Uterine Doppler Research Articles

Dynamic contrast enhanced MRI demonstrate altered placental perfusion in the STOX1A preeclampsia mouse model

IntroductionPreeclampsia, a hypertensive disorder of pregnancy triggered by placental dysfunction, is reproduced in the murine STOX1A model, with hypertension, proteinuria, and abnormalities in umbilical and uterine Dopplers. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is an innovative technique that provides insights into tissue perfusion. The present study aims at analyzing placental perfusion using DCE-MRI to further characterize placental defects in the STOX1A model. MethodsTwo study groups were formed: the "TgSTOX13 pregnancy group" from mating TgSTOX13 genotype males with wild-type females, and the "wild-type pregnancy group" from mating wild-type males with wild-type females. Blood pressure, urinary albumin to creatinine ratio, and fetal weights were measured and compared between the groups, while perfusion parameters were analyzed using both conventional compartmental (1C) and free-time point-Hermite (FTPH) models in the DCE analysis. ResultsSeventeen pregnant mice in the "TgSTOX13 pregnancy group" and thirteen in the "wild-type pregnant group" were included in the analysis. During late gestation, the TgSTOX13 pregnancy group exhibited higher blood pressure, elevated albumin/creatinine ratio, and decreased fetal weights compared to the wild-type pregnancy group. In the DCE analysis utilizing the 1C model, blood flow (Fb) was significantly reduced by approximately 31.8 % in the TgSTOX13 pregnancy group compared to the wild-type pregnancy group (p < 0.01), a finding corroborated by the FTPH model with a reduction estimated at 31.5 % (p < 0.01). DiscussionOur investigation successfully utilized DCE MRI to assess placental perfusion in a mouse model of preeclampsia, revealing a significant reduction of approximately 30 % in the preeclamptic mice, mirroring human pathophysiology.

Role of Uterine Artery Doppler Study Between 11 and 14 Weeks as a Predictor of Preeclampsia.

Introduction Preeclampsia is a serious complication marked by antepartum hemorrhage, resulting in severe maternal and fetal complications. Predicting this condition using placental dysfunction assessments, such as uterine artery Doppler ultrasound, is challenging due to the placenta's evolving structural and biochemical characteristics throughout different stages of pregnancy. Objectives To determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the uterine artery Doppler Pulsatility Index (PI) and Resistive Index (RI) in predicting preeclampsia. To compare the Doppler ultrasound measurements between normal pregnancies and those that develop preeclampsia. To assess the diagnostic accuracy of uterine artery Doppler ultrasound in predicting gestational hypertension in addition to preeclampsia. Methodology Conducted as a prospective study, 116 antenatal mothers with computed gestational ages and scan gestational ages between 11 and 14 weeks, and a previous history of preeclampsia were included. Subjects with chronic hypertension or multiple gestations were excluded. Participants underwent uterine artery Doppler screening, during which the PI and RI were measured upon obtaining three consecutive similar waveforms, and the mean PI of the left and right arteries was calculated. The outcomes of patients with normal pregnancies and those who developed preeclampsia were compared. Data were entered into Microsoft Excel (Microsoft® Corp., Redmond, WA, USA) and analyzed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, NY, USA). Results The mean PI among participants was 1.75 (±0.38), with a range from 1 to 2.75. The mean RI was 0.58 (±0.08), ranging from 0.45 to 0.8. The cutoff for the mean PI in predicting preeclampsia was 2.27, which showed a sensitivity of 92.9%, specificity of 97.1%, PPV of 81.47%, NPV of 99.01%, and a diagnostic accuracy of 96.59% (area under the curve (AUC): 0.982). The cutoff for the mean RI for predicting preeclampsia was 0.695, with a sensitivity of 85.7%, specificity of 98%, PPV of 85.47%, NPV of 98.04%, and diagnostic accuracy of 96.52% (AUC: 0.965). In predicting gestational hypertension, the cutoff for the mean PI was 1.975, with a sensitivity of 80%, specificity of 82.9%, PPV of 17.41%, NPV of 98.92%, and diagnostic accuracy of 82.78% (AUC: 0.848). The cutoff for the mean RI in predicting gestational hypertension was 0.615, showing a sensitivity of 80%, specificity of 80.2%, PPV of 15.4%, NPV of 98.89%, and diagnostic accuracy of 80.19% (AUC: 0.767). Conclusion The research demonstrated that aberrant readings in uterine Doppler ultrasound, specifically in the PI and RI, possess strong overall validity in forecasting the occurrence of preeclampsia.

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

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

A Second Trimester Prediction Algorithm for Early-Onset Hypertensive Disorders of Pregnancy Occurrence and Severity Based on Soluble fms-like Tyrosine Kinase 1 (sFlt-1)/Placental Growth Factor (PlGF) Ratio and Uterine Doppler Ultrasound in Women at Risk.

Hypertensive disorders of pregnancy (HDPs) represent a significant source of severe maternal and fetal morbidity. Screening strategies relying on traditional medical history and clinical risk factors have traditionally shown relatively modest performance, mainly in the prediction of preeclampsia, displaying a sensitivity of 37% for the early-onset form and 29% for the late-onset form. The development of more accurate predictive and diagnostic models of preeclampsia in the early stages of pregnancy represents a matter of high priority. The aim of the present paper is to create an effective second trimester prediction algorithm of early-onset HDP occurrence and severity, by combining the following two biochemical markers: a soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio and uterine artery Doppler ultrasound parameters, namely the pulsatility index (PI) and the resistivity index (RI), in a population of high-risk pregnant women, initially assessed through traditional risk factors. A prospective single-center observational longitudinal study was conducted, in which 100 women with singleton pregnancy and traditional clinical and medical history risk factors for preeclampsia were enrolled at 24 weeks of gestation. Shortly after study enrollment, all women had their sFlt-1 and PlGF levels and mean uterine artery PI and RI determined. All pregnancies were followed up until delivery. Receiver operating characteristic (ROC) analysis established algorithms based on cutoffs for the prediction of the later development of preeclampsia: PI 1.25 (96.15% sensitivity, 86.49% specificity), RI 0.62 (84.6% sensitivity, 89.2% specificity) and sFlt-1/PlGF ratio 59.55 (100% sensitivity, 89.2% specificity). The sFlt-1/PlGF ratio was the best predictor for preeclampsia, as it displayed the highest area under the curve (AUC) of 0.973. The prediction algorithm for the severe form of preeclampsia, complicated by fetal growth restriction leading to preterm birth, antepartum fetal demise or acute fetal distress with a cerebro-placental ratio of <one consisted of the following cutoffs: PI 1.44 (93.75% sensitivity, 95.24% specificity), RI 0.69 (87.5% sensitivity, 100% specificity) and sFlt-1/PlGF ratio 102.74 (93.75% sensitivity, 95.2% specificity). These algorithms may significantly enhance the prediction accuracy of preeclampsia compared to traditional risk factors. The combination of the sFlt-1/PlGF ratio with mean uterine PI and RI in particular displayed an improved performance in the prediction of severe preeclampsia with the above-mentioned complications, compared to the biochemical markers or uterine Doppler parameters used alone. Therefore, HDP screening strategies should increasingly focus on implementing such algorithms for women who are initially regarded as high risk based on traditional risk factors, in order to properly diagnose HDP and properly limit or manage the later maternal and fetal complications.

A new Doppler index, cerebro-placental-uterine ratio, and fetal cardiac parameters in early onset preeclampsia.

Our aim was to investigate the significance of cerebro-placento-uterine ratio CPUR, a new Doppler index, and fetal cardiac parameters (Mod MPI, EFT) in early-onset preeclampsia (EOPE) and to examine whether these parameters are related to perinatal outcome. Forty participants diagnosed with EOPE (preeclampsia cases diagnosed before 34 weeks of gestation) and 40 healthy pregnant women were included in this study. Demographic data were recorded. Doppler parameters such as middle cerebral artery (MCA), umbilical artery (UA), and uterine artery (Ut-A), and left modified myocardial performance index (Mod-MPI) and epicardial fat thickness (EFT) were measured. Cerebroplacental ratio (CPR) was determined by dividing MCA pulsatility index (PI) by UA PI. CPUR was calculated as the ratio of CPR to mean UtA-PI (CPUR = CPR/UtA-PI). All parameters were compared between the EOPE and control groups. Correlation tests were used to examine the relationship between Doppler parameters and perinatal outcome. p values less than 0.05 were considered statistically significant. The pulsatility index of the middle cerebellar artery, CPUR and CPR values were statistically lower in the EOPE group than in the control group (p = 0.002; p = <0.001; p = <0.001; respectively). No statistical differences were found between groups for isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), ejection time (ET), left mod-MPI, EFT (p = 0.117; p = 0.093; p = 0.398; p = 0.882; p = 0.202, respectively). Umbilical artery Doppler pulsatility index (PI), mean uterine artery Doppler pulsatility index (PI), were higher in the EOPE group than in the control group (p = 0.006; and p = <0.001, respectively). The CPUR value for predicting EOPE was ≤1.3652 with 74. 4% sensitivity and 94.9% specificity. Positive correlations were found between CPUR, CPR, and some neonatal parameters. CPUR, a new index combining fetal and uterine Doppler indices, may add contribution to predict adverse perinatal outcome and EOPE.

Association of Placental Cysts with Increased Fetal Anomalies and Growth Restriction: An Observational Cohort Study

Purpose: To investigate the placental cysts in every aspect and evaluate associations with fetal anomalies, fetal growth, accompanying maternal diseases, and obstetric outcomes. Methods: The presented cohort study was conducted with twenty pregnant women diagnosed with placental cysts. Maternal age, obstetrical histories, maternal diseases, ultrasonographic characteristics of cysts, additional ultrasound findings, and fetal anomalies were recorded at the time of diagnosis and each examination. Pregnancy outcomes; birth weight, gestational age at birth, APGAR scores, NICU admissions, amniotic fluid disorders, and fetal growth restriction (FGR) were recorded for all participants. Data were evaluated according to diagnosis time, cyst size at the diagnosis time, delivery time cyst size, fetal anomalies, and obstetric outcomes. Results: All cysts were single. Five of them increased in size with follow-ups. The mean follow-up duration was 12 weeks. There were 9 FGR (64.3%). Six of the FGR patients had cyst sizes &gt;5cm. There were eight fetal anomalies; 5 were heart-associated, and 3 had a single umbilical artery. The frequency of C/S in delivered patients was 78%, and preterm delivery was 35.7%. Conclusion: The presented study showed that placental cysts have clinical importance due to their potential risk for FGR and accompanying fetal anomalies. Appropriate patient follow-ups for cyst size enlargements and anomaly screening, especially for cardiac evaluation, might be important for placental cyst management. Also, uterine artery doppler measurements and prophylactic acetylsalicylic acid use might be under consideration. However, the clinical utility of uterine doppler examination and prophylactic use of acetylsalicylic acid needs further studies.

First-trimester preterm preeclampsia prediction model for prevention with low-dose aspirin.

Preeclampsia (PE) is a major maternal and fetal threat. Previous risk-scoring methods in guidelines lacked precision. The Fetal Medicine Foundation (FMF) proposed a first-trimester PE screening model using Bayes' theorem. FMF prediction model combines maternal characteristics and medical/obstetrical history to determine prior risk and further incorporate maternal blood pressure, maternal serum biomarkers, and uterine Doppler pulsatility index expressed as multiples of the median (MoM) to estimate posterior risk. Low-dose aspirin is one ofthe potential PE prevention strategies. Initiating it before 16 weeks is crucial. Aspirin's antiplatelet and anti-inflammatory properties align with PE's pathophysiology. Dosing and resistance warrant further study, but a standard regimen of 150 mg nightly, starting before 16 weeks, is widely supported. Clinical trials, including ASPRE, affirm aspirin's role in PE prevention. Starting aspirin based on FMF screening significantly reduces preterm PE and associated complications. Emerging research explores predictors like maternal ophthalmic arterial waveform. Regional variations, especially in Asian populations, are considered. Machine learning and AI show promise, but examiner expertise remains essential for accurate prediction. In conclusion, integrating FMF's first-trimester PE screening with low-dose aspirin offers a promising strategy. Further advancements may enhance precision and broaden prevention efforts.

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.

#371 : Immunological Analysis of Endometrial Receptivity: A New Hope for Patients with Recurrent Implantation Failures

Background and Aim: Recurrent implantation failures (RIF) remain always a strong problem for all IVF teams. Our ART Center started in 2015 and quickly we wanted to focus on implantation failure. After 2 or 3 embryo transfers without pregnancy, guidelines provide to perform exams such as karyotypes, Anti phospholipid, thrombophilia, uterine Doppler, hysteroscopy, endometrial biopsy with CD 136, laparoscopy, sperm DNA Fragmentation. However, a large part of these failures remains unexplained. Following the studies performed in France by N. Lédée in 2013, this study evaluates the results of a new exploration based on immunological analysis of endometrial receptivity. Methods: This study is proposed, after other explorations already done, for patients with 6 or more embryos D3 or 3 embryos D5 transferred without pregnancy. Such an analysis is achieved on endometrial biopsy performed in middle luteal phase and sent to MatriceLab (Paris) Immunological exploration is based on uNK count (uterine Natural Killer cells) and cytokines expression. According to these parameters, “individualized” care is proposed to patient for next embryo transfers to correct the disorder identified by analysis. Results: From 2016 to 2020, 114 biopsies have been performed and sent to MatriceLab. 112 were suitable for analysis. According with results, 4 main profiles have been isolated: Normal immunity (22,3%) Dysregulation immunity (77,7%). Low local immune activation (25%). Over local immune activation (40,2%). “Mix” profile (12,5%) 95 patients have been performing FET following the analysis. Mean age 32.6 ±3.6 years. Mean number of transfers before biopsy 3.9 ±1.6. Mean number of embryos previously transferred 9.6 ±4.4. Deliveries in normal immunity group: 33% (n=6). Deliveries in dysregulation group treated with adapted protocol: 53,2% (n=40) Conclusions: This pregnancy rate is much better than usual pregnancy rate expected after six embryos D3 or three embryos D5 transferred without pregnancy.

The Current Role of the sFlt-1/PlGF Ratio and the Uterine-Umbilical-Cerebral Doppler Ultrasound in Predicting and Monitoring Hypertensive Disorders of Pregnancy: An Update with a Review of the Literature.

Regarding the hypertensive disorders of pregnancy, pre-eclampsia (PE) remains one of the leading causes of severe and life-threatening maternal and fetal complications. Screening of early-onset PE (<34 weeks of pregnancy), as well as late-onset PE (≥34 weeks), shows poor performance if based solely on clinical features. In recent years, biochemical markers from maternal blood-the pro-angiogenic protein placental growth factor (PlGF) and the antiangiogenic protein soluble FMS-like tyrosine kinase 1 (sFlt-1)-and Doppler velocimetry indices-primarily the mean uterine pulsatility index (PI), but also the uterine resistivity index (RI), the uterine systolic/diastolic ratio (S/D), uterine and umbilical peak systolic velocity (PSV), end-diastolic velocity (EDV), and uterine notching-have all shown improved screening performance. In this review, we summarize the current status of knowledge regarding the role of biochemical markers and Doppler velocimetry indices in early prediction of the onset and severity of PE and other placenta-related disorders, as well as their role in monitoring established PE and facilitating improved obstetrical surveillance of patients categorized as high-risk in order to prevent adverse outcomes. A sFlt-1/PlGF ratio ≤ 33 ruled out early-onset PE with 95% sensitivity and 94% specificity, whereas a sFlt-1/PlGF ≥88 predicted early-onset PE with 88.0% sensitivity and 99.5% specificity. Concerning the condition's late-onset form, sFlt-1/PlGF ≤ 33 displayed 89.6% sensitivity and 73.1% specificity in ruling out the condition, whereas sFlt-1/PlGF ≥ 110 predicted the condition with 58.2% sensitivity and 95.5% specificity. The cut-off values of the sFlt-1/PlGF ratio for the screening of PE were established in the PROGNOSIS study: a sFlt-1/PlGF ratio equal to or lower than 38 ruled out the onset of PE within one week, regardless of the pregnancy's gestational age. The negative predictive value in this study was 99.3%. In addition, sFlt-1/PlGF > 38 showed 66.2% sensitivity and 83.1% specificity in predicting the occurrence of PE within 4 weeks. Furthermore, 2018 ISUOG Practice Guidelines stated that a second-trimester mean uterine artery PI ≥ 1.44 increases the risk of later PE development. The implementation of a standard screening procedure based on the sFlt-1/PlGF ratio and uterine Doppler velocimetry may improve early detection of pre-eclampsia and other placenta-related disorders.

Second trimester abnormal uterine artery Dopplers and adverse obstetric and neonatal outcomes when PAPP-a is normal

Objectives To explore the association between abnormal uterine artery Dopplers (combined PI > 2.5) - with normal PAPP-A - and adverse obstetric/neonatal outcomes. Methods This was a retrospective cohort study of 800 patients between 1 March 2019 − 23 November 2021 in a tertiary UK hospital, where it is routine to measure uterine artery Dopplers of all pregnancies during their anomaly scans. 400 nulliparous women/birthing people with complete data were included. 400 nulliparous controls scanned in the same time frame (1.5 years) with normal PAPP-A and uterine artery Dopplers were matched for age and BMI. Outcomes included: mode of birth, postpartum complications, birth weight/centile, Apgar score, gestational age at delivery, neonatal unit admission, and clinical neonatal hypoglycemia. Multivariable analysis was used. Results Compared to controls, pregnancies with abnormal uterine artery Dopplers and normal PAPP-A were at increased risk of induction (46.5% vs 35.5%, p = .042), cesarean section (46.0% vs 38.0%, p = .002), emergency cesarean section (35.0% vs 26.5%, p = .009), and pre-eclampsia 5.8% vs 2.5%, p = .021). Their babies were more likely to be admitted to the neonatal unit – mostly for prematurity (15.3% vs 6.3%, p = .0004), hypoglycemia (4.0% vs 1.0%, p = .007), be small for gestational age (26.5% vs 11.5%, p = .0001), had intrauterine growth restriction (10.8% vs 1.3%, p = .0001), and be born prematurely (10.0% vs 3.5%, p = .002). Routine measurement of uterine artery Dopplers increased the detection rate of small for gestational age fetuses by 15.1%. Over half of the babies admitted with neonatal hypoglycemia in pregnancies with abnormal uterine artery Dopplers had an unexplained cause. Conclusions Pregnancies with abnormal uterine Dopplers are not only at increased risk of pre-eclampsia and small for gestational age fetuses/intrauterine growth restriction, but are also at increased risk of emergency cesarean section and adverse neonatal outcomes. The increased incidence of neonatal hypoglycemia is likely driven to some degree by prematurity and placental complications, but possibly also by undiagnosed glucose dysmetabolism. This may warrant routine measurement of uterine artery Dopplers in all pregnancies (regardless of risk), where feasible, to aid antenatal management and counseling.

Third-trimester uterine artery Doppler for prediction of adverse outcome in late small-and adequate for-gestational-age fetuses.

Fetal growth restriction includes all those fetuses that do not reach their own growth potential due to placental insufficiency and therefore at higher risk of adverse perinatal outcomes. Identification and follow-up of these fetuses is essential to decrease this additional risk. Although estimated fetal weight under the 3rd centile and pathological cerebroplacental ratio are the most accepted predictive criteria, some evidence suggests that abnormal uterine artery Doppler may be a useful prognostic parameter in late-onset growth restriction fetuses at the moment of diagnosis. However, its prediction capacity as a standalone parameter is limited. In that context, integrated models of biometric and hemodynamic ultrasound parameters including uterine Doppler have been proposed as an effective approach to stratify the risk and improve perinatal outcomes. Moreover, an association of abnormal uterine artery Doppler and histological findings of placental underperfusion due to vascular obstruction has been described. Finally, it has also been suggested that the evaluation of uterine artery Doppler at third trimester in appropriate-for-gestational-age fetuses could identify cases of subclinical placental insufficiency, but further evidence is needed to define such predictive strategies.

The Role of “Uterine Artery Doppler” at 11 to 13+6 Weeks for Prediction of Preeclampsia: A Systematic Review

Objective: This systematic review is aimed to review the role of uterine artery Doppler in first trimester of pregnancy along with use of maternal characteristics as a predictor of early and late on set pre-eclampsia (PE). Selection Criteria: The search was limited by selecting; only original articles, prospective &amp; retrospective study designs, role of uterine artery Doppler done at 11 to 14 weeks, done on singleton pregnancy and written in English language were included. Data Collection and Analysis: The data extracted for author name, year of publication, place of study, duration of study, study design, outcomes and study variables including maternal factors, uterine artery Doppler and serum markers. Then detailed analysis of uterine artery Doppler performance as predictor in the form of Area under curve, Sensitivity, Specificity, Positive predictive value, Negative Predictive Value and its relation to preeclampsia, Early PE and Late PE. Results: Following the search strategy of PRISMA, 148 full articles reviewed, and 21 articles were included from 2010 to 2021. Out of 21 articles, 19 articles had “prospective study design” whereas two had “retrospective. Out of 21 researches, 15 assessed early preeclampsia, 4 assessed late preeclampsia, 4 assessed both, however 7 articles studies only preeclampsia as an outcome. The extracted estimate show value of first trimester uterine Doppler as a predictor of early and late preeclampsia. Conclusions: The uterine artery Doppler with maternal characteristics is a valuable, noninvasive tool to be used at 11 to 14 weeks as predictor of preeclampsia in the low resource settings where serum markers cannot be available to general population.

Exogenous L-arginine administration improves uterine vascular perfusion, uteroplacental thickness, steroid concentrations and nitric oxide levels in pregnant buffaloes under subtropical conditions.

Heat stress (HS) during pregnancy adversely affects uterine vascular perfusion and foetal development. L-arginine (L-Arg), a nitric oxide (NO) precursor, has been proven to enhance an organ's vascular perfusion. Therefore, this study aimed to examine the effect of L-Arg administration on the pregnant buffaloes' uterine haemodynamics and uteroplacental thickness under environmental HS conditions. For this purpose, pluriparous (n=12) HS-pregnant buffaloes (mid-gestation, 180-190 days; temperature humidity index >85) were haphazardly assigned into two groups, either administered a single intravenous (IV) bolus of 5mg/kg BW of L-Arg Hcl (n=6; ARG) or received normal saline (0.9%; IV; 25 ml) that served as a control group (n=6; CON). Combined uteroplacental thickness (CUPT, mm), middle uterine arteries' (MUA) diameter (mm) and uterine Doppler haemodynamics (ipsilateral and contralateral to the pregnant horn) were examined utilizing B-mode and colour Doppler ultrasonography, respectively. The serum levels of progesterone (P4), estradiol 17β (E2), nitric oxide (NO) and total antioxidant capacity (TAC) were assayed using commercial kits. The experimental time points were - 1, 0, 2, 4, 24, 48, 72, 96 and 120 h post-L-Arg administration. The ARG group showed higher (p < .05) CUPT and MUA diameter values starting at 24 h post-treatment and onward than the control buffalo cows. In addition, there were improvements (p < .05) in the blood flow parameters in the ipsilateral MUA after L-Arg treatment evidenced by lower values of pulsatility and resistive indices starting at 48 and 4h, respectively and onward, and higher values of peak systolic velocity, coloured areas towards the pregnant uterine horn (both 24-72 h). Increases in the NO levels were found during the period between 4 and 120 h in the ARG group compared to the CON group. Moreover, significant increases in the E2 and P4 means were noted in the ARG group, especially at 24 h onward, respectively compared to the CON group. Concerning the TAC status, neither the administration nor the hours affected serum TAC levels in the HS pregnant buffaloes (CON and ARG). In conclusion, L-Arg administration improved uteroplacental thickness and enhanced uterine haemodynamics, NO levels, and steroids production in mid-pregnant buffalo cows under environmental heat stress conditions which could improve foetal growth and development.

How Common are Uterine Doppler Abnormalities for Pregnant Patients with Elevated Maternal Serum Alpha-Fetoprotein (MS-AFP)?

How Common are Uterine Doppler Abnormalities for Pregnant Patients with Elevated Maternal Serum Alpha-Fetoprotein (MS-AFP)?

Second trimester uterine arteries pulsatility index is a function of placental pathology and provides insights on stillbirth aetiology: A multicenter matched case-control study.

The aim of this study was to investigate the relationships between maternal vascular malperfusions (MVM) and second trimester uterine arteries pulsatility index (UtA-PI) in cases of stillbirth (SB), compared to live-birth (LB) matched controls. This was a multicentre, observational, matched case-control study performed at five referral maternity centres over a 4-year period including SB and LB control pregnancies at high-risk for preeclampsia (PE) and/or fetal growth restriction (FGR), matched and stratified for UtA-PI MoM quartiles values of the SB cases. Logistic regression was used to assess the rates of each MVM finding, within each increasing MoM quartile subcategory in SB and matched LB controls. 82 SB and 82 LB matched high-risk pregnancies were included. Placental hypoplasia, placental infarction, retroplacental hematoma, distal villous hypoplasia and accelerated villous maturation showed a significant correlation with UtA-PI. At univariable analysis, placental infarction and distal villous hypoplasia were more highly associated with the increasing quartile uterine Doppler measurements (odds ratio 2.24 and 2.23, respectively). Logistic regressions showed a significant positive and independent association between rates of retroplacental hematoma or distal villous hypoplasia and stillbirth within corresponding UtA-PI MoM quartiles (odds ratio 5.21 and 2.28, respectively). We are providing evidence for characterization of two major etiological stillbirth categories, characterized by a positive or absent association with UtA-PI impairment and specific histopathological placental MVM lesions. Our results support a strict third trimester follow-up of cases with increased second trimester UtA-PI, in order to improve the reproductive chances of these pregnant patients.

VP37.08: Is uterine Doppler and cerebroplacental ratio useful in low‐risk pregnancies to detect adverse outcome?

VP37.08: Is uterine Doppler and cerebroplacental ratio useful in low‐risk pregnancies to detect adverse outcome?

Management of Vandhyatva w.s.r. to thin endometrium through Ayurveda- A single arm open labelled pilot clinical trial.

The four essential factors of conception are Ritu (optimum period for conception), Kshetra (place of conception), Ambu (nutrition), and Beeja (healthy sperm and ovum). Kshetra denotes body as general and to be very specific, especially about the female reproductive system, it is Garbhashaya or the uterine cavity and function is Garbhadhana or conception. The endometrial factor is an important subset in infertility due to poor implantation. To evaluate the efficacy of Saubhagyanandana Ghrita Yonipichu (vaginal tampoon) and Jeevaniya Churna orally in the management of thin endometrium thickness and to evaluate its efficacy in the associate complains of menstrual abnormalities, i.e., irregularity of menstrual cycle, quantity, duration and pain. It was a single-arm open labeled pilot clinical trial, a total of 15 female patients having endometrial thickness <7 mm on transvaginal sonography findings were included in the study. Each patient (n = 15) was given Saubhagyanandana Ghrita Yonipichu (10 mL for 6 days after cessation of menses, for 1 cycle) along with Jeevaniya Churna orally 10 g along with milk twice before meals for 30 days. Assessment of the study was done on Appelbaum's uterine scoring system for the reproduction (USSR) scoring pattern. Results were analyzed by the paired' t-test for the objective parameters and Wilcoxon signed rank-sum test for the subjective parameters. A statistically highly significant difference (P < 0.001) was seen in endometrium thickness, layering, myometrial echogenicity, uterine Doppler flow, endometrial blood flow in zone 3, and total USSR score. Statistical significant difference (P < 0.05) was found in the menstrual abnormalities and a highly statistically significant difference (P < 0.001) was found in ovulation. One of the patients conceived after the treatment. Saubhagyanandana Ghrita Yonipichu (vaginal tampoon) and Jeevaniya Churna orally are effective in improving the thin endometrium.

Doppler studies of placental function

Placental-associated diseases account for most cases of adverse perinatal outcome in developing countries. Doppler evaluation has been incorporated as a predictive parameter at early pregnancy for high-risk placental disease, in the diagnosis and management of those fetuses with impaired intrauterine growth and for the evaluation of fetal wellbeing in those high-risk pregnancies.Uterine Doppler at second trimester predicts most instances of early-onset preeclampsia and intrauterine growth restriction. However, the growing evidence of an effective early propylactic strategy, has turned Uterine Doppler an essential parameter to be included in first trimester predictive algorithms. Umbilical artery Doppler helps in the identification of small-for-gestational-age fetuses at higher risk, and is one of the essential vessels in the assessment of fetal hypoxia impairment, especially in the early cases. It helps in the decision timing for ending the pregnancy improving thus perinatal outcomes. Moreover, in high-risk pregnancies, umbilical artery Doppler has demonstrated to reduce the risk of perinatal deaths and the risk of obstetric interventions. On the other hand, middle cerebral artery Doppler reflects fetal adaptation to hypoxia, and with the cerebroplacental ratio, they improve the detection of fetuses a high risk of adverse perinatal outcome, mostly of those late small fetuses, where most instances of adverse outcome occur in fetuses with normal umbilical artery. Ductus venosous Doppler waveform is a surrogate parameter of the fetal base-acid status. Its use has demonstrated to improve perinatal outcomes, mainly reducing the risk of fetal intrauterine death. Alone or in combination with computerized CTG, it helps tailoring the best moment to end the pregnancy among early cases.

The use of the cerebroplacental ratio in the latent phase of labour to predict adverse outcomes in a resource-limited setting

Background. Risk stratification of pregnant women may decrease the perinatal mortality rate in South Africa. This relies on the assessment of the referring health facility and timeous presentation of the patient. Inaccurate dating affects the ability to detect growth restriction. Patients requiring referral may go undetected and deliver with the inappropriate level of care. Doppler studies can assist in detecting at-risk fetuses. Objectives. To describe the short-term outcomes of fetuses with a normal or abnormal cerebroplacental ratio (CPR) according to the various definitions in the literature. Methods. A cohort of 200 pregnant women were prospectively recruited while in early labour. Patient history including previous ultrasound scans were obtained. Ultrasound was done for biometry, umbilical artery (UA), middle cerebral artery (MCA) and uterine Dopplers, and the CPR was calculated. Labour and delivery details were recorded. An association between an abnormal CPR, adverse outcomes and composite score was determined. Results. Less than a tenth (7.7%; n =15) of the participants had a CPR &lt;1.08. Furthermore, 16.5% ( n =31) of the participants were &lt;5th centile and 24.2% ( n =47) were &lt;10th centile. The composite score of adverse outcomes in those with and without a CPR &lt;5 th centile was not significant ( p =0.737). There was no association between adverse outcomes ( p =0.179) or a composite score ( p =0.237) and the CPR cut-off of the 10th centile. Moreover, there was no association between an abnormal CPR and adverse outcomes after adjusting for confounders. There were no cases of perinatal death or neonatal encephalopathy. Conclusion. An abnormal CPR was not clinically useful in detecting fetuses at risk of adverse outcomes in early labour regardless of the CPR cut-off. However, this is reassuring when normal and may if combined with other parameters still prove useful.