Three-dimensional power Doppler imaging of ovarian stromal blood flow in women with endometriosis undergoing in vitro fertilization.

OBJECTIVE: The aims of this retrospective study were to investigate whether the quantification of ovarian stromal blood flow and/or leptin concentration are predictive of in vitro fertilization (IVF) outcomes in women after laparoscopic ovarian cystectomy for large endometriomas. METHODS: Twenty-two women undergoing IVF after laparoscopic surgery for ovarian endometriomas (> 6 cm) comprised the study group. Twenty-six women with tubal factor infertility constituted the control group. Ovarian stromal blood flow was evaluated by three-dimensional (3D) power Doppler ultrasound imaging using virtual organ computer-aided analysis (VOCAL( trade mark )). Serum and follicular fluid (FF) leptin concentrations were quantified using an enzyme-linked immunosorbent assay kit. RESULTS: There were significantly decreased ovarian stromal blood flow parameters (including vascularization index, flow index (FI), and vascularization flow index) in the endometriosis group without an evident difference in total ovarian volume on the day of human chorionic gonadotropin. The value of FF leptin demonstrated a negative correlation with ovarian stromal FI in the control group, but there was a loss of this effect in the endometriosis group. CONCLUSIONS: Quantification of ovarian stromal blood flow by 3D power Doppler ultrasound in women with endometriosis may provide an important prognostic indicator in those undergoing IVF.     

Sequential changes in uterine artery blood flow pattern between the first and second trimesters of gestation in relation to pregnancy outcome.

OBJECTIVE: To describe sequential changes in uterine artery waveform between the first and second trimesters of gestation and to analyze their association with the subsequent risk of hypertensive disorders and fetal growth restriction (IUGR). METHODS: Sequential uterine artery Doppler recordings were obtained in a final cohort of 870 singleton pregnancies over two gestational age intervals: 11-14 weeks and 19-22 weeks. The left and right uterine arteries were examined by color and pulsed Doppler and the mean pulsatility index (PI) as well as the presence of a bilateral protodiastolic notch were recorded during both intervals. Pregnancies were followed for occurrence of hypertensive disorders and IUGR. RESULTS: Mean uterine artery PI showed a significant linear decrease within each of the two intervals considered, while the prevalence of a bilateral notch showed decreasing values only throughout 11-14 weeks of gestation. Sixty-four (7.3%) pregnancies developed a hypertensive disorder and/or IUGR, including three (0.34%) cases of gestational hypertension, 24 cases of pre-eclampsia (2.75%) and 37 (4.25%) of IUGR. Compared with pregnancies with a normal outcome, complicated pregnancies showed a significantly higher prevalence of a bilateral notch and a higher mean PI in each of the two intervals studied. Compared with normal pregnancies, complicated pregnancies had a significantly higher persistence of a bilateral notch (30% vs. 8%), a higher proportion of women with an abnormal first-trimester uterine artery PI shifting to normal in the second trimester (14% vs. 4%) and a higher incidence of a normal first-trimester mean PI that shifted to abnormal in the second trimester (13% vs. 4%). Persistence of an abnormal mean PI from the first to the second trimester identified the group with the greatest risk for adverse perinatal outcome (OR, 10.7; 95% CI, 3.7-30.9). In addition, women in whom the uterine artery mean PI shifted from abnormal to normal between the two trimesters and women in whom the reverse shift occurred showed a similar intermediate risk (OR, 5; 95% CI, 2.1-10.6), comparable to that in women with persistence of a bilateral notch (OR, 5.6; 95% CI, 2.9-10.7). CONCLUSIONS: The sequence of changes in uterine flow between the first and second trimesters correlates with the subsequent development of hypertensive disorders and IUGR. Women with a persistent abnormal mean PI represent the group with the greatest risk for adverse perinatal outcome.     

Endovaginal doppler flow measurements of the ovarian artery in patients with a normal menstrual cycle and with polycystic ovary syndrome during in vitro fertilization

Women with a normal menstrual cycle (n = 21, controls), polycystic ovary syndrome (n = 10) and hypogonadotropic amenorrhea (n = 3) were stimulated with clomiphen-citrate (4th day to 8th day of the cycle) and with human menopausal gonadotropin (8th day to 11th day). The vascular impedance of the ovary carrying the dominant follicles was monitored by endovaginal pulsed Doppler flow measurement. Simultaneously, serum levels of LH, E₂ and 17-OHP were assayed. Contrary to controls, women with polycystic ovary syndrome or hypogonadotropic amenorrhea showed decreased hormone levels and no lowering of the vascular impedance. In controls, the lower pulsatility index is caused by neovascularization around the dominant follicle and by E₂-induced vasodilatation in the ovarian artery. © 1993 by John Wiley & Sons.     

Blood flow velocity in the uterine and ovarian arteries during the normal menstrual cycle.

Twelve healthy women with regular menstrual cycles were examined with a combination of two-dimensional real-time ultrasound and color and spectral Doppler techniques on cycle days 4 and 8 and daily from cycle day 12 until follicular rupture, then days + 1, +2, +5, +7 and +12 after follicular rupture. The uterine and subendometrial arteries, arteries in the ovarian stroma and hilum, in the wall of the largest follicle of each ovary, and in the wall of the corpus luteum were examined. The pulsatility index and the time-averaged maximum velocity were calculated. In the uterine arteries the pulsatility index was highest on day + 2, after which it decreased successively to its lowest value, whereas the time-averaged maximum velocity reached its highest value on day + 12. Similar changes were observed in the subendometrial arteries. In the non-dominant ovary, neither the pulsatility index nor the time-averaged maximum velocity manifested any consistent changes during the cycle. In the dominant ovary, the time-averaged maximum velocity increased and the pulsatility index decreased after follicular rupture, being significantly higher and lower, respectively, in the luteal than in the follicular phase. These changes were seen in the ovarian hilum, stroma and follicular wall, but were most obvious in the wall of the dominant follicle and of the corpus luteum. We conclude that the blood circulation in the uterus and in the dominant ovary changes considerably during the menstrual cycle, whereas that in the non-dominant ovary shows no unequivocal changes.     

腹腔镜下子宫血管阻断术联合子宫肌瘤剔除术对子宫和卵巢血流的影响研究

目的探讨腹腔镜下子宫血管阻断术联合子宫肌瘤剔除术治疗子宫肌瘤对子宫、卵巢血流的影响。方法将80例子宫肌瘤患者分成对照组和观察组,对照组行腹腔镜下子宫肌瘤剔除术,观察组行腹腔镜下子宫血流阻断术联合子宫肌瘤剔除术。比较两组患者手术前、术后6个月和术后12个月子宫动脉及卵巢动脉血流参数,包括收缩期最大血流速度(Vmax)、舒张末期最小血流速度(Vmin)、阻力指数(RI)和搏动指数(PI)。结果术后6个月、12个月,对照组和观察组子宫动脉Vmax、Vmin水平均低于术前,RI、PI均高于术前(P0.05)。与对照组相比,观察组术后各时间点子宫动脉Vmax、Vmin均明显下降,RI和PI均明显升高(P0.05)。两组患者手术前、术后6个月和术后12个月卵巢动脉血流参数Vmax、Vmin、RI、PI比较差异均无统计学意义(P0.05)。结论腹腔镜下子宫血流阻断术联合子宫肌瘤剔除术能降低子宫血供,对卵巢血流无明显影响。     

子宫动脉栓塞期间卵巢动脉返流的分析

目的:探讨子宫动脉与卵巢动脉之间的交通特点,防止栓塞剂逆流造成误栓形成永久性闭经。材料与方法:75例子宫肌瘤病人在栓塞治疗前血管造影有22例出现造影剂逆流入卵巢动脉,占29.33%。结果:22例造影卵巢动脉逆流的病人中,子宫肌瘤的平均缩小率为34%,小于患子宫肌瘤而造影中无卵巢动脉返流的平均缩小率47%。4例(18.18%)卵巢动脉部分性栓塞而闭经。其中3例为暂时性(13.64%),1例(4.55%)为永久性。结论:子宫动脉栓塞存在卵巢动脉逆流造成永久性闭经的可能。     

Changes in endometrial thickness, width, length and pattern in predicting pregnancy outcome during ovarian stimulation in in vitro fertilization.

OBJECTIVE: To determine whether the clinical features of the endometrium as observed by transvaginal high resolution sonography are predictive of pregnancy outcome in in vitro fertilization cycles. PATIENTS AND METHODS: One hundred and forty-five patients undergoing in vitro fertilization were included in this prospective controlled study. Endometrial thickness, width, length, growth and pattern during the follicular and early luteal phases of stimulated cycles were assessed using transvaginal ultrasound by an operator who was blinded to the protocol of stimulation and to the type of assisted reproductive technology treatment. The relationship between these findings and embryo implantation and pregnancy outcome was examined. RESULTS: There were no significant differences in endometrial thickness, width, length, growth and pattern in conception compared to non-conception cycles. The endometrial growth and its pattern transformation during the stimulation did not influence the pregnancy outcome. CONCLUSION: The endometrial features as assessed by transvaginal ultrasound do not provide significant prognostic information with regard to the outcome of in vitro fertilization.     

卵巢动脉收缩期峰速度与卵巢反应性关系的研究

目的:探讨卵巢动脉收缩期峰值血流速度(PSV)对卵巢反应性的预测价值.方法:185例排卵障碍拟行促排卵患者,阴道彩色B超测卵巢动脉PSV并以均教16.56 cm/s分成两组:Ⅰ组＞16.56 cm/s 89例,Ⅱ组≤16.56 cm/s 96例.两组均给予克罗米芬联合尿促性腺激素(HMG)和戊酸雌二醇治疗,比较两组月经第3天血清促卵泡激素(FSH)、黄体生成素(LH)、雌二醇(E2)、催乳素(PRL)、睾酮(T)、始基卵泡数、绒毛膜促性腺激素(HCG)日平均卵泡E2水平、优势卵泡出现周期、＞14 mm卵泡数、子宫内膜的厚度、HMG用量和周期妊娠率.结果:两组月经第3天FSH、LH、E2、PRL、T和始基卵泡数差异无显著性(P＞0.05);Ⅰ组HCG注射日平均卵泡E2水平、子宫内膜厚度、优势卵泡周期、＞14 mm卵泡数均高于Ⅱ组(P＜0.05);Ⅰ组HMG的用量低于Ⅱ组(P＜0.01),两组的妊娠率和防OHSS取消周期无明显差异(P＞0.05).结论:卵巢动脉PVS是有效预测卵巢反应性的指标.     

脐动脉血流变化对估计脐带绕颈胎儿预后的价值

目的:探讨脐动脉血流变化对估计脐带绕颈胎儿预后的价值。方法:选取2003年1~9月足月妊娠妇女46例,其中观察组34例,均为脐带绕颈1周并经阴道分娩。结合胎儿预后将观察组分为胎窘组(10例)和正常组(24例)。对照组12例,为随机选择的同期正常妊娠并顺产的妇女。应用彩色多普勒超声技术对全部孕妇于临产前和活跃早期检测胎儿脐动脉阻力指标——收缩期峰值流速/舒张末期流速(S/D)、阻力指数(RI)和搏动指数(PI)。结果:①临产前胎儿UA血流S?蛐D、RI、PI值,胎窘组、正常组分别与对照组比较,差异均无显著性(P>0.05)。②活跃早期宫缩期和间歇期,胎儿UA血流S?蛐D、RI、PI值,胎窘组、正常组分别与对照组比较,差异均无显著性(P>0.05)。结论:产前及活跃早期监测脐动脉血流变化不是预测脐带绕颈胎儿不良预后的理想方法。     

Clinical significance of uterine artery blood flow velocity waveforms during provoked uterine contractions in high-risk pregnancy.

OBJECTIVE: To determine whether, in a group of high-risk pregnancies undergoing an oxytocin challenge test (OCT), uterine artery Doppler velocimetry will identify fetuses at risk of distress during the provoked contractions. METHODS: Bilateral uterine artery Doppler velocimetry was performed simultaneously with electronic fetal heart rate (FHR) recordings in 67 high-risk pregnancies subjected to an OCT. Flow velocity waveforms (FVWs) were classified according to pulsatility index (PI), presence of diastolic notching and a novel classification of FVW shapes. The OCT was classified as negative (normal) or positive (late FHR decelerations). Only OCT-negative cases were allowed a trial of vaginal delivery. Non-parametric statistical methods were used to test for differences between the OCT groups. RESULTS: There was no difference in prevalence of high PI or diastolic notching in OCT-positive (n = 10) and OCT-negative (n = 57) cases at basal (resting) measurements or between uterine contractions in either uterine artery (P > or = 0.3). During contractions the PI could not be used for assessment due to the biphasic shape of the FVWs, but there was no difference in distribution of FVW classes between the groups in either the placental side (P > or = 0.3) or contraplacental side (P > or = 0.6) uterine artery. No significant associations between PI or FVW class distribution and birth asphyxia or operative delivery for fetal distress in labor were found (P > or = 0.1). CONCLUSIONS: During uterine contractions there is no difference in uterine artery FVW pattern between OCT-positive and OCT-negative cases. Recording of uterine artery FVWs during the OCT seems to be of limited clinical relevance.     

Color Doppler sonographic analysis of uterine and ovarian artery blood flow in women with polycystic ovary syndrome

PURPOSE: To study the blood flow patterns of utero-ovarian circulation in polycystic ovary syndrome (PCOS) and to assess their relationship with clinical, metabolic, and hormonal data. METHODS: Forty-three women with PCOS and 43 age-matched healthy controls underwent Doppler examination of the utero-ovarian circulation in the follicular phase. Demographic, hormonal, and metabolic parameters were determined. Student's t-test, chi(2)-test, and Spearman correlation test were used for statistical analysis. RESULTS: The ovarian artery pulsatility index (PI), resistance index (RI), and SD ratios were significantly lower in PCOS than in controls on the right side (p < 0.001, p = 0.02, p = 0.001, respectively) as well as on the left side (p < 0.001, p < 0.001, p < 0.001, respectively). The uterine artery systolic/diastolic (S/D) ratio was higher on both sides (p = 0.01) and the PI was higher on the left side (p = 0.02) in PCOS than in controls. The right uterine artery PI was positively correlated with luteinizing hormone and hemoglobin (r = 0.417, p = 0.043; r = 0.427, p = 0.033, respectively), the right uterine artery S/D was positively correlated with body mass index (r = 0.479, p = 0.015), and the left uterine artery PI was positively correlated with insulin (r = 0.458, p = 0.021). CONCLUSION: Doppler sonography of the utero-ovarian circulation may contribute to the evaluation of PCOS patients and a better understanding of the pathophysiology of this syndrome.     

卵巢间质动脉血流动力学指标预测体外受精周期卵巢反应性的价值

目的 探讨卵巢间质动脉血流动力学指标预测体外受精周期卵巢反应性和最佳时间点.方法 选取68例因不孕症行体外受精控制性超促排卵治疗的患者,分别收集其周期降调日、周期第1天、第7天、第10天及人绒毛膜促性腺激素(hCG)注射日卵巢间质动脉血流动力学指标,包括收缩期最大血流速度(PSV)、舒张末期血流速度(EDV)、搏动指数...     

Blood flow velocity in the uterine and ovarian arteries during menstruation.

Eleven healthy women with regular menstrual cycles were examined with a combination of two-dimensional real-time ultrasound and color and spectral Doppler techniques on the 7th day after follicular rupture, and on the 1st, 2nd, 3rd and 4th days of menstrual bleeding. Both uterine arteries, arteries in the stroma and hila of both ovaries, in the wall of the largest follicle of the non-dominant ovary and in the wall of the corpus luteum were examined with the Doppler technique. The pulsatility index (PI) and the time-averaged maximum velocity were calculated. In the uterine arteries, the PI was highest on the first day of menstrual bleeding (median PI 3.2 for the dominant and 3.0 for the non-dominant uterine artery), after which it decreased to its lowest values on the second day (median PI 2.1 and 1.8, respectively) and third day (median PI 2.2 and 2.1, respectively). The time-averaged maximum velocity reached its highest value on the second and third days of menstruation. The corpus luteum was still visible on the first day of menstrual bleeding in all women, and on the second day in five. It was indistinguishable on the third and fourth days of menstruation in all women. In the dominant ovary, the time-averaged maximum velocity of flow in the arteries in the ovarian hilum decreased during menstrual bleeding and was lower during menstruation than in the preceding luteal phase. In the non-dominant ovary, neither the PI nor the time-averaged maximum velocity manifested any consistent changes during the period studied. We conclude that substantial changes in PI and time-averaged maximum velocity occur in the uterine arteries and in the arteries of the dominant ovary during menstruation.     

Doppler-derived umbilical artery absolute velocities and their relationship to fetoplacental volume blood flow: a longitudinal study.

OBJECTIVES: To construct reference ranges for serial measurements of the umbilical artery (UA) absolute blood flow velocities in the second half of pregnancy and to test the hypothesis that significant associations exist between UA velocities and placental volume blood flow assessed from umbilical vein blood flow velocities and diameter. METHODS: This was a prospective longitudinal study of the umbilical circulation. UA absolute velocities and umbilical vein blood flow were measured at 4-weekly intervals between 19 and 42 weeks' gestation in 130 low-risk singleton pregnancies. A total of 511 observations were used to construct the reference ranges and assess the association between UA absolute velocities and placental volume flow using multilevel modeling. RESULTS: Both UA absolute velocities and placental volume blood flow showed a steady increase throughout the second half of pregnancy. However, the gestational age-related increase in the UA end-diastolic velocity (EDV) was greater than the corresponding increase in the peak systolic velocity (PSV). The time-averaged intensity-weighted mean velocity (TAWMV)/time-averaged maximum velocity (TAMXV) was 0.6 indicating probably not a completely parabolic velocity profile. There was a significant positive association (P < 0.00001) between UA absolute velocities and placental volume blood flow, but this association was modified by the gestational age. The intraobserver coefficients of variation for the UA PSV, EDV, TAMXV and TAWMV and placental volume blood flow were 10.17%, 16.29%, 11.46%, 18.18% and 8.61%, respectively. CONCLUSION: We have established new reference ranges for the UA absolute velocities based on longitudinal data. They show a significant association with fetoplacental volume blood flow and may have a clinical value in the assessment of the umbilical circulation.     

经阴道彩色多普勒超声对生育期妇女正常月经周期子宫、卵巢动脉血流动力学的研究

目的观察健康生育期妇女子宫、卵巢动脉在正常月经周期中血流动力学变化规律与特点,以作为判断临床疾病的血流参数.方法应用经阴道彩色多普勒超声分别于月经周期的卵泡发育期、卵泡成熟期、黄体期及黄体萎缩期观察测定子宫动脉、卵巢动脉收缩期峰值流速、舒张末期流速、S/D值及血流阻力指数(RI).结果子宫动脉黄体萎缩期血流阻力指数最低(RI为0.76±0.08),与卵泡发育期、卵泡成熟期及黄体期比较差异有非常显著性意义(P＜0.001).卵巢动脉黄体期血流阻力指数最低(RI为0.49±0.08),与卵泡发育期、卵泡成熟期及黄体萎缩期比较差异有显著性意义(P＜0.05),黄体萎缩期血流阻力指数最高(RI为0.56±0.08).结论健康生育期妇女子宫、卵巢动脉在正常月经周期中血流呈周期性变化,其血供状态与其功能状态密切相关.     

Fetal cerebral and umbilical artery blood flow changes during pregnancy complicated by malaria.

The objectives of our study were to quantify the fetal cerebral artery and umbilical artery blood flow changes daily during a malaria crisis in a pregnant patient and evaluate the sensitivity and the specificity of Doppler indices for the prediction of acute fetal distress at the end of the pregnancy. The study, designed as a prospective and observational one, was carried out in the obstetric department of a government hospital in French Guiana, on 23 women with pregnancies complicated by malaria (age range, 23 +/- 5 years; primiparas, 30%); crisis date: 30.8 +/- 2.5 weeks of gestation; start of treatment: 3.7 +/- 1.3 days after crisis started). The main measures of outcome consisted of daily determinations of fetal Doppler indices during the crisis, evidence of fetal distress (fetal heart rate decelerations) during labor, Apgar scores after birth, gestational age at birth, mode of delivery, and birth weight. During the crisis umbilical artery resistance index increased by 5 to 20% (P < 0.05), cerebral artery resistance index decreased by 5 to 20% (P < 0.05), and CURR decreased by 10 to 35% (P < 0.01), indicating flow redistribution toward the brain. No relationship was found between the CURR value and the following data: parasitemia grade, parity, gestational age of the crisis, date and mode of delivery, and fetal weight. A change in the hypoxia index (% change in CURR during the crisis x number of days of crisis) greater than 150 was associated with abnormal fetal heart rate in 75% of the cases, and a hypoxia index lower than 150 was associated with normal fetal heart rate in 90% of the cases (sensitivity, 89%; specificity, 77%). Lastly, the combination (hypoxia index > 150 and CURR < 1) was associated with abnormal fetal heart rate in 80% of the cases, and one or two of these normal parameters were associated with normal fetal heart rate in 84.6% of the cases (sensitivity, 80%; specificity, 84%). The CURR and the hypoxia index during the malaria crisis can be used to predict acute fetal distress at delivery.     

Comparison of uterine and spiral artery blood flow in women with unexplained and tubal infertility.

OBJECTIVE: To evaluate the possible difference in uterine and spiral artery impedance to blood flow among women with unexplained and tubal infertility during spontaneous and gonadotropin-stimulated cycles. METHODS: We prospectively compared uterine and spiral artery pulsatility index and peak systolic velocity in a longitudinal study in women with either unexplained infertility (n = 20) or tubal infertility (n = 18). Measurements of uterine and spiral artery impedance were taken on days 11-12, 16-17 and 21-23 of the spontaneous cycle and on days 1, 5 and 10 during gonadotropin stimulation. In addition, measurements were taken on the days of oocyte pick-up and embryo transfer. RESULTS: A clinical pregnancy was achieved in 8/20 (40%) women with unexplained and 6/18 (33.3%) women with tubal infertility with in-vitro fertilization treatment. There were no differences in the uterine artery pulsatility index or peak systolic velocity during the spontaneous or the in-vitro fertilization cycle between the two groups. The impedance to blood flow in the uterine or spiral artery did not differ between women conceiving with in-vitro fertilization-embryo transfer and those who did not. However, the spiral artery pulsatility index on the 5th day of gonadotropin stimulation was significantly lower among women with unexplained infertility (0.96 +/- 0.25) compared to women with tubal infertility (1.24 +/- 0.30; P < 0.05), but on the other days of gonadotropin stimulation the spiral artery pulsatility index and peak systolic velocity were similar. CONCLUSIONS: Impaired uterine or spiral artery blood flow is not an important factor in unexplained infertility.     

初产妇子宫动脉频谱多普勒超声表现与妊娠期高血压疾病的关系及对妊娠结局的影响

目的探讨初产妇子宫动脉血流阻力指数(RI)、舒张早期切迹与妊娠期高血压疾病的关系及对妊娠结局的影响。方法选择妊娠20周初产妇632例,测量双侧子宫动脉RI,计算其均值,并观察舒张早期切迹;其中483例RI≤0.58为RI正常组1,149例RI>0.58于妊娠26周再次测量,75例RI≤0.58为RI正常组2,49例RI>0.58为RI异常组。结果 RI正常组1和RI正常组2高血压疾病的发生率差异无统计学意义,故将两组合并为RI正常组。RI异常组的高血压疾病发生率和不良妊娠结局的发生率高于RI正常组。妊娠26周时,有舒张早期切迹的产妇妊娠期高血压疾病及子痫前期、子痫的发生率分别是66.7%、13.3%,高于无切迹者(P<0.05)。结论初产妇子宫动脉RI增高是早期发现妊娠期高血压的一项较敏感指标。     

Correlations in umbilical blood flow Doppler velocities in the human fetus during breathing.

We hypothesized that changes in intrathoracic pressure during fetal breathing episodes result in quantifiable variations in umbilical arterial and venous blood flow velocities, and that these variations are related to compliance properties of each system. We further hypothesized that these variations in velocities are different in fetuses with normal and abnormal umbilical arterial Doppler velocities. Umbilical arterial and venous Doppler velocities were measured simultaneously during breathing episodes in 15 normal fetuses and 14 fetuses with elevated systolic-to-diastolic (S/D) umbilical arterial Doppler velocity ratios. Umbilical arterial end-diastolic velocity changes were less than umbilical venous velocity changes in normal fetuses, but were significantly greater in four fetuses with elevated S/D ratios (p < 0.004). Furthermore, umbilical arterial diastolic velocity minima preceded umbilical venous velocity minima by a time lag that was greater in fetuses with elevated S/D ratios (p < 0.002). These results suggest that differences in umbilical arterial and venous velocity variation during fetal breathing episodes may be related in part to vascular compliance, which may be altered in fetuses with abnormal umbilical arterial Doppler velocity.