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Buskmiller C, Fishel Bartal M, Bonilla M, Denham C, Nguyen R, Sibai B, Pedroza C, Hernandez-Andrade E. First trimester anatomy ultrasound for patients with obesity: a randomized controlled trial. Am J Obstet Gynecol MFM 2023; 5:101143. [PMID: 37669739 DOI: 10.1016/j.ajogmf.2023.101143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/14/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Second-trimester ultrasound is the standard technique for fetal anatomy evaluation in the United States despite international guidelines and literature that suggest that first-trimester timing may be superior in patients with obesity. First-trimester imaging performs well in cohorts of participants with obesity. OBJECTIVE Our aim was to compare the completion rate of a first-trimester fetal anatomy ultrasound scan with that of a second-trimester fetal anatomy ultrasound scan among pregnant people with a body mass index ≥35 kg/m2. STUDY DESIGN This randomized controlled trial enrolled participants with a body mass index ≥35 kg/m2 with a singleton gestation and who presented before 14+0/7 weeks of gestation. Participants were randomized to receive an ultrasound assessment of anatomy at either 12+0/7 to 13+6/7 weeks or at 18+0/7 to 22+6/7 weeks. The primary outcome was completion rate (percentage of scans that optimally imaged all the required fetal structures). Secondary outcomes included the necessity of a transvaginal approach, completion rates for each individual view, number of anomalies identified and missed in each group, scan duration, and patient perspectives. A 1-year pilot sample was analyzed using Bayesian methods for the primary outcome with a neutral prior and frequentist analyses for the remaining outcomes. RESULTS A total of 128 participants were enrolled, and 1 withdrew consent; 62 subjects underwent a first-trimester ultrasound scan and 62 underwent a second-trimester ultrasound scan. A total of 2 participants did not attend the research visits, and 1 sought termination of pregnancy. In the first-trimester group, 66% (41/62) of ultrasound scans were completed in comparison with 53% (33/62) in the second-trimester ultrasound group (Bayesian relative risk, 1.20; 95% credible interval, 0.91-1.73). When compared with a second-trimester scan plus a follow-up ultrasound, a first-trimester ultrasound plus a second-trimester ultrasound was equally successful in completing the anatomy views (76%). First-trimester anatomy ultrasound scans required a transvaginal approach in 63% (39/62) of cases and had a longer duration than a second-trimester ultrasound scan. No anomalies were missed in either group. First-trimester ultrasound participants who responded to a survey described that they were very satisfied with the technique. CONCLUSION In pregnant subjects with a body mass index ≥35 kg/m2, a single first-trimester anatomy ultrasound scan was more likely to obtain all the recommended anatomic views than a single second-trimester ultrasound scan. An evaluation of anatomy at 12+0/7 to 13+6/7 weeks' gestation plus an evaluation at 18+0/7 to 22+6/7 led to complete anatomic evaluation 4 weeks earlier than 2 second trimester scans. Assessment of ultrasound duration in a clinical setting is needed to ensure feasibility outside of a research setting.
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Affiliation(s)
- Cara Buskmiller
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Drs Buskmiller and Fishel Bartal, Mr Bonilla, Mses Denham and Nguyan, and Drs Sibai and Hernandez-Andrade).
| | - Michal Fishel Bartal
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Drs Buskmiller and Fishel Bartal, Mr Bonilla, Mses Denham and Nguyan, and Drs Sibai and Hernandez-Andrade); Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr Fishel Bartal)
| | - Miguel Bonilla
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Drs Buskmiller and Fishel Bartal, Mr Bonilla, Mses Denham and Nguyan, and Drs Sibai and Hernandez-Andrade)
| | - Chloe Denham
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Drs Buskmiller and Fishel Bartal, Mr Bonilla, Mses Denham and Nguyan, and Drs Sibai and Hernandez-Andrade)
| | - Rachel Nguyen
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Drs Buskmiller and Fishel Bartal, Mr Bonilla, Mses Denham and Nguyan, and Drs Sibai and Hernandez-Andrade)
| | - Baha Sibai
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Drs Buskmiller and Fishel Bartal, Mr Bonilla, Mses Denham and Nguyan, and Drs Sibai and Hernandez-Andrade)
| | - Claudia Pedroza
- Center for Clinical Research and Evidence-Based Medicine, The University of Texas Health Science Center at Houston, Houston, TX (Dr Pedroza)
| | - Edgar Hernandez-Andrade
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX (Drs Buskmiller and Fishel Bartal, Mr Bonilla, Mses Denham and Nguyan, and Drs Sibai and Hernandez-Andrade)
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The effect of uterine and spiral artery Doppler velocimetry in predicting miscarriage in threatened miscarriage patients. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.889709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ahn H, Cruz-Martinez R, Hernandez-Andrade E. Variation in the uterine arteries Doppler parameters when obtained transvaginally or transabdominally at different sampling locations. J Matern Fetal Neonatal Med 2021; 35:5709-5716. [PMID: 33657961 DOI: 10.1080/14767058.2021.1892062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION To evaluate differences in Doppler velocimetry parameters when the uterine arteries (UtA) are evaluated transabdominally (TA) at different sampling locations and transvaginally (TV). MATERIALS AND METHODS Five hundred and fifty-seven pregnant women were evaluated between 11 and 39 weeks of gestation. The mean UtA pulsatility index (PI) and prevalence of bilateral notching were obtained at four different locations: (1) TA just above the crossing with the iliac artery; (2) TA just below the crossing with the iliac artery; (3) TA well above approximately 3 cm away from the crossing with the iliac artery; and (4) TV at the point closest to the internal cervical os. Measurements obtained just above the external iliac artery were considered the standard for comparison. Differences among different locations per gestational week were calculated. RESULTS The mean UtA-PI and prevalence of bilateral notching were similar when the uterine arteries were sampled TA just above or just below the crossing with the external iliac artery. The mean UtA-PI values and prevalence of bilateral notching were significantly higher (p < .0001) when obtained TV and significantly lower when obtained 3 cm above the crossing with the external iliac artery (p = .004), as compared to the standard plane just above the crossing. CONCLUSION The mean UtA-PI and prevalence of bilateral notching vary significantly when the uterine arteries are sampled far above the crossing with the external iliac artery or when obtained transvaginally.Key MessageThe predictive performance of the uterine arteries during pregnancy can significantly vary in relation to the approach selected for evaluation and to the location of the Doppler sampling gate.
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Affiliation(s)
- Hyunyoung Ahn
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Edgar Hernandez-Andrade
- Fetal Medicine Research Center, Fetal Medicine México, Querétaro, México.,Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
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Zwertbroek EF, Groen H, Fontanella F, Maggio L, Marchi L, Bilardo CM. Performance of the FMF First-Trimester Preeclampsia-Screening Algorithm in a High-Risk Population in The Netherlands. Fetal Diagn Ther 2021; 48:103-111. [PMID: 33401268 DOI: 10.1159/000512335] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 08/03/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the performance of the first-trimester Fetal Medicine Foundation (FMF) screening algorithm, including maternal characteristics and medical history, blood pressure, pregnancy-associated plasma protein A and placenta growth factor, crown rump length, and uterine artery pulsatility index, for the prediction of preeclampsia in a high-risk population in the Netherlands. METHODS This is a prospective cohort including nulliparous women and women with preeclampsia or intrauterine growth restriction in previous pregnancy. We screened patients at 11-14 weeks of gestation to calculate the risk for preeclampsia. The primary outcome was preeclampsia and gestational age at delivery. Performance of the model was evaluated by area under the receiver operating characteristic (ROC) curves (AUCs) and calibration graphs; based on the ROC curves, optimal predicted risk cutoff values for our study population were defined. RESULTS We analyzed 362 women, of whom 22 (6%) developed preeclampsia. The algorithm showed fair discriminative performance for preeclampsia <34 weeks (AUC 0.81; 95% CI 0.65-0.96) and moderate discriminative performance for both preeclampsia <37 weeks (AUC 0.71; 95% CI 0.51-0.90) and <42 weeks (AUC 0.71; 95% CI 0.61-0.81). Optimal cutoffs based on our study population for preeclampsia <34, <37, and <42 weeks were 1:250, 1:64, and 1:22, respectively. Calibration was poor. CONCLUSIONS Performance of the FMF preeclampsia algorithm was satisfactory to predict early and preterm preeclampsia and less satisfactory for term preeclampsia in a high-risk population. However, by addressing some of the limitations of the present study, the performance can potentially improve. This is essential before implementation is considered.
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Affiliation(s)
- Eva F Zwertbroek
- Obstetrics & Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands,
| | - Henk Groen
- Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Federica Fontanella
- Obstetrics & Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Luana Maggio
- Obstetrics & Gynaecology, Ospedale Buccheri la Ferla FBF Palermo, Palermo, Italy
| | - Laura Marchi
- Obstetrics & Gynaecology, Azienda Unità Sanitaria Locale Toscana Centro, City Hospital, Prato, Italy
| | - Caterina M Bilardo
- Fetal Medicine, University Medical Centre, University of Groningen, Groningen, The Netherlands.,Fetal Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Spiral artery blood flow during pregnancy: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2020; 20:680. [PMID: 33176723 PMCID: PMC7656690 DOI: 10.1186/s12884-020-03150-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 07/31/2020] [Indexed: 11/10/2022] Open
Abstract
Background Downstream remodeling of the spiral arteries (SpA) decreases utero-placental resistance drastically, allowing sustained and increased blood flow to the placenta under all circumstances. We systematically evaluated available reports to visualize adaptation of spiral arteries throughout pregnancy by ultra-sonographic measurements and evaluated when this process is completed. Methods A systematic review and meta-analysis of spiral artery flow (pulsatility index (PI), resistance index (RI) and peak systolic velocity (PSV)) was performed. English written articles were obtained from Pubmed, EMBASE and Cochrane Library and included articles were assessed on quality and risk of bias. Weighted means of Doppler indices were calculated using a random-effects model. Results In healthy pregnancies, PI and RI decreased from 0.80 (95% CI: 0.70–0.89) and 0.50 (95% CI: 0.47–0.54) in the first trimester to 0.50 (95% CI: 0.45–0.55, p < 0.001) and 0.39 (95% CI: 0.37–0.42, p < 0.001) in the second trimester and to 0.49 (95% CI: 0.44–0.53, p = 0.752) and 0.36 (95% CI: 0.35–0.38, p = 0.037) in the third trimester, respectively. In parallel, PSV altered from 0.22 m/s (95% CI: 0.13–0.30 m/s) to 0.28 m/s (95% CI: 0.17–0.40 m/s, p = 0.377) and to 0.25 m/s (95% CI: 0.20–0.30 m/s, p = 0.560) in the three trimesters. In absence of second and third trimester Doppler data in complicated gestation, only a difference in PI was observed between complicated and healthy pregnancies during the first trimester (1.49 vs 0.80, p < 0.001). Although individual studies have identified differences in PI between SpA located in the central part of the placental bed versus those located at its periphery, this meta-analysis could not confirm this (p = 0.349). Conclusions This review and meta-analysis concludes that an observed decrease of SpA PI and RI from the first towards the second trimester parallels the physiological trophoblast invasion converting SpA during early gestation, a process completed in the midst of the second trimester. Higher PI was found in SpA of complicated pregnancies compared to healthy pregnancies, possibly reflecting suboptimal utero-placental circulation. Longitudinal studies examining comprehensively the predictive value of spiral artery Doppler for complicated pregnancies are yet to be carried out.
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Bruin CM, Ganzevoort W, Schuit E, Mensing van Charante NA, Wolf H. Inter- and intra-observer variability in fetal ductus venosus blood flow measurements in high-risk fetuses at 26-32 weeks. Eur J Obstet Gynecol Reprod Biol 2019; 243:67-71. [PMID: 31675632 DOI: 10.1016/j.ejogrb.2019.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/12/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Early preterm fetal growth restriction is a significant contributor to perinatal morbidity and mortality. The ductus venosus pulsatility index for veins (DV PIV) is proposed as a monitoring tool because it appears to improve perinatal outcomes. The test characteristics and robustness of DV PIV have been inadequately described. The aim of this study was to investigate inter- and intra-observer variability of DV PIV. STUDY DESIGN Nineteen women with a gestational age between 26 and 32 completed weeks were included in this study. Doppler sonographic fetal assessment was performed by two independent maternal-fetal medicine specialists. Each sonographer alternately performed three flow tracings for each participant, in the absence of the other sonographer (six tracings in total per patient). DV PIV was calculated automatically from stored tracings by a third researcher. Inter- and intra-observer variability of DV PIV and limits of agreement were assessed using the Bland-Altman method. Comparison of the distribution was performed with Kendall's related samples test, and the intraclass correlation coefficient (ICC) was calculated. RESULTS In total, 114 DV measurements were taken from 19 participants with a median age of 31 years [interquartile range (IQR) 26-34 years] at a median gestational age of 28 weeks (IQR 27-29 weeks). The proportional limits of agreement for intra-observer variation were -0.48 to 0.48 and -0.39 to 0.62 for the two observers. ICCs were 0.66 [95% confidence interval (CI) 0.42-0.84] and 0.68 (95% CI 0.45-0.85). The proportional limits of agreement for inter-observer variation were -0.29 to 0.19 with an ICC of 0.89 (95% CI 0.73-0.96). CONCLUSION Inter-observer variation was far less than intra-observer variation, probably due to mitigation of biological variation by averaging three measurements. DV PIV has acceptable test characteristics for use in a clinical setting when the average of at least three consecutive measurements is used.
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Affiliation(s)
- Clara M Bruin
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ewoud Schuit
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nico A Mensing van Charante
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Gynaecology, Dijklander Ziekenhuis, Hoorn, the Netherlands
| | - Hans Wolf
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Rolnik DL, da Silva Costa F, Sahota D, Hyett J, McLennan A. Quality assessment of uterine artery Doppler measurement in first-trimester combined screening for pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:245-250. [PMID: 29917286 DOI: 10.1002/uog.19116] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/19/2018] [Accepted: 06/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess the quality of mean uterine artery (UtA) pulsatility index (PI) measurement in a first-trimester pre-eclampsia screening program. METHODS Consecutive women with a singleton pregnancy attending first-trimester screening for fetal chromosomal abnormalities also had combined screening for pre-eclampsia based on the Fetal Medicine Foundation (FMF) algorithm, at a large practice in Sydney, Australia, from May 2014 to February 2017. Distributions of mean UtA-PI multiples of the median (MoM) on a logarithmic scale were plotted in relation to the normal median with 95% CI for each operator and for each month. Central tendency and dispersion and cumulative sum charts were produced. Mean UtA-PI MoM values between 0.95 and 1.05 were considered ideal and those between 0.90 and 1.10 were considered acceptable. The screen-positive rates for preterm pre-eclampsia in different groups of sonographers according to their mean log10 UtA-PI MoM were calculated and compared using the chi-square test. RESULTS A total of 21 010 women attended for first-trimester ultrasound and had screening for pre-eclampsia. The overall median UtA-PI MoM was 1.042 (interquartile range (IQR), 0.85-1.26). Of 46 sonographers, 42 (91.3%) performed more than 50 examinations and, of those, 41 (97.6%) measured UtA-PI within the acceptable range. Sonographers measuring UtA-PI MoM on average below 0.95 and those measuring it above 1.05 had, respectively, lower and higher screen-positive rates when compared with those with measurements within the 0.95-1.05 UtA-PI MoM interval (7.2% and 13.2% vs 11.2%, respectively, P < 0.001). CONCLUSION UtA Doppler is measured well among trained operators when following an established protocol. While slight variations are expected, systematic error in this measurement impacts on the screen-positive rate. Therefore, a quality control process should be in place and retraining of staff may be required. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- D L Rolnik
- Perinatal Services, Monash Medical Centre, Melbourne, Australia
| | - F da Silva Costa
- Perinatal Services, Monash Medical Centre, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Monash University and Monash Ultrasound for Women, Melbourne, Australia
| | - D Sahota
- Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Shatin, Hong Kong
| | - J Hyett
- Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, Australia
| | - A McLennan
- Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, Australia
- Sydney Ultrasound for Women, Sydney, Australia
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Drouin O, Johnson JA, Chaemsaithong P, Metcalfe A, Huber J, Schwarzenberger J, Winters E, Stavness L, Tse AWT, Lu J, Lim WT, Leung TY, Bujold E, Sahota D, Poon LC. Transverse technique: complementary approach to measurement of first-trimester uterine artery Doppler. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:639-647. [PMID: 28976627 DOI: 10.1002/uog.18917] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/06/2017] [Accepted: 09/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To define a protocol for the first-trimester assessment of uterine artery pulsatility index (UtA-PI) using the new transverse technique, to evaluate UtA-PI measured using the transverse approach vs that obtained using the conventional sagittal approach and to determine if accelerated onsite training (in both methods) of inexperienced sonographers can achieve reproducible UtA-PI measurements comparable with those obtained by an experienced sonographer. METHODS This was a prospective observational study of women with a singleton pregnancy attending for routine combined first-trimester screening at 11 to 13 + 6 weeks' gestation. The study consisted of two parts, each conducted at a different center (Part 1 in Calgary, Canada and Part 2 in Hong Kong). In Part 1, UtA-PI measurements were performed using the transverse and sagittal techniques by four sonographers trained in both methods, in 10 cases each, and measurement indices (PI), time required and subjective difficulty in obtaining satisfactory measurements were compared. The one sample t-test and Wilcoxon signed rank test were used when appropriate. Bland-Altman plots were used to assess measurement agreement, and intraclass correlation coefficient (ICC) was used to evaluate measurement reliability. A target plot was used to assess measures of central tendency and dispersion. In Part 2, one experienced and three inexperienced sonographers prospectively measured UtA-PI using both approaches in 42 and 35 women, respectively. Inexperienced sonographers underwent accelerated onsite training by the experienced sonographer. Measurement approach and sonographer order were on a random basis. ICC, Bland-Altman and Passing-Bablok analyses were performed to assess measurement agreement and reliability and effect of accelerated training. RESULTS In Part 1, no difference was observed between the two techniques in mean time to acquire the measurements (118 s for sagittal vs 106 s for transverse; P = 0.38). The four sonographers reported that the transverse technique was subjectively easier to perform (P = 0.04). Bias and ICC for mean UtA-PI between sagittal and transverse measurements were -0.05 (95% limits of agreement, -0.48 to 0.37) and 0.94, respectively. Measurements obtained using the transverse technique after correcting for gestational age were significantly closer to the expected distribution than those obtained using the sagittal technique. In Part 2, there were no significant differences in median UtA-PI measured using the different approaches for both experienced and inexperienced sonographers (P > 0.05 for all sonographers). Mean UtA-PI measurement reliability between approaches was high for the experienced (ICC = 0.92) and inexperienced (ICC > 0.80) sonographers. UtA-PI measurement approaches did not deviate from linearity, while bias ranged from -0.10 to 0.07. The median time required was similar between the techniques (56.1 s for sagittal vs 49.3 s for transverse; P = 0.054). CONCLUSIONS This novel transverse approach for the measurement of UtA-PI in the first trimester appears to be comparable with the sagittal approach in terms of reliability, reproducibility and time required, and may be easier to perform. Providing accelerated onsite training can be helpful for improving the reliability of UtA-PI measurements and could potentially facilitate the broad implementation of first-trimester pre-eclampsia screening. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- O Drouin
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
- Department of Obstetrics and Gynaecology, Université Laval, Québec, Canada
| | - J-A Johnson
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
| | - P Chaemsaithong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - A Metcalfe
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
| | - J Huber
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
| | - J Schwarzenberger
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
| | - E Winters
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
| | - L Stavness
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
| | - A W T Tse
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - J Lu
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - W T Lim
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - T Y Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - E Bujold
- Department of Obstetrics and Gynaecology, Université Laval, Québec, Canada
| | - D Sahota
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - L C Poon
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
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Demers ME, Dubé S, Bourdages M, Gasse C, Boutin A, Girard M, Bujold E, Demers S. Comparative Study of Abdominal Versus Transvaginal Ultrasound for Uterine Artery Doppler Velocimetry at 11 to 13 Weeks. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1771-1776. [PMID: 29319201 DOI: 10.1002/jum.14530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 10/04/2017] [Accepted: 10/18/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To compare the first-trimester uterine artery pulsatility index (PI) measured by abdominal and transvaginal ultrasound (US). METHODS We performed a prospective study of singleton pregnant women recruited at 11 to 13 weeks' gestation. The mean uterine artery PI was obtained by abdominal followed by transvaginal US. The mean of the left and right uterine artery PIs was used, and differences between approaches were computed. The intraclass correlation coefficient and a Bland-Altman plot were used to compare the two approaches. RESULTS Data were available for 940 participants, including 928 (99%) with uterine artery PIs obtained on both uterine sides. The mean uterine artery PI decreased with gestational age in both approaches (P < .001). We observed a moderate correlation between abdominal and transvaginal mean uterine artery PIs (intraclass correlation coefficient, 0.72; 95% confidence interval, 0.69 to 0.75). Values obtained by abdominal US (median, 1.70, interquartile range, 1.35 to 2.09) were greater than those obtained by transvaginal US (median, 1.65; interquartile range, 1.37 to 1.99). There was a significant increase in differences as average measurements became higher (P < .01). CONCLUSIONS The first-trimester mean uterine artery PI decreases with gestational age in both approaches. Abdominal US could be associated with greater uterine artery PI values than transvaginal US, especially at higher measurements. The first-trimester uterine artery PI for prediction of adverse perinatal outcomes should be adjusted for gestational age and possibly for the US approach.
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Affiliation(s)
- Marie-Elaine Demers
- Departments of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Samuel Dubé
- Departments of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Mélodie Bourdages
- Departments of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Cedric Gasse
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
- Reproduction, Mother, and Child Health Unit, Centre Hospitalier Universitaire de Québec, Université Laval Research Center, Université Laval, Québec City, Québec, Canada
| | - Amélie Boutin
- Reproduction, Mother, and Child Health Unit, Centre Hospitalier Universitaire de Québec, Université Laval Research Center, Université Laval, Québec City, Québec, Canada
| | - Mario Girard
- Departments of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Emmanuel Bujold
- Departments of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
- Reproduction, Mother, and Child Health Unit, Centre Hospitalier Universitaire de Québec, Université Laval Research Center, Université Laval, Québec City, Québec, Canada
| | - Suzanne Demers
- Departments of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
- Reproduction, Mother, and Child Health Unit, Centre Hospitalier Universitaire de Québec, Université Laval Research Center, Université Laval, Québec City, Québec, Canada
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10
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Marchi L, Gaini C, Franchi C, Mecacci F, Bilardo C, Pasquini L. Intraobserver and interobserver reproducibility of third trimester uterine artery pulsatility index. Prenat Diagn 2017; 37:1198-1202. [DOI: 10.1002/pd.5163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Laura Marchi
- Unit of Fetal Medicine and Diagnosis, Department for Women and Child Health, Careggi University Hospital; University of Florence; Florence Italy
| | - Claudia Gaini
- Unit of Fetal Medicine and Diagnosis, Department for Women and Child Health, Careggi University Hospital; University of Florence; Florence Italy
| | - Chiara Franchi
- Unit of Fetal Medicine and Diagnosis, Department for Women and Child Health, Careggi University Hospital; University of Florence; Florence Italy
| | - Federico Mecacci
- Unit of Fetal Medicine and Diagnosis, Department for Women and Child Health, Careggi University Hospital; University of Florence; Florence Italy
| | - Caterina Bilardo
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen; University of Groningen; Groningen The Netherlands
| | - Lucia Pasquini
- Unit of Fetal Medicine and Diagnosis, Department for Women and Child Health, Careggi University Hospital; University of Florence; Florence Italy
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11
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Rolnik DL, O'Gorman N, Roberge S, Bujold E, Hyett J, Uzan S, Beaufils M, da Silva Costa F. Early screening and prevention of preterm pre-eclampsia with aspirin: time for clinical implementation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:551-556. [PMID: 28887883 DOI: 10.1002/uog.18899] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/01/2017] [Accepted: 09/05/2017] [Indexed: 06/07/2023]
Affiliation(s)
- D L Rolnik
- Perinatal Services, Monash Medical Centre, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - N O'Gorman
- Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Paris Descartes University, Paris, France
| | - S Roberge
- Harris Birthright Centre for Fetal Medicine, King's College Hospital, London, UK
| | - E Bujold
- Department of Obstetrics and Gynecology, Laval University, Quebec, Canada
| | - J Hyett
- Department of High Risk Obstetrics, Royal Prince Alfred Hospital, Sydney, Australia
| | - S Uzan
- Pierre et Marie Curie University, Paris, France
| | | | - F da Silva Costa
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
- Monash Ultrasound for Women, Melbourne, Australia
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