Uterine Artery Doppler Velocimetry Research Articles

PlGF in a clinical setting of pregnancies at risk of preeclampsia and/or intrauterine growth restriction

Placental growth factor (PlGF) is an angiogenic molecule produced by the placenta and implicated in the pathogenesis of preeclampsia (PE) and intrauterine growth restriction (IUGR). We have evaluated utility and applicability of the PlGF test in a clinical setting of pregnancies at risk of PE or complicated by IUGR in order to assess its relationship with pregnancy outcomes. Seventy-three pregnancies were enrolled between 19 and 35 weeks: 57 pregnancies at risk of PE and 16 at diagnosis of IUGR. Maternal circulating PlGF levels were measured by the Triage PlGF test (Alere, San Diego, CA). Pregnancy outcomes were evaluated in relation to three categories of plasma PlGF levels: very low (<12 pg/ml), low (12–100 pg/ml) and normal (≥100 pg/ml). Uterine artery Doppler velocimetry (UADV) pulsatility index (PI) was measured in the same patients on the day of maternal sampling. Pregnancies at risk with very low plasma PlGF levels had significantly lower gestational age at delivery than patients with low or normal PlGF. The rate of emergency C-section was significantly higher in the group with PlGF <12 pg/ml. IUGR pregnancies with very low and low PlGF delivered earlier than patients with normal PlGF. All IUGR with very low and low PlGF had UADV PI > 95th percentile. Our data indicate that PlGF may provide useful information to identify fetuses requiring increased surveillance and possibly urgent delivery in pregnancies at risk of adverse outcomes. Furthermore, in IUGR, PlGF can predict adverse pregnancy outcomes that may be secondary to placental insufficiency.

Óxido nítrico plasmático y doppler de las arterias uterinas en preeclámpticas y embarazadas normotensas sanas

ObjectiveTo establish plasma nitric oxide concentrations in patients with preeclampsia and healthy normotensive pregnant women and to relate doppler findings to serum concentrations. MethodWe selected 160 patients, of which 47 had severe preeclampsia (group A), 33 had mild preeclampsia (group B), and 80 were healthy pregnant women with a similar age to patients in the study groups who served as controls (group C). Blood samples for determination of nitric oxide and doppler measurements were taken in all patients before labour and immediately after diagnosis in the study group. ResultsPlasma nitric oxide (nitrites/nitrates) concentrations were lower in groups A and B than in group C (P<.05). Measurements of the pulsatility index, resistance index and systolic/diastolic blood flow ratio of uterine arteries were higher in both groups of preeclamptic patients (P<.05). Correlations of plasma nitric oxide concentrations with doppler velocimetry values showed a negative and significant association with all the evaluated parameters (P<.05). ConclusionPlasma nitric oxide concentrations were higher in preeclamptic patients than in normotensive pregnant women and there was a significant correlation between plasma concentrations and parameters of doppler velocimetry of uterine arteries.

Uterine Artery Doppler Velocimetry for the Prediction of Preeclampsia among High-risk Pregnancies in Low-resource Setting: Our Experience at Aminu Kano Teaching Hospital, Kano, Nigeria

ABSTRACT Several Doppler studies have demonstrated an association between increased impedance to flow in uterine arteries and subsequent development of preeclampsia. This study evaluated the usefulness of uterine artery Doppler velocimetry in the prediction of preeclampsia in high-risk pregnancies. The study was a prospective cohort study carried out on 138 pregnant women attending antenatal clinic in Aminu Kano Teaching Hospital, a tertiary center in Northern Nigeria. Assessment of uterine artery blood flow by Doppler ultrasound was carried out at 20 to 24 weeks of gestation. The test was considered abnormal when the mean resistance index (RI) in the uterine arteries was .0.58 with or without diastolic notch (DN). The women were then followed up to determine those who developed preeclampsia. The prevalence of preeclampsia in this study was found to be 12.3%. Twenty one of the patients (15.2%) had high uterine artery RI (. 0.58), while 117 (84.8%) had normal RI (&lt;0.58). The prevalence of preeclampsia was significantly higher (p &lt; 0.05) in the group with high RI than in the group with normal RI (57.1 compared with 4.2%). Nine of the patients (6.5%) had DN, while 129 (93.5%) had no DN. The prevalence of preeclampsia was also significantly higher (p &lt; 0.05) in the group with DN than in the group with no DN (55 compared with 9.3%). Both the sensitivity (70.5%) and specificity (92.6%) of abnormal RI in the prediction of preeclampsia were found to be high. This study confirmed the efficacy of second trimester screening for preeclampsia in high-risk pregnancies using a combination of maternal characteristics and uterine artery Doppler. How to cite this article Yusuf M, Galadanci H, Ismail A, Aliyu LD, Danbatta AH. Uterine Artery Doppler Velocimetry for the Prediction of Preeclampsia among High-risk Pregnancies in Low-resource Setting: Our Experience at Aminu Kano Teaching Hospital, Kano, Nigeria. Donald School J Ultrasound Obstet Gynecol 2017;11(3):197-202.

The combination of histidine-rich glycoprotein and uterine artery Doppler velocimetry in the prediction of pre-eclampsia

The combination of histidine-rich glycoprotein and uterine artery Doppler velocimetry in the prediction of pre-eclampsia

Reduced placental volume and flow in severe growth restricted fetuses

OBJECTIVES:To evaluate placental volume and vascular indices in pregnancies with severe fetal growth restriction and determine their correlations to normal reference ranges and Doppler velocimetry results of uterine and umbilical arteries.METHODS:Twenty-seven fetuses with estimated weights below the 3rd percentile for gestational age were evaluated. Placental volume and vascular indices, including vascularization, flow, and vascularization flow indices, were measured by three-dimensional ultrasound using a rotational technique and compared to a previously described nomogram. The observed-to-expected placental volume ratio for gestational age and observed-to-expected placental volume ratio for fetal weight were calculated. Placental parameters correlated with the Doppler velocimetry results of uterine and umbilical arteries.RESULTS:The mean uterine artery pulsatility index was negatively correlated with the observed-to-expected placental volume ratio for gestational age, vascularization index and vascularization flow index. The observed-to-expected placental volume ratio for gestational age and observed-to-expected placental volume ratio for fetal weight and vascularization index were significantly lower in the group with a bilateral protodiastolic notch. No placental parameter correlated with the umbilical artery pulsatility index.CONCLUSIONS:Pregnancies complicated by severe fetal growth restriction are associated with reduced placental volume and vascularization. These findings are related to changes in uterine artery Doppler velocimetry. Future studies on managing severe fetal growth restriction should focus on combined results of placental three-dimensional ultrasound and Doppler studies of uterine arteries.

Fetal Hemodynamic Parameters in Low Risk Pregnancies: Doppler Velocimetry of Uterine, Umbilical, and Middle Cerebral Artery.

Objective. To elaborate curves of longitudinal reference intervals of pulsatility index (PI) and systolic velocity (SV) for uterine (UtA), umbilical (UA), and middle cerebral arteries (MCA), in low risk pregnancies. Methods. Doppler velocimetric measurements of PI and SV from 63 low risk pregnant women between 16 and 41 weeks of gestational age. Means (±SD) for intervals of gestational age and percentiles 5, 50, and 95 were calculated for each parameter. The Intraclass Correlation Coefficients (ICC) were also estimated for assessing intra- and intervariability of measurements. Results. Mean PI of UtA showed decreasing values during pregnancy, but no regular pattern was identified for mean SV. For UA, PI decreased and SV increased along gestation. MCA presented PI increasing values until 32–35 weeks. SV showed higher levels with increasing gestation. High ICC values indicated good reproducibility. Conclusions. Reference intervals for the assessment of SV and PI of UtA, UA, and MCA were established. These reference intervals showed how a normal pregnancy is expected to progress regarding these Doppler velocimetric parameters and are useful to follow high risk pregnancies. The comparison between results using different curves may provide insights about the best patterns to be used.

Is Doppler ultrasound useful for evaluating gestational trophoblastic disease?

Doppler ultrasound is a non-invasive method for evaluating vascularization and is widely used in clinical practice. Gestational trophoblastic neoplasia includes a group of highly vascularized malignancies derived from placental cells. This review summarizes data found in the literature regarding the applications of Doppler ultrasound in managing patients with gestational trophoblastic neoplasia.The PubMed/Medline, Web of Science, Cochrane and LILACS databases were searched for articles published in English until 2014 using the following keywords: “Gestational trophoblastic disease AND Ultrasonography, Doppler.”Twenty-eight articles met the inclusion criteria and were separated into the 4 following groups according to the aim of the study. 1 Doppler ultrasound does not seem to be capable of differentiating partial from complete moles, but it might be useful when evaluating pregnancies in which a complete mole coexists with a normal fetus. 2 There is controversy in the role of uterine artery Doppler velocimetry in the prediction of development of gestational trophoblastic neoplasia. 3 Doppler ultrasound is a useful tool in the diagnosis of gestational trophoblastic neoplasia because abnormal myometrial vascularization and lower uterine artery Doppler indices seem to be correlated with invasive disease. 4 Lower uterine artery Doppler indices in the diagnosis of gestational trophoblastic neoplasia are associated with methotrexate resistance and might play a role in prognosis.CONCLUSION:Several studies support the importance of Doppler ultrasound in the management of patients with gestational trophoblastic neoplasia, particularly the role of Doppler velocimetry in the prediction of trophoblastic neoplasia and the chemoresistance of trophoblastic tumors. Doppler findings should be used as ancillary tools, along with human chorionic gonadotropin assessment, in the diagnosis of gestational trophoblastic neoplasia.

Diagnosis of Placenta Accreta by Uterine Artery Doppler Velocimetry in Patients With Placenta Previa

To evaluate the potential value of uterine artery Doppler velocimetry in diagnosing placenta accreta. Clinical records of all deliveries between April 1991 and March 2013 were retrospectively analyzed. Cases of intrauterine growth restriction, pregnancy-induced hypertension, multiple pregnancies, fetal anomalies, chromosomal abnormalities, and maternal medical illnesses such as cardiovascular disease, renal disease, and diabetes mellitus were excluded. A total of 11,210 cases were evaluated, including 403 cases of placenta previa without accreta (placenta previa) and 39 cases of placenta previa with accreta (placenta accreta). All patients underwent uterine artery Doppler velocimetry to measure the mean resistive index and pulsatility index (PI) in the third trimester. The analysis included participant characteristics such as age, parity, abortion history, previous cesarean delivery, gestational age at delivery, neonatal sex, and birth weight. The mean uterine artery PI was significantly lower in the placenta accreta group compared to previa alone (0.51 versus 0.57; P = .002). The odds ratios for placenta accreta were 2.4 for 2 or more previous abortions (P = .011) and 5.3 and 7.0 for 1 and 2 or more previous cesarean deliveries (P = .001 and .005). With an increase in the mean PI by 0.01, the odds ratio for placenta accreta decreased by 0.94 (P < .001). The area under the receive operating characteristic curve was 0.72 for previous cesarean delivery alone, increasing to 0.77 with the combination of the mean PI and previous cesarean delivery (P = .047). This study suggests that the mean PI measured by uterine artery Doppler velocimetry is reduced in patients with placenta accreta compared to those without accreta. The diagnostic accuracy of placenta accreta can be potentially improved if uterine artery Doppler values and the history of cesarean delivery are combined.

FLUJOMETRÍA DOPPLER EN LA ENFERMEDAD HIPERTENSIVA SEVERA DEL EMBARAZO CON RETARDO DEL CRECIMIENTO ITRAUTERINO

Objetivo. Evaluar el rol del uso de la ultrasonografía Dopple de las arterias umbilical, irterina y cerebral media en el manejo de las enfermedades hipertensiva con retardo de crecimiento intrauterino y su asociación con resultados perinatale adversos. MATERIAL Y MÉTODOS: En este estudio retrospectivo realizado en el centro de diagnóstico ecográfico Ecomed, se seleccionó 32 pacientes por presentar embarazo de riesgo alto, de un total de 158. A las pacientes se les realizó evaluación del bienestar fetal y Doppler de la arteria uterina, umbilical y cerebral, diagnosticándose RCIU y alteraciones de Doppler materno y fetal, por la presencia de notch en la arteria uterina uni o bilateral y por la disminución de la relación entre los índices de resistencia de la arteria cerebral/arteria umbilical, que normalmente es mayor que 1. Un Doppler de arteria umbilical con ausencia de diástole y u trazo, con flujo en reversa fueron considerados signos ominosos para el feto. Se hizo estudios seriados para determinar la conducta obstétrica. Se hizo seguimiento de más pacientes hasta la interrupción del embarazo y posteriormente la evolución de los neonatos en la UCI recién nacidos para la determinación de la morbimortalidad neonatal CONCLUSIONES: La enfermedad hipertensiva del embarazo con retardo, de crecimiento intrauterino, es causa de morbimortalidad perinatal, cuando se asocia a velocimetría Dopple fetal anormal. La presencia de notch en la arteria uterina podría ser un elemento de diagnóstico para predecir toxemia y retardo de crecimiento intrauterino. La prueba de bien estar fetal modificado podrían implementarse para obtener mejores resultados perinatales.

Are uterine and ovarian artery Doppler velocimetry values good pregnancy predictors in clomiphene citrate cycles?

We conducted this prospective study to evaluate the prognostic significance of uterine and ovarian artery Doppler velocimetry in clomiphene citrate (CC) cycles. A total of 80 patients with unexplained infertility were given 100 mg/day of CC from day 3 to day 7 of their cycles in this current prospective study. On cycle day 3, before administration of CC, each patient underwent Doppler transvaginal ultrasonography. The Doppler velocimetries of the right and left uterine and ovarian arteries were recorded and analyzed in association with demographic and clinical parameters. TheThere were 6 out of 80 patients who became pregnant, the overall pregnancy rate in this population was 7.5% for the current study. The cases were divided into two groups according to whether they became pregnant or not. Demographic characteristics showed no statistically significant differences between these groups (p>0.05). However, the duration of infertility did show statistically significant differences between the groups. Doppler velocimetry was not statistically significantly different between the two groups. Doppler velocimetry of the uterine and ovarian arteries is not a factor in the prognosis for pregnancy in CC cycles.

First-trimester uterine artery Doppler analysis in the prediction of later pregnancy complications.

Uterine artery Doppler waveform analysis has been extensively studied in the second trimester of pregnancy as a predictive marker for the later development of preeclampsia and fetal growth restriction. The use of Doppler interrogation of this vessel in the first trimester has gained momentum in recent years. Various measurement techniques and impedance indices have been used to evaluate the relationship between uterine artery Doppler velocimetry and adverse pregnancy outcomes. Overall, first-trimester Doppler interrogation of the uterine artery performs better in the prediction of early-onset than late-onset preeclampsia. As an isolated marker of future disease, its sensitivity in predicting preeclampsia and fetal growth restriction in low risk pregnant women is moderate, at 40–70%. Multiparametric predictive models, combining first-trimester uterine artery pulsatility index with maternal characteristics and biochemical markers, can achieve a detection rate for early-onset preeclampsia of over 90%. The ideal combination of these tests and validation of them in various patient populations will be the focus of future research.

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Objectives To evaluate the effectiveness of early intervention with low dose aspirin (LDA) to prevent preeclampsia in the increasing resistance Index (RI) of the uterine artery Doppler velocimetry. Methods The study was done in Ob/Gyn dept. Dr. Soetomo Hospital Surabaya, Indonesia, involving all of pregnant women with 16–22 weeks of gestational age who lived to occupy as a common people in Mulyorejo sub district from January to December 2013. Sonography was performed for gestational age and uterine artery Doppler velocimetry, RI. The result were classified in to 4 classes, Normal (RI 0.38), Class I (RI ⩾ 0.58), Class II (Diastolic notch (+) with RI 0.58) and Class III (diastolic notch (+) with RI ⩾ 0.58). We gave LDA (81 mg) 1 tablet daily to the Class I, II and III and repeated the sonography after 4 weeks therapy. Results There were 147 pregnant women with 16–22 weeks of pregnancy from 345 pregnant women among 85,292 people who lived in Mulyorejo. The normal results of uterine artery RI were 107 pregnant women, class I, II and III were 15, 9 and 16 cases. From 40 abnormal value, twenty three were re-scanned again after 4 weeks. The results were 5 class I cases becoming normal category but 1 case with pragestational diabetes was increasing to class III. Four class II cases were becoming normal value and 1 still class II. From class III cases decreased to class II, I and normal were 3, 2 and 6 cases, but 1 case still class III. Conclusions LDA was effective to get improved clinical performance by decreasing uterine artery RI in high RI pregnant women at risk of preeclampsia. Disclosures A. Sulistyono Sr.: None. R. Rachmi: None. M.A. Akbar: None. B. Wicaksono: None. E. Ernawati: None. A. Aditiawarman Sr.: None. H.T. Joewono: None. E.G. Dachlan Sr.: None.

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Objectives The study is intended to analyze determining factors of successful conservative treatment of preeclampsia before 34 weeks of gestation. Methods This is a retrospective analytic observational study. Data were retrieved from medical records of patients admitted to Obstetric Ward of Dr Soetomo Hospital, from July to August 2013. The population of the study was patients with severe preeclampsia going through conservative treatment from January 2008 to December 2012. The inclusion criteria included population with complete medical record and without renal disease, SLE, premature rupture of membrane, and IUGR. The dependent variable in this study is the successful or unsuccessful conservative treatment for severe preeclampsia and the independent variables are gestational age, Esbach protein level, albumin serum level, uric acid level, blood pressure stage, Resistance Index and Pulsatility Index of uterine artery Doppler velocimetry, body mass index, parity, and maternal age. Double regression logistic analysis test was used with significant value if the p n = 15) and those with severe preeclampsia who failed conservative treatment ( n = 43, controls). Results Gestational age was significantly different ( p p = 0.003); the ROC curve obtained a cutoff point value of gestational age 31.5 weeks with sensitivity of 80% and specificity of 76.72%. Therefore, gestational age can be used as a determining factor for conservative treatment. Other determining factors were not significantly different ( p p = 0.226, uric acid p = 0.225, blood pressure p = 0.140, uterine artery PI p = 0.358, uterine artery RI p = 0.292, parity p = 0.133, serum albumin p = 0.943, serum creatinine p = 0.699, body mass index p = 0.962, and maternal age p = 0.589. Conclusions Gestational age is a determining factor for the success of conservative treatment of severe preeclampsia. Disclosures Y. Septivera: None. E. Ernawati: None. M.A. Akbar: None. A. Sulistyono: None. A. Aditiawarman: None. H.T. Joewono: None. E.G. Dachlan: None.

Abnormal uterine artery Doppler velocimetry predicts adverse outcomes in patients with abnormal analytes.

Our aim was to determine if uterine artery (UtA) Doppler studies would risk-stratify women with abnormal serum analytes on prenatal genetic screening into those at baseline and increased risk for preeclampsia and small-for-gestational age (SGA). This retrospective cohort study examined outcomes of patients with ⩾one abnormal analyte (PAPP-A<0.3, hCG>3.0, AFP>2.5, inhibin>2.0, or unconjugated estriol<0.3MoM). At approximately 24weeks, we assessed UtA pulsatility index (PI). Preeclampsia, preterm preeclampsia, SGA (birthweight (BW) <10%) and intrauterine growth restriction (IUGR) (BW<3%). We identified 132 patients with ⩾one abnormal analyte, UtA Doppler screening, and delivery outcomes. Twenty-four (18%) had an elevated UtA PI (PI>1.6); preeclampsia occurred in 16 (12%) and 26 (20%) delivered a SGA neonate. Abnormal UtA Doppler PI increased the likelihood of a composite outcome of preeclampsia or SGA from 27% to 71% (LR 6.48 (2.93, 14.30)); a negative UtA Doppler PI reduced the likelihood to 18% (LR 0.57 (0.42, 0.78)). Abnormal UtA Doppler PI increased the likelihood of a more severe composite outcome of preterm preeclampsia or IUGR from 11% to 39% (LR 5.49 (3.03, 9.97)); a negative UtA Doppler study reduced the likelihood to 4% (LR 0.35 (0.16, 0.80)). In patients with abnormal serum analytes, abnormal UtA Doppler PI is significantly associated with preeclampsia or SGA and improves the prediction of these adverse outcomes by 9-15-fold. Providers can incorporate UtA Doppler PI into an abbreviated surveillance regimen; they can be reassured that a normal study markedly decreases the risk of a severe early adverse outcome.

Prediction of preeclampsia and induced delivery at

BackgroundWomen with bilateral abnormal uterine artery Doppler velocimetry (UtADV) are at increased risk for an adverse pregnancy outcome. This study aimed to determine if additional assessment of midtrimester angiogenic factors improves the predictive accuracy of Doppler results for various outcome parameters.MethodsWomen with a bilateral abnormal UtADV, which was defined as a postsystolic incision and/or an increased pulsatility index greater than the 95th centile, and a singleton pregnancy were prospectively recruited between 19 + 0 and 26 + 6 weeks of gestation. Maternal serum levels of placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFLT-1) were measured with a fully automated immunoassay and their ratio was calculated.ResultsAngiogenic factors could predict the development of preeclampsia (PE), as well as induced delivery at <34 weeks of gestation, but failed to predict the development of normotensive intrauterine growth restriction. Twelve (24.0%) of the 50 recruited women developed PE. Nine of these patients had early-onset disease (<34 + 0 weeks). Six (12.0%) patients were delivered at <34 + 0 weeks. The most useful test results in the prediction of PE and induced delivery at <34 + 0 weeks were observed using the sFLT-1/PlGF >95th centile ratio with a sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of 66.7%, 89.5%, 66.7%, and 89.5% for PE, and 85.7%, 86.1%, 50.1%, and 97.4% for induced delivery, respectively. Positive and negative likelihood ratios were 6.33 (95% CI 2.31–17.38) and 0.37 (95% CI 0.17–0.84) for PE, and 6.14 (95% CI 2.76–13.69) and 0.17 (0.03–1.02) for induced delivery, respectively. Corresponding odds ratios were 17.0 (95% CI 3.5–83.0) and 37.0 (95% CI 3.8–363.9), respectively.ConclusionsMeasurement of angiogenic factors improves the specificity of an abnormal UtADV for prediction of PE. Compared with prediction of PE an abnormal sFLT-1/PlGF ratio revealed higher sensitivity for prediction of induced delivery at <34 + 0 weeks. The NPV of 97% will help to reassure most patients with an abnormal UtADV and a normal sFLT-1/PlGF ratio.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2393-14-292) contains supplementary material, which is available to authorized users.

Assessment of uterine, subendometrial blood flows and endometrial gland vascular endothelial growth factor (EG-VEGF) in women with unexplained infertility

Abstract Objective To asses uterine and subendometrial blood flows as well as the endometrial gland vascular endothelial growth factor (EG-VEGF) as markers of endometrial angiogenesis and receptivity in women with unexplained infertility. Methods The study included two groups of women: The Unexplained Infertility Group, included fifty women presented to the infertility outpatient clinic with unexplained primary infertility; and the Fertile Group, included fifty fertile parous women presented to the family planning clinic seeking contraception. On day 6 after detection of urinary LH surge, transvaginal ultrasound scan (TVS) was done for measuring endometrial thickness, uterine artery and subendometrial Doppler velocimetry indices. On the same day of TVS, endometrial samples were taken using office suction sampler for immunohistochemical detection of the anti-vascular endothelial growth factor antibody. Results Women of the Unexplained Infertility Group had lower VEGF score, thinner endometrial thickness, higher subendometrial flow resistance index (RI) and lower subendometrial flow pulsatility index (PI). Conclusion Subendometrial, but not the uterine, blood flow and the EG-VEGF score seem to be significantly lower during the mid-luteal phase in women with unexplained infertility. This may suggest significantly poorer angiogenesis during the assumed peri-implantation period.

Correlation between First and Second Trimester Uterine Artery Doppler Velocimetry and Placental Bed Histopathology.

Aim. To evaluate the relationship between uterine artery Doppler indices and placental bed histopathology independent of clinical outcome. Materials and Methods. Uterine artery measurements were performed to 510 pregnant women who had come for routine antenatal care in 11–14th and 20–24th weeks. Placental bed biopsies from 141 cases were taken during cesarean section. Physiological changes and abnormal placental histology findings were investigated and compared with Doppler findings. Results. 116 biopsies were accepted as adequate biopsy and included in the study. Physiological changes were seen in 100 biopsies. Statistically significant higher PI and RI values in second trimester and higher notch rate in both trimesters were detected in the abnormal placental histology group (P < 0,001). Conclusion. Strong relationship between uterine artery Doppler indices and preeclampsia or intrauterine growth retardation has been shown in previous studies. In our study, we concluded that there is significant relationship between Doppler findings and placental bed histopathology independent of clinical course.

Predictive markers of intrauterine growth restriction

Intrauterine growth restriction is one of the most common and complex problem of the modern obstetrics. Common diseases of the adult as well as obesity, non-insulin dependent diabetes mellitus and cardiovascular disease appear to be related to the abnormal growing in the intrauterine life, in particular with intrauterine growth restriction. This paper aims to review some ultrasound markers (uterine artery Doppler velocimetry) and biomarkers (leptin, adiponectin, endothelin-1, lactate dehydrogenase, s-endoglin, growth factors secreted by placenta: soluble fms-like tyrosine kinase receptor-1, Pregnancy-associated Plasma Protein A, metastin (kisspeptin-54), cited in the literature of the recent years, that can predict uteroplacental insufficiency preceding the fetal intrauterine growth restriction. As an immediate effect, intrauterine growth restriction is associated with perinatal morbidity and increased mortality. Detecting the markers with the highest degree of predictivity, the early identification of this intrauterine fetal vulnerability allows an optimal preventive healthcare actions. <br/><a href=

Longitudinal Changes in Uterine, Umbilical and Fetal MCA Doppler Indices in Late Onset Small Fetuses (Doppler in Small Fetuses)

Objectives: To determine the longitudinal trends and rates of conversion of normal to abnormal uterine (UtA), umbilical (UA) and middle cerebral artery (MCA) Doppler velocimetry throughout the third trimester in late-onset small-for-gestational-age (SGA) fetuses. Background: The finding of a small abdominal circumference should stimulate the sonographer to consider three possible: wrong date, normal small or abnormal small fetus. Methods: UtA, UA and MCA Doppler velocimetry was serially performed in a cohort of singleton consecutive late-onset SGA fetuses with normal Doppler values at diagnosis. The rate of conversion of normal to abnormal Doppler values was evaluated by survival analysis. Longitudinal trends were modeled by means of multilevel analysis. Results: A total number of study group included 150 SGA fetuses with normal Doppler upon diagnosis. Mean gestational age at inclusion and at delivery was 33.23 (SD 1.39) and 38.14 (SD 1.02) weeks, respectively. the longitudinal trends in UA PI and UtA PI showed no changes in contrast to MCA and CPR demonstrated a clear and progressive decrease in values from 7th week of follow up (37week of gestation) to delivery., mean MCA-PI 1.67 (SD 0.16) while mean CPR-PI 2.06 (SD 0.71) in all weeks of follow up for both. Conclusion: Late-onset SGA fetuses with normal Doppler velocimetry upon diagnosis show progression from 37 weeks’ gestation with worsening CPR followed by a decrease in MCA-PI.

The Utility of Uterine Artery Doppler Velocimetry in Prediction of Preeclampsia in a Low-Risk Population

Objective The underlying pathophysiology of preeclampsia is thought to be abnormal trophoblast invasion of the spiral arteries, leading to maldevelopment of uteroplacental perfusion. We estimated whether uterine artery Doppler measurements made in the early second trimester would predict the subsequent development of preeclampsia.