Longitudinal study of Doppler flow resistance indices of the uterine arteries after normal vaginal delivery

Mulic‐Lutvica, Ajlana; Eurenius, Karin; Axelssön, Ove

doi:10.1080/00016340701621569

Cited by 26 publications

(35 citation statements)

References 27 publications

(60 reference statements)

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“…According to our findings, 48 in early puerperium the means of Doppler flow resistance indices are higher than those reported in late pregnancy. Thereafter, they do not change markedly until day 28 postpartum.…”

Section: Doppler Ultrasound During Normal Puerperiumcontrasting

confidence: 51%

“…43,44 How fast these physiological changes return to the nonpregnant state is a controversial issue. [45][46][47][48] Tekay and Jouppila 14 assessed the peripheral vascular resistance of the uterine arteries in 42 postpartum women and found that the pulsatility index (PI) increased significantly in early puerperium compared to pregnancy, remained unchanged during the next 6 weeks and then gradually started to increase again. However, nonpregnant values were not reached even three months after delivery.…”

Section: Doppler Ultrasound During Normal Puerperiummentioning

confidence: 99%

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Postpartum Ultrasound

Mulic‐Lutvica¹

2012

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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This article describes uterine and uterine cavity changes throughout the normal and pathological puerperium, as revealed by various ultrasound modalities. A gray scale ultrasound, color and pulsed Doppler ultrasound and 3D ultrasound were used. It is based on results of several prospective longitudinal studies, which were designed so that every woman was examined at six occasions during the puerperium, namely on postpartum days 1, 3, 7, 14, 28 and 56. The first four examinations were performed transabdominally and the last two transvaginally. The same design was used in all studies. The involution process of the uterus was assessed by measuring the anteroposterior diameter of the uterus and uterine cavity. Morphological findings were recorded. The influence on the involution process of parity, breastfeeding, maternal smoking and infant's birth weight were also evaluated. Besides conventional ultrasound, Doppler technology was used to study hemodynamic events occurring during the normal puerperium. The pulsatility (PI) and resistance (RI) indices in the uterine arteries were measured, and the presence or absence of early diastolic notches was recorded. A hypervascular area in myometrium was assessed by color and power Doppler. Normal involution process was also described by means of 3D ultrasound. The volume of the uterus and uterine cavity after normal vaginal delivery were measured using virtual organ computer-aided analysis (VOCAL) using six adjacent planes and a 30° rotation method. Reference values from uncomplicated puerperium were used when pathological conditions were studied.Results from these studies, which shed light on normal and pathological changes during the puerperium, are summarized in this chapter.

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Section: Doppler Ultrasound During Normal Puerperiumcontrasting

confidence: 51%

Section: Doppler Ultrasound During Normal Puerperiummentioning

confidence: 99%

Postpartum Ultrasound

Mulic‐Lutvica¹

2012

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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“…8 In Figure 2 it can be appreciated that the PI pattern was triphasic in cases 2 and 3, similar to the findings published by Mulic-Lutvica and colleagues in the follow up of the PI in normal spontaneous vaginal deliveries without placenta accreta or retained placenta. 10 Our findings likely represent a separation and interruption of the uteroplacental circulation. In the first case, which ended in profuse bleeding with the attempted removal of the placenta, the PI did not follow the pattern of the other two cases and remained low, probably indicating persistence of the uteroplacental circulation, regardless of the <5 IU/L of b-HCG.…”

Section: Discussionmentioning

confidence: 85%

Utility of the pulsatility index of the uterine arteries and human chorionic gonadotropin in a series of cases of placenta accreta

Dueñas-García¹,

Diaz‐Sotomayor²,

Rico-Olvera³

2011

J of Obstet and Gynaecol

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The conservative management of retained placenta accreta has been proposed as an alternative option in selected cases. Three patients under conservative management of placenta accreta were followed using the pulsatility index of the uterine arteries and the β fraction of human chorionic gonadotropin to determine the degree of vascularity between the uterus and the placenta. In this series of cases of conservative management of placenta accreta, the pulsatility index of the uterine arteries showed a better correlation with the uteroplacental circulation than serum β fraction of human chorionic gonadotropin.

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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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Longitudinal study of Doppler flow resistance indices of the uterine arteries after normal vaginal delivery

Cited by 26 publications

References 27 publications

Postpartum Ultrasound

Postpartum Ultrasound

Utility of the pulsatility index of the uterine arteries and human chorionic gonadotropin in a series of cases of placenta accreta

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

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