Mean Uterine Artery PI Research Articles

Comparison of Pre-eclampsia Screening Algorithms in the First Trimester of Pregnancy Being Used in Thai Nguyen Province.

Objective To compare the rates of pregnancies in high-risk groups for preeclampsia recommended for aspirin prophylactic when screened using various common algorithms. Methods This cross-sectional study was conducted on 1726 pregnant women from 11 to 13 weeks six days of gestation receiving antenatal care at two hospitals: Thai Nguyen National Hospital and a hospital in Thai Nguyen Province from October 2022 to October 2023. All participants provided consent for the study. We collected maternal characteristics, obstetric history,mean arterial pressure (MAP), mean uterine artery-PI (UtA-PI), and placental growth factor serum (PLGF). Screening performance estimates were calculated using the Fetal Medicine Foundation (FMF) and National Institute for Health and Care Excellence (NICE) guidelines. All pregnant women in the study had their preeclampsia risk assessed using all three algorithms with two cut-off points.Our data was collected, entered and analyzed using SPSS software 20.0 (IBM Corp., Armonk, NY). Categorical data was reported as frequency and percentage. McNemar's test was used for analyzing differences in the sizes of individual groups. Results In our study, the most common high-risk factor identified was the history of preeclampsia, 132 cases (7.6%). According to the NICE guideline, BMI ≥ 35 (kg/m²) is considered a moderate risk factor for preeclampsia. Several risk factors, such as BMI ≥ 35 kg/m² and history of diabetes mellitus type 1, were not present in any participants. Only one pregnant woman had chronic kidney disease (0.06%). Out of the 1726 pregnant women surveyed, the rates of high-risk preeclampsia were as follows: 9.9% (171 cases) based on algorithm 1; 10.8% (187 cases) based on algorithm 2 with a cut-off point > 1/100, 11.8% (203 cases) with a cut-off point > 1/150; 10.3 % (178 cases) based on algorithm 3 with a cut-off point > 1/100, and 11.6% (201 cases) with a cut-off point > 1/150. Among these algorithms, pregnant women in the high-risk preeclampsia group were advised to consider taking low-dose aspirin. Conclusion Screening for pre-eclampsia based on NICE recommendations resulted in a lower number of high-risk pregnant women requiring prophylactic aspirin use compared to other algorithms. This means that some pregnant women at risk of developing preeclampsia are not recommended to use aspirin as a preventive measure. Adding PLGF to the screening strategy will help us get closer to pregnant women who are truly at risk of progressing to preterm preeclampsia.

Uterine artery pulsatility index among polycystic ovary disease; case control study

Introduction: Polycystic ovarian syndrome is a multiple organ disorder affects 5 to 10 % female population. The world occurrence of PCOS is 105 million in the age ranges from 15 to 45. The polycystic ovarian syndrome is a set of disorders like amenorrhea, infertility, polycystic ovaries, hyperinsulinemia, hirsutism, acne vulgaris and other symptoms of hyperandrogenism. Color Doppler and Pulse Doppler play a major role in evaluation of uterine artery Resistive index for access correlation with PCOS. PCOS patients suffer from primary and secondary infertility. This study aimed to show assess uterine blood flow and whether there is a correlation between these patterns and specific hormonal parameters.
 A case control study done in Salah Al-Deen governorate during the period of 1st May–1st October 2022. Twenty-five patients with polycystic ovary disease compared with 25 normal healthy women. The ultrasound and Doppler analyses were performed for all women during the follicular phase of the menstrual cycle. Uterine artery blood flow velocities were analyzed and the pulsatility index, were calculated.
 The current study showed that oligomenorrhea found among (72%) of the patients, clinical/biochemical signs of hyperandrogenism found among (76%). The mean LH (mIU/L) was significantly higher among PCO disease cases and also that the mean FSH (mIU/L) was significantly lower among PCO disease cases than control group. There was at increased ovarian volume of > 10 cm3 found among (80%), and ≥12 follicles measuring 2-9 mm found in (84%) of the PCO disease patients. The mean Uterine artery PI was significantly higher among PCO disease cases 2.3 ± 0.5 than control group 1.8 ± 0.4 (P value <0.05).
 The mean ovarian volume was significantly higher among PCO disease cases than control group. The mean Uterine artery PI was significantly higher among PCO disease cases than control group.

Short-term effects of first trimester low-dose aspirin therapy on uterine artery flow in women at high risk for preeclampsia

The aim of the study was to investigate the short-term effects of low-dose aspirin treatment on uterine artery Doppler in pregnancies that were high-risk for preeclampsia. This prospective observational study included 82 patients with singleton pregnancies between 11–14 weeks of gestation. Uterine artery Doppler measurements were obtained by transvaginal ultrasonography at the first prenatal visit of women who started low-dose aspirin treatment due to the high risk of preeclampsia and women who did not receive low-dose aspirin. Uterine artery Doppler measurements of both groups were repeated 7–10 days after the first examination. There was a significant decrease in the presence of uterine artery diastolic notch in the low-dose aspirin group (p < .001). In both groups, the mean uterine artery PI values between the two exams tended to decrease, but the decrease in the control group was the only significant decrease (p = .014). The changes in Doppler indices were more pronounced in the control group. Therefore, they are much more likely to be related to the increase in gestational age than with the use of aspirin. Although there was an improvement in uterine arteries of Doppler measurements in high-risk women, they still had a high resistant flow compared to women with normal pregnancies. IMPACT STATEMENT What is already known on this subject? Pregnant women at high risk of preeclampsia have increased uterine artery resistance. Low-dose aspirin therapy is the only strategy to prevent the development of preeclampsia in these patients. What do the results of this study add? Low-dose aspirin therapy may improve uterine perfusion in the short term. After treatment, uterine artery resistance remains higher than in normal pregnancies. What are the implications of these findings for clinical practice and/or further research? Since baseline uterine blood flow and changes throughout pregnancy can be very different depending on the risk of preeclampsia, aspirin-treated or untreated groups may be used to evaluate the efficacy of aspirin in future studies. For example, patients with 11 weeks and 13 weeks of gestation can be divided into aspirin treated and control groups and efficacy of starting the aspirin treatment at 11 weeks of gestation vs 13 weeks of gestation can be evaluated.

CAN POSTPARTUM BLOOD LOSS BE PREDICTED VIA UTERINE ARTERY DOPPLER ANALYSIS?

Aim: Postpartum bleeding is one of the most important causes of maternal mortality. Herein, we attempted to predict hemoglobin (Hb) decrease by observing uterine artery doppler indices during the early postpartum period.&#x0D; Materials and Method: The study was designed as a prospective cohort study. Pregnant women who visited Gazi University Hospital for normal vaginal delivery between 09/01/2018–09/01/2019 were included, and no risk factors were included.&#x0D; Results: A total of 85 patients were included with the following parameters: average age at birth, 28.4 ± 4.6 years; average gestational age at birth, 38.83 ± 1.21 weeks. No significant correlation was observed among Hb, hematocrit (Htc), WBC, and other changes in PLT and mean uterine artery systole/diastole (S/D), resistance index (RI), and PI values. Furthermore, no statistically significant relationship was observed among uterus volume, mean uterine artery S/D, PI, and RI. Similarly, no significant relationship was observed among uterus volume, Hb, Htc, WBC, and PLT differences. Upon dividing primigravid and multigravida, the mean uterine artery PI median values did not differ according to the groups.&#x0D; Conclusion: No correlation was observed between possible Hb decrease and resistance in the uterine artery. At the same time, other factors that may affect were evaluated (uterus dimensions, gravida, parity, whether there was membrane rupture, delivery times, lacerations during delivery, episiotomy, and birth weight) and no correlation was noted among these factors.

Plasma and amniotic fluid concentrations of nitric oxide: Effects on uterine artery and placental vasculature in women who underwent voluntary pregnancy termination and in women with missed and threatened abortion. A pilot study

ObjectivesFirst trimester miscarriage is a multifactorial event. Various angiogenic factors have been proposed as possible early markers of non-viable pregnancies. The aim of the present study was to evaluate the systemic nitric oxide (NO) production in healthy early pregnancy and its possible role in first trimester miscarriage. Study designWe prospectively enrolled women referred to our Unit for elective termination of pregnancy, threatened abortion or missed abortion. Blood samples were taken for testing circulating NO plasma levels. Subsequently, all patients underwent 2-D ultrasonographic analysis and Color Doppler imaging to assess the pulsatility index of the uterine arteries. 3-D ultrasonographic and power Doppler analysis allowed a volumetric and vascular reconstruction of the placenta. During dilatation and vacuum aspiration, amniotic fluid was collected. ResultsSeventy-two patients were enrolled: 25 with elective termination of pregnancy (Group I); 17 with threatened abortion (Group II); 30 with missed abortion (Group III). Group II showed greater placental volume and lower uterine arteries PI than others. The plasma NO concentration resulted statistically higher in women with threatened abortion, while amniotic fluid NO concentration were higher in the viable pregnancies (Group I) than in the aborted fetuses (Group III). Plasma NO was inversely correlated with both mean arterial pressure and uterine artery PI and was positively correlated with amniotic fluid NO and CRL; amniotic fluid NO was positively correlated with placental Vascularization Index and Vascularization-Flow Index. ConclusionAmniotic NO concentration was higher in viable pregnancies and positively related to Doppler 3D indices of vascularization and blood flow within the placenta. Further studies are needed to elucidate its role in first trimester miscarriage.

872 Racial differences in spiral artery remodeling

Maternal race is a determinant of the frequency and severity of ischemic placental disease. Current Doppler methods infer, but do not directly assess, function of the spiral arteries (SA), the root of placental dysfunction. We developed a novel ultrasound method combining B-flow, spatiotemporal image correlation (STIC) and M-Mode to image and measure SA intraluminal diameter during the maternal cardiac cycle in both systole (S) and diastole (D)(Fig 1). We tested the hypothesis that measurable SA function differs between races. In an IRB-approved prospective longitudinal observational study, we defined a supernormal population (parity=0, no co-morbidities or pregnancy complications) to control covariables. S and D were quantified in all trimesters, with a compound ultrasound technique: In B-flow mode, STIC/4D image blocks of individual SA were acquired systematically in the placental bed. S and D diameters were measured via M-Mode. At the first trimester visit, serum analytes (PAPP-A, PlGF, AFP) were obtained. At each visit, BMI, mean arterial blood pressure, mean uterine artery-PI, gestational age (GA), race and age were recorded. Quality control included formal training, written criteria for image acceptance and screening of every image by senior study personnel, all blinded to patient characteristics/outcome. Longitudinal analysis utilized a linear mixed-effects model with random intercept and random slope. A total of 645 SA were measured serially in 43 women (15 each) at 11-32 weeks. Women self-assigned race as Black (24), White (14) or Asian (5). S and D diameters rose with GA (p<0.001 for both). S was significantly higher in W than B and A (Fig 2) The model showed significant interaction between S and PAPP-A (p<0.0001). The study shows B-flow/M-mode can detect and quantify SA remodeling and illustrates the normal loss of mural tone of these vessels as pregnancy advances. Even when pregnancy outcome is normal, black women show less remodeling, a potential clue to their liability for placental dysfunction across pregnancy and the puerperium.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

VP50.26: Association of increased mean uterine artery PI‐ and HELLP‐like syndrome in third trimester of pregnancy: should measuring uterine artery PI be mandatory?

VP50.26: Association of increased mean uterine artery PI‐ and HELLP‐like syndrome in third trimester of pregnancy: should measuring uterine artery PI be mandatory?

Pilot Interventional Study Comparing Fetomaternal Outcomes of 150 mg Versus 75 mg Aspirin Starting Between 11 and 14 Weeks of Pregnancy in Patients with High Risk of Preeclampsia: A Randomized Control Trial

Hypertensive disorders of pregnancies complicate around 5-10% of pregnancies worldwide, and together they are a member of the deadly triad along with haemorrhage and infection that contribute to a significant amount of maternal morbidity and mortality. To compare differences in the fetomaternal outcomes with the use of 150mg aspirin versus 75mg aspirin in pregnant women found to be at high risk of PE. This was a two-armed double-blind parallel randomized control trial conducted in the Department of Obstetrics and Gynaecology, King George's Medical University, carried over a period of 1year. Preeclampsia occurred in 15 of 87 participants (17%) in the 75mg aspirin group compared with 6 of 91 (6.5%) in the 150mg aspirin group. There were a significantly higher incidence of PE, its severity and lesser period of gestation at delivery in the group given 75mg dose compared to the group given 150mg dose. There were significantly higher values of mean arterial pressure and uterine artery PI in women who developed preeclampsia compared to those who do not in both the groups. Foetal outcomes were observed in both the groups of women, and there was no statistically significant difference between them. This randomized trial showed that among women with singleton pregnancies who were identified by means of first-trimester screening as being at high risk of preterm preeclampsia, use of aspirin 150mg per day started between 11 and 14weeks till 36weeks is a potent intervention to reduce the development of both early- and late-onset preeclampsia as compared to a dose of 75mg per day.

Cerebroplacental and Uterine Doppler Indices in Pregnancies Complicated by Congenital Heart Disease of the Fetus.

Children with congenital heart disease (CHD) are known to have impaired neurodevelopment possibly influenced by altered cerebroplacental hemodynamics antenatally. We compared fetomaternal Doppler patterns in different CHD groups with published normative values during gestation. Retrospective cohort study consisting of 248 CHD fetuses. Subgroups were generated according to the expected ascending aorta oxygen saturation: low portion of high oxygenated umbilical venous (UV) blood (group 1: n = 108), intermediate portion of UV blood due to intracardiac mixing with oxygen poor systemic blood (group 2: n = 103), high (group 3: n = 13) and low portion of UV blood without mixing of blood (group 4: n = 24). Doppler examination included umbilical artery and middle cerebral artery pulsatility index (UA-PI, MCA-PI), cerebroplacental ratio (CPR) and mean uterine artery (mUtA) PI. For mean comparisons at different gestational ages (GA), estimated marginal means from regression models are reported for GA 22 weeks (wks), GA 30 wks and GA 38 wks. Z-score transformed values of MCA-PI (zMCA-PI) were significantly lower in group 1 compared to all other subgroups at GA 30 wks (p < 0.05). At 38 wks, group 1 had significantly lower values of zMCA-PI and zCPR compared to groups 2 and 4. Group 1 fetuses showed a significant association between zMCA-PI and zCPR (negative) and GA as well as zmUtA-PI (positive) and GA compared to reference values. Our data confirm that CHD fetuses have a higher rate of cerebral redistribution in the third trimester. Changes in Doppler patterns were mainly observed in CHD with a low portion of UV blood in the ascending aorta.

Prediction of preeclampsia in the first trimester of pregnancy using maternal characteristics, mean arterial pressure, and uterine artery Doppler data in a Brazilian population.

ObjectiveTo evaluate the performance of the preeclampsia (PE) screening algorithm of the Fetal Medicine Foundation (FMF) during the first trimester in a Brazilian population using maternal characteristics, mean arterial pressure (MAP), and uterine artery Doppler data.MethodsThis is a prospective cohort study that evaluated 701 pregnant women during the first trimester ultrasound screening for chromosomal abnormalities (11–13+6 weeks). All patients provided information regarding clinical and obstetric history, MAP, and mean uterine artery pulsatility index (mean PI). Patients were assigned to four groups based on the presence of PE and gestational age at delivery: group 1 (control), patients without hypertensive disorders (n=571); group 2, PE and delivery before 34 weeks of gestation (n=7); group 3, PE and delivery before 37 weeks of gestation, including patients from group 2 and patients that presented PE with delivery between 34 and 37 weeks (n=17); and group 4, PE and delivery before 42 weeks of gestation, including patients from both groups 2 and 3 and patients that presented PE with delivery between 37 and 42 weeks of gestation (n=34).ResultsAfter the exclusion of 96 patients, we evaluated the data of 605 patients. By combining maternal characteristics, MAP, and the mean uterine artery PI for the detection of PE, we found a sensitivity of 71.4% in group 2, 50% in group 3, and 41.2% in group 4 (false positive rate=10%).ConclusionUsing maternal characteristics, MAP, and uterine artery Doppler data, we were able to identify a significant proportion of patients who developed preterm PE.

Effect of intramural fibroid on uterine and endometrial vascularity in infertile women scheduled for in-vitro fertilization.

To study the effect of intramural fibroids on uterine and endometrial vascularity in infertile women scheduled for in-vitro fertilization (IVF). 3D power Doppler was used to measure the endometrial volume and blood flow indices in 182 women with intramural fibroids not affecting the uterine cavity and compared them to a matched control group without fibroids. There was significantly increased vascularity in the endometrium of the fibroid group as denoted by higher endometrial VI (p=0.018), FI (p=0.027) and Endometrial VFI. No significant difference in mean uterine artery RI (p=0.277) or PI (p=0.187). Among the fibroid group 62.6% had a fibroid >4cm. Women with fibroids >4cm had a significantly higher Endometrial FI (p=0.037), and VFI (p=0.02). Uterine artery blood flow was not affected, as uterine RI (p=0.369) and PI (p=0.321) were not statistically different. Compared with the control group (non fibroid), women with fibroids >4cm had significantly higher endometrial VI (p=0.013), FI (p=0.004), and VFI (p<0.001), whereas women with fibroid ≤4cm had no statistically significant differences in VI (p=0.292), FI (p=0.198), and VFI (p=0.304). Intramural fibroids >4cm significantly increase endometrial vascularity. This increase in blood flow may be a factor that affects the outcome of IVF.

Serum C3 and uterine artery Doppler indices at 14–20 weeks gestation for preeclampsia screening in low-risk primigravidas: A prospective observational study

ProblemPreeclampsia affects 2–10% of human pregnancies with poor screening tests. In order to intervene preventively, high risk population should be identified before the 20th week of pregnancy and by a method not subjected to operator efficiency. MethodologyProspective observational study recruiting 825 low risk primigravidas. Serum C3 and uterine artery Doppler indices were measured at 14–20 weeks. ResultsSerum C3 levels at 14–20 weeks of gestation had a sensitivity 83.3%, specificity 100%, PPV 100% and NPV 98.3% when the cut-off value was 53.1mg/. For the mean RI, the best cut off value found was 0.72 with 100% sensitivity, 99.1% specificity, 92.3% PPV and 100% NPV. For the mean PI the best cut off value was 1.35 with 100% sensitivity, 94.1% specificity, 63.2% PPV and 100% NPV. The combination of serum C3 level and mean uterine artery PI showed 100% sensitivity, 97.4% specificity, 80% PPV and 100% NPV in prediction of PE. ConclusionSerum C3 levels at 14–20 weeks can be used for prediction of PE with comparable results to uterine artery Doppler indices but has the superiority of being operator independent.

Serum tumor necrosis factor-α level and uterine artery Doppler indices at 11–13 weeks’ gestation for preeclampsia screening in low-risk pregnancies: a prospective observational study

Preeclampsia affects 1–2% of human pregnancies with no effective screening test. Studies have found some association between cytokines/other biomarkers and the later onset of preeclampsia. The challenge has been to find indicators with sufficient positive predictive value. A prospective observational study recruiting 500 low-risk pregnant women was carried out. Serum TNF-α and uterine artery Doppler were measured at 11–13 weeks. TNF-α cut-off value ≥14pg/mL had a sensitivity of 67.8% and a specificity of 98% in predicting PE with PPV of 79.4% and NPV of 96.4%. Mean uterine artery PI ≥1.7 had a 100% sensitivity and 84.4% specificity in predicting PE, with a PPV of 41.7% and NPV of 100%. When combining both parameters together we had 88.6% sensitivity and 100% specificity in predicting PE with a PPV of 100% and NPV of 98.6%. Serum TNF-α assay improves the performance of mean uterine artery PI at 11–13 weeks for PE screening and the combination of both tests can rule out PE in the case of normal results.

Serum endocan concentration in women with pre-eclampsia.

To investigate serum endocan levels in pregnant subjects with and without pre-eclampsia. This cross-sectional study was conducted on 49 pregnant women with pre-eclampsia and 32 healthy pregnant women matched for gestational age. Maternal levels of serum endocan were measured with the use of an enzyme-linked immunosorbent assay kit. Mean endocan levels were not significantly different among groups (10.7 ± 4.5 vs. 10.3 ± 3.2 ng/mL, p 0.763). Mean uterine artery PI and RI were higher in the pre-eclampsia group (p < 0.001, p < 0.001). Mean endocan levels were negatively correlated with BMI at the time of blood sampling (r = -0.247, p = 0.044). There was no correlations between mean endocan levels and all the others parameters. These findings suggest that the role of endocan in the pathogenesis of pre-eclampsia was not related to pre-eclampsia; hence, further studies are needed to investigate the role of endocan in the pathogenesis of pre-eclampsia.

Role of transvaginal ultrasonography and colour Doppler in the evaluation of postmenopausal bleeding

Aim of the workThe aim of this study is to evaluate the role of transvaginal ultrasonography and colour Doppler in postmenopausal bleeding. Patients and methodsIn the study fifty female patients with their age ranging between 45 and 80years were subjected to transvaginal US examination and transvaginal colour and pulsed Doppler examination. ResultsAll the malignant cases and 94.7% of the benign cases had endometrial thickness ⩾5mm, however 90% of the control group with the remaining of the benign cases (5.2%) had endometrial thickness <5mm. The mean uterine artery RI and PI were lower in cases with PMB than in control cases and in cases with malignant causes than benign causes. The mean spiral artery RI & PI were lower in cases with benign than in cases with malignant causes of PMB. ConclusionIn conclusion, transvaginal colour Doppler as a noninvasive method has a significant place in the diagnostic procedures for evaluation of PMB. Transvaginal colour Doppler can help in differentiating benign from malignant endometrial changes.

OP09.08: Triple vascular test for prediction of pre-eclampsia

Objectives: Uterine Doppler is used in screening for placentaassociated diseases, such as pre-eclampsia and intrauterine growth restriction of the fetus (IUGR). The aim of this study was to examine the predictive value of second trimester uterine Doppler in pregnancies complicated by systemic lupus eritematosus (SLE). Methods: Observational study on 55 pregnancies in women with SLE treated at our Unit from 2000 to 2008. The Doppler examination was performed between 23+0 and 25+6 weeks of gestation. The mean uterine artery pulsatility index (UtA PI) was calculated. Results: The median (interquartile range, IQR) UtA PI was 1.00 (0.90–1.20). Three patients had a mean uterine artery PI above the 95th centile for gestational age. All these patients developed pre-eclampsia and IUGR. No cases of pre-eclampsia or IUGR were observed in patients with the mean uterine artery PI below the 95th centile for gestational age. The sensitivity was 100% (95% CI 0.44–1.00), specificity was 100% (95% CI 0.93–1.00). Conclusions: In our series, the mean uterine artery PI was an excellent predictor for pre-eclampsia and IUGR in women with SLE.

PP057. The role of uterine artery pulsatility index for prediction of pregnancy outcome, in women affected by pre-eclampsia

Uterine artery (UtA) Pulsatility index assessed in the second trimester is known to be the best predictor of Pre-eclampsia (PE) in women with risk factors. The role of this index when PE occurs seems to be related with clinical outcome. To detect if there does exist a correlation between mean UtA PI, assessed at diagnosis of PE, and: (A) Gestational Age (GA) at delivery; (B) birth weight (BW) percentile. To detect the predictive value of mean UtA PI and the development of adverse pregnancy outcome (APO). Cohort study on 100 consecutive singleton pregnancies complicated with pre-eclampsia referred to our Department from January 2010 and December 2011. Doppler evaluations were performed from diagnosis to delivery. Mean UtA PI obtained at time of diagnosis of PE were analysed. PE was defined according to ISSHP criteria. Clinical and perinatal outcomes were reviewed. APO was defined as Apgar score less than 7 at five minutes, pH <7.20; birth weight <5th percentile (SGA), stillbirth or neonatal death. Receiver-operating characteristics (ROC) curve was used to determine the predictive ability for subsequent development of APO. Maternal characteristics and main pregnancy outcomes are shown in Table 1. Fifty-six pregnancies developed APO. One case of stillbirth and four cases of neonatal death were observed. SGA occurred in 56/100 neonates; 52/95 (55%) live births were admitted to Neonatal Intensive Care Unit. Table 1. Mean UtA PI at diagnosis of PE was 1.40 (SD±0.28) in women that developed APO and 1.10 (SD±0.41) in women that did not develop APO (p=0.02). Pearson's Correlation coefficient for mean UtA PI and GA at Delivery was -0.533 (p=0.002); while for mean UtA PI and BW percentile was -0.466 (p=0.007). The prediction of subsequent development of APO, expressed as the area under ROC curve, was 61.6 (95% CI 0.44-0.79) for UtA PI at Diagnosis of PE. Our data confirm that mean UtA PI, assessed at diagnosis of PE, represent a good independent predictor for GA at delivery end BW percentile. However the predictive value for development of APO seems to be poor.

Vaginal versus intramuscular progesterone in the prevention of preterm labor and their effect on uterine and fetal blood flow

To compare vaginal with intramuscular progesterone administration to prevent preterm labor and to detect the effect of both on the uterine and fetal circulations. Prospective comparative clinical trial. Eighty three pregnant women at 20–24 weeks gestation at risk of preterm labor were classified into: Thirty six women who received micronized progesterone tablets 200 mg vaginally daily (Group 1), 28 women who received 17 alpha hydroxyl progesterone caproate 250 mg intramuscular once weekly (Group 2), and 19 women who had not received any progesterone and settled as control group. Doppler examination of fetal middle cerebral artery, umbilical artery and uterine artery was done before and one week after progesterone administration, progesterone was continued till 36 weeks pregnancy or delivery. Incidence of preterm delivery, mean gestational age and birth weight at delivery, the need for neonatal intensive care unit admission and neonatal mortality. Doppler indices before and after progesterone administration was also measured and compared in both groups. The incidence of preterm delivery in Group 1 and Group 2 was significantly lower than in the control group (25%, 21.4% and 52%, respectively). A significant decrease in fetal MCA-PI and RI was noted after progesterone administration both vaginally and I.M. But a significant decrease in the mean uterine artery RI and PI was noted only after progesterone was administrated vaginally. Vaginally administrated progesterone was nearly as equally effective as intra muscular progesterone in the prevention of PTL in women at risk and both were associated with significant reduction in fetal MCA-PI and RI, but a significant reduction in uterine artery RI and PI was observed only after vaginal progesterone.

P07.05: Uterine artery blood flow volume growth rate in uncomplicated human pregnancies

Objective: 1) To study uterine artery (UtA) flow (ml/min) growth rate along gestation in normal human pregnancies; 2) to evaluate longitudinal changes of UtA flow expressed per unit estimated fetal weight (EFW) (ml/min/kg). Methods: A cohort of twelve singleton uneventful human pregnancies, with a normal mean UtA PI, was included in this longitudinal study. UtA was evidenced by power-Doppler mode and sampled 10–15 mm prior to bifurcation. UtA diameter was measured on a perpendicular view after removing power-Doppler. UtA PI and velocity were measured with a Doppler beam angle < 30◦. The average of three consecutive diameters and velocities was considered. UtA flow was estimated by the formula Q = hV · πD2/4; h coefficient (0.5) was obtained by an ad hoc mathematical model. UtA total flow (ml/min) (right plus left UtA flow) was then expressed per EFW (ml/min/kg). Using linear interpolation, including random effects for the intercept and the slope of gestational age for each fetus, a linear mixed effects model was fitted. Results: Forty-seven ultrasound examinations were performed. Ultrasound exams were performed at 14.3,b1.2 weeks and every 4 weeks until delivery. Each case was definitively included in the study after recording normal perinatal and neonatal outcomes. UtA total flow (ml/min) showed a significant correlation to gestational age (133.6 ml/min at 15 weeks; 415.9 ml/min at 35 weeks) (p < 0.001), with a linear increase of 14.1 ml/min per week (right UtA 5.4 vs. left UtA 8.7 ml/min per week, p NS). UtA flow per unit EFW (ml/min/kg) showed a significant reduction from 780.3 ml/min/kg at 15 weeks to 144.1 ml/min/kg at 35 weeks (reduction rate 40.3 ml/min/kg per week). Conclusions: UtA flow (ml/min) significantly increased along gestation in this longitudinal cohort of normal pregnancies. UtA flow per unit EFW (ml/min/kg) significantly decreased longitudinally, since UtA flow (ml/min) growth rate was lower than fetal weight gain rate along gestation.