Vascularization Flow Index Research Articles

Performance Characteristics of 3-D Power Doppler Ultrasound (3-D-PD) with the Virtual Organ Computer-Aided Analysis (VOCAL) Technique in the Detection of Prostate Cancer.

The purpose of this study was to test the diagnostic performance of 3-D power Doppler ultrasound (3-D-PD) with the virtual organ computer-aided analysis (VOCAL) technique in the detection of prostate cancers (PCa). A total of 99 male patients referred for needle prostate biopsy owing to elevated serum prostate-specific antigen or abnormal direct rectal examination were prospectively included. The transrectal 3-D-PD-VOCAL quantitative vascularity parameters of vascularization index (VI), flow index and vascularization/flow index (VFI) were obtained before biopsy and compared with histopathologic results. We evaluated the predictive values for the detection of clinically significant PCa in the foci from different zones and the discrimination among various cancer grades. 3-D-PD-VOCAL discriminated malignant from benign foci, with cutoff values of 27.4% for VI, 38.2 for flow index and 8.6 for VFI. All parameters had higher areas under the curve in detecting lesions in the peripheral zone than in the transition zone (p < 0.05). VI and VFI had better diagnostic performance in detecting clinically significant PCa than flow index (p < 0.05). The area under the curve, sensitivity, specificity and accuracy in detecting clinically significant PCa were, for the VI and VFI respectively, 95% and 95%, 86% and 94%, 87% and 76%, and 87% and 85%. 3-D-PD-VOCAL initially demonstrated favorable performance in detecting PCa. Further, larger-sample studies based on prostatectomy specimens are needed to evaluate the exact usefulness of the technique.

Role of three-dimensional ultrasound and Doppler in differentiating leiomyoma and adenomyosis of uterus

ObjectiveThe purpose of this study is to evaluate the importance of three-dimensional (3D) power Doppler ultrasound (US) in the diagnosis and differentiation of leiomyoma and adenomyosis of the uterus.BackgroundThe clinical presentation of adenomyosis and leiomyoma overlaps. The 3/4D US imaging has been currently able to produce female pelvis images that are comparable with magnetic resonance imaging and computerized tomography images in both quality and orientation, with the benefit of being without radiation and low cost.Patients and methodsThis study included female patients clinically diagnosed as having uterine leiomyoma and/or adenomyosis and were indicated for hysterectomy. By Doppler velocimetry with the use 3D power Doppler, the waveforms of the ascending main branch of the uterine artery were obtained on both sides of the cervix. Calculation of the resistance index (RI) and pulsatility index (PI) was done in an automatic manner. The averages of arteries on both sides were taken.ResultsThe vascularity of most of the leiomyoma lesions was peripheral and of all of the adenomyosis lesions was central. The adenomyosis group showed significantly decreased vascular index, flow index, and vascular-flow index mean values (P < 0.01), significantly increased uterine artery RI mean values (P < 0.05), and highly significantly increased PI values (P < 0.01).ConclusionThree-dimensional US imaging with power Doppler can increase the accuracy of differentiation between leiomyoma and adenomyosis cases. Significant differences were noted in the vascularity site and Doppler indices.

OC04.04: The prediction of placental volume and vascular indices measured by three‐dimensional Doppler for the first trimester fetal growth restriction

To investigate the 3D power Doppler placental volume and vascular indices for fetal growth restriction (FGR) prediction in the first trimester. Ultrasonic indicators for prediction of first trimester FGR: a prospective cohort study. Ultrasonic indicators, including the 3D power Doppler vascular index (VI), flow index (FI), vascular flow index (VFI), placental volume (PV) and placental quotient (PQ) were measured by 3D ultrasound and virtual organ computer-aided analysis (VOCALTM) in the first trimester pregnancy. Receiver operating characteristic (ROC) curve analysis evaluated the ability of each variable to predict FGR. With 457 pregnancies enrolled, 35 delivered FGR (7.6%). The ultrasonic indicators of PV, PQ, VI, FI and VFI were markedly lower in the FGR pregnancies versus unaffected pregnancy. And the areas under the ROC curves (AUCs) of PV, PQ, VI, FI and VFI for FGR prediction were 0.751, 0.772, 0.870, 0.652 and 0.873, respectively. The result suggests that VI, FI, VFI, PV and PQ in the first trimester pregnancies are predictors factors of FGR. And further findings revealed that the optimum parameter for prediction of FGR pregnancies are vascular index (VI) and vascular flow index (VFI) in the first trimester. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

ENDOMETRIAL VOLUME AND SUBENDOMETRIAL VASCULARITY BY THREE-DIMENSIONAL POWER DOPPLER AND ITS CORRELATION WITH PREGNANCY OUTCOME IN FRESH EMBRYO TRANSFER ICSI CYCLES

Endometrial vascularity is essential in the early endometrial response to embryo implantation, and vascular changes can affect the uterine receptivity. The study aims to evaluate the role of endometrial volume and subendometrial blood flow measured by 3D power Doppler (3DPD) as predictors of pregnancy in fresh embryo transfer ICSI cycles. A prospective cohort study included 122 women undergoing their first ICSI cycles was performed between October 2018 and April 2020. On the day of maximum follicular growth; endometrial thickness, endometrial volume and subendometrial blood flow was assessed using 3DPD, and vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were obtained and compared between the pregnant and the non-pregnant group. Primary outcome was the clinical pregnancy rate. Out of 122 women, 41 (33.6 %) became pregnant, while 82 (66.4%) failed to become pregnant. The endometrial volume was comparable between the two groups (4.02 ± 1.08 vs. 4.50 ± 1.49, p=0.117). Similarly, the endometrial thickness was not different between both groups (9.48 ± 1.42 vs. 9.71 ± 1.53, p=0.197). Additionally, no significant differences in subendometrial VI, FI and VFI between both groups (p= 0.761, 0.265, 0.728 respectively). Evaluation of endometrial volume and subendometrial vascularity by 3DPD are not useful predictors of pregnancy in fresh embryo transfer ICSI cycles

HYSTEROSCOPIC CORRECTION OF INTRACAVITARY LESIONS DOES NOT AFFECT THE ENDOMETRIAL VOLUME AND SUBENDOMETRIAL VASCULARITY BEFORE ICSI

To evaluate the endometrial volume and subendometrial blood flow measured by three-dimensional power Doppler (3DPD) at the day of ovum pick-up after hysteroscopic correction of intracavitary lesions. A prospective cohort study enrolled 106 women undergoing their first ICSI cycles. All women had a history of previous hysteroscopic surgery for correction of intracavitary lesions within six months before ICSI trial. Fifty-five (51.9%) women had a history of polypectomy; 29 (27.4%) metroplasty, 12 (11.3%) adhesiolysis and ten (9.4%) had a history of myomectomy. A control group of 122 women with normal uterine cavity diagnosed by office hysteroscopy were included. On the day of ovum pick-up; endometrial volume and subendometrial blood flow was assessed using 3DPD, and vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated and compared between both groups. Additionally, pulsatility index (PI) and resistance index (RI) of uterine vessels were assessed. The endometrial volume was comparable between both groups (4.28 ± 1.62 vs. 4.78 ± 1.44, p=0.055). Additionally, no significant differences in subendometrial VI, FI and VFI between both groups (p= 0.44, 0.13, 0.717 respectively). Finally, the uterine PI and RI were comparable between both groups (0.83 ± 0.06 vs. 0.84 ± 0.05 and 2.39 ± 0.57 vs. 2.38 ± 0.50, p= 0.981 and 0.577 respectively) Hysteroscopic correction of intracavitary lesions does not affect the endometrial volume and subendometrial vascularity before ICSI cycles

P–688 Assessment of ovarian vascularity by three-dimensional vaginal power Doppler on day two of menstrual cycle to predict the number of mature eggs collected

Abstract Study question Could ovarian vascularity indices, measured by 3-dimensional (3D) vaginal power Doppler, predict the number of mature oocytes collected after controlled ovarian stimulation? Summary answer Ovarian vascularity index (VI) may be an indicator of poor (&amp;lt;three mature eggs collected) and high (&amp;gt;ten mature eggs collected) ovarian responses to gonadotropins. What is known already Poor and/or hyper ovarian responses to gonadotropins may be related to cycle cancellation during controlled ovarian stimulation (COS). In this context, gonadotropin dose is often individualized using patient features that predict ovarian response (such as age, antral follicular count (AFC) and anti-Müllerian hormone (AMH)). In parallel, ovarian vascularity color doppler is a valuable evaluation method to predict the ovarian hyperstimulation syndrome and the growth/maturity of Graafian follicles. The aim of the present study is to estimate the utility of 3-dimensional vaginal power Doppler and ovarian vascular flow indices in the prediction of the number of mature occytes collected after COS. Study design, size, duration A prospective study was conducted on 200 couples undergoing intracytoplasmic sperm injection cycle at Al Hadi Laboratory and Medical center, Beirut, Lebanon. It was performed between January 2020 and July 2020. Couples were categorized into poor responders group (3 or less metaphase II (MII) eggs collected) (n = 43), high responders group (10 or more MII eggs collected) group (n = 66), and normal responders group (more than 3 and less than 10 MII eggs collected) (n = 66). Participants/materials, setting, methods On the second day of the menstrual cycle, ovarian volume and vascularity parameters (vascularity index (VI), flow index (FI), and vascularity flow index (VFI)) were measured using the 3D power Doppler and the Virtual Organ Computer-Aided Analysis. On the same day, the antral follicle count was evaluated and a blood sample for AMH testing was collected. Women included in the study have undergone COS using GnRH antagonist protocol. Main results and the role of chance Receiver operator characteristics (ROC) curve model was used to predict the number of mature eggs collected. 7 parameters were used to predict poor and high ovarian responses (Age, AMH, AFC, ovarian volume, VI, FI and VFI). Ovarian VI significantly predicted poor ovarian response to gonadotropins (p = 0.033 and area under the curve (AUC)=0.668). Subsequently, the cut off value was 0.0025 with 84% sensitivity and 83.3% specificity. In parallel, ovarian VI significantly predicted high ovarian response to gonadotropins (p = 0.036 and AUC (0.778)) with a cut off value 0.0375 and with 77.8% sensitivity and 78.3% specificity. Furthermore, VFI significantly predicted high ovarian response to gonadotropins (p = 0.045; AUC=0.677). Limitations, reasons for caution It will be necessary to perform a prospective analysis on a broad sample size to validate these findings. In addition, it will be interesting to assess the impact of ovarian vascularity on pregnancy outcomes. Wider implications of the findings: Assessing ovarian vascularity prior to ovarian stimulation can help reduce the rate of cycle cancellation. In addition, more studies are welcomed in the field to unravel the mechanisms behind altered ovarian vascularity and to test the possibility of restoring normal ovarian physiology. Trial registration number Not applicable

P–286 Uterine vascularity in women with previous caesarean section and its potential role in implantation failure: a retrospective cohort study

Abstract Study question Does a previous Caesarean section affect uterine vascularisation the day of embryo transfer? Summary answer 3D vascularisation parameters show less uterine irrigation in patients with previous Caesarean section What is known already A recent retrospective cohort study demonstrates that previous Caesarean section impairs live birth rates after assisted reproductive treatment (ART) compared to a previous vaginal delivery. Furthermore, it has been hypothesized about the mechanisms by which post-cesarean section niche may diminish clinical pregnancy rates. One of the hypothetical process mentioned has been a distorted contractility of the uterus caused by fibrosis, which can influence in the vascularisation of the endometrium. Study design, size, duration We retrospectively studied the uterine contractility and 3D vascularisation parameters in women who had an embryo transfer at the Instituto Bernabeu of Alicante, between 2018 and 2020 with one recurrent implantation failure (at least two good quality blastocysts transferred from egg donation treatment). Participants/materials, setting, methods Patients with large myomas (more than 4 cm), adenomyosis or polyp were excluded. In total, 196 patients were assessed on the day of embryo transfer which 12 patients had a previous caesarean section. Uterine contractility was analyzed using 4D ultrasound after 6 minutes of video recording. Vascularisation index and vascularisation flow index were assessed after the endometrial volume definition. Main results and the role of chance Baseline characteristics of both groups were comparable. 3D vascularization parameters were significantly lower in women with a previous caesarean section. Vascularization Index (VI) reached 0,8% in caesarean section group (CS group) versus 2,3% (p = 0,038) and vascularization flow index (VFI) was 0,2 in CS group versus 0,8 (p = 0,038) Despite uterine peristalsis showed less contractility in those patients with previous caesarean section (0,8 contractions per minute versus 1,1 contractions per minute), non-statistical differences were demonstrated (p = 0,154) Limitations, reasons for caution This study is limited by its retrospective design and the low number of cases. Wider implications of the findings: The lower 3D vascularisation indexes support a post-Caesarean section vascular-related impaired perfusion as a hypothetical mechanism. Its correlation with a possible impairment in the embryo implantation after fertility treatments warrants further studies. Trial registration number Not applicable

O-031 Importance of blood flow to human implantation

Abstract text The success of embryo implantation depends on a plethora of factors, with embryo quality and endometrial receptivity belonging to the most important ones. The receptive phenotype of endometrium develops in reaction to appropriate estrogen stimulation in the proliferative phase and embryo-synchronized maturation warranted by the action of progesterone. Uterine blood supply, myometrial contractions and the activity of local immune cells also belong to important factors affecting the outcome of both natural and assisted reproduction. Endometrial perfusion was shown to be an independent receptivity parameter, showing a direct association with pregnancy outcomes. Historically, the use of Doppler parameters of uterine vessels was studied as a reflection of blood flow to the endometrium. Although some authors showed a correlation between blood flow in uterine arteries and success rates in IVF cycles, it might not reflect the actual endometrial flow as most of the blood volume goes through myometrium, not endometrium. Currently, using available ultrasound tools – 2D/3D Power Doppler with VOCAL (Virtual Organ Computer-Aided Analysis) software enables clinicians to evaluate parameters of endometrial perfusion in a matter of minutes. In this method, ultrasound system can calculate indices reflecting endometrial blood flow - vascularity index (VI), endometrial flow index (FI), and endometrial vascularity flow index (VFI) which are based on the total and relative amounts of Power Doppler signal (corresponding to the blood flow) within the volume of interest. Endometrial blood flow parameters can be altered in implantation limiting conditions such as endometriosis or chronic intrauterine inflammation. It was also shown to be influenced by implantation-related hormones such as oxytocin. Oxytocin receptor antagonists were shown to decrease uterine contractions in non-pregnant uteri of women being prepared for embryo transfer procedure. This class of medications has been extensively studied as potential candidates for medications promoting embryo implantation in IVF-ET treatments. In several studies, it was shown that mixed oxytocin/vasopressin V1A receptor antagonist atosiban, which is currently registered in Europe for the tocolysis in preterm labour, had the potential of improving implantation rates. Interestingly, this effect was confirmed also in women without pronounced contractions. Additionally, it has been demonstrated that oxytocin antagonism enhances endometrial decidualization and influences other parameters necessary for the acquisition of the endometrial receptivity phenotype. Considering that atosiban and other oxytocin antagonists relax uterine blood vessels and increase endometrial blood flow, it was hypothesized that improvement in endometrial perfusion could be an additional mechanism for observed support of embryo implantation. A similar finding was confirmed in our study on nolasiban – a non-peptide, orally active, oxytocin receptor-specific antagonist. In the 1st phase study on volunteers undergoing estrogen/progesterone endometrial preparation reflecting the synchronization for embryo transfer, it was confirmed that application of nolasiban decreased uterine contractions and improved FI and VFI parameters of endometrial perfusion. Such an effect lasted for more than 24 hours after dosing. The study results suggested that oxytocin antagonism could have an effect on endometrial perfusion, and its potential clinical significance requires further investigation. In a longer perspective, once confirmed it would mean that, apart from the possibility of observation of endometrial blood flow, we could have a tool for improving it, which would hopefully lead to improved outcomes of assisted reproduction treatments.

Ultrasound markers informative of efficient non-pharmacological correction of hypofibrinolysis at preconception period in patients with recurrent pregnancy loss

Aim. To find reliable ultrasound markers of efficient non-pharmacological correction of hypofibrinolysis at preconception period in patients with recurrent pregnancy loss.Materials and Methods. We conducted a single-center, prospective, non-randomized study in patients with recurrent pregnancy loss and hypofibrinolysis (n = 120), who received intermittent pneumatic compression during preconception care. During the pregnancy, we performed a comprehensive 3D ultrasound examination of the endometrium and corpus luteum in the VOCAL mode. Then, we compared patients with (n = 97) and without (n = 23) favorable outcome. Predictive power of the ultrasound parameters was evaluated by a calculation of the area under the receiver operating characteristic (ROC) curve (AUC) and ROC curve comparison.Results. Vascularization flow index of endometrial perfusion (AUC = 0.566) and corpus luteum (AUC = 0.639) was identified as a potential marker of efficient intermittent pneumatic compression at preconception period.Conclusions. Adequate perfusion of endometrium and corpus luteum, reflected by vascularization flow index, may indirectly indicate successful trophoblast invasion and minimize the risk of recurrent pregnancy loss.

Evaluation of the sublingual microcirculation with sidestream dark field video microscopy in horses anesthetized for an elective procedure or intestinal surgery.

To compare the sublingual microcirculation between healthy horses anesthetized for elective procedures and horses with colic anesthetized for abdominal surgery and to determine the effect of mean arterial blood pressure (MAP) on the microcirculation. 9 horses in the elective group and 8 horses in the colic group. Sublingual microcirculation was assessed with sidestream dark field video microscopy. Videos were captured at 3 time points during anesthesia. Recorded microvasculature parameters were De Backer score (DBS), total density of perfused vessels (PVD) and small vessels (PVD-S), total proportion of perfused vessels (PPV) and small vessels (PPV-S), vascular flow index (MFI), and heterogeneity index (HI). Blood pressure during hypotensive (MAP < 60 mm Hg) and normotensive (MAP ≥ 60 mm Hg) episodes was also recorded. During normotensive episodes, the elective group had significantly better PPV and PPV-S versus the colic group (median PPV, 76% vs 50%; median PPV-S, 73% vs 51%). In both groups, PPV decreased during anesthesia (elective group, -29%; colic group, -16%) but significantly improved in the elective group 15 minutes before the end of anesthesia (59%). During hypotensive episodes, PVD-S was better preserved in the colic group (11.1 vs 3.8 mm/mm2). No differences were identified for the microcirculatory parameters between normo- and hypotensive episodes in the colic group. Sublingual microcirculation was better preserved in healthy horses anesthetized for elective procedures than in horses with colic anesthetized for abdominal surgery despite resuscitation maneuvers. Results indicated that the macrocirculation and microcirculation in critically ill horses may be independent.

Investigation Into the Predictive Potential of Three-Dimensional Ultrasonographic Placental Volume and Vascular Indices in Gestational Diabetes Mellitus.

BackgroundThe use of ultrasonography in pregnancies complicated with gestational diabetes mellitus (GDM) can vary according to clinical practice. This study aims to compare the changes of placental volume (PV) and vascular indices measured by three-dimensional (3D) Power Doppler between pregnant women with and without GDM.Materials and MethodsThis was a prospective study of singleton pregnancies who took the early nuchal translucency examination from January 2018 to September 2019. Data on PV and vascular indices including vascularization index (VI), flow index (FI), and vascularization flow index (VFI) between pregnant women with and without GDM were measured by 3D Power Doppler ultrasound machine. Univariate and multivariate logistic regression determined the association between risk factors and GDM. Receiver operating characteristic (ROC) and area under the ROC curve (AUC) were applied to evaluate the diagnostic value of different parameters for GDM.ResultsOf the 141 pregnant women enrolled, 35 developed GDM and 106 did not. The maternal age and gravida in the GDM group were significantly higher than that in the non-GDM group. The PV, VI, FI, and VFI in the GDM group were significantly lower than that in the non-GDM group. There were no significant differences in other clinical parameters between the two groups. After adjustments in multivariate logistic regression analysis, significant differences were observed in VI [odds ratio (OR) = 0.98, 95% confidence interval (CI) = 0.951–1.002], FI (OR = 0.93, 955 CI: 0.86–1.00), and VFI (OR = 0.67, 95% CI = 0.52–0.87). ROC analysis indicated that the combination of maternal age, gravida, PV, and VFI was more accurate as a marker for detecting GDM than the PV, VI, FI, or VFI alone.ConclusionsThe 3D ultrasonography results suggest that PV and vascular indices (VI, FI, and VFI) during the first trimester may serve as potential markers for GDM diagnosis. The combination of maternal age, gravida, and sonographic markers may have good diagnostic values for GDM, which should be confirmed by further investigations.

Diagnostic value of endometrial volume and flow parameters under 3D ultrasound acquisition in combination with serum CA125 in endometrial lesions

ObjectiveThis study aims to discuss the differential diagnosis value of endometrial volume and flow parameters in combination with serum carbohydrate antigen 125 (CA125) in endometrial benign and malignant lesions. Materials and methodsThe data of 250 patients with endometrial lesions were retrospectively analyzed. Carbohydrate antigen 125 (CA125) was determined before the operation. The morphology, hemodynamics, volume and flow parameters of the endometrium were measured by transvaginal three-dimensional-power Doppler angiography (3D-PDA). The endometrial volume (EV), 3D-PDA vascular index (VI), flow index (FI) and vascularization flow index (VFI) were calculated using the virtual organ computer-aided analysis software (VOCAL). ResultsAccording to the pathological results, 202 patients (80.8%) had benign endometrial lesions and 48 patients (19.2%) had endometrial cancer (EC). The endometrium of EC patients was thicker (15.64 ± 7.26 mm vs. 9.24 ± 5.06 mm, P < 0.001), the endometrial volume was larger (9.23 ± 4.08 ml vs. 2.26 ± 3.42 ml, P < 0.001), and the flow parameters VI, FI and VFI were higher, when compared to those of benign lesions (P < 0.001). The area under the receiver operating characteristic curve (AUROCC) of VI receptors was 0.86, while the AUC of endometrial thickness (ET) was only 0.66. Therefore, the best variable for distinguishing benign and malignant endometrial lesions was VI. The level of CA125 in the EC group significantly increased (40.57 ± 17.45 vs. 17.87 ± 7.64, P < 0.001), and the level of CA125 increased (P < 0.05) with the increase in clinical grade, degree of tumor differentiation, and pelvic lymph node metastasis (P < 0.05). However, the difference in myometrial invasion was not statistically significant (P > 0.05). ConclusionTransvaginal 3D-PDA can clearly show the morphological and hemodynamic characteristics of endometrial lesions, and assist in the detection of EC in combination with serum CA125. This may have important clinical application value.

Combination of three-dimensional placental vascular indices and volume and uterine artery pulsatility index at 10-13 weeks of gestation could improve the prediction of adverse pregnancy outcomes.

To evaluate whether three-dimensional (3D) placental vascular indices and volumes during the first trimester of pregnancy can be used as predictors of subsequent adverse outcomes. This was a prospective cohort study including women with singleton pregnancies between 10 and 13 weeks. 3D placental volume and vascular indices and uterine artery pulsatility index (UtA-PI) were measured. Adverse outcomes were defined whether there was any of the following complications: small for gestational age pregnancy, preterm delivery, and preeclampsia. The serum pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (β-hCG) levels were also compared. We analyzed the screening performances of these parameters for prediction of any of adverse outcomes. Of 348 women screened, 300 women were completed follow-up. Overall, 57 (19.0%) of 300 women developed any of adverse pregnancy outcomes. Multiple logistic regression analysis demonstrated that gestational age-adjusted z-scores of log10 placental volume (odds ratio [OR], 0.572; 95% confidence interval [CI], 0.416-0.788), log10 placental vascularization flow index (VFI; OR, 0.676; 95% CI, 0.496-0.921), and log10 UtA-PI (OR, 1.910; 95% CI, 1.335-2.731) were significantly associated adverse pregnancy outcomes. The multivariate model combining placental VFI, placental volume, UtA-PI, and underweight or obese body mass index exhibited the highest screening performances (AUC=0.77) and PAPP-A and β-hCG did not add any significance to multivariate model. Placental volume and vascular indices at 10-13 weeks of gestation are significantly associated with adverse pregnancy outcomes. Combination of these placental indices and UtA-PI could improve the screening performance for adverse outcomes.

Role of first-trimester three-dimensional (3D) power Doppler of placental blood flow and 3D placental volume in early prediction of pre-eclampsia.

To assess the efficacy of first-trimester three-dimensional (3D) placental volume as well as 3D power Doppler of placental vascular indices for early prediction of pre-eclampsia. The prospective cohort study included over 2019 women with a singleton pregnancy in their first trimester at 11-13+ weeks of pregnancy. All women were examined by 3D abdominal ultrasound, including Doppler techniques for the placental volume and placental vascular indices. Uterine artery Doppler indices were also assessed. All participants were cared for until delivery for assessment of pregnancy outcomes. In all, 163 women developed pre-eclampsia while 1856 women remained normotensive. The women with pre-eclampsia had significantly lower placental volume (77.09ml vs. 99.8ml, p<0.001), and placental vascular indices (vascularization index, flow index, and vascularization flow index were 7.41 vs. 9.89, 39.03 vs. 46.63, and 2.77 vs. 4.4, respectively, p<0.001). In contrast, women with pre-eclampsia had significantly high mean uterine pulsatility index and resistance index (2.02 vs. 1.11, 0.83 vs. 0.64, respectively, p<0.001) compared with the normotensive women. The placental vascular indices were highly sensitive, whereas the placental volume and the mean uterine pulsatility index and resistance index had higher specificity for the prediction of pre-eclampsia. First-trimester assessment through 3D placental volume and power Doppler of placental vascular indices, especially in combination with uterine artery Doppler assessment, revealed an increase in the accuracy of early detection of women at risk for developing pre-eclampsia.

Resistance Training Does Not Decrease Placental Blood Flow During Valsalva Maneuver: A Novel Use of 3D Doppler Power Flow Ultrasonography.

The Valsalva maneuver may increase maternal blood pressure and intra-abdominal pressure, resulting in decreased blood flow to the fetus during resistance training. There is no significant reduction in placental blood flow in pregnancy during resistance training in recreational athletes, as documented by a 3-dimensional power flow Doppler ultrasonography. Cohort. Level 3. A cohort of healthy women who participated in recreational athletics was enrolled in a prospective study to assess placental blood flow during a resistance exercise. A 1 repetition maximum (1RM, up to 50 lb) was determined through a modified chest press as a marker of heavy resistance training. Three-dimensional volume measurements and power Doppler flow were determined at the rest phase and during the 1RM lift phase. The vascular flow index (VFI) was calculated to determine placental perfusion during each phase. A total of 22 women participated. The mean age of participants was 31 years. Gestational age ranged from 13 to 28 weeks. Average 1RM weight lifted was 30 lb. Four women (18%) were able to lift 50 lb, the maximum weight that the study allowed. The remaining 18 women (82%) lifted their true 1RM. Mean VFI during lift phase was 2.185 compared with 2.071 at rest (P = 0.03). There was a slight mean increase in VFI during lift phase, 0.114 (95% CI 0.009-0.182) from 2.071 to 2.185 with lifting (P = 0.03). The 15 women who participated in structured exercise had a mean VFI at rest and during the lift phase of 2.031 and 2.203, respectively (P = 0.01). Three-dimensional power flow Doppler imaging can guide resistance training during pregnancy to prevent fetal injury due to hypoperfusion. Resistance training up to an RM1 of 50 lb did not result in a significant reduction of placental blood flow from resting state in the study population. This technique may be used to guide training parameters among pregnant athletes.

Letrozole Versus Clomiphene Citrate and Natural Cycle: Endometrial Receptivity During Implantation Window in Women With Polycystic Ovary Syndrome.

ObjectiveNumerous studies have reported on ovulation and pregnancy rates in patients with polycystic ovary syndrome (PCOS). However, relevant data on endometrial receptivity are limited. This study was conducted to compare endometrial receptivity during implantation windows among letrozole (LE), clomiphene citrate (CC), and natural cycle, and to assess the predictive value for pregnancy of observed indicators.MethodsThis randomized controlled trial study enrolled 270 patients with PCOS. Patients were given LE (n=90) at a dose of 2.5mg/day or CC (n=90) at a dose of 50 mg/day on cycle days 5–9 for ovulation induction. Patients in the natural cycle group (n=90) did not receive any drug for ovulation induction. Endometrial ultrasonic parameters, integrin αvβ3, and vascular endothelial growth factor (VEGF) concentrations in uterine secretion were detected during the implantation window. The endometrial receptivity, ovulation rate, pregnancy rates, and predictive value of observed indicators for pregnancy were analyzed.ResultsThe successful ovulation rate did not differ between the LE group and CC group (P>0.05). Endometrial ultrasonic parameters [endometrial thickness (ET), endometrial volume (EV), vascularization index (VI), flow index (FI), vascularization flow index (VFI)], integrin αvβ3, and VEGF concentrations in uterine fluid were significantly higher in the LE group compared with the CC group and natural cycle group (P<0.05). The clinical pregnancy and ongoing pregnancy rates of the LE group were significantly higher than in the CC group (P<0.05). Endometrial ultrasonic parameters (VI, FI, and VFI), integrin αvβ3, and VEGF concentrations in uterine fluid of all pregnancy groups were significantly higher compared with the no pregnancy group (P<0.05), and the above parameters in ongoing pregnancy were significantly higher than in biochemical pregnancy (P<0.05). The endometrial FI during the implantation window had the highest predictive value for pregnancy (AUC=0.889). The integrin αvβ3 in uterine fluid had better predictive value (AUC=0.876) than VEGF.ConclusionsEndometrial receptivity during the implantation window of LE is superior to CC in PCOS women, which may be related to higher clinical pregnancy and ongoing pregnancy rates. Endometrial FI examined by 3-D power Doppler, and integrin αvβ3 in uterine secretion during the implantation window, could be preferable non-invasive predictor markers for pregnancy.Clinical Trial Registration www.chictr.org.cn, ChiCTR1900023423.

Detecting the accuracy of three dimensional power Doppler (3DPD) vascular indices for prenatal diagnosis of morbidly adherent placenta in patients with placenta previa

Objective: The study`s objective was to assess the accuracy of prenatal 3-dimensional power Doppler analysis of vascular and flow placental indices to predict the morbidly adherent placenta objectively.Background: Traditionally, 2D ultrasound have been used for the diagnosis of a suspected morbidly adherent placenta previa. Recently ,3D power Doppler technique was introduced to diagnose morbidly adherent placenta (MAP).Study Design: A prospective study executed among women with placenta previa between 28 and 32 weeks of gestation. Patients were examined by 2D ultrasounds which was used in management decisions. 3D Power Doppler vascular, flow and vascular flow indices were measured during the same examination after tracing of maximum placental thickness; data were blinded to obstetricians. Histopathology was used to confirm MAP. Severe morbidly adherent placenta was described as increta/percreta on histopathology, blood loss >2L, and >2 units of PRBC transfused. Sensitivities, specificities, predictive values, and likelihood ratios were calculated.Results: Our results showed that the 3D Doppler VI ≥ 16 predicted MAP with a 100% sensitivity ,100% specificity which are better than those of 2D ultrasound (60.0% and 89.1% respectively).Sever MAP occurred in 51.2% of MAP and 3D Doppler of VI > 33.1 predicted sever MAP with a sensitivity of 73.9% and specificity of 86.4%, which was superior to 2D ultrasound.Conclusion: In placenta previa patients, the vascular index accurately predicts the morbidly adherent placenta. Furthermore, vascular and vascular flow indices of 3D power Doppler were more predictive of severe cases of morbidly adherent placenta compared to 2D ultrasound.

Doppler ultrasound for prediction of IUCD-induced heavy menstrual bleeding: a prospective cohort study

BackgroundPrevious studies reported changes in the local vasoactive substance production within the endometrium with a subsequent increase in vascularity as a possible mechanism of intrauterine contraceptive device (IUCD)-induced heavy menstrual bleeding. This research investigates the role of power Doppler velocimetries of the uterine arteries, endometrium, and sub-endometrium vascularization as a predictor of IUCD-induced heavy menstrual bleeding.ResultsEndometrium flow index (FI) and vascularization flow index (VFI) significantly increased in both groups: women with heavy menstrual bleeding (group A) and women without heavy menstrual bleeding (group B), with significantly higher increase in group A. Endometrium VFI ≥ 0.18 had the highest significant diagnostic characteristics in the prediction of heavy menstrual bleeding, followed by sub-endometrium VI ≥ 3.75.ConclusionThe results of this study suggest an increase in uterine blood flow in women with IUCD-induced menorrhagia. Endometrial and sub-endometrial Doppler vascular indices can be used for the prediction of IUCD-induced heavy menstrual bleeding.

Microcirculation alterations in severe COVID-19 pneumonia.

PurposeTo assess the presence of sublingual microcirculatory and skin perfusion alterations in COVID-19 pneumonia.Materials and methodsThis is a preliminary report of a prospective observational study performed in four teaching intensive care units. We studied 27 mechanically ventilated patients with acute respiratory distress syndrome secondary to COVID-19. Sublingual microcirculation was assessed by hand-held videomicroscopy. A software-assisted analysis of videos was performed. We also measured capillary refill time.ResultsPatients were hemodynamically stable with normal lactate (1.8 [1.6–2.5] mmol/L) and high D-dimer (1.30 [0.58–2.93] μg/mL). Capillary refill time was prolonged (3.5 [3.0–5.0] s). Compared to previously reported normal values, total and perfused vascular density (21.9 ± 3.9 and 21.0 ± 3.5 mm/mm2) and heterogeneity flow index (0.91 ± 0.24) were high; and the proportion of perfused vessels (0.96 ± 0.03), microvascular flow index (2.79 ± 0.10), and red blood cell velocity (1124 ± 161 μm/s) were reduced. The proportion of perfused vessels was inversely correlated with total vascular density (Pearson r = −0.41, P = 0.03).ConclusionsCOVID-19 patients showed an altered tissue perfusion. Sublingual microcirculation was characterized by decreases in the proportion of perfused vessel and flow velocity along with high vascular densities. This last finding might be related to enhanced angiogenesis or hypoxia-induced capillary recruitment.

First trimester screening for pre-eclampsia and intrauterine growth restriction using three-dimensional Doppler angiography (SPIRIT): protocol for a multicentre prospective study in nulliparous pregnant women

IntroductionPre-eclampsia (PE) and intrauterine growth restriction (IUGR) are two major pregnancy complications, related to chronic uteroplacental hypoperfusion. Nowadays, there is no screening or diagnostic test for uteroplacental vascularisation deficiency in...