Title: Prediction of early pregnancy failure by Uterine Artery Color Doppler

Authors: Dr Divya Yadav Sharma, Dr Anu Pathak, Dr Neha Agarwal

 DOI: https://dx.doi.org/10.18535/jmscr/v7i3.153

Abstract

Introduction

First Trimester of Pregnancy is Characterized by many important landmarks with regard to ultimate outcome of pregnancy. Concern about the possibility of spontaneous miscarriage is one of the most common reasons women seek evaluation during their first trimester. Between 11% and 20% of all clinically recognized pregnancies are lost before the 20th week of gestation. Ultrasonography is the best diagnostic method in detecting early pregnancy complications. Uterine vascular relaxation and the increase in uterine blood flow in early pregnancy appears to be important determinants of pregnancy outcome.

Alterations in the normal uterine perfusion pattern have been noted in pregnancies complicated by blighted ovum and missed abortion.

The vascular remodeling in the maternal‐fetal interface may reduce local arterial resistance and thereby increase uteroplacental blood flow. Impairment of this process is associated with pregnancy complications including spontaneous abortion and placental hematoma, intrauterine growth restriction1 .With the advent of transvaginal color Doppler spiral sonography, new insights into uteroplacental circulation during the first trimester have been obtained. The use of Doppler sonography to analyse blood flow in even terminal branches of the uteroplacental circulation encouraged investigators to try and predict early and late pregnancy complications related to abnormal placentation. 2

Transvaginal Color Doppler has enabled precise investigation of fetomaternal   circulation in early pregnancy. Uterine artery Doppler velocimetry by itself or in combination with other biochemical markers seems to be an effective first-trimester screening tool for the ultimate outcome of a healthy pregnancy. Therefore, this study was undertaken to examine the change in blood flow impedance of the uterine artery during early pregnancy by highly sensitive Doppler indices.

References

1.      Sebiha O, Ozkaya U, Ozkan S, Ozeren S, Corakçi A. Doppler examination of uteroplacental circulation in early pregnancy: Can it predict adverse outcome? J Clin Ultrasound 2002; 35: 382–86. (doi:10.1002/jcu).

2.      Jauniaux E, Burton GJ. Pathophysiology of histological changes in early pregnancy loss.Placenta 2005; 26: 114–23. (doi:10.1016/j. placenta.2004.05.011). [PubMed]

3.      Velauthar L, Plana MN, Kalidindi M, Zamora J, Thilaganathan B, Illanes SE, et al.Uterine artery Doppler in the first trimester as a risk factor for adverse pregnancy outcomes: A meta‐analysis involving 55,974 women. Ultrasound ObstetGynecol 2013; 43 (5): 500–7. (doi:10.1002/uog.13275).

4.      Papageorghiou AT, Leslie K. Uterine artery Doppler in the prediction of adverse pregnancy outcome. CurrOpinObstetGynecol 2007; 19: 103–09. (doi:10.1097/GCO.0b013e32809bd964).

5.      Hale SA, Schonberg A, Badger GJ, Bernstein IM. Relationship between prepregnancy and early pregnancy uterine blood flow and resistance index. ReprodSci 2009; 16: 1091–96. (doi:10.1177/1933719109341843). 

6.      ClinObstet Gynecol. 2010 Dec;53(4):879-87. doi: 10.1097/GRF.0b013e3181fbb65d. Uterine artery Doppler in first-trimester pregnancy screening. Bahado-Singh RO1, Jodicke C.

7.      Australas J Ultrasound Med. 2015 May;18(2):60-66. doi: 10.1002/j.2205-0140.2015.tb00043.x. Epub 2015 Dec 31. Özkan MB1, Ozyazici E2, Emiroglu B2, Özkara E3.

8.      J Clin Ultrasound. 2007 Sep;35(7):382-6. Doppler examination of uteroplacental circulation in early pregnancy: can it predict adverse outcome? Ozkaya U1, Ozkan S, Ozeren S, Corakçi A.

9.      Ganapathy R, Ayling LJ, Whitley GS, Cartwright JE, Thilaganathan B. Effect of first‐trimester serum from pregnant women with high‐resistance uterine artery Doppler resistance on extravillous trophoblast invasion. Hum Reprod 2006; 21: 1295–98. (doi:10.1093/humrep/dei482). [PubMed]

Pellizzari P, Pozzan C, Marchiori S, Zen T, Gangemi M. Assessment of uterine artery blood flow in normal first‐trimester pregnancies and in those complicated by uterine bleeding. Ultrasound Obstet Gynecol 2002; 19: 366–70. (doi:10.1046/j.1469–0705.2002.00667.x). [PubMed

Corresponding Author

Dr Divya Yadav Sharma