Role of uterine artery Doppler velocimetry indices and plasma adrenomedullin level in women with unexplained recurrent pregnancy loss (original) (raw)
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Effect of uterine artery blood flow on recurrent pregnancy loss
Clinical and experimental obstetrics & gynecology
We investigated the effect of uterine artery blood flow on recurrent pregnancy loss. One hundred and twelve patients admitted to our clinic were included in the prospective study. The study group consisted of 28 cases with a history of three miscarriages before the 20th gestational week, and the control group consisted of cases with at least one prior live birth without any history of miscarriage or poor obstetric outcome. The mean pulsatility index (PI) , resistance index (RI) and systolic/diastolic ratio (S/D ratio) values of the uterine artery were measured between the 18th and 23rd days of the menstrual cycle via transvaginal Doppler ultrasonography. No statistically significant difference could be detected regarding uterine artery PI (p=0.703), RI (p=0.333), and S/D (p=0.403) values between the study group and the control group (p>0.05). In order to clearly determine etiologic causes of recurrent pregnancy loss, new randomized and controlled clinical trials with large patien...
Role of uterine artery Doppler in assessment of unexplained infertility
Egyptian Journal of Radiology and Nuclear Medicine, 2021
Background: The study aimed to compare the values of uterine artery Doppler indices including resistance index (RI), pulsatility index (PI), and systolic/diastolic (S/D) ratios in fertile female and female with unexplained infertility and investigate their association with unexplained infertility. This study included 70 women divided into two groups. Study group included 40 women with unexplained infertility and control group included 30 fertile women. Results: The mean ages of study and control groups were 26.9 and 28.5 years respectively. In infertile group, the mean values of uterine arteries resistance index (RI), pulsatility index (PI), and systolic/diastolic (S/D) ratios were 0.9, 2.9, and 8.0 respectively. In the fertile control group, mean RI and PI values and S/D ratio were 0.6, 1.5, and 2.7 respectively. There was statistically significant difference as regards RI, PI, and S/D ratios between study and control groups. The best cut off values of RI, PI, and S/D ratios for predicting increased uterine blood flow impedance were more than 0.67, 1.95, and 3 respectively with sensitivity of 100%, 95%, and 100% respectively, specificity of 96.7%, 86.7%, and 96.7% respectively, and diagnostic accuracy of 98.6%, 91.42%, and 98.57% respectively. Conclusion: Uterine artery Doppler indices mean values were higher in unexplained infertility women than fertile women. Uterine artery Doppler indices have high sensitivity and specificity for diagnosis of high uterine blood flow impedance. High uterine blood flow impedance diagnosed by uterine artery Doppler may contribute in the etiology of unexplained infertility. Uterine artery Doppler should be included in investigation of unexplained infertility.
The Egyptian Journal of Hospital Medicine
Background: Abortion is considered recurrent when it happens spontaneously and successively at least two times. Recurrent pregnancy loss (RPL) can occur due to maternal or fetal factors. Studies recommend that uterine artery perfusion could control endometrial receptivity, and that poor uterine perfusion may be a main cause of unexplained abortion. Objective: The aim of the current study is to investigate the ability of uterine Doppler in assessing uterine causes of RPL.
Uterine Artery Doppler in the Prediction of Preeclampsia and Adverse Pregnancy Outcome
Donald School Journal of Ultrasound in Obstetrics & Gynecology, 2009
Preeclampsia and fetal growth restriction are major causes of perinatal mortality and morbidity. Several studies have shown that a generalized endothelial dysfunction is associated with these complications. Clinical trials have shown that pregnant women who demonstrate high resistance in uteroplacental blood flow are at higher risk for preeclampsia. Uterine artery Doppler studies both in the second and the first trimester can predict pregnancies at increased risk of the complications of impaired placentation. The sensitivity for predicting severe preeclampsia ranges between 80 and 90% for a false positive rate of 5 to 7%. Uterine artery Doppler screening at 20 to 24 weeks’ gestation is superior to first trimester screening, and appears to fulfill the requirements for a worthwhile screening test. Further research is needed to better assess the value of various combinations of uterine artery Doppler and maternal serum markers, for the prediction of adverse pregnancy outcome.
The uterine artery blood flow velocity waveform in pathological pregnancy
Early Human Development, 1988
Uterine artery blood flow velocity waveforms (FVW) were recorded longitudinally in 41 women with undisturbed pregnancy as well as in 32 women with complicated pregnancy at 4-week intervals from a gestational age of 18 weeks onwards. Of these women, four did not complete the study. In a second group of 76 patients at least one FVW was recorded after admission to the obstetrical department because of complicated pregnancy. The Pulsatility-Index (PI) for normal pregnancy was based on the results of the 41 women with undisturbed pregnancy (Mulders et al. (1988) Early Hum. Dev., 17, 55-70). The complete study group (n = 145) was divided in two groups, based on the value of the last measured uterine artery PI before delivery; in the abnormal PI group (PI 3 1.02 before 32 weeks or PI 2 0.91 after 32 weeks, n = 38) hypertension, fetal distress during pregnancy, premature delivery, small for gestational age babies @GA) and lower placental weight were all significantly increased. In each of the groups of patients with either SGA, fetal distress during pregnancy, pre-existing hypertension with proteinuria and pregnancy-induced hypertension with or without proteinuria the mean PI was significantly increased as compared to the results in normal pregnancy. Sensitivity and specificity of the last uterine artery PI for the detection of SGA and/or fetal distress during pregnancy were 48.8% and 82.7%, respectively. The longitudinally studied women (n = 73) were divided in two groups, based on uterine artery PI before 32 weeks of gestation; in the abnormal PI group (PI 21.02, n = 12) pregnancy was more complicated by premature delivery and low birth weight. Sensitivity for the early prediction of pathological pregnancies (at least one pathological phenomenon as mentioned above) was 30.4%) whereas specificity was 90.0%.
Doppler assessment of uterine blood flow in recurrent pregnancy loss
International Journal of Gynecology & Obstetrics, 2007
Objective: To compare uterine artery pulsatility index (PI) and flow velocity wave (FVW) patterns between women with no history of abortion and women with recurrent pregnancy loss of unexplained cause. Method: A cross-sectional study was conducted with 43 women with recurrent pregnancy loss and 43 women with no history of abortion and at least 1 child born at term (control
The Egyptian Journal of Hospital Medicine
Background: The high resistance occurring in vessels of placenta pathologically can be assessed by impaired blood flow of uterine arteries of pregnant women. It has been proven that measuring of blood flow in the uterine artery in 1 st trimester is useful. Results from the second trimester, on the other hand, have proven to be more predictable. Objective: The aim of the work was to predict fetal and maternal morbidity and mortality as a result of low placental blood flow. Subjects and Methods: This prospective study included a total of 127 pregnant women, attending for routine first trimester U/S scan at Department of Obstetrics and Gynecology, Zagazig University Hospitals. This study was conducted between April 2020 till December 2020. Results: The mean Doppler Uterine artery resistance index (RI) was 0.587±0.22 ranged from 0.31 to 1.21 and for pulsatility index (PI) 1.56±0.29 ranged from 0.39 to 2.45. The incidence rate of Fetal maternal adverse outcome was 22.8%, distributed as 11.8% Maternal adverse outcome (most prevailing preeclampsia) and 15.7% Fetal adverse outcome (IUGR and preterm). There was statistically significant higher value of Doppler Uterine artery RI and Doppler Uterine artery PI of Adverse outcome compared to Favorable outcome women. Uterine artery PI was good marker to discriminate maternal fetal adverse outcome at late first to second trimester. While uterine artery RI was fair marker to discriminate maternal fetal adverse outcome at late first to second trimester. Conclusions: It could be concluded that uterine artery PI was good marker while uterine artery RI was fair marker to discriminate maternal fetal adverse outcome at late first to second trimester.