Uterine Artery Pulsatility Index Values Research Articles

Prediction by uterine artery Doppler screening of small-for-gestational-age neonates at 19-24 weeks' gestation.

Small-for-gestational-age (SGA) neonates are at increased risk of perinatal mortality and morbidity. We aimed to investigate the performance of uterine artery pulsatility index (UtA-PI) at 19-24 weeks' gestation to predict the delivery of a SGA neonate in a Chinese population. This was a retrospective cohort study using data obtained between January 2010 and June 2018. Doppler ultrasonography was performed at 19-24 weeks' gestation. SGA was defined as birth weight below the 10th centile according to the INTERGROWTH-21st fetal growth standards. The performance of UtA-PI to predict the delivery of a SGA neonate was assessed using receiver-operating-characteristics (ROC)-curve analysis. We included 6964 singleton pregnancies, of which 748 (11%) delivered a SGA neonate, including 115 (15%) women with preterm delivery. Increased UtA-PI was associated with an elevated risk of SGA, both in neonates delivered at or after 37 weeks' gestation (term SGA) and those delivered before 37 weeks (preterm SGA). The areas under the ROC curve (AUCs) for UtA-PI were 64.4% (95% CI, 61.5-67.3%) and 75.8% (95% CI, 69.3-82.3%) for term and preterm SGA, respectively. The performance of combined screening by maternal demographic/clinical characteristics and estimated fetal weight in the detection of term and preterm SGA was improved significantly by the addition of UtA-PI, although the increase in AUC was modest (2.4% for term SGA and 4.9% for preterm SGA). This is the first Chinese study to evaluate the role of UtA-PI at 19-24 weeks' gestation in the prediction of the delivery of a neonate with SGA. The addition of UtA-PI to traditional risk factors improved the screening performance for SGA, and this improvement was greater in predicting preterm SGA compared with term SGA. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Effects of uterine Doppler on midbrain growth and cortical development in late onset fetal growth restricted fetuses: a prospective cross-sectional study

Objective To investigate midbrain growth, including corpus callusum (CC), cerebellar vermis (CV) and cortical development in late fetal growth restriction (FGR) depending on uterine artery (UtA) Pulsatility Index (PI) values. Methods This was a prospective study including singleton fetuses with late FGR characterized by abnormal cerebral placental ratio (CPR). According to UtA PI values, the FGR fetuses were subdivided into normal ≤95th centile) and abnormal (>95th centile). Neurosonography was performed at 33–44 weeks of gestations to assess CC and CV lengths and the depth of Sylvian fissure (SF), parieto-occipital (POF) and calcarine fissures (CF). Neurosonographic variables were normalized for fetal head circumference size. Results The study cohort included 60 fetuses with late FGR, 39 with normal UtA PI and 21 with abnormal PI values. The latter group showed significant differences in CC (median (interquartile range) normal 35.9 (28.49–45.53) vs abnormal UtA PI 25.31(19.76–35.13) mm; p < 0.0022), CV (normal 25.78 (18.19–29.35) abnormal UtA PI 17.03 (14.07–24.16)mm; p = 0.0067); SF (normal 10.58 (8.99–11.97)vs abnormal UtA PI 7.44 (6.23–8.46) mm; p < 0.0001), POF (normal 6.85 (6.35–8.14) vs abnormal UtA PI 4.82 (3.46–7.75) mm; p < = 0.0184) and CF (normal 04.157 (2.85–5.41) vs abnormal UtA PI 2.33 (2.49–4.01)); p < 0.0382). Conclusions Late onset FGR fetuses with abnormal UtA PI showed shorter CC and CV length and delayed cortical development compared to those with normal uterine PI. These findings support the existence of a link between abnormal brain development and changes in utero placental circulation.

Association between abnormal uterine artery pulsatility index and the risk of fetal congenital heart defects: a hospital-based cohort study

To explore the associations between high uterine artery pulsatility index (UtA-PI) values and congenital heart disease (CHD) risk and whether they differed between singleton and multiple pregnancies. This hospital-based cohort study involving 52,047 pregnant women who underwent prenatal examinations from 2012 to 2016. Infants born to the included pregnant women were followed until 42 days after birth to identify those with CHDs. Generalized estimating equations were used to estimate the associations of high right UtA-PI (> 95th percentile) values with maternal preeclampsia and fetal CHDs. Logistic regression analyses were conducted using path analysis models to quantify the effect of high right UtA-PI values on fetal CHD risk. A total of 42,552 women and 43,470 infants (147 with CHDs) were included. Preeclampsia risk was associated with a high right UtA-PI in singleton-pregnant women (adjusted PR, 3.01; 95% CI 2.57–3.52). CHD risk was marginally associated with a high right UtA-PI in singleton-pregnant women (adjusted PR, 2.26, 95% CI 1.03–4.95). Considering only two factors, 96.0% of the fetal CHD risk was mediated by preeclampsia in singleton-pregnant women, while 93.8% of the risk was related to a high right UtA-PI in multiple-pregnant women. A high right UtA-PI was marginally associated with an increased fetal CHD risk in singleton-pregnant women and might play an important role in multiple-pregnant women. Further studies are warranted to confirm these findings given the high loss to follow-up rate.

The multiple reference range of mean uterine artery pulsatility index for natural and in vitro fertilization singletons during 11-14 gestational weeks.

Ultrasonography of the uterine artery (UtA) in the first and second trimesters of pregnancy can assess uterine-placental blood perfusion and guide early clinical prevention. Establishing normal ranges of the UtA pulsatility index (UtA-PI) at 11-14 weeks of pregnancy is helpful for the early identification of high-risk pregnant women and improving the prognosis. This study aimed to establish a reference range of UtA-PI based on crown-rump length (CRL) for spontaneous and in vitro fertilization (IVF) singleton pregnancy during 11-14 weeks, respectively. A prospective study was performed at Peking Union Medical College Hospital. Healthy, low-risk women with a singleton pregnancy at 11-14 gestational weeks were consecutively recruited for this study from December 2017 to December 2020. All participants underwent routine prenatal ultrasound examination. The CRL of the fetus and the UtA-PI were measured in both uterine arteries, and average values were calculated. The LMS method was used to fit the percentile (P)5, P10, P25, P50, P75, P90, and P95 curves of the UtA-PI value of spontaneous and IVF singleton pregnancy with CRL changes, respectively. A total of 1,962 pregnant women with normal fetuses were included in this study, including 1,792 pregnancies conceived naturally and 170 IVF fetuses. The UtA-PI reference range in the spontaneous pregnancy group was consistently higher than that in the IVF group during 11-14 weeks, and showed a statistically significant difference in UtA-PI for spontaneous and IVF pregnancies (P<0.001). According to the LMS method, each percentile curve of UtA-PI decreased with the increase of CRL in both the natural pregnancy group and the IVF group. The P95 range of UtA-PI for pregnant women with naturally conceived and IVF pregnancy was 2.74 to 2.11 and 2.50 to 1.94, respectively. The overall change of UtA-PI differentials of the two groups showed a downward trend and decreased slightly with the increase of CRL. This study provided a single-center, large sample of data and constructed a CRL-based reference value of UtA-PI for spontaneous and IVF singleton pregnancy, which provides a reliable basis for early UtA evaluation and early clinical decision-making during 11-14 gestational weeks.

Assessment of fetal myocardial performance index in pregnant women with SARS-CoV-2 infection: A prospective cohort study.

Our aim was to investigate the effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on fetal myocardial performance in women who had it during their pregnancy. In our prospective cohort study including healthy pregnant women and pregnant with SARS-CoV-2 infection, we collected patients' data between June 2021 and April 2022. Maternal characteristics, gestational age at SARS-CoV-2 infection and ultrasound examination, and body mass index were noted. Fetal biometry, fetal anatomy scanning, placenta, amniotic fluid index (AFI), and Doppler parameters were routinely examined in all patients. Left ventricular myocardial performance index (MPI) was measured during fetal echocardiography examination. Doppler parameters, AFI, and MPI values were compared between two groups. Compared with the control group (n = 80), MPI values were found within normal limits in fetuses of pregnant women with SARS-CoV-2 infection (n = 80) (MPI: 0.38 ± 0.06 in the control groups vs. 0.39 ± 0.05 in the SARS-COV-2 positive group, p = 0.79). There was no relationship between SARS-CoV-2 infection and changes in AFI and umbilical artery pulsatility index (PI) values. Uterine artery PI values were significantly higher in pregnant women with (SARS-CoV-2) infection (0.81 in the control group vs. 0.97 in the SARS-CoV-2 group, p < 0.05). Fetal cardiac functions were not affected in pregnant women with previous (SARS-CoV-2) infection. Further metaanalyses are warranted to confirm the results.

Evaluation of the predictive value of uterine artery doppler in second trimester of pregnancy as a screening tool for preeclampsia

This study was carried out to determine the validity and reliability of Uterine Artery (UtA) Doppler imaging as a screening tool for predicting preeclampsia among pregnant women attending a tertiary care hospital of the Armed Forces in second trimester.Our study was a prospective diagnostic study carried out in 680 pregnant women (age group of 19 to 30 years) in second trimester. Maternal BP was recorded using automated BP apparatus on three occasions (15 minutes apart) in supine posture. This was followed by uterine artery Doppler with measurement of Resistivity index (RI) and Pulsatility index (PI). Patients were followed up every month till 12 weeks post-partum. Statistical analysis was done using SPSS version 21. The mean uterine artery PI was 1.21±0.296 and the mean uterine artery RI value was observed to be 0.58±0.18. The incidence of preeclampsia among the study participants was observed to be 9.9%. The mean uterine artery PI and RI among patient with preeclampsia was found to be significantly higher than those without preeclampsia (p value &amp;#60;0.001). The uterine artery PI values of ≥1.3 when defined as a diagnostic cut off, the sensitivity and specificity was found to be 79.1% and 70.8% respectively. The accuracy was observed to be 71.62%. The uterine artery RI values of ≥0.7 when defined as a diagnostic cut off, the sensitivity and specificity was found to be 44.78% and 89.72% respectively. The accuracy was observed to be 85.29%. Uterine artery PI parameter is found to have better sensitivity than RI in predicting preeclampsia. Consideration of both PI and RI parameters for prediction of preeclampsia significantly increased the specificity of Uterine Artery Doppler Imaging. Uterine Artery Doppler is a useful tool in predicting the risk of preeclampsia among women in second trimester of pregnancy.

‘18-24 HAFTA UTERİN ARTER DOPPLER ULTRASONOGRAFİSİNDE PULSATİLİTE İNDEKSİNİN VE DİYASTOLİK ÇENTİK VARLIĞININ PREEKLAMPSİ ÖNGÖRÜSÜNDEKİ ÖNEMİ’

Aim: To determine second-trimester uterine artery pulsatility index (UA-PI) values and diastolic notch (DN) presences in primigravid, low-risk pregnant women for preeclampsia (PE) prediction.&#x0D; Matherials and Methods: We studied prospectively primigravid, pregnant women between 18 and 24 weeks of gestation who were admitted for routine prenatal care. An ultrasound examination that included measurements of the UA-PI and DN presence was performed and pregnancy outcomes were evaluated.&#x0D; Results: In total 244 primigravid pregnant women were included this study, and 15 (6,1 %) developed PE. When Preeclampsia positive (PEP) group and the preeclampsia negative (PEN) group compared, there was no difference in demographic data. PEP group mean UA-PI value was significantly higher (p&lt; 0,01) when mean time of the delivery week (p&lt; 0,01) and fetal birth weight (p&lt; 0,01) were significantly lower than PEN group.&#x0D; DN was negative (NN) in 163 (66,8 %) pregnant women, and found positive (NP) in 81 (33,2%) pregnant women. NP group had higher PE rates compared to NN group. Bilateral notch positivity increases both PE and early PE rates compared to notch negativity and unilateral notch positivity. The most sensitive and specific value of UA-PI for PE prediction was found 1,13.&#x0D; Conclusion: Uterine artery Doppler is a non-invasive and simple tool to identify high-risk pregnancies and may improve patient-specific practice. Especially pregnant women with a bilateral uterine notch accompanying with abnormal UA-PI values resulted a higher prevalence to develop these severe adverse outcomes. Closer monitoring may help to reduce both maternal and fetal morbidity and mortality in high-risk groups.

Outcomes of pregnancies diagnosed with circumvallate placenta, and use of uterine artery pulsatility index and maternal serum alpha-fetoprotein for prediction of adverse outcomes

ObjectivesTo evaluate the outcomes, and predictive value of uterine artery pulsatility index (UtA-PI) and second-trimester maternal serum alpha-fetoprotein (MSAFP) for adverse obstetric outcomes in cases with morphologically confirmed circumvallate placenta by comparison with normal pregnancies. Study designThis prospective study was conducted in a tertiary referral hospital between January 2017 and December 2019. During the study period, 77 patients with a circumvallate placenta and 77 patients without any placental or feto-maternal diseases or abnormalities were evaluated. The final diagnosis was made based on macroscopic examination of the placenta soon after birth. Demographic characteristics, MSAFP, obstetric complications, haemoglobin after delivery, gestational week of birth, fetal sex, 1- and 5-min Apgar scores, postnatal complications and type of delivery were retrieved from hospital records. Bilateral mean transabdominal UtA-PI and MSAFP were evaluated for the prediction of adverse outcomes. SPSS Version 21.0 for Windows was used for statistical analysis, and receiver operating characteristic (ROC) curves were used for the prediction model of adverse outcomes. ResultsSmoking rate, MSAFP, preterm birth and intrauterine growth restriction (IUGR) were higher in the patients with a circumvallate placenta (p = 0.005, 0.00, 0.025 and 0.027, respectively). The cut-off value of MSAFP was 1.41 (0.60–3.32) and the cut-off value of UtA-PI was 1.2 using the ROC curves, and had sensitivity of 73.7 % and specificity of 71.9 %, and sensitivity of 73.7 % and specificity of 76.3 %, respectively (p < 0.05). ConclusionsCircumvallate placenta was associated with a higher rate of IUGR, preterm birth and bleeding at the time of delivery. In patients with a circumvallate placenta, UtA-PI and MSAFP may be valuable as predictors of IUGR.

Maternal cardiac function at 19-23 weeks' gestation in prediction of pre-eclampsia.

First, to examine the factors from maternal characteristics and medical history that affect maternal cardiovascular indices, and, second, to examine the potential value of maternal cardiovascular indices at 19-23 weeks' gestation, on their own and in combination with maternal factors and the established biomarkers of pre-eclampsia (PE), including uterine artery pulsatility index (UtA-PI), mean arterial pressure (MAP), serum placental growth factor (PlGF) and serum soluble fms-like tyrosine kinase-1 (sFlt-1), in the prediction of subsequent development of PE. This was a prospective observational study in women attending for a routine hospital visit at 19 + 1 to 23 + 3 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, assessment of maternal E/A ratio, E/e' ratio, myocardial performance index, global longitudinal systolic strain, left ventricular ejection fraction, peripheral vascular resistance, left ventricular cardiac output and left ventricular mass indexed for body surface area, and measurement of MAP, UtA-PI, serum PlGF and serum sFlt-1. The measurements of the eight maternal cardiac indices were standardized to remove the effects of maternal characteristics and elements from the medical history. The competing-risks model was used to estimate the individual patient-specific risks of delivery with PE and determine the detection rate, at a 10% false-positive rate, in screening by a combination of maternal demographic characteristics and medical history with biomarkers. The study population of 2853 pregnancies contained 76 (2.7%) that developed PE. In pregnancies that subsequently developed PE, there was evidence of altered cardiac geometry, impaired myocardial function and increased peripheral vascular resistance. All maternal cardiovascular indices were affected significantly by maternal demographic characteristics and elements of medical history known to be associated with an increased risk for subsequent development of PE. After adjustment for maternal demographic characteristics and medical history, the only cardiovascular index that was affected significantly by subsequent development of PE was peripheral vascular resistance. Peripheral vascular resistance multiples of the median (MoM) was correlated with MAP MoM, which is not surprising because blood pressure is involved in the estimation of both. There were weak correlations between several cardiovascular indices and MAP MoM, but none was correlated with MoM values of UtA-PI, PlGF or sFlt-1. The performance of screening for delivery with PE at < 37 weeks' gestation or delivery with PE at any gestational age in screening by maternal demographic characteristics and medical history or combinations of maternal factors with MAP, UtA-PI, PlGF and sFlt-1 was not improved by the addition of peripheral vascular resistance. Assessment of maternal cardiovascular function provides information on the pathophysiology of PE but is not useful in the prediction of PE. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Uterine artery Doppler indices: pulsatility index and resistance index as predictive tools for the incidence of heavy menstrual bleeding related to copper intrauterine contraceptive device.

ObjectivesTo assess the predictive value of the initial uterine artery Doppler indices, the pulsatility index (PI), and resistance index (RI) in the prediction of heavy menstrual bleeding before and after copper intrauterine contraceptive device (IUCD) insertion.MethodsThe current prospective clinical study included 100 women who intended to use a copper IUCD (Cu T-380A) and met the inclusion criteria. Uterine artery Doppler PI and RI indices were calculated before IUCD insertion and at three and six months after insertion. Based on the presence or absence of menorrhagia, all women were classified into two groups: non-bleeding (n=52) and extreme menstrual bleeding (n=48). Receiver operating curve analysis was used to determine the predictive value of uterine artery PI and RI in patients with menorrhagia relevant to IUCD.ResultsThe PI and RI indices displayed a highly significant difference between the IUCD groups at three and six months after insertion (P<0.001). Uterine artery PI ≤2.02 (sensitivity of 95.8%, specificity of 100%, and area below the curve [AUC] of 0.97 at P-value<0.001) and RI ≤0.83 (sensitivity of 93.8%, specificity of 100%, and AUC of 0.949 at P-value<0.001) were correlated with significant menstrual bleeding following insertion of IUCD.ConclusionThe presented results confirmed our assumption that the initial studies of uterine artery Doppler can predict heavy-menstrual bleeding associated with IUCD and therefore, should be conducted in women pursuing reversible long-acting contraception.

The influence of vaginal progesterone on Uterine Artery Pulsatility Index.

Uterine artery Doppler is frequently used in the first trimester and it is one of the more effective measurement methods in the prediction of preeclampsia and intrauterine growth restriction (IUGR). Progesterone is a hormone that is used quite frequently in various indications in obstetrics and gynecologic practice. We aimed to investigate the influence of progesterone on the uterine artery Doppler pulsatility index (PI) at 11-14 gestational weeks. This study is a retrospective case-control study conducted in Selcuk University Faculty of Medicine between January and December 2019. Uterine artery Doppler PI values of patients using progesterone were compared with PI values of patients not using progesterone. Uterine artery PI was measured two times, left and right. Then the mean PI was calculated. All measurements were made by two operators and by the same ultrasonography machine RESULTS: A total of 288 patients, 140 patients using progesterone and 148 patients not using progesterone were included in the study. Demographic characteristics were similar between the groups (p > 0.05). There were no significant differences between the groups in the right and left uterine artery PI values. There was no significant difference for average uterine artery PI between the groups (p < 0.05). Progesterone has no significant influence on uterine artery PI. However, more prospective studies in which all potential confounding factors are considered including serum progesterone levels are needed for this subject.

First- and second-trimester uterine artery pulsatility index as a combination factor in predictive diagnosis of pregnancy-induced hypertension.

Hypertensive disorder of pregnancy is a major cause of fetal and maternal morbidity and mortality. The current approach for pregnancy-induced hypertension (PIH) screening is complex and expensive. The present prospective cohort study assesses the advantage of combining first- and second-trimester uterine artery pulsatility index (UAPI) for predictive diagnosis of PIH. A total of 151 prenatal cases in their first trimester were studied and followed up till delivery. The mean UAPI was calculated for the first and second trimesters during the nuchal translucency and anomaly scans. Receiver operating characteristic analysis was used to calculate the cut-off of UAPI for first-trimester, second-trimester, and both trimesters combined. Twenty-seven (17.9%) pregnant women developed PIH. Mean±SD UAPI values for first and second trimesters were 1.92±0.60 and 1.23±0.36, respectively. The cut-offs for abnormal UAPI were ≥2.51, ≥1.32, and ≥1.91 for first trimester, second trimester, and both trimesters combined, respectively. The sensitivity and specificity of UAPI in predictive diagnosis of PIH were 82% and 95% for first trimester, 93% and 85% for the second trimester, and 93% and 98% for both trimesters combined. Combining UAPI of first and second trimesters improves the predictive diagnosis of PIH, which can be carried out during the nuchal translucency and anomaly scans without imparting extra cost to the patient.

The effect of copper intrauterine device use duration on uterine and ovarian blood flow parameters: A prospective cross‐sectional study

This prospective cross-sectional study aimed to compare uterine and ovarian arterial Doppler signals in regularly menstruating patients who had been using copper intrauterine devices (IUD) for different durations. Four groups of participants were formed (n = 30 for each) depending on the duration of copper IUD use: less than 1 year (group 1), 1 to 3 years (group 2), and over 3 years (group 3). Women without IUDs formed the control group. All participants were called in on the fifth-eighth days of their menstrual cycle for Doppler blood flow assessment. The pulsatility index (PI) and resistance index (RI) values were recorded in uterine and ovarian arteries. The groups 2 and 3 had significantly higher uterine artery PI and RI values than groups 1 and 4. Furthermore, group 2 had uterine and ovarian artery PI and RI values similar to those of group 3. There was a positive relationship between uterine and ovarian arteries' PI and RI values with the duration of IUD use. The presence of an IUD for over a year seems to cause changes in the uterine artery PI and RI values assessed by Doppler ultrasonography.

Uterine artery pulsatility index and serum BMP-9 predict resistance to methotrexate therapy in gestational trophoblastic neoplasia: A cohort study

Methotrexate is the most common first-line chemotherapy for low-risk gestational trophoblastic neoplasia (GTN). Uterine artery pulsatility index (UAPI) is an ultrasound marker for tumor vascularity that has been associated with an increased risk of methotrexate resistance. The combination of circulating angiogenic factor levels with UAPI data may improve the capacity of this model to predict chemoresistance. This was a single-center cohort study of women newly diagnosed between January 2008 and June 2012 with low-risk GTN during postmolar surveillance and treated with single-agent methotrexate at Charing Cross Hospital, a UK national center for treatment of gestational trophoblastic disease. Two hundred seventeen women underwent an ultrasound for UAPI measurement prior to initiation of chemotherapy. To examine serologic markers of methotrexate resistance among this cohort, we performed a case-control study using archived serum from 76 patients who could be matched based on prognostic risk score. Serum samples were examined by immunoassay to measure 8 different angiogenic factors (VEGF-A, FGF-basic, PLGF-1, PDGF-BB, EGF, ANGPT2, BMP-9, and ENG). Receiver-operator characteristic area under the curve (AUC) values were calculated for the ability of each analyte to correctly classify patients as methotrexate sensitive (MTX-S) or resistant (MTX-R). Total human chorionic gonadotropin levels were similar between the MTX-S and MTX-R groups. UAPI values were significantly higher in MTX-S (median 1.30 [interquartile range {IQR} = 0.80-1.90]) compared to MTX-R patients (median 0.875 [IQR = 0.60-1.30]; P < 0.0001) with AUC 0.68 (95% confidence interval 0.61-0.76; P < 0.0001). In univariate analysis, only BMP-9 concentrations were significantly different between groups, lower among MTX-S (median of 225 ng/L, IQR = 170-287) compared to MTX-R patients (median 280 ng/L [IQR = 200-339]; P= 0.03). Combining UAPI with BMP-9 concentration improved prediction for chemoresistance with AUC 0.77 (95% confidence interval 0.66-0.88; P < 0.0001). Circulating levels of BMP-9 are elevated in newly diagnosed women with low-risk GTN destined to fail primary methotrexate therapy. A combined test using serum BMP-9 plus UAPI might improve prediction of MTX-R in low-risk GTN.

Effect of previous cesarean sections on second-trimester uterine artery Doppler.

In this study, we investigated the effects of previous cesarean sections on uterine artery Doppler indices. This prospective cohort study included 153 healthy pregnant women between 18 and 24 weeks of gestation. Seventy-three pregnant women without previous cesarean sections (control group) and 80 pregnant women with previous cesarean sections (study group) were compared in terms of uterine artery Doppler indices. The mean uterine artery pulsatility index (PI) MoM value was 1.18 ± 0.40 in the study group and 1.07 ± 0.35 in the control group (P = 0.046). The number of patients with uterine artery PI values above 95 percentile was 18 (22.5%) in the study group and 5(6.8%) in the control group (P = 0.007). The mean gestational age at birth was significantly lower in the study group (38.2 ± 1.3 vs. 39 ± 1.0, P < 0.001). There was no significant difference between the mean PI, resistance index (RI) and systolic/diastolic (S/D) ratio values of the uterine artery (P = 0.16, 0.11, 0.08, respectively). When the comparison was made with the number of previous cesarean sections, all three index values of the patients who had had more than two cesarean sections were found to be significantly higher. The Doppler flow indices of the uterine artery significantly increased in patients with more than two previous cesarean sections. When evaluating uterine artery Doppler indices in pregnant women with a history of previous cesarean sections, these factors should be considered.

Evaluation of Placental Perfusion Based on Intravoxel Incoherent Motion Diffusion Weighted Imaging (IVIM-DWI) and Its Predictive Value for Late-Onset Fetal Growth Restriction.

Objective The aim of this study was to investigate placental blood perfusion in middle and late pregnancy and explore its predictive value for fetal growth restriction (FGR). Methods All pregnant women included in the study were examined using placental intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI). Three IVIM parameters (D, f, D*) were obtained for each pregnant woman and analyzed using Image J software. Perfusion fraction f is a radiological marker of placental perfusion. The pulsatility index (PI) of the uterine artery is used to indirectly evaluate placental function. Results f-values were significantly lower in the late-onset FGR group compared to the normal late pregnancy group (19.07 vs. 27.78%). In addition, uterine artery PI values were markedly increased in the late-onset FGR group compared to the normal late pregnancy group (1.96 vs. 1.03), and neonatal weight was significantly lower in the late-onset FGR group (2.75 vs. 3.18 kg). There was a significant positive correlation between f-value, uterine artery PI and neonatal weight (r = 0.968, p < 0.01; r = 0.959, p < 0.01). There was a significant negative correlation between f-value and age of gestation (r = − 0.534, p < 0.01). Conclusion Perfusion fraction f was strongly correlated with uterine artery blood flow resistance as measured by color Doppler and had a certain predictive value for late-onset FGR.

First-Trimester Uterine Artery Doppler for the Prediction of SGA at Birth: The Great Obstetrical Syndromes Study

To estimate the role of first-trimester uterine artery pulsatility index (UtA-PI) for the prediction of small-for-gestational age (SGA). We conducted a prospective cohort study of nulliparous women with singleton pregnancy (Great Obstetrical Syndromes study). UtA-PI was performed at 11 + 0 to 13 + 6 weeks and was reported in multiple of median (MoM). SGA was defined as birth weight below the 10th percentile and stratified as term or preterm SGA. Receiver operating characteristic curves analyses with their area under the curve (AUC) were used to estimate the predictive values of UtA-PI, alone and UtA-PI combined with maternal characteristics. We computed the detection rate and false-positive rate (FPR) of the SOGC SGA screening guidelines in our population. Of 4610 participants, SGA was identified in 486 pregnancies (10.3%), including 15 (0.3%) associated with preterm delivery. Compared with unaffected pregnancies, the mean log UtA-PI was significantly higher in term SGA and preterm SGA. The difference between preterm SGA and unaffected pregnancies remains significant after exclusion of SGA without preeclampsia. First-trimester UtA-PI was more predictive of preterm (AUC: 0.89) than term (AUC: 0.60) SGA (P < 0.01). Combined with maternal characteristics, UtA-PI could have predicted 64% of preterm and 20% of term SGA (10% FPR). The SOGC guidelines criteria for early screening of SGA had a detection rate of 21% for a FPR of 21%. First-trimester UtA-PI can be used to predict SGA, but mainly preterm SGA. The current SOGC guidelines criteria for SGA screening are not efficient in nulliparous women.

152. Placental pathology and neonatal outcome in relation to uterine artery Doppler velocimetry in pregnancies complicated by placenta syndrome

Objectives High resistance utero-placental circulation leads to placenta insufficiency related complications for both mother and fetus. The objective of this study was to evaluate the relationship between abnormal uterine artery pulsatility index (UtAPI) Doppler measurements, neonatal outcome and placental histological findings in placenta syndrome (PS) pregnancies. Methods A retrospective pilot study was performed on singleton pregnancies complicated by PS (pre-eclampsia and/or foetal growth restriction). UtA, umbilical (UmbA) and middle cerebral artery (MCA) Doppler measurements were collected within the last two weeks prior to delivery. Patients were divided into two groups according to UtAPI values, in which UtAPI > p95 was considered abnormal. Histological lesions were classified according to the criteria of the Society for Pediatric Pathology. Statistical analysis was performed using independent T-, Mann-Whitney U- and Fisher’s exact test. Multivariate analysis was used to correct UtAPI for gestational age (GA) at delivery and parity. Results The UtA-PI > p95 group (n = 25) showed a higher rate of premature delivery (p = 0,025), caesarean section (p = 0,007) and NICU-admission (p = 0,001) compared to the UtA-PIp95 group showed a significantly higher UmbA-PI (p = 0,004) with absent or reversed flow (p = 0,002), a lower MCA-PI (p = 0,010) and cerebro-placental ratio (p Conclusions In pregnancies complicated by PS, UtA-PI > p95 showed a moderate predictive ability for placental underperfusion independently of GA at delivery and parity. Furthermore, neonatal outcome and Doppler measurements were poorer.

Combination of serum histidine-rich glycoprotein and uterine artery Doppler to predict preeclampsia.

The primary aim of this study is to determine the value of using a combination of serum histidine-rich glycoprotein (HRG) level and uterine artery pulsatility index (PI) in pregnant women at 11-13+6 weeks' gestation to predict preeclampsia. The secondary aim is to determine the association between other pregnancy complications with the use of these combined tests. Transabdominal uterine artery PI and serum HRG level were measured at the time of first-trimester aneuploidy screening at 11-13+6 weeks' gestation in 327 pregnant women. The primary outcome was preeclampsia. The predictive values of this combination test were calculated. Eighteen cases developed preeclampsia (5.5%) and four of these preeclamptic cases were early-onset preeclampsia (1.2%). The sensitivity, specificity, positive predictive value, and negative predictive value of uterine artery PI combined with serum HRG level to predict preeclampsia were 11.1%, 96.8%, 16.7%, and 94.9%, respectively. For the prediction of early-onset preeclampsia, the sensitivity, specificity, positive predictive value, and negative predictive value were 25%, 97.1%, 10%, and 99%, respectively. An abnormal uterine artery PI and abnormal serum HRG level were associated with preterm delivery and intrauterine growth restriction. Our findings reveal that the combination of uterine artery PI and serum HRG level at 11-13+6 weeks of gestation is not an effective method for predicting preeclampsia at the time of first-trimester screening.

Pre-insertion uterine artery Doppler indices may predict intrauterine contraceptive device-related heavy menstrual bleeding

Abstract Objective To test the hypothesis whether initial uterine artery pulsatility index (PI) and resistance index (RI) before insertion of copper-T 380 intrauterine contraceptive device (IUCD) could predict IUCD-related heavy menstrual bleeding or not. Methods This prospective observational study was conducted on 332 women who requested insertion of copper IUCD. Uterine artery PI and RI were measured before insertion and repeated at 3 and 6 months after IUCD insertion. Participants were divided into two groups according to their menstrual calendar and hemoglobin concentration; Normal bleeding group (n = 188) and heavy menstrual bleeding group (n = 144). Receiver-operating characteristic (ROC) curve analysis was used to evaluate the prognostic value of uterine artery PI and RI in prediction of IUCD-related heavy menstrual bleeding. Results Uterine artery Doppler indices does not show significant change 3 and 6 months after IUCD insertion in both groups (p > .05). Uterine artery PI Conclusion Initial uterine artery Doppler studies could be beneficial as a predictor of IUCD related heavy menstrual bleeding and should be implemented during counseling of women desiring long acting reversible contraception.