1
|
Lee B, Janzen C, Aliabadi AR, Lei MYY, Wu H, Liu D, Vangala SS, Devaskar SU, Sung K. Early pregnancy imaging predicts ischemic placental disease. Placenta 2023; 140:90-99. [PMID: 37549442 PMCID: PMC11090111 DOI: 10.1016/j.placenta.2023.07.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 07/13/2023] [Accepted: 07/29/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION To characterize early-gestation changes in placental structure, perfusion, and oxygenation in the context of ischemic placental disease (IPD) as a composite outcome and in individual sub-groups. METHODS In a single-center prospective cohort study, 199 women were recruited from antenatal clinics between February 2017 and February 2019. Maternal magnetic resonance imaging (MRI) studies of the placenta were temporally conducted at two timepoints: 14-16 weeks gestational age (GA) and 19-24 weeks GA. The pregnancy was monitored via four additional study visits, including at delivery. Placental volume, perfusion, and oxygenation were assessed at both MRI timepoints. The primary outcome was defined as pregnancy complicated by IPD, with group assignment confirmed after delivery. RESULTS In early gestation, mothers with IPD who subsequently developed fetal growth restriction (FGR) and/or delivered small-for gestational age (SGA) infants showed significantly decreased MRI indices of placental volume, perfusion, and oxygenation compared to controls. The prediction of FGR or SGA by multiple logistic regression using placental volume, perfusion, and oxygenation revealed receiver operator characteristic curves with areas under the curve of 0.81 (Positive predictive value (PPV) = 0.84, negative predictive value (NPV) = 0.75) at 14-16 weeks GA and 0.66 (PPV = 0.78, NPV = 0.60) at 19-24 weeks GA. DISCUSSION MRI indices showing decreased placental volume, perfusion and oxygenation in early pregnancy were associated with subsequent onset of IPD, with the greatest deviation evident in subjects with FGR and/or SGA. These early-gestation MRI changes may be predictive of the subsequent development of FGR and/or SGA.
Collapse
Affiliation(s)
- Brian Lee
- Department of Pediatrics, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Carla Janzen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Arya R Aliabadi
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Margarida Y Y Lei
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Holden Wu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, 300 Medical Plaza, B119, Los Angeles, CA 90095, USA.
| | - Dapeng Liu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, 300 Medical Plaza, B119, Los Angeles, CA 90095, USA.
| | - Sitaram S Vangala
- Department of Medicine Statistical Core, David Geffen School of Medicine, University of California, 1100 Glendon Ave Suite 1820, Los Angeles, CA, 90095, USA.
| | - Sherin U Devaskar
- Department of Pediatrics, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Kyunghyun Sung
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, 300 Medical Plaza, B119, Los Angeles, CA 90095, USA.
| |
Collapse
|
2
|
Sedaghati F, Gleason RL. A mathematical model of vascular and hemodynamics changes in early and late forms of preeclampsia. Physiol Rep 2023; 11:e15661. [PMID: 37186372 PMCID: PMC10132946 DOI: 10.14814/phy2.15661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 05/17/2023] Open
Abstract
Preeclampsia-eclampsia syndrome is a leading cause of maternal mortality. The precise etiology of preeclampsia is still not well-defined and different forms exist, including early and late forms or preeclampsia, which may arise via distinctly different mechanisms. Low-dose aspirin administered at the end of the first trimester in women identified as high risk has been shown to reduce the incidence of early, but not late, preeclampsia; however, current risk factors show only fair predictive capability. There is a pressing need to develop accurate descriptions for the different forms of preeclampsia. This paper presents 1D fluid, solid, growth, and remodeling models for pregnancies complicated with early and late forms of preeclampsia. Simulations affirm a broad set of literature results that early forms of preeclampsia are characterized by elevated uterine artery pulsatility index (UA-PI) and total peripheral resistance (TPR) and lower cardiac output (CO), with modestly increased mean arterial blood pressure (MAP) in the first half of pregnancy, with elevation of TPR and MAP beginning at 20 weeks. Conversely, late forms of preeclampsia are characterized by only slightly elevated UA-PI and normal pre-term TPR, and slightly elevated MAP and CO throughout pregnancy, with increased TPR and MAP beginning after 34 weeks. Results suggest that preexisting arterial stiffness may be elevated in women that develop both early forms and late forms of preeclampsia; however, data that verify these results are lacking in the literature. Pulse wave velocity increases in early- and late-preeclampsia, coincident with increases in blood pressure; however, these increases are mainly due to the strain-stiffening response of larger arteries, rather than arterial remodeling-derived changes in material properties. These simulations affirm that early forms of preeclampsia may be associated with abnormal placentation, whereas late forms may be more closely associated with preexisting maternal cardiovascular factors; simulations also highlight several critical gaps in available data.
Collapse
Affiliation(s)
- Farbod Sedaghati
- The George W. Woodruff School of Mechanical EngineeringGeorgia Institute of TechnologyAtlantaGeorgiaUSA
| | - Rudolph L. Gleason
- The George W. Woodruff School of Mechanical EngineeringGeorgia Institute of TechnologyAtlantaGeorgiaUSA
- The Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of TechnologyAtlantaGeorgiaUSA
| |
Collapse
|
3
|
Bonell A, Vannevel V, Sonko B, Mohammed N, Vicedo-Cabrera AM, Haines A, Maxwell NS, Hirst J, Prentice AM. A feasibility study of the use of UmbiFlow™ to assess the impact of heat stress on fetoplacental blood flow in field studies. Int J Gynaecol Obstet 2023; 160:430-436. [PMID: 36165637 PMCID: PMC10092781 DOI: 10.1002/ijgo.14480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/09/2022] [Accepted: 09/26/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the use of UmbiFlow™ in field settings to assess the impact of heat stress on umbilical artery resistance index (RI). METHODS This feasibility study was conducted in West Kiang, The Gambia, West Africa; a rural area with increasing exposure to extreme heat. We recruited women with singleton fetuses who performed manual tasks (such as farming) during pregnancy to an observational cohort study. The umbilical artery RI was measured at rest, and during and at the end of a typical working shift in women at 28 weeks or more of pregnancy. Adverse pregnancy outcomes (APO) were classified as stillbirth, preterm birth, low birth weight, or small for gestational age, and all other outcomes as normal. RESULTS A total of 40 participants were included; 23 normal births and 17 APO. Umbilical artery RI demonstrated a nonlinear relationship to heat stress, with indication of a potential threshold value for placental insufficiency at 32°C by universal thermal climate index and 30°C by wet bulb globe temperature. CONCLUSIONS The Umbiflow device proved to be an effective field method for assessing placental function. Dynamic changes in RI may begin to explain the association between extreme heat and APO with an identified threshold of effect.
Collapse
Affiliation(s)
- Ana Bonell
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Valerie Vannevel
- Maternal and Infant Healthcare Strategies Unit, SAMRC, Pretoria, South Africa
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
- Research Centre for Maternal, Fetal, Newborn & Child Healthcare strategies, University of Pretoria, Pretoria, South Africa
| | - Bakary Sonko
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Nuredin Mohammed
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Ana M Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Andy Haines
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Public Health, Environment and Society, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil S Maxwell
- Environmental Extremes Laboratory, University of Brighton, Eastbourne, UK
| | - Jane Hirst
- Nuffield Department of Women's and Reproductive Health and the George Institute for Global Health, University of Oxford, Oxford, UK
| | - Andrew M Prentice
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| |
Collapse
|
4
|
Doan TNA, Bianco-Miotto T, Parry L, Winter M. The role of angiotensin II and relaxin in vascular adaptation to pregnancy. Reproduction 2022; 164:R87-R99. [PMID: 36018774 DOI: 10.1530/rep-21-0428] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/26/2022] [Indexed: 11/08/2022]
Abstract
In brief There is a pregnancy-induced vasodilation of blood vessels, which is known to have a protective effect on cardiovascular function and can be maintained postpartum. This review outlines the cardiovascular changes that occur in a healthy human and rodent pregnancy, as well as different pathways that are activated by angiotensin II and relaxin that result in blood vessel dilation. Abstract During pregnancy, systemic and uteroplacental blood flow increase to ensure an adequate blood supply that carries oxygen and nutrients from the mother to the fetus. This results in changes to the function of the maternal cardiovascular system. There is also a pregnancy-induced vasodilation of blood vessels, which is known to have a protective effect on cardiovascular health/function. Additionally, there is evidence that the effects of maternal vascular vasodilation are maintained post-partum, which may reduce the risk of developing high blood pressure in the next pregnancy and reduce cardiovascular risk later in life. At both non-pregnant and pregnant stages, vascular endothelial cells produce a number of vasodilators and vasoconstrictors, which transduce signals to the contractile vascular smooth muscle cells to control the dilation and constriction of blood vessels. These vascular cells are also targets of other vasoactive factors, including angiotensin II (Ang II) and relaxin. The binding of Ang II to its receptors activates different pathways to regulate the blood vessel vasoconstriction/vasodilation, and relaxin can interact with some of these pathways to induce vasodilation. Based on the available literature, this review outlines the cardiovascular changes that occur in a healthy human pregnancy, supplemented by studies in rodents. A specific focus is placed on vasodilation of blood vessels during pregnancy; the role of endothelial cells and endothelium-derived vasodilators will also be discussed. Additionally, different pathways that are activated by Ang II and relaxin that result in blood vessel dilation will also be reviewed.
Collapse
Affiliation(s)
- Thu Ngoc Anh Doan
- School of Agriculture, Food and Wine, Waite Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Tina Bianco-Miotto
- School of Agriculture, Food and Wine, Waite Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Laura Parry
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,School of Biological Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Marnie Winter
- Future Industries Institute, University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
5
|
Can Demi̇r M, Kaçar C, Polat B. Evaluation of the relationship between placentome perfusion, echotexture, and endocrine changes in cows at the end of pregnancy. Theriogenology 2022; 194:83-91. [DOI: 10.1016/j.theriogenology.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022]
|
6
|
Late-term fetuses with reduced umbilical vein blood flow volume: An under-recognized population at increased risk of growth restriction. Eur J Obstet Gynecol Reprod Biol 2022; 272:182-187. [PMID: 35339807 DOI: 10.1016/j.ejogrb.2022.03.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To investigate the umbilical vein and uterine arteries blood flow volume (UV-Q, UtA-Q) in late-term pregnancies. STUDY DESIGN This was a prospective observational cohort study of singleton pregnancies ≥40 + 0 weeks in which UV-Q and UtA-Q, both absolute and normalized for estimated fetal weight (EFW) values, were evaluated in relation to AC drop of ≥20 percentiles from 20 weeks to term, Doppler signs of fetal cerebral blood flow redistribution and composite adverse perinatal outcome. The presence of neonatal hypoglycaemia and the need of formula milk supplementation were also examined. RESULTS The study population comprised 200 women. Fetuses with AC drop (n = 34) had a significantly lower UV-Q and UV-Q/EFW than fetuses without AC drop (n = 166): median UV-Q 184 ml/min (IQR 143-225) vs 233 ml/min (IQR 181-277), p = 0.0006; median UV-Q/EFW 55 ml/min/kg (IQR 42-66) vs 63 ml/min/kg (IQR 48-74), p = 0.03. Fetuses with cerebral blood flow redistribution (n = 48) had a significantly lower UV-Q and UV-Q/EFW than those without (n = 134): median UV-Q 210 ml/min (IQR 155-263) vs 236 ml/min (IQR 184-278), p = 0.04; median UV-Q/EFV 58 ml/min/kg (IQR 45-70) vs 65 ml/min/kg (IQR 50-76), p = 0.04. There was a significant moderate correlation between middle cerebral artery pulsatility index (MCA-PI) and UV-Q and UV-Q/EFW (Spearman Rho -0.20 and -0.20; p = 0.008 and p = 0.006). CONCLUSIONS The umbilical vein blood flow volume might have a potential role to identify fetuses with stunted growth in late-term pregnancies.
Collapse
|
7
|
Physiological asymmetry in uterine artery blood flow during the first trimester of pregnancy: New insights from a quantitative assessment using Pulsed-wave color Doppler and M-mode color power angio imaging. Placenta 2022; 121:109-115. [DOI: 10.1016/j.placenta.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/20/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022]
|
8
|
A mathematical model of maternal vascular growth and remodeling and changes in maternal hemodynamics in uncomplicated pregnancy. Biomech Model Mechanobiol 2022; 21:647-669. [PMID: 35112224 DOI: 10.1007/s10237-021-01555-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 12/26/2021] [Indexed: 11/02/2022]
Abstract
The maternal vasculature undergoes tremendous growth and remodeling (G&R) that enables a > 15-fold increase in blood flow through the uterine vasculature from conception to term. Hemodynamic metrics (e.g., uterine artery pulsatility index, UA-PI) are useful for the prognosis of pregnancy complications; however, improved characterization of the maternal hemodynamics is necessary to improve prognosis. The goal of this paper is to develop a mathematical framework to characterize maternal vascular G&R and hemodynamics in uncomplicated human pregnancies. A validated 1D model of the human vascular tree from the literature was adapted and inlet blood flow waveforms at the ascending aorta at 4 week increments from 0 to 40 weeks of gestation were prescribed. Peripheral resistances of each terminal vessel were adjusted to achieve target flow rates and mean arterial pressure at each gestational age. Vessel growth was governed by wall shear stress (and axial lengthening in uterine vessels), and changes in vessel distensibility were related to vessel growth. Uterine artery velocity waveforms generated from this model closely resembled ultrasound results from the literature. The literature UA-PI values changed significantly across gestation, increasing in the first month of gestation, then dramatically decreasing from 4 to 20 weeks. Our results captured well the time-course of vessel geometry, material properties, and UA-PI. This 1D fluid-G&R model captured the salient hemodynamic features across a broad range of clinical reports and across gestation for uncomplicated human pregnancy. While results capture available data well, this study highlights significant gaps in available data required to better understand vascular remodeling in pregnancy.
Collapse
|
9
|
Carson J, Warrander L, Johnstone E, van Loon R. Personalising cardiovascular network models in pregnancy: A two-tiered parameter estimation approach. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3267. [PMID: 31799783 PMCID: PMC9286682 DOI: 10.1002/cnm.3267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/07/2019] [Accepted: 09/07/2019] [Indexed: 05/26/2023]
Abstract
Uterine artery Doppler waveforms are often studied to determine whether a patient is at risk of developing pathologies such as pre-eclampsia. Many uterine waveform indices have been developed, which attempt to relate characteristics of the waveform with the physiological adaptation of the maternal cardiovascular system, and are often suggested to be an indicator of increased placenta resistance and arterial stiffness. Doppler waveforms of four patients, two of whom developed pre-eclampsia, are compared with a comprehensive closed-loop model of pregnancy. The closed-loop model has been previously validated but has been extended to include an improved parameter estimation technique that utilises systolic and diastolic blood pressure, cardiac output, heart rate, and pulse wave velocity measurements to adapt model resistances, compliances, blood volume, and the mean vessel areas in the main systemic arteries. The shape of the model-predicted uterine artery velocity waveforms showed good agreement with the characteristics observed in the patient Doppler waveforms. The personalised models obtained now allow a prediction of the uterine pressure waveforms in addition to the uterine velocity. This allows for a more detailed mechanistic analysis of the waveforms, eg, wave intensity analysis, to study existing clinical indices. The findings indicate that to accurately estimate arterial stiffness, both pulse pressure and pulse wave velocities are required. In addition, the results predict that patients who developed pre-eclampsia later in pregnancy have larger vessel areas in the main systemic arteries compared with the two patients who had normal pregnancy outcomes.
Collapse
Affiliation(s)
- Jason Carson
- Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversitySwanseaUK
- Data Science Building, Swansea University Medical SchoolSwansea UniversitySwanseaUK
- HDR UK Wales and Northern IrelandHealth Data Research UKLondonUK
| | - Lynne Warrander
- Maternal and Fetal Health Research Centre, Division of Developmental Biology, Faculty of Medicine Biology and HealthUniversity of ManchesterManchesterUK
| | - Edward Johnstone
- Maternal and Fetal Health Research Centre, Division of Developmental Biology, Faculty of Medicine Biology and HealthUniversity of ManchesterManchesterUK
| | - Raoul van Loon
- Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversitySwanseaUK
| |
Collapse
|
10
|
Nagahama G, Korkes HA, Sass N. Clinical Experience Over 15 Years with the B-Lynch Compression Suture Technique in the Management of Postpartum Hemorrhage. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:655-661. [PMID: 34670299 PMCID: PMC10183868 DOI: 10.1055/s-0041-1735228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To describe the clinical experience with the B-Lynch technique in the management of postpartum hemorrhage as well as the factors related to the indication of the technique and to present the success rates of the application of the B-Lynch technique. METHODS Observational, retrospective, cross-sectional, and analytical study. Patient data was obtained through the study of medical records. The study population comprised of patients who underwent hemostatic suture using the B-Lynch technique, including 104 patients within the period from January 1, 2005, to December 31, 2019. RESULTS Of the total of 104 patients, 82.7% did not present any complications. Blood transfusion and intensive care unit admission were the most prevalent complications, with 13.5% and 15.4%, respectively. Only 1% of the patients had puerperal and surgical site infections. The factors most related to the application of the technique were the presence of previous cesarean section (30.8%), use of oxytocin (16.3%), and preeclampsia (11.6%). Puerperal hysterectomy was performed in 4.8% of the patients due to failure of the method. CONCLUSION The clinical experience with the B-Lynch technique was satisfactory since it presented few complications, with excellent results in hemorrhagic control. Previous cesarean section, the use of oxytocin, and preeclampsia stood out as factors related to the indication of the application of the technique, and the success rate in controlling postpartum hemorrhage was 95.2%.
Collapse
Affiliation(s)
- Gilberto Nagahama
- Department of Obstetrics, Hospital Maternidade Escola de Vila Nova Cachoeirinha, São Paulo, SP, Brazil
| | - Henri Augusto Korkes
- Department of Obstetrics and Gynecology, Faculty of Medicine, Pontifícia Universidade Católica de São Paulo, São Paulo, SP, Brazil
| | - Nelson Sass
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
11
|
Rehman A, Ahmad E, Arshad U, Riaz A, Akhtar MS, Ahmad T, Khan JA, Mohsin I, Shi Z, Sattar A. Effects of immunization against inhibin α-subunit on ovarian structures, pregnancy rate, embryonic and fetal losses, and prolificacy rate in goats where estrus was induced during the non-breeding season. Anim Reprod Sci 2020; 224:106654. [PMID: 33249352 DOI: 10.1016/j.anireprosci.2020.106654] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/28/2022]
Abstract
The objectives of the study were to determine the dose-dependent effects of active immunization against inhibin α-subunit (AIINHA) on ovarian dynamics, concentrations of progesterone (P4), pregnancy rate (PR), embryonic and fetal losses (EFL), and prolificacy during the non-breeding season when there was imposing of a progestin-based treatment regimen to induce estrus in Beetal goats. Goats (n = 30) were randomly assigned into following groups: 1) saline (G-CON-0 mg; n = 10), 2) small dose (G-AIINHA-0.5 mg; n = 10), and 3) large dose (G-AIINHA-1 mg; n = 10). The primary administration of inhibin immunogen was administered at Day -48, followed by another administration at Day -20, and subsequently there was induction of estrus using a progestin based treatment regimen that included a single administration of progestin-containing sponge and PGF2α at Day -8. The sponge was removed, and GnRH was administered at Day -3 followed by breeding (Day 0) at standing estrus. Results indicated mean diameter of the follicles, size of pre-ovulatory follicles and corpora lutea, and post-breeding P4 concentrations were greater (P < 0.05) in the goat does of the G-AIINHA-0.5 than G-CON-0 group. The PR, and EFL, however, did not differ (P> 0.05) among groups, whereas prolificacy rate was greater (P = 0.04) in goat does of the G-AIINHA-0.5 than G-CON-0 groups. The data from this study indicate G-AIINHA-0.5 is the recommended dose of inhibin immunogen to enhance the reproductive performance during non-breeding season in Beetal goats when estrus is induced using a progestin-based treatment regimen.
Collapse
Affiliation(s)
- Abdul Rehman
- Department of Theriogenology, Faculty of Veterinary Science, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
| | - Ejaz Ahmad
- Department of Clinical Sciences, Faculty of Veterinary Science, Bahauddin Zakariya University, Multan 60800, Pakistan.
| | - Usman Arshad
- Department of Theriogenology, Faculty of Veterinary Science, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan; Department of Animal Sciences, University of Florida, Gainesville 32611, USA
| | - Amjad Riaz
- Department of Theriogenology, Faculty of Veterinary Science, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
| | - Muhammad Saleem Akhtar
- Department of Clinical Sciences, Faculty of Veterinary Science, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Tanveer Ahmad
- Department of Clinical Sciences, Faculty of Veterinary Science, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Jawaria Ali Khan
- Department of Veterinary Medicine, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
| | - Imran Mohsin
- Department of Livestock Production, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
| | - Zhendan Shi
- Laboratory of Animal Improvement and Reproduction, Institute of Animal Science, Jiangsu Academy of Agricultural Sciences, Nanjing, 210014, China
| | - Abdul Sattar
- Department of Theriogenology, Faculty of Veterinary Science, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan.
| |
Collapse
|
12
|
Cavoretto PI, Farina A, Gaeta G, Sigismondi C, Spinillo S, Casiero D, Pozzoni M, Vigano P, Papaleo E, Candiani M. Uterine artery Doppler in singleton pregnancies conceived after in-vitro fertilization or intracytoplasmic sperm injection with fresh vs frozen blastocyst transfer: longitudinal cohort study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:603-610. [PMID: 31909549 DOI: 10.1002/uog.21969] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Pregnancies conceived by frozen blastocyst transfer (FBT) have higher gestational age and weight at birth as compared to those derived by fresh blastocyst transfer. The aim of this study was to evaluate uterine artery pulsatility index (UtA-PI) in pregnancies conceived by in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) techniques using fresh vs cryopreserved blastocysts. METHODS This was a prospective longitudinal study of viable singleton IVF/ICSI pregnancies conceived after FBT or fresh blastocyst transfer, that underwent serial ultrasound assessment at San Raffaele Hospital, Milan, Italy at 7-37 gestational weeks. We excluded pregnancies conceived using other assisted reproductive techniques such as egg donation, twin gestation, pregnancy with abnormality and those resulting in miscarriage. Pregnant women underwent ultrasound assessment at 7-10, 11-14, 18-25 and 26-37 weeks' gestation. Mean UtA-PI was measured using Doppler ultrasound according to The Fetal Medicine Foundation criteria. Pregnancy outcomes were recorded. The primary outcome was mean UtA-PI measurement and secondary outcomes were gestational age at birth, birth weight and fetal and maternal complications, including small-for-gestational age (SGA), pre-eclampsia and large-for-gestational age. UtA-PI values were made Gaussian after log10 transformation. Analysis of repeated measures using a multilevel linear mixed model (fixed effects and random effects) was performed. The possible effect of other covariates on UtA-PI Doppler values, including body mass index, SGA and pre-eclampsia, was also evaluated. RESULTS A total of 367 IVF/ICSI cycles, comprising 164 with fresh blastocyst transfer and 203 with FBT, were included and a total of 625 observations (median, 2.5 (range, 1-4)) were collected and analyzed. The FBT group had on average 14% lower UtA-PI compared with the fresh-blastocyst-transfer group. In pregnancies with SGA fetuses, UtA-PI was 18% higher compared to pregnancies without, irrespective of the study group. Pregnancies that underwent fresh blastocyst transfer had significantly lower birth-weight centile (43.4 ± 23.3 vs 50.0 ± 23.1; P = 0.007) and a higher rate of SGA (7.9% vs 2.0%; P = 0.008) compared to those that underwent FBT. No significant differences were found between the two groups with respect to gestational age at birth and rates of preterm birth, pre-eclampsia, gestational diabetes mellitus and large-for-gestational age. CONCLUSION UtA-PI and the proportion of SGA are lower in IVF/ICSI pregnancies conceived after FBT as compared to fresh blastocyst transfer. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- P I Cavoretto
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, University Vita-Salute, Milan, Italy
| | - A Farina
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC), Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Gaeta
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, University Vita-Salute, Milan, Italy
| | - C Sigismondi
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, University Vita-Salute, Milan, Italy
| | - S Spinillo
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, University Vita-Salute, Milan, Italy
| | - D Casiero
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, University Vita-Salute, Milan, Italy
| | - M Pozzoni
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, University Vita-Salute, Milan, Italy
| | - P Vigano
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, University Vita-Salute, Milan, Italy
| | - E Papaleo
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, University Vita-Salute, Milan, Italy
| | - M Candiani
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, University Vita-Salute, Milan, Italy
| |
Collapse
|
13
|
Hassan M, Arshad U, Erdoğan G, Ahmad N. Evaluation of haemodynamic changes of uterine arteries using Doppler ultrasonography during different stages of pregnancy in Bos indicus cows. Reprod Domest Anim 2020; 55:1425-1433. [PMID: 32741044 DOI: 10.1111/rda.13793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/19/2020] [Accepted: 07/28/2020] [Indexed: 12/01/2022]
Abstract
The objectives of the study were to evaluate haemodynamic changes and their relationships among ipsilateral (IPS) and contralateral (CONT) uterine arteries (UA) during different stages of pregnancy in Bos indicus cows. Multiparous pregnant cows (n = 40) having a gestation length 30.47 ± 0.54 (mean ± SD) days were randomly enrolled and subjected to Doppler ultrasonography sequentially at 1st, 2nd, 4th, 6th and 8th months of gestation. Blood flow indices including diameter of UA (mm), blood flow volume (BFVo, ml/min), blood flow velocity (BFVe, cm/s), time-averaged maximum velocity (TAMV, cm/s), pulsatility index (PI) and resistance index (RI) were recorded. Data were analysed with mixed models using the PROC MIXED procedures, and Pearson correlation coefficients were calculated using the PROC CORR statement in SAS. The final statistical models included the fixed effects of side of UA, gestation month and the interaction between side of UA and gestation month. Results revealed that the mean diameter of the UA (12.13 ± 0.22 vs. 10.09 ± 0.22), BFVo (1236.33 ± 0.55 vs. 770.41 ± 0.55), BFVe (17.18 ± 0.42 vs. 15.58 ± 0.42) and TAMV (17.11 ± 0.44 vs. 15.77 ± 0.44) was higher (p < .05) in IPS as compared to CONT side of the UA in cows. However, PI and RI did not differ between IPS and CON arteries of uterus in cows. A very high and positive correlation (r = .89; p < .05) existed between the diameter of UA and BFVo starting from 1st to 8th months of gestation in IPS as well as CONT sides of UA. Moreover, TAMV was highly and positively correlated (r = .91; p < .05) with BFVe throughout the gestation. In conclusion, these haemodynamic changes in the UA could be used as a valuable validity tool to differentiate the compromised pregnancy in Bos indicus cows.
Collapse
Affiliation(s)
- Mubbashar Hassan
- Department of Theriogenology, Faculty of Veterinary Science, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Usman Arshad
- Department of Animal Sciences, University of Florida, Gainesville, FL, USA
| | - Güneş Erdoğan
- Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Nasim Ahmad
- Department of Theriogenology, Faculty of Veterinary Science, University of Veterinary and Animal Sciences, Lahore, Pakistan
| |
Collapse
|
14
|
Jensen OE, Chernyavsky IL. Blood flow and transport in the human placenta. ANNUAL REVIEW OF FLUID MECHANICS 2019; 51:25-47. [PMID: 38410641 PMCID: PMC7615669 DOI: 10.1146/annurev-fluid-010518-040219] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
The placenta is a multi-functional organ that exchanges blood gases and nutrients between a mother and her developing fetus. In humans, fetal blood flows through intricate networks of vessels confined within villous trees, the branches of which are bathed in pools of maternal blood. Fluid mechanics and transport processes play a central role in understanding how these elaborate structures contribute to the function of the placenta, and how their disorganization may lead to disease. Recent advances in imaging and computation have spurred significant advances in simulations of fetal and maternal flows within the placenta, across a range of lengthscales. Models describe jets of maternal blood emerging from spiral arteries into a disordered and deformable porous medium, and solute uptake by fetal blood flowing through elaborate three-dimensional capillary networks. We survey recent developments and emerging challenges in modeling flow and transport in this complex organ.
Collapse
Affiliation(s)
| | - Igor L. Chernyavsky
- School of Mathematics, University of Manchester, UK
- Maternal and Fetal Health Research Centre, Division of Developmental
Biology & Medicine, School of Medical Sciences, Faculty of Biology, Medicine
& Health, University of Manchester, UK
| |
Collapse
|
15
|
Carson J, Lewis M, Rassi D, Van Loon R. A data-driven model to study utero-ovarian blood flow physiology during pregnancy. Biomech Model Mechanobiol 2019; 18:1155-1176. [PMID: 30838498 PMCID: PMC6647440 DOI: 10.1007/s10237-019-01135-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 02/20/2019] [Indexed: 12/30/2022]
Abstract
In this paper, we describe a mathematical model of the cardiovascular system in human pregnancy. An automated, closed-loop 1D-0D modelling framework was developed, and we demonstrate its efficacy in (1) reproducing measured multi-variate cardiovascular variables (pulse pressure, total peripheral resistance and cardiac output) and (2) providing automated estimates of variables that have not been measured (uterine arterial and venous blood flow, pulse wave velocity, pulsatility index). This is the first model capable of estimating volumetric blood flow to the uterus via the utero-ovarian communicating arteries. It is also the first model capable of capturing wave propagation phenomena in the utero-ovarian circulation, which are important for the accurate estimation of arterial stiffness in contemporary obstetric practice. The model will provide a basis for future studies aiming to elucidate the physiological mechanisms underlying the dynamic properties (changing shapes) of vascular flow waveforms that are observed with advancing gestation. This in turn will facilitate the development of methods for the earlier detection of pathologies that have an influence on vascular structure and behaviour.
Collapse
Affiliation(s)
- Jason Carson
- College of Engineering, Swansea University, Bay Campus, Fabian Way, Swansea, SA1 8EN UK
| | - Michael Lewis
- College of Engineering, Swansea University, Bay Campus, Fabian Way, Swansea, SA1 8EN UK
| | - Dareyoush Rassi
- College of Human and Health Sciences, Swansea University, Singleton Campus, Singleton Park, Swansea, SA2 8PP UK
| | - Raoul Van Loon
- College of Engineering, Swansea University, Bay Campus, Fabian Way, Swansea, SA1 8EN UK
| |
Collapse
|
16
|
Hwuang E, Vidorreta M, Schwartz N, Moon BF, Kochar K, Tisdall MD, Detre JA, Witschey WRT. Assessment of uterine artery geometry and hemodynamics in human pregnancy with 4d flow mri and its correlation with doppler ultrasound. J Magn Reson Imaging 2018; 49:59-68. [PMID: 30390347 DOI: 10.1002/jmri.26229] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uterine artery (UtA) hemodynamics might be used to predict risk of hypertensive pregnancy disorders, including preeclampsia and intrauterine growth restriction. PURPOSE OR HYPOTHESIS To determine the feasibility of 4D flow MRI in pregnant subjects by characterizing UtA anatomy, computing UtA flow, and comparing UtA velocity, and pulsatility and resistivity indices (PI, RI) with transabdominal Doppler ultrasound (US). STUDY TYPE Prospective cross-sectional study from June 6, 2016, to May 2, 2018. POPULATION OR SUBJECTS OR PHANTOM OR SPECIMEN OR ANIMAL MODEL Forty-one singleton pregnant subjects (age [range] = 27.0 ± 5.9 [18-41] years) in their second or third trimester. We additionally scanned three subjects who had prepregnancy diabetes or chronic hypertension. FIELD STRENGTH/SEQUENCE The subjects underwent UtA and placenta MRI using noncontrast angiography and 4D flow at 1.5T. ASSESSMENT UtA anatomy was described based on 4D flow-derived noncontrast angiography, while UtA flow properties were characterized by net flow, systolic/mean/diastolic velocity, PI and RI through examination of 4D flow data. PI and RI are standard hemodynamic parameters routinely reported on Doppler US. STATISTICAL TESTS Spearman's rank correlation, Wilcoxon signed rank tests, and Bland-Altman plots were used to preliminarily investigate the relationships between flow parameters, gestational age, and Doppler US. or RESULTS: 4D flow MRI and UtA flow quantification was feasible in all subjects. There was considerable heterogeneity in UtA geometry in each subject between left and right UtAs and between subjects. Mean 4D flow-based parameters were: mean bilateral flow rate = 605.6 ± 220.5 mL/min, PI = 0.72 ± 0.2, and RI = 0.47 ± 0.1. Bilateral flow did not change with gestational age. We found that MRI differed from US in terms of lower PI (mean difference -0.1) and RI (mean difference < -0.1) with Wilcoxon signed rank test P = 0.05 and P = 0.13, respectively. DATA CONCLUSION 4D flow MRI is a feasible approach for describing UtA anatomy and flow in pregnant subjects. LEVEL OF EVIDENCE Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:59-68.
Collapse
Affiliation(s)
- Eileen Hwuang
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marta Vidorreta
- Siemens Healthineers, Tarrytown, New York, USA.,Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nadav Schwartz
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brianna F Moon
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kirpal Kochar
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Matthew Dylan Tisdall
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John A Detre
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Walter R T Witschey
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
17
|
Holm MB, Kristiansen O, Holme AM, Bastani NE, Horne H, Blomhoff R, Haugen G, Henriksen T, Michelsen TM. Placental release of taurine to both the maternal and fetal circulations in human term pregnancies. Amino Acids 2018; 50:1205-1214. [PMID: 29858686 DOI: 10.1007/s00726-018-2576-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/23/2018] [Indexed: 10/14/2022]
Abstract
Taurine is regarded as an essential amino acid in utero, and fetal taurine supply is believed to rely solely on placental transfer from maternal plasma. Despite its potential role in intrauterine growth restriction and other developmental disturbances, human in vivo studies of taurine transfer between the maternal, placental, and fetal compartments are scarce. We studied placental transfer of taurine in uncomplicated human term pregnancies in vivo in a cross-sectional study of 179 mother-fetus pairs. During cesarean section, we obtained placental tissue and plasma from incoming and outgoing vessels on the maternal and fetal sides of the placenta. Taurine was measured by liquid chromatography-tandem mass spectrometry. We calculated paired arteriovenous differences, and measured placental expression of the taurine biosynthetic enzyme cysteine sulfinic acid decarboxylase (CSAD) with quantitative real-time polymerase chain reaction and western blot. We observed a fetal uptake (p < 0.001), an uteroplacental release (p < 0.001), and a negative placental consumption of taurine (p = 0.001), demonstrating a bilateral placental release to the maternal and fetal compartments. Increasing umbilical vein concentrations and fetal uptake was associated with the uteroplacental release to the maternal circulation (rs = - 0.19, p = 0.01/rs = - 0.24, p = 0.003), but not with taurine concentrations in placental tissue. CSAD-mRNA was expressed in placental tissue, suggesting a potential for placental taurine synthesis. Our observations show that the placenta has the capacity to a bilateral taurine release, indicating a fundamental role of taurine in the human placental homeostasis beyond the supply to the fetus.
Collapse
Affiliation(s)
- Maia Blomhoff Holm
- Division of Obstetrics and Gynecology, Department of Obstetrics, Oslo University Hospital, PO BOKS 4950, 0424, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, PO BOKS 1171, Blindern, 0316, Oslo, Norway.
| | - Oddrun Kristiansen
- Division of Obstetrics and Gynecology, Department of Obstetrics, Oslo University Hospital, PO BOKS 4950, 0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, PO BOKS 1171, Blindern, 0316, Oslo, Norway
| | - Ane Moe Holme
- Division of Obstetrics and Gynecology, Department of Obstetrics, Oslo University Hospital, PO BOKS 4950, 0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, PO BOKS 1171, Blindern, 0316, Oslo, Norway
| | - Nasser Ezzatkhah Bastani
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO BOKS 1046, Blindern, 0316, Oslo, Norway
| | - Hildegunn Horne
- Division of Obstetrics and Gynecology, Department of Obstetrics, Oslo University Hospital, PO BOKS 4950, 0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, PO BOKS 1171, Blindern, 0316, Oslo, Norway
| | - Rune Blomhoff
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO BOKS 1046, Blindern, 0316, Oslo, Norway.,Division of Cancer Medicine, Department of Clinical Service, Oslo University Hospital, PO BOKS 4950, 0424, Oslo, Norway
| | - Guttorm Haugen
- Institute of Clinical Medicine, University of Oslo, PO BOKS 1171, Blindern, 0316, Oslo, Norway.,Division of Obstetrics and Gynecology, Department of Fetal Medicine, Oslo University Hospital, PO BOKS 4950, 0424, Oslo, Norway
| | - Tore Henriksen
- Division of Obstetrics and Gynecology, Department of Obstetrics, Oslo University Hospital, PO BOKS 4950, 0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, PO BOKS 1171, Blindern, 0316, Oslo, Norway
| | - Trond Melbye Michelsen
- Division of Obstetrics and Gynecology, Department of Obstetrics, Oslo University Hospital, PO BOKS 4950, 0424, Oslo, Norway.,Norwegian Advisory Unit on Women's Health, Oslo University Hospital, PO BOKS 4950, 0424, Oslo, Norway
| |
Collapse
|
18
|
Dallmann A, Ince I, Meyer M, Willmann S, Eissing T, Hempel G. Gestation-Specific Changes in the Anatomy and Physiology of Healthy Pregnant Women: An Extended Repository of Model Parameters for Physiologically Based Pharmacokinetic Modeling in Pregnancy. Clin Pharmacokinet 2018; 56:1303-1330. [PMID: 28401479 DOI: 10.1007/s40262-017-0539-z] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In the past years, several repositories for anatomical and physiological parameters required for physiologically based pharmacokinetic modeling in pregnant women have been published. While providing a good basis, some important aspects can be further detailed. For example, they did not account for the variability associated with parameters or were lacking key parameters necessary for developing more detailed mechanistic pregnancy physiologically based pharmacokinetic models, such as the composition of pregnancy-specific tissues. OBJECTIVES The aim of this meta-analysis was to provide an updated and extended database of anatomical and physiological parameters in healthy pregnant women that also accounts for changes in the variability of a parameter throughout gestation and for the composition of pregnancy-specific tissues. METHODS A systematic literature search was carried out to collect study data on pregnancy-related changes of anatomical and physiological parameters. For each parameter, a set of mathematical functions was fitted to the data and to the standard deviation observed among the data. The best performing functions were selected based on numerical and visual diagnostics as well as based on physiological plausibility. RESULTS The literature search yielded 473 studies, 302 of which met the criteria to be further analyzed and compiled in a database. In total, the database encompassed 7729 data. Although the availability of quantitative data for some parameters remained limited, mathematical functions could be generated for many important parameters. Gaps were filled based on qualitative knowledge and based on physiologically plausible assumptions. CONCLUSION The presented results facilitate the integration of pregnancy-dependent changes in anatomy and physiology into mechanistic population physiologically based pharmacokinetic models. Such models can ultimately provide a valuable tool to investigate the pharmacokinetics during pregnancy in silico and support informed decision making regarding optimal dosing regimens in this vulnerable special population.
Collapse
Affiliation(s)
- André Dallmann
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, Westfälische Wilhelm-University Münster, Münster, Germany
| | - Ibrahim Ince
- ET-TD-ET Systems Pharmacology CV, Bayer AG, Leverkusen, Germany.
| | - Michaela Meyer
- DD-CS Clinical Pharmacometrics, Bayer AG, Wuppertal, Germany
| | - Stefan Willmann
- DD-CS Clinical Pharmacometrics, Bayer AG, Wuppertal, Germany
| | - Thomas Eissing
- ET-TD-ET Systems Pharmacology CV, Bayer AG, Leverkusen, Germany
| | - Georg Hempel
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, Westfälische Wilhelm-University Münster, Münster, Germany
| |
Collapse
|
19
|
Arneberg HC, Andersen TA, Lorås L, Torp H, Scholbach TM, Eggebø TM. Correlation Between Fetal Weight Gain and Birth Weight with Blood Flow in the Uterine Arteries Calculated with the PixelFlux Technique. Ultrasound Int Open 2018; 4:E16-E22. [PMID: 29682630 PMCID: PMC5907659 DOI: 10.1055/s-0044-102005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 11/07/2017] [Accepted: 01/09/2018] [Indexed: 12/11/2022] Open
Abstract
Introduction The aim was to investigate correlations between fetal weight gain/day and birthweight with blood flow estimates in the uterine arteries calculated with the PixelFlux technique and with measurements from TAmax. We also aimed to examine the agreement between estimates using the two methods. Material and methods We conducted a prospective observational pilot study in pregnancy week 24-25 in women with risk pregnancies referred to the fetal medical centre at St. Olavs Hospital, Trondheim, Norway from March 2016 to June 2016. Blood flow in the uterine arteries was calculated using time-averaged peak velocity (TAmax) and the PixelFlux technique. PixelFlux is a method based on pixelwise calculation of spatially angle-corrected velocities and areas of all pixels inside a vessel during a heart cycle. Results The mean flow calculated from PixelFlux and TAmax was 811 ml/minute and 787 ml/minute, respectively. The intra-class correlation coefficient was 0.83 (95% CI 0.72-0.90) and limits of agreement were -441 ml/minute (95% CI -558 to -324 ml/minute) to 489 ml/minute (95% CI 372 to 606 ml/minute). We observed a significant correlation between mean flow calculated from PixelFlux and birthweight (r=0.41; p<0.01) and between flow calculated from PixelFlux and weight gain/day (r=0.33; p=0.02). Calculation based on TAmax was significant correlated to birthweight (r=0.34; p=0.02), but not to weight-gain/day. Pulsatile index was not correlated to flow, birthweight or fetal weight-gain/day. Conclusions We found significant correlations between estimated blood flow in the uterine arteries using the PixelFlux technique with fetal weight-gain/day and with birthweight. Estimates from two methods showed good agreement.
Collapse
Affiliation(s)
- Helene Caroline Arneberg
- Norwegian University of Science and Technology, Institute of Clinical and Molecular Medicine, Trondheim, Norway
| | - Thea Anette Andersen
- Norwegian University of Science and Technology, Institute of Clinical and Molecular Medicine, Trondheim, Norway
| | - Liv Lorås
- Trondheim University Hospital (St. Olavs Hospital), National Center for Fetal Medicine, Trondheim, Norway
| | - Hans Torp
- Norwegian University of Science and Technology, Department of Circulation and Medical Imaging, Trondheim, Norway
| | | | - Torbjørn Moe Eggebø
- Norwegian University of Science and Technology, Institute of Clinical and Molecular Medicine, Trondheim, Norway.,Trondheim University Hospital (St. Olavs Hospital), National Center for Fetal Medicine, Trondheim, Norway
| |
Collapse
|
20
|
Ferrazzi E, Stampalija T, Monasta L, Di Martino D, Vonck S, Gyselaers W. Maternal hemodynamics: a method to classify hypertensive disorders of pregnancy. Am J Obstet Gynecol 2018; 218:124.e1-124.e11. [PMID: 29102503 DOI: 10.1016/j.ajog.2017.10.226] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 10/23/2017] [Accepted: 10/25/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The classification of hypertensive disorders of pregnancy is based on the time at the onset of hypertension, proteinuria, and other associated complications. Maternal hemodynamic interrogation in hypertensive disorders of pregnancy considers not only the peripheral blood pressure but also the entire cardiovascular system, and it might help to classify the different clinical phenotypes of this syndrome. OBJECTIVE This study aimed to examine cardiovascular parameters in a cohort of patients affected by hypertensive disorders of pregnancy according to the clinical phenotypes that prioritize fetoplacental characteristics and not the time at onset of hypertensive disorders of pregnancy. STUDY DESIGN At the fetal-maternal medicine unit of Ziekenhuis Oost-Limburg (Genk, Belgium), maternal cardiovascular parameters were obtained through impedance cardiography using a noninvasive continuous cardiac output monitor with the patients placed in a standing position. The patients were classified as pregnant women with hypertensive disorders of pregnancy who delivered appropriate- and small-for-gestational-age fetuses. Normotensive pregnant women with an appropriate-for-gestational-age fetus at delivery were enrolled as the control group. The possible impact of obesity (body mass index ≥30 kg/m2) on maternal hemodynamics was reassessed in the same groups. RESULTS Maternal age, parity, body mass index, and blood pressure were not significantly different between the hypertensive disorders of pregnancy/appropriate-for-gestational-age and hypertensive disorders of pregnancy/small-for-gestational-age groups. The mean uterine artery pulsatility index was significantly higher in the hypertensive disorders of pregnancy/small-for-gestational-age group. The cardiac output and cardiac index were significantly lower in the hypertensive disorders of pregnancy/small-for-gestational-age group (cardiac output 6.5 L/min, cardiac index 3.6) than in the hypertensive disorders of pregnancy/appropriate-for-gestational-age group (cardiac output 7.6 L/min, cardiac index 3.9) but not between the hypertensive disorders of pregnancy/appropriate-for-gestational-age and control groups (cardiac output 7.6 L/min, cardiac index 4.0). Total vascular resistance was significantly higher in the hypertensive disorders of pregnancy/small-for-gestational-age group than in the hypertensive disorders of pregnancy/appropriate-for-gestational-age group and the control group. All women with hypertensive disorders of pregnancy showed signs of central arterial dysfunction. The cardiovascular parameters were not influenced by gestational age at the onset of hypertensive disorders of pregnancy, and no difference was observed between the women with appropriate-for-gestational-age fetuses affected by preeclampsia or by gestational hypertension with appropriate-for-gestational-age fetuses. Women in the obese/hypertensive disorders of pregnancy/appropriate-for-gestational-age and obese/hypertensive disorders of pregnancy/small-for-gestational-age groups showed a significant increase in cardiac output, as well as significant changes in other parameters, compared with the nonobese/hypertensive disorders of pregnancy/appropriate-for-gestational-age and nonobese/hypertensive disorders of pregnancy/small-for-gestational-age groups. CONCLUSION Significantly low cardiac output and high total vascular resistance characterized the women with hypertensive disorders of pregnancy associated with small for gestational age due to placental insufficiency, independent of the gestational age at the onset of hypertension. The cardiovascular parameters were not significantly different in the women with appropriate-for-gestational-age or small-for-gestational-age fetuses affected by preeclampsia or gestational hypertension. These findings support the view that maternal hemodynamics may be a candidate diagnostic tool to identify hypertensive disorders in pregnancies associated with small-for-gestational-age fetuses. This additional tool matches other reported evidence provided by uterine Doppler velocimetry, low vascular growth factors in the first trimester, and placental pathology. Obesity is associated with a significantly higher cardiac output and outweighs other determinants of hemodynamics in pregnancy; therefore, in future studies on hypertensive disorders, obesity should be studied as an additional disease and not simply as a demographic characteristic.
Collapse
|
21
|
Non-Invasive Placental Perfusion Imaging in Pregnancies Complicated by Fetal Heart Disease Using Velocity-Selective Arterial Spin Labeled MRI. Sci Rep 2017; 7:16126. [PMID: 29170468 PMCID: PMC5700998 DOI: 10.1038/s41598-017-16461-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/13/2017] [Indexed: 11/27/2022] Open
Abstract
The placenta is a vital organ for fetal growth and development during pregnancy. Congenital heart disease (CHD) is a leading cause of morbidity and mortality in newborns. Despite the parallel development of the placenta and fetal heart early in pregnancy, very few studies suggested an association between placental dysfunction and fetal CHD. In this study, we report placental perfusion of healthy pregnancies and pregnancies complicated by fetal CHD measured using advanced fetal MRI techniques. We studied forty-eight pregnant women (31 healthy volunteers and 17 with fetal CHD) that underwent fetal MRI during their second or third trimester of pregnancy. Placental perfusion imaging was performed using velocity-selective arterial spin labeling (VSASL) and 3D image acquisition with whole-placenta coverage. In pregnancies with fetal CHD, global placental perfusion significantly decreased and regional variation of placental perfusion significantly increased with advancing gestational age; however, no such correlation was found in healthy pregnancies. Also, global placental perfusion was significantly higher in fetal CHD versus controls, in the lateral side-lying patient position versus supine, and in the posterior placental position versus anterior placental position. This study reports for the first time non-invasive whole-placenta perfusion imaging in utero. These data suggest that placental VSASL may serve as a potential biomarker of placental dysfunction in fetuses diagnosed with CHD.
Collapse
|
22
|
Dynamic modeling of uteroplacental blood flow in IUGR indicates vortices and elevated pressure in the intervillous space - a pilot study. Sci Rep 2017; 7:40771. [PMID: 28102332 PMCID: PMC5244422 DOI: 10.1038/srep40771] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 12/12/2016] [Indexed: 01/14/2023] Open
Abstract
Ischemic placental disease is a concept that links intrauterine growth retardation (IUGR) and preeclampsia (PE) back to insufficient remodeling of uterine spiral arteries. The rheological consequences of insufficient remodeling of uterine spiral arteries were hypothesized to mediate the considerably later manifestation of obstetric disease. However, the micro-rheology in the intervillous space (IVS) cannot be examined clinically and rheological animal models of the human IVS do not exist. Thus, an in silico approach was implemented to provide in vivo inaccessible data. The morphology of a spiral artery and the inflow region of the IVS were three-dimensionally reconstructed to provide a morphological stage for the simulations. Advanced high-end supercomputing resources were used to provide blood flow simulations at high spatial resolution. Our simulations revealed turbulent blood flow (high-velocity jets and vortices) combined with elevated blood pressure in the IVS and increased wall shear stress at the villous surface in conjunction with insufficient spiral artery remodeling only. Post-hoc histological analysis of uterine veins showed evidence of increased trophoblast shedding in an IUGR placenta. Our data support that rheological alteration in the IVS is a relevant mechanism linking ischemic placental disease to altered structural integrity and function of the placenta.
Collapse
|
23
|
Milnerowicz-Nabzdyk E, Bizoń A, Zimmer M. How Does Tobacco Smoke Affect Fetal Growth Potential in the First Trimester of Pregnancy as Measured by Volume Parameters of the Fetus, Trophoblast, and Gestational Sac? Reprod Sci 2016; 24:548-559. [DOI: 10.1177/1933719116660845] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ewa Milnerowicz-Nabzdyk
- 2nd Department and Clinic of Obstetrics and Gynaecology, Wroclaw Medical University, Wrocław, Poland
| | - Anna Bizoń
- Department of Biomedical and Environmental Analysis, Wroclaw Medical University, Wrocław, Poland
| | - Mariusz Zimmer
- 2nd Department and Clinic of Obstetrics and Gynaecology, Wroclaw Medical University, Wrocław, Poland
| |
Collapse
|
24
|
Elmetwally M, Rohn K, Meinecke-Tillmann S. Noninvasive color Doppler sonography of uterine blood flow throughout pregnancy in sheep and goats. Theriogenology 2016; 85:1070-9.e1. [DOI: 10.1016/j.theriogenology.2015.11.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 11/22/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
|
25
|
Affiliation(s)
- K S Joseph
- Department of Obstetrics and Gynaecology, School of Population and Public Health, University of British Columbia and the Children's and Women's Hospital and Health Centre of British ColumbiaVancouver, BC, Canada
| |
Collapse
|
26
|
Abstract
Doppler ultrasonography plays an ever-increasing role in obstetric imaging. Although commonly purported to assess blood flow, most studies in this area report purely on velocimetric parameters, rather than true volumetric flow. This review article highlights the physiological importance of this distinction, and reports on a literature review of uterine artery Doppler interrogation in the context of pre-eclampsia, which identified only four original research papers that attempted to assess blood flow. Attention is needed for true volumetric flow assessment in pre-eclampsia research, which may permit a more complete conceptualisation of the pathogenesis and haemodynamic consequences of this condition.
Collapse
Affiliation(s)
- Stefan C Kane
- a Department of Perinatal Medicine , The Royal Women's Hospital , Parkville , Victoria , Australia .,b Department of Obstetrics and Gynaecology , The University of Melbourne , Melbourne , Victoria , Australia
| | - Alicia T Dennis
- b Department of Obstetrics and Gynaecology , The University of Melbourne , Melbourne , Victoria , Australia .,c Department of Anaesthesia , The Royal Women's Hospital , Parkville , Victoria , Australia , and.,d Department of Pharmacology , The University of Melbourne , Melbourne , Victoria , Australia
| |
Collapse
|
27
|
Tarzamni MK, Kefayati M, Maleki M, Fouladi DF. Placental laterality and uterine blood flow at 20–40 weeks’ gestation in low-risk pregnancies. J OBSTET GYNAECOL 2015. [DOI: 10.3109/01443615.2015.1030599] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
28
|
Browne VA, Julian CG, Toledo-Jaldin L, Cioffi-Ragan D, Vargas E, Moore LG. Uterine artery blood flow, fetal hypoxia and fetal growth. Philos Trans R Soc Lond B Biol Sci 2015; 370:20140068. [PMID: 25602072 PMCID: PMC4305169 DOI: 10.1098/rstb.2014.0068] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Evolutionary trade-offs required for bipedalism and brain expansion influence the pregnancy rise in uterine artery (UtA) blood flow and, in turn, reproductive success. We consider the importance of UtA blood flow by reviewing its determinants and presenting data from 191 normotensive (normal, n = 125) or hypertensive (preeclampsia (PE) or gestational hypertension (GH), n = 29) Andean residents of very high (4100-4300 m) or low altitude (400 m, n = 37). Prior studies show that UtA blood flow is reduced in pregnancies with intrauterine growth restriction (IUGR) but whether the IUGR is due to resultant fetal hypoxia is unclear. We found higher UtA blood flow and Doppler indices of fetal hypoxia in normotensive women at high versus low altitude but similar fetal growth. UtA blood flow was markedly lower in early-onset PE versus normal high-altitude women, and their fetuses more hypoxic as indicated by lower fetal heart rate, Doppler indices and greater IUGR. We concluded that, despite greater fetal hypoxia, fetal growth was well defended by higher UtA blood flows in normal Andeans at high altitude but when compounded by lower UtA blood flow in early-onset PE, exaggerated fetal hypoxia caused the fetus to respond by decreasing cardiac output and redistributing blood flow to help maintain brain development at the expense of growth elsewhere. We speculate that UtA blood flow is not only an important supply line but also a trigger for stimulating the metabolic and other processes regulating feto-placental metabolism and growth. Studies using the natural laboratory of high altitude are valuable for identifying the physiological and genetic mechanisms involved in human reproductive success.
Collapse
Affiliation(s)
- Vaughn A Browne
- Department of Emergency Medicine, University of Colorado Denver, Aurora, CO 80045, USA
| | - Colleen G Julian
- Department of Medicine, University of Colorado Denver, Aurora, CO 80045, USA
| | | | - Darleen Cioffi-Ragan
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO 80045, USA
| | - Enrique Vargas
- Instituto Boliviano de Biología de Altura, La Paz, Bolivia
| | - Lorna G Moore
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO 80045, USA
| |
Collapse
|
29
|
Osol G, Moore LG. Maternal uterine vascular remodeling during pregnancy. Microcirculation 2014; 21:38-47. [PMID: 23941526 DOI: 10.1111/micc.12080] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 08/09/2013] [Indexed: 12/01/2022]
Abstract
Remodeling of the maternal uterine vasculature during pregnancy is a unique cardiovascular process that occurs in the adult and results in significant structural and functional changes in large and small arteries and veins, and in the creation of the placenta--a new fetomaternal vascular organ. This expansive, hypertrophic process results in increases in both lumen circumference and length, and is effected through a combination of tissue and cellular hypertrophy, endothelial and vascular smooth muscle hyperplasia, and matrix remodeling. This review summarizes what is currently known about the time course and extent of the remodeling process, and how local vs. systemic factors influence its genesis. The main focus is on upstream maternal vessels rather than spiral artery changes, although the latter are considered from the overall hemodynamic perspective. We also consider some of the underlying mechanisms and provide a hypothetical scenario that integrates our current knowledge. Abrogation of this adaptive vascular process is associated with several human gestational pathologies such as preeclampsia and intrauterine growth restriction (IUGR), which not only raise the risk of infant mortality and morbidity but are also a significant source of maternal mortality and susceptibility to cardiovascular and other diseases for both mother and neonate later in life.
Collapse
Affiliation(s)
- George Osol
- Department of Obstetrics and Gynecology, University of Vermont College of Medicine, Burlington, Vermont, USA
| | | |
Collapse
|
30
|
Abstract
BACKGROUND Uterine artery pseudoaneurysm has a pathognomonic ultrasound appearance. Its occurrence in pregnancy is life-threatening for both mother and fetus. We present an illustrative case and discuss management with selective uterine artery embolization during pregnancy. CASE A 37-year-old pregnant woman presented with profuse painless vaginal blood loss at a gestational age of 27 weeks. Ultrasonography and magnetic resonance imaging indicated a left-sided uterine artery pseudoaneurysm. Selective embolization of the pseudoaneurysm was performed. Blood loss ceased allowing the pregnancy to continue until term. CONCLUSION Endovascular embolization is a feasible therapeutic option for a uterine artery pseudoaneurysm during pregnancy without compromising fetoplacental perfusion.
Collapse
|
31
|
Flo K, Widnes C, Vårtun Å, Acharya G. Blood flow to the scarred gravid uterus at 22-24 weeks of gestation. BJOG 2013; 121:210-5. [DOI: 10.1111/1471-0528.12441] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2013] [Indexed: 11/30/2022]
Affiliation(s)
- K Flo
- Women's Health and Perinatology Research Group; Department of Clinical Medicine; Faculty of Health Sciences; University of Tromsø; Tromsø Norway
- Department of Obstetrics and Gynaecology; University Hospital of North Norway; Tromsø Norway
| | - C Widnes
- Women's Health and Perinatology Research Group; Department of Clinical Medicine; Faculty of Health Sciences; University of Tromsø; Tromsø Norway
- Department of Obstetrics and Gynaecology; University Hospital of North Norway; Tromsø Norway
| | - Å Vårtun
- Women's Health and Perinatology Research Group; Department of Clinical Medicine; Faculty of Health Sciences; University of Tromsø; Tromsø Norway
- Department of Obstetrics and Gynaecology; University Hospital of North Norway; Tromsø Norway
| | - G Acharya
- Women's Health and Perinatology Research Group; Department of Clinical Medicine; Faculty of Health Sciences; University of Tromsø; Tromsø Norway
- Department of Obstetrics and Gynaecology; University Hospital of North Norway; Tromsø Norway
- Department of Clinical Sciences, Intervention and Technology; Karolinska Institute; Stockholm Sweden
| |
Collapse
|
32
|
Lee IW, Chang CH, Cheng YC, Ko HC, Chang FM. A Review of Three-dimensional Ultrasound Applications in Fetal Growth Restriction. J Med Ultrasound 2012. [DOI: 10.1016/j.jmu.2012.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
33
|
Abduljalil K, Furness P, Johnson TN, Rostami-Hodjegan A, Soltani H. Anatomical, Physiological and Metabolic Changes with Gestational Age during Normal Pregnancy. Clin Pharmacokinet 2012; 51:365-96. [DOI: 10.2165/11597440-000000000-00000] [Citation(s) in RCA: 220] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
34
|
Flo K, Wilsgaard T, Acharya G. A new non-invasive method for measuring uterine vascular resistance and its relationship to uterine artery Doppler indices: a longitudinal study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:538-542. [PMID: 21154788 DOI: 10.1002/uog.8907] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To describe a new method for measuring uterine vascular resistance (R(uta) ), establish longitudinal reference ranges and explore the relationship between uterine artery (UtA) Doppler indices and R(uta) . METHODS This was a longitudinal study of 53 low-risk pregnancies. Doppler ultrasonography was used to measure UtA velocities, and the pulsatility index (PI), resistance index (RI) and systolic/diastolic velocity (S/D) ratio were calculated. R(uta) was calculated as a ratio between maternal mean arterial pressure and UtA time-averaged maximum velocity. RESULTS At 22 + 0 to 39 + 6 weeks of gestation, the mean R(uta) decreased from 1628 to 1180 dyne.s/cm(3) (P < 0.0001). UtA velocities increased (P < 0.0001), whereas the PI (0.79-0.56), RI (0.51-0.40) and S/D ratio (2.0-1.7) decreased (P < 0.0001). R(uta) and the UtA Doppler indices were positively associated (P = 0.003-0.001). CONCLUSION We describe a non-invasive method for measuring R(uta) and provide reference ranges for serial evaluation of UtA velocities, Doppler indices and R(uta) .
Collapse
Affiliation(s)
- K Flo
- Faculty of Health Sciences, Women's Health and Perinatology Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | | | | |
Collapse
|
35
|
Ferrazzi E, Rigano S, Padoan A, Boito S, Pennati G, Galan HL. Uterine artery blood flow volume in pregnant women with an abnormal pulsatility index of the uterine arteries delivering normal or intrauterine growth restricted newborns. Placenta 2011; 32:487-92. [PMID: 21531458 DOI: 10.1016/j.placenta.2011.04.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 03/28/2011] [Accepted: 04/06/2011] [Indexed: 11/18/2022]
Abstract
The aim of this study was to assess and compare uterine artery (UtA) blood flow volume in pregnant patients with an abnormal uterine Doppler pulsatility index (PI) who delivered fetuses with an appropriate weight for gestational age (AGA) or with intrauterine growth restricted (IUGR). We prospectively recruited singleton pregnancies with abnormal uterine arteries P.I. between 18 and 38 weeks of gestation regardless of estimated fetal weight (EFW). Vessel diameter and blood flow velocity were measured along the UtA upstream to the vessel bifurcation in both the right and left UtAs. Uterine blood flow volumes measured in these pregnancies were compared to historical Control-pregnancies. Forty-three patients delivered at term a normal weight newborn (AGA-pregnancies). Thirty patients delivered growth restricted newborns at 32 weeks (i.r. 29-36w) with a median weight of 1160 gr (i.r. 1000-2065 gr) (IUGR-pregnancies). At mid-gestation (18 + 0 - 25 + 6 weeks + days of gestation) a significantly lower uterine blood flow volume per unit weight was observed between the two study groups and compared to controls: 142 ml/min/kg in IUGR-pregnancies, 217 ml/min/kg in AGA-pregnancies and 538 ml/min/kg in Control-pregnancies. These striking differences in blood flow volume were already present at mid-gestation, at a time when EFW was still normal. In late gestation (27 + 0 - 37 + 6 weeks + days of gestation), pregnancies with an abnormal uterine P.I. showed persistently low UtA flow (<50% of controls) even when corrected for fetal weight: 81 ml/min/kg in IUGR-pregnancies, 105 ml/min/kg in AGA-pregnancies, and 193 ml/min/kg in Control-pregnancies; p < 0.0001. Our findings are consistent with other recent studies regarding the association between reduced uterine blood flow volume and fetal growth restriction. However, the study brings new insight into the finding of abnormal uterine P.I. in normally grown fetuses typically dismissed as "falsely abnormal" or "false positive" findings. Our study suggests that blood flow volume measurement may serve as a new tool to assess this group of patients and possibly those with ischemic placental diseases that may provide some basis for therapeutic interventions.
Collapse
Affiliation(s)
- E Ferrazzi
- Dept. Clinical Sciences Sacco, Obstet Gynecol, Buzzi Children's Hospital, University of Milan, Italy.
| | | | | | | | | | | |
Collapse
|