Uterine Artery PI Research Articles

Integrated transcriptomic analysis and machine learning for characterizing diagnostic biomarkers and immune cell infiltration in fetal growth restriction.

Fetal growth restriction (FGR) occurs in 10% of pregnancies worldwide. Placenta dysfunction, as one of the most common causes of FGR, is associated with various poor perinatal outcomes. The main objectives of this study were to screen potential diagnostic biomarkers for FGR and to evaluate the function of immune cell infiltration in the process of FGR. Firstly, differential expression genes (DEGs) were identified in two Gene Expression Omnibus (GEO) datasets, and gene set enrichment analysis was performed. Diagnosis-related key genes were identified by using three machine learning algorithms (least absolute shrinkage and selection operator, random forest, and support vector machine model), and the nomogram was then developed. The receiver operating characteristic curve, calibration curve, and decision curve analysis curve were used to verify the validity of the diagnostic model. Using cell-type identification by estimating relative subsets of RNA transcripts (CIBERSORT), the characteristics of immune cell infiltration in placental tissue of FGR were evaluated and the candidate key immune cells of FGR were screened. In addition, this study also validated the diagnostic efficacy of TREM1 in the real world and explored associations between TREM1 and various clinical features. By overlapping the genes selected by three machine learning algorithms, four key genes were identified from 290 DEGs, and the diagnostic model based on the key genes showed good predictive performance (AUC = 0.971). The analysis of immune cell infiltration indicated that a variety of immune cells may be involved in the development of FGR, and nine candidate key immune cells of FGR were screened. Results from real-world data further validated TREM1 as an effective diagnostic biomarker (AUC = 0.894) and TREM1 expression was associated with increased uterine artery PI (UtA-PI) (p-value = 0.029). Four candidate hub genes (SCD, SPINK1, TREM1, and HIST1H2BB) were identified, and the nomogram was constructed for FGR diagnosis. TREM1 was not only associated with a variety of key immune cells but also correlated with increased UtA-PI. The results of this study could provide some new clues for future research on the prediction and treatment of FGR.

Routine ante-natal screening using maternal risk factors and biomarkers for preeclampsia in 11-13+6 weeks of gestation.

Prediction of preeclampsia in first trimester can lead to early initiation of preventative measures, as well as timely therapeutic intervention, that will prevent the maternal and perinatal morbidity and mortality. This study, prediction of preeclampsia at 11-13+6 weeks of gestation, was conducted by using serum placental growth factor (PlGF), serum pregnancy associated plasma protein - A (PAPP-A), uterine artery Doppler indices, and mean arterial pressure (MAP), in low-risk pregnant women. It is an observational longitudinal prospective study. Pregnant women with singleton pregnancies of gestational age 11-13+6 weeks were recruited. MAP, bilateral uterine artery Doppler indices, serum PAPP-A, and PlGF were measured. The follow-up of the patients was regularly done till termination of pregnancy and incidence of preeclampsia were noted. Qualitative variables were compared using Chi-square/Fisher exact test, and sensitivity and specificity of each test were analyzed. Among 139 women, 27 (19%) developed preeclampsia, out of which 10 had early preeclampsia and 17 developed late preeclampsia. By combining all the parameters, the sensitivity in detecting early preeclampsia was found to be 70% and for late preeclampsia cases, 64.7%. The sensitivity of all the parameters in predicting cases of preeclampsia in general is 66.7%, specificity is 74.1%, PPV is 38.3%, and NPV is 72%. The maternal biomarkers serum PAPP-A, serum PlGF, uterine artery PI, MAP have sensitivity of 70% in detecting early preeclampsia cases and for late preeclampsia cases, 64.71%, in first trimester and it will help in early initiation of preventative measures as well as timely therapeutic intervention.

Serial placental profile of women with preeclampsia and normal outcome: Placental biometry/ uterine artery PI a promising marker

Serial placental profile of women with preeclampsia and normal outcome: Placental biometry/ uterine artery PI a promising marker

Placental biophysical model for prediction of early onset fetal growth restriction in first and second trimester of pregnancy: A prospective cohort study

IntroductionTo assess the placental biometry, placental biomarkers and uterine artery Doppler in each trimester of pregnancy for prediction of early-onset fetal growth restriction (EO FGR). MethodsIn this prospective cohort study placental biometry; biomarkers PAPP-A, sFLT-1, and PlGF along with the uterine artery blood flow evaluation was done serially at 11–14, 20–24 and 28–32 weeks of gestation. The above parameters were compared between women with early onset FGR and controls. ResultsOut of 1008 fully followed cases, the small for gestational age fetuses were 227/1008 (22.5 %), and EO FGR were 84/1008(8.3 %).The placental length, volume, and PlGF levels were significantly lower, whereas the uterine artery PI(Ut PI) was significantly higher at all time points among cases. The sFLT-1 level showed a significant increase among cases, whereas it decreased among controls from the first to the second trimester. The detection rate using PV/UtA PI was 60 % in the first trimester and 66.7 % in the second trimester at 30 % FPR. ConclusionThe PV/Ut PI in first and the second trimester was a good marker for the prediction of pregnancies at increased risk of developing EO FGR.

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

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

Assessment of the cerebroplacental ratio and uterine arteries in low-risk pregnancies in early labour for the prediction of obstetric and neonatal outcomes

BackgroundThe evidence-based management of human labor includes the antepartum identification of patients at risk for intrapartum hypoxia. However, available evidence has shown that most of the hypoxic-related complications occur among pregnancies classified at low-risk for intrapartum hypoxia, thus suggesting that the current strategy to identify the pregnancies at risk for intrapartum fetal hypoxia has limited accuracy. ObjectiveTo evaluate the role of the combined assessment of the cerebroplacental ratio (CPR) and uterine arteries (UtA) Doppler in the prediction of obstetric intervention (OI) for suspected intrapartum fetal compromise (IFC) within a cohort of low-risk singleton term pregnancies in early labor. MethodsProspective multicentre observational study conducted across four tertiary Maternity Units between January 2016 and September 2019. Low-risk term pregnancies with spontaneous onset of labor were included. A two-step multivariable model was developed to assess the risk of OI for suspected IFC. The baseline model included antenatal and intrapartum characteristics, while the combined model included antenatal and intrapartum characteristics plus Doppler anomalies such as CPR MoM < 10th percentile and mean UtA Doppler PI MoM ≥ 95th percentile. Predictive performance was determined by receiver–operating characteristics curve analysis. Results804 women were included. At logistic regression analysis, CPR MoM < 10th percentile (aOR 1.269, 95 % CI 1.188–1.356, P < 0.001), mean UtA PI MoM ≥ 95th percentile (aOR 1.012, 95 % CI 1.001–1.022, P = 0.04) were independently associated with OI for suspected IFC. At ROC curve analysis, the combined model including antenatal characteristics plus abnormal CPR and mean UtA PI yielded an AUC of 0.78, 95 %CI(0.71–0.85), p < 0.001, which was significantly higher than the baseline model (AUC 0.61, 95 %CI(0.54–0.69), p = 0.007) (p < 0.001). The combined model was associated with a 0.78 (95 % CI 0.67–0.89) sensitivity, 0.68 (95 % CI 0.65–0.72) specificity, 0.15 (95 % CI 0.11–0.19) PPV, and 0.98 (0.96–0.99) NPV, 2.48 (95 % CI 2.07–2.97) LR + and 0.32 (95 % CI 0.19–0.53) LR- for OI due to suspected IFC. ConclusionsA predictive model including antenatal and intrapartum characteristics combined with abnormal CPR and mean UtA PI has a good capacity to rule out and a moderate capacity to rule in OI due to IFC, albeit with poor predictive value.

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.

Diagnostic Accuracy of Gestosis Score in Comparison to multi-marker Screening as a Predictor of Preeclampsia at 11-14 Weeks of Pregnancy: A Cohort Study.

Pre-eclampsia is a pregnancy-specific multisystemic disorder associated with adverse feto-maternal outcomes. Low-dose Aspirin therapy started in early pregnancy in high-risk women, has significantly reduced the chances of developing PE. Therefore, screening and identification of at-risk mothers are crucial. The present study was planned to study the predictive ability of gestosis score in predicting early-onset pre-eclampsia by comparing it with the multi-marker model. One hundred sixteen women, more than 19 years of age, with live singleton pregnancy at 11-13 weeks of gestation were recruited from the antenatal outpatient department and formed the study cohort. After a detailed history, screening for pre-eclampsia was performed both by multi-marker screening and by gestosis score. Diagnostic accuracy was compared for the two methods of screening. The incidence of pre-eclampsia in the present study cohort was 26.7%. The sensitivity of gestosis score >/= 3 was 84.38% (67.21-94.72) and specificity was 93.18% (85.75-97.46 %). The positive predictive value was 81.82% (67.2%-90.81%), and the negative predictive value was 94.25 (87.98 - 97.35%). The diagnostic accuracy of the gestosis score was 90.83%. Gestosis scoring is a potential tool that can be used as a cost-effective screening method for pre-eclampsia at 11-14 weeks of gestation in low-resource settings. The sensitivity and negative predictive value of the gestosis score is comparable to multi-marker screening using maternal factors, MAP, Uterine artery PI, PAPP-A, and PlGF.

A comparative study of performance of first trimester FMF algorithm for prediction of preeclampsia in singleton and twin pregnancies in coastal Karnataka

Preeclampsia is one of the most common disorders of pregnancy known to complicate 5-10% of all the pregnancies, and it is a component of the deadly triad (along with haemorrhage and infection), that contributes greatly to maternal morbidity and mortality rates. The prevalence of preeclampsia in twin pregnancy is 3-4 fold compared to singleton pregnancy. Timely diagnosis and prevention of this condition is therefore critical. Multiple maternal factors and placental biomarkers have shown to predict preeclampsia in singleton pregnancies. Previous Studies have shown that the proposed algorithms for preeclampsia screening in singletons can also be applied in twins, but with slight modifications and lower accuracy. To study the various parameters included in FMF screening algorithm in first trimester for preeclampsia in singleton and twin pregnancies. To find diagnostic accuracy of screening parameters to predict preeclampsia later in second and third trimester. To study sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) in singleton and twin pregnancy. This prospective observational cohort study conducted in department of Obstetrics and Gynecology, Kasturba Medial College, Hospital, Manipal. Patients were recruited from August 2021 to November 2022. A total of 295 pregnant women were included of which 255 were singleton gestation and 40 were twin gestation. All parameters mentioned in FMF algorithm were obtained between 11week to 13+6 weeks. Patients were followed until delivery for occurrence of pre-eclampsia. Individual parameters of first trimester FMF algorithm of pre-eclampsia screening were analyzed in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) in both singleton and twin study subjects and results were then compared among the groups. In this study a total of 295 pregnant women were recruited. 255 were single gestation of which 47 had preeclampsia and 40 were twin gestation of which 4 had preeclampsia. In the cohort of singleton pregnant women with pre-eclampsia, mean age was noted to be higher (32.77±4.27). They had higher BMI (mean 27.61±3.74) and first trimester MAP was also higher. Similarly, cohort of twin pregnancy with preeclampsia had higher mean of maternal age, BMI and MAP (30.33 ±4.46, 22.83 ± 2.93 and 90.40 ± 1.45 respectively). The Preeclampsia group in both singleton and twin subjects had lower serum concentration and lower MoM values of PAPP-A and PlGF while higher values of free beta HCG and uterine artery PI. Therefore the FMF algorithm for first trimester screening of preeclampsia was found to be a good predictor in both singleton and twin pregnancy. The first trimester FMF algorithm for preeclampsia screening had similar utility in the prediction of preeclampsia in both singleton and twin pregnancy with its individual parameters and combined risk model. However, its accuracy was slightly lesser among twins. Therefore, same screening model can be applicable in singleton and twin gestation.

Effect of Maternal Intravenous Hydration in Management of Oligohydramnios and The Changes in the Fetal Doppler

Background and aim: Oligohydramnios is linked to different fetal and maternal conditions. Maternal hydration improves amniotic fluid content, because it promotes uteroplacental perfusion. The current work aimed to determine the results of intravenous hydration on the amniotic fluid index (AFI) and Doppler measurements of uteroplacental blood circulation during pregnancy with the third trimester oligohydramnios.&#x0D; Patients and methods: The current including 50 pregnant women in their third trimester with oligohydramnios. They were selected from the outpatient clinic at Al-Azhar University Hospitals. All were submitted to clinical evaluation by history and examination, followed by abdominal ultrasound and intravenous hydration therapy. Values before and after hydration were compared, delivery mode and fetal outcome were documented.&#x0D; Results: Maternal age was 30 ± 2.28. The majority of them were multigravida (58.0%) and higher percentage were multiparous (70.0%). The GA at delivery ranged between 32 and 37 weeks of gestation. There was a significant reduction of pulse, mean arterial pressure, temperature, hematocrit after hydration than before hydration. The birth weight ranged between 2765 and 3654 g. AF volume, AMF and uterine artery PI were significantly increased while umbilical artery PI was statistically decreased after hydration that corresponding values before hydration. The mode of delivery was normal vaginal delivery among 34% and cesarean section among 66.0% and the mean Apgar score was 7.8±1.9 and 8.9±0.87 at the first and fifth minutes, respectively.&#x0D; Conclusion: Intravenous maternal hydration therapy was safe and effective in terms of improvement of amniotic fluid index in pregnant females with isolated oligohydramnios in the third trimester. It enhanced the amniotic fluid volume and AFI in females with oligohydramnios.

Efficacy of Yoga therapy as Non-pharmacological management in Women with High-risk Pregnancy: A Single Case Report

This present case study is about a High-risk Pregnancy that includes Pregnancy-induced Hypertension and an abnormal range of Uterine artery pressure, 22 years old female consulted to Gynaecologist for a complaint of missing menstrual cycle. They were diagnosed with Pregnancy positive with the help of a urinary pregnancy test (UPT). In the 13th week, as per a routine follow-up gone for an antenatal ultrasound scan report shows a There is a single live intrauterine gestation with an abnormal range of Right uterine artery PI and left uterine artery PI and diagnosed as a high-risk pregnancy. After a week, time patient has given a blood sample for a thyroid profile. Reports revealed that TRI IODO THYRONINE (T3)-2.13H and THYROXINE (T4) 21.9 H are in the higher range and noticed blood pressure range in higher side diagnosed as Pregnancy induced Hypertension (PIH) High-risk pregnancy will affect both mother and fetus in its way, on mother side, it increases blood pressure called preeclampsia and affects fetal growth result in Intrauterine growth restriction, premature birth, Stillbirth (1). After the 13th week of Pregnancy diagnosed with high-risk Pregnancy, patients are introduced to yoga therapy, including Asana, Pranayama, Meditation, etc., for three days a week regularly till the date of delivery and followed case till delivery. Yoga helps normalize blood pressure and impacts pregnancy outcomes as a standard range of APGAR score in babies and healthy birth weight. Does not show any complications of High-risk Pregnancy on the maternal and fetal side.

Role of sFLT-1/PlGF ratio in predicting severe adverse materno-fetal outcome in high risk women.

To evaluate the role of angiogenic biomarkers in predicting severe adverse materno-fetal outcome (SAO) among women at high risk of preeclampsia (PE). All antenatal women at high risk of PE underwent MAP estimation, sFlt-1/PlGF ratio, uterine artery evaluation at 20-22, 28-30 and 34-36weeks of gestation and were followed until delivery. The severe adverse outcome included severe PE, severe fetal growth restriction with Doppler changes and intrauterine death or early neonatal death. Those who developed SAO were cases and rest were controls, the cases and controls were compared using univariate and multivariate logistic regression analysis. In 54/287(18.8%) SAO was observed, and they comprised of severe PE (21/287, 7.3%), FGR with absent or reverse diastolic flow on Doppler (23/287, 8.0%) and intrauterine death or early neonatal death (10/287, 3.5%). For detecting complications up to 30weeks, the sFLT-1/PlGF ratio at 20weeks (cut off≥38) was the best test (accuracy- 97.6%) followed by MAP and uterine artery Doppler PI. For detecting complications up to 34weeks, prediction was good (accuracy -80.4%) when sFLT-1/PlGF ratio was combined with uterine artery PI. The predictive value of the complications before 34weeks was far superior to that after 34weeks. Combining the sFLT-1/PlGF ratio with the uterine artery PI improved the accuracy of the test (79% to 87%). Increased sFlt-1/PlGF ratio, was a good predictive marker for SAO in the study population. The accuracy of prediction was better for those who developed the complications before 34weeks.

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

Introduction: Polycystic ovarian syndrome is a multiple organ disorder affects 5 to 10 % female population. The world occurrence of PCOS is 105 million in the age ranges from 15 to 45. The polycystic ovarian syndrome is a set of disorders like amenorrhea, infertility, polycystic ovaries, hyperinsulinemia, hirsutism, acne vulgaris and other symptoms of hyperandrogenism. Color Doppler and Pulse Doppler play a major role in evaluation of uterine artery Resistive index for access correlation with PCOS. PCOS patients suffer from primary and secondary infertility. This study aimed to show assess uterine blood flow and whether there is a correlation between these patterns and specific hormonal parameters.&#x0D; A case control study done in Salah Al-Deen governorate during the period of 1st May–1st October 2022. Twenty-five patients with polycystic ovary disease compared with 25 normal healthy women. The ultrasound and Doppler analyses were performed for all women during the follicular phase of the menstrual cycle. Uterine artery blood flow velocities were analyzed and the pulsatility index, were calculated.&#x0D; The current study showed that oligomenorrhea found among (72%) of the patients, clinical/biochemical signs of hyperandrogenism found among (76%). The mean LH (mIU/L) was significantly higher among PCO disease cases and also that the mean FSH (mIU/L) was significantly lower among PCO disease cases than control group. There was at increased ovarian volume of &gt; 10 cm3 found among (80%), and ≥12 follicles measuring 2-9 mm found in (84%) of the PCO disease patients. The mean Uterine artery PI was significantly higher among PCO disease cases 2.3 ± 0.5 than control group 1.8 ± 0.4 (P value &lt;0.05).&#x0D; The mean ovarian volume was significantly higher among PCO disease cases than control group. The mean Uterine artery PI was significantly higher among PCO disease cases than control group.

Sensitivity of Pulsatility index of Uterine Artery on Doppler Ultrasound in Diagnosis of Polycystic Ovarian Syndrome

Objective: This study was planned to explore the sensitivity of uterine artery PI and RI. Method: This descriptive Observational study was carried out in Department of Radiology, Combined Military Hospital, Lahore, within six months after the approval of synopsis. Calculated sample size was of 120 females. The collected data was entered and analyzed by using software SPSS version 25.0. Man and standard deviation was calculated for PI and RI. Frequency and percentage was calculated for sensitivity of Pulsatility Index of uterine artery on 3D Doppler for polycystic ovarian syndrome diagnosis. Results: The accurate diagnosis of PCOs among patients was 80.83%. The results revealed that mean pulstility index of right uterine artery was 2.83±0.99 and for Left uterine artery, it was 1.37±0.69 whereas the combine mean was 2.1±0.84. Similarly, mean value of Resistive Index for right uterine artery was .83±.75 and for Left uterine artery, it was .59±.21 whereas the combine mean was 0.71±0.48. Conclusion: The accuracy of polycystic ovarian syndrome diagnosis is quite high with pelvic color Doppler which supports the usage of color Doppler for the diagnosis of polycystic syndrome in females. Keywords: Polycystic Ovarian Syndrome, Pulsatility Index, Resistive Index

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

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

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

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

Fetal cerebral three-dimensional power Doppler vascularization indices and their relationships with maternal glucose levels in pregnancies complicated with gestational diabetes.

ObjectivesWe aimed to evaluate fetal cerebral circulation using three-dimensional power Doppler (3DPD) vascular indices and to study their relationships with maternal lipid and glycaemic profiles.MethodsCase–control study in women with and without gestational diabetes mellitus (GDM) at 28–32 weeks in which feto-maternal Doppler study and 3DPD cerebral vascularization indices (FI, VI and VFI) were determined. Maternal lipid and glycaemic profiles were also analysed. Both groups were compared and the correlations of the 3DPD indices with studied variables were analysed.ResultsThere were significant differences between groups in cerebral FI (p= 0.02), mean maternal Uterine artery PI (p= 0.009) and glucose levels (p= 0.001), being higher in the GDM group. Significant negative correlations were found in GDM group between VFI and MCA PI (p = 0.02) and between VI and MCA PI (p= 0.01). In the GDM group we found a negative significant correlation between FI, VI, VFI and maternal glucose (r= −0.52, p<0.001; r= −0.32, p=0.03 and r= −0.36, p= 0.01, respectively).ConclusionsFetal cerebral FI values were higher in GDM pregnancies. All 3DPD vascular indices showed an inverse correlation with maternal glucose levels. These findings support the view that GDM may also represent a fetal vascular disorder influencing fetal neurodevelopment.

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

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

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.

Association of combined second trimester maternal serum Homocysteine and Uterine Artery Doppler to predict adverse pregnancy outcome.

Disturbances in placentation increase the risk of maternal and fetal complications. Several biochemical and imaging modalities have been studied, but the hunt for a single effective screening test never became a reality as the causes of this complex condition are multifactorial and polygenetic, many of which we are only beginning to discover. Not many studies have been conducted in the developing countries like India and other low resource settings to consider whether it would be worthwhile to combine inexpensive and effective markers together for better prediction of adverse pregnancy outcome.This study primarily aims to investigate the predictability of combined screening with maternal serum homocysteine and second trimester uterine artery Doppler in diagnosis of adverse pregnancy outcome. A prospective cohort study which involved 100 women with singleton gestation, meeting the inclusion criteria, attending the inpatient or outpatient of Obstetrics and Gynaecology in Amrita Institute of Medical Sciences, Kerala, a tertiary care centre in Southern India from July 2016 and September 2018 was conducted. Serum Homocysteine estimation (tHcy) was done between 18 and 28weeks of gestation with informed consent, and uterine artery (UA) Doppler PI which is a non-invasive routine study was done along with targeted second trimester anomaly scan (18-24weeks) in Fetal Medicine Department. Cutoff values of tHcy and UA PI were computed at 95th (> / = 9.7mmol/l) and 90th percentile, respectively as reported by Onalan et al. [9] and Nicholaides et al. [4]. Statistical analysis was performed using IBM SPSS version 20.0 software. Chi-square test and diagnostic measures were also used. Of the 100 patients, 15% (n = 15) developed hypertensive disorder. 7% (n = 7) had FGR and 7%(n = 7) had spontaneous preterm birth. 6% (n = 6) neonates had an APGAR score < 7 and 8% neonates (n = 8) required immediate NICU admission. Statistically significant association was found when tHcy and UA PI were used together for the prediction of FGR (p = 0.003), preterm birth (p = 0.002) and low APGAR score at birth (p = 0.009) with a specificity of 83.4%. With regard to PIH, both parameters were found to be statistically significant only when used independently (p = 0.001) but not when used in combination (p = 0.17). Both elevated tHcy and abnormal UA PI used in combination predicted adverse pregnancy outcome like FGR but with a low sensitivity of 14.3% and high specificity of 98.9%. However, when used independently these markers predicted FGR with a better sensitivity (tHcy- 28.6% and UA PI- 44.4%). Findings from this study have been promising with potential clinical implications for the diagnosis and management of high-risk pregnancies. Though the independent role of the two markers in screening various adverse pregnancy outcomes could be proved, their combined use to improve predictivity of more complications warrants further studies on a larger population with appropriate randomisation.