POST-PARTUM SUB-CLINICAL ENDOMETRITIS- ALTERATION IN UTERINE HAEMODYNAMICS, INFLAMMATORY MARKERS ON TREATMENT WITH MODIFIED ESTRUS SYNCHRONIZATION PROTOCOLS IN DAIRY COWS

Forty-one dairy cows (n=41) were enrolled to envisage the changes in uterine haemodynamics during sub-clinical endometritis (SCE) and its treatment with modified estrus synchronization protocols at 8 weeks post-partum. Trans-rectal Doppler sonography of both the middle uterine arteries (MUAs) was carried out for assessment of uterine perfusion whereas serum inflammatory markers i.e. IL-6 and C-RP were measured at 8 weeks post-partum and estrus (induced or spontaneous). Modified estrus synchronization protocols (MG6G and MG6GP) were used to adjudge their efficacy in post-partum dairy cows diagnosed with SCE and reproductive parameters were recorded. As a part of result, Doppler indices of both the MUAs at estrus i.e. TAMEAN, TAMAX, Blood flow volume-TAMEAN and TAMAX and diameter of MUA, were significantly lower (P<0.05) after application of MG6G and MG6GP protocols in SCEP as compared to SCEP control cows. Similarly, the IL-6, C-RP concentrations and PMNCs proportion (%) were significantly higher (P<0.05) in SCEP control as compared to cows treated with MG6G and MG6GP protocols. Moreover, on the day of estrus, the uterine haemodynamics, concentration of serum inflammatory markers and PMNCs proportion (%) in treated cows was at par with SCE negative control (SCEN) cows. In terms of reproductive performance, days open were recorded to be significantly lower (P<0.01) in treated and SCEN group as compared to SCEP control cows. In conclusion, sub-clinical endometritis led higher uterine perfusion, release of proinflammatory cytokines and PMNCs proportion which happened to plummet the post-partum reproductive performance was successfully managed with modified estrus synchronization protocols.

Reference ranges Of Uterine Artery Doppler Indices (Pulsatility index and Resistivity index) in pregnant women of Eastern part of Uttar Pradesh INDIA

ObjectivePreeclampsia and eclampsia are one of major cause of maternal mortality. Various parameters like pulsatility index (PI) and resistivity index (RI) of color Doppler are helpful in detection of preeclampsia and intrauterine growth restriction. The reference ranges of the various parameters like uterine artery PI and RI are mainly from western countries. The reference range for Indian Population is lacking. So the objective of the study is to construct reference range of uterine artery for women from eastern India.Material and MethodIn this study, total 201 pregnant patients were included. Color Doppler of normal pregnant women was done at 18 to 22 weeks and then followed up at 28 to 32 weeks gestation. The uterine artery PI and RI was measured during pregnancy. The obtained data were tabulated and 5th, 25th, 50th, 75th, 90th and 95th percentile was calculated. The reference range was constructed according to gestational age starting from 18 to 22 weeks and then from 28 to 34 weeks. Statistical analysis was performed using SPSS.ResultThe main parameter observed are pulsatility and resistivity index of left and right uterine arteries first at 18 to 22 weeks and then followed up at 28 to 34 weeks. Our data suggests that as the gestational age increases both pulsatility and resistivity index decreases. The cut off value for reference range was taken up to 95th percentile. Anything above 95th percentile is abnormal. The reference range for left uterine artery pulsatility index was found to be 1.19 to 1.16 at 18 to 22 weeks, 1.09 at 28 weeks while 0.89 at 34 weeks. Similarly, the reference range for resistivity index was found to be 0.61 at 18 to 22 weeks while it decreases to 0.54 at 28 to 34 weeks.ConclusionReference range of uterine artery doppler indices for the local population is very useful tool to early prediction of Preeclampsia and IUGRs of that population and can aid in timely treatment of mother and baby. Our data shows decrease in pulsatility and resistivity index with increase in the gestational age.

Role of uterine artery Doppler indices for predicting intrauterine pathology inconclusive on 2-dimensional transvaginal imaging among infertile women undergoing frozen embryo transfer cycle

Background: Objective of current study was to correlate uterine artery Doppler parameters with endometrial findings on hysteroscopy and its importance for the prediction of intrauterine pathology inconclusive on 2-dimensional transvaginal imaging prior to frozen embryo transfer.Methods: This was a retrospective study conducted at Medicover fertility center, New Delhi, India. The study population comprised of women with infertility who have undergone hysteroscopy before frozen embryo transfer. Total 70 patients were recruited based on inclusion/exclusion criteria. Intrauterine pathology found in 57.2% (n= 40) patients and 42.8% (n=30) had normal endometrial cavity on hysteroscopy, they were categorized as group 1 and group 2 respectively based on their findings. Both the groups were compared for pre hysteroscopy uterine artery Doppler parameters, resistivity index and pulsatility index. Further clinical pregnancy rate and miscarriage rate were determined in both groups.Results: Both the groups were comparable for age, body mass index, duration, and type of infertility. Mean RI and PI was significantly higher in group 1 as compared to group 2 (0.90±0.025, 2.89±0.291 vs. 0.76±0.043, 1.82±0.27; p value <0.001). The best cut-off value of uterine artery RI was ≥0.87 with sensitivity of 90% (95% CI=0.7634-0.9721), specificity of 100% (95% CI=0.8843-1.0000) and PI was 2.46 with sensitivity of 100% (95% CI=0.9119-1.0000), specificity of 96.7% (95% CI=0.8278-0.9992).Conclusions: Uterine artery Doppler is a non-invasive, cost- effective useful add-on tool for routine endometrial evaluation and can be a good predictor for screening intrauterine pathology and valuable in decision making for pre-IVF hysteroscopy.

Assessment of Asymptomatic Severe Aortic Regurgitation by Doppler-Derived Echo Indices: Comparison with Magnetic Resonance Quantification

Reliable quantification of aortic regurgitation (AR) severity is essential for clinical management. We aimed to compare quantitative and indirect echo-Doppler indices to quantitative cardiac magnetic resonance (CMR) parameters in asymptomatic chronic severe AR. Methods and Results: We evaluated 104 consecutive patients using echocardiography and CMR. A comprehensive 2D, 3D, and Doppler echocardiography was performed. The CMR was used to quantify regurgitation fraction (RF) and volume (RV) using the phase-contrast velocity mapping technique. Concordant grading of AR severity with both techniques was observed in 77 (74%) patients. Correlation between RV and RF as assessed by echocardiography and CMR was relatively good (rs = 0.50 for RV, rs = 0.40 for RF, p < 0.0001). The best correlation between indirect echo-Doppler and CMR parameters was found for diastolic flow reversal (DFR) velocity in descending aorta (rs = 0.62 for RV, rs = 0.50 for RF, p < 0.0001) and 3D vena contracta area (VCA) (rs = 0.48 for RV, rs = 0.38 for RF, p < 0.0001). Using receiver operating characteristic analysis, the largest area under curve (AUC) to predict severe AR by CMR RV was observed for DFR velocity (AUC = 0.79). DFR velocity of 19.5 cm/s provided 78% sensitivity and 80% specificity. The AUC for 3D VCA to predict severe AR by CMR RV was 0.73, with optimal cut-off of 26 mm2 (sensitivity 80% and specificity 66%). Conclusions: Out of the indirect echo-Doppler indices of AR severity, DFR velocity in descending aorta and 3D vena contracta area showed the best correlation with CMR-derived RV and RF in patients with chronic severe AR.

Integrated 2D Doppler indices of uteroplacental and fetal blood flow in diagnosis of intrauterine hypoxia

Relevance . Intrauterine hypoxia associated with placental disorders is a significant factor of ante-, intra- and postnatal fetal and newborn death. Despite clinical examination of pregnant women using ultrasound and cardiotocography, cases of intrauterine hypoxia often remain undetected prenatally. Clinical manifestation of placental disorders and intrauterine hypoxia are associated with pathological changes of blood flow resistance in the uterine, placental and fetal vessels. A combined Doppler assessment of blood flow in the uterine, placental and fetal vessels could improve detection of intrauterine hypoxia. The aim of the study was to assess the prognostic significance of integrated 2D Doppler indices of uteroplacental and fetal blood flow for the detection of fetal hypoxia in the 3rd trimester and to predict unfavorable perinatal outcomes. Materials and Methods. The outcomes of pregnancy of 48 women with fetal hypoxia delivered at 29 - 40 gestational weeks (study group), and 21 women who gave birth to healthy full-term infants (control group) were retrospectively analyzed. On the eve of delivery all women had 2D Doppler assessment of the uterine arteries, umbilical arteries, and fetal middle cerebral artery with an assessment of the cerebro-placental ratio, umbilical-cerebral ratio and cerebro-placental-uterine ratio. Results and Discussion . Analysis of the obtained values of cerebro-placental-uterine ratio, cerebro-placental ratio and umbilical-cerebral ratio showed the benefit from use of integrated 2D Doppler indices in the diagnosis of fetal hypoxia at 29 - 40 gestations weeks and in predicting complications in newborns. The high sensitivity of the cerebro-placental-uterine ratio (90.5%) makes it possible to effectively use this index for the diagnosis of intrauterine hypoxia. Conclusion. Pathological cerebro-placental-uterine ratio 2.44 is a clinically significant 2D Doppler criterion that predicts a high risk of asphyxia, respiratory distress syndrome, hypotrophy, and perinatal hypoxic-ischemic encephalopathy. Lower values of the cerebro-placental ratio and umbilical-cerebral ratio sensitivity (77.1% and 81.3%, respectively) limit their use for the diagnosis of fetal hypoxia as compared with cerebro-placental-uterine ratio.

Gestational week-specific of uterine artery Doppler indices in predicting preeclampsia: a hospital-based retrospective cohort study

Background Plenty of studies explored the relationship between uterine artery (UtA) Doppler indices and the onset of preeclampsia at different trimesters. However, few studies test the gestational week-specific predictive value of the UtA indices for subsequent preeclampsia and compare the difference of right or left UtA indices (e.g., pulsatility or resistance index [PI or RI]). Methods Hospital-based retrospective cohort study of singleton pregnant women who received the Doppler test between 2012 and 2016 was conducted in 2018. The predictive performance of the UtA indices for preeclampsia and its variants, including early-onset preeclampsia (< 34 weeks) and preterm preeclampsia (< 37 weeks), was estimated. Results The UtA indices, with a cutoff value of 1.11 for the right and left UtA-PI, and 0.66 and 0.63 for the right and left UtA-RI, respectively, were effective predictors for subsequent preeclampsia. The prediction was satisfactory at the 9th week of the Doppler scan: areas under the curve ≥ 0.80, the Youden index ranging from 0.54 to 0.58, the sensitivity of 63.2 ~ 73.7%, and the specificity 84.2 ~ 91.3%, respectively. The UtA indices had comparable performance in screening for early-onset and preterm preeclampsia but showed lower predictive value for late-onset cases. Among these indices, the right UtA-RI had the highest specificity (all P < 0.01), while the left UtA-PI showed good authenticity (higher Youden index) in predicting the disorder. Conclusions The second-trimester measured UtA indices had a satisfactory performance at the 9th week in predicting subsequent preeclampsia. The right UtA-RI was the first choice in ruling out preeclampsia, while the left UtA-PI showed the best authenticity of the prediction.

Reference values for fetal Doppler-based cardiocirculatory indices in monochorionic-diamniotic twin pregnancy

Background Placental anastomoses in monochorionic diamniotic (MCDA) twin pregnancy have a major impact on fetal circulation. This study was designed to define reference ranges of cardiac and vascular Doppler indices in MCDA twin pregnancies. Methods This cross-sectional study included 442 uncomplicated MCDA twin fetuses undergoing Doppler ultrasonography at 18–35 weeks of gestation. Left and right myocardial performance index (LV-MPI, RV-MPI), E/A ratio of atrioventricular valves, pulsatility indices of umbilical artery, middle cerebral artery (MCA), and ductus venosus (DV), cerebroplacental ratio, peak systolic velocity of MCA, S/a ratio of DV, and early diastolic filling time of ductus venosus (DV-E) were evaluated under standardized settings. The equation models between Doppler indices and gestational age (GA) were fitted. After adjustment for GA, the correlations between MPI and fetal heart rate (FHR), and between MPI and DV indices were analyzed. Results Estimated centiles of Doppler indices were derived as a function of GA, being distinct in values from those of singletons. There was no correlation between GA-adjusted MPI and FHR. DV-E was inversely related to LV-MPI. Conclusions MCDA twins showed significant changes in some Doppler indices throughout gestation with quantitative differences from singletons, emphasizing the importance of MC twin-specific reference values for clinical application. Further adjustment of MPI for FHR was unnecessary. DV-E is a vascular index indirectly representing fetal diastolic function.