Uterine Artery PI Research Articles

Screening of High-Risk Patient by Uterine Artery Doppler Analysis in The 1st Trimester to Predict Early Onset Pre-Eclampsia

Background: Preeclampsia (PE) is still a major obstetrical problem world-wide. First trimester prediction of PE is of great clinical importance, as it would allow clinicians to focus on high-risk groups and initiate prophylactic medical treatment. The first stage of pre-eclampsia begins in the first trimester by impaired placentation. High-resistant spiral arteries can be detected from the 11th week of gestation by uterine artery (UtA) Doppler examination. Objective: To assess the relationship between 1st trimester uterine artery pulsatility index (UtA PI) and the development of early onset PE.Patients and Methods: Prospective observational study was performed at Mansoura University Hospital. This study was conducted on 109 pregnant women who attended their routine antenatal care visits at the Outpatient Obstetrics and Gynecology Clinic of Mansoura University Hospital. Results: There were statistically high significant difference between both groups in the BMI (p = 0.003), and no statistically significant difference as regards the age, gravidity and gestational age (p > 0.05). Statistically significant difference was evident between two groups in the mean values of UtA PI (p = 0.028). The best cutoff value of UtA PI for the prediction of early onset preeclampsia was ≥ 2.03 with accuracy of 0.79, and that of BMI was ≥ 35 with accuracy of 0.93. Conclusion: This study revealed that first trimester uterine artery Doppler can be used as a reliable screening test for prediction of preeclampsia in high risk women. It is a reliable, noninvasive method of examining uteroplacental perfusion. Abnormal UA Doppler ultrasonography (elevated PI) in 11–14 weeks' gestation can predict pre-eclampsia.

Preeclampsia prediction –First trimester screening markers

Preeclampsia is a multi-system disorder manifested primarily by hypertension and proteinuria during second half of pregnancy. It is a major cause of maternal morbidity and mortality worldwide. Despite decades of research into the condition, the ability of clinicians to predict preeclampsia prior to the onset of symptoms has not improved significantly. In this review we will look at potential biomarkers for early prediction and diagnosis of preeclampsia. To evaluate the efficacy of different biochemical and biophysical markers in the early weeks of gestation as screening tools for early prediction of preeclampsia. This hospital-based prospective observational study conducted on 52 pregnant women, at less than 13 weeks of gestation were recruited. Maternal urine microalbumin, urinary albumin to creatinine ratio, and USG uterine artery PI levels were analyzed among the pregnant women who subsequently developed PE and compare with those who did not develop PE. Methods used for the detection of markers are: immunoturbidimetric method for urine albumin, modified kinetic Jaffe reaction without deproteinization for Urine creatinine and Uterine artery Doppler velocimetry was done by PHILIPS HD11XE transabdominal ultrasound machine using a 4-6 MHz probe with the same sonographer. In the present study, spot urine microalbumin and spot urine albumin to creatinine ratio (UACR) at 11-13 were significantly higher in women who developed PE subsequently when compared to nonpreeclamptic women.(P<0.0001). The mean levels of 1st and 2nd-trimester uterine artery PI significantly high in women who subsequently developed PE when compared to those who did not develop preeclampsia (P<0.0001). Study results showed a strong association between gestational age at delivery and neonatal outcome (neonatal birth weight and APGAR) with preeclampsia. The maternal urine microalbumin, albumin to creatinine ratio, and uterine artery PI found to have good sensitivity and specificity for early prediction of PE. Study concluded that the women who are prone to develop PE subsequently, had high levels of MAP, UAPI, microalbuminuria and urine albumin to creatinine ratio than the normotensive women. In our setting, MAP, UAPI, microalbuminuria, and UACR markers appeared to be better screening modalities. The combination of biochemical markers with the biophysical markers, demographic characteristics, and other novel markers will establish the effective screening models for early prediction of PE. Early identification of high-risk cases will offer an opportunity for prophylactic therapy, such as Low- dose Aspirin in selected groups of high-risk women screened in the first trimester, thus improving the maternal and perinatal outcome.

Role of Uterine Artery Doppler Indices in Patients with Perimenopausal Bleeding for Diagnosis of Endometrial Pathologies: A Prospective Study

Background: Abnormal uterine bleeding is nearly a daily challenge in gynecological practice. In addition, it responsible for a respected percentage of hysterectomies. Early diagnosis is crucial, especially if noninvasive, readily available method is used. Aim of the work: To investigate the usefulness of Doppler transvaginal ultrasound in diagnosis of uterine pathology responsible for abnormal uterine bleeding in the perimenopausal women. Patients and Methods: The study included 156 patients [106 with AUB and 50 healthy controls]. The study was carried out during the duration between February to September 2020. For all females, full history taking, clinical and laboratory investigations were carried out. In addition, transvaginal ultrasonic uterine artery Doppler was done and its indices [Pulsatility index [PI] and resistance index [RI]] were documented. After histopathological results from endometrial biopsy, females were subdivided into two groups [A and B]: Group A included 52 patients with non-significant [dysfunctional] causes of AUB. Group B included 54 patients with significant [pathological] causes of AUB as endometrial hyperplasia and carcinoma. Results: Both groups of AUB were comparable regarding patient age, BMI, pattern of bleeding, number of used vulval pads, and preoperative hemoglobin concentration. However, pathological ABU was associated with high parity, long duration of bleeding, increased number of bleeding days/last month, and significantly lower values of uterine artery PI and RI. Endometrial thickness was significantly increased in ABU when compared to control group. Finally, RI was sensitive than PI in diagnosis of pathological AUB. [area under the curve was 0.998 and 0.834 respectively]. PI had a sensitivity of 70.8%, specificity of 92. % at a cut-off value of 1.82; while RI had sensitivity of 96.2% and specificity of 100.0% at a cutoff value of 0.575.Conclusion: Transvaginal Doppler ultrasound seems to sensitive and specific modality for diagnosis of endometrial abnormalities in females with perimenopausal AUB

OUTCOME OF PREGNANCY IN PATIENTS WITH UNILATERALLY INCREASED UTERINE ARTERY RESISTANCE IN SECOND TRIMESTER

Adverse pregnancy outcome due to impaired placentation have been shown to demonstrate increased impedance in the spiral artery. The spiral arteries are rstly invaded by trophoblasts and which then becomes incorporated into the vessel wall and replaces the endothelium and muscular layer. This results in the conversion of the small spiral arteries into vessels of greater diameter with low resistance and high compliance, in absence of maternal vasomotor control. This study was a Prospective Observational study, carried out in the Department of Obstetrics and Gynaecology, in JLNMCH, Bhagalpur, Bihar. The study population consisted of pregnant women between 18 – 20 weeks of gestation with viable pregnancy. During pregnancy, 63(18.36%) women developed hypertensive disorders. Among these 63 patients, 37(58.73%) women had increased uterine artery pulsatility index in second trimester scan and 26(41.26%) had normal pulsatility index. The results were comparable for gestational hypertension with normal and unilaterally increased uterine artery PI and were not statistically signicant.

Ultrasound placental image texture analysis using artificial intelligence to predict hypertension in pregnancy

Background The placental pathological changes in hypertensive disorders of pregnancy (HDP) starts early in pregnancy, the deep convolutional neural networks (CNN) can identify these changes before its clinical manifestation. Objective To compare the placental quantitative ultrasound image texture of women with HDP to those with the normal outcome. Methods The cases were enrolled in the first trimester of pregnancy, good quality images of the placenta were taken serially in the first, second, and third trimester of pregnancy. The women were followed till delivery, those with normal outcomes were controls, and those with HDP were cases. The images were processed and classified using validated deep learning tools. Results Total of 429 cases were fully followed till delivery, 58 of them had HDP (13.5%). In the first trimester, there was a significant difference in the placental length (p = .033), uterine artery PI (p = .019), biomarkers PAPP-A (p = .001) PlGF (p = .013) and placental image texture (p = .001) between the cases and controls. In the second trimester the uterine artery PI, serum PAPP-A (p = .010) and PlGF (p = .005) levels were significantly low among women who developed hypertension later on pregnancy. The image texture disparity between the two groups was highly significant (p < .001). The model “resnext 101_32x8d” had Cohen kappa score of 0.413 (moderate) and the accuracy score of 0.710 (good). In the first trimester the best sensitivity and specificity was observed for abnormal placental image texture (70.6% and 76.6%, respectively) followed by PlGF (64% and 50%, respectively), in the second trimester the abnormal image texture had the highest sensitivity and specificity (60.4% and 73.3%, respectively) followed by uterine artery PI (58.6% and 54.7%, respectively). Similarly in the third trimester, uterine artery PI had sensitivity and specificity of 60.3% and specificity of 50.7%, whereas the abnormal image texture had sensitivity and specificity of 83.5%. Conclusion Ultrasound placental analysis using artificial intelligence (UPAAI) is a promising technique, would open avenues for more research in this field.

Uterine Artery Doppler and Placental Morphological Features as Predictors of Peripartum Complications in Placenta Previa and Placenta Previa Accreta

Background: Placenta accreta is becoming an increasingly common complication of pregnancy. Placenta accreta originates from abnormal trophoblast invasion. Objective: to assess if uterine artery Doppler and Placental Morphological Features could be predictors of maternal and fetal outcome in pregnancies complicated with placenta previa and placenta previa accreta. Subjects and methods: This study included 80 pregnant women of which they were divided into 3 groups. The first group included 40 pregnant women of normal pregnancies, 2nd one included 20 pregnant women with placenta previa and the 3rd one included 20 pregnant women with suspected placenta previa accreta by ultrasound. Abdominal ultrasound and uterine artery Doppler were done in a week before delivery. Results: There was a direct relationship between presence of lacunae especially high grade, placental vascularity (abnormal) and the mean values of uterine artery PI, RI and presence of peripartum maternal and fetal complications. Conclusion: the gray scale and color Doppler ultrasound have a high diagnostic value in the diagnosis by certain placental morphological features, Including loss of retro-placetal clear zone, thinning of myometrial thickness, Intraplacental lacunae, Intraplacental vascularity and exophytic mass into bladder space. Ultrasound is helpful and non-invasive tool in prediction of maternal and fetal outcome. High grade of placental lacunae and abnormal placental vascularity were highly associated with maternal and fetal complications. Uterine artery Doppler PI and RI is also useful in prediction of maternal complications and fetal complications of placenta previa and placenta previa accreta.

Prediction of hypertension in pregnancy in high risk women using maternal factors and serial placental profile in second and third trimester

IntroductionTo evaluate the role of placental profile markers in second and third trimester of pregnancy in predicting hypertensive disorders of pregnancy (HDP) in women at high risk of preeclampsia. MethodWomen who were at high risk of preeclampsia underwent βhCG, ultrasound assessment of placental length, thickness and its ratio, uterine artery Doppler at 20–24 weeks and 28–32 weeks of gestation, the outcome at delivery was noted. Those who developed HDP were cases and those with normal outcome were controls. The placental profile markers among cases and controls were compared. ResultsHypertensive disorders of pregnancy was seen in 72/160 (45%) high risk women The serum β hCG levels at 20–24 weeks (p = 0.001) and 28–32 weeks (p = 0.018) was significantly high in women who had preeclampsia. Placental thickness was found to be less in among all subgroups of HDP, for preeclampsia, it was significantly low at 20–24 weeks (AUC- 0.743; sensitivity- 75%, specificity- 66.3%) and 28 weeks (AUC -0.764, sensitivity - 75.0% specificity - 78.7%). Uterine artery S/D ratio was considerable high in women with chronic hypertension (AUC -0.765), gestational hypertension (AUC -0.771) and preeclampsia (AUC -0.726) at 20–24 weeks. In preeclampsia group, uterine artery PI was highest and the best marker at 20–24 weeks (AUC -0.935, sensitivity - 100.0%, specificity - 87.6%). DiscussionThe placental profile markers may be used to provide closer follow up in high risk pregnancies with abnormal placental profile levels, while less intense follow up in those with normal levels, thus channelizing the resources.

The Relationship between Abnormal Echocardiography Findings in Fetus with Small Gestational Age

Background: Intrauterine growth restriction (IUGR), refers to a condition in which the fetus does not grow well according to its genetic potential. Development of the cardiovascular system and impairing fetal developmental planning ultimately caused long-term cardiovascular morbidity. In the present study, the incidence of cardiac abnormalities in fetuses affected by IUGR as well as factors related to the occurrence of these abnormalities were evaluated.&#x0D; &#x0D; Material and Methods: In this descriptive-analytical study, pregnant women referred to the Imam Khomeini Hospital in Ahvaz during February 2018 to January 2020 were recruited. Complete clinical information was recorded using a questionnaire. The recorded information included age, birth weight, gestational age, weight and BMI and comorbidities. Then, echocardiographic data; structural abnormalities including septal condition, valves and outflow of large arteries, and the presence of mass or oxygen in the heart and pulmonary arteries, EF and HR, were extracted from the medical records.&#x0D; &#x0D; Results: In the present study, 152 patients were studied. The mean age of patients was 28.2 ranged from 17- to 40year. Fetal echocardiography showed that nearly 60% of fetuses had heart abnormalities. The most common disease was ventricular septal defect (VSD) (n = 21,13.8%), followed by atrial septal defec(ASD) (n = 15,9.9%) and concurrent ASD and VSD was observed in of 11.2% cases (n = 17). The incidence of echocardiographic abnormalities in IUGR fetuses was significantly higher than in SGA (p = 0.0001). However, the type of IUGR did not have a significant relationship with the incidence of echocardiographic findings in terms of time of performance (Early or late). Among the Doppler ultrasound factors, uterine artery PI (p = 0.001) and umbilical artery PI (p = 0.008) were associated with fetal heart abnormalities.&#x0D; &#x0D; Conclusion: In general, the findings of this study showed that the incidence of heart disorders in IUGR fetuses is high and is related to the severity of fetal growth restriction. Cardiac abnormalities are more common in IUGR fetuses than in SGA. Our results have also shown that the umbilical artery PI and uterine artery PI can be used as predictive factors in diagnosing fetal heart abnormalities. Our findings suggest an evaluation of echocardiography in IUGR fetuses.

DOPPLER STUDY OF THE UTERINE AND UMBILICALARTERY TO PREDICT INTRAUTERINE GROWTH RETARDATION

The primary objective of this study is to transvalue the role of colour doppler sonography in the evaluation of pregnancy with intrauterine growth restriction. The study included 50 antenatal women with singleton pregnancy diagnosed as having a fetus with intrauterine growth restriction based on greyscale ultrasound findings. Further, an obstetric Doppler Ultrasound was done, and diagnostic statistics were applied to determine the Umbilical artery PI, RI, and Uterine artery PI, RI and correlating with perinatal outcomes. The specificity, sensitivity, positive predictive value, negative predictive value, and diagnostic accuracy were determined for all Doppler measurements. Among women with an identifiable cause, 42% had pregnancy-induced hypertension (PIH), 40% had moderate to severe anaemia complicating pregnancy. At the same time, 20% of the study group had no detectable cause for IUGR. The persistence of early diastolic notch beyond 26 weeks showed 60% sensitivity as a predictor for the perinatal outcome. The sensitivity of RI, PI of the uterine artery in predicting perinatal outcomes was 73 % and 76.7 %, respectively. Whereas, the sensitivity of RI, PI of the Umbilical artery in predicting perinatal outcomes was 63% and 70%, respectively. Doppler imaging provides indirect evidence of fetal compromise and is known to improve outcomes of high-risk pregnancies with intrauterine growth restriction. Hence, it is of eminent value for monitoring during the pregnancy.

VP50.26: Association of increased mean uterine artery PI‐ and HELLP‐like syndrome in third trimester of pregnancy: should measuring uterine artery PI be mandatory?

VP50.26: Association of increased mean uterine artery PI‐ and HELLP‐like syndrome in third trimester of pregnancy: should measuring uterine artery PI be mandatory?

Sex differences and the effects of intrauterine hypoxia on growth and in vivo heart function of fetal guinea pigs.

We hypothesized that the physiological adaptations of the fetus in response to chronic intrauterine hypoxia depend on its sex and the gestational age of exposure. Pregnant guinea pigs were exposed to room air (normoxia, NMX) or 10.5% O2 (hypoxia, HPX) at either 25 days (early onset) or 50 days (late onset) of gestation until term (~65 days). We evaluated the effects of HPX on hemodynamic and cardiac function indices using Doppler ultrasound and determined sex-related differences in near-term fetuses. Indices of uterine/umbilical artery pulsatility (PI index) and fetal heart systolic and diastolic function [Tei index and passive filling (E-wave) to filling due to atrial contraction (A-wave) (E/A ratios), respectively] were measured in utero and fetal body (FBW) and organ weights measured from extracted fetuses. Both early- and late-onset HPX decreased FBW in both males and females, had no effect on placenta weights, and increased placenta weight-to-FBW ratios. Early- but not late-onset HPX increased uterine artery PI, but neither HPX condition affected umbilical artery PI. Early-onset HPX increased left ventricle E/A ratios in both males and females, whereas late-onset HPX increased the right ventricle E/A ratio in females only. Hypoxia had no effect on the Tei index in either sex. Early- and late-onset HPX induce placental insufficiency and fetal growth restriction and increase diastolic filling depending on the sex, with female fetuses having a greater capacity than males to compensate for intrauterine hypoxia.

75 gr oral glukoz tolerans testi sağlıklı gebelerde maternal ve fetal Doppler parametrelerini etkiler mi? Kesitsel-gözlemsel bir çalışma

Aim: Oral glucose challenge test (OGTT) is widely used around the world screening for gestational diabetes mellitus (GDM). In our study, we aimed to evaluate the effect of 75 g OGTT on maternal and fetal Doppler parameters. Material and Methods: Measurements of umbilical artery PI, RI, S/D, middle cerebral artery (MCA) PSV, PI, RI and mean PI, RI S/D of uterine arteries assessed 1 hour before OGTT and 1 hour following the test in 46 pregnancies between 24-28 weeks of gestation. Mann Whitney-U test was employed to compare variables. Statistical significance was established at p&amp;lt;0.05. Results: The mean age of pregnant women was 24.6±5.4, the mean gravity status was 2.3±0.8, the mean BMI was 25.5±5.5 kg/m, and the mean gestational age was 26.5±1.6 Mean umbilical artery PI: 1.14±0.26, RI: 0.71±0.14, S/D ratio 2.24±0.73 calculated 1 hour before test and mean PI: 1.04±0.43, RI: 0.58±0.21, S/D ratio 2.01±0.44 and there was no significance (p: 0.64, 0,56, 0.71). Mean MCA PSV: 30.4±11.3 cm/sn, PI:1.89±0.36, RI: 0.81±0.19 measured 1 hour before test and 1 hour following test Mean MCA were PSV: 38.4±13.2 cm/sn, PI: 2.11±0.24, RI: 0.68± 0.21 and there was no difference (p: 0.83, 0.66, 0.82). Mean uterine arteries PI:1.13±0.21, RI: 0.69±0.11, S/D ratio 2.03±0.34 measured before the test and mean PI:1.24±0.11, RI: 0.74±0.16, S/D ratio 1.87±0.22 calculated after the test and these results were similar (p: 0.72, 0.79, 0.56). Conclusion: There was no significant effect on maternal and fetal Doppler parameters of 75 g OGTT among healthy pregnancies.

Predictive Value of both Serum Placental protein 13 Level and Uterine Artery Doppler for Prediction of Pre-Eclampsia

Background: Preeclampsia [PE] is one of the commonest medical emergencies. It had high morbidity for the mother and her infant. Early diagnosis could reduce such morbidity. Aim of the work: To evaluate the role of maternal serum placental protein [PP13] levels and uterine artery Doppler in early prediction and prognosis of preeclampsia.Patients and Methods: The study included 60 pregnant women in their first and early second trimester with high risk for preeclampsia. Patients were divided into three groups: control, mild and sever preeclampsia. All were subjected to proper history taking, clinical and obstetrical examination, laboratory investigations and ultrasound examination.Results: Cesarean delivery was significantly increased in preeclampsia compared to controls [55% of mild and 20% of severe disease compared to 15% of controls]. Both uterine artery resistance index [RI] and pulsatility index [PI] were significantly increased in PE when compared to control and in severe when compared to mild PE groups. Finally, PP13 was significantly decreased in patients with severe PE [171.7±35.9] when compared to mild PE [213.1±41.8] or control group [254.8±51.1]. In addition, there was significant decrease in cases with mild PE when compared to control group. Finally, there was inverse [negative], moderate and statistically significant correlation between PP-13 from one side and each of systolic BP, diastolic BP, uterine artery RI and PI. In addition, both RI and PI were proportionally correlated with PI and RI.Conclusion: The present study showed that PP13 combined with PI or RI can predict PE with a good sensitivity and specificity.

Mid-trimester ultrasound parameters for predicting birth weight in low risk pregnancies vs high-risk pregnancies complicated with pre-gestational diabetes mellitus.

The aim of the study was to assess the utility of mid-trimester ultrasound parameters in predicting birth weight in low-risk pregnancy and high-risk pregnancy complicated with pregestational diabetes mellitus. A study group comprised 97 healthy women and 160 women with pregestational diabetes (PGDM, type 1), all in singleton pregnancy. Ultrasound examination was performed between weeks 11 and 14, and in weeks 20 and 30 of gestation, based on recommendations of the Polish Society of Gynecologists and Obstetricians, Ultrasonography Division. We also checked uterine artery blood flow parameters. There is a correlation between the birth weight and ultrasound-ascertained parameters, including those characterising uterine artery blood flow and foetal biometry [abdominal circumference (AC), femoral length (FL), biparietal dimension (BPD)].The biparietal dimension (BPD), head circumference (HC) abdominal circumference (AC) and pre-existing diabetes are the ultrasound predictors of LGA. The presence of an early-diastolic uterine artery blood flow waveform notching, as well as the uterine artery pulsatility index (UAPI), femoral length (FL) and hypertension in pregnancy are the ultrasound predictors of SGA. In the subset of women with pre-gestational diabetes (PGDM), there is a negative correlation between the birth weight and the uterine artery pulsatility index and early-diastolic uterine artery blood flow waveform notching. In women with pre-gestational diabetes mellitus (PGDM), femoral length (FL) is a significant predictor of LGA and in case of SGA significant predictors are uterine artery pulsatility index, artery blood flow waveform notching and femoral length (FL). Midtrimester ultrasound parameters with confirmed usefulness in the prediction of birth weight in low-risk pregnancy and high-risk pregnancy complicated with pregestational diabetes mellitus include: uterine artery PI, early-diastolic uterine artery blood flow waveform notching and foetal biometry.

Role of uterine and umbilical artery doppler in prediction of developing pre- eclampsia in pregnancy

Results: The pregnant women were grouped into two groups: 65 women who developed PE with or without other pregnancy complications and 30 pregnant women who did not develop PE. Among the pregnant women that developed PE, 20 had mild PE and 45 had severe PE. The mean age of pregnant women who developed PE was 31.03 ± 3.11 years with a range of 22–39 years, while the mean age of pregnant women who did not develop PE was 30.65 ± 5.20 years with a range of 15–48. Conclusion: The findings of our study show that the PSV and EDV were significantly lower, whereas the RI, PI and S/D were significantly higher in cases that developed PE. The uterine artery PI is the best predictor of PE. A combination of the uterine artery PSV and the umbilical artery PSV best predict severity of PE among pregnant women.

Diagnostic Accuracy of Doppler Ultrasound in Predicting Perinatal Outcome in Appropriate for Gestational Age Fetuses: A Prospective Study.

To elucidate the role of Doppler ultrasound in predicting perinatal outcome in appropriate for gestational age (AGA) fetuses at term. Prospective study carried out in a dedicated research ultrasound clinic. The inclusion criterion was AGA fetuses, defined as those with an estimated fetal weight between the 10th and 90th percentile, at 36 + 0-37 + 6 weeks of gestation. The primary outcome was a composite score of adverse perinatal outcome including either adverse intrapartum events or abnormal acid-base status at birth. Secondary outcomes were the individual components of the primary outcome. The Doppler parameters explored were umbilical artery (UA) PI, middle cerebral artery (MCA) PI, uterine arteries (UtA) PI and cerebroplacental ratio (CPR). Attending clinicians were blinded to Doppler findings. Logistic regression and ROC curve analyses were used to analyze the data. 553 AGA fetuses were included. There was no difference in mean UA PI (p = 0.486), MCA PI (p = 0.621), CPR (p = 0.832) and UtA PI (p = 0.611) between pregnancies complicated by composite perinatal morbidity compared to those not complicated by composite perinatal morbidity. In pregnancies complicated by adverse intrapartum outcome, the mean MCA PI (1.47 ± 0.4 vs 1.61 ± 0.4, p = 0.0039) was lower compared to the control group, while there was no difference in UA PI (p = 0.758), CPR (p = 0.108), and UtA PI (p = 0.177). Finally, there was no difference in any of the Doppler parameters explored between AGA fetuses with abnormal acid-base status at birth compared to those without abnormal acid-base status at birth. In the logistic regression analysis, UA PI, MCA PI, CPR, UtA PI, EFW and AC percentiles were not independently associated with composite adverse outcome, adverse intrapartum outcome or abnormal acid-base status at birth in non-SGA fetuses. The diagnostic performance of all of these Doppler parameters for predicting composite adverse outcome, adverse intrapartum outcome and abnormal acid-base status was poor. Cerebroplacental and maternal Doppler is not associated with or predictive of adverse pregnancy outcome in AGA fetuses close to term.

The predictive value of 11-14 week uterine artery Doppler indices for hypertensive pregnancy complications

Introduction. Hypertensive complications of pregnancy can often lead to serious, even life-threatening situations for the mother and fetus. First-trimester uterine artery Doppler can be a predictive tool for such complications. Materials and method. At the Department of Obstetrics and Gynecology of the Arad County Emergency Clinical Hospital, we examined 305 pregnant patients, from 11 weeks to 13 weeks+6 days gestational age, by ultrasound, both as inpatients and outpatients, and we have assessed the evolution of their pregnancy. Results. There were 21 patients with hypertensive pregnancy complications (6.89%) and 284 patients with normal outcome (93.11%). Three patients had pregnancy-induced hypertension (0.98%), and 18 had preeclampsia (PE; 5.9%), with 12 cases of mild PE (3.95%) and six cases of severe PE (1.97%). The sensitivity for uterine artery PI above the 95th percentile, for uterine artery RI above the 95th percentile, and for uterine artery PI/RI above the 95th percentile was 0%, 0-33.33% and 0%, respectively. The specificity was 94.72-95.03%, 94.98-95.42% and 94.98-95.03%, respectively. The positive predictive value was 0%, 0-13.33% and 0%, respectively. The negative predictive value was 92.76-98.97%, 93.45-99.31% and 92.76-98.97%, respectively. Odds ratios were 0.453-3.966, 1.147-10.286 and 0.453-3.966, respectively. Conclusions. Uterine artery Doppler indices above the 95th percentile during the 11-14 week gestational age offers low to medium detection rates, the best index being the resistivity index.

Intraplacental Villous Artery Doppler as an Independent Predictor for Placenta-Mediated Disease and Its Comparison with Uterine Artery Doppler and/or Placental Biochemical Markers in Predictive Models: A Prospective Cohort Study

Objectives: To validate intraplacental villous artery (IPVA) Doppler as a predictor for placenta-mediated diseases (PMDs), to compare its predictive value with uterine artery (UtA) Doppler and placental biochemical markers, and to assess its value in predictive PMD models. Methods: IPVA and UtA indices (pulsatility index [PI] and resistance index [RI]) were recorded at 18–24 weeks of gestation in a cohort of 117 women. The predictive values of IPVA, UtA, and placental biochemical markers were analyzed and compared between the PMD group (the women who developed preeclampsia or intrauterine growth restriction) and the non-PMD group (the women who remained healthy throughout pregnancy and 3 months postpartum) using the receiver-operating characteristic curves. Logistic regression was used to compare predictive models for PMDs based on IPVA, UtA, and/or biochemical markers. Results: 31 (26.5%) women developed PMD (17 preeclampsia and 14 intrauterine growth restriction). IPVA PI was significantly higher in the PMD group than in the non-PMD group (p = 0.001). UtA PI and RI values remained nonsignificant between both groups (p = 0.066 and 0.104, respectively). IPVA PI from the 3 main branches of the placenta, and specifically the central main stem villi, showed a strong association with PMDs in comparison to UtA (p = 0.03 and 0.001 vs. 0.29). Model prediction including IPVA and UtA PI with or without placental biomarkers did not add any further significance to IPVA PI alone (p = 0.03, 0.41, and 0.36). Conclusions: IPVA PI appears superior to UtA PI or RI and placental biomarkers in PMD prediction. Model prediction for PMDs including IPVA, UtA Doppler, and biochemical markers did not enhance prediction values compared to IPVA Doppler alone.

The effect of vaginal progesterone on Doppler findings in increased uterine artery resistance

Objective The present study aimed to evaluate the effect of vaginal progesterone on Doppler finding in increased uterine artery resistance compared with aspirin. Materials and methods This study is a double-blind randomized clinical trial that was conducted on 140 pregnant women with increased uterine artery resistance who were referred to the Shariati hospital (Tehran, Iran) in 2017–2018. Patients were randomized to 1 of the 3 treatment groups – group A: tablet aspirin 80 mg; group B: vaginal suppository progesterone; and group C: control group without any intervention. Low-risk pregnant women at the gestational age of 16–20 weeks, were assessed by the uterine artery Doppler. In the presence of increased resistance of the uterine artery, patients were randomly assigned to one of the three above mentioned groups. Results The results of paired t-tests for right uterine artery pulsatility index (RUA.PI), right uterine artery resistance index (RUA.RI), left uterine artery PI (LUA.PI), and left uterine artery RI (LUA.RI) before and after of intervention in the three groups were statistically significant. Also, the one-way analysis of variance (ANOVA) results for comparison between three groups showed that before the intervention only means of RUA.PI has a significant difference between three groups (p = .025), but means of all variables after intervention shows a significant difference (p < .001). Conclusion The findings showed that the use of vaginal progesterone suppressed the resistance of uterine artery compared to aspirin.

First trimester uterine artery pulsatility index levels in euploid and aneuploid pregnancies.

To examine whether the uterine artery PI is different in aneuploid and euploid pregnancies. Retrospective case-matched study at the department of prenatal medicine at the University of Tuebingen, Germany. The study involved patients with complete data on first trimester screening for trisomies and preeclampsia except PlGF. For each case with trisomy 21 we randomly selected 50 cases with a euploid fetus where complete data on screening for aneuploidy and preeclampsia were also available. The uterine artery pulsatility index and the corresponding MoM values of euploid and the aneuploid population were compared with a Man-Whitney U test. The dataset consisted of 4591 singleton pregnancies. The karyotype was normal in 4500 cases and was abnormal in the remaining 91 pregnancies. There were 50 pregnancies with trisomy 21, 31 with trisomy 18 and 13, and 10 with triploidy. In the group with euploid fetuses, median uterine artery PI was 1.55 (0.99 MoM). In the group with trisomy 21, the median PI (1.42) and MoM (0.89) levels were both significantly lower than in the euploid (p < 0.001). However, the measurements in the trisomy 18 and 13 [1.61 (0.93 MoM)] and in the triploidy [1.99 (1.13 MoM)] groups were not significantly different from those in the euploid group (p = 0.468 and p = 0.632, respectively). In conclusion, uterine artery PI levels in the first trimester are slightly lower in pregnancies with trisomy 21. This knowledge may prove to be useful in cases where a low PAPP-A level is seen on the first trimester maternal serum biochemical evaluation to differentiate whether the more likely cause for this finding is placental dysfunction or aneuploidy, specifically trisomy 21.