Digital auscultation of the uterine artery: a measure of uteroplacental perfusion

Abstract

This observational study investigated digital auscultation for the purpose of assessing the clinical feasibility of monitoring vascular sounds in pregnancy. The study was performed at the Regional Hospital Viborg, Denmark, and included 29 pregnant women, 10 non-pregnant women and 10 male participants. Digital auscultation was performed with an electronic stethoscope bilaterally near the uterine arteries and correlated to the clinical diagnosis of preeclampsia (PE), intrauterine growth restriction (IUGR) or normal pregnancy in the group of pregnant participants. In the group of non-pregnant participants, digital auscultation was performed as control measurements in the same anatomical positions. The auscultations displayed pulse waveforms comprising systolic and diastolic periods in 20 of the 29 pregnant participants. However, in the non-pregnant and male participants, the pulse waveforms were absent. The pulsatile patterns are thus likely to originate from the arteries in relation to the pregnant uterus. In the participants displaying pulse waveforms, the presence of a dicrotic notch appeared with a sensitivity of 89% and a specificity of 100% in the discrimination of normal pregnancies (n = 11) from pregnancies with PE or IUGR (n = 9), (p < 0.001). This preliminary study shows the potential of identifying vascular complications during pregnancy such as preeclampsia and intrauterine growth restriction. The morphology of the derived pulse contour should be investigated and could be further developed to identify pathophysiology.

Separation and characterization of maternal cardiac and vascular sounds in the third trimester of pregnancy

“…Certainly, the recorded sound could stem from the external iliac artery or the inferior epigastric artery. However, in our initial study, no pulsatile sound patterns could be obtained when microphones were placed in corresponding positions in nonpregnant or male participants.…”

“…). The presence of a dicrotic notch in the pulse contour is associated with an adverse pregnancy outcome such as fetal growth restriction and pre‐eclampsia . Therefore, the presence or absence of dicrotic notches during the 180‐second signals was noted by visual examination of the pulse contours.…”

“…We previously reported that the uteroplacental blood flow elicits a vascular sound that is recordable with an electronic stethoscope on the abdomen, and that can be used to differentiate between normal and pathologic perfusion. Other studies indicate that inadequate uteroplacental blood flow might occur as a result of uneven perfusion because of localized turbulence, rather than as a result of underperfusion.…”

Association between maternal vascular murmur and the small‐for‐gestational‐age fetus with abnormal umbilical artery Doppler flow

“…The maternal vascular murmur (MVM) is a new acoustic marker of disturbed maternal vascular flow that is currently being investigated in the prenatal clinical context. The hypothesis of the present study was that MVM could be used to identify fetuses compromised by placental dysfunction attributable to abnormal spiral artery modification.…”

“…5,6 The ability to distinguish a healthy fetus with a normal or low weight from a compromised fetus is not only critical in the clinical context, but is also important as a source of preclinical information: in the long term, the fetal response to placental dysfunction is associated with comorbidities such as cardiovascular and metabolic diseases. 7,8 The maternal vascular murmur (MVM) is a new acoustic marker of disturbed maternal vascular flow [9][10][11] that is currently being investigated in the prenatal clinical context. The hypothesis of the present study was that MVM could be used to identify fetuses compromised by placental dysfunction attributable to abnormal spiral artery modification.…”