Prospective Evaluation of Uterine Artery Flow Velocity Waveforms at 12–14 and 22–24 Weeks of Gestation in Relation to Pregnancy Outcome and Birth Weight

Abstract

Objective: Uterine artery flow velocity was prospectively assessed using Doppler ultrasound at 12–14 and 22–24 weeks of gestation in the prediction of subsequent complications related to uteroplacental insufficiency: preeclampsia, pregnancy-induced hypertension, fetal growth restriction, fetal death and placental abruption, and to elucidate its relationship with birth weight. Methods: Uterine artery Doppler assessment was obtained during routine ultrasound screening in 263 unselected women. Flow velocity waveforms were coded according to the number of notches present at each scanning, respectively: none (0, 0), uni-/bilateral notches that disappeared (1, 0) or (2, 0), uni-/bilateral notches that persisted unilaterally (1, 1) or (2, 1), and persistent bilateral notches (2, 2). Results: Complete outcome data was obtained for 243 (92.4%) women. Of these women, 55 (22.6%) and 84 (34.6%) women had uni- and bilateral notches, respectively, at 12–14 weeks’ gestation; 14 (5.8%) and 21 (8.6%) patients had uni- and bilateral notches, respectively, at 22–24 weeks’ gestation. Analysis of complication rates for the four groups showed that they increased with notch persistence (5.7, 13.5, 57.1 and 76.2%), while the corresponding mean birth weight declined (3,273, 3,180, 2,698 and 2,418 g). Conclusion: The absence or early disappearance of uterine artery notches is associated with fewer complications related to uteroplacental insufficiency and normal birth weight, whereas their late and partial disappearance or bilateral persistence tends to compromise the prognosis.

Effects of maternal nutrient restriction followed by realimentation during midgestation on uterine blood flow in beef cows

“…In addition, both resistance indices decreased. Research using Doppler technology to assess changes during pregnancy in women suggests that to have better placentation and a greater birth weight, uterine artery resistance needs to decrease early for better fetal and maternal health [22,23]. For example, in human pregnancies, when uterine artery resistance remains high or does not decrease during the last third of gestation, there is an association with deficiency in nutrient supply.…”

Early treatment with low-dose aspirin is effective for the prevention of preeclampsia and related complications in high-risk patients selected by the analysis of their historic risk factors

“…7 Thus, the baseline risk of preeclampsia or intrauterine growth retardation should be estimated and low-dose aspirin started early on the presence of significant historic risk factors, such as previous severe preeclampsia or moderate to severe renal insufficiency. 8 A 2-stage Doppler artery screening in first and second trimester could also define a high-risk population, 9 and promising results have been published for aspirin prevention with first-trimester uterine artery Doppler selection in high-risk pregnancies. Response:…”

Colour Doppler study of uterine artery between 10-14 weeks of gestation as a predictor of intra-uterine growth restriction and preeclampsia

“…Martinez et al, Carbillon et al, Melchiorre K et al found that compared with the normal pregnancies, complicated pregnancies had significantly higher persistence of a bilateral notch. 22,23 The presence of bilateral notches in the first-trimester uterine artery waveform was a relatively poor predictor of pre-eclampsia because of the high prevalence of this finding in normal pregnancies concluding that early bilateral notching alone is unlikely to be useful in screening for pregnancy complications.…”