A longitudinal Doppler ultrasonographic assessment of the alterations in peripheral vascular resistance of uterine arteries and ultrasonographic findings of the involuting uterus during the puerperium

Tekay, Aydin; Jouppila, Pentti

doi:10.1016/s0002-9378(12)90913-8

Cited by 34 publications

(56 citation statements)

References 13 publications

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“…By prospectively studying SS patients from the third trimester through 6 weeks postpartum, we observed changes in uterine blood flow during this transition using noninvasive Doppler velocimetry. Our results are consistent with patterns previously reported using Doppler examination for the noninvasive study of physiologic and pathologic changes in the uterus and fetoplacental units in humans without SS disease [10][11][12]. In all of our patients, we observed progressively increased S/D ratios in the postpartum period and a return of the prediastolic notch by the 3rd postpartum week.…”

Section: Discussionsupporting

confidence: 92%

“…Specifically, the S/D ratios increased progressively and significantly from a mean of 2.34 B 0.56 in the third trimester to postpartum values of 2.72 B 0.72 at 24 h, 5.68 B 0.84 at 3 weeks and finally 6.88 + 0.96 at 6 weeks. These values are higher than those reported from studies in patients without SS disease [10,12].…”

Section: Discussioncontrasting

confidence: 69%

“…The reappearance of the diastolic notch could reflect the reversal of alterations in the spiral arteries induced by trophoblastic invasion during pregnancy. However, in a previous study, Tekay and Jouppila [12] showed that the diastolic notch reappeared less than 2 days postpartum, making it unlikely that this is the only explanation. Subinvolution of the placental bed during the postpartum period is characterized by partial occlusion of uteroplacental arteries including thrombosis and could result in the increased uterine S/D ratios.…”

Section: Discussionmentioning

confidence: 90%

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Postpartum Uterine-Artery Velocity Waveforms in Women with Sickle Cell Disease

Anyaegbunam

García²,

Mikhail³

1998

Gynecol Obstet Invest

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Objective: To investigate the changes in uterine Doppler velocimetry during the postpartum period in women with homozygous sickle cell (SS) disease and to correlate these findings with values in the third trimester and with neonatal outcomes. Methods: We studied the postpartum changes in uterine Doppler velocimetry in 16 women with SS disease in relation to third-trimester systolic/diastolic (S/D) ratios and neonatal outcome. All patients had repeated measures of uterine S/D ratios biweekly in the third trimester from 28 weeks of pregnancy until delivery, and at 24 h, and 3 and 6 weeks postpartum. Results: Overall the mean S/D ratio in the first 24 h for these 16 women was 2.72 ± 0.72 and increased progressively to a mean S/D ratio of 6.88 ± 0.96 at 6 weeks postpartum, with the reappearance of a diastolic notch by the 3rd postpartum week. Twelve women who had normal (≤2.6) uterine S/D ratios during pregnancy delivered appropriate-for-gestational-age (AGA) infants. The remaining 4 women had abnormal uterine S/D ratios, and in 3 of these pregnancies, small-for-gestational-age (SGA) infants were delivered. The mean S/D ratios for the subgroups with abnormal value at each of the three postpartum periods were significantly higher than for the 12 SS patients with normal third-trimester values. Postpartum S/D ratios for the 3 women with SGA births were also significantly higher at 24 h and 6 weeks postpartum when compared to SS patients with AGA infants. Conclusion: We concluded that postpartum S/D ratios are higher in women with SS disease that have abnormal values in the third trimester and that they are associated with SGA births. In SS patients the nonpregnant pattern of uterine artery velocity waveforms which reappears postpartum may reflect an increase in the uteroplacental circulatory impedence due to reversal of the alterations in the spiral arteries induced by trophoblastic invasion during pregnancy or subinvolution of the placental bed. Additional studies are needed to further elucidate these important hemodynamic changes in women with hemoglobinopathies and to identify patterns predictive of neonatal outcomes in these high-risk patients.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 69%

Section: Discussionmentioning

confidence: 90%

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Postpartum Uterine-Artery Velocity Waveforms in Women with Sickle Cell Disease

Anyaegbunam

García²,

Mikhail³

1998

Gynecol Obstet Invest

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“…A more extended period of follow-up would be needed, considering that it would take more than several weeks for uterine artery indices to return to the non-pregnant state, as shown in studies on the postpartum uterine artery Doppler of normal pregnancies [1924263839]. We believe this kind of information would enhance our understanding on vascular changes during postpartum in hypertensive women.…”

Section: Discussionmentioning

confidence: 95%

“…There have been several reports on the postpartum changes of uterine artery Doppler in normal pregnancies [1920212223242526]. In most of these studies, uterine artery indices such as the resistance and pulsatility indices increased during the postpartum period [192022232426], although some could not find significant changes during the postpartum period [2125]. However, there is a paucity of information regarding the postpartum uterine artery Doppler in hypertensive pregnancies.…”

Section: Introductionmentioning

confidence: 99%

Uterine artery pulsatility index in hypertensive pregnancies: When does the index normalize in the puerperium?

et al. 2016

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ObjectiveTo investigate whether the uterine artery pulsatility index (UtA PI) of hypertensive pregnancies is higher than that of normal pregnancies in the puerperium, as well as in the antepartum period.MethodsThe UtA PI was measured in hypertensive (group 1) and normal pregnancies (group 2) during antepartum, immediate postpartum or late postpartum periods. Using the transvaginal approach, the bilateral uterine artery indices were measured.ResultsOne hundred twenty-two women were enrolled: group 1, hypertensive disease in pregnancy (11 cases in antepartum, 13 cases in immediate postpartum and 10 cases in late postpartum period); group 2, normal pregnancies (32 cases in antepartum, 29 cases in immediate postpartum and 27 cases in late postpartum). In antepartum and immediate postpartum periods, the mean UtA PI and the proportion of cases with an early diastolic notch were higher in group 1 than in group 2 (antepartum mean UtA PI, 1.14 in group 1 vs. 0.68 in group 2, P<0.001; early diastolic notch, 46% vs. 9%, P<0.05; immediate postpartum mean UtA PI, 1.30 vs. 1.08, P<0.05; early diastolic notch, 85% vs. 48%, P<0.05). In late postpartum period, the mean value of UtA PI of group 1 was still higher than that of group 2, although the proportion of cases with an early diastolic notch was not different (mean UtA PI, 1.43 vs. 1.20, P<0.05; early diastolic notch, 60% vs. 52%, P=0.73).ConclusionThe UtA PI in hypertensive pregnancies was still higher than normal pregnancies in puerperal periods, suggesting that more than several weeks are required to resolve increased uterine artery vascular impedance.

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