1
|
Mattesini P, Ramalli A, Petrusca L, Basset O, Liebgott H, Tortoli P. Spectral Doppler Measurements With 2-D Sparse Arrays. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:278-285. [PMID: 31562082 DOI: 10.1109/tuffc.2019.2944090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The 2-D sparse arrays, in which a few hundreds of elements are distributed on the probe surface according to an optimization procedure, represent an alternative to full 2-D arrays, including thousands of elements usually organized in a grid. Sparse arrays have already been used in B-mode imaging tests, but their application to Doppler investigations has not been reported yet. Since the sparsity of the elements influences the acoustic field, a corresponding influence on the mean frequency (Fm), bandwidth (BW), and signal-to-noise ratio (SNR) of the Doppler spectra is expected. This article aims to assess, by simulations and experiments, to what extent the use of a sparse rather than a full gridded 2-D array has an impact on spectral Doppler measurements. Parabolic flows were investigated by a 3 MHz, 1024-element gridded array and by a sparse array; the latter was obtained by properly selecting a subgroup of 256 elements from the full array. Simulations show that the mean Doppler frequency does not change between the sparse and the full array while there are significant differences on the BW (average reduction of 17.2% for the sparse array, due to different apertures of the two probes) and on the signal power (Ps) (22 dB, due to the different number of active elements). These results are confirmed by flow phantom experiments, which also highlight that the most critical difference between sparse and full gridded array in Doppler measurements is in terms of SNR (-16.8 dB).
Collapse
|
2
|
Zamir M, Nelson DM, Ginosar Y. Geometric and hemodynamic characterization of uterine spiral arteries: The concept of resistance reserve. Placenta 2018; 68:59-64. [PMID: 30055671 DOI: 10.1016/j.placenta.2018.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/27/2018] [Accepted: 06/08/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The coiled geometry of spiral arteries in the human uteroplacental circulation is a hemodynamic enigma because of added length of a spiral artery compared with that of a straight artery, as well as added complexity of the flow within the vessel because of the coiling curvature. METHODS We examined the geometric and hemodynamic characteristics of mathematically defined helical and spiral arteries and compared these with the corresponding characteristics of a straight artery traversing the same depth of tissue, with the aim of gaining some insight into the possible role of spiral geometry in uteroplacental perfusion. RESULTS The results indicate that the added length of a spiral artery provides the uteroplacental circulation with a reserve of high resistance to flow. The effect of coiling geometry on the flow within the artery is the development of churning vortices in planes normal (perpendicular) to the main flow direction. CONCLUSIONS In the early stages of pregnancy the reserve of high resistance is intact, thus keeping blood supply low. As pregnancy progresses, the reserve is gradually purged by trophoblast invasion and transformation of the distal portion of the spiral artery into an open funnel, thus providing the required high blood supply. The development of churning vortices within the spiral artery support earlier suggestions in the literature that the "spurts" of maternal blood emerging from these arteries may play a role in shaping the anatomy of the villous trees among placental lobules.
Collapse
Affiliation(s)
- Mair Zamir
- Department of Applied Mathematics, Department of Medical Biophysics, The University of Western Ontario, London, Canada.
| | - D Michael Nelson
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA
| | - Yehuda Ginosar
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA; Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| |
Collapse
|
3
|
McKelvey A, Pateman K, Balchin I, Peebles DM, Rodeck CH, David AL. Total uterine artery blood volume flow rate in nulliparous women is associated with birth weight and gestational age at delivery. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:54-60. [PMID: 26990029 DOI: 10.1002/uog.15917] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 01/27/2016] [Accepted: 03/15/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To investigate the relationship between total uterine artery blood volume flow rate (TVFR) and birth weight and gestational age at delivery, and to establish normal ranges of TVFR throughout pregnancy. METHODS This was a prospective cohort study of 334 nulliparous women booking antenatal care at University College London Hospital between August 2008 and September 2009. Women underwent a transabdominal ultrasound examination of uterine arteries for measurement of TVFR at 12, 20 and 24 weeks' gestation. Pregnancy outcomes were recorded and linear regression was used to study the relationship between TVFR and gestational age at delivery and birth weight. RESULTS A total of 551 ultrasound scans were performed. There was a significant, positive correlation between TVFR at 11-13 weeks (TVFR1) and at 22-26 weeks (TVFR3) and birth weight. For every 100-mL/min increase in TVFR1 and TVFR3, there was an increase in birth weight of 45 g and 27 g, respectively. There was also a positive association between TVFR1 and gestational age at delivery, with a 1.4-day increase in gestational age for every 100-mL/min increase of TVFR1. CONCLUSION Ultrasound measurement of TVFR in the first trimester is significantly associated with both birth weight and gestational age at delivery. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- A McKelvey
- The East Anglian Centre for Fetal Medicine, Norfolk and Norwich University College Hospitals Foundation Trust, Norwich, UK
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, UK
| | - K Pateman
- Department of Gynaecological Ultrasound, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, UK
| | - I Balchin
- Department of Obstetrics & Gynaecology, Women and Children Health Complex, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - D M Peebles
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, UK
| | - C H Rodeck
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, UK
| | - A L David
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
4
|
Uterine artery pulsatility index in hypertensive pregnancies: When does the index normalize in the puerperium? Obstet Gynecol Sci 2016; 59:463-469. [PMID: 27896248 PMCID: PMC5120065 DOI: 10.5468/ogs.2016.59.6.463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/16/2016] [Accepted: 09/03/2016] [Indexed: 11/08/2022] Open
Abstract
Objective To investigate whether the uterine artery pulsatility index (UtA PI) of hypertensive pregnancies is higher than that of normal pregnancies in the puerperium, as well as in the antepartum period. Methods The UtA PI was measured in hypertensive (group 1) and normal pregnancies (group 2) during antepartum, immediate postpartum or late postpartum periods. Using the transvaginal approach, the bilateral uterine artery indices were measured. Results One hundred twenty-two women were enrolled: group 1, hypertensive disease in pregnancy (11 cases in antepartum, 13 cases in immediate postpartum and 10 cases in late postpartum period); group 2, normal pregnancies (32 cases in antepartum, 29 cases in immediate postpartum and 27 cases in late postpartum). In antepartum and immediate postpartum periods, the mean UtA PI and the proportion of cases with an early diastolic notch were higher in group 1 than in group 2 (antepartum mean UtA PI, 1.14 in group 1 vs. 0.68 in group 2, P<0.001; early diastolic notch, 46% vs. 9%, P<0.05; immediate postpartum mean UtA PI, 1.30 vs. 1.08, P<0.05; early diastolic notch, 85% vs. 48%, P<0.05). In late postpartum period, the mean value of UtA PI of group 1 was still higher than that of group 2, although the proportion of cases with an early diastolic notch was not different (mean UtA PI, 1.43 vs. 1.20, P<0.05; early diastolic notch, 60% vs. 52%, P=0.73). Conclusion The UtA PI in hypertensive pregnancies was still higher than normal pregnancies in puerperal periods, suggesting that more than several weeks are required to resolve increased uterine artery vascular impedance.
Collapse
|
5
|
Yücel B, Gedikbasi A, Dündar O, Olgac Y, Yıldırım D, Yıldırım G, Polat I. The utility of first trimester uterine artery Doppler, placental volume and PAPP-A levels alone and in combination to predict preeclampsia. Pregnancy Hypertens 2016; 6:269-273. [DOI: 10.1016/j.preghy.2016.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/16/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
|
6
|
Mandel D, Pryde P, Shah D, Iruretagoyena J. Use of Doppler ultrasound in the management of uteroplacental perfusion during cardiopulmonary bypass in pregnancy. Int J Obstet Anesth 2016; 27:75-80. [DOI: 10.1016/j.ijoa.2016.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 01/12/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
|
7
|
Cardiac time intervals derived by magnetocardiography in fetuses exposed to pregnancy hypertension syndromes. J Perinatol 2016; 36:643-8. [PMID: 27031323 DOI: 10.1038/jp.2016.58] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/18/2016] [Accepted: 03/03/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To test the hypothesis that fetuses exposed to maternal preeclampsia or chronic hypertension have deranged development of cardiac time intervals. STUDY DESIGN Pregnancies were divided into three groups: Intrauterine Growth Restricted (IUGR), Hypertensive, and Normal. Each group's mean fetal cardiac time intervals (P, PR, QRS and RR) derived by magnetocardiography were calculated using an analysis of covariance model's regression-adjusted estimates for a gestational age of 35 weeks. RESULTS We reviewed 141 recordings from 21 IUGR, 46 Hypertensive and 74 Normal patients. The IUGR, Hypertensive and Normal groups, respectively, had adjusted mean intervals in milliseconds of 66.4, 66.8 and 76.2 for P (P=0.001), 95.9, 101.6 and 109.6 for PR (P=0.002), 77.2, 78.7 and 78.7 for QRS (P=0.81) and 429.8, 429.2 and 428.5 for RR (P=0.97). CONCLUSION P and PR intervals are abbreviated in normotrophic fetuses exposed to maternal hypertension, suggesting shortened atrioventricular conduction times.
Collapse
|
8
|
Bibeau K, Sicotte B, Béland M, Bhat M, Gaboury L, Couture R, St-Louis J, Brochu M. Placental Underperfusion in a Rat Model of Intrauterine Growth Restriction Induced by a Reduced Plasma Volume Expansion. PLoS One 2016; 11:e0145982. [PMID: 26727492 PMCID: PMC4703198 DOI: 10.1371/journal.pone.0145982] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 12/11/2015] [Indexed: 12/20/2022] Open
Abstract
Lower maternal plasma volume expansion was found in idiopathic intrauterine growth restriction (IUGR) but the link remains to be elucidated. An animal model of IUGR was developed by giving a low-sodium diet to rats over the last week of gestation. This treatment prevents full expansion of maternal circulating volume and the increase in uterine artery diameter, leading to reduced placental weight compared to normal gestation. We aimed to verify whether this is associated with reduced remodeling of uteroplacental circulation and placental hypoxia. Dams were divided into two groups: IUGR group and normal-fed controls. Blood velocity waveforms in the main uterine artery were obtained by Doppler sonography on days 14, 18 and 21 of pregnancy. On day 22 (term = 23 days), rats were sacrificed and placentas and uterine radial arteries were collected. Diameter and myogenic response of uterine arteries supplying placentas were determined while expression of hypoxia-modulated genes (HIF-1α, VEGFA and VEGFR2), apoptotic enzyme (Caspase -3 and -9) and glycogen cells clusters were measured in control and IUGR term-placentas. In the IUGR group, impaired blood velocity in the main uterine artery along with increased resistance index was observed without alteration in umbilical artery blood velocity. Radial uterine artery diameter was reduced while myogenic response was increased. IUGR placentas displayed increased expression of hypoxia markers without change in the caspases and increased glycogen cells in the junctional zone. The present data suggest that reduced placental and fetal growth in our IUGR model may be mediated, in part, through reduced maternal uteroplacental blood flow and increased placental hypoxia.
Collapse
Affiliation(s)
- Karine Bibeau
- Department of Molecular and Integrative Physiology, Université de Montréal, Montréal, Québec, Canada
| | - Benoit Sicotte
- Department of Molecular and Integrative Physiology, Université de Montréal, Montréal, Québec, Canada
| | - Mélanie Béland
- Department of Pathology and Cellular Biology, Université de Montréal, Montréal, Québec, Canada
| | - Menakshi Bhat
- Department of Molecular and Integrative Physiology, Université de Montréal, Montréal, Québec, Canada
| | - Louis Gaboury
- Department of Pathology and Cellular Biology, Université de Montréal, Montréal, Québec, Canada
| | - Réjean Couture
- Department of Molecular and Integrative Physiology, Université de Montréal, Montréal, Québec, Canada
| | - Jean St-Louis
- Department of Obstetrics-Gynecology, Université de Montréal, Montréal, Québec, Canada
| | - Michèle Brochu
- Department of Molecular and Integrative Physiology, Université de Montréal, Montréal, Québec, Canada
- * E-mail:
| |
Collapse
|
9
|
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]
|
10
|
Velocimetría Doppler del flujo sanguíneo de la arteria uterina y riesgo de muerte perinatal en preeclámpsicas. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2014. [DOI: 10.1016/j.gine.2013.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
11
|
Ricci S, Bassi L, Tortoli P. Real-time vector velocity assessment through multigate Doppler and plane waves. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2014; 61:314-324. [PMID: 24474137 DOI: 10.1109/tuffc.2014.6722616] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Several ultrasound (US) methods have been recently proposed to produce 2-D velocity vector fields with high temporal and spatial resolution. However, the real-time implementation in US scanners is heavily hampered by the high calculation power required. In this work, we report a real-time vector Doppler imaging method which has been integrated in an open research system. The proposed approach exploits the plane waves transmitted from two sub-arrays of a linear probe to estimate the velocity vectors in 512 sample volumes aligned along the probe axis. The method has been tested for accuracy and reproducibility through simulations and in vitro experiments. Simulations over a 0° to 90° angle range of a 0.5 m/s peak parabolic flow have yielded 0.75° bias and 1.1° standard deviation for direction measurement, and 0.6 cm/s bias with 3.1% coefficient of variation for velocity assessment. In vitro tests have supported the simulation results. Preliminary measurements on the carotid artery of a volunteer have highlighted the real-time system capability of imaging complex flow configurations in an intuitive, easy, and quick way, as shown in a sample supplementary movie. These features have allowed reproducible peak velocity measurements to be obtained, as needed for quantitative investigations on patients.
Collapse
|
12
|
|
13
|
Simonazzi G, Curti A, Cattani L, Rizzo N, Pilu G. Outcome of severe placental insufficiency with abnormal umbilical artery Doppler prior to fetal viability. BJOG 2013; 120:754-7. [DOI: 10.1111/1471-0528.12133] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2012] [Indexed: 12/01/2022]
Affiliation(s)
- G Simonazzi
- Department of Obstetrics and Gynecology; St. Orsola Malpighi Hospital; University of Bologna; Bologna; Italy
| | - A Curti
- Department of Obstetrics and Gynecology; St. Orsola Malpighi Hospital; University of Bologna; Bologna; Italy
| | - L Cattani
- Department of Obstetrics and Gynecology; St. Orsola Malpighi Hospital; University of Bologna; Bologna; Italy
| | - N Rizzo
- Department of Obstetrics and Gynecology; St. Orsola Malpighi Hospital; University of Bologna; Bologna; Italy
| | - G Pilu
- Department of Obstetrics and Gynecology; St. Orsola Malpighi Hospital; University of Bologna; Bologna; Italy
| |
Collapse
|
14
|
OUSEY JC, KÖLLING M, NEWTON R, WRIGHT M, ALLEN WR. Uterine haemodynamics in young and aged pregnant mares measured using Doppler ultrasonography. Equine Vet J 2012:15-21. [DOI: 10.1111/j.2042-3306.2011.00446.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
15
|
Schober P, Loer SA, Schwarte LA. Transesophageal Doppler devices: A technical review. J Clin Monit Comput 2009; 23:391-401. [DOI: 10.1007/s10877-009-9204-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 09/30/2009] [Indexed: 11/29/2022]
|
16
|
Wei SH, Helmy M, Cohen AJ. CT evaluation of placental abruption in pregnant trauma patients. Emerg Radiol 2009; 16:365-73. [PMID: 19277736 PMCID: PMC2716448 DOI: 10.1007/s10140-009-0804-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 02/24/2009] [Indexed: 12/01/2022]
Abstract
The purpose of the study was to assess the possibility of placental injury detection on computed tomography (CT) in pregnant trauma patients. The images and dictated reports of 44 CT scans of pregnant women who presented to the University of California Irvine Medical Center (UCIMC) from 2003 to 2008 for traumatic abdominal conditions were reviewed for placental abruption. Performances of original dictated reports, an untrained reviewer, and a trained reviewer (who was trained on 22 non-traumatic scans) were compared. Of the 66 pregnant women who received abdominal CT scans, 44 sustained abdominal trauma. Seven suffered placental abruptions, all of which were identified on CT. Sensitivity and specificity were 100% and 79.5%, respectively, for the untrained reviewer, 100% and 82.1% for the trained reviewer, and 42.9% and 89.7% for the original dictated reports. Placental abruptions are often overlooked on CT scan. Sensitivity may be improved by systematic evaluation of the placenta and specificity by training on normal placental morphology.
Collapse
Affiliation(s)
- Sindy H Wei
- Department of Medicine, University of California Irvine Medical Center, Orange, CA 92868, USA
| | | | | |
Collapse
|
17
|
Ginosar Y, Nadjari M, Hoffman A, Firman N, Davidson E, Weiniger C, Rosen L, Weissman C, Elchalal U. Antepartum continuous epidural ropivacaine therapy reduces uterine artery vascular resistance in pre-eclampsia: a randomized, dose-ranging, placebo-controlled study †. Br J Anaesth 2009; 102:369-78. [DOI: 10.1093/bja/aen402] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|