No abstract

No abstract

Chronic hypertension is frequently encountered during pregnancy and needs to be distinguished from other hypertensive complications of pregnancy, such as preeclampsia and gestational hypertension. The prevalence of this pregnancy complication is attributable to the increased prevalence of obesity and maternal age at childbearing. Women with chronic arterial hypertension are at increased risk for several pregnancy complications, including superimposed preeclampsia, caesarean delivery, preterm delivery <37 weeks gestation, birth weight <2500 g, neonatal unit admission, and perinatal death. Therefore, specialized attention should be given to these women as part of family planning before conception to provide counseling about the pregnancy risks, to inform about surveillance of fetal well-being, to determine the timing of delivery, and to optimize BP control before, during, and after birth.

BackgroundCyclic 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.MethodsFrom 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.ResultsThe 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.ConclusionsThe 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.