Uterine Artery Doppler Imaging Research Articles

Evaluation of the predictive value of uterine artery doppler in second trimester of pregnancy as a screening tool for preeclampsia

This study was carried out to determine the validity and reliability of Uterine Artery (UtA) Doppler imaging as a screening tool for predicting preeclampsia among pregnant women attending a tertiary care hospital of the Armed Forces in second trimester.Our study was a prospective diagnostic study carried out in 680 pregnant women (age group of 19 to 30 years) in second trimester. Maternal BP was recorded using automated BP apparatus on three occasions (15 minutes apart) in supine posture. This was followed by uterine artery Doppler with measurement of Resistivity index (RI) and Pulsatility index (PI). Patients were followed up every month till 12 weeks post-partum. Statistical analysis was done using SPSS version 21. The mean uterine artery PI was 1.21±0.296 and the mean uterine artery RI value was observed to be 0.58±0.18. The incidence of preeclampsia among the study participants was observed to be 9.9%. The mean uterine artery PI and RI among patient with preeclampsia was found to be significantly higher than those without preeclampsia (p value <0.001). The uterine artery PI values of ≥1.3 when defined as a diagnostic cut off, the sensitivity and specificity was found to be 79.1% and 70.8% respectively. The accuracy was observed to be 71.62%. The uterine artery RI values of ≥0.7 when defined as a diagnostic cut off, the sensitivity and specificity was found to be 44.78% and 89.72% respectively. The accuracy was observed to be 85.29%. Uterine artery PI parameter is found to have better sensitivity than RI in predicting preeclampsia. Consideration of both PI and RI parameters for prediction of preeclampsia significantly increased the specificity of Uterine Artery Doppler Imaging. Uterine Artery Doppler is a useful tool in predicting the risk of preeclampsia among women in second trimester of pregnancy.

Prediction and prevention of preeclampsia by physicians in Brazil: An original study.

Considering the worldwide importance of preeclampsia, especially in Brazil, the screening of pregnant women at greater risk of developing the disease and the application of preventive measures are essential. This study aimed to assess the medical performance in this context in Brazil. A survey was developed to quantify the number of physicians who prescribe acetylsalicylic acid (ASA) and/or calcium for preeclampsia prevention. The survey was sent to all Brazilian obstetricians affiliated to the Brazilian Federation of OBGYN by email and WhatsApp. The survey remained opened for 6 months and included questions about the use of ASA and calcium, as well as about the use of a complementary test to predict preeclampsia. The sample consisted of 360 responding physicians and 100% coverage of responses from physicians from the five different regions of Brazil was obtained. The vast majority of respondents (94.72%) prescribe ASA to prevent preeclampsia, with 80.3% prescribing a dose of 100 mg/day. Calcium is prescribed by 83.9% of the respondents. The majority of the interviewed sample (58.6%) requests uterine artery Doppler imaging to predict preeclampsia and 31.7% do not request any additional test. When the analysis was performed by region, only the northern region differed from the other Brazilian regions regarding the use of ASA and calcium for preeclampsia prevention. While more than 90% of physicians in the other regions prescribe ASA, 40% in the northern region do not use it (p < 0.0001). Regarding calcium, 30% of physicians in northern Brazil do not use the drug for preeclampsia prevention, a percentage that also differs from the other regions where the medication is prescribed by 80 to 90% of physicians (p = 0.021). The vast majority of Brazilian physicians prescribe low-dose aspirin and calcium carbonate to prevent preeclampsia in high-risk pregnant women. In addition to the identification of clinical risk factors, most doctors use Doppler of the uterine arteries as a predictive method. In the northern region of Brazil, physicians use aspirin and calcium less frequently for preventing preeclampsia compared to the rest of the country.

Diagnostic Evaluation of Uterine Artery Doppler Imaging for the Prediction of Early Abnormal Pregnancy

Objective: to assess the predictive value of Doppler imaging of the uterine artery in the identification of early intrauterine abnormal pregnancy as compared to a normal intrauterine pregnancy.&#x0D; Subjects and methods: one hundred and twenty pregnant ladies, at their 6-12 weeks of gestation, with a singleton pregnancy were included in this population-based case-control study. Thirty women with a missed miscarriage, 30 with hydatidiform mole, 30 with a blighted ovum, and 30 as a control group, without risk factors, underwent Doppler interrogation of the uterine arteries. Resistive index (RI), pulsatility index (PI), and the systolic/diastolic ratio (S/D) were measured for both sides. The t-test, or ANOVA test when appropriate, was used to analyze the relationship between the variables.&#x0D; Results: there was a significant reduction of RI mean, PI mean, and S/D ratio among women with different types of abnormal pregnancy compared with the control group. RI and PI mean levels were significantly lower in women with hydatidiform mole and significantly higher in women with missed miscarriage. Lower left S/D mean level was significantly associated with hydatidiform mole and upper left S/D level was associated significantly with control women. For prediction of missed miscarriage; right and left uterine artery RI shows a sensitivity of 80%, 73.3%, a specificity of 68%, 71.1%, and the highest AUC was 0.78 for both.For prediction of molar pregnancy, right and left uterine artery RI showed a sensitivity of 63% for both, a specificity of 54.4%, 60%, and the highest AUC was 0.58, 0.61 respectively.&#x0D; Conclusions: Uterine artery Doppler ultrasonography at 6-12 weeks of gestation is predictive for early pregnancy complications such as missed abortion, hydatidiform mole, and blighted ovum.

Prediction of adverse pregnancy outcomes using uterine artery Doppler imaging at 22-24 weeks of pregnancy: A North Indian experience.

Objective:The aim of this study was to assess the predictive value of uterine artery Doppler imaging at 22-24 weeks of gestation for adverse pregnancy outcomes.Materials and Methods:This was a prospective study in which uterine artery Doppler was performed at 22-24 weeks of gestation in 165 pregnant women with singleton pregnancies. A pulsatility index (PI) more than 1.45 or bilateral uterine notching was labeled as abnormal Doppler. The pregnancy outcome was assessed in terms of normal outcome, preeclampsia, fetal growth restriction (FGR), low birth weight, spontaneous preterm delivery, oligohydramnios, fetal loss or at least one adverse outcome.Results:Out of 165 patients, 35 (21.2%) had abnormal second trimester uterine artery Doppler. In pregnancies that resulted in preeclampsia (PE), (n=21), FGR, (n=21), and low birth weight (n=39), the median uterine artery PI was higher (1.52, 1.41, and 1.27 respectively). In the presence of abnormal Doppler, the risk of PE [OR=10.7, 95% confidence interval (CI): (3.91-29.1); p<0.001], FGR [OR=4.34, 95% CI: (1.62-11.6); p=0.002], low birth weight [OR=6.39, 95% CI: (3.16-12.9); p<0.001] and the risk of at least one obstetric complication [OR=8.73, 95% CI: (3.5-21.3); p<0.001] was significantly high. The positive predictive value of abnormal uterine artery Doppler was highest for preeclampsia (36.84%) among all adverse pregnancy outcomes assessed.Conclusion:Uterine artery Doppler ultrasonography at 22-24 weeks of gestation is a significant predictor of at least one adverse pregnancy outcome, with the highest prediction for preeclampsia.

Maternal demographics and hemodynamics for the prediction of fetal growth restriction at booking, in pregnancies at high risk for placental insufficiency.

Fetal growth restriction (FGR) is associated with poor perinatal outcomes. Screening and prevention tools for FGR, such as uterine artery Doppler imaging and aspirin, underperform in high-risk groups, compared with general antenatal populations. There is a paucity of sensitive screening tests for the early prediction of FGR in high-risk pregnancies. This was a prospective observational study based in a dedicated antenatal hypertension clinic at a tertiary UK hospital. We assessed maternal demographic and central hemodynamic variables as predictors for FGR in a group of women at high risk for placental insufficiency due to chronic hypertension (n = 55) or a history of hypertension in a previous pregnancy (n = 71). Outcome variables were birthweight z-score as well as development of FGR (defined as birthweight below the 5th or 3rd centile). Maternal hemodynamics were assessed using a noninvasive transthoracic bioreactance monitor (Cheetah NICOM). The mean gestation at presentation was 13.6 (range: 8.5-19.5) weeks. Sixteen women delivered babies below the 5th centile. Ten of these were below the 3rd centile. Independent predictors of birthweight z-score were body surface area, peripheral vascular resistance and white ethnicity (R(2) = 0.26, p < 0.0001). Independent predictors of FGR were maternal height and cardiac output. The area under the receiver operator characteristic curve for prediction of FGR was 0.915 (95% CI 0.859-0.972) and 0.9079 (95% CI 0.823-0.990) for FGR below the 5th and 3rd centiles, respectively. In women with chronic hypertension or a history of hypertension in a previous pregnancy, maternal size and cardiac output at booking provide a sensitive screening tool for FGR.

Maternal Arterial Stiffness in Women Who Subsequently Develop Pre-Eclampsia

Background/ObjectivesPre-eclampsia (PE) is associated with profound changes in the maternal cardiovascular system. The aim of the present study was to assess whether alterations in the maternal arterial stiffness precede the onset of PE in at risk women.Methodology/Principal FindingsThis was a cross sectional study involving 70 pregnant women with normal and 70 women with abnormal uterine artery Doppler examination at 22–24 weeks of gestation. All women had their arterial stiffness (augmentation index and pulse wave velocity of the carotid-femoral and carotid-radial parts of the arterial tree) assessed by applanation tonometry in the second trimester of pregnancy, at the time of the uterine artery Doppler imaging. Among the 140 women participating in the study 29 developed PE (PE group) and 111 did not (non-PE group). Compared to the non-PE group, women that developed PE had higher central systolic (94.9±8.6 mmHg vs 104.3±11.1 mmHg; p = <0.01) and diastolic (64.0±6.0 vs 72.4±9.1; p<0.01) blood pressures. All the arterial stiffness indices were adjusted for possible confounders and expressed as multiples of the median (MoM) of the non-PE group. The adjusted median augmentation index was similar between the two groups (p = 0.84). The adjusted median pulse wave velocities were higher in the PE group compared to the non-PE group (carotid-femoral: 1.10±0.14 MoMs vs 0.99±0.11 MoMs; p<0.01 and carotid-radial: 1.08±0.12 MoMs vs 1.0±0.11 MoMs; p<0.01).Conclusions/SignificanceIncreased maternal arterial stiffness, as assessed by pulse wave velocity, predates the development of PE in at risk women.

Hypertensive disorders in pregnancy: screening by uterine artery Doppler imaging and blood pressure at 11–13 weeks

To examine the performance of screening for hypertensive disorders in pregnancy at 11-13 weeks by a combination of the maternal history, uterine artery Doppler imaging and blood pressure. This was a prospective screening study for pre-eclampsia (PE) requiring delivery before 34 weeks (early PE), late PE and gestational hypertension (GH) in women attending for their routine first hospital visit in pregnancy at 11 + 0 to 13 + 6 weeks of gestation. Maternal history was recorded, color flow Doppler imaging was used to identify the uterine artery with the lowest pulsatility index (L-PI) and automated devices were used to measure the mean arterial pressure (MAP). The performance of screening for PE and GH by a combination of the maternal factor-derived a-priori risk, the uterine artery L-PI and MAP was determined. There were 8061 (96.4%) cases unaffected by PE or GH, 165 (2.0%) that developed PE including 37 that required delivery before 34 weeks (early PE) and 128 with late PE, and 140 (1.7%) that developed GH. The MAP was higher in early PE, late PE and GH than in the unaffected group (P < 0.0001), and in early PE than in GH (P = 0.002). The uterine artery L-PI was significantly higher in early PE and late PE than in the unaffected group (P < 0.0001), in early PE than late PE or GH (P < 0.0001), and in GH than in the unaffected group (P = 0.014). In screening by a combination of the maternal factor-derived a-priori risk, uterine artery L-PI and MAP, the estimated detection rate at a 10% false-positive rate was 89.2% (95% CI, 74.6-96.9%) for early PE, 57.0% (95% CI, 48.0-65.7%) for late PE and 50.0% (95% CI, 41.4-58.6%) for GH. Effective screening for hypertensive disorders in pregnancy is provided by a combination of maternal history, uterine artery Doppler imaging and blood pressure at 11-13 weeks.

First-Trimester Prediction of Early Preeclampsia

Preeclampsia, which presents after midgestation, is the most common pregnancy complication associated with serious maternal-fetal morbidity and mortality; and at present the only effective treatment is delivery of the placenta. The ability to predict in very early pregnancy those women at risk for preeclampsia might decrease maternal and fetal morbidity through closer surveillance by physicians experienced or specialized in high-risk obstetrics, as well as delivery at tertiary care centers. Reliable prediction would also permit institution of preventive or treatment regimens, unavailable in 2009, although exciting possibilities are under scrutiny.1 Investigators have been evaluating tests to predict preeclampsia for >50 years without much success.2,3 These have included tests relating to placental perfusion and vascular resistance (eg, the “rollover” and cold pressor tests, as well as uterine artery Doppler evaluation); placental products (eg, proangiogenic and antiangiogenic proteins, human chorionic gonadotropin, placental protein 13, and inhibin A); renal dysfunction (eg, fractional urate clearance and microalbuminuria); and endothelial dysfunction (eg, fibronectin, P- and L-selectin, and vascular cell adhesion molecule 1). The list is enormous, and recently investigators have begun exploring the fields of proteomics and metabolomics for tests to predict preeclampsia. A large systemic review published in 20042 and to be updated in 20093 concluded that no single …

First‐trimester uterine artery Doppler indices in term and preterm pre‐eclampsia

To assess the relationship between first-trimester uterine artery Doppler measurements and the development of term and preterm pre-eclampsia. This prospective study of uterine artery Doppler findings at 11-14 weeks in 3058 singleton pregnancies included 57 and 33 cases of term and preterm pre-eclampsia, respectively. The first-trimester uterine artery resistance index (RI) was significantly higher in women who subsequently developed preterm pre-eclampsia (mean RI, 0.79) than in those with a normal outcome (mean RI, 0.70; P = 0.0001) or those who developed pre-eclampsia at term (mean RI, 0.72; P = 0.002). There were no significant differences in first-trimester mean uterine artery RI (P = 0.136) or prevalence of bilateral notches (P = 0.459) between women who had a normal pregnancy outcome and those who developed pre-eclampsia at term. The receiver-operating characteristics curves for the prediction of term and preterm pre-eclampsia by uterine artery Doppler imaging demonstrated a significant association with development of preterm pre-eclampsia (P = 0.0001; area under the curve (AUC), 0.76; 95% CI, 0.66-0.86) but not term pre-eclampsia (P = 0.25; AUC, 0.54; 95% CI, 0.46-0.63). The uterine artery Doppler data in this study suggest that preterm pre-eclampsia is strongly associated with defective invasion of the spiral arteries, in contrast to the findings in term pre-eclampsia which may be a consequence of placental deterioration at term. Our study findings support, but do not prove, a rigid separation between the etiology of early- and late-onset pre-eclampsia. Although there is a strong relationship between first-trimester uterine artery Doppler indices and the subsequent development of preterm pre-eclampsia, our data do not support its routine introduction into clinical practice.

Outcome of Fetuses With Antenatally Diagnosed Short Femur

Short femur-below the fifth centile for gestational age might reflect inaccurate dating or may be a normal variant in a constitutionally small fetus, but it also has been associated with skeletal dysplasias and chromosomal abnormalities. Recent studies have reported an association between isolated short femur in the second trimester and delivery of a small-for-gestational age infant, possibly as the result of uteroplacental insufficiency. This retrospective study reviewed all pregnancies seen at a tertiary referral unit at 18-24 weeks' gestation with a fetal femur length below the fifth centile for gestational age. The gestational age and the size of the fetal nuchal translucency had been determined as part of a Down syndrome screening test at 11-14 weeks' gestation. Repeated fetal measurements identified 11 fetuses who did not have short femur. Of the 118 remaining cases, detailed ultrasonographic examination demonstrated associated abnormalities in 46, or 39%. Among these cases, the associated conditions were skeletal dysplasia (35%), chromosomal abnormalities (22%), and genetic syndromes (9%). In 35% of cases, the fetus had multiple anomalies without a specific diagnosis. In 72 instances, 61% of the total, short femur was an isolated finding. In 46% of isolated cases, evaluation revealed early, severe intrauterine growth restriction with abnormal umbilical artery Doppler findings, and delivery took place before 37 weeks' gestation. In 90% of these cases, abnormal uterine artery Doppler findings were apparent at the time of presentation. Preeclampsia developed in 36% of these pregnancies, and the rate of intrauterine death was 33%. Both of these events were considerably less frequent when uterine artery Doppler imaging was normal. In pregnancies with short fetal femur, the major determinants of outcome are the presence of other fetal abnormalities and abnormal uterine artery Doppler findings.

Outcome of fetuses with antenatally diagnosed short femur

To examine the outcome of fetuses diagnosed with short femur length at the time of the routine anomaly scan. This was a retrospective review of all pregnancies referred to a tertiary referral unit with fetal femur length below the 5(th) centile for gestation at 18-24 weeks of gestation. All patients had undergone pregnancy dating and assessment of the risk of chromosomal abnormalities by measurement of fetal nuchal translucency at 11 to 13 + 6 weeks. Over 5 years, 129 cases were evaluated. Detailed ultrasound examination showed associated fetal abnormalities in 46 (36%) cases, and these were classified as non-isolated. In this group, skeletal dysplasias (n = 16), chromosomal abnormalities (n = 10) and genetic syndromes (n = 4) were the most common associations. In contrast, there were no cases of chromosomal abnormalities or skeletal dysplasia in the 83 (64%) isolated cases. Early severe intrauterine growth restriction (IUGR) with abnormal umbilical artery Doppler findings and delivery before 37 weeks occurred in 33/83 (40%) cases with isolated short femur, and 90% of these had abnormal uterine artery Doppler findings at the time of presentation. These pregnancies also had high rates of pre-eclampsia (36%) and intrauterine death (33%). Those with normal uterine artery Doppler imaging were at low risk for these complications. In a population previously screened by first-trimester fetal nuchal translucency measurement, the finding of isolated short femur at 18-24 weeks is unlikely to be due to aneuploidy. Severe IUGR associated with high mortality occurs in 40%, making uterine artery Doppler evaluation a useful clinical tool.

Prediction of pre‐eclampsia by uterine artery Doppler imaging: relationship to gestational age at delivery and small‐for‐gestational age

To determine the relationship between pre-eclampsia, small-for-gestational age (SGA) and gestational age at delivery, and the effect of this relationship on the prediction of pre-eclampsia by uterine artery Doppler imaging. This was a multicenter prospective Doppler study of the uterine artery at 22-24 weeks of gestation in unselected women with singleton pregnancies. In the 30,639 pregnancies examined, the median uterine artery pulsatility index (PI) was 1.0 and the 95(th) centile was 1.58. In 614 (2%) cases the woman developed pre-eclampsia and in this group there was an inverse significant association between the gestational age at delivery and prevalence of SGA (r = - 0.99, P < 0.0001), and between the gestational at delivery and mean uterine artery PI (r = - 0.51, P < 0.0001) and prevalence of mean uterine artery PI above the 95(th) centile (r = - 0.99, P < 0.0001). The mean uterine artery PI was above the 95(th) centile in 77.2% of women who developed pre-eclampsia requiring delivery before 34 weeks, in 35.9% of those delivering at 34-37 weeks and in 21.9% of those delivering after 37 weeks. The respective percentages were 82.3%, 46.9% and 28.8% for those with pre-eclampsia and SGA, and 43.8%, 21.2% and 8.4% for those with SGA but without pre-eclampsia. Pre-eclampsia requiring early delivery is more likely to be associated with SGA than less severe pre-eclampsia in women who deliver at term. Doppler ultrasound assessment of the uterine arteries is more effective in identifying pre-eclampsia requiring preterm than term delivery.

Usefulness of a placental profile in high-risk pregnancies

Test the hypothesis that a placental function profile can reassure most high-risk women with normal test results yet accurately can identify a subset of women who are destined for major complications that will be attributable to placental disease. This was a prospective study of 212 high-risk pregnancies that used the placental profile (16- to 18-week maternal serum screening, 18- to 23-week uterine artery Doppler imaging, and placental morphologic condition). Odds ratios (95% CI) were derived for intrauterine fetal death (IUFD), preterm delivery at < 34 weeks of gestation, preeclampsia/hemolysis, elevated liver enzymes, and low platelet count syndrome (HELLP) syndrome, small for gestational age delivery, and early-onset intrauterine growth restriction (IUGR); all normal test results (n =125) were compared with > or = 1 abnormal test results. The odds of the development of adverse outcomes were significantly less in women with all normal test results (preeclampsia/HELLP [odds ratio, 0.2; 95% CI, 0.1-0.4]), preterm delivery (odds ratio, 0.1; 95% CI, 0.06-0.3), small for gestational age delivery (odds ratio, 0.2; 95% CI, 0.09-0.3), early-onset IUGR (0), and IUFD (odds ratio, 0.05 [0.01-0.2]). Combining those women with two (n = 21) of 3 (n = 15) abnormal test results together predicted 14 of 19 severe IUGR and 15 of 22 IUFD cases. This placental function profile at 16-23 weeks of gestation can reassure women with normal test results by identifying a smaller subset of women who are at reduced risk of perinatal morbidity or death from severe IUGR.