Uterine Artery Resistance Index Research Articles

The Performance of the Uterine Artery Resistance Index following Stimulation of the Cervix in the Diagnosis of Endometriosis: A Prospective Study

Background: We speculated that stimulating the uterine cervix of patients may increase blood flow resistance of the uterine artery more significantly in women with endometriosis than those without. Accordingly, the resistance index (RI) of the uterine artery following stimulation of the cervix may offer a novel and promising non-invasive method for diagnosing endometriosis. In this prospective study, the aim was to determine the performance of the uterine artery resistance index (RI) following stimulation of the cervix in the diagnosis of endometriosis. Methods: This prospective cohort study included 270 patients with non-uterine diseases who were scheduled for laparoscopic surgery. Each patient underwent Doppler sonography for peak systolic velocity (PSV), end diastolic velocity (EDV), and RI before and after stimulation of the cervix, in addition to conventional ultrasound examination one day prior to laparoscopic surgery. The cervix was stimulated using a double convex array electronic vaginal probe for real-time tissue elastography. Results: Laparoscopic surgical evaluation revealed endometriosis in 91 (33.7%) patients. Following stimulation of the cervix, the RI of the uterine artery was significantly increased in the endometriosis group (p = 0.00), but no significant increase in the RI was observed in the control group (p = 0.45). The sensitivity and specificity of the post-stimulation RI for diagnosing endometriosis (using a cut off of 0.83) were 85.71% (95% confidence interval (CI): 76.45–91.88) and 88.83% (95% CI: 83.05–92.87), respectively. For peritoneal endometriosis (PEM), sensitivity and specificity were 86.96% (95% CI: 65.33–96.57) and 88.83% (95% CI: 83.05–92.87), respectively. The sensitivity and specificity of transvaginal ultrasonography (TVU) for diagnosing endometriosis were 63.74% (95% CI: 52.93–73.37) and 94.41% (95% CI: 89.68–97.14), respectively. The positive rate for TVU in diagnosing all endometrioses was 63.7%, and this was lower than that for the post-stimulation RI (84.6%, p = 0.001). Conclusions: Stimulation of the cervix leads to a significant decrease in uterine blood perfusion in women with endometriosis. TVU is a sensitive and specific method for the diagnosis of endometrioma, while the RI is a more sensitive parameter for diagnosing PEM than TVU. For the diagnosis of endometriosis, especially for PEM, the post-stimulation RI may prove to be a promising non-invasive diagnostic technique.

Intracavitary physiotherapy combined with acupuncture mediated AMPK/mTOR signalling to improve endometrial receptivity in patients with thin endometrium

ObjectiveTo explore the mechanism of intracavitary physiotherapy combined with acupuncture to improve the receptivity of thin endometrium. MethodsFrom October 2020 to April 2021, 40 patients diagnosed with thin endometrium and preparing for hormone replacement cycle freeze–thaw embryo transfer in our centre for Reproduction were included, 40 patients were randomized to treatment group and control group. 20 patients with normal endometrium during the same period were selected as the normal group.All patients underwent freeze–thaw embryo transfer using hormone replacement cycles.The treatment group added endovascular physiotherapy combined with acupuncture. ResultsThe endometrial receptivity of the patients with thin endometrium was significantly lower than that of the normal group(P < 0.01). Endovascular therapy combined with acupuncture can significantly increase endometrial thickness in patients with thin endometrium and the proportion of patients with type A endometrium, reduce bilateral Uterine arterial pulsatilityindex (PI), Uterine arterial resistance index (RI), and peaksystolicvelocity/diastolicvelocity (S/D), upregulate the expression of HOXA10 protein and mRNA in endometrium tissue, and improve the rate of embryo implantation and clinical pregnancy(P < 0.01).there was no significant difference between the treatment group and the normal group (P > 0.05). This may be related to the regulation of the AMPK/mTOR signalling pathway by intracavitary physiotherapy combined with acupuncture, downregulation of the expression of the AMPK gene and protein and upregulation of the expression of the mTOR gene and protein. Conclusions1. Abnormal energy metabolism is present in the endometrium of patients with thin endometrium, which affects the autophagy process and leads to a decrease in the receptivity of thin endometrium. 2. Intracavitary physiotherapy combined with acupuncture mediated the AMPK/mTOR pathway to improve energy metabolism, promote the autophagy process, improve endometrial morphology and ultrasonic indicators of patients, upregulate the expression of endometrial receptivity-related HOXA10 genes and proteins, and improve the embryo implantation rate and clinical pregnancy rate.

Fetal and Neonatal Middle Cerebral Artery Hemodynamic Changes and Significance under Ultrasound Detection in Hypertensive Disorder Complicating Pregnancy Patients with Different Severities.

Colour Doppler ultrasound was applied for monitoring the hemodynamic parameters of fetal uterine artery (UtA), umbilical artery (UA), and middle cerebral artery (MCA) during pregnancy. In hypertension disease complicating pregnancy, these hemodynamic measures and their therapeutic applicability value were reviewed (HDCP). 120 singleton pregnant women were chosen, with 40 cases of mild preeclampsia (mild group), 40 cases of severe preeclampsia (severe group), and 40 normal control pregnant women (control group). The hemodynamic parameters of UtA, MCA, and UA were monitored in the three groups, including pulsatility index (PI), resistance index (RI), and the systolic/diastolic velocity (S/D). The parameters PI, RI, S/D, and venous catheter shunt rate (Qdv/Quv) of UtA and UA in the severe group were higher than those in the normal group and the mild group, showing the differences statistically significant (P < 0.05). The PI, RI, and S/D of MCA in the severe group were lower than those in the normal group and the mild group (P < 0.05). The changing trends of PI, RI, and S/D in the severe group were all first increased and then decreased in the early, middle, and later pregnancy (P < 0.05). The area under the curve (AUC) was 0.98 in the receiver operating characteristic (ROC) curve created using a combination of hemodynamic measures and pregnancy outcomes, and the sensitivity and specificity for predicting bad outcomes were 94.7 percent and 96.4 percent, respectively. Colour Doppler ultrasound may accurately detect changes in the PI, RI, and S/D of UtA, MCA, and UA in pregnant women and serve as a reference for determining the intrauterine state of the fetuses and predicting bad pregnancy outcomes. In particular, the parameters in later pregnancy were higher worthy of diagnostic value for adverse pregnancy outcomes. The combination of various parameters could make an improvement of the diagnostic accuracy and provide a basis for guiding treatment as well as determining the optimal timing of delivery.

Doppler ultrasound findings in symptomatic pregnant women diagnosed with COVID-19

The primary aim of this study was to investigate the potential impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on maternal and foetal Doppler findings. Doppler ultrasound findings were compared in 40 pregnant women diagnosed with COVID-19 disease who required hospitalisation (group 1) and 30 healthy pregnant women (group 2). Maternal characteristics and birth histories were recorded. Body mass index, gestational week at birth, type of delivery, oligihydroamnios, pre-term birth (<37 weeks), low birth weight (<10 percentile), perinatal death and f1st and 5th minute Apgar scores were recorded. Birth weights and foetal biophysical profile (BPP) scores in group 1 were significantly lower than those in group 2. There was a statistically significant between-group difference in the umbilical artery pulsatility index (PI), umbilical artery resistive index (RI), middle cerebral artery (MCA) PI, MCA RI, mean uterine artery (UtA) PI, mean UtA RI and cerebroplacental ratio (CPR), the parameters used to evaluate foetal-maternal blood flow. In the pregnant group diagnosed with COVID-19 and hospitalised, all foetal-maternal Doppler indicators of foetal-maternal blood flow were impaired, and birth weights and BPP scores in these patients were statistically significantly lower than those in the healthy controls. Impact statement What is already known on this subject? Foetal and maternal vascular malperfusion characterised by decidual arteriopathy have been reported in pathologies of placentas from pregnant women with SARS-CoV-2 infection. What the results of this study add? It was determined that COVID-19 disrupted foetal and maternal blood flow. What the implications are of these findings for clinical practice and/or further research? Foetal biometric measurements and foetal Doppler may be useful in the follow-up of perinatal outcomes in pregnant women with COVID-19

Effect of Zhujingqiaoyun Receptivity of Infertility with Kidney Deficiency Based on Ultrasonic Evaluation.

Objective This study aims to explore the effect of the prescription for Zhujingqiaoyun receptivity in patients with infertility. Methods This project is a prospective randomized controlled clinical study, including infertility diagnostic criteria and dialectical kidney deficiency patients. 60 cases were randomly divided into 2 groups: the control group, where medication complex packing estradiol tablets were given, and the treatment group, on the basis of the control group, which was given Zhujingqiaoyun receptivity plus or minus. Transvaginal ultrasound was used to observe the endometrial thickness, endometrial volume, endometrial blood supply, and other aspects of patients in the two groups to evaluate the endometrial receptivity before and after treatment, and to record the pregnancy rate and safety of patients in the two groups after three menstrual cycles. Results There was no significant difference in age, course of disease, and endometrial thickness between the two groups (P > 0.05). Before and after treatment, the endometrial thickness of the two groups increased significantly, and the uterine artery blood flow pulsatility index (PI) and resistance index (RI) decreased significantly (P < 0.05). The endometrial volume in the control group was significantly lower than that in the treatment group, and the difference was statistically significant (P < 0.05). The endometrial FI and VFI in the control group were significantly lower than those in the treatment group, and the difference was statistically significant (P < 0.05). In the treatment group, 30 cases were treated for 3 months, and 11 of those were pregnant (36.7%). There were 30 cases in the control group, and 5 cases were pregnant (16.67%). Both groups had good safety. SPSS 22.0 statistical software was used for the chi-square test. Conclusion Zhujingqiaoyun receptivity on endometrial receptivity can treat infertility patients with good efficacy, increasing endometrial thickness and reducing uterine artery blood flow index. It is worthy of clinical promotion to improve pregnancy rates.

THE ROLE OF COLOUR DOPPLER IMAGING IN THE DIAGNOSIS OF PCOS

PCOS(Poly Cystic Ovarian Syndrome) is a hormonal disorder that affects women during their reproductive years (18-30year ).It is a condition that affects ovulation and the ovaries.Many fluid-filled sacs develop inside the ovaries in PCOS.These are follicles,each of which contains an immature egg.The egg is never mature enough to cause ovulation to occur. Important alterations in ovarian vascularization at the level of introvarian arteries occur in PCOS patients. Objective: Is colour Doppler ultrasonography is helpful in evaluation of PCOS. Method: An electronic database search with data range from 1999-2021 was performed(Science Direct, Google Scholar, PubMed, Springer).28 articles were found.All studies fully available evaluating PCOS ondoppler ultrasound. Results: Performance of Doppler ultrasound diagnosis was evaluated. PCOS patients had decreased ovarian artery pulsatility index (PI), resistance index (RI), and SD ratios and increased uterine artery pulsatility index (PI), resistance index (RI), and SD ratios. Conclusion: It is concluded that lowest ovarian stromal resistance levels were found in the patients than the controls.

Endometrial Carcinoma: Diagnostic Accuracy of Color Doppler Ultrasound in Diagnosis

Aim: The objective of this research was to observe the diagnostic accuracy of color Doppler ultrasound for diagnosing endometrial Ca (carcinoma) in PMB women. Study Design: Cross-sectional Study Place and Duration: Radiology Department of Hayatabad Medical Complex, Peshawar for duration from December 2020 till May 2021 Method: One hundred and sixty patients with abnormal vaginal bleeding (postmenopausal bleeding) were included. Patient’s ages were ranging between 45 to 75 years. After taking complete consent, patients detailed history age, gender, socio-economic status and previous hospital visited record was recorded. ET (endometrial thickness), UARI (uterine artery resistive index) and results of DUS (Doppler ultrasound) were noted. Patients marked endometrial Ca whom ET was &gt;5mm and UARI was &lt;0.7. Histopathology results as a gold standard were also noted. The results of DUS (Doppler ultrasound) were demonstrated with histopathology record. Results: Mean age of patients was 62.36±8.44 years. Mean BMI was 28.24±2.38 kg/m2. Endometrial carcinoma was found in 129 (80.63%) patients by Doppler ultrasound while histopathological findings revealed that 125 (78.13%) patients had endometrial carcinoma. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of DUS were recorded as 96.80%, 77.14%, 93.80%, 87.10% and 92.50% respectively. Conclusion: Doppler ultrasound is very useful diagnostic modality for diagnosing endometrial carcinoma in patients having post-menopausal bleeding. Keywords: Postmenopausal Bleeding, Endometrial Carcinoma, Doppler ultrasound, Endometrial Thickness, Uterine Artery Resistive Index

THE ROLE OF COLOUR DOPPLER IMAGING IN THE DIAGNOSIS OF PCOS

PCOS(Poly Cystic Ovarian Syndrome) is a hormonal disorder that affects women during their reproductive years (18-30year ).It is a condition that affects ovulation and the ovaries.Many fluid-filled sacs develop inside the ovaries in PCOS.These are follicles,each of which contains an immature egg.The egg is never mature enough to cause ovulation to occur. Important alterations in ovarian vascularization at the level of introvarian arteries occur in PCOS patients. Objective: Is colour Doppler ultrasonography is helpful in evaluation of PCOS. Method: An electronic database search with data range from 1999-2021 was performed(Science Direct, Google Scholar, PubMed, Springer).28 articles were found.All studies fully available evaluating PCOS ondoppler ultrasound. Results: Performance of Doppler ultrasound diagnosis was evaluated. PCOS patients had decreased ovarian artery pulsatility index (PI), resistance index (RI), and SD ratios and increased uterine artery pulsatility index (PI), resistance index (RI), and SD ratios. Conclusion: It is concluded that lowest ovarian stromal resistance levels were found in the patients than the controls.

Analysis of Causes and Results of Fetal Growth in Utero Caused by Genetic Factors Detected by Ultrasound.

In order to investigate the value of the ultrasonic monitoring of maternal and fetal vascular parameters, serum vitamin D, and placental growth factor (PLGF) in predicting fetal growth restriction (FGR), a method of ultrasonic detection of genetic factors causing fetal growth in utero was proposed. 125 pregnant women with FGR diagnosed in our hospital from June 2018 to June 2021 (the FGR group) and 125 pregnant women with a normal prenatal examination (the control group) were collected retrospectively. The systolic/diastolic blood flow ratio (S/D), pulsatile index (PI), and resistance index (RI) of the fetal umbilical artery (UA), middle cerebral artery (MCA), and maternal uterine artery (UtA) were monitored by ultrasound at 20 to 24 weeks of gestation, and the levels of serum vitamin D and PLGF were detected. The receiver operating characteristic curve (ROC curve) was used to evaluate the predictive value of FGR. The results showed that the S/D, PI, and RI of UA in the FGR group were higher than those in the control group, the areas under the curve (AUC) were 0.866, 0.817, and 0.849, and the sensitivity and specificity were (72.8%, 91.2%), (50.4%, 100%), and (72.8%, 91.2%), respectively. The S/D, PI, and RI of MCA were lower than those of the control group. The AUC was 0.882, 0.869, and 0.834, respectively; the sensitivity and specificity were (92.0%, 74.4%), (88.8%, 81.6%), and (90.4%, 72%), respectively. The S/D, PI, and RI of UtA were higher than those of the control group; the AUC was 0.768, 0.729, and 0.732; the sensitivity and specificity were (91.2%, 52%), (48%, 90.4%), and (48.8%, 90.4%), respectively. The serum levels of vitamin D and PLGF were lower than those of the control group (AUC 0.784 and 0.807), and the sensitivity and specificity were (54.4%, 91.2%) and (99.2%, 52%), respectively. It was concluded that the ultrasound monitoring of UA, MCA, and UtA in pregnant women in the middle of pregnancy and detection of serum vitamin D and PLGF levels had a certain predictive value for FGR. Moreover, the comprehensive evaluation could reduce the occurrence of FGR in high-risk pregnant women.

Spectral Doppler ultrasound in the placental development of Mangalarga Marchador mares

The aim of the study was to correlate the spectral index of the right and left uterine arteries with equine placental development in mares with advanced pregnancies. We examined 32 multiparous Mangalarga Marchador mares with gestation of 150–240 days. During pregnancy, the pulsatility index (PI) and resistance index (RI) of the uterine arteries were obtained using spectral Doppler ultrasonography, and the combined uteroplacental thickness was obtained monthly using B-mode ultrasonography. The combined uteroplacental thickness correlated with gestational time of up to 13 years of age, and the significant difference was observed from the sixth month onwards. The CUPT stayed within the ideal measurements for this breed and for this gestational period. There was no correlation of CUPT with PI, however a negative and significant correlation of the RI was observed. The resistance index differed significantly among age groups, and the RI of the left uterine artery tended to decrease in all age groups. Furthermore, only RI differed significantly between the medians of gestatinal age. The left PI dropped in older mares. Thus, there an increased blood perfusion in the uterine arteries of mares with advanced pregnancies and among different age categories during placental and fetal physiological development.

Correlation between Parturients' Uterine Artery Blood Flow Spectra in the First and Second Trimesters of Pregnancy and Fetal Growth Restriction.

Objective To explore the correlation between parturients' uterine artery blood flow spectra in the first and second trimesters of pregnancy and fetal growth restriction (FGR). Methods The data of parturients treated in our hospital from February 2018 to February 2020 were retrospectively analyzed, 50 parturients with FGR were selected as the FGR group, and other 50 healthy cases were selected as the control group. In the first trimester (11-12 weeks of gestation) and the second trimester of pregnancy (13–24 weeks of gestation), the parturients of the two groups accepted the color Doppler ultrasonography (CDS), their hemodynamics indicators of uterine artery were recorded, and the correlation between their uterine artery blood flow spectra in the two periods and FGR was analyzed with the Receiver Operating Characteristic (ROC) curve. Results No statistical differences in the parturients' general information including age, gestational weeks, gravidity, and parity between the two groups were observed (P > 0.05); the newborn's body weight, Apgar scores, number of preterm infants, and the number of infants transferring to the neonatal intensive care unit (NICU) were significantly different between the two groups (P < 0.05); in the first and second trimesters of pregnancy, the uterine artery pulsatility index (UtA-PI), uterine artery resistance index (UtA-RI), maximal systolic flow velocity, and systolic/diastolic (UtA-S/D) ratio were significantly higher in the FGR group than in the control group (P < 0.05), and the time-averaged maximal velocity (TAMX) was significantly lower in the FGR group than in the control group (P < 0.001); in early pregnancy, the incidence of early diastolic notch at bilateral uterine arteries between the two groups was not significantly different (P > 0.05), and the unilateral and total incidence in the first trimester as well as the unilateral, bilateral, and total incidence in the second trimester were significantly higher in the FGR group than in the control group (P < 0.05); in the first trimester, the sensitivity of detecting FGR with a uterine artery blood flow spectrum was 0.820, AUC (95% CI) = 0.840 (0.757–0.923), and in the second trimester, it was 0.860, AUC (95% CI) = 0.900 (0.832–0.968). Conclusion There is a correlation between uterine artery blood flow spectra in the first and second trimesters of pregnancy and FGR, and the sensitivity of spectrum in the first trimester is higher than that in the second trimester, presenting a better clinical application value.

Corpus luteum number and the maternal renin-angiotensin-aldosterone system as determinants of utero-placental (vascular) development: the Rotterdam Periconceptional Cohort

BackgroundPregnancies with > 1 corpus luteum (CL) display a hyperdynamic circulation and an increased risk of small-for-gestational age deliveries. Among the factors released by the CL is prorenin, the inactive precursor of renin. Since the renin-angiotensin-aldosterone system (RAAS) is involved in early hemodynamic pregnancy adaptation, we linked both CL number and first-trimester concentrations of prorenin (as an indicator of RAAS activity) and the aldosterone/renin ratio (as an indicator of angiotensin-independent aldosterone effectiveness) to non-invasive markers of utero-placental (vascular) development, measured longitudinally from the first trimester onwards.MethodsA total of 201 women, who conceived naturally or after in-vitro fertilization treatment (with 0 (n = 8), 1 (n = 143), or > 1 (n = 51) CL), were selected from the Rotterdam Periconceptional Cohort. Maternal RAAS components were determined at 11 weeks gestation. Placental volume and utero-placental vascular volume were measured from transvaginal 3D ultrasound scans at 7, 9 and 11 weeks gestation, pulsatility and resistance indices of the uterine arteries were assessed by pulsed wave Doppler ultrasounds at 7, 9, 11, 13, 22 and 32 weeks gestation. At birth placental weight was obtained using standardized procedures.ResultsPregnancies without a CL show lower uterine artery indices throughout gestation than 1 CL and > 1 CL pregnancies, while parameters of placental development are comparable among the CL groups. After adjustment for patient- and treatment-related factors, first-trimester prorenin concentrations are positively associated with uterine artery pulsatility and resistance indices (β 0.06, 95% CI 0.01;0.12, p = 0.04 and β 0.10, 95% CI 0.01;0.20, p = 0.04, respectively), while high prorenin concentrations are negatively associated with first-trimester utero-placental vascular volume (β -0.23, 95% CI -0.44;-0.02, p = 0.04) and placental weight (β -93.8, 95%CI -160.3;-27.4, p = 0.006). In contrast, the aldosterone/renin ratio is positively associated with first-trimester placental volume (β 0.12, 95% CI 0.01;0.24, p = 0.04).ConclusionsThe absence of a CL, resulting in low prorenin concentrations, associates with low uterine artery pulsatility and resistance, while high prorenin concentrations associate with a low utero-placental vascular volume and weight. These data support a scenario in which excess prorenin, by upregulating angiotensin II, increases uterine resistance, thereby preventing normal placental (vascular) development, and increasing the risk of small-for-gestational age deliveries. Simultaneously, high aldosterone concentrations, by ensuring volume expansion, exert the opposite.

Role of Maternal Uterine Artery Doppler Versus Serum β-hCG During the First Trimester in the Prediction of Preeclampsia and IUGR

Objective: Preeclampsia accounts for 15% of maternal deaths and may cause fetal morbidity and mortality. The aim of this research was to evaluate the efficacy of maternal uterine artery Doppler versus serum beta-human chorionic gonadotropin (β-hCG), during the first trimester, in predicting preeclampsia and intrauterine growth restriction (IUGR). Materials and Methods: In a convenient sample of 388 pregnant women, uterine artery resistive index (RI) and pulsatility index (PI) were assessed, and serum β-hCG level was measured at 11 to 13 weeks of gestation. The patients’ maternal blood pressure and fetal growth were monitored. Results: The patients with preeclampsia (n = 58) showed a significant uterine RI and PI increase with a significant β-hCG decrease compared with the normotensive patients (n = 330). The specificity of uterine PI and RI to predict preeclampsia and IUGR is higher than that of β-hCG. However, the sensitivity of combined diagnostic tools is higher than the singular use of these diagnostic tests. Conclusion: Uterine artery Doppler may be better than serum β-hCG in predicting preeclampsia and IUGR. However, combined diagnostic techniques may be better to screen at-risk patients.

Effects of Administering Exogenous Bovine Somatotropin During the First Trimester of Pregnancy Altered Uterine Hemodynamics in Suckled Beef Cows

The objective of this study was to examine the effects of recombinant bovine somatotropin (bST) administration on uterine hemodynamics and subsequent fetal programming in suckled cows during the first trimester of gestation. Crossbred beef cows (n = 152) were stratified by breed, days postpartum, parity, cyclicity status, and body condition score (BCS) before being assigned to either receive injections of bST every other week (BST; 500-mg/14 d) starting at fixed-time artificial insemination (TAI; d 0) until d 97 or to receive no bST (CTL). Blood samples were collected until d 97 for analysis of plasma concentrations of insulin-like growth factor 1 (IGF-1). Pregnancy was assessed via transrectal ultrasonography on d 41 and 173. A subset of pregnant cows (BST, n = 24; CTL, n = 28) were selected for assessment of uterine arterial blood flow (BF), pulsatility index, and resistance index (RI) of the uterine arteries ipsilateral and contralateral to the conceptus via color Doppler ultrasonography on d 97 and 233 of gestation. No differences (P = 0.99) were detected in body weight (BW) or BCS of dams; however, plasma concentrations of IGF-1 were greater (P &amp;lt; 0.001) in BST-treated cows. Color Doppler ultrasonography parameters differed whereby a treatment × day interaction (P = 0.007) was detected for RI on d 97 (P = 0.048); however, on d 233, RI did not differ (P &amp;gt; 0.10) but ipsilateral BF for BST-treated cows was greater (P = 0.0319) than controls. Mean heart girth diameter, crown-to-rump length, and neonate BW at 7 ± 5 d of calf age did not differ (P &amp;gt; 0.10). Liver tissue samples from each calf were collected for analysis of mRNA expression of target insulin-like growth factor system ligands. There was no difference in gene expression of hepatic IGF-1 between treatments (P = 0.99). A treatment × sex interaction was determined, where BST heifers had increased mRNA expression of IGFR1 compared to BST bulls (P = 0.03). Bi-weekly administration of bST until d 97 of pregnancy increased plasma concentrations of IGF-1, altered uterine hemodynamics in dams, induced sex-specific changes in liver gene expression of the offspring but failed to alter calf morphometries or calf performance until weaning.

Is Copper Intra Uterine Contraceptive Device-Induced Menorrhagia Correlated with Changes in Transvaginal Ultrasound Findings before and after Insertion?

Background: Many women all around the world use the Cu T 380A for contraception as it is cheap and effective way for contraception. Menorrhagia is the most common cause of removal of the intra uterine contraceptive device (IUCD) and it is a very annoying side effect for IUCD users. Finding a way to avoid such a complaint is important to find a proper way for contraception. Objective: To prove the correlation between the Cu IUCD-induced menorrhagia and the findings of the transvaginal Doppler ultrasound. Patients and Method: It was a prospective cross-sectional study and it was conducted on eighty four women who were referred to the family planning clinic of Zagazig University Hospital and Zagazig General Hospital for Cu T-380A IUCD insertion. The study was conducted in the period from 1/1/2019 to 30/7/2019. Then, all specimen had been classified into 2 groups:Group 1 (n =37): with menorrhagia, and group 2 (n = 47) without menorrhagia. Results: Uterine artery pulsatility index (PI) and resistance index (RI) after one month of insertion were significantly lower than at time of insertion among women with IUCD-induced menorrhagia. Endometrial thickness after one month of insertion was significantly higher than at time of insertion among women with IUCD-induced menorrhagia. PI and RI at time of insertion were significantly lower in women with IUD-induced menorrhagia than in those using IUD with normal menstrual bleeding. Uterine artery PI ≤ 1.99 and RI ≤ 0.82 have been associated with menorrhagia at time of insertion. Conclusions: The transvaginal Doppler ultrasound is very helpful in prediction of menorrhagia among IUCD users.

Ageing impairs restoration of endometrial blood flow impedance after laparoscopic myomectomy in infertile women with uterine fibroids

The aim of this study was to evaluate temporal changes in endometrial blood flow after laparoscopic myomectomy (LM). Nineteen infertile women with uterine fibroids who underwent LM were included. The uterine radial artery resistance index (RA-RI) and recovery index were measured before and at 1 week and 3 months after LM. The median RA-RI at 1 week but not 3 months after LM was significantly higher than before. The median recovery indexes at 1 week and 3 months after LM were 14.3% and 1.3%, respectively. Although there was no significant correlation between the patient’s age and recovery index at 1 week (r = 0.28, p = .24) after LM, a moderately significant correlation was observed at 3 months (r = 0.54, p = .002). In conclusion, the endometrial blood flow after LM changed over time, and recovery of blood flow was negatively correlated with patient age. IMPACT STATEMENT What is already known on this subject? Uterine blood flow is important for wound healing after myomectomy, but no studies have evaluated endometrial blood flow after myomectomy. What do the results of this study add? The endometrial blood flow impedance of RA-RI increased after LM and returned to before surgery at 3 months postoperatively. RA-RI recovery index negatively correlated with patient age. What are the implications of these findings for clinical practice and/or further research? The changes in endometrial blood flow impedance after myomectomy suggest that endometrial blood flow may be involved in wound healing at the enucleation site. The impairment of endometrial blood flow recovery after myomectomy due to increased age may provide a rationale for individualised wound healing after myomectomy. The measurement of endometrial blood flow may be useful in personalising the assessment of the waiting period for pregnancy after myomectomy.

Abstract 31: Esomeprazole Improves Blood Pressure, Intrauterine Growth, Inflammation, And Vascular Function During Placental Ischemia Through Inhibition Of NLRP3

Preeclampsia (PE), a multisystem hypertensive disorder of pregnancy is characterized by intrauterine growth restriction (IUGR), inflammation, and vascular dysfunction. NLRP3 inflammasome is a cytoplasmic complex that mediates inflammation and is implicated in CVD. Clinical studies show an association between PE and increased placental NLRP3 expression. We hypothesized that inhibition of NLRP3 using (1) a specific NLRP3 small molecule inhibitor, MCC950 (M9, 20 mg/kg/d, i.p.) or (2) esomeprazole (ESO, 3.5 mg/kg/d, oral), a therapeutic that is safe in pregnancy, would improve MAP, inflammation, IUGR, and vascular dysfunction in the reduced uterine perfusion pressure (RUPP) rat model of placental ischemia. Sham (S) or RUPP surgery was performed in pregnant Sprague Dawley rats on gestation day (GD) 14. A subset of rats from both groups received either vehicle, M9, or ESO on GD14-19 (n=9/group). On GD18, Uterine Artery Resistance Index (UARI) was measured via Doppler Ultrasound. MAP, fetal, and placental weight were measured, and blood and tissues were processed for additional analyses on GD19. MAP (mmHg) was elevated in RUPP (133±1) vs S (108±2; p&lt;0.05). Treatment with M9 or ESO in RUPP decreased MAP (111±1 and 115±3, respectively; p&lt;0.05 vs RUPP). Fetal weight (g) was reduced in RUPP (2.1±0.04) vs S (2.4±0.05), and ESO normalized fetal weight (2.4±0.01; p&lt;0.05 vs RUPP). Placental NLRP3 mRNA expression increased 5-fold in RUPP vs S (p&lt;0.05); and was less than 2 fold in M9 and ESO treated RUPP rats (p&lt;0.05 vs RUPP). Inflammatory T-helper 17 and cytolytic NK cells, evaluated by flow cytometry, were increased in the circulation, placenta, and kidney of RUPP vs S controls. Treatment with M9 or ESO normalized both cell populations in all tissues (p&lt;0.05 vs RUPP). UARI was increased in RUPP (0.71±0.03) versus S (0.56±0.01; p&lt;0.05) and was decreased to 0.48±0.01 in M9 and 0.61±0.03 in ESO-treated RUPPs (p&lt;0.05 vs RUPP). Renal vascular resistance (mmHg/mL/min/g) was increased in RUPP (42±8) vs S (23±4, p&lt;0.05) and was normalized to 26±3 after treatment with M9 (p&lt;0.05 vs RUPP). These data implicate NLRP3 in mediating inflammation and vascular dysfunction to cause maternal HTN and IUGR in RUPP; and identify NLRP3 as a potential target and ESO as a potential therapeutic for PE.

Pulsatility and Resistance Indices of Uterine and Ovarian Arteries in Anovulatory Women With Polycystic Ovary Syndrome.

We aimed to compare the ovarian and uterine artery blood flow of anovulatory patients with polycystic ovary syndrome (PCOS) with those of ovulatory women throughout the menstrual cycle using color Doppler ultrasound. Seventy-one women with PCOS, who were admitted to the infertility outpatient clinic of a training and research hospital, were included in the study. The patients were divided into 2 groups as anovulatory (group 1, n = 23) and ovulatory (group 2, n = 37). Each patient was followed up throughout her menstrual cycle and included in either group 1 or group 2. Anovulatory cycles were determined by consecutive ultrasound examinations, and the progesterone value was measured in the luteal period. Eleven patients were excluded from the study because they did not continue their follow-up. The uterine and ovarian artery pulsatility and resistance indices of all patients in both groups were evaluated 3 times throughout a menstrual cycle: 7th to 10th day, 13th to 17th day, and 21st to 25th day. It was observed that the uterine artery resistances of the patients with anovulatory cycles remained relatively high throughout the menstrual cycle compared with ovulatory cycles. Both pulsatility and resistance indices of uterine and ovarian arteries were significantly higher in anovulatory cycles compared with ovulatory cycles at all evaluation times throughout the menstrual cycle (P < 0.05). Ovarian artery resistance in anovulatory patients did not significantly change during the menstrual cycle. Anovulatory patients with PCOS have higher uterine and ovarian artery resistance than ovulatory artery resistance, and the former shows a significant decrease throughout the cycle.

Abstract 25: Inhibition Of The Agonistic Ang II Type 1 Receptor Autoantibody In A Rat Model Of Preeclampsia Improves Uteroplacental Perfusion And Fetal Growth In Late Gestation

Placenta ischemia, the initiating factor in preeclampsia (PE), is associated with intrauterine growth restriction (IUGR) and increased blood pressure (BP) in offspring. Yet, the only treatment for PE is delivery of the baby and placenta. The Reduced Uterine Perfusion Pressure (RUPP) rat model induced by placental ischemia at gestational day 14 (G14) mimics many facets of human PE including pregnancy-specific hypertension, an increase in the agonistic ANG II Type 1 receptor autoantibody (AT1-AA), IUGR and increased BP in the offspring. Inhibition of AT1-AA using an epitope-binding inhibitory peptide ('n7AAc') attenuates increased BP at gestational day 19 in the RUPP. Yet, whether use of ‘n7aac’ improves fetal growth and mitigates increased BP in the offspring is unknown. Thus, we tested the hypothesis that maternal administration of ‘n7aac’ improves fetal growth by attenuating reduced uterine blood flow and impaired placental remodeling. Sham or RUPP surgery was performed at G14 with administration of vehicle or ‘n7aac’ (144μg/day) via mini osmotic pump until gestational day 20 (G20). At G20 uterine artery resistance index was significantly elevated in vehicle RUPP (0.69±0.02 mm/s n=10) compared to vehicle Sham (0.48±0.02 mm/s n=8) (P&lt;0.0001) and not increased in treated RUPP (0.49±0.02 mm/s n=10) or treated Sham (0.48±0.02 mm/s n=9). Fetal weight was significantly reduced in vehicle RUPP (3.24±0.2 g) compared to vehicle Sham (3.92±0.05 g) (P=0.013) and not decreased in treated RUPP (3.70±0.04 g) or Sham (3.98±0.10 g). Litter size of viable pups at G20 was only reduced in treated RUPP (5.3±1.4) compared to vehicle Sham (11.56±0.7) (P=0.003). Importantly, using in vivo imaging, little to no auto fluorescence of rhodamine-labeled peptide (480 μg/kg/day, n=4) was detectable in the pups at G20. Thus, our results demonstrate that maternal treatment with ‘n7aac’ in the RUPP rat model of PE improve UARI, which is associated with improved fetal weight at G20 in response to placental ischemia. Whether this benefit continues to birth and mitigates increased BP in IUGR offspring is unknown but is the focus of future studies. In conclusion, inhibition of the AT1AA during PE may not only provide benefit to the mother, but may also be associated with benefit in the offspring.

Diagnostic Evaluation of Uterine Artery Doppler Imaging for the Prediction of Early Abnormal Pregnancy

Objective: to assess the predictive value of Doppler imaging of the uterine artery in the identification of early intrauterine abnormal pregnancy as compared to a normal intrauterine pregnancy.&#x0D; Subjects and methods: one hundred and twenty pregnant ladies, at their 6-12 weeks of gestation, with a singleton pregnancy were included in this population-based case-control study. Thirty women with a missed miscarriage, 30 with hydatidiform mole, 30 with a blighted ovum, and 30 as a control group, without risk factors, underwent Doppler interrogation of the uterine arteries. Resistive index (RI), pulsatility index (PI), and the systolic/diastolic ratio (S/D) were measured for both sides. The t-test, or ANOVA test when appropriate, was used to analyze the relationship between the variables.&#x0D; Results: there was a significant reduction of RI mean, PI mean, and S/D ratio among women with different types of abnormal pregnancy compared with the control group. RI and PI mean levels were significantly lower in women with hydatidiform mole and significantly higher in women with missed miscarriage. Lower left S/D mean level was significantly associated with hydatidiform mole and upper left S/D level was associated significantly with control women. For prediction of missed miscarriage; right and left uterine artery RI shows a sensitivity of 80%, 73.3%, a specificity of 68%, 71.1%, and the highest AUC was 0.78 for both.For prediction of molar pregnancy, right and left uterine artery RI showed a sensitivity of 63% for both, a specificity of 54.4%, 60%, and the highest AUC was 0.58, 0.61 respectively.&#x0D; Conclusions: Uterine artery Doppler ultrasonography at 6-12 weeks of gestation is predictive for early pregnancy complications such as missed abortion, hydatidiform mole, and blighted ovum.