An integrated model for the prediction of preeclampsia using maternal factors and uterine artery Doppler velocimetry in unselected low-risk women

OBJECTIVE: The purpose of this study was to develop a predictive model for preeclampsia. STUDY DESIGN: This was a prospective screening study for preeclampsia using uterine artery Doppler ultrasound in unselected low-risk singleton pregnancies at community hospitals in the UK (n = 32,157). Logistic regression models were developed and their predictive ability assessed using the area under the receiver operator curve (AROC). RESULTS: Six hundred twelve (2.0%) women developed preeclampsia, and 144 (0.5%) required early delivery (<34 weeks). A model using both maternal and ultrasound factors had an AROC of 0.798, which was higher than ultrasound alone (0.729, P < .0001) or maternal factors alone (0.712, P < .0001). In early onset disease, the ROC of ultrasound alone (0.922) was not significantly improved by adding maternal predictors (0.945, P = .27). In contrast, late onset disease was better predicted by the combined model (AROC 0.798) than ultrasound alone (AROC 0.729, P < .0001) or maternal factors alone (AROC 0.712, P < .0001). CONCLUSION: The combination of uterine artery Doppler ultrasound and maternal factors provided the best estimate of risk.     

Abnormal uterine artery Doppler velocimetry predicts adverse outcomes in patients with abnormal analytes

ObjectivesOur aim was to determine if uterine artery (UtA) Doppler studies would risk-stratify women with abnormal serum analytes on prenatal genetic screening into those at baseline and increased risk for preeclampsia and small-for-gestational age (SGA).Study designThis retrospective cohort study examined outcomes of patients with ⩾one abnormal analyte (PAPP-A < 0.3, hCG > 3.0, AFP > 2.5, inhibin > 2.0, or unconjugated estriol < 0.3MoM). At approximately 24 weeks, we assessed UtA pulsatility index (PI).Main outcome measuresPreeclampsia, preterm preeclampsia, SGA (birthweight (BW) <10%) and intrauterine growth restriction (IUGR) (BW < 3%).ResultsWe identified 132 patients with ⩾one abnormal analyte, UtA Doppler screening, and delivery outcomes. Twenty-four (18%) had an elevated UtA PI (PI > 1.6); preeclampsia occurred in 16 (12%) and 26 (20%) delivered a SGA neonate. Abnormal UtA Doppler PI increased the likelihood of a composite outcome of preeclampsia or SGA from 27% to 71% (LR 6.48 (2.93, 14.30)); a negative UtA Doppler PI reduced the likelihood to 18% (LR 0.57 (0.42, 0.78)). Abnormal UtA Doppler PI increased the likelihood of a more severe composite outcome of preterm preeclampsia or IUGR from 11% to 39% (LR 5.49 (3.03, 9.97)); a negative UtA Doppler study reduced the likelihood to 4% (LR 0.35 (0.16, 0.80)).ConclusionsIn patients with abnormal serum analytes, abnormal UtA Doppler PI is significantly associated with preeclampsia or SGA and improves the prediction of these adverse outcomes by 9–15-fold. Providers can incorporate UtA Doppler PI into an abbreviated surveillance regimen; they can be reassured that a normal study markedly decreases the risk of a severe early adverse outcome.     

Biophysical interaction between blood pressure and uterine artery Doppler for the occurrence of early-onset preeclampsia: A prospective cohort study

ObjectivesWe evaluated the biological interaction between blood pressure (BP) and uterine artery Doppler (UAD) in the second trimester for early-onset preeclampsia (EO-PE) risk.Study designA prospective cohort study.Main outcome measuresIn 2410 pregnant women, mean pulsatility index (mPI) and mean notch depth index (mNDI) were examined by UAD at 16–23 weeks’ gestation. We defined EO-PE as PE with onset at <34 weeks, abnormal UAD as coexistence of mPI ? 90th percentile and mNDI ? 90th percentile, and high BP as systolic BP/diastolic BP ? 120/80 mmHg. Abnormal UAD and high BP were combined as a series of dummy variables, and were entered into a logistic regression model. The relative excess risk due to biological interaction (RERI) was calculated using the following equation: RERI = odds ratio (OR) in women with both high BP and abnormal UAD – OR in women with high BP alone – OR in women with abnormal UAD alone +1. RERI ? 10 was considered as strong.ResultsEO-PE and late-onset PE (LO-PE) occurred in 1.1% and 1.2%, respectively. Adjusted odds ratio (95% CI) in women with abnormal UAD alone, high BP alone, and both high BP and abnormal UAD for predicting EO-PE was 4.3 (0.37–49), 12 (2.6–55) and 85 (17–422), respectively; and that for predicting LO-PE was 6.3 (1.5–27), 6.1 (2.1–17) and 15 (3.6–61), respectively. The RERI for EO-PE and LO-PE was 70 and 3.3, respectively.ConclusionHigh BP and abnormal UAD may have a strong biological interaction for the occurrence of EO-PE.     

Uterine artery Doppler velocimetry with leiomyomas

The study was conducted to establish a correlation between Doppler velocimetry in relation to uterine weight in any phase of the menstrual cycle and symptoms in women who have leiomyomas. Doppler velocimetry was carried out on both uterine arteries in 18 pre-menopausal women and one post-menopausal woman prior to undergoing abdominal hysterectomy at Winthrop University Hospital in Mineola, NY and at Ioannina University Hospital. The t-test was used for statistical analysis. Changes in flow velocity correlatd directly with uterine size. When a division at 500 g was used, S/D ratio was 2.74±0.53 for larger uteri vs. 4.2±1.24 for smaller uteri, p<0.006. Eight women presented heavy bleeding and the mean S/D ratio was 3.75±1.36 while eleven women presented mild bleeding and the mean S/D ratio was 3.51±1.2 (p>0.5). Thus the study has demonstrated that in cases of uterine leiomyomas, the uterine artery flow increases although angiography had previously shown decreased vascularity within the tumor. Received: 9 April 1997 / Accepted: 22 December 1997     

Postpartum uterine artery Doppler velocimetry among patients following a delivery complicated with preeclampsia

Objective: To evaluate postpartum uterine artery (UtA) velocimetry in patients following severe preeclampsia (PET) as compared with normotensive controls. Study Design: Postpartum UtA velocimetry was obtained prospectively during the early postpartum period. The right and left UtA pulsatility index (PI) was measured and the presence of an early diastolic notch was noted. For categorical variables, the χ2 test or Fisher exact was used as appropriate and for continuous variables the t-test was used. The p value <0.05 was considered statistically significant. Results: Thirty-one patients following severe PET and 52 normotensive controls were included in the study. Following severe PET, higher rates of intrauterine growth restriction, cesarean delivery, preterm delivery and accordingly lower neonatal birth weight were noted. Postpartum UtA velocimetry measurements were performed on average 51.2?h after delivery (range 8–169). Right and left UtA PI was comparable between patients following severe PET and controls. The presence of unilateral and bilateral early diastolic notches were significantly higher in patients following severe PET. Conclusions: The pathophysiology of uterine involution and the physiologic return of the uterine arteries to the non-pregnant state may be different following severe PET.     

Identification of patients at risk for preeclampsia with the use of uterine artery Doppler velocimetry and copeptin

Purpose: To investigate the relationship between maternal copeptin levels and uterine artery Doppler examination and progress of preeclampsia.

Materials and methods: A cross-sectional study was designed with women those were screened at 20?+?0 – 24+ 6 weeks’ gestation between May 2014 and August 2014. The obstetric records of all normotensive women were examined. Uterine artery Doppler velocimetry results and serum copeptin levels were measured. The patients were divided into two groups according to normal (n?=?67) and abnormal uterine artery Doppler (n?=?21) findings.

Results: Maternal age was significantly lower in group 1 (n?=?21, 23.9%) than in group 2 (n=?67, 76.1%) (p?p?=?0.002).

Conclusions: Copeptin levels are significantly higher in patients who develop preeclampsia.     

Improvement of uterine artery Doppler velocimetry indices after metroplasty in arcuate uteri

OBJECTIVE: Our study aimed to evaluate the effect of metroplasty performed in arcuate uteri on uterine artery Doppler velocimetry. STUDY DESIGN: We performed uterine artery Doppler velocimetry transvaginally before and after metroplasty in 36 women with arcuate uteri. Pulsatility indexes (PI) of uterine arteries were calculated and the presence or absence of a protodiastolic notch was evaluated. RESULTS: Comparing Doppler indexes before and after metroplasty, we found that uterine artery impedance improves as assessed by lower mean PI. We observed that PI after intervention was significantly lower compared with indexes before for mean Doppler index evaluations (mean uterine PI pre: 2.07+/-0.61 and post: 1.49+/-0.24 [p<0.03]). No differences were observed as regards bilateral protodiastolic notch absence or presence. A protodiastolic notch was present in 22 out of 36 women before metroplasty (61%), and a notch was observed in 19 out of 36 (52%) after metroplasty. CONCLUSIONS: Our results suggest that, metroplasty, as well as making the uterine cavity wider, leads to better uterine perfusion.     

A quantitative investigation of hemodynamic adaptation to pregnancy using uterine artery Doppler ultrasonography and finger photoplethysmography

Objective: Normal pregnancy is characterized by maternal hemodynamic adaptations of cardiovascular system and uterine artery. We aimed to investigate quantitatively the relationship between uterine artery Doppler (Ut AD) ultrasonography and finger photoplethysmography (PPG) in each of the three trimesters. Methods: Eighty normal pregnancy subjects were recruited from the nulliparous women with uncomplicated singleton pregnancy presenting for a routine ultrasound scan and divided into three groups according to their trimester. Comparative analysis were conducted between Ut AD ultrasonography and finger PPG within and across trimesters, particularly with focus on the relationship between Uterine Artery Resistance Index (UtA RI) and photoplethysmographic reflection index (PPG RI) throughout pregnancy. Additional 10 preeclampsia patients in third trimester were enrolled for comparison. Results: Both UtA RI and PPG RI were markedly decreased with gestation in normal pregnancy and generally consistent with each other in trend. The preeclampsia patients of third trimester were significantly higher in both indices, even more than normal pregnancy subjects of first trimester. Conclusions: The results of this study revealed clear relationship between UtA RI and PPG RI throughout pregnancy which could be exploited to enhance the potential ability in early recognition of pathophysiologic process in maternal adaptation and prediction of complicated pregnancy.     

The accuracy of transvaginal ultrasound and uterine artery Doppler in the prediction of adenomyosis

ObjectiveTo measure the accuracy of the ultrasonographic features in predicting adenomyosis and to determine if there is a role for uterine artery Doppler in adenomyosis prediction.Study designA prospective comparative study.SettingCairo University hospital.Materials and methodsThree hundred and fifty-two women who were scheduled for hysterectomy for various indications underwent preoperative transvaginal ultrasound scan (TVS) and uterine artery Doppler velocimetry in an attempt to diagnose adenomyosis. All the results were then correlated with histopathological results after hysterectomy.ResultsForty-eight participants were ultrasonographically diagnosed as having adenomyosis from which 37 patients were histologically confirmed. Both groups were comparable in age, but adenomyosis tend to occur in multiparas. We found that subendometrial linear striations, myometrial cysts’ number and poor endometrial delineation were significantly associated with adenomyosis. Sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of TVS for diagnosing adenomyosis were: 75.68%, 90.79%, 49.12%, 96.95% and 89.20%, respectively. Heterogenous myometrial echotexture was the most common ultrasonographic feature in adenomyotic cases. Neither uterine artery resistance index nor pulsatility index showed significant association with adenomyosis.ConclusionTVS is a potentially valuable tool in predicting adenomyosis especially when subendometrial linear echogenic striations, myometrial cysts, and poor endometrial delineations were found. However, uterine artery Doppler has no diagnostic values.     

Carriage of the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism does not influence the first and second trimester uterine artery Doppler flow

Objective

MTHFR C677T polymorphism is a genetic factor increasing both risk factors for atherosclerotic vascular diseases and obstetric complications like preeclampsia (PE) and fetal growth restriction (FGR). Increased uterine artery impedance, measured by uterine artery Doppler in the second trimester of pregnancy is also associated with PE and FGR. In this study we aimed to analyze whether MTHFR influences first and second trimester uterine artery impedance.

Study design

In a prospective, controlled, open, single center study of 1955 consecutive singleton pregnant women, smears from buccal gingival cells were analyzed for MTHFR by hybridisation on micro arrays. Uterine artery PI values and unilateral or bilateral diastolic notch were measured at 12 and 22 weeks of gestation. Statistical significance was calculated by the x²-test.

Results

MTHFR C677T polymorphism showed a normal distribution in our population. Mean uterine artery Doppler values and bilateral or unilateral notch occurrences from 1697 statistical evaluated women did not show significant differences in any MTHFR genotype (C/C, C/T, T/T) both at 12 or 22 weeks of gestation.

Conclusion

In summary, the data presented in this adequately powered, prospective, controlled study establish that the MTHFR C677T polymorphism does not influence Doppler flow measurements.     

Ophthalmic artery Doppler velocimetry in healthy pregnancy

OBJECTIVES: To establish normative data for ophthalmic artery Doppler parameters throughout a healthy pregnancy, to investigate the possible correlation between these Doppler measurements and gestational age, and to test intraobserver variability. METHODS: A prospective cross-sectional study was performed to assess various Doppler parameters in 276 healthy women between 20 and 39 weeks of gestation. The following measurements were obtained: pulsatility and resistance indices (PI, RI), peak systolic velocity (PSV), peak diastolic velocity (PDV), end diastolic flow velocity (EDFV), and peak ratio (PR). Quantile regression was used to estimate reference values throughout pregnancy and P<0.05 was considered significant. The intraclass correlation coefficient (Intra-CC) was used to calculate intraobserver variability. RESULTS: The 5th and 95th prediction intervals for each gestational age are presented. No significant correlation was detected between Doppler indices and gestational age. Intra-CC was excellent (0.996). CONCLUSIONS: Reference values were generated for ophthalmic artery Doppler measurements, and they did not vary significantly during healthy pregnancy.     

First trimester uterine artery Doppler for the prediction of preeclampsia and foetal growth restriction

Feasibility and reproducibility of uterine artery Doppler (UAD) at 11–14 gestational weeks was recently confirmed. Normal range values were established for resistance and pulsatility indexes. A body of evidence supports that the risk of developing preeclampsia or foetal growth restriction is highest when UAD impedance (evaluated by sus-mentioned indexes or uterine artery notch persistence) remains bilaterally high from first to second trimester, whereas the risk is lowest when UAD impedance is low from 11 to 14 gestational weeks. In unselected women, the sensitivity of 11–14 weeks-UAD is high but the positive predictive value is low, and data do not support its introduction as the sole predictive test. In models using maternal history and 11–14 weeks-UAD, the negative predictive value is high while abnormal UAD may identify a high proportion of women that will develop early-onset preeclampsia. Algorithms combining biochemical markers could still improve this prediction rate at higher cost and complexity.     

Color Doppler evaluation of blood flow changes in leiomyomas after uterine artery ligation.

OBJECTIVE: To detect possible changes in main blood vessels within leiomyomas after uterine artery ligation using color Doppler sonography. METHOD: Blood flow in main leiomyoma blood vessels was measured before and after the procedure in 14 women who also had abnormal uterine bleeding, pelvic pain or pressure, and/or anemia. RESULTS: Of the 14 patients, 13 reported complete disappearance of preoperative pain or pressure and 1 reported significant relief. Within 1 week to 4 months after uterine artery ligation, major blood flow within leiomyomas had significantly decreased in all patients. Eight months after the procedure, 1 of the women became pregnant. CONCLUSION: Laparoscopic uterine artery ligation via a lateral retroperitoneal technique is a safe and effective treatment for leiomyomas. Color Doppler sonography verified the ability of the procedure to diminish blood flow within leiomyomas in all patients.     

经阴道多普勒血流超声检查对子宫肌瘤血流动力学特点的研究

目的：研究子宫肌瘤患者的肌瘤血流及子宫动脉血流动力学特点。方法：对50例绝经前与10例绝经后子宫肌瘤患者（研究组）及21例绝经前与10例绝经后无子宫肌瘤者（对照组）进行经阴道多普勒血流超声检查。结果：研究组子宫动脉（UA）的搏动指数（PI）与阻力指数（RI）明显低于对照组（绝经前P＜0．01、P＜0．05；绝经后P＜0．05、P＜0．02）；收缩末期最大速度（A）和舒张末期速度（B）均高于各自的对照组，P＜0．001）；血流量（BFV）明显高于对照组（绝经前产＜0．002；绝经后P＜0．001）。绝经前有月经改变和无月经改变者的所有多普勒参数之间差异无显著性（P＞0．05），表明子宫体积、肌瘤体积与子宫动脉RI、BFV之间有高度相关性。此外，发现20％（10／50）绝经前肌瘤患者和60％（6／10）绝经后肌瘤患者的肌瘤假膜处血流RI＜0．40，术后病理学检查均证明为良性子宫平滑肌瘤。结论：本研究结果表明，绝经前、后子宫肌瘤患者UA及宫壁血管血流动力学均发生改变，BFV明显增加，RI值降低。     

Doppler ultrasound of the uterine artery in the prediction of severe complications during low-risk pregnancies

Aim The aim of this prospective study was to assess the role of uterine artery colour Doppler waveform analysis in the prediction of adverse pregnancy outcome such as preeclampsia, intrauterine growth retardation, placental abruption or a combination of outcome parameters.Methods Various uterine artery Doppler ultrasound parameters (RI>0.58, RI>0.7 and unilateral or bilateral notching) were tested. A second objective was to compare the predictive power of uterine artery Doppler ultrasound at 19–22 gestational weeks and 23–26 weeks gestation for an adverse pregnancy outcome.Results The mean time of delivery was 39+0 weeks of gestation. Eight newborns (2%) were delivered before 34 weeks of gestation. The mean birth weight was 3,240 g. Dystrophic fetuses (<10% percentile) were registered in 35 cases (10%). In 31 of the 346 women (9%) a cesarean section was performed because of abnormal fetal heart recording. Preeclampsia was diagnosed in 17 cases (5%). In 5 cases (1.4%) a placental abruption and 2 (0.6%) intrauterine fetal deaths were diagnosed. The sensitivity of notching for the prediction of preeclampsia was 88% and for the prediction of a severe pregnancy complication (preeclampsia and/or intrauterine growth retardation and/or intrauterine fetal death and/or placental abruption) at any gestational age was 62% with relative risks of 9.7 and 2.2, respectively. The sensitivity of notching for severe pregnancy complications requiring delivery before 34 weeks was 64% with a relative risk of 2.4. The sensitivity of notching in the uterine arteries for developing an IUGR was 56% with a relative risk of 1.7.Conclusion The predictive value of uterine artery Doppler for adverse pregnancy outcome in a low-risk population is of limited diagnostic value. Performing uterine artery Doppler studies at 23–26 weeks gestation instead of 19–22 weeks gestation increases the predictive value for adverse pregnancy outcomes.     

Factors Associated with Uterine Artery Doppler Anomalies in Patients with Preeclampsia

Uterine artery Doppler anomalies are associated with unfavorable outcomes in women with preeclampsia.?Objectives:?To examine the association between abnormal uterine artery Doppler and severity of preeclampsia.?Study Design:?Retrospective analysis of a population of 287 patients with preeclampsia who underwent a uterine artery Doppler velocimetric examination at the onset of preeclampsia, between 1996 and 2002. The population was classified into three groups: Group I had normal uterine artery Doppler findings; Group II had a high uterine artery resistance index; and, Group III had both high uterine artery resistance index and bilateral notches.?Results:?Compared to Group I, preeclampsia occurred earlier in Group II (76.3%) (p < 0.001), and HELLP syndrome was most frequent in Group III. The frequency of fetal growth restriction (£ 3^rd percentile) was different between groups (19.1, 32.4 and 49.7% in groups I, II and III, respectively). The perinatal death rate was significantly higher in group III than the other two groups (12.8% vs 2.9%, p < 0.01).?Conclusions:?In patients with preeclampsia, the presence of uterine artery Doppler anomalies (high resistance index with or without bilateral notches) was associated with unfavorable pregnancy outcomes.     

Maternal,fetal and perinatal characteristics of preeclampsia cases with and without abnormalities in uterine artery Doppler indexes

Abstract

Objective: To compare the maternal and fetal characteristics and perinatal outcome in mild and severe preeclampsia cases with and without uterine artery Doppler abnormalities.

Methods: Two hundred and fifty-nine mild and severe preeclampsia cases were evaluated retrospectively. Doppler measurements were done in the section where uterine artery raised from the hypogastric artery. Pulsatility index above the 95th percentile of the corresponding gestational age was accepted as abnormal.

Results: In mild and severe preeclampsia cases with abnormal Doppler (AD), the rate of intrauterine growth restriction, preterm birth and low birth weight was higher than, but the neonatal intensive care unit stay was similar to the cases with normal Doppler. Base excess was higher in the AD group, in mild and severe preeclampsia. The rate of low Apgar score at 5?min and perinatal mortality was higher in the AD group, in the mild preeclampsia. The strongest independent predictor of the perinatal morbidity and mortality was the presence of prematurity and of the prematurity was the presence of abnormal uterine artery Doppler.

Conclusions: Maternal and perinatal morbidity and perinatal mortality increase in mild to severe preeclampsia cases with abnormal uterine artery Doppler. The abnormal uterine artery Doppler increases the morbidity and mortality by increasing the risk of prematurity.