Uterine and spiral artery flow velocity waveforms in pregnancy‐induced hypertension and/or intrauterine growth retardation

Abstract

The objectives of this study were to characterize spiral artery flow velocity waveforms in normal pregnancies and pregnancies complicated by pregnancy-induced hypertension and/or intrauterine growth retardation, and to examine the diagnostic potential for predicting adverse perinatal outcomes in complicated pregnancies compared with uterine and umbilical artery flow velocity waveforms. In this cross-sectional study, 160 normal and 43 complicated pregnancies were assessed by color and pulsed Doppler during 18-41 weeks of gestation. Flow velocity waveforms were obtained from the spiral, uterine and fetal umbilical arteries. In normal pregnancies, the resistance index of spiral artery flow velocity waveforms decreased significantly with advancing gestation (r = -0.256, p < 0.001). In abnormal pregnancies complicated by pregnancy-induced hypertension and/or intrauterine growth retardation, the incidence of adverse perinatal outcome was significantly higher in patients with abnormal spiral artery resistance indices than in patients with normal spiral artery resistance indices (p < 0.001). An abnormal spiral artery resistance index had a better diagnostic accuracy for adverse perinatal outcome (sensitivity 85.0%, specificity 91.3%, positive predictive value 89.5%, negative predictive value 87.5%, accuracy 88.4%) when compared with the resistance index of uterine and umbilical artery waveforms and presence of a diastolic notch of the uterine artery waveform. Color flow imaging facilitates the precise analysis of spiral artery flow velocity waveforms and provides more accurate information about the uteroplacental circulation in the evaluation of placental function.

Reference range for uterine artery Doppler pulsatility index using transvaginal ultrasound at 20–24w6d of gestation in a low-risk Brazilian population

“…The same findings (1.14-0.95) have been confirmed by Ferreira et al (8) and by our results. Furthermore, our study also confirms previous reports (6,(25)(26)(27) indicating that the mean UtA Doppler PI has a significant and progressive decline with advancing GA. Takahashi The means UtA PI of our study were similar to these studies performed in different ethnic population. Although our study assessed the UtA Doppler by transvaginal route, we believe that our results may be generalized for other ethnic populations.…”

Internal iliac and uterine arteries Doppler ultrasound in the assessment of normotensive and chronic hypertensive pregnant women

“…With the purpose to investigate the uteroplacental circulation1935, emphasis has been put on the study of uterine arteries in the course of the normal pregnancy or its association with the risk for placentation disorders20. There is a general agreement that a progressive decline in uterine artery vascular resistance accompanies the normal pregnancy56781213141618.…”

“…They show that along the normal course of the pregnancy, there is a regular decrement of PI, indicating that the uterine arteries conversion from resistance vessels (narrow bore) to high capacity vessels (larger bore), is most important to meet the increased demands of blood by the growing foetus81134. In contrast, the observation of high resistance patterns in the uterine arteries of pregnant women was associated with local reduction of blood supply, higher incidence of preeclampsia578, intrauterine growth retardation111935 and more unfavourable perinatal outcomes1135.…”

“…In fact, abnormal uterine artery blood flow employing Doppler ultrasound assessment, at both the first and second trimesters, was shown to associate with subsequent perinatal complications1718192021 and some studies even referred the analysis of Doppler wave variations as a means to assess the potential benefits of therapeutic interventions20212223.…”

Longitudinal Doppler sonographic measurements of vascular impedance in the central and peripheral spiral arteries throughout pregnancy

“…Furthermore, except for the series of Matijevic et al, 1 most investigators either measured only the central-placental portion of the spiral artery 4,5 or did not specify where in the placenta the measurement was made. [6][7][8] In this series, we measured spiral artery impedance periodically throughout pregnancy; we also comCorrespondence to: C.-C. Chang pared impedance measured at the placental center and at the periphery.…”