Value Of Uterine Artery Doppler Research Articles

The predictive value of uterine artery Doppler in the success rate of pregnancy from the first frozen embryo transfer during the implantation window

BackgroundWorldwide, frozen embryo transfer (FET) has become a new strategy for the treatment of infertility. The success of FET is closely related to endometrial receptivity. Does uterine artery Doppler during the implantation window predict pregnancy outcome from the first FET?MethodsA total of 115 retrospectively collected cycles were included in the study, with 64 cycles of clinical pregnancy and 51 cycles of nonclinical pregnancy; There were 99 nonabsent end-diastolic flow (NAEDF) cycles and 16 absent end-diastolic flow (AEDF) cycles. The differences in uterine artery Doppler findings between different pregnancy outcomes were investigated. The clinical pregnancy rate and spontaneous abortion rate in the NAEDF and AEDF groups were compared. The predictive value of uterine artery Doppler during the implantation window in the success rate of pregnancy from the first FET was also investigated.ResultsBetween the clinical pregnancy group and the nonclinical pregnancy group, there were no significant differences in the mean resistance index (mRI) (Z = -1.065, p = 0.287), mean pulsatility index (mPI) (Z = -0.340, p = 0.734), and mean peak systolic/end-diastolic velocity(mS/D) (Z = -0.953, p = 0.341); there were significant differences in the mean peak systolic velocity (mPSV) (Z = -1.982, p = 0.048) and mean end-diastolic velocity (mEDV) (Z = -2.767, p = 0.006). Between the NAEDF and AEDF groups, there was no significant difference in the clinical pregnancy rate (χ2 = 0.003, p = 0.959), and there was a significant difference in the spontaneous abortion rate (χ2 = 3.465, p = 0.019). Compared with uterine artery Doppler alone, its combination with artificial abortion history, waist-to-hip ratio, LH (Luteinizing hormone) of P (Progesterone) administration day, mPSV and mEDV had a higher predictive value regarding clinical pregnancy from the first FET [ROC-AUC 0.782, 95% CI (0.680–0.883) vs. 0.692, 95% CI (0.587–0.797)].ConclusionsUterine artery Doppler, particularly mPSV and mEDV during the implantation window, was useful for predicting clinical pregnancy, and AEDF was related to spontaneous abortion in the first trimester. Uterine artery Doppler combined with artificial abortion history, waist-to-hip ratio, LH of P administration day, mPSV and mEDV have a higher predictive value than uterine artery Doppler alone regarding the pregnancy from the first FET.

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.

Use of uterine artery Doppler velocimetry values to predict pregnancy in clomiphene citrate-induced intrauterine insemination cycles in patients with polycystic ovary syndrome

Objective: The aim of this study is to investigate the effectiveness of uterine artery Doppler velocimetry values to predict pregnancy in clomiphene citrate-induced intrauterine insemination cycles (IUI) in patients with polycystic ovary syndrome (PCOS). Materials and methods: Patients with PCOS who applied to the infertility outpatient clinic between 01/06/2020 and 31/11/2021 were included in this prospective interventional study. For ovulation induction, patients used clomiphene citrate (CC) 50-150 mg daily between days 5 and 9 of the cycle. When at least one dominant follicle of 17 mm or larger was detected in serial transvaginal ultrasound controls, ovulation was triggered and IUI was performed 36 hours later. Uterine artery flow Resistance Index (RI), Pulsatility Index (PI) and systolic-diastolic ratio (S/D) were evaluated with Doppler ultrasound in all patients on the 3rd day of the cycle and on the trigger day. Uterine artery Doppler values of the group that achieved pregnancy and those who could not conceive were compared as the main outcome of the study. Results: The study was designed on 56 cycles in which IUI can be performed after ovulation induction. In these 56 cycles, 10 pregnancy were obtained and the clinical pregnancy rate was 17.9%. The pregnant and non-pregnant groups were similar in terms of demographic characteristics, basal hormone levels, basal period and trigger day endometrial thickness, follicle number and mean dominant follicle diameter (p>0.005). There was no significant difference in mean uterine artery Doppler values (PI, RI and S/D) measured on the 3rd day of the cycle and on the trigger day between the pregnant and non-pregnant groups (p>0.005). Conclusion: Considering the hormonal changes in stimulated cycles and the effect of CC itself on endometrial receptivity, we think that only uterine artery Doppler values are not effective in predicting pregnancy success in CC-induced IUI cycles in patients with PCOS.

Use of uterine artery Doppler velocimetry values to predict pregnancy in intrauterine insemination cycles in couples with unexplained infertility

Background/Aim: It is known that pregnancy success in IUI cycles performed in couples with unexplained infertility is below 20% even under the best conditions. Predicting the success in IUI cycles and directing patients to appropriate assisted reproductive treatment is essential for the time and budget. In this context, we aimed to investigate the use of uterine artery Doppler velocimetry values to predict pregnancy in intrauterine insemination (IUI) cycles in couples with unexplained infertility. Methods: In this prospective cohort study, couples with unexplained infertility were randomly assigned to two groups: clomiphene citrate (CC) and gonadotropin. The CC group used 50-150 mg CC daily between the 5th and 9th days of the menstrual period, while the gonadotropin group used 37.5-75 IU of recFSH daily from the 3rd day of the menstrual period until the dominant follicle developed. Ovulation was triggered by recHcg when at least one dominant follicle of 17 mm or larger was detected. Intrauterine insemination was performed 36 hours after the trigger. Uterine artery flow pulsatility index (PI), resistance index (RI)and the systolic-diastolic ratio (S/D) were measured in all patients by Doppler ultrasound on the 3rd day of menstruation and trigger day. Uterine artery Doppler values of the group that achieved pregnancy and those who could not conceive were compared as the main outcome of the study. Results: The study was designed over 143 IUI cycles, 89 cycles in the gonadotropin group and 54 cycles in the CC group. In 143 IUI cycles, 24 (16%) pregnancies were obtained, seven (12%) in the CC group and 17 (12%) in the gonadotropin group. In both CC and gonadotropin cycles, mean age, BMI, duration of infertility, hormone levels on the third day of menstruation, endometrial thickness on 3rd day of menstruation and on the trigger day, dominant follicle number and mean follicle diameter were similar in the pregnant and non-pregnant groups (P<0.05). There was no statistical difference in uterine artery Doppler values (RI, PI and S/D) measured neither on the 3rd day of the cycle nor on the trigger day between pregnant and non-pregnant groups in patients receiving CC or gonadotropin (P<0.05). Conclusion: Considering the hormonal changes in stimulated cycles or other factors that may have an impact on endometrial blood flow and endometrial receptivity, we think that only uterine artery Doppler velocity measurement values are not effective in predicting pregnancy success in CC or gonadotropin-induced IUI cycles.

Diagnosis of Placenta Accreta by Uterine Artery Doppler Velicometry in Patients with Placenta Previa

Background: Placenta accreta occurs in the complete or partial absence of the decidua basalis. Women with previous cesarean delivery or placenta previa are known to be at greater risk of placenta accreta. Objectives: to evaluate ultrasound accuracy in diagnosing placenta accreta and its variants and to detect the potential value of uterine artery Doppler in diagnosing placenta accreta and to assess the impact of antenatal diagnosis in Egyptian population. Patients and Methods: This prospective study was conducted on (100) pregnant women diagnosed as placenta previa by ultrasonography and were candidates for either emergency or elective repeated CS or hysterectomy (if the diagnosis of placenta accreta is confirmed). All these patients were randomly selected from the Obstetrics Clinic at Beni-Suef General Hospital during their 3rd trimester. The study was approved by the medical ethics committee of Al-Azhar University academic and ethical committee and a written informed consent was obtained from all patients. Results: The results obtained from this study indicated no statistically significant differences regarding the mean values of uterine artery Doppler PI and RI between cases of placenta accreta and non accreta (p value =.078 & 0.58 respectively) in correlation with histopathological assessment. Our results showed no statistically significant correlation regarding mean values of uterine artery Doppler PI and RI between cases of placenta accreta and placenta non accreta (p values = 0.341, 0.953 respectively) in correlation with intra-operative assessment. Conclusion: Several ultrasound criteria can be used in diagnosis of placenta accreta, as this study showed their high accuracy. They include loss of retroplacental clear zone, presence of abnormal placental lacunae, myometrial thinning and utero-vesical hypervascularity. On the other hand, both loss of retroplacental clear zone, abnormal placental lacunae can predict which patient will mostly have CS hysterectomy.

Diagnosis of Placenta Accreta by Uterine Artery Doppler Velicometry in Patients with Placenta Previa

Background: Placenta accreta occurs in the complete or partial absence of the decidua basalis. Women with previous cesarean delivery or placenta previa are known to be at greater risk of placenta accreta. Objectives: to evaluate ultrasound accuracy in diagnosing placenta accreta and its variants and to detect the potential value of uterine artery Doppler in diagnosing placenta accreta and to assess the impact of antenatal diagnosis in Egyptian population. Patients and Methods: This prospective study was conducted on (100) pregnant women diagnosed as placenta previa by ultrasonography and were candidates for either emergency or elective repeated CS or hysterectomy (if the diagnosis of placenta accreta is confirmed). All these patients were randomly selected from the Obstetrics Clinic at Beni-Suef General Hospital during their 3rd trimester. The study was approved by the medical ethics committee of Al-Azhar University academic and ethical committee and a written informed consent was obtained from all patients. Results: The results obtained from this study indicated no statistically significant differences regarding the mean values of uterine artery Doppler PI and RI between cases of placenta accreta and non accreta (p value =.078 & 0.58 respectively) in correlation with histopathological assessment. Our results showed no statistically significant correlation regarding mean values of uterine artery Doppler PI and RI between cases of placenta accreta and placenta non accreta (p values = 0.341, 0.953 respectively) in correlation with intra-operative assessment. Conclusion: Several ultrasound criteria can be used in diagnosis of placenta accreta, as this study showed their high accuracy. They include loss of retroplacental clear zone, presence of abnormal placental lacunae, myometrial thinning and utero-vesical hypervascularity. On the other hand, both loss of retroplacental clear zone, abnormal placental lacunae can predict which patient will mostly have CS hysterectomy.

Uterine Artery Doppler Velocimetry in Placenta Previa and Placenta Accreta

AbstractBackground: Placenta previa and placenta accreta are common obstetrical problem. Placenta previa is partially or totally implanted placenta in the lower uterine segment, this abnormality in the site occurs with different degrees, placenta previa lateralis, marginalis and centralis either incomplete or complete. Abnormal placental adhesion means that the placenta invades the uterine myometrium with different degree. This morbid adhesion is called “Placenta Accreta”, with different grades according to the degree of the trophoblastic invasion through the myometrium and bladder serosa as placenta accreta vera, placenta increta and placenta percreta. Incidence of placenta accreta is increased over the past years mainly due to increasing rates of cesarean delivery. Placenta accreta may lead to massive obstetric hemorrhage with attempt to remove the placenta leading to several complications up to death. Diagnosis of placenta accreta can be done by different modalities such as Ultrasound Grey scale, Color Doppler, Magnetic Resonance Imaging (MRI). Ultrasonography is usually employed as the primary modality for antenatal diagnosis of invasive placentation. Over recent years, Color Doppler Sonography (CDS) have been started to be used to predict placental abnormalities. CDS, a noninvasive and simple tool, is useful indistinguishing normal and abnormal placentation.Aim of Study: The aim of this work was to study uterine artery doppler velocimeteric changes in patients with placenta previa and placenta accrete.Patients and Methods: 30 pregnant females were included in this comparative prospective clinical study subdivided into two group; Group (A) Includes 15 patients with anterior placenta previa, and Group (B) Include 15 patients with anterior placenta previa accrete. Both groups were diagnosed by trans-abdominal Ultrasonography either from outpatient clinics or inpatient department of Tanta University Hospital seeking for antenatal care from Octorber 2017 to August 2018. All patients underwent uterine artery Doppler velocimetry to measure the mean Resistive Index (RI) and Pulsatility Index (PI) in the third trimester and compared between both groups.Results: the mean uterine artery velocemtric changes including mean Resistive Indices (RI) and mean Pusitility Indices (PI) were significantly lower in the placenta accreta group compared to placenta previa group (with mean for RI 0.41 versus 0.45; p=0.001) and (with mean for PI 0.50 versus 0.56; p=0.001), the uterine artery Doppler values in combina-tion with maternal characteristics, such as previous history of cesarean deliveries, will improve screening accuracy of placenta accrete (p=0.022). Conclustion: This study suggests that the mean PI and RI measured by uterine artery Doppler velocimetry is reduced in patients with placenta accreta compared to those without accreta. Accuracy of diagnosis can be potentially improved in invasive placentation if uterine artery Doppler values and the history of cesarean delivery are combined.

Uterine Artery Doppler Velocimetry During Individually Prescribed Exercise in Pregnancy.

To evaluate uterine artery blood flow in response to typical exercise sessions performed in pregnancy in accordance with the current recommendations from the American College of Obstetricians and Gynecologists and the U.S. Department of Health and Human Services. This prospective cross-sectional study measured uterine artery Doppler velocimetry in healthy pregnant women after individually prescribed exercise, including 1) moderate-intensity exercise (40-59% of heart rate reserve) in both nonexercisers and regular exercisers and 2) vigorous-intensity exercise (60-84% of heart rate reserve) in women who regularly engage in exercise. Resting uterine artery Doppler measures were obtained after a 20-minute fetal heart tracing; then the exercise session was performed. Immediately after the exercise session ended, the participants returned to the semirecumbent, leftward tilt position for ultrasound examination. Uterine artery measures were obtained 3.4±0.9 minutes (mean±SD) postexercise. Forty-five healthy pregnant women participated in the study: 30 regular exercisers and 15 nonexercisers. For the moderate-intensity session, mean gestational age was 31.1 and 31.7 weeks for the exercisers and nonexercisers, respectively. Mean uterine artery Doppler indices (pulsatility index, resistance index, systolic/diastolic ratio) did not significantly change with exercise. For the vigorous-intensity session, the average gestational age was 31.5 weeks. After vigorous activity, all mean uterine artery Doppler indices showed reductions postexercise, for example, pulsatility index decreased from 0.63±0.12 to 0.58±0.12 (P=.04). Individually prescribed exercise according to guidelines for pregnant women does not adversely alter uterine artery Doppler values, suggesting that uterine blood flow is not reduced as a result of exercise.

The Study of Predictive Value of Uterine Artery Doppler in Incidence of Preeclampsia and Intrauterine Growth Restrictions in Pregnant Women

Objectives: Preeclampsia is considered as one of the most important causes of death among pregnant women all around the world. This study aimed to study the predictive value of uterine artery Doppler ultrasonography in the incidence of preeclampsia and the intrauterine growth restriction (IUGR) in pregnant women who attended Fatemieh hospital. Materials and Methods: This study was performed by the prospective cohort method and the statistical population included 108 pregnant women, in their 18-22 weeks of pregnancy, with a singleton pregnancy who referred to the prenatal Fatemieh Hospital of Hamadan during 2013-2016. The uterine artery Doppler ultrasonography was performed and the incidence of IUGR and the occurrence of preeclampsia in the followed pregnancy was evaluated in these patients. Data were analyzed by SPSS 16.0 using the chi-square and Mann-Whitney U statistical tests. Results: The mean difference of pulsatility index (PI) in patients with preeclampsia was statistically significant compared to healthy individuals (P=0.001). In addition, the mean difference of PI in individuals with infants suffering from IUGR was statistically significant compared with the infants not suffering from the IUGR (P=0.001). Further, the incidence of preeclampsia and IUGR in women with a bilateral notch in ultrasonography was significantly greater than those of the women with no report of a bilateral notch in ultrasonography (P=0.001). Conclusions: Therefore, Doppler ultrasonography of the uterine artery has a predictive value in preeclampsia among pregnant women.

EP16.04: The value of uterine artery Doppler at 18–24 weeks' gestation in predicting adverse pregnancy outcomes among pregnant women with chronic hypertension

To evaluate the value of uterine artery Doppler in predicting adverse pregnancy outcomes among women with chronic hypertension in a tertiary hospital. This is a retrospective diagnostic validity study evaluating the value of uterine artery (UA) Doppler at 18-24 weeks age of gestation in predicting adverse pregnancy outcomes among women with Chronic Hypertension (CH) in a tertiary hospital from January 1, 2012 to December 31, 2013, who delivered 24 weeks or more. CH was defined as persistent BP greater than 140/90 mmHg diagnosed before pregnancy or before 20 gestation. Abnormal UA Doppler was described as the presence of an elevated uterine artery resistance index or the presence of a diastolic notch or both. Patients diagnosed with fetal congenital anomaly, other medical problems and higher order gestation were excluded. Fifty-five % CH women had an abnormal UA Doppler and 45%of them had normal results. Among the CH patients with abnormal UA Doppler, the most common adverse pregnancy outcomes were superimposed pre-eclampsia (SPE) (57%), preterm delivery (43%), and IUGR (27%). The findings of abnormal UA Doppler has a high sensitivity of 92.6% and specificity of 63.3% for the development of SPE, with a PPV of 57% and a high negative predictive value of 94%. The positive likelihood ratio (LR) of CH women with abnormal UA Doppler to develop SPE is 2.5 higher compared to those with normal UA Doppler. Abnormal UA Doppler has a sensitivity of 38.1% and a specificity of 83.3% to have babies that are SGA with a positive LR of 2.29, PPV of 72.7% and negative predictive value of 53.6%. Abnormal UA Doppler has a low sensitivity of 5% and but a high specificity of 100% for stillbirth with a PPV 100% and negative predictive value of 46%. UA Doppler study between 18-24 weeks gestation among CH women could be a good predictor and screening tool to asses high risk women to develop adverse pregnancy outcomes especially superimposed pre-eclampsia.

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.

Beta-Human Chorionic Gonadotropin and Uterine Artery Doppler Measurements for the Prediction of Success of Single Dose Methotrexate Treatment in Tubal Ectopic Pregnancies

Objectives: To evaluate the impact of the uterine artery Doppler values and the change of β-Human chorionic gonadotropin (β-HCG) levels from day 0 to day 4 for prediction of the success of single dose methotrexate treatment in tubal pregnancy cases. Study Design: 50 patients with tubal pregnancy were included the prospective study. The location and size of ectopic pregnancy, bilateral uterine artery pulsed color doppler imaging was examined by ultrasonography and serum β-HCG levels were measured on day 0, 4, 7 of treatment. Success was defined as decrease of β-HCG level &lt;10 mIU/mL with single dose methotrexate treatment. Multiple dose methotrexate treatment and surgical treatment were considered as treatment failure.Results: 32 patients (64%) treated with single dose methotrexate, 14 patients (28%) treated with multiple dose methotrexate, and 4 patients (8%) treated with surgery. In the group with β-HCG level decrease &gt; 15.04% on day 4, single-dose methotrexate therapy were 3.82 times more successful than the group without &gt; 15.04% β-HCG decrease. However, no significant alteration of uterine artery Doppler measurements was determined on the same days.Conclusion: Reduction rate in the β-HCG level on day 4 of treatment can be used in determination the success of single-dose methotrexate therapy.

Diagnosis of Placenta Accreta by Uterine Artery Doppler Velocimetry in Patients With Placenta Previa

To evaluate the potential value of uterine artery Doppler velocimetry in diagnosing placenta accreta. Clinical records of all deliveries between April 1991 and March 2013 were retrospectively analyzed. Cases of intrauterine growth restriction, pregnancy-induced hypertension, multiple pregnancies, fetal anomalies, chromosomal abnormalities, and maternal medical illnesses such as cardiovascular disease, renal disease, and diabetes mellitus were excluded. A total of 11,210 cases were evaluated, including 403 cases of placenta previa without accreta (placenta previa) and 39 cases of placenta previa with accreta (placenta accreta). All patients underwent uterine artery Doppler velocimetry to measure the mean resistive index and pulsatility index (PI) in the third trimester. The analysis included participant characteristics such as age, parity, abortion history, previous cesarean delivery, gestational age at delivery, neonatal sex, and birth weight. The mean uterine artery PI was significantly lower in the placenta accreta group compared to previa alone (0.51 versus 0.57; P = .002). The odds ratios for placenta accreta were 2.4 for 2 or more previous abortions (P = .011) and 5.3 and 7.0 for 1 and 2 or more previous cesarean deliveries (P = .001 and .005). With an increase in the mean PI by 0.01, the odds ratio for placenta accreta decreased by 0.94 (P < .001). The area under the receive operating characteristic curve was 0.72 for previous cesarean delivery alone, increasing to 0.77 with the combination of the mean PI and previous cesarean delivery (P = .047). This study suggests that the mean PI measured by uterine artery Doppler velocimetry is reduced in patients with placenta accreta compared to those without accreta. The diagnostic accuracy of placenta accreta can be potentially improved if uterine artery Doppler values and the history of cesarean delivery are combined.

The value of uterine artery Doppler and NT-proBNP levels in the second trimester to predict preeclampsia.

To determine the maternal serum N-Terminal proBNP levels in predicting development of preeclampsia. Sixty-eight patients were included in the study. The study group consisted of patients with the finding of diastolic notch with abnormal pulsatility index (PI) between 21-24 weeks gestation and the control group consisted of patients without diastolic notch and normal PI. The study included high-risk patients who did not have a history of hypertensive disorder before pregnancy, heart failure, recurrent pregnancy loss, autoimmune disorder or diabetes. The groups were compared in terms of NT-ProBNP levels, development of preeclampsia, obstetric and neonatal problems. There was no significant difference between groups in terms of age, gravidity, parity, uric acid levels, and NT-proBNP levels. There was significant difference between the groups in terms of week of birth, rate of cesarean section and fetal weight. Furthermore, there were significant differences between the two groups when compared in terms of obstetric and neonatal problems (p < 0.05). Obstetric and neonatal problems were more common in the notch with abnormal (PI) group. The NT-pro BNP levels were found to be comparable among groups. Preeclampsia was the most common obstetric problem (11.7%). We were unable to document significant difference in patients who developed preeclampsia. Bilateral notch together with abnormal PI measurements in the uterine artery Doppler screening during the second trimester was associated with poor perinatal outcomes. Such an association was not significant in the NT-proBNP measurements. Larger trials focused on late-onset preeclampsia are needed to draw definitive conclusions.

Uterine artery Doppler in high-risk pregnancies at 23-24 gestational weeks is of value in predicting adverse outcome of pregnancy and selecting cases for more intense surveillance.

To assess the role of the placental arterial Doppler examination at 23-24 gestational weeks for predicting adverse perinatal outcome in high-risk pregnancies. Retrospective register study. Skåne University Hospital in Malmö. Six hundred and forty-five women with high-risk pregnancies, without fetal malformations or chromosomal abnormalities. Placental (uterine and umbilical artery) Doppler ultrasound examination at 23-24 gestational weeks. Adverse perinatal outcomes including preeclampsia, small-for-gestational age newborns (smaller than 3rd percentile or smaller than the 10th percentile), preterm delivery (<34 weeks or <37 weeks of gestation at delivery), cesarean section, admission to the neonatal intensive care unit and intra-uterine fetal death. Abnormal uterine artery Doppler values were detected in 45% of this high-risk group but abnormal umbilical artery Doppler indices were only seen in 3.7%. Adverse perinatal outcome increased significantly with increasing placental vascular impedance (p < 0.0001). There were seven cases of intrauterine fetal death and in five the uterine artery Doppler values at 23-24 weeks were abnormal. A strong correlation between abnormal uterine artery Doppler and preeclampsia was present, but not with other forms of hypertensive disorder. Placental Doppler screening at 23-24 weeks can be used in detecting pregnancies at risk of adverse outcome and in selecting cases for more intense surveillance. A surveillance plan is proposed based on Doppler screening at 23-24 weeks of gestation.

Uterine Artery Doppler in Women with History of Previous Pre Eclampsia and Women with Chronic Hypertension: Re-evaluation of a Prognostic Value in a High-Risk Population

Objective: To evaluate the prognostic role of uterine artery Doppler for pre-eclampsia in high-risk patients. Because of the higher prevalence of new onset of disease in a high-risk population, a better performance could be expected in this special group. Methods: This retrospective study compares uterine artery Doppler to predict pre-eclampsia in patients with a history of pre-eclampsia and also in patients with chronic hypertension, both with high-risk to develop recurrent, superimposed or new onset pre eclampsia. Doppler measurements of uterine arteries were performed every 4 weeks in the 1st and 2nd trimester. Results: Pre-eclampsia occured in 33% of current high-risk pregnancies. The best performance of pre eclampsia was provided by bilateral notching plus increased PI ≥ 2.5, both in the 1st and 2nd trimester. In the 1st trimester the specifity was 81% (95% CI: 58-95) in the Prior PE group and 95% (95% CI: 74-100) in the C. H. group. In the 2nd trimester the sensitivity was 97% (95% CI: 86-100) in the Prior PE group and 100% (95% CI: 93 100) in the C. H. group. Sensitivity was very low in the 1st and 2nd trimester. Conclusion: Our results show, that the negative predictive value of uterine artery Doppler works well even in a high risk group. Data however suggest relative poor positive predictive value of uterine artery Doppler even in a high-risk population using a cut-off of 2.5 PI. A value of the uterine artery Doppler using a high cut-off might be in the increased specifity. Nevertheless, a combination of the uterine artery Doppler with biochemical markers and maternal parameters seems to be essential.

Carriage of the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism does not influence the first and second trimester uterine artery Doppler flow

Objective MTHFR C677T polymorphism is a genetic factor increasing both risk factors for atherosclerotic vascular diseases and obstetric complications like preeclampsia (PE) and fetal growth restriction (FGR). Increased uterine artery impedance, measured by uterine artery Doppler in the second trimester of pregnancy is also associated with PE and FGR. In this study we aimed to analyze whether MTHFR influences first and second trimester uterine artery impedance. Study design In a prospective, controlled, open, single center study of 1955 consecutive singleton pregnant women , smears from buccal gingival cells were analyzed for MTHFR by hybridisation on micro arrays. Uterine artery PI values and unilateral or bilateral diastolic notch were measured at 12 and 22 weeks of gestation. Statistical significance was calculated by the x 2-test. Results MTHFR C677T polymorphism showed a normal distribution in our population. Mean uterine artery Doppler values and bilateral or unilateral notch occurrences from 1697 statistical evaluated women did not show significant differences in any MTHFR genotype (C/C, C/T, T/T) both at 12 or 22 weeks of gestation. Conclusion In summary, the data presented in this adequately powered, prospective, controlled study establish that the MTHFR C677T polymorphism does not influence Doppler flow measurements.

Predicting Risks of Preeclampsia and Small for Gestational Age Infant by Uterine Artery Doppler

Objective: To assess the value of uterine artery Doppler as a screening test for preeclampsia and/or having a small-for-gestational-age (SGA) infant in healthy pregnant women. Methods: Color Doppler ultrasound was used to examine both uterine arteries in 400 healthy pregnant women at 24.8 ± 2.0 (range, 22 to 28) weeks of gestation. The mean pulsatility index of both uterine arteries was calculated and the presence of an early diastolic notch in the waveform was noted. Results: Twenty-six (6.5%) of the 400 women developed preeclampsia and/or had an SGA infant. The optimal cutoff value for the mean pulsatility index in predicting preeclampsia and/or having an SGA infant was 0.857. When using a high mean pulsatility index and/or the presence of any early diastolic notch, the detection of preeclampsia and/or having SGA infant were a sensitivity of 76.9%, a specificity of 52.9%, a positive predictive value of 10.2%, and a negative predictive value of 97.1%, respectively. Conclusion: Women with an abnormal uterine artery Doppler great a considerably higher risk for developing preeclampsia and/or having an SGA infant.

Morbidity and mortality associated with pre‐eclampsia at two tertiary care hospitals in Sri Lanka

The exercise by Dissanayake et al. made an interesting read. Their conclusion that pre-eclampsia in Sinhalese women is associated with increased maternal morbidity and fetal morbidity and mortality is an eye opener to the local health-care providers policy makers and program managers. It also invites further studies on blood pressure variation during pregnancy in Sinhalese women and the postulation of a different cut-off level for diagnosing elevated blood pressure in pregnancy. It may be prudent to educate local obstetricians and other care providers of pregnant women of the detrimental effects of delaying intervention until blood pressure reaches 140/90 mmHg and the likelihood of developing more severe disease by the time the blood pressure reaches the cut-off level which seems to be more suitable for Caucasian women. The study re-evaluates the importance of pre-pregnancy counseling and assessment including blood pressure in fertile women in assessing the rise in blood pressure. As the authors correctly suggest there is an urgent need to invest in specialized maternal care services managing women with pre-eclampsia and neonatal intensive care services in Sri Lanka. In the meantime there are a few drawbacks to the study which need to be considered. The two hospitals utilized to recruit the study samples were teaching hospitals in metropolitan Colombo. These institutions represented only a prescreened and referred group of women from local hospitals and antenatal clinics. So the applicability of the results generated to a larger population is questionable. There may be a type II error accounting for the statistically non-significant result obtained with the booking blood pressures of early onset and late onset groups of pre-eclampsia. This is in contrast to our day-to-day experience in which we often see fluctuating blood pressure values with on-and-off higher readings in early onset preeclamptic patients. The value of uterine artery Doppler in detecting such a subtle change may need to be considered with its reasonable sensitivity specificity rapidity and non-invasiveness in detecting pregnancies destined to develop pre-eclampsia. Though Sri Lanka is not yet ready to supplement all pregnant mothers with a Doppler analysis the future is promising. Moreover it is well-known that blood pressure is poorly measured in clinical practice with digit preference (rounding the final digit of blood pressure to 0). We failed to find a note on this regard in the study. The study does however add some valuable tips to our existing knowledge on gestational hypertension in Sri Lankan women. It opens the door for further studies to generate a novel diagnostic criterion for preeclampsia for Sri Lankan women. (full text)

P07.06: The value of uterine artery Doppler at 22–24 weeks' gestation in the prediction of adverse perinatal outcome in an unselected population

P07.06: The value of uterine artery Doppler at 22–24 weeks' gestation in the prediction of adverse perinatal outcome in an unselected population