume measurement by 3D ultrasound and uterine artery Doppler in the first trimester allow prediction of fetal weight at birth. Inclusion criteria were: singleton pregnancy and gestational age between 11 + 0 and 13 + 6 weeks. Exclusion criteria were: smoking, pre-existing diabetes, fetal anomalies, serious maternal disease and maternal medication affecting fetal growth. In our prospective cohort study of 80 patients uterine artery Doppler (mean pulsatilitiy index, bilateral notching) and placental volumetry by 3D ultrasound were routinely performed and the placental ratio (PR = placental volume : crown − rump length) was calculated. Primary outcome variables were birth weight below or above the 10th percentile in our population. Statistics were based on logistic regression analysis. Sensitivity and specificity of predicting fetal birth weight below the 10th percentile were tested. Maternal body mass index (P = 0.043) and placental ratio (P < 0.001) were significantly associated with fetal birth weight in univariate regression analysis. All other parameters demonstrated no significant effect. In multivariate analysis the placental ratio was the only parameter predicting fetal birth weight category at a significant level (P = 0.002), with a sensitivity of 60% and a specificity of 72%. 3D-placental volumetry in the first trimester appears to be an early predictor of IUGR and the percentile of fetal birth weigth.

OC216: Treatment with NO donor patches in asymptomatic women with bilateral notch and elevated total vascular resistance

OC216: Treatment with NO donor patches in asymptomatic women with bilateral notch and elevated total vascular resistance

OP01.04: Total vascular resistance is already elevated at 24 weeks' gestation in patients with subsequent complications in persisting bilateral notching of uterine artery Doppler waveforms

OP01.04: Total vascular resistance is already elevated at 24 weeks' gestation in patients with subsequent complications in persisting bilateral notching of uterine artery Doppler waveforms

OC215: Elevated total vascular resistance more than persisting bilateral notches of uterine artery Doppler waveforms identifies patients at risk of pregnancy complications

OC215: Elevated total vascular resistance more than persisting bilateral notches of uterine artery Doppler waveforms identifies patients at risk of pregnancy complications

Uterine Artery Velocity Waveforms as Predictors of Pregnancy Outcome in Patients with Antiphospholipid Syndrome

In pregnant women, antiphospholipid syndrome (APS) is associated with an increased risk for preeclampsia, fetal intrauterine growth restriction, and other complications related to uteroplacental insufficiency. In normal pregnancy, impedance to flow in the uterine arteries decreases with gestation, as the likely consequence of the physiologic change of spiral arteries into low-resistance vessels. The presence of antiphospholipid antibodies can impair this vascular adaptation, resulting in a reduced placental perfusion. Doppler investigation provides a noninvasive method for the study of uteroplacental blood flow. Several studies were performed to detect the predictive role of uterine artery Doppler velocimetry in relation to pregnancy outcome in APS patients. In some studies, a high resistance index in the uterine arteries strongly predicted the subsequent development of obstetric complications. In other studies, persistent bilateral uterine artery notches identified the risk of preeclampsia and fetal intrauterine growth restriction. To date, the uterine artery Doppler velocimetry resulted to be a useful tool for identifying APS pregnancies at risk for adverse pregnancy outcome. These findings might have important implications for the management of these patients.

Increased Apoptosis in First Trimester Extravillous Trophoblasts from Pregnancies at Higher Risk of Developing Preeclampsia

Preeclampsia complicates 5 to 10% of pregnancies and is a leading cause of maternal and fetal mortality and morbidity. Although the cause is unknown, inadequate invasion and remodeling of maternal uterine arteries by extravillous trophoblasts (EVTs) in the first trimester is a common feature. Uterine spiral artery resistance as detected by Doppler ultrasound is commonly used in the second trimester to identify pregnancies destined to develop preeclampsia. Correlation between high uterine resistance and the failure of trophoblast invasion has been reported as early as 12 weeks. However, the reason for this failure has not been established. Understanding the processes involved would significantly improve our diagnostic potential. In this study, we correlated increased first trimester uterine artery resistance with a biological abnormality in trophoblast function. EVTs derived from high-resistance pregnancies were more sensitive to apoptotic stimuli than those from normal-resistance pregnancies. Survival of EVTs from high-resistance pregnancies could be increased by nitric oxide, whereas inhibition of nitric oxide in cells from normal-resistance pregnancies increased apoptotic sensitivity. This predates the onset of symptoms by several weeks and provides evidence for a mechanism responsible for the incomplete uterine vessel remodeling and the differences in artery resistance between preeclamptic and normal pregnancies.

Screening for pre‐eclampsia and small for gestational age fetuses at the 11–14 weeks scan by uterine artery Dopplers

To assess the role of uterine artery Doppler studies at 11-14 weeks in screening for pre-eclampsia (PET), small for gestational age (SGA) fetuses, and placental abruption. Prospective study on 1,123 women presenting for routine ultrasound examination at 11-14 weeks for nuchal translucency measurement. Uterine artery blood flow was studied by transvaginal colour Doppler, the mean pulsatility index (PI) was calculated, and the presence of a diastolic notch was recorded. The mean, median and 95th centile of uterine artery PI were 1.71, 1.64 and 2.54, respectively. Bilateral notches were observed in 63.4%, and a unilateral notch in 18.4% of cases. The sensitivity of mean uterine artery PI>or=95th centile for PET, early onset severe PET necessitating delivery before 34 weeks, SGA<or=5th centile, SGA necessitating delivery before 34 weeks, SGA<or=10th centile and placental abruption were 21.4, 33.3, 17.8, 100, 9.6 and 44.4%, respectively. One in 6 women with increased resistance in the uterine arteries at 11-14 weeks will develop a complication related to utero-placental insufficiency. Abnormal uterine Dopplers at 11-14 weeks identified one-third of women with severe early onset pre-eclampsia, all fetuses with SGA<or=5th centile that were delivered at<or=34 weeks, and 40% of cases with placental abruption. Uterine artery Doppler examination at the 11-14 weeks scan can identify a high risk population in which preventive or therapeutic interventions might be effective.

Identification of patients at risk for early onset and/or severe preeclampsia with the use of uterine artery Doppler velocimetry and placental growth factor

Preeclampsia has been proposed to be an antiangiogenic state that may be detected by the determination of the concentrations of the soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) and placental growth factor (PlGF) in maternal blood even before the clinical development of the disease. The purpose of this study was to determine the role of the combined use of uterine artery Doppler velocimetry (UADV) and maternal plasma PlGF and sVEGFR-1 concentrations in the second trimester for the identification of patients at risk for severe and/or early onset preeclampsia. A prospective cohort study was designed to examine the relationship between abnormal UADV and plasma concentrations of PlGF and sVEGFR-1 in 3348 pregnant women. Plasma samples were obtained between 22 and 26 weeks of gestation at the time of ultrasound examination. Abnormal UADV was defined as the presence of bilateral uterine artery notches and/or a mean pulsatility index above the 95th percentile for the gestational age. Maternal plasma PlGF and sVEGFR-1 concentrations were determined with the use of sensitive and specific immunoassays. The primary outcome was the development of early onset preeclampsia (< or = 34 weeks of gestation) and/or severe preeclampsia. Secondary outcomes included preeclampsia, the delivery of a small for gestational age (SGA) neonate without preeclampsia, spontaneous preterm birth at < or = 32 and < or = 35 weeks of gestation, and a composite of severe neonatal morbidity. Contingency tables, chi-square test, receiver operating characteristic curve, and multivariate logistic regression were used for statistical analyses. A probability value of < .05 was considered significant. (1) The prevalence of preeclampsia, severe preeclampsia, and early onset preeclampsia were 3.4% (113/3296), 1.0% (33/3296), and 0.8% (25/3208), respectively. UADV was performed in 95.4% (3146/3296) and maternal plasma PlGF concentrations were determined in 93.5% (3081/3296) of the study population. (2) Abnormal UADV and a maternal plasma PlGF of < 280 pg/mL were independent risk factors for the occurrence of preeclampsia, severe preeclampsia, early onset preeclampsia, and SGA without preeclampsia. (3) Among patients with abnormal UADV, maternal plasma PlGF concentration contributed significantly in the identification of patients destined to develop early onset preeclampsia (area under the curve, 0.80; P < .001) and severe preeclampsia (area under the curve, 0.77; P < .001). (4) In contrast, maternal plasma sVEGFR-1 concentration was of limited use in the prediction of early onset and/or severe preeclampsia. (5) The combination of abnormal UADV and maternal plasma PlGF of < 280 pg/mL was associated with an odds ratio (OR) of 43.8 (95% CI, 18.48-103.89) for the development of early onset preeclampsia, an OR of 37.4 (95% CI, 17.64-79.07) for the development of severe preeclampsia, an OR of 8.6 (95% CI, 5.35-13.74) for the development of preeclampsia, and an OR of 2.7 (95% CI, 1.73-4.26) for the delivery of a SGA neonate in the absence of preeclampsia. The combination of abnormal UADV and maternal plasma PlGF concentration of < 280 pg/mL in the second trimester is associated with a high risk for preeclampsia and early onset and/or severe preeclampsia in a low-risk population. Among those with abnormal UADV, a maternal plasma concentration of PlGF of < 280 pg/mL identifies most patients who will experience early onset and/or severe preeclampsia.

Three‐dimensional analysis of the occlusal plane related to the hamular–incisive–papilla occlusal plane in young adults

The planes which serve as references for cranium and face in dental clinical application included the occlusal plane, Frankfort plane, Camper's plane and hamular-incisive-papilla (HIP) plane. The HIP occlusal plane is a horizontal plane passing through the bilateral hamular notches and the incisive papilla (Dent Surv. 1975;51:60). The aim of this study was to estimate the relationship between the various occlusal planes and the HIP plane in Taiwanese young adults with approximately optimal occlusion. Study casts of 100 young adults (50 men and 50 women) were selected in this study. All market points on the maxillary casts were measured by a three-dimensional precise measuring device. The angular relationship between the four various occlusal planes and the HIP plane were investigated. The vertical distances between the cusp tips and incisal edges of maxillary teeth to the HIP plane were measured. Data were performed by the Statistic analysis software programme (JMP 4.02). The Student's t-test and Pearson's correlation test were used to test the statistical significance (P < 0.05). The results showed that the occlusal plane defined as the incisal edge of maxillary central incisor to mesiobuccal cusp tips of maxillary second molars had the smallest included angle with the HIP plane (2.61 +/- 0.81 degrees). The incisal edge of maxillary right central incisal to mesiopalatal cusp tips of maxillary first molars had the largest included angle with the HIP plane (7.72 +/- 1.60 degrees). The curve is drawn through the buccal cusp tips of maxillary teeth had better parallelism with the HIP plane.

First‐trimester uterine artery Doppler and spontaneous preterm delivery

To assess the relationship between first-trimester uterine artery Doppler measurements and spontaneous preterm delivery. This was a retrospective analysis of uterine artery Doppler findings at 11-14 weeks in 73 singleton pregnancies with spontaneous preterm labor and 2417 pregnancies delivered at term. The uterine artery mean resistance index (RI) was 0.68 (coefficient of variation 19%) and 0.69 (17%) in the preterm and term delivery groups, respectively (P = 0.35). The mean pulsatility index (PI) was 1.42 (39%) and 1.42 (46%) in the term and preterm delivery groups, respectively (P = 0.95). Bilateral diastolic notches were present in 34% of preterm deliveries and 33% of controls (P = 0.84). Restricting the analysis to the 19 pregnancies with preterm delivery before 34 weeks of gestation, no significant difference from controls was observed for RI (mean 0.71, coefficient of variation 11%, P = 0.41), PI (mean 1.56, coefficient of variation 29%, P = 0.27) or the number of bilateral notches (42%, P = 0.41). Despite pathological evidence suggesting that defective placentation is associated with spontaneous preterm delivery, first trimester uterine artery resistance, as assessed by Doppler ultrasound investigation, is not different in pregnancies subsequently complicated by preterm labor compared to pregnancies delivered at term. This finding may be explained by a late failure of trophoblast development in cases destined to deliver preterm.

Maternal Uterine Artery Doppler Flow Velocimetry and the Risk of Stillbirth

We sought to relate the risk of antepartum stillbirth to uterine artery Doppler flow velocimetry at 22-24 weeks. Data were available from 30,519 unselected women from seven units in the UK who had uterine artery Doppler performed between 22 and 24 weeks of gestation. The risk of stillbirth (n=109) was assessed using time to event and logistic regression analysis. Stillbirths were subdivided into placental (due to abruption, preeclampsia, or growth restriction) or unexplained. The risk of placental stillbirth was increased among women with a mean pulsatility index in the top decile (adjusted hazard ratio [HR] 5.5, 95% confidence interval [CI] 2.8-10.6) and those with a bilateral notch (adjusted HR 3.9, 95% CI 2.0-7.8). The relationship between a mean pulsatility index in the top decile and the risk of unexplained stillbirth was weaker (adjusted HR 2.5, 95% CI 1.1-5.6) and there was no association with a bilateral notch. Placental stillbirths occurred at earlier gestations than unexplained stillbirths (median [interquartile range] 30 [26-36] compared with 38 [36-40], P<.001). Consequently, being in the top 5% of predicted risk of stillbirth on the basis of the combination of mean pulsatility index and notching was a good predictor (sensitivity, specificity, and positive likelihood ratio) of all cause stillbirth up to 32 weeks (58%, 95%, and 12.1, respectively) but a poor predictor of stillbirth at later gestations (7%, 95%, and 1.3, respectively). Abnormal uterine artery Doppler was a better predictor of the risk of stillbirth due to placental causes than unexplained stillbirth. Consequently, abnormal uterine artery Doppler was a good predictor of stillbirth at extreme preterm gestations but a poor predictor of stillbirth at term. II.

Transabdominal uterine arteries doppler between 11-14 weeks of gestation for prediction of outcome in high risk pregnancies

ObjectiveTo assess the value of early transabdominal uterine arteries Doppler ultrasound for prediction of gestational outcomes in pregnancies at high risk for preeclampsia.Study designObservational study. Doppler ultrasound of uterine arteries at 11-14 weeks' gestation was performed in 76 women. Presence of diastolic notch and resistance index (RI) were investigated. Abnormal uterine Doppler was defined by presence of bilateral notching or by mean RI > 0.80. Adverse outcomes evaluated were preeclampsia, fetal growth restriction, placental abruption, intrauterine death and complications associated with impaired placentation requiring delivery before 34 weeks of gestation.ResultsAmong 76 women 30 had abnormal uterine Doppler indices and 46 had normal RI and normal Doppler waveform configuration at 11-14 weeks' gestation. Abnormal uterine flow was related to a significantly higher incidence of preeclampsia (16.6% vs 0%; p= 0.0041), fetal growth restriction (26.6% vs 0%; p= 0.0002), intrauterine death (13.3% vs 0%; p= 0.0109) and iatrogenic preterm delivery (20% vs 2.15% ; p= 0.0087).Among pregnancies with normal Doppler indices no one was complicated by preeclampsia or fetal growth restriction. Normal waveform configuration had 97.8% of negative predictive value for complications requiring elective delivery before 34 weeks.ConclusionNormal Doppler indices in the first trimester are strongly related to normal outcome of pregnancy in women at high risk for preeclampsia. Results of this study support a change in the antepartum care of already identified high risk women with normal uterine Doppler waveform configuration at 11-14 weeks of gestation. ObjectiveTo assess the value of early transabdominal uterine arteries Doppler ultrasound for prediction of gestational outcomes in pregnancies at high risk for preeclampsia. To assess the value of early transabdominal uterine arteries Doppler ultrasound for prediction of gestational outcomes in pregnancies at high risk for preeclampsia. Study designObservational study. Doppler ultrasound of uterine arteries at 11-14 weeks' gestation was performed in 76 women. Presence of diastolic notch and resistance index (RI) were investigated. Abnormal uterine Doppler was defined by presence of bilateral notching or by mean RI > 0.80. Adverse outcomes evaluated were preeclampsia, fetal growth restriction, placental abruption, intrauterine death and complications associated with impaired placentation requiring delivery before 34 weeks of gestation. Observational study. Doppler ultrasound of uterine arteries at 11-14 weeks' gestation was performed in 76 women. Presence of diastolic notch and resistance index (RI) were investigated. Abnormal uterine Doppler was defined by presence of bilateral notching or by mean RI > 0.80. Adverse outcomes evaluated were preeclampsia, fetal growth restriction, placental abruption, intrauterine death and complications associated with impaired placentation requiring delivery before 34 weeks of gestation. ResultsAmong 76 women 30 had abnormal uterine Doppler indices and 46 had normal RI and normal Doppler waveform configuration at 11-14 weeks' gestation. Abnormal uterine flow was related to a significantly higher incidence of preeclampsia (16.6% vs 0%; p= 0.0041), fetal growth restriction (26.6% vs 0%; p= 0.0002), intrauterine death (13.3% vs 0%; p= 0.0109) and iatrogenic preterm delivery (20% vs 2.15% ; p= 0.0087).Among pregnancies with normal Doppler indices no one was complicated by preeclampsia or fetal growth restriction. Normal waveform configuration had 97.8% of negative predictive value for complications requiring elective delivery before 34 weeks. Among 76 women 30 had abnormal uterine Doppler indices and 46 had normal RI and normal Doppler waveform configuration at 11-14 weeks' gestation. Abnormal uterine flow was related to a significantly higher incidence of preeclampsia (16.6% vs 0%; p= 0.0041), fetal growth restriction (26.6% vs 0%; p= 0.0002), intrauterine death (13.3% vs 0%; p= 0.0109) and iatrogenic preterm delivery (20% vs 2.15% ; p= 0.0087).Among pregnancies with normal Doppler indices no one was complicated by preeclampsia or fetal growth restriction. Normal waveform configuration had 97.8% of negative predictive value for complications requiring elective delivery before 34 weeks. ConclusionNormal Doppler indices in the first trimester are strongly related to normal outcome of pregnancy in women at high risk for preeclampsia. Results of this study support a change in the antepartum care of already identified high risk women with normal uterine Doppler waveform configuration at 11-14 weeks of gestation. Normal Doppler indices in the first trimester are strongly related to normal outcome of pregnancy in women at high risk for preeclampsia. Results of this study support a change in the antepartum care of already identified high risk women with normal uterine Doppler waveform configuration at 11-14 weeks of gestation.

Combining mid-trimester maternal plasma homocysteine with uterine artery doppler velocimetry: is it useful?

To investigate the possible association between mid-trimester maternal plasma homocysteine concentration, uterine artery Doppler measurements in a two-stage screening strategy, and outcome of pregnancy. This prospective observational study was conducted on healthy women undergoing screening for pre-eclampsia by uterine artery Doppler velocimetry at 20-22 and 24-26 weeks of gestation. Abnormal uterine artery blood flow was defined as an average resistance index (RI) > 0.58 and/or bilateral early diastolic notch. Homocysteine measurement was performed by two competitive immunoassay methods involving two steps at 20-22 and 24-26 weeks' gestation. Sixty women enrolled. Abnormal Doppler findings were found in 18 of 60 (30%) women at 20-22 weeks of gestation. This proportion was reduced to 10% (6/60) at 24-26 weeks of gestation, and two of these six women developed pre-eclampsia later in pregnancy. There was no significant difference in the maternal plasma homocysteine levels in women with abnormal Doppler findings when compared with controls at first and second visits (p > 0.05). Mid-trimester maternal homocysteine concentration is not elevated in women with abnormal uterine artery Doppler findings in a two-stage screening method.

Uterine artery Doppler velocimetry at 11–14 weeks in singleton pregnancies conceived by assisted reproductive technology

Singleton pregnancies resulting from assisted reproductive technologies (ART) have an increased risk of preterm delivery, pre-eclampsia and intrauterine growth restriction. The aim of the present study was to determine whether first-trimester trophoblastic invasion, as assessed by uterine artery Doppler velocimetry, is different in singleton pregnancies resulting from ART compared to those conceived naturally. Case-control study on 31 singleton ART pregnancies (26 in-vitro fertilization-embryo transfer, five intracytoplasmic sperm injection) and 62 matched pregnancies conceived spontaneously. Doppler velocimetry was performed at 11-14 weeks of gestation. The mean resistance index (coefficient of variation) was 0.70 (17%) and 0.70 (18%) in ART and controls, respectively (P = 0.92). The corresponding values for mean pulsatility index were 1.40 (44%) and 1.47 (44%) in ART and controls, respectively (P = 0.58). Pregnancies with no, unilateral or bilateral diastolic notches were 48%, 26%, 26% and 36%, 37%, 27%, in ART and controls, respectively (P = 0.43). There are no differences in uterine artery Doppler indices between pregnancies obtained by invasive ART and naturally conceived matched controls. This finding suggests that there is no major difference in trophoblastic invasion of the maternal spiral arteries between ART and spontaneous pregnancies.

Sequential changes in uterine artery blood flow pattern between the first and second trimesters of gestation in relation to pregnancy outcome

To describe sequential changes in uterine artery waveform between the first and second trimesters of gestation and to analyze their association with the subsequent risk of hypertensive disorders and fetal growth restriction (IUGR). Sequential uterine artery Doppler recordings were obtained in a final cohort of 870 singleton pregnancies over two gestational age intervals: 11-14 weeks and 19-22 weeks. The left and right uterine arteries were examined by color and pulsed Doppler and the mean pulsatility index (PI) as well as the presence of a bilateral protodiastolic notch were recorded during both intervals. Pregnancies were followed for occurrence of hypertensive disorders and IUGR. Mean uterine artery PI showed a significant linear decrease within each of the two intervals considered, while the prevalence of a bilateral notch showed decreasing values only throughout 11-14 weeks of gestation. Sixty-four (7.3%) pregnancies developed a hypertensive disorder and/or IUGR, including three (0.34%) cases of gestational hypertension, 24 cases of pre-eclampsia (2.75%) and 37 (4.25%) of IUGR. Compared with pregnancies with a normal outcome, complicated pregnancies showed a significantly higher prevalence of a bilateral notch and a higher mean PI in each of the two intervals studied. Compared with normal pregnancies, complicated pregnancies had a significantly higher persistence of a bilateral notch (30% vs. 8%), a higher proportion of women with an abnormal first-trimester uterine artery PI shifting to normal in the second trimester (14% vs. 4%) and a higher incidence of a normal first-trimester mean PI that shifted to abnormal in the second trimester (13% vs. 4%). Persistence of an abnormal mean PI from the first to the second trimester identified the group with the greatest risk for adverse perinatal outcome (OR, 10.7; 95% CI, 3.7-30.9). In addition, women in whom the uterine artery mean PI shifted from abnormal to normal between the two trimesters and women in whom the reverse shift occurred showed a similar intermediate risk (OR, 5; 95% CI, 2.1-10.6), comparable to that in women with persistence of a bilateral notch (OR, 5.6; 95% CI, 2.9-10.7). The sequence of changes in uterine flow between the first and second trimesters correlates with the subsequent development of hypertensive disorders and IUGR. Women with a persistent abnormal mean PI represent the group with the greatest risk for adverse perinatal outcome.

P07.02: First‐trimester uterine artery Doppler and pre‐eclampsia

To assess the predictivity of first-trimester uterine artery Doppler measurements for pre-eclampsia. Uterine artery Doppler findings were prospectively obtained at 11–14 weeks in 3100 singleton pregnancies. Pre-eclampsia was defined as a blood pressure > 140/90 mmHg, and proteinuria of ≥ 300 mg in 24hrs, or two readings of at least 1 + on dipstick analysis of midstream or catheter urine specimens if no 24-hour urine collection was available. There were 54 cases of pre-eclampsia (1.7%), for 16 of which (0.5%) delivery before 37 weeks was necessary. Sensitivity and specificity of different cut-offs of uterine resistance index (RI), pulsatility index (PI), bilateral diastolic notches, and their combinations for the prediction of pre-eclampsia are shown in the Table. First-trimester uterine artery Doppler has a limited usefulness for screening for pre-eclampsia in an unselected obstetric population.

Adverse outcome in women with thrombophilia and bilateral uterine artery notches

Discrepancies about a possible relationship between prothrombotic mutations and a decreased uteroplacental blood flow are present in literature. We prospectively evaluated a cohort of pregnant women (n = 41) with bilateral uterine artery notches and found that women with inherited thrombophilia showed a sixfold higher risk to have an adverse outcome than women without.

1264: The role of Doppler ultrasound in obstetrics

1264: The role of Doppler ultrasound in obstetrics