Uterine artery Doppler ultrasound in second pregnancy with previous elective cesarean section*

Torabi, Sara; Sheikh, Mahdi; Masrour, Farzaneh Fattahi; Shamshirsaz, Alireza A.; Bateni, Zhoobin H.; Nassr, Ahmed A.; Pooransari, Parichehr; Talebian, Marzieh; Hantoushzadeh, Sedigheh

doi:10.1080/14767058.2018.1430132

Cited by 8 publications

(12 citation statements)

References 21 publications

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“…Moreover, a higher number of patients with increased uterine artery PI values and a higher rate of poor pregnancy outcomes were detected in the group with a history of previous cesarean sections. 13 The results of the study by Torabi et al is consistent with the present study. However, the study group of patients in their study consisted of women with one previous cesarean section and no subgroup analysis was performed regarding the number of previous cesarean sections and uterine artery Doppler PI values.…”

Section: Discussionsupporting

confidence: 93%

“…8 Recent studies have investigated the effect of previous cesarean sections on uterine artery Doppler indices in pregnant women, but contradictory results have been revealed. 9,10 To our knowledge, there is no study investigating the relationship between the number of previous cesarean sections and Doppler indices. In this study, we aimed to test the hypothesis that cesarean scarring may increase uterine artery Doppler indices, evaluate the relationship between the uterine artery Doppler indices and the number of previous cesarean sections and analyze its effect on pregnancy complications.…”

Section: Introductionmentioning

confidence: 99%

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Effect of previous cesarean sections on second‐trimester uterine artery Doppler

Işıkalan

Yeniçeri

Toprak

et al. 2020

J of Obstet and Gynaecol

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Aim In this study, we investigated the effects of previous cesarean sections on uterine artery Doppler indices. Methods This prospective cohort study included 153 healthy pregnant women between 18 and 24 weeks of gestation. Seventy‐three pregnant women without previous cesarean sections (control group) and 80 pregnant women with previous cesarean sections (study group) were compared in terms of uterine artery Doppler indices. Results The mean uterine artery pulsatility index (PI) MoM value was 1.18 ± 0.40 in the study group and 1.07 ± 0.35 in the control group (P = 0.046). The number of patients with uterine artery PI values above 95 percentile was 18 (22.5%) in the study group and 5(6.8%) in the control group (P = 0.007). The mean gestational age at birth was significantly lower in the study group (38.2 ± 1.3 vs. 39 ± 1.0, P < 0.001). There was no significant difference between the mean PI, resistance index (RI) and systolic/diastolic (S/D) ratio values of the uterine artery (P = 0.16, 0.11, 0.08, respectively). When the comparison was made with the number of previous cesarean sections, all three index values of the patients who had had more than two cesarean sections were found to be significantly higher. Conclusion The Doppler flow indices of the uterine artery significantly increased in patients with more than two previous cesarean sections. When evaluating uterine artery Doppler indices in pregnant women with a history of previous cesarean sections, these factors should be considered.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Effect of previous cesarean sections on second‐trimester uterine artery Doppler

Işıkalan

Yeniçeri

Toprak

et al. 2020

J of Obstet and Gynaecol

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“…Recent systematic review suggested that UtA-PIs are more consistent and may be more predictive if measured in the second trimester of pregnancy 29 . Therefore a previously published case–control study conducted between 18 and 22 weeks’ gestation that reported the mean ± standard deviation (SD) of UtA-PI in CD (n = 200) and NCD (n = 200) of 1.25 ± 0.4 and 1.16 ± 0.34, respectively ( p = 0.02) was chosen for calculation of sample size 23 . To be conservative, type I error was fixed at a maximum value of 5% and an 80% power, which gave an estimate of 269 participants required for the CD and NCD groups.…”

Section: Methodsmentioning

confidence: 99%

“…Parity, but not route of delivery in previous pregnancies, is an established confounder that needs to be adjusted for the first-trimester mean UtA-PI MoMs as per the FMF’s algorithm 21 , 22 . On the other hand, UtA Doppler measurements in the second (18–22 and 22–24 weeks’ gestation) and third (26–32 weeks’ gestation) trimester of pregnancy demonstrated a trend toward increased uterine vascular resistance in women with previous CD compared to those without previous CD (NCD) 23 – 25 . In theory, laceration or kinking of the UtAs from low-transverse uterine incision and suture repair at the level of uterine isthmus where the left and right UtAs are clinically interrogated as per a standardized technique may explain the consequent changes of UtA hemodynamics 17 .…”

Section: Introductionmentioning

confidence: 99%

Uterine artery Doppler indices throughout gestation in women with and without previous Cesarean deliveries: a prospective longitudinal case–control study

Yapan

Tachawatcharapunya

Surasereewong

et al. 2022

Sci Rep

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To determine whether a history of previous Cesarean delivery (CD) impacts uterine artery (UtA) Doppler indices throughout pregnancy. Women with and without CD (NCD) were prospectively enrolled for sequential assessments of the UtA mean/median pulsatility index (UtA-PI), resistance index (UtA-RI), and systolic/diastolic ratio (UtA-S/D) at 11–13 + 6, 14–19 + 6, 30–34 + 6, and 35–37 + 6 weeks’ gestation. Data from 269/269, 246/257, 237/254, and 219/242 CD/NCD participants from each gestational period were available for analysis. Multiples of the median (MoMs) of UtA Doppler indices showed biphasic temporal (Δ) pattern; with an initial dropping until the second trimester, then a subsequent elevation until late in pregnancy (p < 0.05). The measurements and Δs of the UtA indices between CD and NCD were not different (p > 0.05). Mixed-effects modelling ruled out effects from nulliparity (n = 0 and 167 for CD and NCD, respectively) (p > 0.05). History of CD neither influenced the measurements nor the temporal changes of the UtA Doppler indices throughout pregnancy. The biphasic Δs of UtA Doppler indices added to the longitudinal data pool, and may aid in future development of a more personalized prediction using sequential/contingent methodologies, which may reduce the false results from the current cross-sectional screening.

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“…This provides information that could formulate a causal hypothesis for the observed association. A case control study found that the uterine artery Doppler waveform between 18-22 weeks' gestation is more likely to be notched (14.5% vs. 6%, p<0.001) and have a higher average pulsatility index (1.25 vs 1.16, p<0.02) in women who had an elective CD compared to a VB 31 . Notably, women who had a prior CD also have a higher incidence of preeclampsia 32,33 .…”

Section: Implications (In Light Of Other Evidence)mentioning

confidence: 99%

Risk of stillbirth after a previous caesarean delivery: A Swedish nationwide cohort study

Khalaf

Heazell

Kublickas

et al. 2023

Preprint

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Objectives To investigate the risk of stillbirth in relation to; 1) a previous CD compared to those following a vaginal birth (VB); and 2) vaginal birth after caesarean (VBAC) compared to a repeat CD. Design Population-based cohort study. Setting The Swedish Medical Birth registry Population Women with their first and second singletons between 1982 and 2012. Methods Multivariable logistic regression models were performed to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) of the association between CD in the first pregnancy and stillbirth in the second pregnancy and the association between VBAC and stillbirth. Sub-group analyses were performed by types of CD and timing of stillbirth (antepartum and intrapartum). Main outcome measures Stillbirth (antepartum and intrapartum fetal death). Results Of the 1,771,700 singleton births from 885,850 women,117,114 (13.2%) women had a CD in the first pregnancy, and 51,755 had VBAC in the second pregnancy. We found a 37% increased odds of stillbirth (aOR:1.37 [95% CI, 1.23–1.52]) in women with a previous CD compared to VB. The odds of intrapartum stillbirth was higher in previous pre-labour CD group (aOR:2.72 [95% CI, 1.51–4.91]) than the previous in-labour CD group (aOR:1.35 [95% CI, 0.76–2.40,]), although not statistically significant in the latter case. No increased odds was found for intrapartum stillbirth in women who had VBAC (aOR:0.99 [95% CI, 0.48–2.06]) compared to women who had a repeat CD, whereas women with antepartum stillbirth were more likely to have a VBAC (aOR:4.49 [95% CI, 3.55–5.67]). Conclusions This study confirms that a CD is associated with an increased risk of subsequent stillbirth, with a greater risk among pre-labour CD. This association is not solely mediated by increases in intrapartum asphyxia, uterine rupture or attempted VBAC. Further research is needed to understand this association, but these findings might help health care providers to reach optimal decisions regarding mode of birth, particularly when CD is unnecessary.

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Uterine artery Doppler ultrasound in second pregnancy with previous elective cesarean section*

Abstract: CD seems to be associated with increased risks of impaired placental function and circulation and adverse pregnancy outcomes in the subsequent pregnancy, particularly in women with anteriorly located placenta near the previous uterine scar.

Cited by 8 publications

References 21 publications

Effect of previous cesarean sections on second‐trimester uterine artery Doppler

Effect of previous cesarean sections on second‐trimester uterine artery Doppler

Uterine artery Doppler indices throughout gestation in women with and without previous Cesarean deliveries: a prospective longitudinal case–control study

Risk of stillbirth after a previous caesarean delivery: A Swedish nationwide cohort study

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