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Zhi R, Tao X, Li Q, Yu M, Li H. Association between transabdominal uterine artery Doppler and small-for-gestational-age: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:659. [PMID: 37704965 PMCID: PMC10500919 DOI: 10.1186/s12884-023-05968-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/31/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND The association between uterine artery Doppler (UtA) measurements and small for gestational age (SGA) has not been quantitatively analyzed throughout the whole pregnancy. This systematic review and meta-analysis aims to comprehensively explore the association between UtA measurements and SGA in the first, second, and third trimesters. METHODS Studies were searched from Pubmed, Embase, Cochrane Library, and Web of Science. Weighted mean difference (WMD), odds ratio (OR), and relative risk (RR) with 95% confidence interval (CI) were used as the effect size. Heterogeneity of all effect sizes was tested and quantified using I2 statistics. Sensitivity analysis was conducted for all outcomes, and publication bias was evaluated using Begg's test. RESULTS A total of 41 studies were finally included in our meta-analysis. In the first trimester, mean PI was significantly higher in the SGA group than the non-SGA group (WMD: 0.31, 95%CI: 0.19-0.44). In the second trimester, odds of notch presence (OR: 2.54, 95%CI: 2.10-3.08), mean PI (WMD: 0.21, 95%CI: 0.12-0.30), and mean RI (WMD: 0.05, 95%CI: 0.05-0.06) were higher in the SGA group. Also, abnormal UtA measurements were associated with the increased odds of SGA (all P < 0.05). In the third trimester, PI z-score (WMD: 0.62, 95%CI: 0.33-0.91) and PI MoM (WMD: 0.08, 95%CI: 0.06-0.09) showed a significant increase in the SGA group. The odds of SGA were higher in the women with mean PI > 95% (OR: 6.03, 95%CI: 3.24-11.24). CONCLUSIONS Abnormal UtA measurements were associated with high odds of SGA, suggesting that UtA might be an adjunctive screening method for SGA in the whole pregnancy.
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Affiliation(s)
- Ruijuan Zhi
- Department of Ultrasound, The First People's Hospital of Lianyungang, No.6 Zhenhua East Road, Haizhou District, Lianyungang, 222061, P.R. China
| | - Xiangping Tao
- Department of Pediatrics, The Affiliated Lianyungang Oriental Hospital of Xuzhou Medical University, Lianyungang, 222000, P.R. China
| | - Qingtao Li
- Department of Obstetrics and Gynecology, The First People's Hospital of Lianyungang, Lianyungang, 222061, P.R. China
| | - Ming Yu
- Department of Ultrasound, The First People's Hospital of Lianyungang, No.6 Zhenhua East Road, Haizhou District, Lianyungang, 222061, P.R. China
| | - Honge Li
- Department of Ultrasound, The First People's Hospital of Lianyungang, No.6 Zhenhua East Road, Haizhou District, Lianyungang, 222061, P.R. China.
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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.
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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
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Li M, Yue C. Abnormal uterine artery Doppler ultrasound during gestational 21-23 weeks associated with pre-eclampsia. Int J Gynaecol Obstet 2023; 161:264-270. [PMID: 36049891 DOI: 10.1002/ijgo.14435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/28/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess whether abnormal uterine artery Doppler ultrasound during weeks 21-23 of pregnancy was associated with an increased risk of pre-eclampsia. METHODS Our retrospective cohort study analyzed uterine artery ultrasound parameters in singleton pregnant women at 21-23 weeks of pregnancy and assessed the association between abnormal ultrasound findings and the risk of pre-eclampsia. Multivariate logistic regression analysis was conducted to estimate the relative risk between uterine artery ultrasound and pre-eclampsia. RESULTS Compared with normal results, unilateral pulsatile index abnormality (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.71-3.10), bilateral pulsatile index anomalies (OR 6.21, 95% CI 3.53-10.95), unilateral resistance index abnormality (OR 2.36, 95% CI 1.75-3.17), bilateral resistance index anomalies (OR 2.83, 95% CI 1.27-6.32), unilateral notch (OR 3.66, 95% CI 2.03-6.62), bilateral notch (OR 5.80, 95% CI 3.30-10.20) were associated with pre-eclampsia. For every 0.1 increase in the median multiple of mean pulsatile index, the risk of pre-eclampsia increased by 13%; for every 0.1 increase in the median multiple of mean resistance index, the risk of pre-eclampsia increased by 22%. CONCLUSION Multiples of the median for the pulsatile and resistance indices are an effective evaluation tool. Abnormal uterine artery ultrasound indices are strongly associated with the development of pre-eclampsia.
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Affiliation(s)
- Meng Li
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Chaoyan Yue
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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Shipp TD, Zelop CM, Maturen KE, Deshmukh SP, Dudiak KM, Henrichsen TL, Oliver ER, Poder L, Sadowski EA, Simpson L, Weber TM, Winter T, Glanc P. ACR Appropriateness Criteria ® Growth Disturbances-Risk of Fetal Growth Restriction. J Am Coll Radiol 2020; 16:S116-S125. [PMID: 31054738 DOI: 10.1016/j.jacr.2019.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 11/29/2022]
Abstract
Fetal growth restriction, or an estimated fetal weight of less than the 10th percentile, is associated with adverse perinatal outcome. Optimizing management for obtaining the most favorable outcome for mother and fetus is largely based on detailed ultrasound findings. Identifying and performing those ultrasound procedures that are most associated with adverse outcome is necessary for proper patient management. Transabdominal ultrasound is the mainstay of initial management and assessment of fetal growth. For those fetuses that are identified as small for gestational age, assessment of fetal well-being with biophysical profile and Doppler velocimetry provide vital information for differentiating those fetuses that may be compromised and may require delivery and those that are well compensated. Delivery of the pregnancy is primarily based upon the gestational age of the pregnancy and the ultrasound findings. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Thomas D Shipp
- Brigham & Women's Hospital, Boston, Massachusetts; American Congress of Obstetricians and Gynecologists.
| | - Carolyn M Zelop
- Valley Hospital, Ridgewood, New Jersey and NYU School of Medicine, New York, New York; American Congress of Obstetricians and Gynecologists
| | | | | | | | | | - Edward R Oliver
- Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Liina Poder
- University of California San Francisco, San Francisco, California
| | | | - Lynn Simpson
- Columbia University, New York, New York; American Congress of Obstetricians and Gynecologists
| | | | - Tom Winter
- University of Utah, Salt Lake City, Utah
| | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Desai P. Notch depth index alone and in combination with pi in prediction of preeclampsia at or before 32 weeks of pregnancy. Pregnancy Hypertens 2019; 16:11-15. [PMID: 31056144 DOI: 10.1016/j.preghy.2019.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 01/20/2019] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Pankaj Desai
- Janani Maternity Hospital, Vadodara, India; Department of Obgyn, Medical College and S.S.G. Hospital, Vadodara, India.
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Reddy M, Springhall EA, Rolnik DL, da Silva Costa F. How to perform first trimester combined screening for pre-eclampsia. Australas J Ultrasound Med 2018; 21:191-197. [DOI: 10.1002/ajum.12111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Maya Reddy
- Perinatal Services; Monash Medical Centre; 246 Clayton Road Clayton Victoria Australia
- Department of Obstetrics and Gynaecology; Monash University; 246 Clayton Road Clayton Victoria Australia
| | | | - Daniel Lorber Rolnik
- Perinatal Services; Monash Medical Centre; 246 Clayton Road Clayton Victoria Australia
| | - Fabricio da Silva Costa
- Perinatal Services; Monash Medical Centre; 246 Clayton Road Clayton Victoria Australia
- Department of Obstetrics and Gynaecology; Monash University; 246 Clayton Road Clayton Victoria Australia
- Monash Ultrasound for Women; Melbourne Victoria Australia
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Torabi S, Sheikh M, Fattahi Masrour F, Shamshirsaz AA, Bateni ZH, Nassr AA, Pooransari P, Talebian M, Hantoushzadeh S. Uterine artery Doppler ultrasound in second pregnancy with previous elective cesarean section. J Matern Fetal Neonatal Med 2018; 32:2221-2227. [DOI: 10.1080/14767058.2018.1430132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Shirin Torabi
- Maternal, Fetal and Neonatal Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sheikh
- Maternal, Fetal and Neonatal Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Fattahi Masrour
- Maternal, Fetal and Neonatal Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza A. Shamshirsaz
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX, USA
- Texas Children’s Hospital Pavilion for Women, Houston, TX, USA
| | - Zhoobin H. Bateni
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX, USA
- Texas Children’s Hospital Pavilion for Women, Houston, TX, USA
| | - Ahmed A. Nassr
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX, USA
- Texas Children’s Hospital Pavilion for Women, Houston, TX, USA
- Department of Obstetrics and Gynecology, Women’s Health Hospital, Assiut University, Assiut, Egypt
| | - Parichehr Pooransari
- Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Talebian
- Maternal, Fetal and Neonatal Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Hantoushzadeh
- Maternal, Fetal and Neonatal Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Breastfeeding Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Kumar M, Singh S, Sharma K, Singh R, Ravi V, Bhattacharya J. Adverse fetal outcome: is first trimester ultrasound and Doppler better predictor than biomarkers? J Matern Fetal Neonatal Med 2016; 30:1410-1416. [PMID: 27430153 DOI: 10.1080/14767058.2016.1214709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the predictive value of first trimester biomarkers and ultrasound in determining adverse fetal outcomes in a low risk Asian population. MATERIAL AND METHOD All low risk, singleton pregnancies between 11 and 14 weeks gestation underwent ultrasound with uterine artery Doppler along with PAPP-A and free β-hCG estimation, and were followed till delivery to observe the outcome. The adverse fetal outcomes detected were structural anomaly, aneuploidy, intrauterine growth restriction, preterm birth and stillbirth (SB). RESULTS Out of 3500 women screened, 417 cases had adverse fetal outcome in the absence of maternal complication, 2151 had normal outcome. Major structural anomaly was detected in first trimester in 17/28 (60.7%) cases. The most important markers for adverse fetal outcome were increased uterine artery pulsatility index (UPI) (p = 0.028, OR 1.5, 95% CI: 1.05-2.38, AUC 0.56) for IUGR, nuchal translucency (p = 0.001, OR 1.7, 95% CI: 1.11-2.77, AUC 0.60) for major anomaly and low PAPP-A (p = 0.017, OR -0.075, 95% CI: 0.87-0.98, AUC 0.621) for SB. CONCLUSION UPI, NT and PAPP-A in the first trimester are significant markers of adverse fetal outcome, although the sensitivity and specificity are not high they have a high negative predictive value.
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Affiliation(s)
| | | | | | - Ritu Singh
- d Department of Biochemistry , LHMC , New Delhi , India , and
| | - V Ravi
- e Lady Sri Ram College , New Delhi , India
| | - J Bhattacharya
- d Department of Biochemistry , LHMC , New Delhi , India , and
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Timur H, Çinar M, Hançerlioğullari N, Alkan M, İnal HA, Uygur D, Yilmaz N. Associations between first-trimester uterine artery Doppler velocimetry indices and adverse perinatal outcomes in women conceiving via in vitro fertilization. J Matern Fetal Neonatal Med 2016; 30:684-688. [DOI: 10.1080/14767058.2016.1182979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Hakan Timur
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Mehmet Çinar
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Necati Hançerlioğullari
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Mihriban Alkan
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Hasan Ali İnal
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Dilek Uygur
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
| | - Nafiye Yilmaz
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey
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