Early Diastolic Notch Research Articles

Serum fatty acid binding protein 4 and Doppler of uterine artery ultrasound in the first trimester for the prediction of preeclampsia.

The objective of this study was to determine the predictive value of serum fatty acid binding protein 4 (FABP4) combined with Doppler of the uterine artery in singleton pregnancy at gestational age (GA) 11-13+6 weeks for prediction of preeclampsia. A prospective observational study included singleton pregnant women at GA 11-13+6 weeks and was conducted at the Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, between December 2020 and April 2022. Serum FABP4 levels and Doppler of the uterine artery were performed. Pregnancy outcomes were recorded. The predictive values of these combined tests at the optimal cut-off values were determined to predict preeclampsia. A total of 330 participants with 15 cases of preeclampsia (4.5%) and 6 cases of them had preterm preeclampsia (GA < 37 weeks) (1.8%) were analyzed. Women with preeclampsia had significantly higher serum FABP4 levels than normal pregnant women (12.9 ± 6.5 ng/ml vs 10.1 ± 4.8 ng/ml, p = 0.034) but no difference in the mean pulsatility index (PI) of the uterine artery and the presence of an early diastolic notch. When using serum FABP4 levels greater than 1.0 multiple of the median of GA as a cut-off value to predict preeclampsia, combined with abnormal Doppler PI of the uterine artery, the sensitivity, specificity, positive predictive value, and negative predictive value were 73.3%, 47.3%, 6.2%, and 97.4%, respectively. This study demonstrated that serum FABP4 levels combined with Doppler of the uterine artery at GA 11-13+6 weeks were effective in predicting preeclampsia.

First trimester SHARP1 and second-trimester uterine artery Doppler to predict preeclampsia

Objectives The objective of this study was to identify the predictive value of the first-trimester serum SHARP1 level and the second-trimester uterine artery Doppler in singleton pregnancy for the prediction of preeclampsia. Methods A prospective study including singleton pregnancy presenting at an antenatal clinic, King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University from 2019–March 2020 was conducted. Serum SHARP1 was collected at the gestational age (GA) of 11–13+6 weeks, and transabdominal uterine artery Doppler ultrasound was performed at GA of 18–24 weeks. Serum SHARP1 level and uterine artery pulsatility index (PI) were combined to calculate the predictive value for preeclampsia detection. Results 288 pregnant women were enrolled in the first trimester, but only 249 participants completed the study. Thirteen patients had preeclampsia (5.2%), which three cases (1.2%) had early-onset preeclampsia. The median serum SHARP1 level in the first trimester of pregnant women with preeclampsia was lower than the normal pregnancy group (1392 pg/ml vs. 1941 pg/ml, p = 0.046). The second-trimester uterine artery PI and prevalence of early diastolic notching were higher in the preeclampsia group than in the normal pregnancy group (p = 0.029 and p = 0.001, respectively). When the first-trimester serum SHARP1 level is combined with the second-trimester uterine artery PI, the sensitivity, specificity, PPV, and NPV for preeclampsia prediction were 84.6%, 47.5%, 8.2%, and 98.3%, respectively. Conclusions This study demonstrated that serum SHARP1 level in the first trimester combined with the uterine artery PI in the second trimester had good sensitivity to predict preeclampsia.

Evaluation of second trimester uterine artery doppler indices in women diagnosed with COVID-19 during the first trimester of their pregnancy.

This study aimed at evaluating the hypothesis that 6-14 months pregnant women diagnosed with COVID-19 may have abnormal placental function detectable by increased uterine artery Doppler indices in the second trimester and whether these women could benefit from treatment.A total of 63 women were diagnosed with COVID-19 during the first trimester of their pregnancy and 68 healthy women were involved according to the exclusion criteria. In both groups, Doppler measurements were performed for the determination of high-risk pregnancy by increased uterine artery Doppler indices in the second trimester.It was observed that uterine artery Doppler indices (PI and RI) were significantly increased in second trimester women with COVID-19 infection compared to those without COVID-19. Furthermore, the number of women with a PI value exceeding the 95th percentile and the number of patients with early diastolic notch were higher in the COVID group compared to the control group.Doppler Ultrasound measurement may be a potential method for the management of high-risk pregnancies after asymptomatic/mild COVID-19 infection.

Progress Toward Reversed Uterine Diastolic Flow in the Third Trimester - An Inauspicious Sign.

Increased uteroplacental resistance is associated with high uterine artery pulsatility and resistance indices and early diastolic notching. Evolution toward reversed diastolic uterine flow in the third trimester was scarcely reported previously. The feature was related to severe complications for both mother and fetus. Data were collected from 3638 pregnancies undergoing prenatal care in our hospital. In this study, we aimed to identify those pregnancies with development of a reversed diastolic flow at the spectral Doppler interrogation of uterine arteries later than 24 weeks of gestation. A secondary aim was to follow up and actively manage these pregnancies. Previously, reversed uterine diastolic flow was reported during the third trimester in four cases only. In our study three pregnancies only developed reversed uterine arteries diastolic flow, none being associated with preeclampsia. All cases evolved with complications at birth. Progressive deterioration of uterine arteries flow is possible during pregnancy. Reversed diastolic flow is a rare occurrence in the third trimester of pregnancy. Based on current knowledge, it may be considered an ominous sign and should trigger a close follow-up. Future studies using routine investigation of uterine arteries flow late in pregnancy may prove informative.

Assessment of Obstetric Doppler Ultrasound in High-Risk Pregnancy and Its Perinatal Outcome

Background: Intrauterine growth restriction (IUGR) is associated with an increased risk of perinatal mortality &amp; morbidity. It accounts for a sizeable number of future unhealthy children, which is a significant burden to parents and society. IUGR can be minimized to some extent by timely &amp; accurate detection of IUGR. Aims and objectives: To evaluate various waveforms of the umbilical artery, middle cerebral artery, ductus venosus, and cerebroplacental ratio as a predictor of adverse pregnancy outcomes in high-risk pregnancies. Materials and Methods: Eightywomen with a gestational age of 24 to 36 weeks were studied in the department of Radiodiagnosis of SAMC &amp; PGI, Indore, Madhya Pradesh, from April 2021 to September 2022. Subjects were divided into non-complicated pregnancy [Appropriate for gestational age (AGA); n=40) and high-risk pregnancy [Small for gestational age (SGA); n=40; ≥18 years of age, with or without risk factors]. All underwent Doppler interrogation of the uterine arteries, umbilical artery, middle cerebral artery, and ductus venosus between 24-36 weeks of gestation. Results: Elevated head circumference (HC)/ abdominal circumference (AC) ratio, elevated femur length (FL)/AC ratio, presence of oligohydramnios without ruptured membrane, and advanced placental grade was more frequently observed among SGA babies. In this series, among the various risk factors, hypertension was a significant risk factor for IUGR, which other workers also accepted. Pulsatility index (PI), resistive index (RI) and systolic/diastolic (SD) ratio of uterine &amp; umbilical arteries was significantly raised in SGA babies compared to AGA babies. In contrast, middle cerebral artery (MCA)'s PI, RI, and SD ratios were significantly lower in SGA babies than in AGA babies. Uterine artery early Diastolic Notch was seen in 11 cases &amp; all of them delivered SGA babies. Hypertension was present in 8 of these 11 cases. Absent Diastolic Flow was detected in only one case, and the foetus ......

Contribution of Second Trimester Sonographic Placental Morphology to Uterine Artery Doppler in the Prediction of Placenta-Mediated Pregnancy Complications.

Second-trimester uterine artery Doppler is a well-established tool for the prediction of preeclampsia and fetal growth restriction. At delivery, placentas from affected pregnancies may have gross pathologic findings. Some of these features are detectable by ultrasound, but the relative importance of placental morphologic assessment and uterine artery Doppler in mid-pregnancy is presently unclear. To characterize the association of second-trimester sonographic placental morphology markers with placenta-mediated complications and determine whether these markers are predictive of placental dysfunction independent of uterine artery Doppler. This was a retrospective cohort study of patients with a singleton pregnancy at high risk of placental complications who underwent a sonographic placental study at mid-gestation (160/7-246/7 weeks' gestation) in a single tertiary referral center between 2016-2019. The sonographic placental study included assessment of placental dimensions (length, width, and thickness), placental texture appearance, umbilical cord anatomy, and uterine artery Doppler (mean pulsatility index and early diastolic notching). Placental area and volume were calculated based on placental length, width, and thickness. Continuous placental markers were converted to multiples on medians (MoM). The primary outcome was a composite of early-onset preeclampsia and birthweight &lt; 3rd centile. A total of 429 eligible patients were identified during the study period, of whom 45 (10.5%) experienced the primary outcome. The rate of the primary outcome increased progressively with decreasing placental length, width, and area, and increased progressively with increasing mean uterine artery pulsatility index (PI). By contrast, placental thickness followed a U-shaped relationship with the primary outcome. Placental length, width, and area, mean uterine artery PI and bilateral uterine artery notching were all associated with the primary outcome. However, in the adjusted analysis, the association persisted only for placenta area (adjusted odds ratio [aOR] 0.21, 95%-confidence interval [CI] 0.06-0.73) and mean uterine artery PI (aOR 11.71, 95%-CI 3.84-35.72). The area under the ROC curve was highest for mean uterine artery PI (0.80, 95%-CI 0.71-0.89) and was significantly higher than that of placental area (0.67, 95%-CI 0.57-0.76, p = 0.44). A model that included both mean uterine artery PI and placental area did not significantly increase the area under the curve (0.82, 95%-CI 0.74-0.90, p = 0.255), and was associated with a relatively minor increase in specificity for the primary outcome compared with mean uterine artery PI alone (63% [95%-CI 58-68%] vs. 52% [95%-CI 47-57%]). Placental area is independently associated with the risk of placenta-mediated complications yet, when combined with uterine artery Doppler, did not further improve the prediction of such complications compared with uterine artery Doppler alone.

Second-trimester serum high mobility group box-1 and uterine artery Doppler to predict preeclampsia

The objective of this study was to identify the predictive value for preeclampsia of second-trimester serum high mobility group box-1 (HMGB1) and uterine artery Doppler in singleton pregnancies. Between April 2020 and April 2021, a prospective study was conducted on singleton pregnancies with a gestational age of 16–20+6 weeks at King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Maternal characteristics, uterine artery Doppler, and serum HMGB1 were collected. Serum HMGB1 levels and mean uterine artery pulsatility index (UAPI) were combined to calculate the predictive value for preeclampsia. A total of 393 pregnant women were analyzed, with 25 cases (6.4%) developing preeclampsia and 5 cases (1.3%) developing early-onset preeclampsia. Baseline characteristics of preeclampsia and normal pregnant women were comparable. Preeclamptic pregnant women had significantly higher mean serum HMGB1 levels than normal pregnant women (1112.8 ± 363.1 ng/mL vs 910.8 ± 486.1 ng/mL, p = 0.013). There was no difference in the mean UAPI. Any early-diastolic notching was found more frequently in the preeclampsia group (32.0% vs 12.5%, p = 0.013). The cut-off value for serum HMGB1 levels above 1.04 MoM as abnormal value to predict preeclampsia had sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 88.0%, 53.5%, 11.4% and 98.5%, respectively. When using abnormal serum HMGB1 levels combined with mean UAPI above 95th percentile, the sensitivity, specificity, PPV and NPV to predict preeclampsia were 88.0%, 50.8%, 10.8% and 98.4%, respectively. This study showed that serum HMGB1 at 16–20+6 weeks of gestation were effective in predicting preeclampsia. The addition of UAPI did not improve the prediction performance.

Uterine Myomas and Sarcomas - Clinical and Ultrasound Characteristics and Differential Diagnosis Using Pulsed and Color Doppler Techniques.

Uterine tumors are a challenge encountered by every gynecologist in clinical practice. In the era of increasing incidence of endometrial cancer in the general population of women at reproductive age, compared to other genital malignancies, we should not forget about other tumors originating from the mucous and muscular layer of the uterus. Clear ultrasonographic differentiation of uterine tumors into benign (myomas) and malignant (sarcomas) lesions may sometimes prove impossible. Myomas, the most common uterine tumors, are characterized by discrete vascularization on color Doppler and high blood flow velocity as well as the lack of early diastolic notch on Doppler ultrasound. Sarcomas, on the other hand, show characteristic rich vascularization. Rapid tumor growth should also be noted when making the diagnosis. There are multiple known causes of uterine tumors. So far, no clear Doppler flow markers have been identified to characterize benign and malignant lesions.

Utilization of Uterine and Umbilical Artery Doppler in the Second and Third Trimesters to Predict Adverse Pregnancy Outcomes: A Nigerian Experience.

Objective: To assess the utility of uterine and umbilical artery Doppler in the second and third-trimester in predicting adverse pregnancy outcomes.Methodology: In a prospective longitudinal study, the demographic, clinical, Doppler ultrasound parameters of the uterine and umbilical arteries of 84 consecutive women attending the antenatal clinic at 22–24 weeks and 116 women at 30–34 weeks gestation and pregnancy outcomes were documented and analyzed.Results: Pregnant women with adverse pregnancy outcomes had significantly higher second-trimester mean uterine systolic/diastolic (S/D) ratio (p = 0.001), pulsatility index (PI; p = 0.003), umbilical artery S/D (p = 0.016), and resistivity index (RI; p = 0.041) as well as higher third-trimester uterine S/D and PI. While pregnancies with adverse fetal outcomes showed significantly higher uterine artery S/D and PI at the second trimester, third-trimester uterine showed higher S/D, RI, and PI and umbilical artery PI than in women with normal fetal outcomes. The combination of uterine PI and early diastolic notch were predictors of maternal outcomes and correctly predicted 73% (p < 0.001) in the second trimester. By the third trimester, the uterine PI alone was the best predictor and accurately predicted about 62% of maternal outcomes (p = 0.028). In addition, the second-trimester uterine S/D and early diastolic notch and uterine PI in the third trimester correctly predicted 79% and 78% of fetal outcomes, respectively.Conclusion: Among unselected pregnant women population, the second-trimester Doppler parameters are better predictors of maternal adverse pregnancy outcomes, while adverse fetal outcome prediction by uterine and umbilical Doppler at the second- and the third-trimester parameters are comparable.

Loss of E-Cadherin Staining Continuity in the Trophoblastic Basal Membrane Correlates with Increased Resistance in Uterine Arteries and Proteinuria in Patients with Pregnancy-Induced Hypertension.

Pregnancy-induced hypertension (PIH), especially when complicated with pre-eclampsia (PE), could be a life-threatening complication of pregnancy. Pre-eclampsia is one of the leading causes of perinatal morbidity and mortality in women. Pre-eclampsia is mainly characterized by hypertension and kidney damage with proteinuria. Abnormal placentation and altered structure of the placental barrier are believed to participate in the pathogenesis of pregnancy-induced hypertension, leading to PE. In the current study, we aimed to analyze the immunohistochemical expression pattern of E-cadherin and p120, two markers of epithelial–mesenchymal transition, in placental samples derived from a group of 55 patients with pregnancy-induced hypertension, including pre-eclampsia and 37 healthy pregnant controls. The results were correlated with the presence of an obtained early uterine artery flow notching during diastole on Doppler ultrasound. We observed a higher frequency of discontinuous E-cadherin staining in the basement membrane of syncytiotrophoblast in patients with PIH/PE compared to controls (p < 0.001, Fisher’s exact test). Moreover, the loss of continuity of E-cadherin expression correlated with the presence of a bilateral early diastolic notch on Doppler ultrasound (p < 0.001, Fisher’s exact test) and the presence of proteinuria (p = 0.013, Fisher’s exact test). These findings suggest that E-cadherin contributes to the integrity of the placental barrier, and its loss could be an immunohistochemical marker of PE.

Utility of uterine artery doppler indices for prediction of preeclampsia: A narrative review with systematic analysis

Background: Hypertensive disorders complicating pregnancy are common. Preeclampsia and eclampsia are major causes of maternal morbidity and mortality, particularly in developing countries. With prompt recognition of symptoms and early diagnosis of preeclampsia can lead to improved maternal and neonatal outcomes. Although, numerous tests have been proposed for the prediction of preeclampsia, their results have been inconsistent. So, we focused our research to study the uterine artery doppler for predicting preeclampsia in high-risk women. Methodology: We conducted a search on Google Scholar and PubMed based on Medical Subject Heading terms preeclampsia and uterine artery Doppler ultrasound. The articles between 2016 and 2020 which were in English were taken into consideration. We performed a qualitative interpretation as an approach for extracting the data. Results: Majority of the studies showed raised pulsatility index as a good predictor of preeclampsia, although it was closely followed by uterine artery notching which is in the early diastolic period. Conclusion: The findings of our research suggest that uterine artery Doppler indices and early diastolic notch can be used as a tool for the prediction of preeclampsia with high confidence.

Ovarian and uterine two-dimensional and Doppler ultrasonographic changes in the feline peri-estrus period.

The aim of this study was to evaluate two-dimensional and Doppler ultrasonographic changes of the ovary and uterus during estrus and the early post-estrus period in domestic cats. Two-dimensional and Doppler ultrasonographic evaluations of the ovaries and uterus were performed in seven queens on days 1, 3 and 5 of estrus, and 5 days after estrus (AE5). On day 1, 5.4 ± 0.5 follicles of 2.1 ± 0.1 mm were detected progressively increasing in number and size up to day 5 and then decreased on AE5 (P <0.05). A maximum follicular diameter of 4.1 ± 0.1 mm was achieved on day 5. Both during and after estrus, the uterus was generally hypoechoic compared with the surrounding tissues and delineated by a thin hyperechoic line corresponding to the serosa. In some animals, the uterine layers were distinguished during and after estrus. The blood flow waveforms of the intraovarian and uterine arteries were characterized by a systolic peak and diastolic flow extending throughout the remainder of the cardiac cycle to the next systole. In the uterine artery waveforms, the early diastolic notch was mild or absent during most estrous observations. The resistance index of the intraovarian arteries decreased up to day 5, and then increased on AE5 (P <0.05). The resistance index of the uterine arteries was lower during estrus than in the post-estrus period (P <0.05). It is concluded that in the domestic cat, follicular number and diameter as well as ovarian and uterine blood flow changed during and immediately after estrus. Doppler ultrasound proved suitable to evaluate the hemodynamic changes involved in the cyclic remodeling of ovarian and uterine tissues that occurs during and after follicular growth in domestic cats.

Role of Doppler Waveforms in Pregnancy-Induced Hypertension and Its Correlation With Perinatal Outcome.

ObjectivesThe present study aims to measure the role of Doppler waveforms in pregnancy-induced hypertension (PIH) and its relationship with the perinatal outcome.MethodsWe have studied 50 pregnant women with PIH with gestational age (GA) 30-40 weeks for Umbilical Artery (UmA), Middle Cerebral Artery (MCA) and Uterine Artery (UtA) Doppler waveforms. Comparison between the various Doppler indices, i.e., Pulsatility Index (PI), Resistive Index (RI) and S/D ratio, with the severity of the disease and the perinatal outcomes were evaluated using appropriate statistical tests considering a threshold value of p-value <0.05 as significant. The Statistical Package for the Social Sciences (SPSS) version-16 (SPSS Inc, Chicago, USA) and MedCalc software (MedCalc Software Ltd, Ostend, Belgium) were used for data analysis.ResultsHalf (50%) of the cases attributed to the 26 to 30 years age group were at 38 to 40 weeks of gestation. Out of the 50 patients, 68% were primigravida, and 74% had severe PIH. Mean UmA PI, mean MCA PI, mean MCA RI, and mean Cerebro Placental Ratio (CPR) were differed significantly among mild and severe PIH patients (p-value<0.05). Perinatal outcomes in 33 (66%) cases were adverse. The abnormal UmA RI, MCA RI, MCA PI, MCA S/D were significantly linked with poor pregnancy outcomes (p-value <0.05). PIH cases with the presence of early diastolic notch of UtA (p-value <0.01), abnormal PI CPR (p-value <0.001) and S/D CPR (p-value <0.003) were observed to have more adverse outcomes. PI CPR had the highest sensitivity (84.8%), and the existence of early diastolic notch of UtA and MCA-PI were most specific in diagnosing adverse perinatal outcomes.ConclusionCPR-PI is a valuable indicator of adverse perinatal outcomes in PIH. Doppler studies of multiple vessels may help manage high-risk pregnancies as it may provide helpful information about the fetus at risk of hypoxia and placental insufficiency.

Association of second trimester uterine artery Doppler parameters with maternal hypertension 2–7 years after delivery

BackgroundReduced uterine artery compliance is associated with adverse pregnancy outcomes (APOs) and may indicate underlying maternal cardiovascular pathology. We investigated associations between second trimester uterine artery Doppler (UAD) parameters and incident maternal hypertension 2–7 years after delivery. MethodsA cohort of 10,038 nulliparous US participants was recruited early in pregnancy. A subgroup of 3739, without baseline hypertension and with complete follow-up visits 2–7 years after delivery, were included in this analysis. We investigated UAD indicators of compliance including: 1) early diastolic notch; 2) resistance index (RI); and 3) pulsatility index (PI). We defined hypertension as systolic blood pressure ≥130 mmHg, diastolic ≥80 mmHg, or antihypertensive medication use. We calculated odds ratios (OR) and 95 % confidence intervals (95%CI) for associations between UAD parameters and hypertension, adjusting for age, obesity, race/ethnicity, insurance, smoking, and APOs. ResultsA total of 187 (5 %) participants developed hypertension after the index pregnancy. Presence of early diastolic notch on UAD was not associated with incident hypertension. Increased RI and PI correlated with higher odds of hypertension (RI: adjusted OR 1.15 [95 % CI 1.03–1.30]; PI: adjusted OR 1.03 [95%CI 1.01–1.05] for each 0.1 unit increase). Maximum RI above 0.84 or maximum PI above 2.3 more than doubled the odds of incident hypertension (RI: adjusted OR 2.49, 95%CI 1.45–4.26; PI: adjusted OR 2.36, 95%CI 1.45–3.86). ConclusionHigher resistance and pulsatility indices measured on second trimester UAD were associated with increased odds of incident hypertension 2–7 years later, and may be biomarkers of higher maternal cardiovascular risk.

Abnormal placental perfusion and the risk of stillbirth: a hospital-based retrospective cohort study

BackgroundA lack of information on specific and interventional factors for stillbirth has made designing preventive strategies difficult, and the stillbirth rate has declined more slowly than the neonatal death rate. We compared the prevalence of stillbirth among the offspring of women with or without abnormal placental perfusion (APP).MethodsWe conducted a hospital-based retrospective cohort study involving women with a singleton pregnancy between 2012 and 2016 (N = 41,632). Multivariate analysis was performed to compare the prevalence of stillbirth in infants exposed to APP (defined as any abnormality in right or left uterine artery pulsatility index or resistance index [UtA-PI, −RI] [e.g., > 95th percentile] or presence of early diastolic notching) with that in those not exposed to APP.ResultsStillbirths were more common among women with APP than among those with normal placental perfusion (stillbirth rate, 4.3 ‰ vs 0.9 ‰; odds ratio (OR), 4.2; 95% confidence interval (CI), 2.2 to 8.0). The association strengths were consistent across groups of infants exposed to APP that separately defined by abnormality in right or left UtA-PI or -RI (OR ranged from 3.2 to 5.3; all P ≤ 0.008). The associations were slightly stronger for the unexplained stillbirths. Most of the unexplained stillbirth risk was attributed to APP (59.0%), while a foetal sex disparity existed (94.5% for males and 58.0% for females). Women with normal placental perfusion and a male foetus had higher credibility (e.g., higher specificities) in excluding stillbirths than those with APP and a female foetus at any given false negative rate from 1 to 10% (93.4% ~ 94.1% vs. 12.3% ~ 14.0%).ConclusionsAPP is associated with and accounts for most of the unexplained stillbirth risk. Different mechanisms exist between the sexes. The performance of screening for stillbirth may be improved by stratification according to sex and placental perfusion.

633 Association of second-trimester uterine artery doppler abnormalities with maternal hypertension 2-7 years after delivery

Adverse pregnancy outcomes (APO) are associated with future maternal cardiovascular disease. Uterine artery Doppler (UAD) has been used to try to predict APO, and could indicate a greater chance of future maternal cardiovascular risk. We investigated associations between 2nd-trimester UAD parameters with development of new maternal hypertension (HTN) 2-7 years after delivery. The Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be Heart Health Study (nuMoM2b-HHS) is a long-running, prospective cohort study that has followed a diverse cohort of 4475 US women since early in their 1st pregnancies. We calculated odds ratios and 95% confidence intervals for associations between abnormal UAD parameters and incident HTN. Women who had baseline chronic HTN, who did not undergo UAD in the index pregnancy, or who were missing data regarding HTN at follow up were excluded. We defined abnormal UAD as any of the following: presence of early diastolic notch, elevated resistance index (RI), or elevated pulsatility index (PI). We defined HTN as systolic blood pressure ≥130 mmHg, diastolic blood pressure ≥80 mmHg, or self-reported use of an anti-HTN medication at the nuMoM2b-HHS study visit. Models were adjusted for age, BMI, self-reported race/ethnicity, insurance status, smoking, and APO. We tested for interactions between abnormal UAD and APO. A total of 3737 women were included in the analysis, of whom 187 (5%) developed HTN after the index pregnancy (Table 1). The abnormal UAD composite exposure was not associated with incident HTN. However, higher maximum RI and PI were each significantly associated with higher odds of incident HTN (Table 2). APO during the index pregnancy did not significantly modify this association. In this prospective cohort of women followed from early pregnancy, having either a higher RI or PI in the early 2nd trimester was associated with higher odds of developing HTN years after delivery. These UAD abnormalities may be early biomarkers of underlying maternal vascular dysfunction.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Role of Uterine Artery Doppler to Predict Pregnancy Induced Hypertension and Intrauterine Growth Restriction

Introduction: Early screening for preeclampsia and IUGR using Doppler ultrasound may allow vigilant antenatal surveillance, early diagnosis, proper treatment, and appropriate timing of fetal delivery in order to avoid serious sequelae. The present study was to evaluate the predictive value, sensitivity, and specificity of uterine artery Doppler at18-20 weeks of gestation with regards to the development of preeclampsia using pulsatility index as a parameter.&#x0D; Methods: A total of 100 females between 18-20 wks of gestation were included in the present Prospective observational study was carried out in Obstetrics and Gynecology department at tertiary care hospital from June 2010 to June 2012.&#x0D; Results: In the low-risk group, an early diastolic notch was present in 5(10%) females, out of these 3(60%) developed PIH, and 4(80%) developed IUGR. The pulsatility index was abnormal in 8(16%) women. Out of these 5(62.5%) developed PIH and 3(37.5%) developed IUGR. In the high-risk group, an early diastolic notch was present in 8(16%) females, out of these 7(87.5%) developed PIH, and 6(75%) developed IUGR. The pulsatility index was abnormal in 9(18%) women, where 6(66.6%) developed PIH and 8(88.88%) developed IUGR.&#x0D; Conclusion: Abnormal uterine artery Doppler at 24 weeks of gestation was a statistically significant predictor of PIH in both low-risk and high-risk groups.&#x0D; Key Words: Doppler, Pre-eclampsia, Pulsatility index, IUGR

DOPPLER STUDY OF THE UTERINE AND UMBILICALARTERY TO PREDICT INTRAUTERINE GROWTH RETARDATION

The primary objective of this study is to transvalue the role of colour doppler sonography in the evaluation of pregnancy with intrauterine growth restriction. The study included 50 antenatal women with singleton pregnancy diagnosed as having a fetus with intrauterine growth restriction based on greyscale ultrasound findings. Further, an obstetric Doppler Ultrasound was done, and diagnostic statistics were applied to determine the Umbilical artery PI, RI, and Uterine artery PI, RI and correlating with perinatal outcomes. The specificity, sensitivity, positive predictive value, negative predictive value, and diagnostic accuracy were determined for all Doppler measurements. Among women with an identifiable cause, 42% had pregnancy-induced hypertension (PIH), 40% had moderate to severe anaemia complicating pregnancy. At the same time, 20% of the study group had no detectable cause for IUGR. The persistence of early diastolic notch beyond 26 weeks showed 60% sensitivity as a predictor for the perinatal outcome. The sensitivity of RI, PI of the uterine artery in predicting perinatal outcomes was 73 % and 76.7 %, respectively. Whereas, the sensitivity of RI, PI of the Umbilical artery in predicting perinatal outcomes was 63% and 70%, respectively. Doppler imaging provides indirect evidence of fetal compromise and is known to improve outcomes of high-risk pregnancies with intrauterine growth restriction. Hence, it is of eminent value for monitoring during the pregnancy.

Prediction of Preeclampsia in Pregnant Population Using Diastolic Notch of Uterine Artery by Duplex Color Doppler Study

Background: Use of Duplex Color Doppler Sonography is gaining increasing popularity for assessment of blood vessels in various disease processes around the world. The past 20 years have seen an enormous growth in both technical aspects of Doppler ultrasound and its application in obstetric and fetal medicine.&#x0D; Objective: This cross-sectional study was carried out to observe Doppler wave form in subjects with preeclampsia. Specific objective was to see RI and PI in different groups of study subjects from 24th to 37th weeks and find out significant difference of different Doppler indices between two groups (i.e., to calculate the proportion of subjects having early diastolic notch in two groups).&#x0D; Materials and Methods: Enrolling 40 subjects with preeclampsia, this study was done in the Department of Radiology &amp; Imaging, Dhaka Medical College Hospital, Dhaka, over a period of six months from 20th June 2014 to 19th December 2014. A total number of 40 normal pregnancies were also included for comparison.&#x0D; Results: Majority (35% in normal and 37.5% in preeclampsia) of the respondents were found in the age group of 21−30 years. Unpaired t-test revealed no significant difference between mean age of two groups. Among normal group, mean±SD of PI and RI were 1.12±0.0846 and 0.571±0.058 respectively and in preeclamptic group mean PI and RI were 2.497±0.369 and 0.8255±0.087. There was statistically significant (by unpaired t-test) difference in mean Doppler indices between these two groups. Early diastolic notch was found in 90% subjects with preeclampsia and 5% subjects with normal pregnancy. Chi-square test showed that there was statistically significant difference regarding presence of early diastolic notch between normal regarding subjects and subjects with preeclampsia.&#x0D; Conclusion: From the study result it was concluded that Doppler indices with presence of early diastolic notch are reliable indicators for early detection of preeclampsia.&#x0D; J Enam Med Col 2020; 10(1): 33-38

The Transverse versus the Sagittal Approach in First-Trimester Uterine Artery Doppler Measurement.

ObjectiveThe uterine artery pulsatility index (UtA-PI) is an important marker for predicting and assessing the risk of various complications such as pre-eclampsia and fetal growth restriction. The measurement of UtA-PI in the first trimester is usually conducted via the sagittal approach. The aim of this study was to evaluate UtA Doppler measurement using the transverse approach in the first trimester.MethodsThis was a prospective observational study of 50 women with singleton pregnancy at between 11-13+6 weeks of gestation. Uterine artery (UtA) Doppler variables were measured using both the transverse and sagittal approach. The two approaches were compared in terms of time required to complete the measurements and early diastolic notch. The sample t-test and Wilcoxon rank sign test were used to analyze the outcomes when appropriate. Bland–Altman plots were used to determine the agreement between the two approaches. A P-value <0.05 was considered statistically significant. Intra-class correlation (ICC) was used to evaluate the reliability of measurements.ResultsThere were a total of 50 pregnant women who participated in the study and completed the study protocol. The mean age of all subjects was 29.6 years, and 24 (48%) were nulliparous. We observed no difference in terms of mean UtA-PI between the two approaches (sagittal: 2.04, transverse: 2.03; mean difference 0.01, CI −0.01, 0.04; p>0.309), nor in the means of any other UtA variables. However, there were differences between the two approaches in terms of early diastolic notch (sagittal: 11, transverse: 13; p>0.999) and the mean time required to complete the measurements (transverse: 21.7 s, sagittal: 24.3 s; p=0.001). The intra-class correlation coefficients (ICCs) were 0.985, 0.963, and 0.988 for the right, left, and mean UtA-PIs respectively.ConclusionThe transverse approach at a bladder depth of less than 5 cm performed better than the sagittal approach in the measurement of first-trimester uterine arteries. It may, thus, may be useful as a complementary approach in cases in which there is difficulty obtaining measurements using the sagittal approach.