Blood flow velocity waveforms in large maternal and uterine vessels throughout pregnancy and postpartum: a longitudinal study using Duplex sonography

Baumann, Hans; Kirkinen, Pertti; Mueller, Robert A.; Schnarwyler, B.; Hugh, A.; Hugh, R.

doi:10.1111/j.1471-0528.1988.tb06819.x

Cited by 18 publications

(15 citation statements)

References 36 publications

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“…The findings of Baumann et al (1988) who observed a rapid increase of the Resistance Index in the arcuate arteries on the placental side after delivery, disagree with the results of Sohn and Stolz, who did not find any changes in Resistance Index 10 days before to ten days after scheduled date of parturition (Sohn & Stolz 1994). Prefumo et al (2004) observed a slightly higher Resistance Index of the uterine artery in parous compared to nulliparous women between week 18 and 23 of respective gestation (0.54 -0.56%).…”

Section: Discussioncontrasting

confidence: 55%

Permanently increased conductance of the murine uterine arcade after the first pregnancy

Wassel¹,

Kuhn²,

Gassmann³

et al. 2006

European Journal of Morphology

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Mechanical forces due to increased blood flow during the first pregnancy might induce a permanently higher conductance of the uterine arcade. Number of endothelial and smooth muscle cells, cross-sectional area and wall thickness of the uterine artery were measured in nulliparous mice (n = 11) and until the 93rd day after parturition in primiparous mice (n = 44). Inner diameter and wall area were calculated. Three months after the first pregnancy, uterine artery wall thickness was not altered compared to nulliparous mice. In contrast, inner diameter increased 1.6-fold, wall area 1.5-fold and the numbers of endothelial and smooth muscle cells increased 1.5 times. These changes were completely stable during the whole observation period. The increased blood flow during the first pregnancy might be a mandatory mechanical stimulus for uterine arcade maturation. This physiological maturation process could result in abortion explaining the higher prevalence of unexplained pregnancy losses in primiparous women.

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Section: Discussioncontrasting

confidence: 55%

Permanently increased conductance of the murine uterine arcade after the first pregnancy

Wassel¹,

Kuhn²,

Gassmann³

et al. 2006

European Journal of Morphology

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“…By prospectively studying SS patients from the third trimester through 6 weeks postpartum, we observed changes in uterine blood flow during this transition using noninvasive Doppler velocimetry. Our results are consistent with patterns previously reported using Doppler examination for the noninvasive study of physiologic and pathologic changes in the uterus and fetoplacental units in humans without SS disease [10][11][12]. In all of our patients, we observed progressively increased S/D ratios in the postpartum period and a return of the prediastolic notch by the 3rd postpartum week.…”

Section: Discussionsupporting

confidence: 82%

Postpartum Uterine-Artery Velocity Waveforms in Women with Sickle Cell Disease

Anyaegbunam

García²,

Mikhail³

1998

Gynecol Obstet Invest

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Objective: To investigate the changes in uterine Doppler velocimetry during the postpartum period in women with homozygous sickle cell (SS) disease and to correlate these findings with values in the third trimester and with neonatal outcomes. Methods: We studied the postpartum changes in uterine Doppler velocimetry in 16 women with SS disease in relation to third-trimester systolic/diastolic (S/D) ratios and neonatal outcome. All patients had repeated measures of uterine S/D ratios biweekly in the third trimester from 28 weeks of pregnancy until delivery, and at 24 h, and 3 and 6 weeks postpartum. Results: Overall the mean S/D ratio in the first 24 h for these 16 women was 2.72 ± 0.72 and increased progressively to a mean S/D ratio of 6.88 ± 0.96 at 6 weeks postpartum, with the reappearance of a diastolic notch by the 3rd postpartum week. Twelve women who had normal (≤2.6) uterine S/D ratios during pregnancy delivered appropriate-for-gestational-age (AGA) infants. The remaining 4 women had abnormal uterine S/D ratios, and in 3 of these pregnancies, small-for-gestational-age (SGA) infants were delivered. The mean S/D ratios for the subgroups with abnormal value at each of the three postpartum periods were significantly higher than for the 12 SS patients with normal third-trimester values. Postpartum S/D ratios for the 3 women with SGA births were also significantly higher at 24 h and 6 weeks postpartum when compared to SS patients with AGA infants. Conclusion: We concluded that postpartum S/D ratios are higher in women with SS disease that have abnormal values in the third trimester and that they are associated with SGA births. In SS patients the nonpregnant pattern of uterine artery velocity waveforms which reappears postpartum may reflect an increase in the uteroplacental circulatory impedence due to reversal of the alterations in the spiral arteries induced by trophoblastic invasion during pregnancy or subinvolution of the placental bed. Additional studies are needed to further elucidate these important hemodynamic changes in women with hemoglobinopathies and to identify patterns predictive of neonatal outcomes in these high-risk patients.

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“…The gravid uterus is relatively immobile and is not easily displaced by a tilt that is comfortable to the patient or to the operating surgeon [6]. Aortic compression may still be present even despite a tilt of 34° [5], but at a 30° tilt, the subject may slide off the inclined plane [13]. On the contrary, the displaced uterus in the left lateral position is likely to remain displaced when the patient is turned back into left lateral‐to‐tilt position, as demonstrated by the current study.…”

Section: Discussionmentioning

confidence: 99%

Effect of positioning from supine and left lateral positions to left lateral tilt on maternal blood flow velocities and waveforms in full‐term parturients

Kundra

Velraj²,

Amirthalingam

et al. 2012

Anaesthesia

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SummaryPositioning the parturient from supine to the left lateral tilt position (supine-to-tilt) may not effectively displace the gravid uterus, but turning from the left lateral position to the left lateral tilt position (left lateral-to-tilt) may keep the gravid uterus displaced and prevent aortocaval compression. Fifty-one full-term parturients were randomly placed in the left lateral position, supine-to-tilt and left lateral-to-tilt positions using a Crawford wedge. Femoral vein area, femoral vein velocity, femoral artery area, pulsatility index, resistance index and right arm mean arterial blood pressure and heart rate were recorded. Our results showed a lower mean (SD) femoral vein area ( ) and a higher femoral vein velocity (7.9 (1.2) vs 6.1 (1.6) cm.s ) with left lateral-to-tilt when compared with supine-to-tilt (all p < 0.001). Our results suggest that moving a full-term parturient from the full left lateral to the lateral tilt position may prevent aortocaval compression in full-term parturients more efficiently than when positioning the parturient from a supine to left lateral tilt position.

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Blood flow velocity waveforms in large maternal and uterine vessels throughout pregnancy and postpartum: a longitudinal study using Duplex sonography

Cited by 18 publications

References 36 publications

Permanently increased conductance of the murine uterine arcade after the first pregnancy

Permanently increased conductance of the murine uterine arcade after the first pregnancy

Postpartum Uterine-Artery Velocity Waveforms in Women with Sickle Cell Disease

Effect of positioning from supine and left lateral positions to left lateral tilt on maternal blood flow velocities and waveforms in full‐term parturients

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