Association of Uterine Artery Doppler Resistance Index and Birth Weight: Effect of Customized Birth Weight Standards

Background: Pre-eclampsia affects 2-5% of pregnancies and is a major cause of perinatal and maternal morbidity and mortality. Doppler is a non-invasive method for evaluation of feto-placental circulation without affecting pregnancy. A high resistance index in uterine artery Doppler waveform has been shown to be the best non-invasive screening test. Thus, we have conducted this study to find out the predictive value of transvaginal uterine artery doppler in early pregnancy for the prediction of pre-eclampsia. The aim of the study was early prediction of pre-eclampsia by trans-vaginal uterine artery Doppler study at 12-16 weeks.Methods: According to the study criteria 100 antenatal women between 12 to 16 weeks of singleton pregnancy attending out patient in the Department of OBG of S. D. M. Medical College Dharwad were included. After an informed consent, the women underwent ultrasound for dating and subsequently trans-vaginal ultrasound along with color doppler was performed to obtain uterine artery indices. These women were again rescanned at 24-26 weeks of gestation trans-abdominally and further followed up clinically for development of preeclampsia.Results: Out of 100 women, 22 patients developed preeclampsia. At 12-16 weeks 35% of women had bilateral uterine artery notching, mean RI was 0.57 and PI was 0.89. When uterine artery notch at 12-16 weeks alone was considered, 34.28% of women developed preeclampsia. Detection rate increased to 85.71% when RI>0.65 was also included along with notching. Uterine artery notching at 12-16 weeks gestation had 34.29% sensitivity, 84.62% specificity, 70.51% NPV. When notch and RI>0.65 considered together sensitivity and NPV increases to 85.71% to 98.25%.Conclusions: The uterine artery Doppler waveform indices at 12-16 weeks are the best non-invasive screening test available for early prediction of preeclampsia.

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Role of uterine artery doppler at 18-22 weeks in the prediction of pre-eclampsia: a prospective study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20204300 ◽

2020 ◽

Vol 9 (10) ◽

pp. 4130

Author(s):

Lakshmi Manjeera M. ◽

Patricia Malini Pereira

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Pulsatility Index ◽

Uterine Artery ◽

Resistance Index ◽

Early Screening ◽

Predictive Values ◽

Uterine Artery Doppler ◽

Doppler Study

Background: Pre-eclampsia is the most common pregnancy complication associated with serious maternal and fetal morbidity. Uterine artery Doppler reflects the impaired trophoblastic invasion of the uterine spiral arteries, which is involved in the aetiology of preeclampsia. Thus, uterine artery Doppler was proposed as a screening test for pre-eclampsia.Methods: A prospective cohort study of 100 singleton pregnancies was conducted in a tertiary centre and the study population were subjected to uterine artery Doppler study at 18-22 weeks gestation. Uterine artery Doppler indices of pulsatility index (PI), resistance index (RI) and persistence of diastolic notch was obtained and the outcome of pre-eclampsia was studied.Results: Out of 100 women, 14 women developed pre-eclampsia in which the resistance index showed a sensitivity of 21.4%, specificity of 91.8%, positive predictive value of 30% and negative predictive value of 87.7% and pulsatility index showed sensitivity of 35.7%, specificity of 90.6%, positive predictive value of 38.4% and negative predictive value of 89.6%. Diastolic notch had a sensitivity of 35.7%, specificity of 98.8%, positive predictive value of 83.3% and a negative predictive value of 90.4%.Conclusions: The high negative predictive values, indicated that women with normal Doppler velocimetry were unlikely to develop preeclampsia. Uterine artery Doppler, being non-invasive can be included during routine sonography to identify patients at risk of developing pre-eclampsia. Early, screening for pre-eclampsia will help in individualized antenatal surveillance and initiation of prophylactic therapy, early to reduce the adverse maternal and foetal complications of preeclampsia.

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Does Pentaerytrithyltetranitrate reduce fetal growth restriction in pregnancies complicated by uterine mal-perfusion? Study protocol of the PETN-study: a randomized controlled multicenter-trial

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2456-7 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

T. Groten ◽

◽

T. Lehmann ◽

E. Schleußner

Keyword(s):

Birth Weight ◽

Fetal Growth ◽

Fetal Growth Restriction ◽

Uterine Artery ◽

Therapeutic Option ◽

Multicenter Trial ◽

Growth Restriction ◽

Organic Nitrate ◽

Phosphodiesterase Type 5 Inhibitors ◽

Uterine Artery Doppler

Abstract Background Affecting approximately 10% of pregnancies, fetal growth restriction (FGR), is the most important cause of perinatal mortality and morbidity. Impaired placental function and consequent mal-perfusion of the placenta is the leading cause of FGR. Although, screening for placental insufficiency based on uterine artery Doppler measurement is well established, there is no treatment option for pregnancies threatened by FGR. The organic nitrate pentaerithrityl tetranitrate (PETN) is widely used for the treatment of cardiovascular disease and has been shown to have protective effects on human endothelial cells. In a randomized placebo controlled pilot-study our group could demonstrate a risk reduction of 39% for the development of FGR, and FGR or death, by administering PETN to patients with impaired uterine artery Doppler at mid gestation. To confirm these results a prospective randomized placebo controlled double-blinded multicentre trial was now initiated. Method The trial has been initiated in 14 centres in Germany. Inclusion criteria are abnormal uterine artery Doppler, defined by mean PI > 1.6, at 190 to 226 weeks of gestation in singleton pregnancies. Included patients will be monitored in 4-week intervals. Primary outcome measures are development of FGR (birth weight < 10th percentile), severe FGR (birth weight < 3rd centile) and perinatal death. Placental abruption, birth weight below the 3rd, 5th and 10th centile, development of FGR requiring delivery before 34 weeks` gestation, neonatal intensive care unit admission, and spontaneous preterm delivery < 34 weeks` and 37 weeks` gestation will be assessed as secondary endpoints. Patient enrolment was started in August 2017. Results are expected in 2020. Discussion During the past decade therapeutic agents with possible perfusion optimizing potential have been evaluated in clinical trials to treat FGR. Meta-analysis and sub-analysis of trials targeting preeclampsia revealed ASS to have a potential in reducing FGR. Phosphodiesterase-type-5 inhibitors have recently been tested in a worldwide RCT for therapy of established FGR, failing to show an effect on neonatal outcome. The ongoing multicenter trial will, by confirming our previous results, finally provide a therapeutic option in cases at risk for FGR. Trial registration DRKS00011374 registered at September 29th, 2017 and NCT03669185, registered September 13th, 2018.

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The Relationship between Serum Ischemia-Modified Albumin Levels and Uterine Artery Doppler Parameters in Patients with Primary Dysmenorrhea

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0040-1715141 ◽

2020 ◽

Vol 42 (10) ◽

pp. 630-633

Author(s):

Ertugrul Sen ◽

Ozhan Ozdemir ◽

Seyda Ozdemir ◽

Cemal Resat Atalay

Keyword(s):

Blood Flow ◽

Luteal Phase ◽

Uterine Artery ◽

Resistance Index ◽

Primary Dysmenorrhea ◽

Menstrual Phase ◽

Uterine Artery Doppler ◽

Ischemia Modified Albumin ◽

Doppler Indices ◽

The Relationship

Abstract Objective Primary dysmenorrhea occurs due to abnormal levels of prostanoids, uterine contractions, and uterine blood flow. However, the reasons for pain in primary dysmenorrhea have not yet been clarified. We examined the blood flow alterations in patients with primary dysmenorrhea and determined the relationship between ischemia-modified albumin (IMA) levels, as an ischemia indicator, and primary dysmenorrhea. Methods In the present study, 37 patients who had primary dysmenorrhea and were in their luteal and menstrual phase of their menstrual cycles were included. Thirty individuals who had similar demographic characteristics, who were between 18 and 30 years old and did not have gynecologic disease were included as control individuals. Their uterine artery Doppler indices and serum IMA levels were measured. Results Menstrual phase plasma IMA levels were significantly higher than luteal phase IMA levels, both in the patient and in the control groups (p < 0.001). Although the menstrual phase IMA levels of patients were significantly higher than those of controls, luteal phase IMA levels were not significantly different between the two groups. Menstrual uterine artery pulsatility index (PI) and resistance index (RI) of primary dysmenorrhea patients were significantly different when compared with luteal uterine artery PI and RI levels. There was a positive correlation between menstrual phase IMA and uterine artery PI and RI in the primary dysmenorrhea. Conclusion Ischemia plays an important role in the etiology of the pain, which is frequently observed in patients with primary dysmenorrhea. Ischemia-modified albumin levels are considered as an efficient marker to determine the severity of pain and to indicate ischemia in primary dysmenorrhea.

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Uterine artery Doppler, birth weight and timing of onset of pre-eclampsia: providing insights into the dual etiology of late-onset pre-eclampsia

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.13310 ◽

2014 ◽

Vol 44 (3) ◽

pp. 293-298 ◽

Cited By ~ 58

Author(s):

S. Verlohren ◽

K. Melchiorre ◽

A. Khalil ◽

B. Thilaganathan

Keyword(s):

Birth Weight ◽

Uterine Artery ◽

Late Onset ◽

Uterine Artery Doppler ◽

Timing Of Onset

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Uterine artery Doppler wave form indices in the second trimester: Resistance index, notch measurement and placental position

Journal of Obstetrics and Gynaecology ◽

10.3109/01443619409027836 ◽

1994 ◽

Vol 14 (4) ◽

pp. 237-243

Author(s):

Claudia Ferrier ◽

Robyn A. North ◽

G. Becker ◽

Diane Long ◽

Juliene Hallo ◽

...

Keyword(s):

Uterine Artery ◽

Resistance Index ◽

Wave Form ◽

Second Trimester ◽

Uterine Artery Doppler

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Maternal pregnancy associated plasma protein-A (PAPP-A) and uterine artery Doppler changes as predictors of pre-eclampsia: a prospective observational study from a teaching hospital in Mysore, Karnataka, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190977 ◽

2019 ◽

Vol 8 (4) ◽

pp. 1317

Author(s):

Sharanya Satish ◽

K. B. Suma ◽

Madhu B. ◽

Sujatha M. S.

Keyword(s):

At Risk ◽

Pregnant Women ◽

Uterine Artery ◽

Protein A ◽

Resistance Index ◽

Doppler Imaging ◽

Hypertensive Disorder ◽

Serum Samples ◽

Uterine Artery Doppler ◽

Low Serum

Background: Hypertensive disorder affects 10-12% of pregnancies. Identifying women, who are at risk is conducive to prompt gestational management. PAPP-A is a protein complex produced by the developing trophoblasts. Low levels of PAPP-A at 10–14 weeks is a marker of impaired placentation and a smaller placental mass. Doppler imaging permits non-invasive evaluation of the uteroplacental circulation and is invaluable in the management of high-risk pregnancies. The uterine artery Doppler screening identifies patients at risk for developing preeclampsia. To study the association of PAPP-A and the uterine artery Doppler changes as predictor of pre-eclampsia in pregnant women at 11-14 weeks of gestation.Methods: This was a prospective study of 150 pregnant women presenting at 11-14 weeks of gestation for a prenatal check-up. After considering the inclusion and exclusion criteria, serum samples for PAPP-A were assayed. Ultrasound Doppler was used to obtain uterine artery flow velocity waveforms and mean pulsatility index and resistance index of uterine arteries were calculated. Cases were followed up till term and observed for development of pre-eclampsia.Results: 48.6% had low serum PAPP-A levels, in which 77% developed PE. The Mean PI and RI is 2.34±1.16 and 0.58±0.1 respectively. 30% women with abnormal PI values and 24% of women with abnormal RI values developed PE.Conclusions: The combination of maternal history with low serum PAPP-A levels and abnormal uterine artery Doppler at 11-14 weeks can be used as predictor of pre-eclampsia.

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Evaluation of the Relationship Between Placental Thickness and Obstetric Doppler Parameters During the Second Trimester

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2019.1016 ◽

2019 ◽

pp. 1

Author(s):

Emine Aydin ◽

Ayca Nazli Bulut

Keyword(s):

Uterine Artery ◽

Umbilical Artery ◽

Resistance Index ◽

Second Trimester ◽

Uterine Artery Doppler ◽

Diastolic Velocity ◽

Single Operator ◽

Umbilical Artery Doppler ◽

Doppler Evaluation ◽

Placental Thickness

OBJECTIVE: To determine whether there is a relationship between placental thickness and the umbilical artery and uterine artery Doppler evaluation in the second trimester. STUDY DESIGN: The placental thickness and the umbilical artery and uterine artery Doppler evaluations were recorded by a single operator for patients who were admitted for an obstetric follow-up or fetal anatomy screening at 18-28 gestational weeks. The relation between these variables was investigated by evaluating the patients only once.RESULTS: In our study, the mean placental thickness was 31.7 (SD±8.01) mm. The umbilical artery Doppler parameters did not correlate with the placental thickness. The uterine artery Doppler systolic/diastolic velocity, Pulsatility index and Resistance index values positively correlated with the placental thickness. However, these correlations were not statistically significant. CONCLUSIONS: Although there was no relationship between the placental thickness and obstetric Doppler parameters in this study, we suggest that they are likely important factors and their significance should be evaluated in future studies

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