Uterine Artery Doppler Parameters Research Articles

ROLE OF DOPPLER ULTRASOUND AT 13 WEEKS GESTATION IN PREDICTION OF PRE-ECLAMPSIA

Objective: The objective of this study was to assess the role of Doppler ultrasound (USG) at 13-week gestation in the prediction of pre-eclampsia (PE) and to assess the mean pulsatility index (PI) in uterine arteries at 13-week Doppler ultrasonography for the early prediction of PE. Methods: This was a observational prospective cohort study in which all the pregnant females at 12–14 weeks gestation were subjected to Doppler waveform analysis on color Doppler USG machines. Obstetric parameters of fetal biometry, mean PI (using the TVS method), and percentiles were calculated using fetal medicine foundation proforma. Reports were categorized as high risk or low risk for the development of PE. Routine USG follow-up scanning was done at 18–20 weeks (Anomaly scan) 24–28 weeks (Growth scan) and 34–36 weeks (Doppler scan) for the development of PE and intrauterine growth restriction. Development or absence of PE was noted. Results: Four hundred antenatal patients were included in the study. The maximum number of patients was in the age group 21–30 years (75.50%). No significant difference in the occurrence of PE in different age groups was found in our study. The incidence of PE was 3.33% (1 out of 30) in patients who developed PE at a later stage. Similar incidence of hypertension was 10% (three out of 30), smoking, and diabetes in 2 and 3 each. The mean uterine artery PI level at 12–14 weeks was 3.11±0.12 in patients who developed PE. In our study, 24 (80%) high-risk (>1:150) and 10 (33.33%) low-risk (≤1:150) patients developed PE. Out of 30, 4 (13.33%) had Apgar 0–3, 6 (20%) had Apgar 4–6, and 20 (66.67%) had Apgar 7–10 in patients who developed PE. Conclusion: High mean uterine artery PI between 12 and 14 weeks gestation is a good predictor of PE and can be used as an effective screening tool. Diastolic notch in the uterine artery and combination of uterine artery Doppler parameters is better in the prediction of PE.

Second-trimester Uterine Artery Doppler Parameters but not Triple Test Analytes, May Predict Gestational Diabetes Mellitus

Second-trimester Uterine Artery Doppler Parameters but not Triple Test Analytes, May Predict Gestational Diabetes Mellitus

Comparative evaluation of placental elasticity in normal pregnancy and pregnancy-induced hypertension and its association with uterine artery pulsatility index and fetal outcome

Background: Pregnancy-induced hypertension (PIH) is associated with significant maternal as well as fetal morbidity and untreated cases may be associated with poor pregnancy outcomes. It brings about various histological and morphological changes in the placenta such as infarcts, fibrosis, and calcification thereby affecting the well-being of fetus. Detection of it at an early stage is important from the point of view of management as early intervention is associated with improved maternal and fetal outcome. Shear wave elastography (SWE) of placenta is a non-invasive investigation that can detect changes in placental elasticity during the pregnancy. Aims and Objectives: The aim of the study was to assess and compare the difference in values of placental elasticity in normal pregnancy and in clinically diagnosed cases of PIH and to study its association with uterine artery-pulsatility index (UtA-PI) and fetal outcome. Materials and Methods: This was a prospective and observational study in which pregnant females with gestational age of 20–34 weeks who were referred to radiology department for routine sonography including the clinically diagnosed pregnancies with PIH were included on the basis of a predefined inclusion and exclusion criteria. A total of 106 individuals were included in the study, B-mode sonography, uterine artery Doppler, and placental SWE were performed in all these patients. All these pregnancies were followed up for the fetal outcome. Results: The mean gestational age of the studied cases was found to be 26.51±4.415 weeks. Higher SWE values were found, as compared to the normal pregnancies, in pregnancies complicated by PIH and the difference was found to be statistically highly significant (P<0.001). Placental SWE showed a strong association with UtA-PI and fetal outcome. Incidence of adverse fetal outcome such as preterm deliveries, intrauterine death, stillbirths, and small for gestational age babies was more commonly seen in PIH group and the difference was statistically significant (P<0.005). Incidence of birth asphyxia (as determined by low APGAR score) and neonatal intensive care unit admissions was more in neonates born to patients with PIH as compared to those in healthy women and the difference was statistically significant (P<0.005). Conclusion: SWE has the potency to detect the changes in placental morphology and can help with diagnosis of pregnancies complicated with PIH. It does have a synergistic role to play alongside the uterine artery Doppler and clinical parameters to predict the pregnancies with PIH.

Comparison of Uterine Artery Dynamics in Normotensive and Hypertensive Pregnancies on Doppler Ultrasound

Background: Hypertension during pregnancy is a common disease that can alter the health of both mothers and fetus. It is a leading cause of maternal, fetal, and neonatal death, as well as an increased risk of having an undesirable pregnancy outcome. Objective: To compare uterine artery dynamics in normotensive and gestational hypertensive pregnancies on Doppler ultrasound. Methodology: A cross-sectional case control study was carried out in Radiology department of District Head Quarter (DHQ) hospital, Faisalabad. Written consent was taken from all patients before the ultrasound examination. The calculated sample size was 98. Patients were assessed for eligibility in inclusion criteria. Confirmation of intrauterine living pregnancy and gestational age was done with routine obstetric ultrasound. Enrolled pregnant patients both normal and hypertensive were assessed for uterine artery Doppler ultrasound examination. Results: Ninety eight women, forty-nine with hypertension and forty-nine normal women participated in the investigation. The comparison of data showed that pre pregnancy weight and mean blood pressure were significantly high in hypertensive group when compared to the normotensive group (P <0.05). Doppler ultrasound also showed that the values of uterine artery parameters such as S/D Ratio, PI, RI was significantly high in hypertensive group when compared to the normotensive group (P <0.05). Conclusion: The Uterine artery Doppler parameters are significantly higher in hypertensive patients as compared to normotensive patients. According to the findings of our study, notching on the right, left, or bilateral, as well as Pulsatility index and Resistivity Index, are diagnostic parameters for evaluating the complications before they worsen. Keywords: Uterine artery, Gestational hypertension, Doppler Ultrasound, Doppler Indices, Pre-Eclampsia

A Comparative Study of Uterine Artery Doppler Parameters and Endometrial Characteristics in Women with Unexplained Infertility and Fertile Women at a Nigerian Teaching Hospital

Objectives: To investigate the uterine artery Doppler parameters and endometrial characteristics in women with unexplained infertility.
 Methods: A prospective case-control study of 42 women with unexplained infertility and 42 fertile controls. Their mid-luteal phase transvaginal Doppler parameters of both uterine arteries and endometrial characteristics (endometrial blood flow, thickness and volume) were investigated and analysed. P values < 0.05 was statistically significant.
 Results: The mean uterine artery pulsatility index (PI) and resistivity index (RI) of the cases (women with unexplained infertility) were significantly higher compared to the values in the fertile controls (PI = 2.81±0.61 vs 2.15±0.65; p=0.001) (RI= 0.87±0.08 vs 0.82±0.07; p=0.003). In addition, the end-diastolic volume (EDV) (6.12±4.17 vs 9.37±5.14; p=0.007) and endometrial-subendometrial blood flow (p=0.036) were significantly lower in the cases compared to the controls. Multivariate logistics analysis showed that PI was independently associated with infertile status (p=0.006). There was no significant difference in the mean PSV (48.69±10.9 vs 50.58±11.30; p=0.602), endometrial thickness (10.30+3.13 vs 10.72+3.10; p=0.544), endometrial volume (7.82+1.56 vs 8.23+1.71; p=0.323), mean age (32.28±4.062 vs 31.91±3.58 years; p=0.502), body mass index (26.15±2.71kg/m2 vs 25.24±2.85 kg/m2; p=0.18) menstrual bleeding days (4.07±0.89 days vs 4.02±0.95 days; p=0.481) duration of menstrual cycle (28.02±1.09 days vs 27.64±1.36 days; p= 0.162), smoking history (p=0.909) and alcohol intake (p=0.507) of the infertile women compared with the fertile controls, respectively.
 Conclusion: Women with unexplained infertility have increased uterine artery Doppler PI and RI and reduced endometrial-subendometrial perfusion compared with fertile controls.
 Authors
 A E Smart 1, G O Obajimi 2, A J Adekanmi 3 4, M O Obajimi 3

Role of placental, fetal and maternal cardiovascular markers in predicting adverse outcome in women with suspected or confirmed pre-eclampsia.

To assess the performance of placental, fetal and maternal cardiovascular markers in the prediction of adverse perinatal and maternal outcomes in women with suspected or confirmed pre-eclampsia. This was a prospective prognostic accuracy study of women with suspected or confirmed pre-eclampsia who underwent a series of investigations to measure maternal hemodynamic indices, mean arterial pressure, augmentation index, ophthalmic artery peak systolic velocity (PSV) ratio, uterine artery pulsatility index (UtA-PI), fetal biometric and Doppler parameters, soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF). The performance of these markers, individually or in combination, in predicting adverse perinatal and maternal outcomes was then assessed using receiver-operating-characteristics (ROC)-curve analysis. Adverse maternal outcome was defined as one or more of severe hypertension, admission to the intensive care unit, eclampsia, placental abruption, HELLP syndrome, disseminated intravascular coagulation, platelets < 100 × 109 /L, creatinine > 90 μmol/L and alanine aminotransferase > 100 U/L. Adverse perinatal outcome was defined as one or more of preterm birth at or before 34 + 0 weeks, neonatal intensive care unit admission for > 48 h, respiratory distress syndrome, intraventricular hemorrhage, hypoxic ischemic encephalopathy, necrotizing enterocolitis, retinopathy of prematurity and confirmed fetal infection. We recruited 126 women with suspected (n = 31) or confirmed (n = 95) pre-eclampsia at a median gestational age of 33.9 weeks (interquartile range, 30.9-36.3 weeks). Pregnancies with adverse perinatal outcome compared to those without had a higher median UtA-PI (1.3 vs 0.8; P < 0.001), ophthalmic artery PSV ratio (0.8 vs 0.7; P = 0.01) and umbilical artery PI percentile (82.0 vs 68.5; P < 0.01) and lower median estimated fetal weight percentile (4.0 vs 43.0; P < 0.001), abdominal circumference percentile (4.0 vs 63.0; P < 0.001), middle cerebral artery PI percentile (28.0 vs 58.5; P < 0.001) and cerebroplacental ratio percentile (18.0 vs 46.5; P < 0.001). Pregnancies with adverse perinatal outcome also had a higher median sFlt-1 (8208.0 pg/mL vs 4508.0 pg/mL; P < 0.001), lower PlGF (27.2 pg/mL vs 76.3 pg/mL; P < 0.001) and a higher sFlt-1/PlGF ratio (445.4 vs 74.4; P < 0.001). The best performing individual marker for predicting adverse perinatal outcome was the sFlt-1/PlGF ratio (area under the ROC curve (AUC), 0.87 (95% CI, 0.81-0.93)), followed by estimated fetal weight (AUC, 0.81 (95% CI, 0.73-0.89)). Women who experienced adverse maternal outcome had a higher median sFlt-1 level (7471.0 pg/mL vs 5131.0 pg/mL; P < 0.001) and sFlt-1/PlGF ratio (204.3 vs 93.3; P < 0.001) and a lower PlGF level (37.0 pg/mL vs 66.1 pg/mL; P = 0.01) and estimated fetal weight percentile (16.5 vs 37.0; P = 0.04). All markers performed poorly in predicting adverse maternal outcome, with sFlt-1 (AUC, 0.69 (95% CI, 0.60-0.79)) and sFlt-1/PlGF ratio (AUC, 0.69 (95% CI, 0.59-0.78)) demonstrating the best individual performance. The addition of cardiovascular, fetal or other placental indices to the sFlt-1/PlGF ratio did not improve the prediction of adverse maternal or perinatal outcomes. The sFlt-1/PlGF ratio performs well in predicting adverse perinatal outcomes but is a poor predictor of adverse maternal outcomes in women with suspected or diagnosed pre-eclampsia. The addition of cardiovascular or fetal indices to the model is unlikely to improve the prognostic performance of the sFlt-1/PlGF ratio. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Endometrial thickness and uterine artery Doppler parameters as soft markers for prediction of endometrial cancer in postmenopausal bleeding women: a cross-sectional study at tertiary referral hospitals from Vietnam.

ObjectiveTo determine the value of endometrial thickness (ET) and Doppler indices of uterine artery (UtA) as sonographic markers in predicting endometrial cancer (EC) among postmenopausal bleeding (PMB) women in low-resource settings as Vietnam.MethodsThis cross-sectional study was conducted at the Hue University Hospital and Hue Central Hospital between June 2016 and June 2019. The study enrolled all women who complained of PMB and were followed by transvaginal Doppler ultrasound. Their definitive histopathological examination was the gold standard for comparison.ResultsThe UtA Doppler indices, including resistance index (RI), pulsatility index (PI), and peak systolic velocity (PSV), were significantly lower in the malignant group than in the benign group. The threshold values of the UtA, RI ≤0.73 and PI ≤1.42, were found with an area under receiver operating characteristic curve (AUC) of 0.85–0.88, and the sensitivity and specificity were 91.3% and 83.3%, respectively. Unlike PSV, the diagnostic value was the lowest, with an AUC of 0.72. ET was a good predictor for the diagnosis of EC, with an AUC of 0.89. In women with PMB, when using the cutoff value of EC more than 12.5 mm, the sensitivity and specificity were 93.8% and 77.8%, respectively. In addition, the higher the stage of EC, the lower the RI and PI and the greater the EC.ConclusionET, and RI, PI, and PSV of the UtA could help in differentiating malignant from benign endometrial changes. Pulsed ultrasonic Doppler velocimetry seems to play a role in predicting the higher stages of EC. Further studies are needed to confirm these findings.

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

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

Marijuana use, fetal growth, and uterine artery Dopplers

Objective Marijuana (MJ) use is associated with adverse effects on fetal growth. We aimed to investigate the timing of suboptimal fetal growth onset in MJ-exposed pregnancies. In addition, we aimed to explore the relationship between MJ-exposure and both abnormal uterine artery (UtA) Doppler parameters and small for gestational age (SGA). Study design This was a secondary analysis of a prospective multicenter cohort that enrolled nulliparous individuals delivering non-anomalous fetuses beyond 20 weeks’ gestation. Marijuana exposure was ascertained by self-report or clinical urine toxicology testing. Ultrasound estimated fetal weights (EFWs) were assessed in participants at both 16w0d–21w6d and 22w0d–29w6d. EFWs and birth weight (BW) were converted to weight percentiles (wPCT). EFW and BW wPCTs were calculated using population-based standards. Additionally, a customized standard designed to be applicable to both EFWs and BWs within the same model was also used to allow for EFW to BW percentile trajectories. The primary outcome, longitudinal wPCT, was compared between individuals with and without MJ use in a linear mixed-effects regression model adjusting for tobacco. For modeling, wPCT was smoothed across gestational age; MJ was estimated as an intercept and linear difference in the slope of gestational age. UtA Doppler notching, resistance index (RI), and pulsatility index (PI) at 16w0d–21w6d were compared using t-test and χ 2. SGA at delivery was also compared. Results Nine thousand one hundred and sixty-three individuals met inclusion criteria; 136 (1.5%) used MJ during pregnancy. Individuals who used MJ were more likely to be younger, identify as non-Hispanic Black, and have had less education. Fetuses exposed to MJ had lower wPCT beginning at 28 weeks using population-based and customized standards, when compared to those without exposure. UtA notching, PI, and RI were similar between groups. SGA was more frequent in neonates exposed to MJ using both population-based (22 vs. 9%, p<.001) and customized (25 vs. 14%, p<.001) curves. Conclusions MJ-exposed fetuses were estimated to be smaller than unexposed fetuses starting at 28 weeks’ gestation across both growth standards without a difference in UtA Doppler parameters.

Mid-luteal uterine artery Doppler indices in the prediction of pregnancy outcome in nulliparous women undergoing assisted reproduction

Traditionally, the assessment of endometrial receptivity at transvaginal ultrasound scan has been based on the thickness and the morphological appearance of the endometrium. The objective of this study was to prospectively evaluate endometrial thickness (ET), endometrial morphology and uterine artery Doppler parameters prior to assisted reproduction treatment (ART) in the prediction of pregnancy outcome. This was a prospective cohort study. ET, morphology and uterine artery Doppler (UtAD) pulsatility index (PI) and resistance index (RI) were measured in the mid-luteal stage of the menstrual cycle ultrasonographically, timed with urinary luteinizing hormone testing. A total of 50 women were included in the analysis. The clinical pregnancy rate (CPR) per embryo transfer was 42.0% (n = 21/50). Twenty nine women (58.0%) had an unsuccessful outcome. There were no differences in mean ± SD endometrial thickness (ET) (10.0 ± 1.8 mm vs. 10.5 ± 2.4; p = 0.43), or endometrial morphology (100% (n = 21) vs 100% (n = 29); p = 1.00) between the pregnant and not pregnant groups. Similarly, there were no differences in mean ± SD UtAD PI (2.17 ± 0.83 vs. 2.07 ± 0.81; p = 0.67 or mean ± SD UtAD RI (0.84 ± 0.10 vs. 0.81 ± 0.10; p = 0.30). Ultrasonographic endometrial assessment did not differentiate between those who would have a subsequent clinical pregnancy.

The effect of 75-g oral glucose tolerance test on maternal and foetal Doppler parameters in healthy pregnancies: a cross-sectional observational study

Hyperglycaemia can alter placental resistance to blood flow and hyperglycaemia has adverse perinatal outcomes. Oral glucose tolerance testing (OGTT) increases the maternal plasma glucose levels temporarily and mimics metabolic hyperglycaemia. The blood flow of the uterine artery (UtA), umbilical artery (UA), middle cerebral artery (MCA) were assessed before, 1 and 2 h following the OGTT by using Doppler ultrasonography. Z-score of cerebroplacental ratio (CPR), pulsatility index (PI) for three vessels were evaluated separately. All measurements of the MCA, UA, UtA Doppler parameters were not statistically different for fasting, and 1 and 2 h following the 75 g OGTT in the 53 pregnant women with a singleton gestation in the low-risk group. This study results show that acute hyperglycaemia induced by OGTT has no effect on maternal and foetal Doppler parameters in healthy pregnancies. IMPACT STATEMENT What is already known on this subject? Foetal glucose is affected by maternal blood glucose concentrations and placental blood flow. Acute hyperglycaemia may have an effect on maternal, and foetal Doppler parameters among healthy pregnancies What do the results of this study add? Our findings indicate that blood flow velocity metric measurements in the UA, MCA and UtA were not affected by the OGTT in healthy pregnant women. What are the implications of these findings for clinical practice and/or further research? Acute hyperglycaemia induced by OGTT does not have any effect on fetomaternal circulation, especially foetal brain blood flow. Other foetal vessels including ductus venosus, renal artery, etc. may be affected by maternal blood glucose levels during the OGTT or in diabetic patients. Future prospective studies consisting of diabetic patients are warranted to verify the exact effect of glucose levels on foetal and maternal circulation.

To study the role of mean arterial pressure, urine calcium creatinine ratio and uterine artery Doppler between 20 -24 weeks of gestation in predicting preeclampsia

Introduction: Pre-eclampsia affects 3–5% of all pregnancies1-9 and is a leading cause of maternal morbidity and mortality (12% of all maternal deaths) and also leads to perinatal consequences. The initial pathological changes of preeclampsia begin in the late first trimester leading to chronic placental insufficiency. Hence prediction of preeclampsia in early gestation is of great interest, as early therapeutical intervention such as aspirin3-6 might reduce the risk of preeclampsia. So in our study, we aim to ascertain the role of mean arterial pressure (clinical), urine calcium creatinine ratio (biochemical) and uterine artery Doppler (radiological) parameters in predicting preeclampsia. Aims and Objectives: To study mean arterial pressure, spot urine calcium creatinine ratio, Doppler of uterine artery between 20-24 weeks of gestational age as predictor of preeclampsia and to know the effectiveness of combination of above parameters in predicting preeclampsia. Materials and Methods: It was a prospective study involving 100 low risk pregnant women of any parity with gestational age of 20-24 weeks. All study individuals were followed till term and the end point of the study was considered to be the development of preeclampsia as per the ACOG criteria 2013. Results: All parameters (mean arterial pressure, urine calcium creatinine ratio and uterine artery Doppler) were individually found to be statistically significant predictor. Doppler of uterine artery was found to be a better predictor of preeclampsia when compared to mean arterial pressure and urine calcium creatinine ratio individually. Combination of all three parameters was found to be the better predictor than individual parameter. Keywords: Preeclampsia, Mean arterial pressure, Urine calcium creatinine ratio and uterine artery Doppler.

Antepartum and postpartum uterine artery impedance in women with pre-eclampsia: a case control study

This is a cohort study which included 100 cases with pre-eclampsia (PE) and 100 controls, done to compare the antepartum and postpartum uterine artery (UtA) Doppler velocimetry between them. UtA PI and RI were measured before and within 48–72 h after delivery. There was a highly significant difference between the cases and controls, regarding the UtA RI (0.70 ± 0.10 and 0.72 ± 0.10, versus 0.59 ± 0.12 and 0.60 ± 0.11) and PI (1.41 ± 0.89 and 1.45 ± 0.90 versus 0.85 ± 0.30 and 0.90 ± 0.34) measured at the antepartum and postpartum periods, respectively. Age and gestational age were significantly related to the postpartum and changes in the UtA PI. The gestational age was also correlated to UtA RI changes. Both the antepartum and postpartum mean blood pressure were correlated with postpartum UtA RI and PI and PI changes after delivery. We concluded that uterine artery Doppler indices changes are more common in women with PE, than in normotensive women with significant correlations with age and gestational age. Impact statement What is already known on this subject? After delivery, the haemodynamic changes that occurred with pregnancy reverse. Both the heart rate and the cardiac output decreased to reach the non-pregnant state. Impedance to flow in the uterine artery rises as the nutritional needs are decreased abruptly. What do the results of this study add? Both the antepartum and postpartum measurement of uterine artery Doppler indices is significantly higher in women with PE when compared to control women. The persistent uterine artery impedance is a result of inadequate trophoblastic invasion within the basal part of the decidua basalis and myometrium or persistently increased maternal vascular tone. What are the implications of these findings for clinical practice and/or further research? The uterine artery Doppler parameters return to the non-pregnant values in normal pregnancies. Knowing such information may help in understanding the haemodynamics of the uterine vasculature during puerperium in hypertensive patients.

To study the changes in maternal hemodynamics with intravenous labetalol or nifedipine in acute severe hypertension.

To study the maternal hemodynamic changes in acute severe hypertension after treatment with intravenous labetalol or oral nifedipine using color doppler ultrasound. We evaluated thirty pregnant women with gestational age between 28 and 40weeks in acute severe hypertension (more than or equal to 160/105mmHg) which were randomly allocated to receive either intravenous labetalol or oral nifedipine until blood pressure was lowered to less than or equal to 140/90mmHg. Doppler vascular indices namely pulsatility index, resistance index, S/D ratio of bilateral uterine arteries and maternal renal artery were measured baseline at the time of acute severe hypertension and repeated after control of blood pressure, to assess the changes in maternal hemodynamics if any with labetalol or nifedipine. When evaluating right uterine artery Doppler parameters, a trend to increase in PI and RI was observed in those who received labetalol and nifedipine however the difference was not statistically significant. Whereas, while evaluating left uterine artery indices a trend to decrease PI was seen in nifedipine group but the difference was not statistically significant. On intergroup comparison there was no any significant change in any of uterine artery as well as renal artery indices in either group. The use of labetalol and nifedipine were not related to any significant changes in maternal Doppler, which is reassuring about the safety of these drugs when treating acute severe hypertension in pregnancy.

Plasma antioxidant enzyme levels in smoker and non-smoker pregnant women and their correlation with uterine arterial Doppler parameters

Introduction: Cigarettes contain many free radicals and cause oxidative stress in the body. Its contents decrease blood fluidity and blood stream by affecting the vascular endothelium; further, they directly or indirectly impair placental perfusion. Material and Method: Catalase (CAT), malondialdehyde (MDA) and total sulfhydryl (SH) levels were analysed in venous blood specimens obtained from 49 smoker and 35 non-smoker pregnant women (age, 18-35 y) who were in the second trimester. Uterine arterial Doppler ultrasonography was performed to evaluate uterine perfusion. Pulsatile index (PI), resistance index (RI) and systole/diastole ratio (S/D) was measured. The smoker group was further subdivided into two groups: 1. those who smoked for 5 y. Obtained data were analysed using the SPSS 11 statistical programme. Results: No significant differences were observed between the smoker and non-smoker groups in terms of demographic parameters and right–left uterine arterial Doppler parameters. The mean S/D ratio was significantly higher in the smoker group (P=0.01). The mean PI, mean RI and plasma MDA, CAT and total SH levels were similar in both groups. Although not statistically significant, the mean PI, RI and S/D ratio values of the smoker pregnant women who smoked for ≥ 5 y was found to be higher than of those who smoked for <5 y. Conclusion: There is no correlation between plasma antioxidant enzyme levels and uterine artery Doppler parameters; however, the duration of smoking may affect uterine perfusion.

EP16.18: Pregnancy association of abnormal Doppler indices with inherited thrombophilia

Thrombophilia reflects a hypercoagulable condition with an increased thrombogenic potential during pregnancy. The most frequent causes of inherited thrombophilia are the factor V Leiden mutation and the prothrombin gene mutation. Repetitively, it has been hypothesised that thrombophilic mutations associate an increased risk of thrombosis at the low flow maternal-placental interface resulting in placenta-mediated complications, such as miscarriage, fetal loss, pre-eclampsia, fetal growth impairment, and abruption. Our prospective study aimed to determine the impact of thrombophilic mutations on second and third trimester umbilical and uterine artery Doppler parameters. Four hundred and forty-eight pregnant women were tested for the presence of factor V Leiden mutation, prothrombin gene mutation and also for a series of minor thrombophilic mutations. Each patient included in the study has been examined by ultrasound corresponding to its gestational age with the measurement of umbilical and uterine artery velocity. The measured parameters (pulsatility index and resistivity index) were interpreted consistent with gestational age nomograms. The incidence of factor V Leiden mutation was 10.4% in the studied group and the incidence of the prothrombin gene mutation was 4.46%; 11 cases (2.4%) expressed both major mutation. In 6.6% of cases corresponding to second trimester pregnancies with factor V Leiden mutation an increased pulsatility index of umbilical artery was found and 11% of these cases had a high pulsatility index of the uterine artery. For the cases with both major thrombophilic mutations present, Doppler parameters were increased in 4 from 6 cases. Even if inherited thrombophilia is not considered a major risk factor for most adverse pregnancy outcomes, Doppler assessment of fetal status is imperative for high-risk population. In our study, the impact of thrombophilia on Doppler indices was modest and limited to major mutations.

OP 33 Correlation between uterine artery Doppler parameters and sFlt-1/PlGF ratio in different types of hypertensive pregnancy disorders

Introduction The underlying pathology of hypertensive pregnancy disorders is a failure in trophoblast invasion and spiral artery remodeling. This leads to a misbalanced release of antiangiogenic sFlt-1 and angiogenic PlGF placental factors and to a high resistance and low compliance to uterine artery blood flow. Consequently, in hypertensive pregnancy disorders, sFlt-1/PlGF ratio and uteroplacental impedance are increased. Objective To explore correlations between sFlt-1/PlGF ratio and uterine artery Doppler parameters in pregnancies complicated by different types of hypertensive pregnancy disorders. Patients and methods We performed prospective observational study to derive and calculate sFlt-1/PlGF ratio and to measure uterine artery resistance index (RI-AtU) and pulsatility index (PI-AtU) in singleton pregnancies in whom preeclampsia (PE), preeclampsia with intrauterine growth retardation (PE (+IUGR)), or intrauterine growth retardation (IUGR) was suspected on admittance after 24 weeks 0 days. For statistical analyses, we used multiple comparisons (Bonferroni test) and Sperman’s rho. Results Demographic and clinical characteristics are presented in Fig. 1. Values for sFlt-1/PlGF ratio, RI-AtU and PI-AtU are presented in Fig. 2. Log values of sFlt-1/PlGF ratio were not significantly different among groups. Average RI-AtU and PI-AtU were significantly higher in PE(+IUGR) compared to PE (p = 0.28; p = 0.05; respectively) but were not significantly different between IUGR and PE, or IUGR and PE (+IUGR). In PE, RI-AtU and PI-AtU were significantly positively correlated with sFlt-1/PlGF ratio (p = 0.01; p = 0.050; respectively). In IUGR, only RI-AtU was significantly positively correlated with sFlt-1/PlGF ratio (p = 0.041). In PE (+IUGR), neither RI-AtU nor PI-AtU were correlated with sFlt-1/PlGF ratio. Conclusion Differences in correlations between sFlt-1/PlGF ratio and uterine artery Doppler parameters suggest that PE might be a decompensation phase of beforehand healthy cardiovascular system due to uteroplacental vascular pathology. However, PE (+IUGR) and IUGR might be a consequence of various degrees of preexisting systemic cardiovascular pathology which might lead to various degrees of uteroplacental pathology. Download : Download high-res image (367KB) Download : Download full-size image Download : Download high-res image (349KB) Download : Download full-size image

First trimester uterine artery Doppler, sFlt-1 and PlGF to predict preeclampsia in a high-risk population

Objective: The study aims to evaluate the accuracy of combining uterine artery Doppler (UAD), PlGF and sFlt-1 in the first trimester for preeclampsia screening.Methods: Prospectively enrolled women at high risk of preeclampsia were included. Transabdominal UAD measurements and serum biomarkers were collected between 11 and 13 weeks of gestation in three university hospitals and in one general hospital. The main outcome was preeclampsia. UAD parameters and biomarker levels among women with preeclampsia were compared with those of women in the unaffected group in univariate and multivariate analyses.Results: Out of 226 women included from May 2007 to January 2011, 27 (11.9%) women developed preeclampsia. Among women affected by preeclampsia, the lowest pulsatility index was higher (p = 0.02), bilateral notching was more frequent (p = 0.01), and PlGF was lower (p < 0.001). No significant differences were observed for other indicators. The multivariate model, adjusted for laboratory and sonographic indicators, had an area under the curve (AUC) estimated at 0.76, which was not significantly different from the AUC of the univariate model adjusted only for PlGF (p = 0.7).Conclusion: In a high-risk population, PlGF in the first trimester is useful for predicting preeclampsia, but neither sFlt-1 nor any UAD indices improved the prediction of preeclampsia.

Arterial Resistance in Late First Trimester as a Predictor of Subsequent Pregnancy-Related Hypertension.

This study aimed to examine the association between indicators of arterial resistance occurring late in the first trimester and the subsequent development of pregnancy-related hypertension. This study took place between May 2014 and August 2015 and included 329 consecutive women with singleton pregnancies attending the antenatal clinics of a medical college in Karnataka, India, during this period. Pulse pressure (PP) and uterine artery Doppler parameters were recorded between 11-14 gestational weeks. Consequently, women were followed-up until after delivery for subsequent hypertension. Hypertension occurred more frequently if PP was high (17.6% versus 14.4% of pregnancies without high PP; P = 0.713), if a diastolic notch (DN) was present (15.1% versus 12.8% of pregnancies with an absent DN; P = 0.612) and if the resistive index (RI) was raised (22.2% versus 14.3% of pregnancies without raised RI; P = 0.366). A raised pulsatility index (PI) was significantly associated with hypertension (P = 0.013). The risk of hypertension was approximately seven-fold higher if two or more arterial resistance indicators were used, except with a present DN plus a raised RI or a present DN plus high PP. All arterial resistance indicators showed negative predictability (>85.6%) and good specificity (≥95.0%), except for the presence of a DN. A population-specific cut-off PI value of 1.72 had high negative predictability (92.8%) and good sensitivity (70.8%) and specificity (65.1%). Raised PI in the late first trimester was a significant predictor of hypertension later in pregnancy. A combination of arterial resistance indicators may enhance prediction of subsequent hypertension.

Evaluation of biochemical markers combined with uterine artery Doppler parameters in fetuses with growth restriction: a case–control study

Assessing the biochemical markers levels and the uterine artery Doppler (UtA) parameters in fetuses with growth restriction (FGR). Prospective case-control study included 66 patients with diagnosis of FGR and 64 healthy pregnancies at 24-41weeks of gestation. For both groups, maternal circulating concentrations of biochemical factors of soluble fms-like tyrosine kinase-1 (sFlt-1), soluble endoglin(sEng), adiponectin, A disintegrin and metalloproteinases (ADAM-12), pregnancy-associated plasma protein-A (PAPP-A), angiopoietin-2 (ANGI-2), vascular endothelial growth factor (VEGF) and transforming growth factor-β (TGF-β) were assayed by ELISA and UtA by Doppler were performed. ANOVA, Mann-Whitney tests and Pearson correlation coefficient were applied to compare the biochemical factors, UtA Doppler and EFW Z-score between the groups. Concentrations of sFlt-1, sEng, PAPP-A were significantly higher in FGR than controls (p<0.0001, p=0.02 and p=0.03, respectively), but concentration of ANGI-2 (p<0.0001) was significantly lower in FGR than controls and ADAM-12 levels had a tendency to be lower in the FGR, though not statistically significant (p=0.059). Increased sEng concentrations were correlated with abnormal UtA Doppler in FGR. Fetal growth restriction fetuses showed increased serum levels of sFlt-1, sEng and PAPP-A with levels of ANGI-2 decreased and a positive association between elevated concentrations of sEng and changing impedance of UtA Doppler were observed.