Uterine artery score and perinatal outcome

Hernández‐Andrade, Edgar; Brodszki, Jana; Lingman, Göran; Gudmundsson, Sæmundur; Molin, Johan; Maršál, Karel

doi:10.1046/j.1469-0705.2002.00665.x

Cited by 72 publications

(63 citation statements)

References 17 publications

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“…However, its contribution in the identification and follow-up of high-risk fetuses has not been deeply studied. Different authors reported an increased risk for abnormal perinatal outcomes in presence of increased uterine arteries PI, despite having a normal UA-PI [23]. …”

Section: Discussionmentioning

confidence: 99%

Changes in Central and Peripheral Circulation in Intrauterine Growth-Restricted Fetuses at Different Stages of Umbilical Artery Flow Deterioration: New Fetal Cardiac and Brain Parameters

Benavides-Serralde

Scheier²,

Cruz‐Martínez³

et al. 2011

Gynecol Obstet Invest

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Objective: To evaluate changes in central and peripheral circulation, including new and standard parameters of the fetal brain and heart in fetuses with intrauterine growth restriction (IUGR) in relation to progressive deterioration of the umbilical artery (UA). Methods: Seventy-two IUGR fetuses were studied longitudinally. IUGR was defined as an estimated fetal weight <10th centile for gestational age. Fetuses were classified according the UA pulsatility index (PI) as: group 1, normal UA-PI (<95th centile; <1.645 z-scores), group 2, UA-PI (≧95th centile and <99th centile; ≧1.645 and <3 z-scores), group 3, UA absent end-diastolic flow, and group 4, UA reversed end-diastolic flow. Middle cerebral artery (MCA), anterior cerebral artery segments 1 (ACA1) and 2 (ACA2), aortic isthmus blood flow index (IFI), modified myocardial performance index (Mod-MPI), ductus venosus (DV), renal artery (RA), femoral artery (FA) and amniotic fluid index (AFI) were weekly evaluated until delivery. Results: A total of 263 scans were performed (median, 3 (range: 1–23) per patient). There were 6 intrauterine and 2 neonatal deaths. Although all cerebral arteries showed a reduction in the PI, ACA1 showed the earliest vasodilatation. From group 2 onwards, all cerebral vessels had a similar pattern of vasodilatation. Mod-MPI became abnormal at group 1 with no further changes. IFI and DV became constantly abnormal starting from group 2. No changes in the RA-PI or FA-PI were documented. Conclusion: The process of hemodynamic deterioration in IUGR fetuses seems to be earlier represented by the ACA1 and the Mod-MPI. Signs of further deterioration were observed in the DV, IFI and MCA. The peripheral blood in the RA and FA did not show any change. AFI showed a late deterioration process.

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Section: Discussionmentioning

confidence: 99%

Changes in Central and Peripheral Circulation in Intrauterine Growth-Restricted Fetuses at Different Stages of Umbilical Artery Flow Deterioration: New Fetal Cardiac and Brain Parameters

Benavides-Serralde

Scheier²,

Cruz‐Martínez³

et al. 2011

Gynecol Obstet Invest

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“…However, number of studies proved that uterine artery Doppler useful even in the third trimester to identify adverse perinatal outcome. 7,8 The aim of present study was to investigate the association between third-trimester uterine artery Doppler assessment and adverse obstetric outcome.…”

Section: Introductionmentioning

confidence: 99%

Third trimester Doppler ultrasound as prediction of obstetric outcome in high-risk pregnancy, Gujarat, India

Ghosh

Oza

Meel

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Doppler ultrasound has emerged as beneficial tool in the assessment of the fetal and placental circulation and in the prediction of adverse pregnancy outcome. Umbilical artery Doppler has proved helpful to supervise the growth restricted fetuses and compromised vasculature as in hypertensive disorders high risk pregnancies. Objective of present study was to investigate the association between third-trimester uterine artery Doppler assessment and adverse obstetric outcome.Methods: This prospective study was done among 110 high risk pregnancies. Vessel like uterine artery, umbilical artery, middle cerebral artery and ductus venosus were studied in present study. Indices calculated: Peak systolic velocity, End diastolic velocity, Mean velocity, Systolic/diastolic ratio, Pulsatility index (PI) and resistance index (RI) of middle cerebral artery (MCA), Ductus venosus S/A ratio.Results: bilateral notch was present statistically significant (p<0.05) in 18.1% and absent in 28.2% among cases of adverse perinatal outcome. UA S/D ratio was >3 in 22.7% and <3 in 11.8% among cases of adverse perinatal outcome and findings were statistically significant (p<0.05). End diastolic velocity was reduced in statistically significant (p<0.05) in 9.1% and normal in 20.1% among cases of adverse perinatal outcome. MCA PI was <lower limit statistically significant (p<0.05) in 24.5% and >lower limit in 18.2% among cases of adverse perinatal outcome. MCA PI/UA PI ratio was <1 statistically significant (p<0.05) in 25.5% and absent in 17.3% among cases of adverse perinatal outcome.Conclusions: Increase in UA PI and decrease in MCA PI are early marker for detection of fetal compromise. Ratio of indices between MCA PI and UA PI reflects brain sparing effect as well as placental insufficiency and these are more specific in detection of IUGR than individual artery indices.

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“…Previous uterine artery Doppler studies during the third-trimester examined pregnancies presenting with PE or fetal growth restriction and reported that the outcome was worse if impedance to flow was increased [20,21,22,23,24,25,26]. Two previous screening studies at 30-33 weeks' gestation examined 4,855 pregnancies and reported that at FPR of 5% screening by a combination of maternal characteristics and uterine artery PI or MAP detected 49 and 57%, respectively, of intermediate PE requiring delivery at 34-37 weeks and 37 and 49% of late PE with delivery at ≥38 weeks [27,28].…”

Section: Discussionmentioning

confidence: 99%

Competing Risk Model in Screening for Preeclampsia by Mean Arterial Pressure and Uterine Artery Pulsatility Index at 30-33 Weeks' Gestation

Tayyar

Larroca²,

Poon

et al. 2014

Fetal Diagn Ther

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Objective: To assess risk for preeclampsia (PE) based on maternal characteristics, mean arterial pressure (MAP) and uterine artery pulsatility index (Ut-PI) at 30-33 weeks' gestation. Methods: Screening study in singleton pregnancies including 2,140 that subsequently developed PE and 83,615 that were unaffected by PE, gestational hypertension or delivery of small-for-gestational-age neonates (normal group). We developed a survival time model for the time of delivery for PE by combination of maternal characteristics and history with MAP and Ut-PI multiple of the median (MoM) values (biophysical test). Data on third-trimester MAP and Ut-PI were available in 350 cases of PE and 13,878 of the normal group. The detection rate of PE requiring delivery within 4, 6 and 8 weeks of the visit was estimated. Results: In pregnancies with PE the log₁₀ MoM values of MAP and Ut-PI were inversely related to gestational age at delivery. Biophysical testing detected 90, 65 and 53% of PE with delivery within 4, 6 and 8 weeks of the visit, at a fixed false-positive rate of 5%. Interpretation: Testing by maternal characteristics, Ut-PI and MAP at 30-33 weeks could identify 90% of pregnancies developing PE and requiring delivery within the subsequent 4 weeks.

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Uterine artery score and perinatal outcome

Abstract: In high-risk third-trimester pregnancies, Doppler velocity waveforms of the uterine arteries can be evaluated using the uterine artery score disregarding the placental location. The uterine artery score possesses a high predictive value regarding adverse perinatal outcome.

Cited by 72 publications

References 17 publications

Changes in Central and Peripheral Circulation in Intrauterine Growth-Restricted Fetuses at Different Stages of Umbilical Artery Flow Deterioration: New Fetal Cardiac and Brain Parameters

Changes in Central and Peripheral Circulation in Intrauterine Growth-Restricted Fetuses at Different Stages of Umbilical Artery Flow Deterioration: New Fetal Cardiac and Brain Parameters

Third trimester Doppler ultrasound as prediction of obstetric outcome in high-risk pregnancy, Gujarat, India

Competing Risk Model in Screening for Preeclampsia by Mean Arterial Pressure and Uterine Artery Pulsatility Index at 30-33 Weeks' Gestation

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