Understanding the uterine artery Doppler waveform and its relationship to spiral artery remodelling

Lloyd-Davies, Claire; Collins, Sally; Burton, Graham J.

doi:10.1016/j.placenta.2021.01.004

Cited by 16 publications

(14 citation statements)

References 46 publications

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“…Spiral artery transformation failure in PE could lead to an increase in uterine artery blood flow resistance [ 13 ], which could be captured as an abnormality, such as by the presence of an impedance on the uterine artery Doppler. These changes support the uterine artery Doppler velocimetry-based screening of patients who are at risk of developing PE [ 14 ]. Furthermore, some studies have shown that uterine artery PI is a promising marker for predicting PE [ 15 , 16 ].…”

Section: Introductionsupporting

confidence: 57%

Combination of Maternal Serum ESM-1 and PLGF with Uterine Artery Doppler PI for Predicting Preeclampsia

Xie

Chen

Yang

et al. 2023

JCM

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Objective: This study aimed to determine whether the combination of pregnancy-associated endothelial cell-specific molecule 1 (ESM-1), the placental growth factor (PLGF) in the first- and second-trimester maternal serum, and the uterine artery Doppler pulsatility index (PI) in the second trimester can predict preeclampsia (PE). Methods: The serum levels of ESM-1 and PLGF in 33 severe preeclampsia (SPE) patients, 18 mild preeclampsia patients (MPE), and 60 age-matched normal controls (CON) were measured. The Doppler ultrasonography was performed, and the artery pulsatility index (PI) was calculated for the same subjects. Results: The 2nd PLGF level was significantly lower and the 2nd PI was higher than those in the MPE group. Combining the 2nd PLGF with the 2nd PI yielded an AUC of 0.819 (83.33% sensitivity and 70.00% specificity). In the SPE group, the 1st ESM-1 level and the 2nd PLGF level were significantly lower, and the 2nd ESM-1 level and the 2nd PI were significantly higher in the SPE group. The combination of the 1st ESM-1, the 2nd PLGF, and the 2nd PI yielded an AUC of 0.912 (72.73% sensitivity and 95.00% specificity). Conclusions: The 1st ESM-1 and the 2nd PLGF levels and the 2nd PI were associated with PE. The combination of serum biomarkers and the PI improved the screening efficiency of the PE prediction, especially for SPE.

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Section: Introductionsupporting

confidence: 57%

Combination of Maternal Serum ESM-1 and PLGF with Uterine Artery Doppler PI for Predicting Preeclampsia

Xie

Chen

Yang

et al. 2023

JCM

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“…Theoretically, (partial) failure of the spiral arteries, which anatomically are downstream of the uterine artery, to adapt to pregnancy, causes its abnormal Doppler profile 16 . However, recent studies have suggested that the other uterine vessels, including arcuate arteries, placental bed arterio‐venous anastomoses and radial arteries, play a more significant role in uterine artery Doppler ultrasound than previously thought 17 . It has been hypothesized that, in turn, DV lesions impact uteroplacental blood flow, and subsequently uterine artery Dopplers 16 .…”

Section: Discussionmentioning

confidence: 99%

“… 16 However, recent studies have suggested that the other uterine vessels, including arcuate arteries, placental bed arterio‐venous anastomoses and radial arteries, play a more significant role in uterine artery Doppler ultrasound than previously thought. 17 It has been hypothesized that, in turn, DV lesions impact uteroplacental blood flow, and subsequently uterine artery Dopplers. 16 To our knowledge, we are the first to investigate the association of Doppler profile and placental ultrasound parameters with DV in a diverse clinical group.…”

Section: Discussionmentioning

confidence: 99%

The association between decidual vasculopathy and abnormal uterine artery Doppler measurement

Stevens

Schiffer

Teixeira

et al. 2022

Acta Obstet Gynecol Scand

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Introduction: Placental syndrome is an umbrella term encompassing the clinical phenotypes of preeclampsia and fetal growth restriction, and is associated with high maternal and neonatal morbidity. In women with placental syndrome, histologicl examination of the uteroplacental unit commonly demonstrates pathological lesions, such as decidual vasculopathy. Decidual vasculopathy are pathological changes in

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“…In contrast to these findings, one study found no association between uterine artery pulsatility index and acute atherosis ( 217 ). The reasons for these discrepant findings may be that the spiral arteries are not visualized directly by Doppler studies, but rather indirectly by studying the blood flow of the larger uterine arteries ( 214 , 216 – 218 ). Uterine and spiral arteries differ much in structure, size and function.…”

Section: Clinical Translationmentioning

confidence: 99%

“…Uterine and spiral arteries differ much in structure, size and function. Uterine artery ultrasonography has historically been viewed as a reflection of spiral artery remodeling ( 219 ), but recent studies indicate that the radial arteries, as well as the maternal vascular system, may have a larger impact on uterine artery waveforms than the spiral arteries ( 218 ). Doppler ultrasonography is hence unlikely a reliable tool for diagnosing uteroplacental acute atherosis.…”

Section: Clinical Translationmentioning

confidence: 99%

Acute Atherosis Lesions at the Fetal-Maternal Border: Current Knowledge and Implications for Maternal Cardiovascular Health

et al. 2021

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Decidua basalis, the endometrium of pregnancy, is an important interface between maternal and fetal tissues, made up of both maternal and fetal cells. Acute atherosis is a uteroplacental spiral artery lesion. These patchy arterial wall lesions containing foam cells are predominantly found in the decidua basalis, at the tips of the maternal arteries, where they feed into the placental intervillous space. Acute atherosis is prevalent in preeclampsia and other obstetric syndromes such as fetal growth restriction. Causal factors and effects of acute atherosis remain uncertain. This is in part because decidua basalis is challenging to sample systematically and in large amounts following delivery. We summarize our decidua basalis vacuum suction method, which facilitates tissue-based studies of acute atherosis. We also describe our evidence-based research definition of acute atherosis. Here, we comprehensively review the existing literature on acute atherosis, its underlying mechanisms and possible short- and long-term effects. We propose that multiple pathways leading to decidual vascular inflammation may promote acute atherosis formation, with or without poor spiral artery remodeling and/or preeclampsia. These include maternal alloreactivity, ischemia-reperfusion injury, preexisting systemic inflammation, and microbial infection. The concept of acute atherosis as an inflammatory lesion is not novel. The lesions themselves have an inflammatory phenotype and resemble other arterial lesions of more extensively studied etiology. We discuss findings of concurrently dysregulated proteins involved in immune regulation and cardiovascular function in women with acute atherosis. We also propose a novel hypothesis linking cellular fetal microchimerism, which is prevalent in women with preeclampsia, with acute atherosis in pregnancy and future cardiovascular and neurovascular disease. Finally, women with a history of preeclampsia have an increased risk of premature cardiovascular disease. We review whether presence of acute atherosis may identify women at especially high risk for premature cardiovascular disease.

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Understanding the uterine artery Doppler waveform and its relationship to spiral artery remodelling

Cited by 16 publications

References 46 publications

Combination of Maternal Serum ESM-1 and PLGF with Uterine Artery Doppler PI for Predicting Preeclampsia

Combination of Maternal Serum ESM-1 and PLGF with Uterine Artery Doppler PI for Predicting Preeclampsia

The association between decidual vasculopathy and abnormal uterine artery Doppler measurement

Acute Atherosis Lesions at the Fetal-Maternal Border: Current Knowledge and Implications for Maternal Cardiovascular Health

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