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Doppler Uterine Artery Flow Velocimetry in Prediction of Preterm Labor
Mahyar Mohammadi Fard,Alireza Mirgholami,Masoud Pezeshki Rad
Iranian Journal of Radiology , 2009,
Abstract: "nIntroduction: To evaluate the role of Doppler waveforms of the uterine vessels in predicting preterm labor. "nMaterials and Methods: This was a retrospective analysis of the uterine artery Doppler findings of 28 15-25 week singleton pregnancies with a spontaneous preterm labor were compared to 326 pregnancies delivered at term. 354 women who presented to our medical center from April 20, 2008 to November 20, 2008 were enrolled in the study. Pulsed-wave Doppler measurements were made of the maternal uterine arteries. These women were followed up until delivery. "nResults: The uterine artery mean resistance index (RI) was 0.76 and 0.66 in the preterm and term delivery groups, respectively (P < 0.05). Bilateral diastolic notches were present in 41% of the preterm deliveries and 27% of the controls (P < 0.05). The mean pulsatility index (PI) was 1.40 and 1.83 (46%) in the term and preterm delivery groups, respectively (P < 0.05). "nConclusion: Doppler of the uterine vessels could prove to be a good predictor of preterm labor. "nKey words: premature labor, prenatal diagnosis, uterus blood supply, pregnancy, ultrasound, color Doppler.
Colour Doppler Study of Umbilical Artery in Antenatal Women with Severe Preeclampsia and Foetal Outcome  [PDF]
Yadlapalli Indiramani, V. Ratnakumari, B. Jyothirmayi
Open Journal of Obstetrics and Gynecology (OJOG) , 2016, DOI: 10.4236/ojog.2016.62016
Abstract: Hypertensive disorders are the most common medical complications of pregnancy (7.15%). Doppler analysis of umbilical artery S/D ratio PI and RI, absent or reversal of EDV were evaluated and follow up results studied in severe preeclampsia women between 26 to 40 weeks. Doppler analysis of Uterine Artery and Middle Cerebral Artery is also studied. Doppler study guides in decision making and follows up in severe preeclampsia and guides in reducing perinatal morbidity and mortality. Period of Study: This is a prospective randomised study conducted at Niloufer Hospital for Women and Children Red Hills Hyderabad from September 2011 to June 2014. Material and Methods: 100 pregnant women with severe preeclampsia who attended Antenatal Out-Patient Department and got admitted in Emergency ward underwent Umbilical artery velocimetry by means of a Colour doppler vision (6000 Toshiba corp Tokyo Japan) using 3.5_5 MHZ Trasabdominal traducer. Results: Total number of 100 women were studied. In this 60 women had foetuses with abnormal umbilical artery flow velocimetry and 40 had normal umbilical artery flow velocimetry. The average birth weight and diagnosis to delivery interval were lower in foetuses with abnormal umbilical artery doppler. Admission to neonatal intensive care unit is high. The APGAR score at 1 minute is <7 in 20 women with abnormal umbilical artery doppler compared to 17 women with normal umbilical artery doppler. Compared to 32 women with normal umbilical artery doppler, the APGAR score is more than 7 in 31 women with abnormal umbilical artery Doppler. P = 0.639647 and chi-square statistic = 0.2192, the result is statistically not significant at p-value < 0.05, implying that APGAR scores are not dependent on doppler findings alone. Conclusion: Doppler study guides obstetrician to assess the physiological status of the foetus and it helps in identifying the changes in the foetal circulation. This study suggests that doppler assessment of foe to placental circulation including umbilical artery is a better prognostic indicator in severe PE and helps in timely intervention. The foetuses with normal artery flow velocimetry area at a lower risk of having poor APGAR score than those with abnormal velocimetry and NICU admissions are less with normal umbilical artery flow velocimetry. The average birth weight of neonates with abnormal umbilical artery was lower compared to neonates with normal umbilical artery velocimetry.
Correlation between the Doppler velocimetry findings of the uterine arteries during the first and second trimesters of pregnancy
Liao, Adolfo Wenjaw;Toyama, Julio;Costa, Verbênia;Ramos, Carla;Brizot, Maria;Zugaib, Marcelo;
Revista da Associa??o Médica Brasileira , 2009, DOI: 10.1590/S0104-42302009000200026
Abstract: objectives: evaluate the feasibility of transvaginal uterine artery doppler examination in the first and second trimesters of pregnancy, establish reference ranges in a brazilian population and examine the correlation between these doppler findings. methods: longitudinal prospective study at the antenatal clinic of a tertiary teaching hospital. uterine artery doppler examinations were carried out transvaginally at 11 to 14 weeks and 20 to 25 weeks of gestation. uterine artery mean pulsatility index (pi) distributions were determined and the presence or absence of an early diastolic notch was also noted. the degree of correlation between first and second trimester doppler findings was examined. results: three hundred and forty four women with live singleton pregnancies and normal outcome were first examined at a mean gestation of 12.7 weeks. the values corresponding to the 50th and 95th centiles of mean pi were 1.69 and 2.48. bilateral notches were observed in 44% of cases and unilateral notches were present in 19%. second trimester doppler examinations were carried out at a mean gestation of 23.2 weeks and corresponding figures for the 50th and 95th centiles were 1.03 and 1.57. bilateral notches were noted in 4.4% of the cases. first trimester impedance indices were significantly higher and positively correlated to second trimester findings (r = 0.42, p<0.0001). conclusion: uterine artery doppler examination can be successfully performed transvaginally and incorporated into scans that are routinely offered to women during their antenatal care in the first and second trimesters. doppler indices obtained during the first trimester are significantly higher than those of the second trimester and findings at both scans are significantly correlated.
Maternal History and Uterine Artery Doppler in the Assessment of Risk for Development of Early- and Late-Onset Preeclampsia and Intrauterine Growth Restriction  [PDF]
Elisa Llurba,Elena Carreras,Eduard Gratacós,Miquel Juan,Judith Astor,Angels Vives,Eduard Hermosilla,Ines Calero,Pilar Millán,Bárbara García-Valdecasas,Lluís Cabero
Obstetrics and Gynecology International , 2009, DOI: 10.1155/2009/275613
Abstract: Objective. To examine the value of one-step uterine artery Doppler at 20 weeks of gestation in the prediction pre-eclampsia (PE) and/or intrauterine growth restriction (IUGR). Methods. A prospective multicentre study that included all women with singleton pregnancies at 19–22 weeks of gestation (w). The mean pulsatility index (mPI) of both uterine arteries was calculated. Receiver-operating characteristics curves (ROC) were drawn to compare uterine artery Doppler and maternal risk factors for the prediction of early-onset PE and/or IUGR (before 32 w) and late-onset PE and/or IUGR. Results. 6,586 women were included in the study. Complete outcome data was recorded for 6,035 of these women (91.6%). PE developed in 75 (1.2%) and IUGR in 69 (1.1%) cases. Uterine Doppler mPI was 0.99 and the 90th centile was 1.40. For 10% false-positive rate, uterine Doppler mPI identified 70.6% of pregnancies that subsequently developed early-onset PE and 73.3% of pregnancies that developed early-onset IUGR. The test had a lower detection rate for the late-onset forms of the disease (23.5% for PE and 30% for IUGR). Maternal history has a low sensitivity in the detection of early-onset cases, although it is better at detecting late-onset PE. Conclusion. Uterine artery Doppler and maternal risk factors seem to select two different populations - early and late-onset PE which might suggest a different pathogenesis.
A comparative study of folate and vitamin B12 serum levels in preeclamptic versus normotensive pregnant women in correlation with uterine and umbilical artery Doppler findings and pregnancy outcome  [cached]
Ahmed Mahmoud,Eman A. Elkattan,Ashraf A. Eldaly,Eman F. Omran
Journal of the Turkish-German Gynecological Association , 2009,
Abstract: Objective: To detect the serum levels of folate and B12 in both preclamptic and normotensive pregnant women and to determine whether there is any relation between these levels with the uterine and umbilical artery Doppler indices as well as the pregnancy outcome.Material and Methods: This case controlled study comprised 79 pregnant patients with preeclampsia and 113 healthy, normotensive pregnant women with singleton pregnancies at gestational ages ranging from 34- 40 weeks. Patients were not obese (BMI<30) and did not suffer from chronic hypertension, chronic renal or liver disease nor diabetes mellitus. Serum folate and B12 were detected in all cases. They were also subjected to a Doppler study of both the uterine and umbilical arteries. Serum folate and B12 blood levels as well as the Doppler study indices (RI and PI) were compared in both groups.Results: The serum folate level was significantly lower in preeclamptic patients than normal pregnant women (p<0.001). It was significantly correlated to uterine artery Doppler indices (RI and PI) and negatively correlated to umbilical artery Doppler indices (RI and PI). Low serum folate was significantly correlated to poor maternal outcome. Low serum folate was also significantly correlated to poor perinatal outcome.Serum B12 level was not significantly different in preeclamptic patients from the control group (P value=0.14).Conclusion: Serum folate was significantly lower in preeclamptic pregnant women with a significant correlation to increased uterine and umbilical RI, PI and poor maternal and neonatal outcome.
Valor de la flujometría Doppler de arterias uterinas para la predicción de algunas complicaciones en gestantes con hipertensión arterial crónica Value of uterine artery Doppler flowmetry for the prediction of some complications in pregnant women with chronic arterial hypertension  [cached]
Martha Mohamed Abdelaziz,Alfredo Nodarse Rodríguez,José María Pérez Penco,Tamara Pouymiró Beltrá
Revista Cubana de Obstetricia y Ginecolog?-a , 2007,
Abstract: La hipertensión arterial crónica (HTAc) durante la gestación se asocia con un incremento del riesgo de preeclampsia y restricción del crecimento fetal (RCIU). Con el objetivo de evaluar el valor de la flujometría Doppler de las arterias uterinas a las 24 semanas en la predicción de estas complicaciones, se realizó un estudio prospectivo y descriptivo en 222 gestantes con HTAc atendidas en el Hospital Ramón González Coro de Ciudad de La Habana. Se estudió la asociación entre la presencia de muesca diastólica después de las 24 semanas, el índice de pulsatilidad (IP) y la relación sístole/diástole (S/D) anormales; con la ocurrencia de RCIU y preeclampsia, se determinó la sensibilidad, especificidad, valor predictivo positivo (VPP) y negativo (VPN) de la prueba para estos eventos. La sensibilidad de la muesca diastólica para la aparición de RCIU fue del 78,6 % y el VPN del 98,4 %, mientras que para la preeclampsia los valores fueron 64 % y 94,1 % respectivamente. El IP anormal, tuvo una sensibilidad del 85,7 % y un VPN de 98,9 % para la predicción de la aparición de RCIU; mientras que para la preeclampsia los valores fueron de 71,0 % y 95,0 %, respectivamente. La S/D anormal tuvo una sensibilidad de 64,3 % y un VPN de 96,3% en la predicción de RCIU; y para la aparición de preeclampsia, los valores fueron de 58,1 % y de 90,4 % respectivamente. Los VPN elevados indican el valor del Doppler de las arterias uterinas en la predicción de la ausencia de resultados adversos en gestantes con HTAc. Chronic arterial hypertension (CAH) during pregnancy is associated with an increased risk of preeclampsia and intrauterine growth restriction (IUGR). In order to evaluate the value of the uterine artery Doppler flowmetry at 24 weeks in the prediction of these complications, a prospective and descriptive study was conducted among 222 pregnant women with chronic arterial hypertension that received attention at Ramón Gonzalaez Coro Hospital, in Havana City. The association between the presence of diastolic notch at 24 weeks, the pulsatility index (PI), and the abnormal S/D ratio was studied The sensitivity, specificity, positive predictive value (PPV) and negative predicitive value (NPV) of the test for IUGR and preeclampsia were determined. The sensitivity of the diastolic notch for the appearance of IURG was 78.6 % and the NPV was 98.4 %, whereas for eclampsia, the values were 64 % and 94.1 %, respectively. The abnormal PI had a sensitivity of 85.7 % and a NPV of 98.8 % for the predicition of the appearance of IUGR. As to eclampsia, the values were 71.0 % and 95.0 %, respec
Velocimetría Doppler de la arteria uterina como factor de predicción de preeclampsia y crecimiento fetal restringido
Quintero,Janeth; Villamediana,Julio; Paravisini,Iván; Brito,Julio; Cadena,Luis;
Revista de Obstetricia y Ginecología de Venezuela , 2002,
Abstract: objective: to determine the usefulness of uterine artery doppler ultrasound in the prediction of pre eclampsia or fetal growth restriction, in low risk women. method: uterine arteries doppler screening was performed in 100 pregnant women, since 26 week. a systolic/diastolic index was calculated from each uterine artery and the presence or absence of a notch was determined. systolic/diastolic index > 2.7 or notch was defined as abnormal. all patients were followed to birth and main outcome measures were preeclampsia and fetal growth restriction. setting: high risk obstetric, prenatal service at "concepcion palacios" maternity hospital. results: eight women (8%) developed preeclampsia and eight women (8%) developed fetal growth restriction. the sensitivity and specificity of bilateral notch for preeclampsia and fetal growth restriction was: 62,5%, 92,2% and 85,7%, 93,4% respectively. the sensitivity and specificity of abnormal systolic/diastolic index for preeclampsia and fetal growth restriction was: 37,5%, 94,5% and 87,5%, 98,9% respectively. conclusion: uterine artery doppler waveform analysis is useful in the prediction of preeclampsia and fetal growth restriction in low risk women.
Abnormal Doppler flow velocimetry in the growth restricted foetus as a predictor for necrotising enterocolitis.  [cached]
Bhatt A,Tank P,Barmade K,Damania K
Journal of Postgraduate Medicine , 2002,
Abstract: BACKGROUND: Obstetric decision- making for the growth restricted foetus has to take into consideration the benefits and risks of waiting for pulmonary maturity and continued exposure to hostile intra-uterine environment. Necrotising Enterocolitis (NEC) results from continued exposure to hostile environment and is an important cause of poor neonatal outcome. AIMS: To evaluate the predictive value of abnormal Doppler flow velocimetry of the foetal umbilical artery for NEC and neonatal mortality. SETTINGS AND DESIGN: A retrospective study carried out at a tertiary care centre for obstetric and neonatal care. MATERIALS AND METHOD: Seventy-seven neonates with birth weight less than 2000 gm, born over a period of 18 months were studied. These pregnancies were identified as having growth abnormalities of the foetus. Besides other tests of foetal well-being, they were also subjected to Doppler flow velocimetry of the foeto-placental vasculature. Obstetric outcome was evaluated with reference to period of gestation and route of delivery. The neonatal outcome was reviewed with reference to birth weight, Apgar scores and evidence of NEC. STATISTICAL ANALYSIS USED: Chi square test. RESULTS: In the group of patients with Absent or Reverse End Diastolic Frequencies (A/R EDF) in the umbilical arteries, positive predictive value for NEC was 52.6%, (RR 30.2; OR 264). The mortality from NEC was 50%. When umbilical artery velocimetry did not show A/REDF, there were no cases of NEC or mortality. Abnormal umbilical or uterine artery flow increased the rate of caesarean section to 62.5% as compared to 17.6% in cases where umbilical artery flow was normal. CONCLUSION: In antenatally identified pregnancies at risk for foetal growth restriction, abnormal Doppler velocimetry in the form of A/REDF in the umbilical arteries is a useful guide to predict NEC and mortality in the early neonatal period.
Effect of lycopene in prevention of preeclampsia in high risk pregnant women  [cached]
Ramalingappa Antartani,Kiran Ashok
Journal of the Turkish-German Gynecological Association , 2011,
Abstract: Objective: To evaluate the effect of pre-natal supplementation of antioxidant Lycopene in prevention of pre-eclampsia in the high risk pregnant women. We also assessed the effect of lycopene supplementation on intra-uterine growth restriction and the perinatal outcome in women at high risk of developing pre-eclampsia.Materials and Methods: A total of 54 women between 14-28 weeks of pregnancy who were at high risk of developing pre-eclampsia were considered for the study. Inclusion criteria were women with a previous history of preeclampsia, a growth-retarded fetus, perinatal death, multifetal gestation and chronic hypertension. Of the total of 54 women, 30 women were randomized to receive Lycopene in a dose of 2 mg twice daily starting from the date of entry and were instructed to continue the drug regularly until delivery. The other 24 women were randomized to the control group and they did not take lycopene. The controls were matched to cases with respect to the risk factors for the development of preeclampsia. Both groups were followed at monthly intervals. In addition, a Doppler assessment for evidence of intrauterine growth retardation was done at around 28 wks of gestation. Data regarding development of preeclampsia, period of gestation during delivery, mode of delivery, fetal weight and perinatal outcome were recorded and subjected to statistical analysis.Results: Of the 30 women randomized to receive the drug, ten women were lost to follow-up. Thus only 20 women in the treatment group completed the study. All the 24 women in the control group completed the study. Lycopene was not found to decrease the incidence of pre-eclampsia in high risk women. Women in the lycopene supplementation group had significantly lesser incidence of growth restricted babies and had a significantly better perinatal outcome compared to women in the placebo group.Conclusion: Lycopene supplementation does not decrease the incidence of preeclampsia in high risk women. However lycopene supplementation does seem to help in reducing the incidence of intra-uterine growth restriction.
Velocimetría Doppler de la arteria uterina como factor de predicción de preeclampsia y crecimiento fetal restringido
Janeth Quintero,Julio Villamediana,Iván Paravisini,Julio Brito
Revista de Obstetricia y Ginecología de Venezuela , 2002,
Abstract: Objetivo: Determinar la utilidad del Doppler en la arteria uterina para la predicción de preeclampsia y crecimiento fetal restringido en una población de bajo riesgo. Método: Se realizó Doppler en las arterias uterinas a partir de la semana 26 en 100 embarazadas. Un índice sístole/diástole > 2,7 o la incisura diastólica fue definido como anormal. La preeclampsia o el crecimiento fetal restringido fueron los parámetros principalmente evaluados en cuanto a pronóstico. Ambiente: Consulta de alto riesgo obstétrico del Servicio Prenatal de la Maternidad "Concepción Palacios". Resultados: Ocho pacientes (8%) desarrollaron preeclampsia e igual número desarrolló crecimiento fetal restringido. La sensibilidad y especificidad de la incisura bilateral para predecir preeclampsia y crecimiento fetal restringido fue: 62,5%, 92,2% y 85,7%, 93,4% respectivamente. La sensibilidad y especificidad del índice sístole/diástole anormal en la predicción de preeclampsia y crecimiento fetal restringido fue: 37,5%, 94,5% y 87,5%, 98,9% respectivamente. Conclusión: El Doppler de la arteria uterina es útil en la predicción de preeclampsia o crecimiento fetal restringido. Objective: To determine the usefulness of uterine artery Doppler ultrasound in the prediction of pre eclampsia or fetal growth restriction, in low risk women. Method: Uterine arteries Doppler screening was performed in 100 pregnant women, since 26 week. A systolic/diastolic index was calculated from each uterine artery and the presence or absence of a notch was determined. Systolic/diastolic index > 2.7 or notch was defined as abnormal. All patients were followed to birth and main outcome measures were preeclampsia and fetal growth restriction. Setting: High risk obstetric, prenatal service at "Concepcion Palacios" Maternity Hospital. Results: Eight women (8%) developed preeclampsia and eight women (8%) developed fetal growth restriction. The sensitivity and specificity of bilateral notch for preeclampsia and fetal growth restriction was: 62,5%, 92,2% and 85,7%, 93,4% respectively. The sensitivity and specificity of abnormal systolic/diastolic index for preeclampsia and fetal growth restriction was: 37,5%, 94,5% and 87,5%, 98,9% respectively. Conclusion: uterine artery Doppler waveform analysis is useful in the prediction of preeclampsia and fetal growth restriction in low risk women.
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