Estimation of forming uteroplacental blood flow in patients with threatened miscarriage in the presence of progesterone deficiency in the first trimester of pregnancy

The aim of the study was to assess the architectonics of the venous bed of the fetus part of placenta from women with the exacerbation of cytomegalovirus (CMV) infection in the first trimester of pregnancy. There were examined 75 patients after the term birth, among them there were 25 seropositive women with the exacerbation of CMV infection in the first trimester of pregnancy without clinical signs of threatened miscarriage; 23 seropositive women with the exacerbation of CMV infection in the first trimester of pregnancy and clinical signs of threatened miscarriage; 27 seronegative women without threatened miscarriage. The architectonics of the venous bed of the fetus part was studied with the pressing of contrast (red lead oxide in the linseed oil) through the umbilical vein into the vessels and placenta cotyledons. The roentgen shots were done at the device RUM-20 M “Sapphire”. During the research of the venous bed of the fetus part of placenta from women with the exacerbation of CMV infection and threatened miscarriage in the first trimester of pregnancy there was identified a velamentous attachment of the umbilical cord with the segmentary narrowing and venous varices as well as with the decrease of the outer diameter of veins of preconfluent zone of the fetus part of the organ. There is an increase in the number of asymmetrically located biconfluent venous vessels, the quantity of marginally located and blindly finishing curved vessels of veins and venous roots, which does not provide the effective blood flow and leads to the ischemia of the peripheral (edge) part of placenta. This reduces the delivery of oxygen and metabolites to the fetus, is accompanied with the development of plethora, stasis, thrombosis and inflammation in veins and arteries, as well as the increase of the risk of partial non-progressive separation of normally placed placenta and its partial intimate attachment to the uterus.

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Suppression of trophoblast uterine spiral artery remodeling by estrogen during baboon pregnancy: impact on uterine and fetal blood flow dynamics

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00590.2011 ◽

2012 ◽

Vol 302 (10) ◽

pp. H1936-H1944 ◽

Cited By ~ 18

Author(s):

Graham W. Aberdeen ◽

Thomas W. Bonagura ◽

Chris R. Harman ◽

Gerald J. Pepe ◽

Eugene D. Albrecht

Keyword(s):

Blood Flow ◽

Uterine Artery ◽

Umbilical Artery ◽

First Trimester ◽

Flow Dynamics ◽

Spiral Artery ◽

Uteroplacental Blood Flow ◽

Blood Flow Dynamics ◽

Artery Remodeling ◽

The Impact

The present study was conducted to determine the impact of suppressing trophoblast remodeling of the uterine spiral arteries by prematurely elevating estrogen levels in the first trimester of baboon pregnancy on uterine and umbilical blood flow dynamics. Uteroplacental blood flow was assessed by Doppler ultrasonography after acute administration of saline (basal state) and serotonin on days 60, 100, and 160 of gestation (term: 184 days) to baboons in which uterine spiral artery remodeling had been suppressed by the administration of estradiol on days 25–59 of gestation. Maternal blood pressure in the basal state was increased ( P < 0.01), and uterine artery diastolic notching and the umbilical artery pulsatility index and systolic-to-diastolic ratio, reflecting downstream flow impedance, were increased ( P < 0.01) after serotonin administration on day 160, but not earlier, in baboons treated with estradiol in early gestation. These changes in uteroplacental flow dynamics in serotonin-infused, estradiol-treated animals were accompanied by a decrease ( P < 0.05) in uterine and umbilical artery volume flow and fetal bradycardia. The results of this study show that suppression of uterine artery remodeling by advancing the rise in estrogen from the second trimester to the first trimester disrupted uteroplacental blood flow dynamics and fetal homeostasis after vasochallenge late in primate pregnancy.

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NICE guideline “Ectopic pregnancy and miscarriage”: new changes and importance for the clinicist

Reproductive Endocrinology ◽

10.18370/2309-4117.2021.62.48-52 ◽

2021 ◽

pp. 48-52

Author(s):

- -

Keyword(s):

Ectopic Pregnancy ◽

Clinical Guidelines ◽

Vaginal Bleeding ◽

Recurrent Miscarriage ◽

First Trimester ◽

Current Data ◽

Nice Guideline ◽

Threatened Miscarriage ◽

Patients At Risk ◽

First Trimester Of Pregnancy

The purpose of this publication is to summarize the current data on the effectiveness of progestogens in patients with threatened miscarriage (vaginal bleeding in the first trimester of pregnancy) and to review the updated UK National Institute for Health and Care Excel (NICE) clinical guidelines on ectopic pregnancy and miscarriage.In accordance with the opinion of the Cochrane Society experts and the updated NICE clinical guidelines for 2021, vaginal progesterone at a dose of 800 mg/day is the only intervention that has been shown to be effective in increasing live births compared to placebo for women with one or more previous miscarriages and early vaginal bleeding (relative risk 1.08, 95% confidence interval 1.02–1.15, high certainty evidence). Upon confirmation of fetal heartbeat, this treatment should be extended until 16 weeks of gestation.There is still uncertainty over the effectiveness and safety of alternative progestogen treatments (as dydrogesterone) for threatened and recurrent miscarriage. There is also no evidence of benefit of any other preparations or doses of progesterone in patients at risk of miscarriage.

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P–397 Threatened Miscarriage and increase in Perinatal Morbidity

Human Reproduction ◽

10.1093/humrep/deab130.396 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

R Pillai ◽

D Tincello ◽

N Potdar

Keyword(s):

Early Pregnancy ◽

First Trimester ◽

Low Risk ◽

P Value ◽

Control Cohort ◽

Neonatal Asphyxia ◽

Threatened Miscarriage ◽

First Trimester Of Pregnancy ◽

Asymptomatic Control ◽

In Pregnancy

Abstract Study question Are women presenting with bleeding in the first trimester of pregnancy at a higher risk for perinatal complications later in pregnancy? Summary answer Women presenting with bleeding in the first trimester of pregnancy are more likely to experience perinatal and neonatal morbidity in pregnancy. What is known already Observational studies and a previously reported systematic review showed that women who experienced threatened miscarriage are more likely to have still birth, intra uterine growth restriction (IUGR), low birth weight, pre-eclampsia, placental abruption, placenta previa, preterm labour, preterm prelabour rupture of membrane, neonatal asphyxia and congenital anomalies in pregnancy. However, the evidence has been inconclusive and currently the women who experience threatened miscarriage receive low risk care. Study design, size, duration This was a prospective cohort study conducted on 298 women with threatened miscarriage (Cohort A) and 107 asymptomatic women (Cohort B). The women were recruited over a period of 18 months and were followed up for 9 months until delivery. Participants/materials, setting, methods Cohort A were women who presented with bleeding in the early pregnancy assessment unit and had a confirmed heartbeat on ultrasound scan between 6 weeks and 11 + 6 weeks of pregnancy and cohort B were women who were asymptomatic and booked with the community midwives as low risk. Both groups of women were followed up prospectively until delivery and data were collected on any perinatal outcomes and complications for both mother and the neonate. Main results and the role of chance The analysis showed that women who had bleeding in early pregnancy were more likely to have preterm delivery (RR 95% CI; 2.98 (1.07 – 8.27)); IUGR (unable to calculate the RR, as none of the women who continued their pregnancies beyond 24 weeks of gestation, developed IUGR in the asymptomatic control cohort. Nonetheless, IUGR occurred more frequently in the threatened miscarriage cohort than the asymptomatic cohort (P-value 0.02)); LBW (RR 95% CI; 6.14 (1.49 – 25.19), neonatal asphyxia (unable to calculate the RR, as none of the babies who were born to women in the asymptomatic control cohort develop neonatal asphyxia. Nonetheless, neonatal asphyxia occurred more frequently in the threatened miscarriage cohort than the asymptomatic cohort (P-value 0.02)). Preterm prelabour rupture of membrane was not significant with a P-value of 0.07. Limitations, reasons for caution The major limitation of this study was lower sample size and hence due to the rarity of many of the perinatal and neonatal outcomes, we were unable to calculate the relative risk. Wider implications of the findings: Current study agrees with the existing literature and reaffirms the association of perinatal and neonatal morbidities with threatened miscarriage and this group of women need to be managed as high-risk group antenatally. Trial registration number Not applicable

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First-trimester NRBC Count in Maternal Circulation: Correlation with Doppler Ultrasound Studies

Journal of Histochemistry & Cytochemistry ◽

10.1369/jhc.4a6411.2005 ◽

2005 ◽

Vol 53 (3) ◽

pp. 315-317

Author(s):

Ariadni Mavrou ◽

Aggeliki Kolialexi ◽

Athena Souka ◽

Athanasios Pilalis ◽

Yannis Kavalakis ◽

...

Keyword(s):

Blood Flow ◽

High Resistance ◽

First Trimester ◽

Maternal Circulation ◽

Arterial Perfusion ◽

Uterine Arteries ◽

Nucleated Red Blood Cells ◽

High Impedance ◽

First Trimester Of Pregnancy ◽

Doppler Indices

This study aimed to determine whether the number of nucleated red blood cells (NRBCs) in maternal circulation during the first trimester of pregnancy could identify pregnancies that will have an anomalous Doppler in the second trimester. A total of 85 blood samples were obtained at 11–14 weeks of gestation with mean uterine arterial perfusion index >1.6, as noted by Doppler ultrasonography. NRBCs were enriched by magnetic automated cell sorting using anti-CD71 and were stained with May/Grunwald/Giemsa. A total of 4.8 NRBCs (range 1–75) were identified in 68 cases. Follow-up scans at 22–24 weeks were available in 46 cases. In 39 women, blood flow in the uterine arteries normalized, whereas in seven, high resistance was noted. One woman in the high-resistance group developed preeclampsia (PET; four NRBCs) and another delivered an intrauterine growth restriction (IUGR) baby (75 NRBCs). The number of NRBCs in women whose Doppler indices later normalized and in those who continued to have increased impedance was similar. The study indicates that NRBC number in maternal circulation during the first trimester cannot be used to screen pregnancies at high risk for developing preeclampsia (PET)/IUGR. High-impedance blood flow in the uterine arteries in the first trimester may be due to an unfinished process of trophoblastic invasion, most likely to be completed successfully by 22–24 weeks.

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Diagnostic role of uterine artery dopplerometry in the first trimester of pregnancy

Journal of obstetrics and women s diseases ◽

10.17816/jowd95621 ◽

2021 ◽

Vol 50 (4) ◽

pp. 25-28

Author(s):

V. I. Orlov ◽

A. V. Orlov ◽

T. A. Zamanskaya ◽

T. V. Podolskaya

Keyword(s):

Blood Flow ◽

First Trimester ◽

Uterine Blood Flow ◽

Sonographic Examination ◽

New Approach ◽

Uterine Arteries ◽

Diagnostic Role ◽

Threatened Abortion ◽

First Trimester Of Pregnancy

A Doppler sonographic examination of blood flow in the left and right uterine arteries was carried out in women in the first trimester of pregnancy. Systolic- diastolic ratio (S/D) andpulsative index (PI) were assessed in 71 women with physiological course of pregnancy and in 49 women with threatened abortion. The investigation revealed clear connection of the uterine blood flow lateralization and corpus luteum localization. These interrelations are characterized differently in case of physiological pregnancy and threatened abortion. The new approach to the evaluation of uterine blood flow gives an ability ofpreclinical diagnostics of threatened abortion.

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