Transvaginal uterine and umbilical artery Doppler examination of 12–16 weeks and the subsequent development of pre‐eclampsia and intrauterine growth retardation

Abstract

We aimed to determine whether Doppler measurements obtained from the uterine and umbilical arteries in early pregnancy correlate with the subsequent development of pre-eclampsia, or the delivery of a small-for-gestational-age (SGA) baby. A follow-up study was carried out in 652 women with singleton pregnancies who had transvaginal uterine and umbilical artery Doppler examinations performed at 12-16 weeks' gestation. Measurements included: the presence or absence of an early diastolic notch, vessel diameter, resistance index (RI), pulsatility index (PI), time-averaged mean velocity (TAV), maximum systolic velocity and volume flow in the right and left uterine arteries and RI and PI in the umbilical arteries. The main outcome measures were: intrauterine death, birth weight, pre-eclampsia (proteinuric pregnancy-induced hypertension, PPIH) and antepartum hemorrhage. Twelve pregnancies terminated in the second trimester, and in 14 the outcome is unknown. In the remaining 626 women, 44 (7.0%) pregnancies ended in a premature delivery, 30 (4.7%) women developed PPIH, 60 (9.6%) infants were SGA (< 10th centile), of which 19 were < 5th centile and five were < 3rd centile, and 23 (3.7%) women suffered an antepartum hemorrhage. At 12-16 weeks, 205 (32.7%) women had bilateral (right and left) notching of the uterine artery waveforms. When compared to values from women with a normal pregnancy outcome, women who subsequently developed PPIH demonstrated a significant difference in mean uterine artery TAV (24.6 cm/s for PPIH vs. 33.25 cm/s for normal outcome, p < 0.003), volume flow (120.5 ml/min vs. 184.5 ml/min, p < 0.001) and elevated resistance (mean RI = 0.80 vs. 0.695, p < 0.001). In women with bilateral notching, there were significant differences between values for pregnancies with PPIH (odds ratio (OR) 42.02, 95% confidence interval (CI) 5.66, 311.99), being SGA at birth (OR 8.61, 95% CI 4.0, 20.0) or delivering prematurely (OR 2.38, 95% CI 1.19, 4.75), compared with pregnancies with a normal outcome. We conclude that abnormal Doppler values, indicative of a failure to modify the uterine circulation in early pregnancy, are associated with premature delivery, the development of PPIH and the delivery of an SGA baby. This information may be of value in increasing our understanding of the pathophysiological events that lead to the subsequent development of uteroplacental complications such as pre-eclampsia.

Prediction of Pre-Eclampsia by a Combination of Maternal History, Uterine Artery Doppler, and Mean Arterial Pressure (A Prospective Study of 200 Cases)

“…Harringon et al [13] compared the uterine artery mean Doppler values obtained from pregnancies that resulted in appropriate for gestational age (AGA) babies and those which resulted in delivery of SGA babies. The mean PI, in Table 1 Mean, 5th, 50th, and 95th percentiles for the mean uterine artery pulsatility index (Ut.API) between 22 and 24 ?…”

First‐trimester sonographic umbilical cord diameter and the growth of the human embryo

“…This phenomenon may in part be explained by the progressive disintegration of the spiral arteries as a consequence of trophoblastic invasion and in part by the increasing diameter of the umbilical vessels. Moreover, an increased umbilical artery resistance to blood flow has been noted in patients who develop a pregnancyrelated hypertensive disorder in comparison with patients with a normal pregnancy course 15 . In our experience 37% of embryos whose mother subsequently developed preeclampsia had an umbilical cord diameter early in pregnancy of at least 2 standard deviations below the mean.…”

Evaluation of Early Pregnancy Failure with Ultrasound

“…However, the use of Doppler in the late first trimester may become a more useful tool in predicting other developing placental diseases like pre-eclampsia and molar pregnancies. 50,[53][54][55][56][57][58][59][60] Even evaluation of the corpus luteum size and morphology has been investigated to predict early pregnancy failure. Unfortunately, little reliable correlation was found between corpus luteum volume or morphology and hormone (estradiol, progesterone and 17-hydroxyprogesterone) levels.…”