Colour Doppler study of uterine artery between 10-14 weeks of gestation as a predictor of intra-uterine growth restriction and preeclampsia

Authors

  • Nupur Mittal Department of Obstetrics and Gynaecology, UP Rural Institute of Medical Sciences and Research, Saifai, UP, India
  • Pragyashree . Department of Obstetrics and Gynaecology, UP Rural Institute of Medical Sciences and Research, Saifai, UP, India
  • Priya Sharma Department of Obstetrics and Gynaecology, UP Rural Institute of Medical Sciences and Research, Saifai, UP, India
  • Soniya Vishwakarma Department of Obstetrics and Gynaecology, UP Rural Institute of Medical Sciences and Research, Saifai, UP, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20162666

Keywords:

Preeclampsia, IUGR, Uterine artery Doppler, Resistance index, Pulsatility index

Abstract

Background: Successful pregnancy is a result of countless ongoing interactions between the placental and the maternal immune and cardiovascular systems. Pre-eclampsia and intrauterine growth restriction (IUGR) remains important causes of maternal and neonatal morbidity and mortality. These conditions arise from placental insufficiency which can be seen as alterations in waveforms in the uterine artery (UtA) in early pregnancy. We investigated the predictive accuracy of UtA Doppler indices for both conditions in the first trimester early enough to provide a window for preventive interventions.

Methods: It was a prospective cohort study. (UtA) Doppler was carried out at 11-14 weeks in 100 singleton pregnancies attending for routine care. The right and left UtA were identified and velocity waveforms were obtained. Mean pulsatility index (PI), mean resistance index (RI) and diastolic notch were noted. Results were tabulated and analyzed.

Results: 18% developed Preeclampsia and 16% developed IUGR. The first trimester UtA mean RI and mean PI were significantly higher in patients who are destined to develop Preeclampsia and IUGR. No significant relationship was found between IUGR, Preeclampsia and diatolic notch. Mean RI is a better predictor of IUGR and Pre-eclampsia compared to Mean PI. Using receiver operating characteristics (ROC) curve, the best cut-off of mean RI to detect the Pre-eclampsia and IUGR is 0.68.

Conclusions: UtA Doppler at 11–14 weeks of gestation identifies a high proportion of women who will develop severe pre-eclampsia, and/or IUGR.

References

Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet. 2005;365:785-99.

Khan KS, Wojdyla D, Say L, Gulmezoqlu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367:1066-74.

Walker JJ. Pre-eclampsia. Lancet. 2000;356:1260-5.

Wen SW, Huang L, Liston R, Heaman M, Baskett T, Rusen ID, et al.; Maternal Health Study Group, Canadian Perinatal Surveillance System. Severe maternal morbidity in Canada, 1991-2001. CMAJ. 2005;173:759-64.

Roberts JM, Cooper DW. Pathogenesis and genetics of pre-eclampsia. Lancet. 2001;357:53-6.

Khong TY, De Wolf F, Robertson WB, Brosens I. Inadequate maternal vascular response to placentation in pregnancies complicated by pre-eclampsia and by small-for-gestational age infants. Br J Obstet Gynaecol. 1986;93:1049-59.

Pijnenborg R, Anthony J, Davey DA, Rees A, Tiltman A, Vercruysse L, et al. Placental bed spiral arteries in the hypertensive disorders of pregnancy. Br J Obstet Gynaecol. 1991;98:648-55.

Shanklin DR, Sibai BM. Ultrastructural aspects of pre-eclampsia I: Placental bed and boundary vessels. Am J Obstet Gynecol. 1989;161:735-41.

Pijnenborg R, Bland JM, Robertson WB, Brosens I. Uteroplacental arterial changes related to interstitial trophoblast migration in early human pregnancy. Placenta. 1983;4:397-413.

Kam EPY, Gardner L, Loke YW, King A. The role of trophoblast in the physiological change in decidual spiral arteries. Hum Reprod. 1999;14:2131-8.

Kaufmann P, Black S, Huppertz B. Endovascular trophoblast invasion: implications for the pathogenesis of intrauterine growth retardation and preeclampsia. Biol Reprod. 2003;69:1-7.

Campbell S, Griffin DR, Pearce JM, j Diaz- Recasens TE cohen-Overbeek, Wilson K, et al. New Doppler technique for assessing uteroplacental blood flow. Lancet. 1983;26:675-7.

Trudinger BJ, Giles WB, Cook CM. Uteroplacental blood flow velocity – time waveforms in normal and complicated pregnancy. Br J Obstet and Gynecol. 1985;92:39-45.

Ducey J. Complication of Hypertension in pregnancy based on Doppler Velocimetry. Am. J Obstet Gynecol. 1987;157:680-5.

Gomez O. Uterine artery Doppler at 11-14 weeks of gestation to screen for hypertensive disorders and associated complications in an unselected population. Human Reproduction. 2006;21(5):1295-8.

Martin AM, Bindra R, Curcio P, Cicero S, Nicolaides KH. Screening for pre-eclampsia and fetal growth restriction by uterine artery Doppler at 11-14 weeks of gestation. Ultrasound Obstet Gynecol. 2001;18:583-6.

Odibo AO, Zhong Y, Goetzinger KR, Odibo L, Bick JL, Bower CR, et al. First-trimester placental protein 13, PAPP-A, uterine artery Doppler and maternal characteristics in the prediction of pre-eclampsia. 2011;32(8):598-602.

Melchiorre K, Leslie K, Prefumo F, Bhide A, Thilaganathan B. First-trimester uterine artery Doppler indices in the prediction of small-for-gestational age pregnancy and intrauterine growth restriction. Ultrasound Obstet Gynecol. 2009;33:524-9.

Fratelli N, Rampello S, Guala M, Platto C, Frusca T. Transabdominal uterine artery Doppler between 11 and 14 weeks of gestation for the prediction of outcome in high-risk pregnancies. The Journal of Maternal-Fetal and Neonatal Medicine. 2008;21(6):403-6.

Schuchter K, Metzenbauer M, Hafner E, Philipp K. Uterine artery Doppler and placental volume in the first trimester in the prediction of pregnancy complications. Ultrasound Obstet Gynecol. 2001;18:590-2.

Dugoff L, Lynch AM, Cioffi-Ragan D, Hobbins JC, Schultz LK, Malone FD, et al. First Trimester Uterine artery Doppler Abnormalities predict subsequent intrauterine growth restriction. American Journal of Obstetrics and Gynecology. 2005;193:1208-12.

Carbillon L, Uzan M, Largilliere C. Prospective evaluation of uterine artery flow velocity waveforms at 12-14 and 22-24 weeks of gestation in relation to pregnancy outcome and birth weight. Fetal Diagn Ther. 2004;19:381-4.

Melchiorre K, Wormald B, Leslie K, Bhide A, Thilaganathan B. First-trimester uterine artery Doppler indices in term and preterm pre-eclampsia. Ultrasound Obstet Gynecol. 2008;32:133-7.

Downloads

Published

2017-01-11

Issue

Section

Original Research Articles