Higher Uterine Artery Pulsatility Index Research Articles

Bridging the notch: quantification of the end diastolic notch to better predict fetal growth restriction.

We aimed to evaluate several quantitative methods to describe the diastolic notch (DN) and compare their performance in the prediction of fetal growth restriction. Patients who underwent a placental scan at 16-26 weeks of gestation and delivered between Jan 2016 and Dec 2020 were included. The uterine artery pulsatility index was measured for all of the patients. In patients with a DN, it was quantified using the notch index and notch depth index. Odds ratios for small for gestational age neonates (defined as birth weight <10th and <5th percentile) were calculated. Predictive values of uterine artery pulsatility, notch, and notch depth index for fetal growth restriction were calculated. Overall, 514 patients were included, with 69 (13.4%) of them delivering a small for gestational age neonate (birth weight<10th percentile). Of these, 20 (20.9%) had a mean uterine artery pulsatility index >95th percentile, 13 (18.8%) had a unilateral notch, and 11 (15.9%) had a bilateral notch. 16 patients (23.2%) had both a high uterine artery pulsatility index (>95th percentile) and a diastolic notch. Comparison of the performance between uterine artery pulsatility, notch, and notch depth index using receiver operating characteristic curves to predict fetal growth restriction <10th percentile found area under the curve values of 0.659, 0.679, and 0.704, respectively, with overlapping confidence intervals. Quantifying the diastolic notch at 16-26 weeks of gestation did not provide any added benefit in terms of prediction of neonatal birth weight below the 10th or 5th percentile for gestational age, compared with uterine artery pulsatility index.

Relationship between maternal obesity and first-trimester TSH in women with negative anti-TPO antibodies.

Obesity is associated with increased thyroid-stimulating hormone (TSH) in non-pregnant subjects, but this phenomenon has not been fully characterized during pregnancy. Our aim was to evaluate the impact of BMI on first-trimester TSH in a wide cohort of pregnant women with negative anti-thyroperoxidase antibodies (AbTPO) and its implications on uterine artery pulsatility index (UtA-PI), a marker of early placentation. The study included 2268 AbTPO-negative pregnant women at their first antenatal visit. Anamnestic data, BMI, TSH, anti-nuclear antibody (ANA) and extractable nuclear antigen (ENA) positivity and mean UtA-PI were collected. A total of 1693 women had normal weight, 435 were overweight and 140 were obese. Maternal age, ANA/ENA positivity, history of autoimmune diseases and familiar history of thyroid diseases were similar in the three groups. TSH was significantly higher in obese women (1.8 (IQR: 1.4-2.4) mU/L) when compared to normal weight (1.6 (IQR: 1.2-2.2) mU/L) and overweight (median: 1.6 (IQR: 1.2-2.2) mU/L) ones (P < 0.001). BMI was significantly related with the risk of having a TSH level ≥4 mU/L at logistic regression, independently from non-thyroid autoimmunity, smoking or familiar predisposition for thyroid diseases (OR: 1.125, 95% CI: 1.080-1.172, P < 0.001). A restricted cubic splines regression showed a non-linear relationship between BMI and TSH. Women with a TSH ≥4 mU/L had a higher UtA-PI, independently from BMI. Overweight/obesity is significantly related with TSH serum levels in AbTPO-negative pregnant women, independently from the other risk factors for hypothyroidism during pregnancy. The increase of TSH levels could be clinically relevant, as suggested by its association with abnormal UtA-PI, a surrogate marker of abnormal placentation.

Association between abnormal uterine artery pulsatility index and the risk of fetal congenital heart defects: a hospital-based cohort study

To explore the associations between high uterine artery pulsatility index (UtA-PI) values and congenital heart disease (CHD) risk and whether they differed between singleton and multiple pregnancies. This hospital-based cohort study involving 52,047 pregnant women who underwent prenatal examinations from 2012 to 2016. Infants born to the included pregnant women were followed until 42 days after birth to identify those with CHDs. Generalized estimating equations were used to estimate the associations of high right UtA-PI (> 95th percentile) values with maternal preeclampsia and fetal CHDs. Logistic regression analyses were conducted using path analysis models to quantify the effect of high right UtA-PI values on fetal CHD risk. A total of 42,552 women and 43,470 infants (147 with CHDs) were included. Preeclampsia risk was associated with a high right UtA-PI in singleton-pregnant women (adjusted PR, 3.01; 95% CI 2.57–3.52). CHD risk was marginally associated with a high right UtA-PI in singleton-pregnant women (adjusted PR, 2.26, 95% CI 1.03–4.95). Considering only two factors, 96.0% of the fetal CHD risk was mediated by preeclampsia in singleton-pregnant women, while 93.8% of the risk was related to a high right UtA-PI in multiple-pregnant women. A high right UtA-PI was marginally associated with an increased fetal CHD risk in singleton-pregnant women and might play an important role in multiple-pregnant women. Further studies are warranted to confirm these findings given the high loss to follow-up rate.

Gebeliğin birinci trimesterinde sistemik inflamatuar belirteçler ile yüksek uterin arter pulsatilite indeksi ilişkisi

Introduction: Preeclampsia is a serious complication of pregnancy leading to maternal and perinatal morbidity and mortality. The etiopathogenesis still remains unsolved, however, various theories currently become well-proved. The leading etiopathogenetic mechanisms are impaired placentation, and placental hypoxia, immune mechanisms, systemic inflammatory reaction, endothelial damage and maternal cardiovascular maladaptation. These mechanisms overlap and induce each other. There are some preventive interventions only if the patients at high-risk are identified timely. This study aimed to investigate the relationship between the inflammatory pathway and placental insufficiency in the first trimester, utilizing the clinical markers of both. It also aims to find out a cheap and easy test to identify those who absolutely need to undergo a comprehensive risk assessment. Methods: This retrospective observational study included 28 patients with high uterine artery resistance (pulsatility index &amp;gt;90th centile) in the first trimester as study group and 67 patients with normal uterine artery resistance in the first trimester as control group. The two groups were compared in terms of risk factors for preeclampsia. Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio as systemic inflammatory markers were compared between the groups. ROC analysis was performed to obtain a cut-off value for predicting high uterine artery pulsatility index. Results: Demographic data, anamnestic and examination risk factors for preeclampsia did not differ between the groups. However, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio were significantly higher in the patients with uterine artery pulsatility index above 90th centile. A cut off value of 3.58 and 136.9 of Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio, respectively were determined for predicting first trimester uterine artery pulsatility index above 90th centile. Conclusions: Neutrophil/lymphocyte and platelet/lymphocyte ratio can simply be used to identify the patients who need referral for uterine artery doppler assessment. Keywords: preeclampsia, uterine artery, pulsatil flow, neutrophil, lymphocyte, placenta

Uterine Artery Doppler Pulsatility Index in the First Trimester as a Forecaster of Pre-Eclampsia in Primary Gravida

Objective: To uncover a correlation between a high uterine artery pulsatility index on Doppler ultrasound and the early onset of pre-eclampsia to reduce maternal and fetal morbidity and mortality.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Department of Gynecology and Obstetrics, Combined Military Hospital, Multan Pakistan, from Jun 2020 to Dec 2021.&#x0D; Methodology: After Ethical Approval and informed consent, the umbilical artery pulsatility (UAPI) of the patients was measured by a transabdominal scan(TAS) between 75 and 100 days. Raised UAPI was correlated with early onset preeclampsia.&#x0D; Results: One hundred and sixty pregnant women were included in the study, out of which 34(21.3%) women developed preeclampsia, and 126(78.8%) were normal patients. Maternal weight (p=0.001), maternal BMI (p=0.002), gestational age and weight at delivery (p=0.001), and uterine artery doppler pulsatility index (p=0.001) had statistically significant differences with pre-eclampsia and regular patients among the target population.&#x0D; Conclusion: First-trimester uterine artery pulsatility index on Doppler ultrasound is a beneficial technique to recognize the women by risk status and target them to prevent pre-eclampsia.

Machine‐learning‐based prediction of pre‐eclampsia using first‐trimester maternal characteristics and biomarkers

To evaluate the accuracy of predicting the risk of developing pre-eclampsia (PE) according to first-trimester maternal demographic characteristics, medical history and biomarkers using artificial-intelligence and machine-learning methods. The data were derived from prospective non-interventional screening for PE at 11-13 weeks' gestation at two maternity hospitals in the UK. The data were divided into three subsets. The first set, including 30 437 subjects, was used to develop the training process, the second set of 10 000 subjects was utilized to optimize the machine-learning hyperparameters and the third set of 20 352 subjects was coded and used for model validation. An artificial neural network was used to predict from the demographic characteristics and medical history the prior risk that was then combined with biomarker values to determine the risk of PE and preterm PE with delivery at < 37 weeks' gestation. An additional network was trained without including race as input. Biomarkers included uterine artery pulsatility index (UtA-PI), mean arterial blood pressure (MAP), placental growth factor (PlGF) and pregnancy-associated plasma protein-A. All markers were entered using raw values without conversion into standardized multiples of the median. The prediction accuracy was estimated using the area under the receiver-operating-characteristics curve (AUC). We further computed the detection rate at 10%, 20% and 40% false-positive rates (FPR). The impact of taking aspirin was also added. Shapley values were calculated to evaluate the contribution of each parameter to the prediction of risk. We used a non-parametric test to compare the expected AUC with the one obtained when we randomly scrambled the labels and kept the predictions. For the general prediction, we performed 10 000 permutations of the labels. When the AUC was higher than the one obtained in all 10 000 permutations, we reported a P-value of < 0.0001. For the race-specific analysis, we performed 1000 permutations. When the AUC was higher than the AUC in permutations, we reported a P-value of < 0.001. The detection rate for preterm PE vs no PE, at a 10% FPR, was 53.3% when screening by maternal factors only, and the corresponding AUC was 0.816; these increased to 75.3% and 0.909, respectively, with the addition of biomarkers into the model. Information on race was important for the prediction accuracy; when race was not used to train the model, at a 10% FPR, the detection rate of preterm PE vs no PE decreased to 34.5-45.5% (for different races) when screening by maternal factors only and to 55.0-62.1% when biomarkers were added. The major predictors of PE were high MAP and UtA-PI, and low PlGF. The accuracy of prediction of all PE cases was lower than that for preterm PE. Aspirin use was recommended for cases who were at high risk of preterm PE. The AUC of all PE vs no PE was 0.770 when screening by maternal factors and 0.817 when the biomarkers were added; the respective detection rates, at a 10% FPR, were 41.3% and 52.9%. Screening for PE using a non-linear machine-learning-based approach does not require a population-based normalization, and its performance is similar to that of logistic regression. Removing race information from the model reduces its prediction accuracy, especially for the non-white populations when only maternal factors are considered. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Evaluation of oxidative/nitrative stress and uterine artery pulsatility index in early pregnancy.

Increased oxidative/nitrative stress is characteristic not only in pathologic, but also in healthy pregnancy. High uterine artery pulsatility index (UtAPI) at the end of the first trimester is associated with altered placentation and elevated risk for adverse pregnancy outcomes. We aimed to examine the relationship of systemic oxidative/nitrative stress and uterine artery pulsatility index in the first trimester and their correlation to pregnancy outcomes. Healthy pregnant women were recruited at 12-13th gestational week ultrasound examination; UtAPI was determined by color Doppler ultrasound. Patients were divided into high (UtAPI ≥ 2.3) (n = 30) and low (n = 31) resistance groups, and pregnancies were followed until labor. Systemic oxidative/nitrative stress was estimated by measuring total peroxide level, total antioxidant capacity and nitrotyrosine level. Plasma total peroxide level was significantly lower (2,510 ± 39 µM vs. 2,285 ± 59 µM), total antioxidant capacity was higher (781 ± 16 mM CRE vs. 822 ± 13 mM CRE) in the high UtAPI group, which were accompanied by lower birth weight (3,317 ± 64 vs. 3,517 ± 77 g, P < 0.05). Plasma total peroxide level showed a negative correlation (by Pearson) to UtAPI (P < 0.01) and positive correlation to birth weight (P < 0.05). According to our results, lower systemic oxidative stress showed correlation with high UtAPI measured between the 12-13th weeks of gestation. We also found significant differences in the birth weight of healthy newborns; therefore it is worth examining this relationship in pathological pregnancies.

Poor sleep is associated with higher blood pressure and uterine artery pulsatility index in pregnancy: a prospective cohort study.

ObjectiveTo elucidate the association between sleep disturbances and blood pressure as well as uterine artery Doppler during pregnancy in women with no pre‐existing hypertension.DesignProspective cohort study.SettingOutpatient specialist clinics at KK Women’s and Children’s Hospital, Singapore.PopulationWomen with viable singleton pregnancies confirmed by ultrasonography at less than 14 weeks of amenorrhoea at first visit.MethodsIn all, 926 subjects were recruited for this study in the outpatient specialist clinics at KK Women’s and Children’s Hospital, Singapore, between 1 September 2010 and 31 August 2014. They were followed up throughout pregnancy with sleep quality, blood pressure and uterine artery Doppler assessed at each visit.Main outcome measuresSleep quality, blood pressure and uterine artery Doppler.ResultsSleep progressively worsened as pregnancy advanced. Shorter sleep duration and poorer sleep efficiency were associated with higher blood pressure, especially in the first trimester. Mixed model analysis demonstrated an overall positive association between sleep quality represented by Pittsburgh Sleep Quality Index (PSQI) score and diastolic blood pressure (DBP) (P < 0.001) and mean arterial pressure (MAP) (P = 0.005) during pregnancy after considering all trimesters. Sleep duration was found to be negatively associated with both systolic blood pressure (SBP) (P = 0.029) and DBP (P = 0.002), whereas sleep efficiency was negatively correlated with DBP (P = 0.002) only. Overall poor sleep during pregnancy was also found to be associated with a higher uterine artery pulsatility index.ConclusionOur prospective study demonstrated that poor sleep quality is significantly associated with higher blood pressure and uterine artery pulsatility index during pregnancy.Tweetable abstractPoor sleep quality is significantly associated with higher blood pressure and higher uterine artery pulsatility index during pregnancy.

B-mode and Doppler Ultrasonographic Assessment of Uterine Involution in Ewes Treated with Two Different Doses of ProstaglandinF2α

Background: Several studies consisted of postmortem evaluations and B-mode ultrasonography have been performed on ovine uterine involution. However, researches with Doppler ultrasonography are very limited in ewes. Doppler ultrasonography is a non-invasive method which provides information about vascular dynamics of the tissues which cannot be examined by B-mode ultrasonography. The aim of the study was to evaluate the effects of two different PGF2α doses on uterine measurements by real time B-mode ultrasonography; and on uterine artery hemodynamics by pulsed-wave Doppler analysis during postpartum uterine involution in ewes.Materials, Methods &amp; Results: The study was conducted with 30 primiparous Kiwircik ewes which lambed singleton without any complication. The ewes were randomly divided into three groups (n= 10 for each group). A single i.m. injection of 125 μg/sheep PGF2α, 75 μg/sheep PGF2α, and 1.0 mL/sheep sterile saline solution were administered to Group 1, 2, and 3, respectively. The day of parturition was considered as the first day of the study. Examinations were performed on days 1, 2, 3, 7, 14, 21 and 28. Diameters of previously gravid horn and caruncles were measured by real time B-mod ultrasonography. Presence of lochia was also noted. Uterine artery pulsatility index (PI), resistance index (RI), systolic/diastolic ratio (S/D) values were measured by pulsed-wave Doppler ultrasonography. The one-way analysis of variance and Duncan’s test were used for statistical analysis. The mean previously gravid horn diameters of ewes were 8.30 ± 0.16 cm and 1.53 ± 0.07 cm on day 1 and day 28, respectively. Previously gravid horn and caruncle diameters had a similar declining pattern in all groups as involution period proceeded. Involution was mostly completed by day 21. More than 50% reduction in uterine size was achieved in prostaglandin administered groups by day 7. Caruncles were not able to be identified after the second week postpartum. Lochia was observed for a longer period in control group. Uterine artery PI and RI showed fluctuations throughout involution period with a similar pattern among groups. S/D values progressively increased until day 14, then showed a decreasing pattern.Discussion: The effects of different PGF2α doses on uterine measurements and uterine artery hemodynamics during postpartum period were compared in ewes for the first time. The uterine size reduction in prostaglandin administered groups suggested that both PGF2α doses were effective in uterine involution. The last observation of lochia in uterine cavity were achieved by day 7 in prostaglandin administered groups, suggesting both PGF2α doses trigger uterine contractions which lead to the removal of uterine content. Automatic measurements by Doppler device were taken in order to provide uniformity and to prevent operator-based bias. The significantly higher uterine artery PI value found in Group 1 on day 1 might suggest the stimulatory effect of PGF2α administration on uterine contractility synergitically with already released endogenous PGF2α. Uterine artery PI and RI showed fluctuations throughout involution period and reached their peak values on day 14. The increasing S/D values up to day 14 indicated increasing diastolic flow, increasing resistance and decreasing blood perfusion in prostaglandin administered groups. Prostaglandin administered groups tended to show higher hemodynamic parameters throughout the study which suggested a vasoconstrictor effect of PGF2α. In conclusion, PGF2α administration on the day of parturition might have constrictor effects both on uterine artery and myometrium which leads to a reduction in uterine blood flow and a rapid decline in uterine size especially during early puerperium even with a reduced dose.

Uterine Artery Doppler in Pregnancy: Women with PCOS Compared to Healthy Controls.

The objective of this study was to investigate possible differences in uterine artery pulsatility index (UtAPI) between pregnant women with PCOS and healthy controls and to explore possible effects of metformin on UtAPI. Material and Methods. The study was conducted in a tertiary center. Forty-eight pregnant women diagnosed with PCOS before pregnancy and 124 healthy pregnant women were included. Women with PCOS were randomly assigned to metformin 2000 mg daily or a placebo. UtAPI was measured five times during 1st and 2nd trimesters of pregnancy in women with PCOS and four times in healthy controls. Results. There was no difference in UtAPI between PCOS women and healthy controls at any point in time (p = 0.34–0.77). In women with PCOS, randomly assigned to metformin 2000 mg or placebo, UtAPI was unaffected by metformin two hours after intake of the first dose of study medication (p = 0.34). All PCOS women, regardless of randomization, had higher UtAPI two hours after intake of study medication and a meal compared to before a meal (p = 0.02). Conclusions. In the first and second trimesters of pregnancy, there was no difference in UtAPI between women with PCOS and healthy controls. Metformin had no immediate effect on the UtAPI. Interestingly, blood flow decreased after a meal, suggesting that time since last meal should be taken into consideration when interpreting the results of UtAPI measurements in pregnancy. This trial is registered with ClinicalTrials.gov (NCT00466622) Metformin in Pregnant PCOS women (PregMet) (NCT00159536).

The Assessment of Association between Uterine Artery Pulsatility Index at 30-34 Week's Gestation and Adverse Perinatal Outcome.

Background:Given the high prevalence of adverse perinatal outcome in the developing countries and the association between uterine artery (UtA) blood flow and fetal status in the uterine, in the current study, we assess the association between UtA pulsatility index (UtA-PI) at 30–34 week's gestation and adverse perinatal outcome.Materials and Methods:This cohort study included 100 pregnant women at 30–34 weeks’ gestation. At baseline, UtA-PI was evaluated with color Doppler through abdominal ultrasound. Then, adverse perinatal outcomes including preterm labor, intrauterine fetal death, preeclampsia, low 5-min Apgar score (<7), low umbilical arterial cord blood pH, admitted to Intensive Care Unit in the first 3 days of birth, low birth weight, infant with low weight, death of newborns, cesarean section for respiratory distress, and meconial amniotic fluid were recorded. Ultimately, the collected data were analyzed using SPSS, version 20.Results:The presence of small-for-gestational-age fetuses indicated the highest prevalent adverse prenatal outcome with the incidence of 13.3% and 58.5%, respectively, among pregnancies with normal UtA-PI as well as those with high UtA-PI (P < 0.001). Overall, given that sensitivity and specificity of high UtA-PI were 37.5% and 73.3%, respectively, it could not properly predict adverse perinatal outcome (P = 0.360).Conclusion:According to the results, although the incidence of some of adverse perinatal outcomes in pregnant women with high UtA-PI was higher compared to those with normal UtA-PI, this factor alone cannot predict adverse perinatal outcome well. Therefore, this factor may predict these outcomes well, in the subgroups with high-risk pregnancies or with some blood factors or with pregnancy complications.

Nitric oxide/Asymmetric Dimethylarginine Axis may Interplay With Some Sex Hormones for Pathogenesis and Severity of Pre-eclampsia: Study controlled by Uterine Arterial Doppler.

Objectives: To evaluate relations of asymmetric dimethylarginine (ADMA) and nitric oxide (NO) with estrogen (E2) and progesterone (Pg) and its role in pathogenesis and severity of pre-eclampsia (PE). Patients & Methods: At 12th week gestational age (GA) constitutional data, systolic and diastolic blood pressures (SBP and DBP), uterine artery pulsatility index (UAPI) and serum NO, ADMA, E2 and Pg levels were determined for primigravida attending the antenatal care unit. During pregnancy, women who developed PE were categorized as early or late and mild or severe according to ACOG Practice Bulletin of PE guidelines. Studied parameters were evaluated statistically as early predictors for development and severity of PE. Results: Ninety pregnant women developed PE; 39 early and 51 late. Only 13 women had severe and 77 women had mild PE. At 12th week GA, UAPI and serum ADMA levels were significantly higher with significantly lower E2 and NO levels in PE women than women free of PE and in early than in late PE. High SBP at time of PE diagnosis showed positive significant correlation with body mass index (BMI) and serum ADMA levels but showed negative significant correlation with serum NO and E2 levels. Serum ADMA levels showed positive significant correlation with BMI, but negative significant correlation with serum E2 levels. High UAPI, serum ADMA and high BMI were significant early predictors for PE development and severity. Conclusion: Disturbed maternal serum ADMA/NO axis and low E2 serum levels may underlie PE development. High BMI and low E2 level may have a role in PE pathogenesis through induction of high serum ADMA levels. High UAPI and serum ADMA at 12th week GA could be used as early predictors of PE especially early-onset and severe PE.

Association between uterine artery Doppler blood flow changes and arterial wall elasticity in pregnant women

Introduction: Uterine artery (UtA) Doppler velocimetry changes and increased arterial stiffness are associated with preeclampsia. We aimed to investigate the relation between UtA velocimetry changes and arterial stiffness in pregnant women.Methods: Doppler velocimetry and photoplethysmographic digital pulse wave analysis (DPA) were performed in 173 pregnant women in the second or the third trimester, where UtA Doppler pulsatility index (PI), diastolic notching, and UtA score (UAS) combining notching and high PI were calculated. DPA stiffness parameters representing large arteries were ejection elasticity index (EEI) and b/a, small arteries dicrotic index (DI) and d/a, and global stiffness the aging index (AI).Results: One hundred and thirty women had normal Doppler and 43 had diastolic notching, of whom nine had high PI. DI indicated increased stiffness in small arteries when notching was present (p = 0.044) and showed a significant but weak correlation to UAS (p = 0.025, tau 0.12). EEI and b/a indicated increased large artery stiffness (p ≤0.014), d/a small artery stiffness (p = 0.023), and AI a systemic stiffness (p = 0.040) when high PI.Conclusion: High UtA PI was associated with increased systemic arterial stiffness, whereas notching was related to increased stiffness in small arteries only. This indicates pathophysiological differences between the two Doppler parameters.

First Trimester Screening for Pre-eclampsia and Fetal Growth Restriction

AbstractThis paper is an analysis of the effectiveness of various first trimester markers in detecting uteroplacental insufficiency. The various parameters used for screening in 3373 women were uterine artery pulsatility index (PI) &gt;90th percentile, maternal characteristics, mean arterial pressure (MAP), PAPP-A lower than 0.5 MoM, and PlGF test. Adverse pregnancy outcomes related to uteroplacental insufficiency, namely low birth weight, fetal loss, delivery before 36 weeks (due to abnormal fetal Doppler or oligohydramnios), and hypertension were assessed. Adverse outcomes were found in 37 % of patients who had high uterine PI, in 52 % of cases that had a positive risk after inclusion of maternal characteristics, MAP, and uterine artery Doppler, 55 % of women with low PAPP-A values, 85 % in cases that had both low PAPP-A values and high uterine artery PI, in all the cases positive for early onset pre-eclampsia (PE), and in 65 % of cases positive for late onset PE after inclusion of all parameters mentioned above with PlGF testing. Hence, PlGF test had the maximum detection rate for early onset PE. However, the predictive efficacy for detection of PE and fetal growth restriction (FGR) is quite good when PAPP-A is combined along with first trimester risk prediction using maternal characteristics, MAP, and uterine artery PI. The adverse outcomes were very minimal in the screen negative group, thus first trimester screening for PE and FGR definitely helps in triaging patients earlier in pregnancy giving the advantage of adding low-dose aspirin and increasing surveillance in screen positive group which would help us in minimizing adverse perinatal outcomes.

Uterine artery pulsatility index at 30-34 weeks' gestation in the prediction of adverse perinatal outcome.

To investigate the potential value of uterine artery (UtA) Doppler at 30-34 weeks' gestation in the prediction of adverse perinatal outcome. This was a screening study in 30 780 singleton pregnancies at 30-34 weeks. UtA pulsatility index (UtA-PI) was measured and the values were converted to multiples of the median (MoM) after adjustment for variables relating to maternal characteristics and medical history that affect the measurements. Multivariable logistic regression analysis was used to determine if measuring UtA-PI improved the prediction of adverse perinatal outcome provided by screening with maternal characteristics, medical history and obstetric factors. The detection rate (DR) and false-positive rate (FPR) of screening by UtA-PI were estimated for stillbirth, Cesarean section for fetal distress, umbilical arterial cord blood pH ≤ 7.0 or umbilical venous cord blood pH ≤ 7.1 and 5-min Apgar score < 7. The incidence of adverse perinatal outcome was higher in small-for-gestational-age (SGA) fetuses than in non-SGA fetuses, but the majority of cases with each adverse outcome were in the non-SGA group, including about 70% of stillbirths and more than 80% with Cesarean section for fetal distress, low cord blood pH and low Apgar score. The performance of UtA-PI > 95(th) percentile in screening for each adverse outcome was poor with DR of 6-16% and a FPR of 5-6%. The DR of adverse outcome when screening by high UtA-PI was greater in pregnancies complicated by SGA than in non-SGA pregnancies; 24% vs 13% for stillbirth, 15% vs 5% for Cesarean section for fetal distress, 30% vs 9% for low cord blood pH and 20% vs 3% for low 5-min Apgar score, respectively. High UtA-PI at 30-34 weeks' gestation may be useful in the prediction of adverse perinatal outcome in pregnancies with a SGA fetus, however, in the absence of SGA, UtA-PI is a poor predictor of adverse outcome. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Association between previously unknown connective tissue disease and subclinical hypothyroidism diagnosed during first trimester of pregnancy

To investigate the presence of autoimmune rheumatic disorders among women with autoimmune thyroid disorders diagnosed during the first trimester of pregnancy and subsequent pregnancy outcomes. Case-control study. Tertiary obstetric and gynecologic center. Pregnant women in the first trimester of pregnancy. Clinical, laboratory, ultrasonographic evaluations. Thyroid-stimulating hormone (TSH) level; antibodies against thyroperoxidase, thyroid globulin and TSH receptor detection; screening for rheumatic symptoms and antinuclear antibodies (ANA); uterine artery pulsatility index evaluation; pregnancy complication onset. Out of 3,450 women enrolled, 106 (3%) were diagnosed with autoimmune thyroid disorders. ANA were present in 18 (16.9%) of 106 cases and 26 (12.6%) of 206 controls. Of the cases, 28 (26.4%) of 106 reported rheumatic symptoms, 5 of these were diagnosed with Sjögren syndrome or with undefined connective tissue disease. Autoimmune thyroid diseases are statistically significantly associated with a higher risk of preeclampsia, fetal growth restriction, and overall pregnancy complications compared with controls, with a higher uterine artery pulsatility index, suggesting a defective placentation in thyroid disorders. The effect of ANA-positivity on moderate/severe adverse pregnancy outcomes was statistically significant among the patients with thyroid disorders (9 of 18 as compared to 8 of 88, odds ratio 9.65; 95% confidence interval, 2.613-7.81). Connective tissue diseases are frequently associated with autoimmune thyroid disorders diagnosed during the first trimester of pregnancy. Thyroid autoimmunity and ANA positivity independently increased the risk of adverse pregnancy outcomes.

Resolution of high uterine artery pulsatility index and notching following sildenafil citrate treatment in a growth‐restricted pregnancy

Resolution of high uterine artery pulsatility index and notching following sildenafil citrate treatment in a growth‐restricted pregnancy

Maternal Hemodynamics at 11–13 Weeks of Gestation in Pregnancies Delivering Small for Gestational Age Neonates

Objective: To examine aortic systolic blood pressure (SBP_Ao), pulse wave velocity (PWV) and augmentation index (adjusted to a heart rate of 75 beats per minute, AIx-75) at 11–13 weeks’ gestation in pregnancies delivering small for gestational age (SGA) neonates with and without preeclampsia (PE). Methods: At 11+0 to 13+6 weeks’ gestation, maternal history was recorded and PWV, AIx-75, SBP_Ao, uterine artery pulsatility index (PI) and maternal serum pregnancy-associated plasma protein-A (PAPP-A) were measured. We compared women with (n = 337) and without (n = 48) PE that delivered SGA neonates with unaffected controls (n = 6,429). Results: In the SGA group without PE, compared to unaffected controls, there was no significant difference in AIx-75 (1.03 vs. 1.00 multiple of the median, MoM), PWV (0.98 vs. 1.00 MoM) or SBP_Ao (1.01 vs. 1.00 MoM), but uterine artery PI was increased (1.10 vs. 1.00 MoM) and PAPP-A decreased (0.85 vs. 1.00 MoM). In SGA with PE, compared to unaffected controls, there was increased AIx-75 (1.13 vs. 1.00 MoM), SBP_Ao (1.09 vs. 1.00 MoM), uterine artery PI (1.40 vs. 1.00 MoM) and decreased PAPP-A (0.72 vs. 1.00 MoM), but no significant difference in PWV (1.05 vs. 1.00 MoM). Conclusion: In pregnancies with SGA neonates, impaired placentation is reflected in low PAPP-A and high uterine artery PI at 11–13 weeks’ gestation. In the SGA group with PE, but not in those without PE, there is increased SBP_Ao and AIx-75.

Physical activity and maternal–fetal circulation measured by Doppler ultrasound

To examine the association of physical activity on maternal-fetal circulation measured by uterine and umbilical artery Doppler flow velocimetry waveforms. Participants included 781 pregnant women with Doppler ultrasounds of the uterine and umbilical artery and who self-reported past week physical activity. Linear and generalized estimating equation regression models were used to examine these associations. Moderate-to-vigorous total and recreational activity were associated with higher uterine artery pulsatility index (PI) and an increased risk of uterine artery notching as compared with reporting no total or recreational physical activity, respectively. Moderate-to-vigorous work activity was associated with lower uterine artery PI and a reduced risk of uterine artery notching as compared with no work activity. No associations were identified with the umbilical circulation measured by the resistance index. In this epidemiologic study, recreational and work activity were associated with opposite effects on uterine artery PI and uterine artery notching, although associations were modest in magnitude.

Uterine artery Doppler screening for pre‐eclampsia: comparison of the lower, mean and higher first‐trimester pulsatility indices

A previous study suggested that the lower uterine artery pulsatility index (PI) is a better predictor of pre-eclampsia than is either the mean or higher indices. The aim of this study was to assess the relative value of these three indices for the prediction of pre-eclampsia in the first trimester of pregnancy. This was a prospective study of 6221 singleton pregnancies. Uterine artery PI was obtained at the time of the 11-14-week nuchal translucency scan and receiver-operating characteristics curves for the lower, mean and higher PI value of the two uterine arteries in the prediction of pre-eclampsia were calculated. There were 178 cases of pre-eclampsia. The associations between uterine artery PI and pre-eclampsia were stronger for early (requiring delivery < 34 weeks' gestation) and preterm (requiring delivery < 37 weeks) pre-eclampsia compared to pre-eclampsia at any gestation. There was no significant difference in the strength of the association between lower, mean and higher PI for pre-eclampsia at any gestation. First-trimester uterine artery PI is strongly associated with the development of early and preterm pre-eclampsia. Lower, mean and higher uterine artery PIs are comparable in screening for pre-eclampsia. Any differences that exist between the lower, mean and higher uterine artery indices are unlikely to have a significant impact on screening sensitivities.