Doppler Sonography of Uterine Arteries at 20–23 Weeks: Depth of Notch Gives Information on Probability of Adverse Pregnancy Outcome and Degree of Fetal Growth Restriction in a Low-Risk Population

Abstract

Objective: Our purpose was to assess the relation between the depth of notch in the uterine arteries at 20–23 weeks and the incidence and severity of subsequent pregnancy complications. Methods: The Notch Index (NI) was defined as (C – D)/C, with C = postsystolic zenith and D = postsystolic nadir. For evaluation, the mean NI of the two uterine arteries was determined. Adverse pregnancy outcome was defined as presence of SGA ≤5th percentile, pre-eclampsia, preterm delivery <33 weeks, placental abruption or intrauterine or neonatal death. Women who received preventive treatment (Aspirin or low-molecular heparin) were excluded. Results: A notch was present in 957 of 15,888 singleton pregnancies (6.0%; unilateral = 4.37%, bilateral = 1.66%). The incidence of adverse pregnancy outcome was 5.3%; it increased from 4.6% for women without notch to 41.8% for those with a mean NI ≧0.2 and higher. Moreover, higher mean NI values tended to be associated with lower birth weight. In addition to the maternal age, parity, mean Pulsatility Index and presence of notch, the depth of notch made an additional significant contribution to the assessment of the probability of adverse pregnancy outcome. Conclusion: Besides the classic parameters such as maternal age, history of adverse pregnancy outcome, parity, impedance and the presence of notch, also the depth of notch seems to be valuable in the assessment of adverse pregnancy outcome risk. Especially in cases where very high or very low values of NI are measured, quantification of the depth of notch may give more information than the description of the presence of notch alone. This might be of value for future multivariate models for risk assessment of adverse pregnancy outcome.

Establishing reference values for mean notch depth index, pulsatility index and resistance index in the uterine artery at 16–23 weeks' gestation

“…Therefore, we believe that mNDI should be measured in additive to mPI, mRI and BN for increasing accuracy to predict placental diseases related with placental dysfunction. However, our cohorts were relative smaller numbers than those in recent clinical studies using the mPI; 3,4,6,14 therefore, our results should be validated in a larger cohort study.…”

Value of Doppler sonography near term: can umbilical and uterine artery indices in low-risk pregnancies predict perinatal outcome?

“…Furthermore, some studies indicated that the depth of the notch could predict the perinatal outcome. Becker and Vonk [3] found that deep notching in the uterine arteries at 20 -23 weeks was associated with adverse pregnancy outcome. In contrast, Ghosh et al [12] suggested that the uteroplacental vascular impedance was a better predictor than the presence of notching in the third trimester for adverse outcome of SGA suspected pregnancies.…”

Prevalence Alteration of Doppler Uterine Arteries Between Week 20 – 24 of Gestation in Low Risk Population

“…El presente estudio se planteó con la finalidad de establecer si hay cambios en la prevalencia de las alteraciones del Doppler de arterias uterinas en el segundo trimestre en pacientes categorizadas como bajo riesgo debido a que la población estudiada tiene diferencias sociodemográficas y de clasificación con respecto a los estudios previamente realizados (3,4,9).…”

“…Se considera alto riesgo obstétrico aquellas pacientes con: 1 factor de riesgo alto para trastornos hipertensivos asociados al embarazo o presencia de dos o más factores de riesgo moderados para esta condición, pacientes con puntuación ≥ 3 en la escala de Herrera y Hurtado o alto riesgo para trabajo de parto pre -término por presencia factores de riesgo reproductivos y ginecológicos (1,2). Las pacientes que no cumplen con los anteriores criterios son consideradas de bajo riesgo obstétrico; sin embargo, en la práctica clínica se observan desenlaces maternos o fetales adversos en esta población (3,4). En las poblaciones de bajo riesgo obstétrico se han visto desenlaces adversos como: preclampsia, restricción del crecimiento intrauterino, feto pequeño para la edad gestacional (FPEG), parto pretérmino < de 33 semanas, muerte fetal intrauterina y desprendimiento de placenta; todas estas, condiciones asociadas a la alteración en la invasión del trofoblasto (3,4,5,6).…”

“…Las pacientes que no cumplen con los anteriores criterios son consideradas de bajo riesgo obstétrico; sin embargo, en la práctica clínica se observan desenlaces maternos o fetales adversos en esta población (3,4). En las poblaciones de bajo riesgo obstétrico se han visto desenlaces adversos como: preclampsia, restricción del crecimiento intrauterino, feto pequeño para la edad gestacional (FPEG), parto pretérmino < de 33 semanas, muerte fetal intrauterina y desprendimiento de placenta; todas estas, condiciones asociadas a la alteración en la invasión del trofoblasto (3,4,5,6). En la literatura se ha reportado como el Doppler de arterias uterinas puede identificar la alteración en el proceso de placentación, mostrando desde una disminución del flujo sanguíneo en diástole hasta flujo reverso en los casos más severos (5,7).…”