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Sun B, Smith N, Dixon AJ, Osei-Owusu P. Phosphodiesterases Mediate the Augmentation of Myogenic Constriction by Inhibitory G Protein Signaling and is Negatively Modulated by the Dual Action of RGS2 and 5. Function (Oxf) 2024; 5:zqae003. [PMID: 38486977 PMCID: PMC10935470 DOI: 10.1093/function/zqae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 03/17/2024] Open
Abstract
G protein regulation by regulators of G protein signaling (RGS) proteins play a key role in vascular tone maintenance. The loss of Gi/o and Gq/11 regulation by RGS2 and RGS5 in non-pregnant mice is implicated in augmented vascular tone and decreased uterine blood flow (UBF). RGS2 and 5 are closely related and co-expressed in uterine arteries (UA). However, whether and how RGS2 and 5 coordinate their regulatory activities to finetune G protein signaling and regulate vascular tone are unclear. Here, we determined how the integrated activity of RGS2 and 5 modulates vascular tone to promote UBF. Using ultrasonography and pressure myography, we examined uterine hemodynamics and myogenic tone (MT) of UA of wild type (WT), Rgs2-/-, Rgs5-/-, and Rgs2/5 dbKO mice. We found that MT was reduced in Rgs5-/- relative to WT or Rgs2-/- UA. Activating Gi/o with dopamine increased, whereas exogenous cAMP decreased MT in Rgs5-/- UA to levels in WT UA. Dual deletion of Rgs2 and 5 abolished the reduced MT due to the absence of Rgs5 and enhanced dopamine-induced Gi/o effects in Rgs2/5 dbKO UA. Conversely, and as in WT UA, Gi/o inhibition with pertussis toxin or exogenous cAMP decreased MT in Rgs2/5 dbKO to levels in Rgs5-/- UA. Inhibition of phosphodiesterases (PDE) concentration-dependently decreased and normalized MT in all genotypes, and blocked dopamine-induced MT augmentation in Rgs2-/-, Rgs5-/-, and Rgs2/5 dbKO UA. We conclude that Gi/o augments UA MT in the absence of RGS2 by a novel mechanism involving PDE-mediated inhibition of cAMP-dependent vasodilatation..
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Affiliation(s)
- Bo Sun
- Department of Physiology and Biophysics, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Nia Smith
- Department of Physiology and Biophysics, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Alethia J Dixon
- Department of Physiology and Biophysics, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Patrick Osei-Owusu
- Department of Physiology and Biophysics, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
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Allerkamp HH, Leighton S, Pole T, Clark AR, James JL. Synergistic regulation of uterine radial artery adaptation to pregnancy by paracrine and hemodynamic factors. Am J Physiol Heart Circ Physiol 2023; 325:H790-H805. [PMID: 37539447 PMCID: PMC10643003 DOI: 10.1152/ajpheart.00205.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/05/2023]
Abstract
Fetal growth throughout pregnancy relies on delivery of an increasing volume of maternal blood to the placenta. To facilitate this, the uterine vascular network adapts structurally and functionally, resulting in wider blood vessels with decreased flow-mediated reactivity. Impaired remodeling of the rate-limiting uterine radial arteries has been associated with fetal growth restriction. However, the mechanisms underlying normal or pathological radial artery remodeling are poorly understood. Here, we used pressure myography to determine the roles of hemodynamic (resistance, flow rate, shear stress) and paracrine [β-estradiol, progesterone, placental growth factor (PlGF), vascular endothelial growth factor] factors on rat radial artery reactivity. We show that β-estradiol, progesterone, and PlGF attenuate flow-mediated constriction of radial arteries from nonpregnant rats, allowing them to withstand higher flow rates in a similar manner to pregnant vessels. This effect was partly mediated by nitric oxide (NO) production. To better understand how the combination of paracrine factors and shear stress may impact human radial artery remodeling in the first half of gestation, computational models of uterine hemodynamics, incorporating physiological parameters for trophoblast plugging and spiral artery remodeling, were used to predict shear stress in the upstream radial arteries across the first half of pregnancy. Human microvascular endothelial cells subjected to these predicted shear stresses demonstrated higher NO production when paracrine factors were added. This suggests that synergistic effects of paracrine and hemodynamic factors induce uterine vascular remodeling and that alterations in this balance could impair radial artery adaptation, limiting blood flow to the placenta and negatively impacting fetal growth.NEW & NOTEWORTHY Placenta-specific paracrine factors β-estradiol, progesterone, and placental growth factor attenuate flow-mediated constriction of the rate-limiting uterine radial arteries, enabling higher flow rates in pregnancy. These paracrine factors induce their actions in part via nitric oxide mediated mechanisms. A synergistic combination of paracrine factors and shear stress is likely necessary to produce sufficient levels of nitric oxide during early human pregnancy to trigger adequate uterine vascular adaptation.
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Affiliation(s)
- H. H. Allerkamp
- Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - S. Leighton
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - T. Pole
- Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - A. R. Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - J. L. James
- Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Ouidir M, Tekola-Ayele F, Canty T, Grantz KL, Sciscione A, Tong D, Jones RR, Sundaram R, Williams A, Stevens D, Mendola P. Acute ambient air pollution exposure and placental Doppler results in the NICHD fetal growth studies - Singleton cohort. Environ Res 2021; 202:111728. [PMID: 34297937 PMCID: PMC8578287 DOI: 10.1016/j.envres.2021.111728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/21/2021] [Accepted: 07/16/2021] [Indexed: 05/29/2023]
Abstract
BACKGROUND Increased placental vascular resistance is a proposed mechanism by which air pollution exposure during pregnancy lowers birth weight and increases pregnancy-induced hypertensive disorders. OBJECTIVE To examine the impact of acute air pollution exposure during pregnancy on uterine and umbilical artery Doppler indicators of placental vascular resistance. METHODS After a first ultrasound to confirm gestational age, 2562 pregnant women recruited in 12 clinics throughout the United States underwent up to five standardized ultrasounds with Doppler measurements. Exposures to 11 air pollutants were estimated for the hour of ultrasound and each of the 2 h prior to ultrasound at the clinics using the National Air Quality Forecast Capability reanalysis products. We used mixed logistic regression to study the longitudinal odds ratio (OR) of any, uni- or bi-lateral systolic and diastolic uterine artery notching compared to no notching and the longitudinal OR of abnormal end diastolic flow of the umbilical artery compared to forward flow. Uterine and umbilical artery resistance indexes were studied using linear mixed models. RESULTS Each inter-quartile range (IQR) increase of particulate matter < 2.5 μm, nitrate, ammonium, primary organic matter (POM) and nitrogen dioxide during the hour of ultrasound was associated with a decreased risk of unilateral systolic notch and with increased resistance index of the left uterine artery. For the umbilical artery, each IQR increase in ozone was associated with decreased resistance index (b: -0.26, 95 % CI: -0.52, -0.01) and with a decreased risk of abnormal end diastolic flow (OR: 0.36, 95 % CI: 0.14, 0.94); while each IQR increase of elemental carbon and POM was associated with increased risk of abnormal end diastolic flow (OR: 1.47, 95 % CI: 1.02, 2.13 and OR: 1.67, 95 % CI: 1.17, 2.39, respectively). DISCUSSION Our results suggest acute air pollution exposure may influence placental vascular resistance.
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Affiliation(s)
- Marion Ouidir
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Fasil Tekola-Ayele
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Timothy Canty
- Department of Atmospheric and Oceanic Science, University of Maryland, College Park, MD, USA
| | - Katherine L Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Anthony Sciscione
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE, USA
| | - Daniel Tong
- Center for Spatial Science and Systems, George Mason University, Fairfax, VA, USA
| | - Rena R Jones
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Rajeshwari Sundaram
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Andrew Williams
- University of North Dakota, School of Medicine & Health Sciences, Grand Forks, ND, USA
| | - Danielle Stevens
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Pauline Mendola
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA; Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
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Carson J, Warrander L, Johnstone E, van Loon R. Personalising cardiovascular network models in pregnancy: A two-tiered parameter estimation approach. Int J Numer Method Biomed Eng 2021; 37:e3267. [PMID: 31799783 PMCID: PMC9286682 DOI: 10.1002/cnm.3267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/07/2019] [Accepted: 09/07/2019] [Indexed: 05/26/2023]
Abstract
Uterine artery Doppler waveforms are often studied to determine whether a patient is at risk of developing pathologies such as pre-eclampsia. Many uterine waveform indices have been developed, which attempt to relate characteristics of the waveform with the physiological adaptation of the maternal cardiovascular system, and are often suggested to be an indicator of increased placenta resistance and arterial stiffness. Doppler waveforms of four patients, two of whom developed pre-eclampsia, are compared with a comprehensive closed-loop model of pregnancy. The closed-loop model has been previously validated but has been extended to include an improved parameter estimation technique that utilises systolic and diastolic blood pressure, cardiac output, heart rate, and pulse wave velocity measurements to adapt model resistances, compliances, blood volume, and the mean vessel areas in the main systemic arteries. The shape of the model-predicted uterine artery velocity waveforms showed good agreement with the characteristics observed in the patient Doppler waveforms. The personalised models obtained now allow a prediction of the uterine pressure waveforms in addition to the uterine velocity. This allows for a more detailed mechanistic analysis of the waveforms, eg, wave intensity analysis, to study existing clinical indices. The findings indicate that to accurately estimate arterial stiffness, both pulse pressure and pulse wave velocities are required. In addition, the results predict that patients who developed pre-eclampsia later in pregnancy have larger vessel areas in the main systemic arteries compared with the two patients who had normal pregnancy outcomes.
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Affiliation(s)
- Jason Carson
- Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversitySwanseaUK
- Data Science Building, Swansea University Medical SchoolSwansea UniversitySwanseaUK
- HDR UK Wales and Northern IrelandHealth Data Research UKLondonUK
| | - Lynne Warrander
- Maternal and Fetal Health Research Centre, Division of Developmental Biology, Faculty of Medicine Biology and HealthUniversity of ManchesterManchesterUK
| | - Edward Johnstone
- Maternal and Fetal Health Research Centre, Division of Developmental Biology, Faculty of Medicine Biology and HealthUniversity of ManchesterManchesterUK
| | - Raoul van Loon
- Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversitySwanseaUK
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van Zijl MD, Koullali B, Mol BWJ, Snijders RJ, Kazemier BM, Pajkrt E. The predictive capacity of uterine artery Doppler for preterm birth-A cohort study. Acta Obstet Gynecol Scand 2020; 99:494-502. [PMID: 31715024 PMCID: PMC7155020 DOI: 10.1111/aogs.13770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 10/25/2019] [Accepted: 11/05/2019] [Indexed: 12/22/2022]
Abstract
Introduction Mid‐trimester uterine artery resistance measured with Doppler sonography is predictive for iatrogenic preterm birth. In view of the emerging association between hypertensive disease in pregnancy and spontaneous preterm birth, we hypothesized that uterine artery resistance could also predict spontaneous preterm birth. Material and methods We performed a cohort study of women with singleton pregnancies. Uterine artery resistance was routinely measured at the 18‐22 weeks anomaly scan. Pregnancies complicated by congenital anomalies or intrauterine fetal death were excluded. We analyzed if the waveform of the uterine artery (no notch, unilateral notch or bilateral notch) was predictive for spontaneous and iatrogenic preterm birth, defined as delivery before 37 weeks of gestation. Furthermore, we assessed whether the uterine artery pulsatility index was associated with the risk of preterm birth. Results Between January 2009 and December 2016 we collected uterine Doppler indices and relevant outcome data in 4521 women. Mean gestational age at measurement was 19+6 weeks. There were 137 (3.0%) women with a bilateral and 213 (4.7%) with a unilateral notch. Mean gestational age at birth was 38+6 weeks. Spontaneous and iatrogenic preterm birth rates were 5.7% and 4.9%, respectively. Mean uterine artery resistance was 1.12 in the spontaneous preterm birth group compared with 1.04 in the term group (P = 0.004) The risk of preterm birth was increased with high uterine artery resistance (OR 2.9 per unit; 95% CI 2.4‐3.9). Prevalence of spontaneous preterm birth increased from 5.5% in women without a notch in the uterine arteries to 8.0% in women with a unilateral notch and 8.0% in women with a bilateral notch. For iatrogenic preterm birth, these rates were 3.9%, 13.6% and 23.4%, respectively. Likelihood ratios for the prediction of spontaneous preterm birth were 1.6 (95% CI 1.0‐2.6) and 1.9 (95% CI 1.0‐3.5) for unilateral and bilateral notches, respectively, and for iatrogenic preterm birth they were 3.6 (95% CI 2.5‐5.2) and 6.8 (95% CI 4.7‐9.9) for unilateral and bilateral notches, respectively. Of all women with bilateral notching, 31.4% delivered preterm. Conclusions Mid‐trimester uterine artery resistance measured at 18‐22 weeks of gestation is a weak predictor of spontaneous preterm birth.
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Affiliation(s)
- Maud D van Zijl
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, the Netherlands
| | - Bouchra Koullali
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, the Netherlands
| | - Ben W J Mol
- Department of Obstetrics and Gynecology, School of Medicine, Monash University, Melbourne, Vic, Australia
| | - Rosalinde J Snijders
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, the Netherlands
| | - Brenda M Kazemier
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, the Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, the Netherlands
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Carson J, Lewis M, Rassi D, Van Loon R. A data-driven model to study utero-ovarian blood flow physiology during pregnancy. Biomech Model Mechanobiol 2019; 18:1155-1176. [PMID: 30838498 PMCID: PMC6647440 DOI: 10.1007/s10237-019-01135-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 02/20/2019] [Indexed: 12/30/2022]
Abstract
In this paper, we describe a mathematical model of the cardiovascular system in human pregnancy. An automated, closed-loop 1D-0D modelling framework was developed, and we demonstrate its efficacy in (1) reproducing measured multi-variate cardiovascular variables (pulse pressure, total peripheral resistance and cardiac output) and (2) providing automated estimates of variables that have not been measured (uterine arterial and venous blood flow, pulse wave velocity, pulsatility index). This is the first model capable of estimating volumetric blood flow to the uterus via the utero-ovarian communicating arteries. It is also the first model capable of capturing wave propagation phenomena in the utero-ovarian circulation, which are important for the accurate estimation of arterial stiffness in contemporary obstetric practice. The model will provide a basis for future studies aiming to elucidate the physiological mechanisms underlying the dynamic properties (changing shapes) of vascular flow waveforms that are observed with advancing gestation. This in turn will facilitate the development of methods for the earlier detection of pathologies that have an influence on vascular structure and behaviour.
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Affiliation(s)
- Jason Carson
- College of Engineering, Swansea University, Bay Campus, Fabian Way, Swansea, SA1 8EN UK
| | - Michael Lewis
- College of Engineering, Swansea University, Bay Campus, Fabian Way, Swansea, SA1 8EN UK
| | - Dareyoush Rassi
- College of Human and Health Sciences, Swansea University, Singleton Campus, Singleton Park, Swansea, SA2 8PP UK
| | - Raoul Van Loon
- College of Engineering, Swansea University, Bay Campus, Fabian Way, Swansea, SA1 8EN UK
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Parry S, Sciscione A, Haas DM, Grobman WA, Iams JD, Mercer BM, Silver RM, Simhan HN, Wapner RJ, Wing DA, Elovitz MA, Schubert FP, Peaceman A, Esplin MS, Caritis S, Nageotte MP, Carper BA, Saade GR, Reddy UM, Parker CB. Role of early second-trimester uterine artery Doppler screening to predict small-for-gestational-age babies in nulliparous women. Am J Obstet Gynecol 2017; 217:594.e1-594.e10. [PMID: 28712949 DOI: 10.1016/j.ajog.2017.06.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 06/04/2017] [Accepted: 06/08/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Trophoblastic invasion of the uterine spiral arteries substantially increases compliance to accommodate increased blood flow to the placenta. Failure of this process impedes uterine artery blood flow, and this may be detected by uterine artery Doppler flow studies. However, the clinical utility of uterine artery Doppler flow studies in the prediction of adverse pregnancy outcomes in a general population remains largely unknown. OBJECTIVE We sought to determine the utility of early second-trimester uterine artery Doppler studies as a predictor of small-for-gestational-age neonates. STUDY DESIGN Nulliparous women with a viable singleton pregnancy were recruited during their first trimester into an observational prospective cohort study at 8 institutions across the United States. Participants were seen at 3 study visits during pregnancy and again at delivery. Three indices of uterine artery Doppler flow (resistance index, pulsatility index, and diastolic notching) were measured in the right and left uterine arteries between 16 weeks 0 days' and 22 weeks 6 days' gestation. Test characteristics for varying thresholds in the prediction of small for gestational age (defined as birthweight <5th percentile for gestational age [Alexander growth curve]) were evaluated. RESULTS Uterine artery Doppler indices, birthweight, and gestational age at birth were available for 8024 women. Birthweight <5th percentile for gestational age occurred in 358 (4.5%) births. Typical thresholds for the uterine artery Doppler indices were all associated with birthweight <5th percentile for gestational age (P < .0001 for each), but the positive predictive values for these cutoffs were all <15% and areas under receiver operating characteristic curves ranged from 0.50-0.60. Across the continuous scales for these measures, the areas under receiver operating characteristic curves ranged from 0.56-0.62. Incorporating maternal age, early pregnancy body mass index, race/ethnicity, smoking status prior to pregnancy, chronic hypertension, and pregestational diabetes in the prediction model resulted in only modest improvements in the areas under receiver operating characteristic curves ranging from 0.63-0.66. CONCLUSION In this large prospective cohort, early second-trimester uterine artery Doppler studies were not a clinically useful test for predicting small-for-gestational-age babies.
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James JL, Chamley LW, Clark AR. Feeding Your Baby In Utero: How the Uteroplacental Circulation Impacts Pregnancy. Physiology (Bethesda) 2017; 32:234-245. [DOI: 10.1152/physiol.00033.2016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/20/2016] [Accepted: 12/22/2016] [Indexed: 11/22/2022] Open
Abstract
The utero-placental circulation links the maternal and fetal circulations during pregnancy, ensuring adequate gas and nutrient exchange, and consequently fetal growth. However, our understanding of this circulatory system remains incomplete. Here, we discuss how the utero-placental circulation is established, how it changes dynamically during pregnancy, and how this may impact on pregnancy success, highlighting how we may address knowledge gaps through advances in imaging and computational modeling approaches.
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Affiliation(s)
- Joanna L. James
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand; and
| | - Lawrence W. Chamley
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand; and
| | - Alys R. Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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Marshall SA, Senadheera SN, Parry LJ, Girling JE. The Role of Relaxin in Normal and Abnormal Uterine Function During the Menstrual Cycle and Early Pregnancy. Reprod Sci 2016; 24:342-354. [DOI: 10.1177/1933719116657189] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Sarah A. Marshall
- School of Biosciences, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Laura J. Parry
- School of Biosciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Jane E. Girling
- Department of Obstetrics and Gynaecology, Gynaecology Research Centre, The University of Melbourne and Royal Women’s Hospital, Melbourne, Victoria, Australia
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Agra IK, Brizot ML, Miyadahira MY, Carvalho MH, Francisco RP, Zugaib M. The effect of prenatally administered vaginal progesterone on uterine artery Doppler in asymptomatic twin pregnancies. Eur J Obstet Gynecol Reprod Biol 2016; 205:11-4. [PMID: 27552173 DOI: 10.1016/j.ejogrb.2016.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/22/2016] [Accepted: 08/01/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study investigated the influence of vaginal progesterone on uterine circulation in asymptomatic twin gestations. STUDY DESIGN This study was a secondary analysis of a randomized, double-blind, placebo-controlled trial of twin pregnancies exposed to vaginal progesterone or placebo. We included all trial participants who had undergone uterine artery pulsatility index evaluation at the time of randomization. During each ultrasound examination, the uterine artery pulsatility index was evaluated transabdominally. The mean uterine artery pulsatility index between the progesterone and placebo groups were compared for each gestational age, starting between 18 to 34 weeks and 6days and were analyzed at three (Time 1), six (Time 2) and nine (Time 3) weeks after randomization. RESULTS The final analysis included 128 women in the progesterone group and 122 women in the placebo group. The baseline characteristics were similar in both groups. No difference in the mean uterine artery pulsatility index was observed between the progesterone and placebo groups at each week of gestation or throughout gestation. CONCLUSIONS In twin pregnancies, the use of vaginal progesterone in the second half of pregnancy does not influence uterine circulation.
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Guedes-Martins L, Gaio R, Saraiva J, Cerdeira S, Matos L, Silva E, Macedo F, Almeida H. Reference ranges for uterine artery pulsatility index during the menstrual cycle: a cross-sectional study. PLoS One 2015; 10:e0119103. [PMID: 25742286 PMCID: PMC4351196 DOI: 10.1371/journal.pone.0119103] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/28/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cyclic endometrial neoangiogenesis contributes to changes in local vascular patterns and is amenable to non-invasive assessment with Doppler sonography. We hypothesize that the uterine artery (UtA) impedance, measured by its pulsatility index (PI), exhibits a regular pattern during the normal menstrual cycle. Therefore, the main study objective was to derive normative new day-cycle-based reference ranges for the UtA-PI during the entire cycle from days 1 to 34 according to the isolated time effect and potential confounders such as age and parity. METHODS From January 2009 to December 2012, a cross-sectional study of 1,821 healthy women undergoing routine gynaecological ultrasound was performed. The Doppler flow of the right and left UtA-PI was studied transvaginally by colour and pulsed Doppler imaging. The mean right and left values and the presence or absence of a bilateral protodiastolic notch were recorded. Reference intervals for the PI according to the cycle day were generated by classical linear regression. RESULTS The majority of patients (97.5%) presented unilateral or bilateral UtA notches. The crude 5th, 50th, and 95th reference percentile curves of the UtA-PI at 1-34 days of the normal menstrual cycle were derived. In all curves, a progressive significant decrease occurred during the first 13 days, followed by an increase and recovery in the UtA-PI. The adjusted 5th, 50th, and 95th reference percentile curves for the effects of age and parity were also obtained. These two conditions generated an approximately identical UtA-PI pattern during the cycle, except with small but significant reductions at the temporal extremes. CONCLUSIONS The median, 5th, and the 95th percentiles of the UtA-PI decrease during the first third of the menstrual cycle and recover to their initial values during the last two thirds of the cycle. The rates of decrease and recovery depend significantly on age and parity.
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Affiliation(s)
- Luís Guedes-Martins
- Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal; Centro Hospitalar do Porto EPE, Departamento da Mulher e da Medicina Reprodutiva, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - Rita Gaio
- Department of Mathematics, Faculty of Sciences, University of Porto, Rua do Campo Alegre, 4169-007 Porto, Portugal; CMUP-Centre of Mathematics, University of Porto, Rua do Campo Alegre, 4169-007 Porto, Portugal
| | - Joaquim Saraiva
- Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; Centro Hospitalar do Porto EPE, Departamento da Mulher e da Medicina Reprodutiva, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal; Obstetrics-Gynecology, Private Hospital Trofa, 4785-409 Trofa, Portugal
| | - Sofia Cerdeira
- Gulbenkian Program for Advanced Medical Education, 1067-001 Lisbon, Portugal; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Liliana Matos
- Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal; Faculty of Nutrition and Food Sciences, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Elisabete Silva
- Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal
| | - Filipe Macedo
- Department of Cardiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Henrique Almeida
- Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal; Obstetrics-Gynecology, Hospital-CUF Porto, 4100-180 Porto, Portugal
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Cimsit C, Yoldemir T, Akpinar IN. Shear wave elastography in placental dysfunction: comparison of elasticity values in normal and preeclamptic pregnancies in the second trimester. J Ultrasound Med 2015; 34:151-159. [PMID: 25542951 DOI: 10.7863/ultra.34.1.151] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The aim of this study was to determine whether shear wave elastography of the placenta differs between normal pregnancies and pregnancies complicated by preeclampsia between 20 and 23 weeks' gestation. METHODS A prospective study was performed with 204 consecutive singleton pregnancies that had routine anomaly scanning between 20 and 23 weeks' gestation. One hundred twenty-nine of these patients were examined with shear wave elastography; 101 women who had clinically normal pregnancies with normal fetal biometric measurements and normal deliveries without any perinatal complications formed group A, and 28 women who had a clinical diagnosis of early-onset preeclampsia before anomaly scanning formed group B. Women with either posterior placentations (n = 63) or other obstetric disorders (n = 12) were excluded from the study. RESULTS Shear wave elastographic values for group B were significantly higher than those for group A (P < .05). No statistically significant difference was found between the elasticity values measured at the center or edge of the placenta (P > .05). CONCLUSIONS Shear wave elastography differentiates between the placental elasticity of normal pregnancies and pregnancies complicated by preeclampsia when performed during the second trimester. As a new method for tissue characterization, shear wave elastography is useful for evaluation of placental function and can be used as a supplement to existing methods for prediction of preeclampsia.
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Affiliation(s)
- Canan Cimsit
- From the Departments of Radiology (C.C., I.N.A.) and Obstetrics and Gynecology (T.Y.), Marmara University Training and Research Hospital Istanbul, Turkey.
| | - Tevfik Yoldemir
- From the Departments of Radiology (C.C., I.N.A.) and Obstetrics and Gynecology (T.Y.), Marmara University Training and Research Hospital Istanbul, Turkey
| | - Ihsan Nuri Akpinar
- From the Departments of Radiology (C.C., I.N.A.) and Obstetrics and Gynecology (T.Y.), Marmara University Training and Research Hospital Istanbul, Turkey
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Guedes-Martins L, Saraiva J, Felgueiras Ó, Carvalho M, Cerdeira A, Macedo F, Gaio R, Almeida H. Uterine artery impedance during puerperium in normotensive and chronic hypertensive pregnant women. Arch Gynecol Obstet 2014; 291:1237-46. [DOI: 10.1007/s00404-014-3560-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 11/25/2014] [Indexed: 11/24/2022]
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Linask KK, Han M, Bravo-Valenzuela NJM. Changes in vitelline and utero-placental hemodynamics: implications for cardiovascular development. Front Physiol 2014; 5:390. [PMID: 25426076 PMCID: PMC4227466 DOI: 10.3389/fphys.2014.00390] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 09/21/2014] [Indexed: 12/31/2022] Open
Abstract
Analyses of cardiovascular development have shown an important interplay between heart function, blood flow, and morphogenesis of heart structure during the formation of a four-chambered heart. It is known that changes in vitelline and placental blood flow seemingly contribute substantially to early cardiac hemodynamics. This suggests that in order to understand mammalian cardiac structure-hemodynamic functional relationships, blood flow from the extra-embryonic circulation needs to be taken into account and its possible impact on cardiogenesis defined. Previously published Doppler ultrasound analyses and data of utero-placental blood flow from human studies and those using the mouse model are compared to changes observed with environmental exposures that lead to cardiovascular anomalies. Use of current concepts and models related to mechanotransduction of blood flow and fluid forces may help in the future to better define the characteristics of normal and abnormal utero-placental blood flow and the changes in the biophysical parameters that may contribute to congenital heart defects. Evidence from multiple studies is discussed to provide a framework for future modeling of the impact of experimental changes in blood flow on the mouse heart during normal and abnormal cardiogenesis.
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Affiliation(s)
- Kersti K Linask
- Department of Pediatrics, Morsani College of Medicine, Children's Research Institute, University of South Florida Health St. Petersburg, FL, USA
| | - Mingda Han
- Department of Pediatrics, Morsani College of Medicine, Children's Research Institute, University of South Florida Health St. Petersburg, FL, USA
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Cimsit C, Yoldemir T, Akpinar IN. Strain elastography in placental dysfunction: placental elasticity differences in normal and preeclamptic pregnancies in the second trimester. Arch Gynecol Obstet 2014; 291:811-7. [DOI: 10.1007/s00404-014-3479-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 09/12/2014] [Indexed: 12/21/2022]
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Diniz CP, Araujo Júnior E, Lima MMDS, Guazelli CAF, Moron AF. Ultrasound and Doppler assessment of uterus during puerperium after normal delivery. J Matern Fetal Neonatal Med 2014; 27:1905-11. [DOI: 10.3109/14767058.2014.882895] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Guedes-Martins L, Cunha A, Saraiva J, Gaio R, Macedo F, Almeida H. Internal iliac and uterine arteries Doppler ultrasound in the assessment of normotensive and chronic hypertensive pregnant women. Sci Rep 2014; 4:3785. [PMID: 24445576 PMCID: PMC3896929 DOI: 10.1038/srep03785] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/02/2014] [Indexed: 11/21/2022] Open
Abstract
The objective of this work was to compare Doppler flows pulsatility index (PI) and resistance indexes (RI) of uterine and internal iliac arteries during pregnancy in low risk women and in those with stage-1 essential hypertension. From January 2010 and December 2012, a longitudinal and prospective study was carried out in 103 singleton uneventful pregnancies (72 low-risk pregnancies and 31 with stage 1 essential hypertension)at the 1st, 2nd and 3rd trimesters. Multiple linear regression models, fitted using generalized least squares and whose errors were allowed to be correlated and/or have unequal variances, were employed; a model for the relative differences of both arteries impedance was utilized. In both groups, uterine artery PI and RI exhibited a gestational age related decreasing trend whereas internal iliac artery PI and RI increased. The model testing the hemodynamic adaptation in women with and without hypertension showed similar trend. Irrespective of blood pressure conditions, the internal iliac artery resistance pattern contrasts with the capacitance pattern of its immediate pelvic division, suggesting a pregnancy-related regulatory mechanism in the pelvic circulation.
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Affiliation(s)
- L Guedes-Martins
- 1] Departamento de Biologia Experimental, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal [2] IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal [3] Centro Hospitalar do Porto EPE, Departamento da Mulher e da Medicina Reprodutiva, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - A Cunha
- Centro Hospitalar do Porto EPE, Departamento da Mulher e da Medicina Reprodutiva, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - J Saraiva
- Centro Hospitalar do Porto EPE, Departamento da Mulher e da Medicina Reprodutiva, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - R Gaio
- 1] Department of Mathematics, Faculty of Sciences of the University of Porto, Portugal [2] CMUP-Centre of Mathematics of the University of Porto, Portugal
| | - F Macedo
- 1] Departamento de Medicina, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal [2] Centro Hospitalar S. João, 4200-319 Porto, Portugal
| | - H Almeida
- 1] Departamento de Biologia Experimental, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal [2] IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal [3] Ginecologia-Obstetrícia, Hospital-CUF Porto, 4100 180 Porto, Portugal
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Nouh AA, Shalaby SM. The predictive value of uterine blood flow in detecting the risk of adverse pregnancy outcome in patients with polycystic ovary syndrome. Middle East Fertility Society Journal 2011. [DOI: 10.1016/j.mefs.2011.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Yildiz S, Sezer S, Boyar H, Cece H, Ziylan SZ, Vural M, Turksoy O. Impact of passive smoking on uterine, umbilical, and fetal middle cerebral artery blood flows. Jpn J Radiol 2011; 29:718-24. [DOI: 10.1007/s11604-011-0622-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 07/05/2011] [Indexed: 10/16/2022]
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Santos Filho ODO, Nardozza LMM, Araujo Júnior E, Camano L, Moron AF. Repercussões da cicatriz uterina resultante de cesariana prévia na dopplervelocimetria das artérias uterinas entre 26 e 32 semanas. Radiol Bras 2011. [DOI: 10.1590/s0100-39842011000300008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Avaliar as repercussões da cicatriz uterina na dopplervelocimetria das artérias uterinas, entre 26 e 32 semanas, em gestantes primíparas com uma cesariana prévia, considerando quando esta foi realizada fora (cesárea eletiva) ou durante o trabalho de parto. MATERIAIS E MÉTODOS: Estudo prospectivo transversal em 45 gestantes, divididas em três grupos: 17 gestantes com cicatriz prévia resultante de cesariana eletiva (grupo A); 14 gestantes com uma cicatriz prévia oriunda de cesariana executada em trabalho de parto (grupo B); 14 gestantes cujo único parto anterior foi realizado por via vaginal (grupo C). A dopplervelocimetria das artérias uterinas foi realizada pela via abdominal. Foram calculados as médias, medianas e desvios-padrão (DP) para cada grupo em estudo. Em relação ao índice de pulsatilidade, a comparação dos grupos foi conduzida pelo teste não paramétrico de Kruskal-Wallis. RESULTADOS: Os valores médios do índice de pulsatilidade no grupo A variaram de 0,60 a 1,60 (média: 0,90; DP: 0,29), no grupo B, de 0,53 a 1,43 (média: 0,87; DP: 0,24), e no grupo C, de 0,65 a 1,65 (média: 1,01; DP: 0,37); p = 0,6329. CONCLUSÃO: Não houve repercussões da cicatriz de cesariana prévia na dopplervelocimetria das artérias uterinas avaliadas de 26 a 32 semanas de gestação.
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Flo K, Wilsgaard T, Acharya G. A new non-invasive method for measuring uterine vascular resistance and its relationship to uterine artery Doppler indices: a longitudinal study. Ultrasound Obstet Gynecol 2011; 37:538-542. [PMID: 21154788 DOI: 10.1002/uog.8907] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To describe a new method for measuring uterine vascular resistance (R(uta) ), establish longitudinal reference ranges and explore the relationship between uterine artery (UtA) Doppler indices and R(uta) . METHODS This was a longitudinal study of 53 low-risk pregnancies. Doppler ultrasonography was used to measure UtA velocities, and the pulsatility index (PI), resistance index (RI) and systolic/diastolic velocity (S/D) ratio were calculated. R(uta) was calculated as a ratio between maternal mean arterial pressure and UtA time-averaged maximum velocity. RESULTS At 22 + 0 to 39 + 6 weeks of gestation, the mean R(uta) decreased from 1628 to 1180 dyne.s/cm(3) (P < 0.0001). UtA velocities increased (P < 0.0001), whereas the PI (0.79-0.56), RI (0.51-0.40) and S/D ratio (2.0-1.7) decreased (P < 0.0001). R(uta) and the UtA Doppler indices were positively associated (P = 0.003-0.001). CONCLUSION We describe a non-invasive method for measuring R(uta) and provide reference ranges for serial evaluation of UtA velocities, Doppler indices and R(uta) .
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Affiliation(s)
- K Flo
- Faculty of Health Sciences, Women's Health and Perinatology Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
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Cooley SM, Donnelly JC, Walsh T, MacMahon C, Gillan J, Geary MP. The impact of umbilical and uterine artery Doppler indices on antenatal course, labor and delivery in a low-risk primigravid population. J Perinat Med 2011; 39:143-9. [PMID: 21126220 DOI: 10.1515/jpm.2010.130] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To evaluate the impact of umbilical and uterine artery Doppler in the second and third trimester on antenatal course, labor and delivery in a low-risk primigravid population. METHODS Prospective recruitment of 1011 low-risk primigravidas with uterine and umbilical artery Doppler assessment at 22-24 weeks and 36 weeks. All mothers and infants were reviewed postnatally with a retrospective analysis of ultrasound and clinical outcome data. RESULTS Elevated uterine artery indices were associated with increased rates of threatened miscarriage, higher rates of pre-eclampsia (PET) and a higher incidence of fetal birth weight <2nd and 9th centile for gestation. Uterine artery pulsatility index (PI) >95th centile for gestation was associated with statistically higher rates of small-for-gestational age (SGA) infants. Elevated umbilical artery indices were associated with higher rates of induction of labor and a higher incidence of fetal birth weight infants <2nd and 9th centile for gestation. Umbilical artery PI >95th centile for gestation was associated with statistically higher rates of SGA infants. CONCLUSION Elevated uterine and umbilical artery indices are associated with higher rates of maternal and fetal disease.
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Affiliation(s)
- Sharon M Cooley
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin 1, Ireland.
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Espinoza J, Kusanovic JP, Bahado-Singh R, Gervasi MT, Romero R, Lee W, Vaisbuch E, Mazaki-Tovi S, Mittal P, Gotsch F, Erez O, Gomez R, Yeo L, Hassan SS. Should bilateral uterine artery notching be used in the risk assessment for preeclampsia, small-for-gestational-age, and gestational hypertension? J Ultrasound Med 2010; 29:1103-1115. [PMID: 20587434 PMCID: PMC3020574 DOI: 10.7863/jum.2010.29.7.1103] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the value of bilateral uterine artery notching in the second trimester in the risk assessment for preeclampsia, gestational hypertension, and small-for-gestational-age (SGA) without preeclampsia. METHODS This prospective cohort study included 4190 singleton pregnancies that underwent ultrasound examination between 23 and 25 weeks' gestation. The 95th percentiles of the mean pulsatility index (PI) and resistive index (RI) of both uterine arteries were calculated. Multivariable logistic regression analyses were performed to determine if bilateral uterine artery notching is an independent explanatory variable for the occurrence of preeclampsia, early-onset preeclampsia (<or=34 weeks), late-onset preeclampsia (>34 weeks), gestational hypertension, and delivery of an SGA neonate without preeclampsia, while controlling for confounding factors. RESULTS (1) The prevalence of preeclampsia, early-onset preeclampsia, late-onset preeclampsia, SGA, and gestational hypertension were 3.4%, 0.5%, 2.9%, 10%, and 7.9%, respectively; (2) 7.2% of the study population had bilateral uterine artery notching; and (3) bilateral uterine artery notching was an independent explanatory variable for the development of preeclampsia (odds ratio [OR], 2.1; 95% confidence interval [CI],1.28-3.36), early-onset preeclampsia (OR, 4.47; 95% CI, 1.50-13.35), and gestational hypertension (OR, 1.50; 95% CI, 1.02-2.26), but not for late-onset preeclampsia or SGA. CONCLUSIONS Bilateral uterine notching between 23 and 25 weeks' gestation is an independent risk factor for the development of early-onset preeclampsia and gestational hypertension. Thus, bilateral uterine artery notching should be considered in the assessment of risk for the development of these pregnancy complications.
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Affiliation(s)
- Jimmy Espinoza
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, Michigan, USA
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, Michigan, USA
| | - Ray Bahado-Singh
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, Michigan, USA
| | - Maria Teresa Gervasi
- Department of Obstetrics and Gynecology, Azienda Ospedaliera of Padova, Padova, Italy
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
| | - Wesley Lee
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Division of Fetal Imaging, Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Edi Vaisbuch
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, Michigan, USA
| | - Shali Mazaki-Tovi
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, Michigan, USA
| | - Pooja Mittal
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, Michigan, USA
| | - Francesca Gotsch
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | - Offer Erez
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, Michigan, USA
| | - Ricardo Gomez
- CEDIP (Center for Perinatal Diagnosis and Research), Department of Obstetrics and Gynecology, Sotero del Rio Hospital, P. Universidad Catolica de Chile, Santiago, Chile
| | - Lami Yeo
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, Michigan, USA
| | - Sonia S. Hassan
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, Michigan, USA
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Khalil A, Harrington K, Muttukrishna S, Jauniaux E. Effect of antihypertensive therapy with alpha-methyldopa on uterine artery Doppler in pregnancies with hypertensive disorders. Ultrasound Obstet Gynecol 2010; 35:688-694. [PMID: 20201113 DOI: 10.1002/uog.7611] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Antihypertensive drugs lower blood pressure by direct vascular effects or central vasodilatory mechanisms. Their effect on uterine artery Doppler resistance indices in hypertensive disorders of pregnancy is uncertain. This study aimed to evaluate the impact of antihypertensive therapy with alpha-methyldopa on maternal uterine artery Doppler pulsatility index (PI) and resistance index (RI) in women presenting with hypertensive disorders of pregnancy. METHODS This was a cross-sectional study of 51 women with pre-eclampsia, 29 with gestational hypertension and 80 matched normotensive controls. Uterine artery PI and RI were measured at recruitment (between 24 and 40 weeks' gestation) and, in the hypertensive groups, 24-48 h after starting alpha-methyldopa. Differences between mild and severe, and between early- and late-onset pre-eclampsia were compared using the Mann-Whitney test. The Wilcoxon rank sum test was used to compare measurements before and after treatment. RESULTS Prior to treatment, uterine artery PI and RI were significantly higher in women with pre-eclampsia compared with those with gestational hypertension and controls (P < 0.0001). The median uterine artery PI multiple of the median (MoM) was significantly higher (P < 0.0001) in early-onset than in late-onset pre-eclampsia (1.83 (range, 0.88-3.65) vs. 1.19 (range, 0.91-1.72)) and in severe compared with mild disease (2.26 (range, 2.02-3.65) vs. 1.29 (range, 0.88-2.9)). Uterine artery PI- and RI-MoMs in both pre-eclampsia and gestational hypertension, before and after 34 weeks' gestation, were not affected by alpha-methyldopa treatment. CONCLUSIONS Antihypertensive therapy using alpha-methyldopa in women presenting with hypertensive disorders of pregnancy has no significant effect on uterine artery resistance to blood flow, suggesting that it does not impair uteroplacental circulation in these cases.
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Affiliation(s)
- A Khalil
- Academic Department of Obstetrics and Gynaecology, UCL Institute for Women's Health, University College London, London, UK.
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Issa B, Moore RJ, Bowtell RW, Baker PN, Johnson IR, Worthington BS, Gowland PA. Quantification of blood velocity and flow rates in the uterine vessels using echo planar imaging at 0.5 Tesla. J Magn Reson Imaging 2010; 31:921-7. [DOI: 10.1002/jmri.22119] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Hale SA, Schonberg A, Badger GJ, Bernstein IM. Relationship between prepregnancy and early pregnancy uterine blood flow and resistance index. Reprod Sci 2009; 16:1091-6. [PMID: 19657141 DOI: 10.1177/1933719109341843] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We evaluated the relationship between prepregnancy and early pregnancy uterine blood flow (UBF) and resistance index (RI). Nineteen nulliparous participants were studied during cycle day 8 + 4, and early pregnancy (13.4 + 1.6 weeks). Color Doppler ultrasound of both uterine arteries and maternal heart was performed to calculate uterine RI, volumetric UBF, and cardiac output (CO), respectively. We observed a strong negative association of uterine RI with prepregnancy UBF (r = -.82, P < .001) that weakened, but remained significant in early pregnancy (r =-.48, P = .04). Prepregnancy uterine index (UBF/CO) was significantly associated with early pregnancy uterine index; r = .48, P = .04). There was also a trend associating prepregnancy and early pregnancy volumetric UBF (r = .44, P = .068). Prepregnancy UBF may be a determinant of early pregnancy UBF and UBF may have independent value as a predictor of adverse pregnancy outcome.
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Affiliation(s)
- Sarah A Hale
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, Vermont 05404, USA
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Sciscione AC, Hayes EJ. Uterine artery Doppler flow studies in obstetric practice. Am J Obstet Gynecol 2009; 201:121-6. [PMID: 19646563 DOI: 10.1016/j.ajog.2009.03.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 03/04/2009] [Accepted: 03/06/2009] [Indexed: 10/20/2022]
Abstract
The advent of sonography has changed the practice of obstetrics by providing a window to the womb through which the anatomic structure of the fetus can be evaluated. The addition of Doppler flow studies of maternal and fetal vessels has provided a tool where the physiology of the maternal-fetal unit can be assessed. This information can provide the physician and the patient with vital information for a subsequent approach to the pregnancy. The use of fetal Doppler blood flow studies has become common in the evaluation and management of pregnancies complicated by conditions such as suspected fetal growth restriction and red blood cell isoimmunization to guide intrauterine therapy and delivery. The most commonly assessed Doppler flow studies of the fetus are the umbilical artery and middle cerebral artery (MCA). Doppler flow studies of the MCA are used in the assessment of the fetus at risk for anemia and growth-restricted fetus. Doppler flow studies of the umbilical artery can reflect abnormalities in "down-stream" or the fetal side of placental resistance, and the assessment of the maternal vasculature evaluates "up-stream" blood flow or the maternal side of placental resistance. The purpose of this review is to describe the clinical utility of uterine artery Doppler flow studies in the prediction of adverse pregnancy outcomes in low and high risk populations.
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Daniel-Spiegel E, Weiner Z, Weiner E, Shalev E. Umbilical-placental blood flow gradient during the early second trimester of pregnancy. J Matern Fetal Neonatal Med 2009. [DOI: 10.1080/jmf.17.2.133.136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Etty Daniel-Spiegel
- Department of Obstetrics and Gynecology, Ha'Emek Medical Center, Afula and the Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Ha'Emek Medical Center, Afula and the Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
| | - Ehud Weiner
- Department of Obstetrics and Gynecology, Ha'Emek Medical Center, Afula and the Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
| | - Eliezer Shalev
- Department of Obstetrics and Gynecology, Ha'Emek Medical Center, Afula and the Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
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Stabile I, Campbell S, Grudzinskas JG. Doppler assessed uteroplacental blood flow impedance in the first trimester: Physiological variation with site of measurement. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443618909151029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Anyaegbunam A, Langer O, Axiotis CA, Brustman L, Halpert R, Merkatz IR. Doppler velocimetry and small for gestational age pregnancies in sickle cell disease associated with abnormal placental pathology. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443619109013577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Arduini D, Rizzo G. Doppler ultrasonography in uteroplacental insufficiency. Fet Matern Med Rev 1994; 6:153-66. [DOI: 10.1017/s0965539500001091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Much of our understanding of uteroplacental insufficiency has been derived from animal research and the study of the pathology of human placental and uterine biopsies. These studies have shown how the placenta plays a major role in the development of normal pregnancy and how placental dysfunction is generally caused by factors interfering with the normal growth of the uteroplacental and/or fetoplacental circulations. These abnormalities lead to a deficient supply of oxygen and nutrients to the fetus and to several complications of pregnancy such as gestational hypertension, preeclampsia and intrauterine growth retardation (IUGR).
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Abramowicz JS, Sheiner E. Ultrasound of the placenta: a systematic approach. Part II: functional assessment (Doppler). Placenta 2008; 29:921-9. [PMID: 18799213 DOI: 10.1016/j.placenta.2008.08.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Revised: 08/08/2008] [Accepted: 08/11/2008] [Indexed: 11/16/2022]
Abstract
Doppler velocimetry is the ideal clinical tool to assess placental performance in high-risk pregnancies. It also has value in predicting later complications and outcome in pregnancies which appear uncomplicated. All three circulations (fetal, placental and maternal) may be interrogated by Doppler technology. In the following review, we present basic physics aspects of Doppler and discuss mainly Doppler investigation of the fetal-placental circulation (umbilical artery, intraplacental circulation) as well as the uterine arteries. The assessment of umbilical blood flow provides information on blood perfusion of the fetal-placental unit. The diastolic blood flow velocity component in umbilical artery increases with advancing gestation. In pregnancies complicated by placental dysfunction, there may be a reduction in the number of functional villi and/or small blood vessels with, as a result, increased impedance, reflected, mainly, by a decrease in end-diastolic velocity. When the resistance increases even more, there is no diastolic forward velocity (absent end-diastolic velocity). Further increase in the resistance causes reversed end-diastolic velocity, which is considered a late step in the cascade of events leading to intrauterine fetal demise. Doppler assessment of the umbilical arteries was found to improve outcome of high-risk pregnancies, and reduce hospital admissions. On the contrary, routine Doppler ultrasound in low risk or unselected populations does not seem to confer benefit on mother or newborn. Uterine artery Doppler is a useful test in predicting pregnancies at high risk of developing complications related to uteroplacental insufficiency. It identifies women who may benefit from increased antenatal surveillance or prophylactic therapy. Three-dimensional power Doppler sonography can provide new insights into placental pathophysiology.
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Affiliation(s)
- J S Abramowicz
- Department of Obstetrics and Gynecology, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
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Abstract
The development of Doppler processing extended the scope of sonographic imaging from an anatomical to a physiological basis. This technique became established as a clinical tool in human gynaecology. For example, it has been discussed that the implantation of an embryo is influenced by the uterine blood flow. In cows, this uterine blood flow was investigated, using surgically implanted Doppler ultrasonic or electromagnetic blood flow probes prior to the introduction of colour Doppler sonography in bovine medicine. Therefore, the aims of our studies were to use transrectal Doppler sonography for the non-invasive measurement of uterine and ovarian blood flow in cows and to determine changes in genital perfusion during the oestrous cycle, pregnancy and puerperium, respectively. The results of our studies show that transrectal flow imaging can be used to obtain blood flow velocity waveforms from the uterine arteries at any time during the oestrous cycle, pregnancy and puerperium. During all these phases, characteristic changes in the uterine blood flow could be observed. This uterine blood flow was low during diestrus and high during proestrus and oestrus. During pregnancy, an exponential rise in uterine blood supply could be detected. There was a positive relationship between the uterine blood flow volume (BFV) at the end of gestation and the birth weight of calves. During puerperium, the uterine BFV declined tremendously, especially during the first week after birth. In cows, with pathological disturbances of the pueperium a delayed decrease in the uterine BFV was observed. Characteristic alterations occurred also in the luteal blood flow during the oestrous cycle, which were highly related to those of the progesterone levels. Furthermore, it has been detected by the colour Doppler technique that there is no decrease, but an increase of the luteal blood flow at the beginning of luteolysis in cows. Another group has found that there are close relationships between the LH-surge and the follicular blood flow before ovulation. In conclusion, these studies show that transrectal colour Doppler sonography is a useful technique for the investigation of the genital blood flow and provides new information about physiological changes of the genital organs during, all reproductive phases. The influence of the genital blood flow on fertility in cows needs to be examined further in future studies.
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Affiliation(s)
- K Herzog
- Clinic for Cattle, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany.
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Abstract
We performed uterine artery Doppler velocimetry in 16 nulliparous and 16 parous women with non-preeclamptic singleton gestations and 16 nulliparous and 16 parous women with dichorionic twin gestations at 17-18 and 26-27 weeks of gestation. In both singleton and twin pregnancies, the average pulsatility index (PI) in nulliparous women was significantly higher than that in parous women at 17-18 weeks of gestation. At 26-27 weeks of gestation, however, there were no significant differences in PI between nulliparous and parous women with either singleton or twin pregnancies. During the early second-trimester of non-preeclamptic singleton and twin pregnancies, parity has a significant effect on uterine artery blood flow.
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Affiliation(s)
- Shunji Suzuki
- Department of Obstetrics and Gynecology, Tokyo Rinkai Hospital, Japan.
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Mu J, Adamson SL. Developmental changes in hemodynamics of uterine artery, utero- and umbilicoplacental, and vitelline circulations in mouse throughout gestation. Am J Physiol Heart Circ Physiol 2006; 291:H1421-8. [PMID: 16603699 DOI: 10.1152/ajpheart.00031.2006] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In human pregnancy, abnormal placental hemodynamics likely contribute to the etiology of early-onset preeclampsia and fetal intrauterine growth restriction. The mouse is increasingly being deployed to study normal and abnormal mammalian placental development, yet the placental hemodynamics in normal pregnancy in mice is currently unknown. We used ultrasound biomicroscopy to noninvasively image and record Doppler blood velocity waveforms from the maternal and embryonic placental circulations in mice throughout gestation. In the uterine artery, peak systolic velocity (PSV) increased significantly from 23 ± 2 (SE) to 59 ± 3 cm/s, and end-diastolic velocity (EDV) increased from 7 ± 1 to 28 ± 2 cm/s in nonpregnant versus full-term females so that the uterine arterial resistance index (RI) decreased from 0.70 ± 0.02 to 0.53 ± 0.02. Velocities in the maternal arterial canal in the placenta were low and nearly steady and increased from 0.9 ± 0.03 cm/s at embryonic day 10.5 (E10.5) to 2.4 ± 0.07 cm/s at E18.5. PSV in the umbilical artery increased steadily from 0.8 ± 0.1 cm/s at E8.5 to 15 ± 0.6 cm/s at E18.5, whereas PSV in the vitelline artery increased from 0.6 ± 0.1 cm/s at E8.5 to 4 ± 0.2 cm/s at E13.5 and then remained stable to term. In the umbilical artery, the EDV detection rate was 0% at ≤E14.5 and 94% at E18.5, and the RI decreased from 1 to 0.82 ± 0.01 during this interval. We conclude that ultrasound biomicroscopy can be used to monitor placental hemodynamics during pregnancy in mice. These results provide novel information concerning the development of the vitelline and placental circulations in mice and reveal strong similarities in placental hemodynamics between mice and humans.
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Affiliation(s)
- Junwu Mu
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, and Department of Obstetrics and Gynecology, University of Toronto, ON, Canada M5G 1X5
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Espinoza J, Romero R, Kim YM, Kusanovic JP, Hassan S, Erez O, Gotsch F, Than NG, Papp Z, Kim CJ. Normal and abnormal transformation of the spiral arteries during pregnancy. J Perinat Med 2006; 34:447-58. [PMID: 17140293 PMCID: PMC7062302 DOI: 10.1515/jpm.2006.089] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article reviews the anatomy and physiology of the uterine circulation, with emphasis on the remodeling of spiral arteries during normal pregnancy, and the timing and anatomical pathways of trophoblast invasion of the spiral arteries. We review the definitions of the placental bed and basal plate of the placenta, their relevance to the study of the physiologic transformation of the spiral arteries, as well as the methods to obtain and examine placental bed biopsy specimens. We also examine the role of the extravillous trophoblast in normal and abnormal pregnancies, and the criteria used to diagnose failure of physiologic transformation of the spiral arteries. Finally, we comment on the use of uterine artery Doppler velocimetry as a surrogate marker of chronic uteroplacental ischemia.
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Affiliation(s)
- Jimmy Espinoza
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan USA
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Yeon Mee Kim
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan USA
- Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan USA
| | - Sonia Hassan
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Offer Erez
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan USA
| | - Francesca Gotsch
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan USA
| | - Nandor Gabor Than
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan USA
| | - Zoltán Papp
- First Department of Obstetrics and Gynecology, Semmelweis University, Budapest Hungary
| | - Chong Jai Kim
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan USA
- Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Vainio M, Kujansuu E, Koivisto AM, Mäenpää J. Bilateral notching of uterine arteries at 12-14 weeks of gestation for prediction of hypertensive disorders of pregnancy. Acta Obstet Gynecol Scand 2005; 84:1062-7. [PMID: 16232173 DOI: 10.1111/j.0001-6349.2005.00889.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the value of transvaginal uterine artery Doppler ultrasound at 12--14 weeks of gestation in predicting hypertensive disorders of pregnancy in high-risk women. METHODS One hundred and twenty high-risk women were evaluated prospectively by Doppler ultrasound of uterine and umbilical arteries at 12--14 weeks of gestation. The presence of bilateral notches, resistance and pulsatility index (PI), mean and maximum flow velocities of uterine arteries, and resistance and PI of umbilical arteries were investigated. Those with bilateral notching were randomized to acetylsalicylic acid (n=43) or placebo groups (n=43) and were followed up twice during pregnancy with the same ultrasound measurements. The women without bilateral notches (n=29) served as controls. In this study, we compared 43 women in the placebo group to 29 controls without bilateral notches. The outcome measures were pregnancy-induced hypertension, pre-eclampsia and intrauterine growth restriction. RESULTS The sensitivity of bilateral notching in predicting hypertensive disorders of pregnancy decreased with advancing pregnancy from 91 to 35%, and the specificity and the positive predictive values increased from 41 to 94% and from 7 to 70%, respectively. The negative predictive values ranged from 86 to 97%. CONCLUSION Bilateral notching of uterine arteries at 12--14 weeks is a useful tool in predicting the development of hypertensive disorders in high-risk pregnancies. It is also a suitable test for surveillance of high-risk pregnancies.
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Affiliation(s)
- Merja Vainio
- Department of Obstetrics and Gynecology, Hyvinkää Hospital, Hyvinkää, Finland.
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Abstract
UNLABELLED In this review, the various biochemical tests that have been proposed for the prediction of preeclampsia are described and evaluated. Placenta hormone markers do not predict future disease. They denounce the early placental changes that are part of the evolving disease and only predict the imminent of preeclamptic syndrome. This explains why tests are better predictors when preeclampsia supervenes shortly, and why screening in the first trimester is unlikely to work as well as in the second trimester. The use of multiple markers in the screening should reflect different aspects of the disease process and could increase the specificity and sensitivity of the screening and work on different etiologic factors. The possible use of second-trimester biochemical screening to predict the risk of preeclampsia remains to be investigated in the high-risk population. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES After completion of this article, the reader should be able to list the various theories on the etiology of preeclampsia, to relate the various risk factors for the development of preeclampsia, and to describe the various screening tests for preeclampsia.
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Affiliation(s)
- Khalid Farag
- Department of Obstetrics and Gynaecology, Barnsley District General Hospital, Barnsley, UK
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Abstract
Transrectal color Doppler sonography was used to investigate uterine and umbilical blood flow during pregnancy (duration, 46-48 weeks) in four mares. The resistance index (RI) and blood flow volume (VOL) of the uterine arteries ipsilateral and contralateral to the conceptus, and the presence of an early diastolic notch in the Doppler wave, were evaluated every 4 week throughout pregnancy. Fetal blood flow was calculated semiquantitatively every 2 week (from 20 to 40 weeks), using the RI of the umbilical arteries. During the entire period of investigation, there were no significant individual variations in uterine RI and VOL nor differences between the two uterine arteries. Mean RI decreased by more than half during pregnancy from 0.89 +/- 0.01 to 0.39 +/- 0.03, and mean VOL increased almost 400-fold from 69 +/- 37 to 27,467 +/- 8851 ml/min. There were relationships (P<0.0001) between week of pregnancy (x) and RI as well as VOL. These were described by the equations RI=0.938-0.150 ln(x) and VOL (ml/min)=7.621x(2.157). Log transformed total estrogen (TE) were related to RI (r=-0.879; P<0.05) as well as to VOL (r=0.888; P<0.05). The notch in the Doppler wave of the uterine artery disappeared between 18 and 26 weeks. There was a correlation (P<0.0001) between week of gestation (x) and RI values of the umbilical arteries; this was described by the equation RI=1.763-0.071x+0.001x2. Further studies are needed to determine whether transrectal color Doppler sonography could be used to identify mares at risk of abortion.
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Affiliation(s)
- Heinrich Bollwein
- Department of Animal Reproduction, Veterinary College, University of Munich, Königinstr 12, 80539 Munich, Germany.
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Abstract
PURPOSE OF REVIEW Doppler applications in pregnancy are expanding exponentially. Flow velocity waveforms provide important information 12 weeks to term, from maternal vessels, placental circulation and fetal systemic vessels, with implications for both mother and fetus. As applications proliferate, awareness of the complexity of fetal and placental circulations, in normal pregnancy and in sequential responses to compromise, has also grown. The necessary data are now available to establish core values in Doppler evaluation for at-risk pregnancies. RECENT FINDINGS Uterine arteries depict maternal vascular effects of the invading placenta, predicting the frequency and severity of pre-eclampsia and intrauterine growth restriction. New evidence suggests early treatment based on this principle, significantly reduces these impacts. Umbilical artery Doppler reflects downstream placental vascular resistance, strongly correlated with intrauterine growth restriction and the multisystem effects of placental deficiency. Abnormalities are progressive, with reduction, loss, and finally a reversal of diastolic flow. When umbilical arteries become abnormal, the differentiation of fetal status requires Doppler information from systemic vessels. Middle cerebral artery changes begin when the redistribution of cardiac output reflects rising placental resistance, demonstrating 'brain sparing' when cerebrovascular dilation occurs. In the compromised intrauterine growth retarded fetus, precordial veins illustrate fetal cardiac function, changing as the respiratory status declines. This Doppler information is combined with biophysical profile scoring to determine the need for and timing of intervention. SUMMARY Doppler evaluation of at-risk pregnancies provides crucial prognostic and diagnostic detail about placentation and fetal adaptation. What has been research detail is now becoming the standard of care, in comprehensive fetal-maternal assessment.
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Affiliation(s)
- Chris R Harman
- Center for Advanced Fetal Care, Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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Affiliation(s)
- Michael Y Divon
- Department of Obstetrics and Gynecology, Lenox-Hill Hospital, New York, New York 10021, USA.
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Papageorghiou AT, To MS, Yu CK, Nicolaides KH. Repeatability of measurement of uterine artery pulsatility index using transvaginal color Doppler. Ultrasound Obstet Gynecol 2001; 18:456-459. [PMID: 11844164 DOI: 10.1046/j.0960-7692.2001.00578.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To assess the repeatability of measuring the pulsatility index of the uterine arteries using transvaginal color Doppler at 23 weeks of gestation. PATIENTS AND METHODS The pulsatility index was measured in 100 women with singleton pregnancies attending for routine transvaginal Doppler examination of the uterine arteries at 23 weeks. To assess the repeatability of different components of variability, six measurements of the uterine artery pulsatility index were made on one of the uterine arteries in each patient. RESULTS Six measurements of the pulsatility index were successfully measured in all 100 patients, resulting in a total of 600 measurements. The repeatability was unrelated to the pulsatility index. On 95% of occasions the intraobserver, interobserver and waveform tracing repeatability was less than 0.24, 0.27 and 0.14, respectively. CONCLUSIONS Measurement of the pulsatility index using transvaginal color Doppler is highly reproducible when the examination is carried out by well-trained operators.
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Affiliation(s)
- A T Papageorghiou
- Harris Birthright Research Centre, King's College Hospital, London, UK
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Konje JC, Kaufmann P, Bell SC, Taylor DJ. A longitudinal study of quantitative uterine blood flow with the use of color power angiography in appropriate for gestational age pregnancies. Am J Obstet Gynecol 2001; 185:608-13. [PMID: 11568786 DOI: 10.1067/mob.2001.117187] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to examine longitudinally changes in quantified blood volume flow in the uterine arteries during pregnancy with the use of color power angiography. STUDY DESIGN Color power angiography was used to quantify volume flow in the uterine arteries of 57 women with singleton uncomplicated pregnancies between 20 and 38 weeks' gestation. Comparisons were made between blood flow in the 2 arteries in relation to the location of the placenta. Linear regression models were used to estimate gestational age derived volumetric changes in these vessels. RESULTS The diameter of the uterine arteries increased from 2.6 mm (SD, 0.2 mm) at 20 weeks to 4.8 mm (SD, 0.7 mm) at 38 weeks of gestation. The total uterine artery blood volume flow increased from 513 mL/min (SD, 127 mL/min) at 20 weeks to 970 mL/min (SD, 193 mL/min) at 38 weeks. The rate of increase was maximum between 20 and 24 weeks (39 mL/min per week). The laterality of the placenta significantly affected the diameter and blood volume flow in each uterine artery. The diameters on the ipsilateral side were significantly greater (by 10.8% +/- 2.4%) than the diameters on the contralateral side at all gestations (P < .05). Similarly, blood volume flow was significantly greater (by 17.8% +/- 2.2%) on the ipsilateral side at all gestations (P < .05). There were, however, no statistically significant differences between the vessel diameters and blood volume flow in those cases in which the placenta was central. Total uterine artery volume flow per kilogram of estimated fetal weight decreased from 1544 mL/kg per minute at 20 weeks to 296 mL/kg per minute at 38 weeks of gestation. CONCLUSION Total quantified uterine artery blood volume flow increases while blood flow per kilogram of fetal weight decreases with gestation. Blood volume flow in the ipsilateral artery to the placenta was significantly higher than that in the contralateral artery. Calculating total uterine artery volume flow by doubling the blood flow from 1 artery (as was previously done) may therefore either result in an over or underestimation, depending on the relationship between the vessel and the laterality of the placenta. Color power angiography is a simple noninvasive tool for determining uterine artery blood volume flow.
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Affiliation(s)
- J C Konje
- Fetal Growth and Development Research Group, Department of Obstetrics & Gynaecology, University of Leicester, England.
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Abstract
The delivery of infants before 37 weeks gestation is a leading cause of perinatal mortality and morbidity in the United States. Traditional methods of predicting women at risk relying on obstetric history or premonitory symptoms (detected clinically or by tocodynamometry) are neither sensitive nor specific. Recent approaches to predicting preterm delivery have included sonographic measurement of cervical length and various biochemical assays. Although more sensitive than traditional methods, none of these alone exhibits sufficient accuracy to warrant widespread use. We contend that the failure of current approaches to predicting preterm delivery reflects an inadequate understanding of the underlying pathogenesis. Clinical and experimental evidence support the concept that most cases of preterm delivery reflect four pathogenic processes, which share a common final biological pathway leading to uterine contractions and cervical changes with or without premature rupture of membranes. These pathogeneses are: (1) activation of the maternal or fetal hypothalamic-pituitary-adrenal axis; (2) decidual-chorioamniotic or systemic inflammation; (3) decidual haemorrhage (i.e. abruption); and (4) pathological distention of the uterus. Our research seeks to combine the most useful biophysical and biochemical markers of such processes with optimal clinical and epidemiological predictors into a composite, easily applied risk tool. This integrated approach has the potential to identify at-risk asymptomatic patients with high sensitivity, specificity, and positive and negative predictive values, and also to ascertain underlying pathogenic processes that can lead to targeted therapy. To accomplish these goals, we employ logistic regression and artificial neural network models to assess and apply the appropriate weight to markers associated with each of the above pathogenic pathways, in addition to markers of the final common pathway leading to fetal membrane rupture, cervical extracellular matrix degradation, and myometrial activation. By combining these markers, we expect ultimately to produce a predictive model that is more robust than any existing method, and that identifies the relative contribution of each pathogenic process. Further analysis of this model using a neural network will enable us to identify asymptomatic patients destined to deliver preterm with high sensitivity, specificity, positive and negative predictive values, and to assess the relative contribution of each of the four distinct pathogeneses to this preterm delivery risk.
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Affiliation(s)
- C J Lockwood
- Department of Obstetrics & Gynecology, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA
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46
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Abstract
OBJECTIVE To determine whether placental laterality and discordant uterine artery impedance during pregnancy is a random event or the result of uterine artery pathology. METHODS We identified 50 patients with unilateral placenta and pathologic uterine artery impedance during their current pregnancy and enrolled them in the study. Thirty-three of these patients met the inclusion criteria and returned during the first 10 days of their third normal menstrual cycle after delivery. We examined the pelvic anatomy to rule out any pelvic pathology and then used color and pulsed wave duplex Doppler to identify the uterine artery in the immediate vicinity of the paracervical area at the level of the isthmus. We obtained the uterine artery resistance index (RI) from each uterine artery. We performed statistical analysis by means of t-test. RESULTS The uterine artery ipsilateral to the placenta exhibited significantly lower impedance than the contralateral in the pregnant state. When the placenta was right, the values (mean +/- SD) were 0.60 +/- 0.11 vs. 0.73 +/- 0.09 for the right and left artery, respectively. When the placenta was left the values were 0.57 +/- 0.08 vs. 0.77 +/- 0.07 for the left and right uterine artery, respectively. In the nonpregnant state, the corresponding values were 0.90 +/- 0.04 vs. 0.90 +/- 0.05 and 0.91 +/- 0.05 vs. 0.90 +/- 0.04, respectively. CONCLUSION In patients with a unilateral placenta and discordant pathological uterine artery impedance during pregnancy, there is no evidence of discordant impedance between the two uterine arteries in the postpartum period. We speculate that the location of placental implantation may not be the result of preexisting uterine artery discordant impedance.
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Affiliation(s)
- A Kofinas
- Department of Obstetrics and Gynecology of The Brooklyn Hospital Center, New York 11201, USA
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Matsumura N, Inoue T, Fukuoka M, Sagawa N, Fujii S. Changes in the serum levels of human chorionic gonadotropin and the pulsatility index of uterine arteries during conservative management of retained adherent placenta. J Obstet Gynaecol Res 2000; 26:81-7. [PMID: 10870298 DOI: 10.1111/j.1447-0756.2000.tb01288.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Our purpose was to assess the natural course of retained adherent placenta at term. METHODS Five cases of retained adherent placenta, clinically diagnosed as placenta accreta, were managed conservatively without methotrexate. To assess the biochemical and circulatory changes in the placentas, the serum levels of human chorionic gonadotropin (hCG) and the pulsatility index (PI) of the uterine arteries were examined. RESULTS Serum hCG levels decreased spontaneously; the half-life of serum hCG was calculated to be 5.2 +/- 0.26 days (mean +/- SEM). The PI of the uterine arteries remained at the level of pregnant women at term, but became elevated within a few days after the removal of the placentas. All the placentas were successfully removed transvaginally within 6 weeks postpartum. CONCLUSIONS The changes in serum hCG observed in this study indicated the spontaneous degeneration of the placenta. Such changes might be similar to those reported to occur during treatment with methotrexate. In contrast, the PI of the uterine arteries did not reflect degeneration of the placenta.
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Affiliation(s)
- N Matsumura
- Department of Gynecology and Obstetrics, Kyoto University, Graduate School of Medicine, Kyoto, Japan
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48
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Abstract
We determined the relationship between the histopathological findings of the placental bed and Doppler flow measurements of the uterine artery in women with preeclampsia and fetal growth retardation. Doppler velocimetry in the uterine artery was evaluated in 17 pregnant women with preeclampsia, 15 of whom had fetal growth retardation, and 20 normal pregnant women, within 14 days of Caesarean delivery and placental bed biopsy. The placental bed biopsies were evaluated in terms of trophoblast migration into the myometrium and physiological changes of the spiral arteries. The results were compared with Doppler velocimetry values. Trophoblast migration and physiological changes were not detected in 10 (59%) cases with preeclampsia and in 4 (20%) with normal pregnancies (p<0.05). In the preeclamptic group, 9 of 15 cases that were complicated with intrauterine growth retardation had no trophoblastic migration into the myometrium. The mean systolic/diastolic ratio, resistance index and pulsatility index of the uterine artery in women with preeclampsia and fetal growth retardation was significantly higher than women with normal pregnancies (p<0.01). The mean resistance index of the uterine artery in the impaired migration group was significantly higher than the migration group (p=0.02). The incidence of impaired trophoblast migration was significantly higher in the group with a high systolic/diastolic ratio (above 2.5) and resistance index (above 0.58) than cases with low systolic/diastolic ratio and resistance index (72%, 23% respectively, p<0.05). The incidence of early diastolic notch in the impaired trophoblast migration group was significantly higher than the migration group (57% versus 13%, p<0.01). Our study supports the hypothesis that high uterine artery flow resistance is related to the reduced trophoblast migration into the myometrium and inadequate physiological changes in the spiral arteries in women with intrauterine growth retardation and preeclampsia.
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Affiliation(s)
- S Sağol
- Department of Obstetrics and Gynaecology, Ege University, Medical Faculty, Izmir, Turkey
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Abstract
OBJECTIVE To investigate the usefulness of grade II uterine diastolic notch to predict maternal or perinatal outcome during conservative management of preeclampsia. STUDY DESIGN We reviewed medical charts of 35 pregnant women admitted for hypertension and > or =1+ urine dipstick protein determination and who had a uterine Doppler examination at admission. Grade I notch was defined as a 'nadir' in early diastole higher than half of peak diastolic notch velocity. Grade II diastolic notch was defined as a 'nadir' in early diastole lower than half of peak diastolic notch velocity. RESULTS Thirty-one preeclamptic women were admitted at 30.1+/-3 weeks. Of them, 23 had a grade I notch (group I) and eight a grade II notch (group II). Rates of abruptio placenta, eclampsia, thrombocytopenia, stillbirth, birth weight < or = 3rd centile, fetal distress before delivery and neonatal death were similar in the two groups. Rates of delivery before 32 weeks and newborn spending more than 48 h in neonatal intensive care unit were significantly higher in group II. Admission-to-delivery interval was significantly lower in group II (2.6+/-1.5 vs. 9.4+/-8.7 days, P<0.05). CONCLUSION Grade II notch seems to identify in preeclamptic women those with a higher risk of early pregnancy termination.
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Affiliation(s)
- B Haddad
- Department of Obstetrics and Gynecology, C.H.I. Créteil, France.
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