Uterine Artery Notching Research Articles

Uterine Artery Doppler as Predictive Measure for Fetal Growth Restriction in Chronic Hypertensive Patients

Background: Fetal growth restriction (FGR) is when the fetal weight is less than tenth centile for the given gestational age. Chronic hypertension is one of the risk factors of FGR. Growth restricted fetuses are at risk of intrauterine death and many comorbidities later in life. Detection of those fetuses at risk of developing FGR can help in timely intervention and better outcome.Objective: To evaluate uterine artery Doppler for prediction of FGR in patients with chronic hypertension.Methods: One hundred and sixty four women having chronic hypertension at 24 weeks of gestation were included in the study. Women with multiple pregnancy and comorbidities other than hypertension were excluded. Doppler USG of uterine arteries was done at 24 weeks of gestation by radiologist and absence or presence of diastolic uterine artery notch was observed. Patients were divided into 2 groups A and B depending upon the presence or absence of notch respectively. These women were followed till they delivered and by taking birth weight as an outcome measure, frequency of fetal growth restriction (FGR) was found in both groups by the researchers themselves.Results: The mean age of women in group A was 26.76± 3.89 and in group B was 26.21 ± 3.57 years. Major portion of women was multipara 58% (96 women). Forty (24.39%) patients developed fetal growth restriction while 124 patients (75.61%) fetuses were of normal weight. Among the patients who had growth retarded foetuses 35.37% patients were in group A and 13.41% were in group B with p-value of 0.001.Conclusion: Uterine artery doppler diastolic notch at 24 weeks of gestation has significant association with development of FGR in patients with chronic hypertension.

Investigation of the relationship between diastolic notching in uterine artery Doppler and serum salusin alpha and beta concentrations in the first trimester

Objective Studies have shown that members of the salusin family regulate the migration and proliferation of arterial smooth muscle cells and increase the tendency to atherosclerosis through fibrosis and calcification in the vascular wall. However, the effect of salusins on the uterine artery has not yet been investigated. This study was conducted to investigate whether serum salusin alpha and beta concentrations in the first trimester are associated with diastolic notching in uterine artery Doppler. Methods This non-interventional cohort study was conducted on 88 pregnant women, 44 of whom had diastolic notching on unilateral or bilateral uterine artery Doppler, and 44 of whom did not have diastolic notching on uterine artery Doppler. The uterine artery notch positive and negative groups were compared in terms of serum salusin alpha and beta concentrations. Results The two groups were similar in terms of demographic characteristics (p < 0.05). The median salusin alpha concentration was found to be 689.4 pg/ml in the uterine artery notch positive group, while it was 734.6 pg/ml in the uterine artery notch negative group (p = 0.608). The median salusin beta concentration was found to be 674.5 pg/ml in the uterine artery notch positive group, while it was 693.8 pg/ml in the uterine artery notch negative group (p = 0.453). Participants were regrouped into normal and high uterine artery resistance and compared in terms of serum salusin alpha and beta concentrations. The median salusin alpha concentration was found to be 994.5 pg/ml in the high uterine artery PI group, while it was 685.2 pg/ml in the normal uterine artery PI group (p = 0.698). The median salusin beta concentration was found to be 1,100.8 pg/ml in the high uterine artery PI group, while it was 669.1 pg/ml in the normal uterine artery PI group (p = 0.584). Conclusion Although the sample size was too small to draw a definitive conclusion, our results indicate that uterine artery diastolic notching or increased resistance in the uterine artery does not appear to be associated with serum salusin alpha or beta concentrations.

Real World, Single-Centre Experience of Pregnancy in Patients with Philadelphia Negative Myeloproliferative Neoplasms

Pregnancy in myeloproliferative neoplasms (MPN) is commonly associated with maternal and foetal complications due to increased risks of thromboembolic and haemorrhagic events and placental dysfunction. The incidence of UK pregnancies in MPN is estimated as 3·2/100 000 maternities per year (Alimam, S., et al 2016, Br J Haematol 2016; 175:31-36; Robinson et al, Br J Haematol 2020;189:625-34). Here we present pregnancy outcomes of MPN patients attending University College London Hospital (UCLH), a large UK tertiary referral centre, between 2015 and 2023. Twenty-three patients were identified with a median age at MPN diagnosis of 33 years (range (r), 13 - 46). The majority of patients (21/23, 91.3%) had a diagnosis of ET or triple negative (TN) thrombocytosis and 8.7% (2/23) a diagnosis of polycythaemia vera (PV). In 61.4% of pregnancies, diagnosis was known at conception. Regarding mutational status, JAK2V617F was present in 10/23 (43.5%) patients, CALR in 5/23 (21.7%) and MPL in 1/23 (4.3%). The remaining 7/23 (30.4%) patients were TN. Median VAF for JAK2V617F and CALR were 15.8% (r, 21.1 - 33%) and 25.9% (r, 5.7 - 46%), respectively. The cohort collectively experienced 57 pregnancies, 38 of which were managed at UCLH. Focusing on pregnancies managed at UCLH, median age at pregnancy was 34.5 years (r, 22 - 47). Conception was spontaneous in 31/38 (81.6%) pregnancies. Six (15.8%) patients required assisted conception and had a higher median age of 38.5 years (r, 35 - 47). Where gestation at delivery was known, 92.6% (25/31) of live births delivered at term (&amp;gt;37 weeks). Caesarean rate was significant at 41.9% (13/31), of which 61.5% were emergency sections. The live birth rate of the 57 overall pregnancies was 76.9% and 88.6% in the 38 managed at UCLH. At UCLH, we adopt an individualised approach to managing pregnant women with MPNs, working alongside obstetricians and obstetric haematology colleagues. Consequently, as shown in Table 1, there were bespoke regimens for individual patients. Low dose aspirin was prescribed throughout pregnancy in the majority (78.9%, 30/38) of pregnancies. In 18.4% (7/38), cytoreduction was established prior to pregnancy. In 42.9% (3/7), pegylated interferon (PegIFN) was commenced to optimise counts prior to pregnancy and in 42.9% (3/7) as long term count control. One patient was cytoreduced with hydroxycarbamide prior to pregnancy and subsequently switched to PegIFN. Low molecular weight heparin (LMWH) was administered at some point during pregnancy in 60.9% (14/23) of patients and 57.9% (22/38) of pregnancies. 65.8% (25/38) underwent monitoring with uterine artery (UA) dopplers. Median gestation for UA assessment was 20 weeks (r, 19 - 28). UA dopplers were reported as abnormal in 16% (4/25). In two patients, this was due to a raised combined pulsatility index, UA notching in one and was unspecified in one patient. Nine (39.1%) patients experienced foetal loss, with 12 miscarriages recorded across the total 57 pregnancies and 4 miscarriages in the 38 pregnancies managed at UCLH. Median maternal age was 31.5 (r, 24 - 42) and median gestation was 8 weeks (r, 5 - 24). Six (66.7%) patients experiencing foetal loss had a diagnosis of ET, 2 (22.2%) PV and 1 (11.1%) TN thrombocytosis. Three miscarriages occurred in one patient, who demonstrated a concurrent heterozygous prothrombin G20210A mutation in addition to ET. Eight (34.8%, 8/23) patients collectively experienced 11 haemorrhagic events. The majority (72.7%) were post-partum haemorrhage (PPH), 37.5% of which were classified as major or severe. Three (27.3%) bleeding events occurred whilst on aspirin monotherapy, 3 (27.3%) on combined LMWH and aspirin, 1 (9.1%) on LWMH alone and 1 (9.1%) on LMWH and PIFN. With regards to thrombosis, one patient with undiagnosed ET had a cerebral venous sinus thrombosis at 11-weeks gestation. A total of 2/23 (8.7%) patients' pregnancies resulted in hypertensive complications and pre-eclampsia, both resulting in delivery with caesarean section at 34 and 35 weeks. Although the live birth rate is encouraging, our data highlights that patients with MPN remain at increased risk of miscarriage, early delivery and haemorrhagic events. There remain inconsistencies in the management of pregnancy in MPN and, although we adopt an individualised patient-centred approach, there is an unmet need for further study and development of evidence based treatment algorithms.

Contribution of Second Trimester Sonographic Placental Morphology to Uterine Artery Doppler in the Prediction of Placenta-Mediated Pregnancy Complications.

Second-trimester uterine artery Doppler is a well-established tool for the prediction of preeclampsia and fetal growth restriction. At delivery, placentas from affected pregnancies may have gross pathologic findings. Some of these features are detectable by ultrasound, but the relative importance of placental morphologic assessment and uterine artery Doppler in mid-pregnancy is presently unclear. To characterize the association of second-trimester sonographic placental morphology markers with placenta-mediated complications and determine whether these markers are predictive of placental dysfunction independent of uterine artery Doppler. This was a retrospective cohort study of patients with a singleton pregnancy at high risk of placental complications who underwent a sonographic placental study at mid-gestation (160/7-246/7 weeks' gestation) in a single tertiary referral center between 2016-2019. The sonographic placental study included assessment of placental dimensions (length, width, and thickness), placental texture appearance, umbilical cord anatomy, and uterine artery Doppler (mean pulsatility index and early diastolic notching). Placental area and volume were calculated based on placental length, width, and thickness. Continuous placental markers were converted to multiples on medians (MoM). The primary outcome was a composite of early-onset preeclampsia and birthweight &lt; 3rd centile. A total of 429 eligible patients were identified during the study period, of whom 45 (10.5%) experienced the primary outcome. The rate of the primary outcome increased progressively with decreasing placental length, width, and area, and increased progressively with increasing mean uterine artery pulsatility index (PI). By contrast, placental thickness followed a U-shaped relationship with the primary outcome. Placental length, width, and area, mean uterine artery PI and bilateral uterine artery notching were all associated with the primary outcome. However, in the adjusted analysis, the association persisted only for placenta area (adjusted odds ratio [aOR] 0.21, 95%-confidence interval [CI] 0.06-0.73) and mean uterine artery PI (aOR 11.71, 95%-CI 3.84-35.72). The area under the ROC curve was highest for mean uterine artery PI (0.80, 95%-CI 0.71-0.89) and was significantly higher than that of placental area (0.67, 95%-CI 0.57-0.76, p = 0.44). A model that included both mean uterine artery PI and placental area did not significantly increase the area under the curve (0.82, 95%-CI 0.74-0.90, p = 0.255), and was associated with a relatively minor increase in specificity for the primary outcome compared with mean uterine artery PI alone (63% [95%-CI 58-68%] vs. 52% [95%-CI 47-57%]). Placental area is independently associated with the risk of placenta-mediated complications yet, when combined with uterine artery Doppler, did not further improve the prediction of such complications compared with uterine artery Doppler alone.

Role of Uterine Artery Doppler at 11-14 Weeks of Pregnancy in Early Prediction of Preeclampsia: A Prospective Cohort Study

Introduction: Doppler ultrasonography, by comparing systolic and diastolic waveforms helps in assessment of uteroplacental circulation. Since preeclampsia has ethnic and geographical variations, it is important to understand the prediction modalities in various populations. Aim: To investigate the role of elevated Pulsatility Index (PI) and presence of diastolic notch using uterine artery doppler in early pregnancy in predicting development of preeclampsia among pregnant women. Materials and Methods: A prospective cohort study was conducted on pregnant females visiting the antenatal clinic or Outpatient Department or admitted in the Department of Obstetrics and Gynaecology at People's College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India, from November 2019 to October 2021. All cases were subjected to uterine artery doppler study, between 11-14 weeks of pregnancy, to note pulsatility index and diastolic notch. All the participants were then screened periodically during their antenatal visits for development of features of preeclampsia and were followed-up monthly upto 20 weeks, every 15 days upto 32 weeks and then weekly till delivery. Pregnancy outcome were measured in terms of presence or absence of preeclampsia. Data was compiled using Microsoft Excel and analysed using Statistical Package for Social Sciences (SPSS) IBM software version 20.0. Categorical data was expressed as frequency and proportions whereas continuous data was expressed as mean and standard deviation. Results: The present study was conducted on a total of 116 cases with the mean age of 26.75±4.31 years. Out of 116 cases, 26 cases developed preeclampsia. Diastolic notch was present in 17 cases (65.4%) patients with preeclampsia and 23 cases (25.6%) non preeclampsia patients. Pulsatility index of more than 1.71 was noted in 14 cases (53.8%) cases with preeclampsia where as 87 cases (96.7%) with non preeclampsia had pulsatility index of less than 1.71. The specificity of diastolic notch 74.4% where as that of pulsatility Index was 96.7 % and the diagnostic accuracy of diastolic notch 72.4% where as that of pulsatility index was 87.1%. Conclusion: Uterine artery doppler is a promising tool for predicting development of preeclampsia by analysing both PI as well as diastolic notch in uterine artery. Doppler had high overall diagnostic accuracy for preeclampsia.

Utility of uterine artery doppler indices for prediction of preeclampsia: A narrative review with systematic analysis

Background: Hypertensive disorders complicating pregnancy are common. Preeclampsia and eclampsia are major causes of maternal morbidity and mortality, particularly in developing countries. With prompt recognition of symptoms and early diagnosis of preeclampsia can lead to improved maternal and neonatal outcomes. Although, numerous tests have been proposed for the prediction of preeclampsia, their results have been inconsistent. So, we focused our research to study the uterine artery doppler for predicting preeclampsia in high-risk women. Methodology: We conducted a search on Google Scholar and PubMed based on Medical Subject Heading terms preeclampsia and uterine artery Doppler ultrasound. The articles between 2016 and 2020 which were in English were taken into consideration. We performed a qualitative interpretation as an approach for extracting the data. Results: Majority of the studies showed raised pulsatility index as a good predictor of preeclampsia, although it was closely followed by uterine artery notching which is in the early diastolic period. Conclusion: The findings of our research suggest that uterine artery Doppler indices and early diastolic notch can be used as a tool for the prediction of preeclampsia with high confidence.

Doppler Velocimetry evaluation in high-risk pregnancy for prediction of Preeclampsia

Background: The uterine and umbilical artery Doppler scan is a valuable tool for evaluation of utero-placental blood flow in pregnancy. They help in detecting uteroplacental insufficiency thus predicting preeclampsia and other effects of faulty placentation which increase the risk of adverse effects on both mother and fetus. Aims and Objective: This study aimed to evaluate and compare the uterine artery and umbilical artery Doppler indices in second and third trimester for prediction of preeclampsia in high-risk pregnancies. Materials and Methods: In this prospective observational study done over a years’ time, 50 high-risk pregnant mothers were recruited and the Doppler scans were done at 21-25 weeks and 31-35 weeks. The necessary clinical observations were recorded throughout the antenatal period and the data analysis was done. Results: Majority (56%) were in 20-29 years range with mean age of 24±6.1 years. Out of the 50 women, 21 had abnormal uterine artery Doppler and 12 had umbilical artery abnormality along with uterine derangement. Preeclampsia developed in 3 of them. The hypertensive disorders of pregnancy were diagnosed in 13 women, preeclampsia in 3, eclampsia in 1and other HDPs in 9. The persistence of notch in uterine artery was observed in 7 women, of these 2 developed PIH. Only one patient had uterine artery PI&gt;1.45 at 24 weeks who subsequently developed preeclampsia. Among 4 patients of preeclampsia and eclampsia, 3 had 2nd trimester uterine and 3rd trimester umbilical Doppler abnormalities and only 1 had normal doppler indices. In 2nd trimester the sensitivity, specificity and PPV are higher for uterine artery PI as compared to umbilical artery PI. Hence, uterine artery doppler seems to be a better screening tool for early prediction of PIH. The third trimester umbilical artery PI with higher specificity (96%) and PPV (50%) can diagnose preeclampsia better. One patient had absent diastolic flow and she developed preeclampsia and IUGR. The combined uterine and umbilical artery doppler is a better screening modality as it has a higher sensitivity (75%) and NPV (99.26%). Conclusion: The uterine and umbilical artery Doppler velocimetry are potential tools for uteroplacental surveillance of high-risk pregnancies which can identify patients at risk and help in taking timely action to prevent complications.

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.

Acute ambient air pollution exposure and placental Doppler results in the NICHD fetal growth studies – Singleton cohort

BackgroundIncreased placental vascular resistance is a proposed mechanism by which air pollution exposure during pregnancy lowers birth weight and increases pregnancy-induced hypertensive disorders. ObjectiveTo examine the impact of acute air pollution exposure during pregnancy on uterine and umbilical artery Doppler indicators of placental vascular resistance. MethodsAfter a first ultrasound to confirm gestational age, 2562 pregnant women recruited in 12 clinics throughout the United States underwent up to five standardized ultrasounds with Doppler measurements. Exposures to 11 air pollutants were estimated for the hour of ultrasound and each of the 2 h prior to ultrasound at the clinics using the National Air Quality Forecast Capability reanalysis products. We used mixed logistic regression to study the longitudinal odds ratio (OR) of any, uni- or bi-lateral systolic and diastolic uterine artery notching compared to no notching and the longitudinal OR of abnormal end diastolic flow of the umbilical artery compared to forward flow. Uterine and umbilical artery resistance indexes were studied using linear mixed models. ResultsEach inter-quartile range (IQR) increase of particulate matter < 2.5 μm, nitrate, ammonium, primary organic matter (POM) and nitrogen dioxide during the hour of ultrasound was associated with a decreased risk of unilateral systolic notch and with increased resistance index of the left uterine artery. For the umbilical artery, each IQR increase in ozone was associated with decreased resistance index (b: −0.26, 95 % CI: −0.52, −0.01) and with a decreased risk of abnormal end diastolic flow (OR: 0.36, 95 % CI: 0.14, 0.94); while each IQR increase of elemental carbon and POM was associated with increased risk of abnormal end diastolic flow (OR: 1.47, 95 % CI: 1.02, 2.13 and OR: 1.67, 95 % CI: 1.17, 2.39, respectively). DiscussionOur results suggest acute air pollution exposure may influence placental vascular resistance.

Role of Uterine Artery Doppler Ultrasound in Predicting Pre-Eclampsia in High-Risk Women.

Background and objectivePre-eclampsia (PE) is a major cause of maternal morbidity and mortality. The utility of Doppler ultrasonography (U/S) in predicting PE has not been extensively explored. This study aimed to determine the role of Doppler U/S in predicting PE among high-risk women.MethodologyThis was a retrospective observational study conducted at the Department of Obstetrics and Gynecology of Abbasi Shaheed Hospital in Karachi, over a period of one year, from January 2019 till December 2019. A total of 325 women were initially screened for risk factors for PE. Among them, 75 women were eventually found to have risk factors for PE and hence included in the study. Uterine artery Doppler U/S was performed to evaluate uterine artery’s flow velocity waveforms. They were then used to calculate the presence of diastolic notch and resistance index (RI). At each antenatal visit, the risk factors for PE such as BP, proteinuria, and signs and symptoms were noted. Women were labeled to have PE if they developed hypertension (BP >140/90) after 20 weeks of gestation in combination with proteinuria.ResultsTwenty women (28%) had a normal Doppler flow of the uterine arteries. In 54 (72%) women, a unilateral/bilateral RI >0.58 was observed, and 29 women (38.7%) had a bilateral Rl >0.58. Notching of the uterine artery was also observed in 42 (26.7%, unilateral/bilateral) and in 22 (29.3%) bilaterally. Among the 75 women, BP of 140/90 mmHg along with proteinuria was observed in 56 (76.7%) cases, which were hence diagnosed as PE. Based on the cutoff of Rl and notching of the uterine artery, the overall sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of Doppler U/S in predicting PE were 71.4%, 26.3%, 23.8%, and 74.1%, respectively. As far as individual Doppler U/S indices were concerned, RI >0.58 (unilateral/bilateral) was found to be most sensitive (71%), while the presence of uterine artery notch (unilateral/bilateral) was most specific in predicting PE.ConclusionAbnormal Doppler U/S has good overall sensitivity in predicting PE. Among individual Doppler indices, notching of uterine arteries had a better specificity compared to high RI.

Utero-placental and cerebrovascular indices in pregnant women with systemic lupus erythematosus: Relation to disease activity and pregnancy outcome

Aim of the workTo assess maternal and fetal vascular indices in SLE patients during pregnancy, and the impact of disease activity on these vascular indices. Patients and methods30 pregnant SLE patients and 30 age -matched healthy females with uncomplicated pregnancies were assessed during the third trimester using ultrasonography (US) and Doppler study to detect fetal biometry, the uterine, umbilical (UA) and fetal middle cerebral (MCA) arterial resistance (RI) and pulsatility (PI) indices, as well as cerebro-placental ratio (CPR). Disease activity was determined using the SLE Disease Activity Index (SLEDAI). ResultsThe mean uterine artery PI, RI and the UA-PI in SLE group were significantly higher than controls (p value < 0.001), but no significant difference as regards UA-RI (p = 0.68) between both groups. There was unilateral uterine artery notch in 20% and bilateral in 6.7% while it was absent in 73.3%. The MCA-PI was significantly lower in SLE group (p = 0.003), Where the MCA-RI showed higher values than control (p < 0.001). The CPR showed a lower significant values for SLE group compared to controls (p < 0.001), while the PR interval was significantly higher in SLE group (p = 0.006). Fetal biometry showed no significant difference between two groups apart from higher abdominal circumference (AC) values in controls (p = 0.01). There was no significant correlation between abnormal vascular indices or biometric parameters and SLEDAI score (p > 0.05). ConclusionPregnancies in SLE are associated with abnormal maternal and fetal vascular indices. Doppler US can identify at-risk pregnancies and optimize the time of delivery; confirming a good pregnancy outcome.

Role of uterine artery Doppler in early prediction of pre-eclampsia and intrauterine growth restriction at 16-24 weeks of gestation

Introduction: Pre-eclampsia and intrauterine growth restriction are important causes of maternal and perinatal morbidity and mortality. Gestational age at the onset of pre-eclampsia will determine the degree of fetal compromise. Hence, early detection of preeclampsia is important to improve maternal and perinatal outcome. Utero placental circulation can be non-invasively assessed by Doppler analysis of uterine arteries. Aims and Objectives: The aim of our study is early prediction of pre-eclampsia and Intra uterine growth restriction by Doppler assessment of uterine artery. Materials and Methods: 100 antenatal women of singleton pregnancy at 16-24 weeks of gestation were selected for study in the department of Obstetrics and Gynecology at MNR Medical College, Sangareddy from May 2015 to April 2016. Doppler evaluation of uterine artery along with routine biometry was done. Results: Out of 100 cases studied, 19 patients showed abnormal uterine artery Doppler results and among these 16(84.2%) developed preeclampsia, 8(42%) had intrauterine growth restriction, 6(31.5%) babies required NICU admission and 2(10.5%) intrauterine fetal deaths were noted. Sensitivity and specificity to detect pre-eclampsia was 84.2% and 83% respectively and that of intrauterine growth restriction was 42% and 96% respectively. Conclusion: Uterine artery notching, high PI, RI in uterine artery Doppler analysis can be a good screening tool for early prediction of pre-eclampsia and intrauterine growth restriction. Keywords: Pre-eclampsia, Intrauterine growth restriction, Uterine artery Doppler.

Associations of maternal age at the start of pregnancy with placental function throughout pregnancy: The Generation R Study

ObjectiveTo examine the associations of maternal age at the start of pregnancy across the full range with second and third trimester uterine and umbilical artery flow indices, and placental weight. Study designIn a population-based prospective cohort study among 8271 pregnant women, we measured second and third trimester uterine artery resistance and umbilical artery pulsatility indices and the presence of third trimester uterine artery notching using Doppler ultrasound. ResultsCompared to women aged 25−29.9 years, higher maternal age was associated with a higher third trimester uterine artery resistance index (difference for women 30−34.9 years was 0.10 SD (95% Confidence Interval (CI) 0.02 to 0.17), and for women aged ≥40 years 0.33 SD (95% CI 0.08 to 0.57), overall linear trend 0.02 SD (95% CI 0.01 to 0.03) per year). Compared to women aged 25−29.9 years, women younger than 20 years had an increased risk of third trimester uterine artery notching (Odds Ratio (OR) 1.97 (95% CI 1.30–3.00)). A linear trend was present with a decrease in risk of third trimester uterine artery notching per year increase in maternal age (OR 0.96 (95% CI 0.94 to 0.98)). Maternal age was not consistently associated with umbilical artery pulsatility indices or placental weight. ConclusionsYoung maternal age is associated with higher risk of third trimester uterine artery notching, whereas advanced maternal age is associated with a higher third trimester uterine artery resistance index, which may predispose to an increased risk of pregnancy complications.

Third-trimester uterine artery Doppler for prediction of adverse outcome in late small-for-gestational-age fetuses: systematic review and meta-analysis.

To investigate the predictive ability for adverse perinatal outcome of abnormal third-trimester uterine artery Doppler in late small-for-gestational-age (SGA) fetuses. A systematic search was performed to identify relevant observational studies and randomized controlled trials evaluating the performance of abnormal third-trimester uterine artery Doppler for the prediction of adverse perinatal outcome in suspected SGA fetuses and SGA neonates. Abnormal uterine artery Doppler was defined as uterine artery pulsatility index > 95th percentile or ≥ 2 SD above the mean, or bilateral uterine artery notching. Hierarchical summary receiver-operating-characteristics (ROC) curves were constructed using random-effects modeling. Bayesian analysis was used to calculate the posterior probability of adverse perinatal outcome following an abnormal or normal uterine artery Doppler assessment. Seventeen observational studies (including 7552 fetuses either diagnosed with suspected SGA (n = 3461) or later diagnosed as a SGA neonate (n = 4091)) met the inclusion criteria; no randomized-controlled trials met the inclusion criteria. Summary ROC curves showed that, among suspected SGA fetuses, the best predictive accuracy of abnormal third-trimester uterine artery Doppler was for perinatal mortality and the worst was for composite adverse perinatal outcome, with areas under the summary ROC curves of 0.90 and 0.66, respectively. The corresponding positive and negative likelihood ratios were 16.5 and 0.6 for perinatal mortality and 2.82 and 0.65 for composite adverse perinatal outcome, respectively. Following an abnormal vs normal uterine artery Doppler assessment, the posterior risks for composite adverse perinatal outcome, admission to the neonatal intensive care unit, Cesarean section for intrapartum fetal compromise, 5-min Apgar score < 7, neonatal acidosis and perinatal death were: 52.3% vs 20.2%, 48.6% vs 18.7%, 23.1% vs 15.2%, 3.59% vs 1.32%, 9.15% vs 5.12% and 31.4% vs 1.64%, respectively. Abnormal uterine artery Doppler in the third trimester appears to be moderately useful in predicting perinatal death in pregnancies with suspected SGA. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

The predictive value of sonographic placental markers for adverse pregnancy outcome in women with chronic kidney disease.

To determine the rate of sonographic placental markers and their predictive value for preeclampsia and fetal growth restriction in women with chronic kidney disease (CKD). A retrospective cohort study of women with CKD followed at a tertiary referral center between 2016 and 2019 (n=86). All women underwent 2nd trimester sonographic placental examinations that included assessment of placental morphology, umbilical cord, and uterine artery Doppler. Continuous placental markers were converted to multiples on medians (MoM). Predictive value of sonographic markers for preeclampsia and birthweight<10th percentile. Women in the cohort had a high rate of preeclampsia (24.4%), birthweight<10th% (26.7%), and preterm birth (30.2%). The most important markers were placental volume and uterine artery Doppler: the risk of preeclampsia was elevated in women with low placental volume (51.7% vs. 10.9%; OR=8.79 [2.70-28.59] for preeclampsia; and 40.0% vs. 9.1%; OR=6.67 [1.85-24.04] for preterm preeclampsia), and in women with bilateral uterine artery notching (62.5% vs. 20.8%; OR=6.35 [1.37-29.45] for preeclampsia; and 62.5% vs. 10.4%; OR=14.38 [1.29-71.75] for preterm preeclampsia). The combination of both markers had the strongest predictive value for preeclampsia (positive likelihood ratio=8.25 [6.84-9.95]). Low placental volume and bilateral uterine notching were also associated with birthweight<10th percentile. A 2nd-trimester sonographic placental study can identify a subgroup of women with CKD who are at most risk of preeclampsia and fetal growth restriction. Such data may inform their subsequent perinatal care and assist care providers in the often challenging distinction between preeclampsia flare of underlying CKD.

Uterine artery pulsatility index as a relevant parameter in the prediction of preeclampsia

Preeclampsia is a clinical syndrome that occurs in 5-10% of pregnancies with increased perinatal morbidity and mortality. According to ISUOG (International Society of Ultrasound in Obstetrics &amp; Gynecology), the use of the uterine artery pulsatility index (PI) is an important sensitive method in predicting the risk of preeclampsia. This study is to emphasize the value of PI as a more relevant predictive parameter in the detection of preeclampsia in the second trimester compared to the presence of isolated uterine artery notch. For the above purpose, 96 patients were examined at the University Clinic of Gynecology and Obstetrics in Skopje, divided into 2 groups: study and control group. The study group consisted of 48 patients from 14 to 20 gestational weeks with present uterine artery notch, being the main inclusion criterion. The control group consisted of 48 pregnant patients at the same gestational age with absence of uterine artery notch. In the study group, 43.7% developed clinical syndrome of preeclampsia. The resistance index (RI) value was up to 0.73 and the predictive value of the RI was 57.1%. In patients who developed preeclampsia syndrome, the value of the PI above 1.75 was of much greater predictive value, with value of 71.4%. The sensitivity of these values was 88%, which is a reliable parameter. PI is a reliable parameter in detecting the risk of developing preeclampsia and an indicator of great clinical significance in the daily practice in perinatology. Keywords: preeclampsia; prediction; pulsatility index

Relationship Between Placental Calcification and Estimated Fetal Weight Percentile at 30-34 Weeks of Pregnancy

Objectives: The identification of at-risk fetus is considered as one of the most difficult challenges for clinicians and researchers although the clinical significance of placental calcifications (PCs) and its relation to adverse pregnancy outcome are controversial. Therefore, the present study aimed to evaluate the relationship between PC and estimated fetal weight (EFW) percentile at 30-34 weeks of pregnancy. Materials and Methods: This prospective cross-sectional study was carried out on all pregnant women except for multiple pregnancy subjects who were admitted to an outpatient perinatal center from October 2016 to September 2018. Several parameters were measured at 30-34 weeks of pregnancy, including EFW, umbilical artery pulsatility index (PI), middle cerebral artery PI, cerebroplacental ratio (CPR), right and left uterine artery PI, along with right and left uterine artery notch. Finally, the calcification of the placenta with any shape and degree was determined as well. Results: In this study, 739 pregnant women were evaluated for PC, including patients with PC (9.87%), small-for-gestational age (SGA, 3.65%), and those with at least one abnormal Doppler index (23.95%). Patients with PC and those with at least one abnormal Doppler index had significantly higher SGA (29.62% and 12.42%, respectively). In addition, there were 55.55% and 30.13% patients with SGA and PC in the group with at least one abnormality in terms of Doppler indices. Conclusions: In general, the findings showed that PC is more common in SGA. Based on the results, at least one abnormality in Doppler indices was more common in PC and SGA, and uterine artery Doppler abnormality was the most prevalent abnormal findings in the arterial Doppler. Thus, PC may be an important marker for adverse pregnancy outcomes.

Third trimester uterine artery Doppler indices as predictors of preeclampsia and neonatal small for gestational age

Objective: To test the hypothesis that third-trimester uterine artery Doppler (UAD) predicts adverse pregnancy and neonatal outcomes in a high-risk population.Study design: This is a nested case control study of women with singleton gestations referred for a fetal growth ultrasound between 24 and 36 weeks. Third-trimester UAD was performed if estimated fetal weight (Hadlock’s chart) was <20th percentile as these patients were considered high risk for poor pregnancy outcomes. The primary outcomes assessed were neonatal small for gestational age (SGA) and hypertensive disorders. Secondary outcomes included pH <7.10, NICU admission, Apgar <7 at 5 minutes, respiratory distress syndrome, hypoglycemia, and a composite (presence of one or more of the secondary outcomes) neonatal adverse outcome. The sensitivity and specificity of the UAD indices for predicting these outcomes were compared.Results: Among 200 women included, neonatal SGA occurred in 91 (46%) neonates, preeclampsia in 21 (10.5%), early preeclampsia in 4 (2%) and a composite adverse outcome in 67 (34%) neonates. Abnormal UAD indices, specifically left uterine artery notching and pulsatile index (PI) >95th percentile, were significantly correlated with an increased relative risk (RR) of a number of outcomes. Left uterine artery notching was significantly associated with SGA, RR 1.76 (1.03–3.04), preeclampsia, RR 2.53 (1.47–4.37) and early preeclampsia, RR 2.88 (1.34–6.20). The PI >95th percentile was significantly associated with SGA, RR 1.83 (1.21–2.76), NICU admission, RR 1.79 (1.14–2.79), preeclampsia, RR 1.98 (1.29–3.03), and early preeclampsia, RR 3.13 (2.54–3.86). The mean UAD PI >95th percentile had the best sensitivity for SGA, but the area under the ROC curve (AUC) was modest (0.60, 95% CI = 0.53–0.67). Left uterine artery notching and PI >95th percentile had similar predictive utility for preeclampsia AUC 0.65, 95% CI = 0.53–0.76 (mean uterine artery PI >95th percentile) and AUC 0.66, 95% CI = 0.54–0.77 (left uterine artery notching).Conclusion: Abnormal third-trimester UAD indices are associated with adverse perinatal outcomes including neonatal SGA, preeclampsia, and early preeclampsia. Though statistically significantly correlated, the predictive value of UAD indices for adverse pregnancy and neonatal outcomes was modest.

Placental development and function in women with a history of placenta-related complications: a systematic review.

Women with a history of placenta-related pregnancy complications, such as preeclampsia, intrauterine growth restriction or preterm delivery, have an increased risk for recurrence of such complications. This recurrence is likely the result of underlying endothelial dysfunction that leads to abnormal placentation, especially in complications with an early onset. This study provides an overview of biomarkers of placental development and function in pregnancies from women with a history of placenta-related complications. A systematic literature search was conducted limited to human studies and including keywords related to a history of placenta-related complications and markers of placental development and function. Two independent reviewers assessed eligibility and quality of 1553 retrieved unique articles. Five articles reporting on placental development and function in women with an obstetric history of preeclampsia (n=3), intrauterine growth restriction (n=1) and preterm delivery (n=2) were eligible for quality assessment. We identified associations between a history of preeclampsia and abnormal placental histological findings at term in the current pregnancy, but found contradictory results regarding presence of uterine artery notching. In women with a history of very preterm delivery (<32weeks), one study showed associations with abnormal placental histology. Literature on the association between a history of placenta-related complications and placental development and function in subsequent pregnancies is scarce and studies are heterogeneous. However, literature shows that placenta-related pregnancy complications are associated with subsequent placental histology.

EP16.17: Contribution of uterine artery Doppler in the prediction of uteroplacental insufficiency

A prospective descriptive study was conducted in Department “A” of gynecology and obstetrics in the maternity centre of Tunis. We followed 50 patients, with previous pregnancy complications correlated to placental insufficiency. Patients were randomised in two groups. The first group received Aspirin. The second one received Aspirin + Enoxaparin. For each patient, uterine artery Doppler was performed in the first, second then third trimesters. We evaluated the presence of uterine artery notch. Adverse pregnancy outcomes were notified and correlated to the sonographic results. Iatrogenic events were recorded. A first trimester bilateral uterine artery notch was found in 36% of the patients. A second trimester bilateral notch was found in 18% of the cases. 20% of patients had a unilateral notch in the second trimester. 6 % (n=3) of included patients had severe pregnancy outcome (2 cases of fetal death and 1 severe pre-eclampsia) These 3 patients had persistent bilateral uterine Artery Doppler notch. Mild complications were found in 7% of cases (mild pre-eclampsia). Severe adverse pregnancy outcomes seem to be correlated to the persistence of uterine Artery Doppler Notch after the first trimester despite the use of Aspirin and enoxaparin. Uterine artery Doppler screening could be a non invasive method to predict uteroplacental insufficiency in high risk populations. Persistent bilateral uterine artery notch could predict late severe adverse pregnancy outcome. Its association with maternal characteristics study and biochemical markers could better its predictive value.