Uterine Artery Research Articles

The role of color doppler in high risk pregnancies: A prospective comparative study

Pregnancy can be considered as the most beautiful period of a woman’s life. The recent medical advances are helpful in taking very good care of the female throughout her pregnancy. The pregnancy is constantly observed by clinical examination, laboratory investigations, and radiographic examinations at specific intervals throughout its course.To study the role of doppler ultrasound in high-risk pregnancies.This is a prospective comparative study was conducted in department of Obstetrics and Gynaecology at Government medical college, Nagpur. The study period was 12 months. 232 patients were included in this study.In our study, 2 patients had Chronic hypertension, 2 patients had GDM, 1 patient had Gestational hypertension, 3 patients had Anaemia, 6 patients had Heart Disease, 5 patients had HIV positive,15 patients had Hypothyroidism, 2 patients had Increased BP, 1 patient had Overt DM,6 patients had Pre-eclampsia,1 patient had previous abortion, 4 patients had Rh negative, 5 patients had Sickle Cell Disease(SS) and 15 patients had Sickle Cell trait(AS). Distribution of normal doppler changes in cases according to high risk factor was statistically significant (p<0.0001).In our study, NICU Admission with doppler changes was statistically significant and Association of Baby weight in cases according to doppler changes in uterine artery and Baby weight in cases according to doppler changes in umbilical artery was not statistically significant.

Uterine Artery Embolization Versus Hysterectomy in Postpartum Hemorrhage: A Systematic Review With Meta-Analysis.

The objective of this study is to perform a meta-analysis comparing the effectiveness of uterine artery embolization (UAE) versus peripartum hysterectomy for acute refractory postpartum hemorrhage (PPH) control. We systematically searched 6 medical databases for studies comparing UAE and hysterectomy in PPH. Outcomes examined were mortality, hospitalization duration (HD) in days, and red blood cells (RBC) units utilization. Statistical analysis used RevMan 5.1.7 and random-effects models. Odds ratios (OR) and mean differences (MDs) with 95% confidence intervals (CIs) were used for dichotomous and continuous outcomes, respectively. We included 833 patients from 4 cohort studies, with 583 (70%) undergoing UAE. The UAE population required fewer RBC units (MD: -7.39; 95% CI: -14.73 to -0.04; p=0.05) and had shorter HD (MD: -3.22; 95% CI: -5.42 to -1.02; p=0.004). Lower mortality rates were noted for UAE in the pooled analysis, but no statistical significance. Uterine artery embolization demonstrated lower procedural complications (16.45% vs. 28.8%), in which UAE had less ureter and bladder lesions (OR: 0.05; 95% CI: 0.01-0.38; p=0.004 and OR: 0.02; 95% CI: 0.00-0.15; p<0.001, respectively). Only 35 (6%) required conversion to hysterectomy, while 27 (4.6%) underwent re-embolization with 100% bleeding control. Uterine artery embolization did not hinder fertility, with normal menstruation restored in 19 patients with postoligomenorrhea. Uterine artery embolization for the control of PPH is associated with lower use of RBC units and HD, but similar rates of mortality are noted when compared to hysterectomy. These results associated with uterine preservation could support its importance for refractory PPH management. Uterine Artery Embolization is associated with a shorter hospitalization duration and reduced use of red blood cell units when compared with hysterectomy in refractory postpartum hemorrhage. Although demonstrating similar mortality rates, these findings, together with fertility preservation, support the method incorporation as a valuable option in obstetric services.

Surgical treatment and reproductive outcomes in caesarean scar pregnancy at a single center

BackgroundTo investigate factors associated with different reproductive outcomes in patients with Caesarean scar pregnancies (CSPs).MethodsBetween May 2017 and July 2022, 549 patients underwent ultrasound-guided uterine aspiration and laparoscopic scar repair at the Gynaecology Department of Hubei Maternal and Child Health Hospital. Ultrasound-guided uterine aspiration was performed in patients with type I and II CSPs, and laparoscopic scar repair was performed in patients with type III CSP. The reproductive outcomes of 100 patients with fertility needs were followed up and compared between the groups.ResultsOf 100 patients, 43% had live births (43/100), 19% had abortions (19/100), 38% had secondary infertility (38/100), 15% had recurrent CSPs (RCSPs) (15/100). The reproductive outcomes of patients with CSPs after surgical treatment were not correlated with age, body mass index, time of gestation, yields, abortions, Caesarean sections, length of hospital stay, weeks of menopause during treatment, maximum diameter of the gestational sac, thickness of the remaining muscle layer of the uterine scar, type of CSP, surgical method, uterine artery embolisation during treatment, major bleeding, or presence of uterine adhesions after surgery. Abortion after treatment was the only risk factor affecting RCSPs (odds ratio 11.25, 95% confidence interval, 3.302–38.325; P < 0.01) and it had a certain predictive value for RCSP occurrence (area under the curve, 0.741).ConclusionsThe recurrence probability of CSPs was low, and women with childbearing intentions after CSPs should be encouraged to become pregnant again. Abortion after CSP is a risk factor for RCSP. No significant difference in reproductive outcomes was observed between the patients who underwent ultrasound-guided uterine aspiration and those who underwent laparoscopic scar repair for CSP.

Case Report: Uterine artery embolization after dysfunctional uterine bleeding due to incomplete abortion in female

Dysfunctional uterine bleeding (DUB), a serious clinical challenge caused by incomplete abortion in female, calls for efficient and minimally invasive therapies to treat symptoms and protect reproductive health. Uterine artery embolization (UAE) has been discovered as a viable therapeutic strategy to treat DUB following an incomplete abortion. The existing information and clinical experience of UAE for this particular indication were thoroughly reviewed. A female’s quality of life may be negatively affected by incomplete abortion, which is defined as residual fetal tissue inside the uterine cavity. This frequently results in heavy and continuous uterine bleeding. Medical procedures and traditional management techniques such as dilatation and curettage (D&amp;C) do not always produce the desired effects or might have inherent dangers. UAE, a less invasive technique first developed for treating uterine fibroids, has shown promise as a substitute solution for DUB caused by an incomplete abortion.

Uterine artery embolization in the treatment of uterine fibroids and the preservation of reproductive health in women 40 years of age and older: A retrospective study

Aim. To evaluate the effect of uterine artery embolization (UAE) on reproductive health in women 40 years and older. Materials and methods. A retrospective study was conducted at the perinatal center of the District Clinical Hospital of Khanty-Mansiysk. Patients were divided into two groups: the main group (group 1; n=57) included women with uterine fibroids after UAE, and the control group (group 2; n=42) included women without a history of uterine fibroids. Results. Women with uterine fibroids were statistically more likely to have grade 1 obesity (χ2=4.39; p=0.04) and less likely to have normal body weight (χ2=8.73; p=0.00) compared to women without fibroids. Smoking increased the risk of uterine fibroids twofold (χ2=4.49; p=0.03; odds ratio 1.97; confidence interval 0.64-6.11). More women with uterine fibroids had a history of abortions (n=42; 73.7%) than those without uterine fibroids (n=19; 45.2%; χ2=8.27; p=0.01). The most common gynecological comorbidities in women with uterine fibroids included inflammatory disease of the uterus (N71), endometrial polyp (N84), and endometriosis (N80); p0.05. The most common extragenital diseases in patients with uterine fibroids included thyroid disease, hypertension, and iron deficiency anemia (p0.05). Contour SE embolization agent with spherical particles was more often associated with pain (χ2=0.18; p=0.67) and less often with fever (χ2=4.47; p=0.03). There was a decrease in the number of short menstrual cycles (less than 24 days) from the moment before surgical treatment and after 24 months (χ2=34.580; p0.001) and an increase in the number of cycles of 24–38 days (χ2=14.887; p=0.005). At 24 months after UAE, there were more women with a menstrual period of less than 3 days (χ2=10.385; p=0.035) and fewer with a menstrual period of more than 8 days (χ2=34.573; p0.001). Ultrasound showed a decreased ovarian reserve at 6, 12 and 24 months after UAE (p0.05). Conclusion. When assessing the reproductive health of women 40 years and older after embolization of the uterine arteries, it was found that this method of treatment of symptomatic uterine fibroids leads to a decrease in the duration and heaviness of menstruation but increases the risk of an ovarian reserve decrease.

In Vivo Administration of Phosphatidic Acid, a Direct Alcohol Target Rescues Fetal Growth Restriction and Maternal Uterine Artery Dysfunction in Rat FASD Model

Fetal growth restriction is a hallmark of Fetal Alcohol Syndrome (FAS) and is accompanied by maternal uterine circulatory maladaptation. FAS is the most severe form of Fetal Alcohol Spectrum Disorder (FASD), a term for the range of conditions that can develop in a fetus when their pregnant mother consumes alcohol. Alcohol exerts specific direct effects on lipids that control fundamental developmental processes. We previously demonstrated that direct in vitro application of phosphatidic acid (PA, the simplest phospholipid and a direct target of alcohol exposure) to excised uterine arteries from alcohol-exposed rats improved vascular function, but it is unknown if PA can rescue end organ phenotypes in our FASD animal model. Pregnant Sprague-Dawley rats (n = 40 total dams) were gavaged daily from gestational day (GD) 5 to GD 19 with alcohol or maltose dextrin, with and without PA supplementation, for a total of four unique groups. To translate and assess the beneficial effects of PA, we hypothesized that in vivo administration of PA concomitant with chronic binge alcohol would reverse uterine artery dysfunction and fetal growth deficits in our FASD model. Mean fetal weights and placental efficiency were significantly lower in the binge alcohol group compared with those in the control (p &lt; 0.05). However, these differences between the alcohol and the control groups were completely abolished by auxiliary in vivo PA administration with alcohol, indicating a reversal of the classic FAS growth restriction phenotype. Acetylcholine (ACh)-induced uterine artery relaxation was significantly impaired in the uterine arteries of chronic in vivo binge alcohol-administered rats compared to the controls (p &lt; 0.05). Supplementation of PA in vivo throughout pregnancy reversed the alcohol-induced vasodilatory deficit; no differences were detected following in vivo PA administration between the pair-fed control and PA alcohol groups. Maximal ACh-induced vasodilation was significantly lower in the alcohol group compared to all the other treatments, including control, control PA, and alcohol PA groups (p &lt; 0.05). When analyzing excitatory vasodilatory p1177-eNOS, alcohol-induced downregulation of p1177-eNOS was completely reversed following in vivo PA supplementation. In summary, these novel data utilize a specific alcohol target pathway (PA) to demonstrate a lipid-based preventive strategy and provide critical insights important for the development of translatable interventions.

Overexpressed Trophoblast Glycoprotein Contributes to Preeclampsia Development by Inducing Abnormal Trophoblast Migration and Invasion Toward the Uterine Spiral Artery.

Preeclampsia is a significant pregnancy disorder with an unknown cause, mainly attributed to impaired spiral arterial remodeling. Using RNA sequencing, we identified key genes in placental tissues from healthy individuals and preeclampsia patients. Placenta and plasma samples from pregnant women were collected to detect the expression of TPBG (trophoblast glycoprotein). Pregnant rats were injected with TPBG-carrying adenovirus to detect preeclamptic features. HTR-8/SVneo cells transfected with a TPBG overexpression lentiviral vector were used in cell function experiments. The downstream molecular mechanisms of TPBG were explored using RNA sequencing and single-cell RNA sequencing data. TPBG expression was knocked down in the lipopolysaccharide-induced preeclampsia-like rat model to rescue the preeclampsia features. We also assessed TPBG's potential as an early preeclampsia predictor using clinical plasma samples. TPBG emerged as a crucial differentially expressed gene, expressed specifically in syncytiotrophoblasts and extravillous trophoblasts. Subsequently, we established a rat model with preeclampsia-like phenotypes by intravenously injecting TPBG-expressing adenoviruses, observing impaired spiral arterial remodeling, thus indicating a causal correlation between TPBG overexpression and preeclampsia. Studies with HTR-8/SVneo cells, chorionic villous explants, and transwell assays showed TPBG overexpression disrupts trophoblast/extravillous trophoblast migration/invasion and chemotaxis. Notably, TPBG knockdown alleviated the lipopolysaccharide-induced preeclampsia-like rat model. We enhanced preeclampsia risk prediction in early gestation by combining TPBG expression with established clinical predictors. These findings are the first to show that TPBG overexpression contributes to preeclampsia development by affecting uterine spiral artery remodeling. We propose TPBG levels in maternal blood as a predictor of preeclampsia risk. The proposed mechanism by which TPBG overexpression contributes to the occurrence of preeclampsia via its disruptive effect on trophoblast and extravillous trophoblast migration/invasion on uterine spiral artery remodeling, thereby increasing the risk of preeclampsia.

IL1β-NFκβ-Myocardin signaling axis governs trophoblast-directed plasticity of vascular smooth muscle cells.

Vascular smooth muscle cell (VSMC) plasticity is fundamental in uterine spiral artery remodeling during placentation in Eutherian mammals. Our previous work showed that the invasion of trophoblast cells into uterine myometrium coincides with a phenotypic change of VSMCs. Here, we elucidate the mechanism by which trophoblast cells confer VSMC plasticity. Analysis of genetic markers on E13.5, E16.5, and E19.5 in the rat metrial gland, the entry point of uterine arteries, revealed that trophoblast invasion is associated with downregulation of MYOCARDIN, α-smooth muscle actin, and calponin1, and concomitant upregulation of Smemb in VSMCs. Myocardin overexpression or knockdown in VSMCs led to upregulation or downregulation of contractile markers, respectively. Co-culture of trophoblast cells with VSMCs decreased MYOCARDIN expression along with compromised expression of contractile markers in VSMCs. However, co-culture of trophoblast cells with VSMCs overexpressing MYOCARDIN inhibited their change in phenotype, whereas, overexpression of transactivation domain deleted MYOCARDIN failed to elicit this response. Furthermore, the co-culture of trophoblast cells with VSMCs led to the activation of NFκβ signaling. Interestingly, despite producing IL-1β, trophoblast cells possess only the decoy receptor, whereas, VSMCs possess the IL-1β signaling receptor. Treatment of VSMCs with exogenous IL-1β led to a decrease in MYOCARDIN and an increase in phosphorylation of NFκβ. The effect of trophoblast cells in the downregulation of MYOCARDIN in VSMCs was reversed by blocking NFκβ translocation to the nucleus. Together, these data highlight that trophoblast cells direct VSMC plasticity, and trophoblast-derived IL-1β is a key player in downregulating MYOCARDIN via the NFκβ signaling pathway.

Disruption of maternal vascular remodeling by a fetal endoretrovirus-derived gene in preeclampsia

BackgroundPreeclampsia, one of the most lethal pregnancy-related diseases, is associated with the disruption of uterine spiral artery remodeling during placentation. However, the early molecular events leading to preeclampsia remain unknown.ResultsBy analyzing placentas from preeclampsia, non-preeclampsia, and twin pregnancies with selective intrauterine growth restriction, we show that the pathogenesis of preeclampsia is attributed to immature trophoblast and maldeveloped endothelial cells. Delayed epigenetic reprogramming during early extraembryonic tissue development leads to generation of excessive immature trophoblast cells. We find reduction of de novo DNA methylation in these trophoblast cells results in selective overexpression of maternally imprinted genes, including the endoretrovirus-derived gene PEG10 (paternally expressed gene 10). PEG10 forms virus-like particles, which are transferred from the trophoblast to the closely proximate endothelial cells. In normal pregnancy, only a low amount of PEG10 is transferred to maternal cells; however, in preeclampsia, excessive PEG10 disrupts maternal vascular development by inhibiting TGF-beta signaling.ConclusionsOur study reveals the intricate epigenetic mechanisms that regulate trans-generational genetic conflict and ultimately ensure proper maternal–fetal interface formation.

Maternal vascular indices at 36 weeks' gestation in small and growth restricted fetuses.

To compare maternal vascular indices and hemodynamic parameters at 35-37 weeks' gestation, in pregnancies complicated by small for gestational age (SGA) fetuses and those with fetal growth restriction (FGR). This was a prospective observational non-intervention study in women with singleton pregnancies attending for a routine hospital visit at 35+0 to 36+6 weeks' gestation. The visit included recording of maternal demographic characteristics and medical history, vascular indices and hemodynamic parameters obtained by a non-invasive operator independent device, including pulse wave velocity, augmention index, cardiac output, stroke volume, central systolic and diastolic blood pressure, total peripheral resistance and fetal heart rate. Hypertensive disorders of pregnancy were excluded and the values in the SGA and FGR groups were compared between them and with unaffected pregnancies. Diagnosis of SGA was based on the birth of a baby with birthweight below the 10th percentile for gestational age. In FGR, in addition to a birthweight below the 10th percentile, at the 35-37 weeks scan Doppler studies had shown that the uterine artery or umbilical artery pulsatility index (PI) was above the 95th percentile for gestational age or the fetal middle cerebral artery PI was below the 5th percentile. In the 6,413 women included in the study there were 605 (9.4%) cases of SGA, 133 (2.1%) of FGR and 5,675 (88.5%) unaffected by SGA or FGR. Women with SGA or FGR, compared to unaffected pregnancies, had increased peripheral vascular resistance and reduced cardiac output. Central systolic and diastolic blood pressure were also increased, whereas aortic stiffness assessed by pulse wave velocity and augmentation index did not differ between affected and unaffected pregnancies. In the FGR, compared to the SGA group, central systolic and diastolic blood pressure were higher, whereas, heart rate was lower. In SGA and FGR pregnancies there are deranged maternal hemodynamic responses when these are compared to normal pregnancies. Mothers with FGR babies have higher central blood pressure compared to SGA ones, but it remains unclear whether these differences are driven by the size of the fetus or pathological fetal growth. This article is protected by copyright. All rights reserved.

Prospective Validation of First-Trimester Screening for Preterm Preeclampsia in Nulliparous Women (PREDICTION Study).

Fetal Medicine Foundation (FMF) studies suggest that preterm preeclampsia can be predicted in the first trimester by combining biophysical, biochemical, and ultrasound markers and prevented using aspirin. We aimed to evaluate the FMF preterm preeclampsia screening test in nulliparous women. We conducted a prospective multicenter cohort study of nulliparous women recruited at 11 to 14 weeks. Maternal characteristics, mean arterial blood pressure, PAPP-A (pregnancy-associated plasma protein A), PlGF (placental growth factor) in maternal blood, and uterine artery pulsatility index were collected at recruitment. The risk of preterm preeclampsia was calculated by a third party blinded to pregnancy outcomes. Receiver operating characteristic curves were used to estimate the detection rate (sensitivity) and the false-positive rate (1-specificity) for preterm (<37 weeks) and for early-onset (<34 weeks) preeclampsia according to the FMF screening test and according to the American College of Obstetricians and Gynecologists criteria. We recruited 7554 participants including 7325 (97%) who remained eligible after 20 weeks of which 65 (0.9%) developed preterm preeclampsia, and 22 (0.3%) developed early-onset preeclampsia. Using the FMF algorithm (cutoff of ≥1 in 110 for preterm preeclampsia), the detection rate was 63.1% for preterm preeclampsia and 77.3% for early-onset preeclampsia at a false-positive rate of 15.8%. Using the American College of Obstetricians and Gynecologists criteria, the equivalent detection rates would have been 61.5% and 59.1%, respectively, for a false-positive rate of 34.3%. The first-trimester FMF preeclampsia screening test predicts two-thirds of preterm preeclampsia and three-quarters of early-onset preeclampsia in nulliparous women, with a false-positive rate of ≈16%. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02189148.

Distinguishing the Uterine Artery, the Ureter, and Nerves in Laparoscopic Surgical Images Using Ensembles of Binary Semantic Segmentation Networks.

Performing a minimally invasive surgery comes with a significant advantage regarding rehabilitating the patient after the operation. But it also causes difficulties, mainly for the surgeon or expert who performs the surgical intervention, since only visual information is available and they cannot use their tactile senses during keyhole surgeries. This is the case with laparoscopic hysterectomy since some organs are also difficult to distinguish based on visual information, making laparoscope-based hysterectomy challenging. In this paper, we propose a solution based on semantic segmentation, which can create pixel-accurate predictions of surgical images and differentiate the uterine arteries, ureters, and nerves. We trained three binary semantic segmentation models based on the U-Net architecture with the EfficientNet-b3 encoder; then, we developed two ensemble techniques that enhanced the segmentation performance. Our pixel-wise ensemble examines the segmentation map of the binary networks on the lowest level of pixels. The other algorithm developed is a region-based ensemble technique that takes this examination to a higher level and makes the ensemble based on every connected component detected by the binary segmentation networks. We also introduced and trained a classic multi-class semantic segmentation model as a reference and compared it to the ensemble-based approaches. We used 586 manually annotated images from 38 surgical videos for this research and published this dataset.

131 DNA methylation profile in bovine fetal liver is affected by maternal vitamin and mineral supplementation during early gestation

Abstract Early gestation is the critical period for successful pregnancy establishment. During this period, maternal nutrition affects fetal development with potentially long-lasting consequences on offspring performance. Despite the known effects of vitamins and minerals on embryonic development, supplementation is still not a widely adopted practice. Here we focused on the effects of maternal vitamin and mineral supplementation from pre-breeding to d 83 of gestation. We hypothesized that the DNA methylation pattern of genes involved with fetal hepatic metabolism and function would be altered in response to vitamin and mineral supplementation during early gestation. Sixteen Angus crossbred heifers (~16 mo of age) were randomly assigned to either a treatment (vitamin and mineral supplementation, VTM, n = 8) or control (corn-based carrier without supplementation, NoVTM, n = 8) group. Supplemented heifers received 0.45 kg •heifer-1•d-1 of to provide 113 g of vitamin-mineral premix (Purina Wind &amp; Rain Storm All-Season 7.5 Complete, Land O’Lakes, Inc., Arden Hills, MN) from d 71 to 148 before breeding to d 83 of gestation. All heifers received 100% of NRC recommended nutritional requirements targeting 0.28 kg •heifer-1•d-1 of gain. The heifers were bred through artificial insemination following a 7-d Co-Synch + CIDR estrus synchronization protocol. All pregnant heifers were surgically ovariohysterectomized on d 83, and liver samples were collected from the fetuses. DNA methylation profiles from 16 fetuses (8 per treatment) were determined using Reduced Representation Bisulfite Sequencing (RRBS). The analysis was conducted using methylKit pipeline where data was normalized using principal components. We identified 794 differentially methylated cytosines (DMCs) for the control (NoVTM) vs VTM comparison. Most of the DMCs were found in introns followed by intergenic, promoter, and exonic regions. Among these DMCs, 60% (479) were hypermethylated and 40% (315) were hypomethylated, potentially regulating 739 nearby genes (FDR &amp;lt; 0.1). Biological processes over-represented by these genes included transport of ions through voltage gated channels (KCNK13, KCNT1, CACNA1B, KCNK9, LRRC55, KCNAB2, CACNA1S, KCNJ2, CACNG5, CLIC5, TPCN2, KCNQ1), which may be associated to pregnancy establishment by inducing pregnancy-associated relaxation and uterine artery dilatation. Some genes associated with structural development were also regulated by VTM supplementation (i.e., TIAM1, COL18A1, DYSF, BMP10, RXRA, EHMT1, COL4A2, PLEC, ZFAT, MTMR2, NAV1, ANHX, ACACB, and LIMK2). Collectively, these results suggest that periconceptual maternal vitamin and mineral supplementation affects the methylation pattern and potentially regulates the expression of genes involved in fetal liver development and ion transport.

Retraction: Randomized controlled trial of the effect of bilateral uterine artery ligation during cesarean among women at risk of uterine atony.

Retraction: A. Samy, M. K. Ali, A. M. Abbas, H. A. Wahab, A. A. Wali, A. H. Hussien, M. Mostafa, M. A. Taymour, A. I. Ogila, Y. Ahmad, A. Essam, M. Mahmoud, "Randomized controlled trial of the effect of bilateral uterine artery ligation during cesarean among women at risk of uterine atony," International Journal of Gynecology & Obstetrics, 148, no. 2 (2020): 219-224, https://doi.org/10.1002/ijgo.13064. The above article, published online on 22 November 2019 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the Editor-in Chief, Michael Geary, International Federation of Gynecology and Obstetrics and John Wiley & Sons Ltd. The retraction has been agreed following an investigation based on concerns raised by a third party. The investigation uncovered: Inconsistencies between the original data provided during the investigation and the published article; some P-values in Tables1, 2 and 3 could not be reproduced by the Research Integrity team. Discrepancies between planned and actual sample sizes, and between sample sizes stated in the trial registry and in the published paper Unusual dependencies between variables in the study data provided by the author; for instance there is no satisfactory explanation for the unusual relationship between anaemia and age. As a result, the article's conclusions can no longer be considered valid. The authors did not agree with the decision to retract their article.

Clinical Importance of the First Trimester Uterine Artery Doppler Measurements in Patients with Hyperemesis Gravidarum

Clinical Importance of the First Trimester Uterine Artery Doppler Measurements in Patients with Hyperemesis Gravidarum

Long-term outcomes of uterine artery embolization in patients with early hypotonic postpartum hemorrhage

Introduction. Obstetric haemorrhage remains the number one cause of maternal death globally. Today, the frequency of hypotonic postpartum hemorrhage (PPH) reaches 80% in the obstetric hemorrhage profile.Objective. To evaluate the long-term outcomes of uterine artery embolization (UAE) for the treatment of early hypotonic postpartum hemorrhage (PPH).Material and methods. 136 patients were examined 2–8 years after UAE performed for early hypotonic postpartum hemorrhage. A survey was conducted for everyone. Ultrasound of the pelvic organs on the 5th–7th day of the menstrual cycle with an assessment of endometrial thickness, ovarian volume, number of antral follicles, and also Dopplerography were performed in 34 patients. Hormonal status was studied in 34 patients, that were examined in the first phase of the menstrual cycle, with an assessment of serum levels of anti-Mullerian hormone (AMH), follicle-stimulating (FSH) and luteinizing (LH) hormones.Results. 19.1% (26/136) of patients planned pregnancy. Pregnancy occurred in 61.5% (16/26). Term delivery occurred in 38.5% (10/26), PPH recurrence occurred in 30% (3/10), placenta accretion was not detected. 23.1% (6/26) patients were pregnant at the time of the survey. Neither morphological nor functional changes of the ovaries were detected in patients 2–8 years after UAE.Conclusions. Uterine artery embolization is a safe method of therapy of early hypotonic postpartum hemorrhage.

Uterine Artery Pulsatility Index in Pregnant Kidney or Liver Recipients and Its Impact on Perinatal Outcome

The uterine artery pulsatility index (UtA PI) is associated with blood flow to the placenta. Its increased values imply impaired placentation. This study aimed to evaluate UtA PI measurements in first-trimester ultrasound in pregnancies after kidney (KTx) or liver transplantation (LTx) and its relationship with perinatal outcome. A retrospective analysis of 72 pregnancies in female kidney (35) or liver (37) transplant recipients between 2017 and 2023 was performed. Data concerning UtA PI were available for 17 kidney and 19 liver recipients. Statistical analysis of variables between KTx and LTx groups and the correlation with perinatal outcomes was performed using Student's t test and Pearson's correlation with P < .05 considered statistically significant. The mean UtA PI results were similar, and there were no statistical differences between the group of pregnant kidney and liver recipients with mean values of 1.46 (SD 0.44] and 1.73 (SD 0.51] respectively (P = .10). The mean neonate birth weight was lower in KTx group (2158 g ([SD 723 g]) compared with the LTx group (2780 g [SD 754g]; P =.02). In the KTx and LTx groups, mean UtA PI was in negative correlation with Apgar score in the first minute (P = .04, P = .01 respectively). Uterine artery Doppler is useful in predicting perinatal outcomes in the general population and organ recipient pregnancies, even in the early stages of pregnancy, as we observed the correlation between UtA PI and Apgar score. Pregnant kidney recipients remain at higher risk for complications and more unpredictable outcomes than liver recipients.

Efficacy and Safety Analyses of Recombinant Factor VIIa in Severe Post-Partum Hemorrhage.

Background: Despite a range of available treatments, it is still sometimes challenging to treat patients with severe post-partum hemorrhage (sPPH). Objective: This study evaluated the efficacy and safety of recombinant activated factor VIIa (rFVIIa) in sPPH management. Methods: An open-label, multi-center, randomized controlled trial (RCT; NCT00370877) and four observational studies (OS; OS-1 (NCT04723979), OS-2, OS-3, and OS-4) were analyzed regarding efficacy (need for subsequent invasive procedures, including uterine compression sutures, uterine or iliac artery ligations, arterial embolization, or hysterectomy) and safety (incidence of thromboembolic events (TE) and maternal mortality) of rFVIIa for sPPH. The RCT, and OS-1 and OS-2, included a control group of women who did not receive rFVIIa (with propensity score-matching used in OS-1 and OS-2), whereas OS-3 and OS-4 provided descriptive data for rFVIIa-exposed women only. Results: A total of 446 women exposed to rFVIIa and 1717 non-exposed controls were included. In the RCT, fewer rFVIIa-exposed women (50% [21/42]) had an invasive procedure versus non-exposed women (91% [38/42]; odds ratio: 0.11; 95% confidence interval: 0.03-0.35). In OS-1, more rFVIIa-exposed women (58% [22/38]) had an invasive procedure versus non-exposed women (35% [13.3/38]; odds ratio: 2.46; 95% confidence interval: 1.06-5.99). In OS-2, 17% (3/18) of rFVIIa-exposed women and 32% (5.6/17.8) of non-exposed women had an invasive procedure (odds ratio: 0.33; 95% confidence interval: 0.03-1.75). Across all included women, TEs occurred in 1.5% (0.2% arterial and 1.2% venous) of rFVIIa-exposed women and 1.6% (0.2% arterial and 1.4% venous) of non-exposed women with available data. Conclusions: The positive treatment effect of rFVIIa on the RCT was not confirmed in the OS. However, the safety analysis did not show any increased incidence of TEs with rFVIIa treatment.

Role of soluble fms-like tyrosine kinase-1/placental growth factor ratio along with uterine artery Doppler for the prediction of pre-eclampsia – A case–control study

Background: Hypertensive disorders of pregnancy are becoming the leading cause of maternal morbidity and mortality worldwide and are responsible for 9–25% of deaths 1. They are believed to occur due to an imbalance between pro-angiogenic factors, like placental growth factor (PlGF) and anti-angiogenic factors, like soluble fms-like tyrosine kinase-1 (sFLT-1). Aims and Objectives: The aim of the study was to evaluate the role of the sFLT-1/PlGF ratio along with uterine artery Doppler for the prediction of pre-eclampsia (PE). Materials and Methods: The current study was a prospective case–control study conducted at Sri Ramachandra Medical College and Hospital, Chennai, from 2018 to 2020. Blood samples for sFLT-1 and PlGF and uterine artery Doppler were done in 100 pregnant mothers who are at 16–20-week gestation attending antenatal outpatient department in the Department of Obstetrics and Gynecology. Results: We found that the mean sFLT-1 in high-risk group was 826.17 ng/L (standard deviation [SD]±251.31) compared to 924.69 ng/L (SD±360.61) in low-risk groups. The mean PlGF in the high-risk group was 23.07 ng/L (SD±4.68) compared to 27.43 ng/L (SD±5.62) in low-risk group. The mean sFLT-1/PlGF ratio was increased in high-risk group of about 39.68 (SD±22.77) compared to 35 (SD±16.98) in low-risk group. Women with high resistance uterine artery Doppler have 8.5 odds of getting PE compared to those with normal uterine artery Doppler. Conclusion: According to our study, the sFLT-1/PlGF ratio carries more sensitivity (90%) and negative predictive value (74.19%) if we keep the value as 32.25 along with uterine Doppler rather than their individual values for the prediction of PE.

Pseudoaneurysm of the uterine artery, a rare cause of postpartum hemorrhage: Report of two cases and literature review

Pseudoaneurysm of the uterine artery is among the rare causes of postpartum secondary hemorrhage. Its diagnosis is suspected in the presence of significant uterine bleeding without any other obvious cause, and its diagnostic confirmation relies on Doppler ultrasound and angiography. We report the cases of two patients who experienced postpartum secondary hemorrhage, in whom pelvic ultrasound suspected an aneurysm, confirmed and treated by angiography. The post-embolization outcomes were favorable, marked by complete cessation of bleeding. Clinical and ultrasound follow-up at one month did not reveal recurrence of bleeding and demonstrated the disappearance of the previously described pseudoaneurysm.