The association between fetal Doppler and uterine artery blood volume flow in term pregnancies: a pilot study

Abstract

Purpose To investigate the relationship between uterine artery blood volume flow and fetal Doppler indices in term pregnancies.

Materials and Methods A prospective observational study in a tertiary-care university hospital was performed between December 2021 and May 2022. We included only term pregnancies that received accurate ultrasound scans until a week before the birth. The uterine artery (UtA) diameter and UtA volume blood flow were estimated and recorded. The volume of each artery was summed to obtain the total uterine artery volume blood flow (QUtA). The following fetal Doppler indices were evaluated: Umbilical artery (UA), middle cerebral artery (MCA), ductus venosus (DV), and cerebroplacental ratio (CPR). Linear regression analysis was performed to investigate the relationship between the QUtA and the fetal Doppler indices.

Results 49 pregnancies were included. The UA pulsatility index (PI) analysis showed a significant association with QUtA (r2=0.40, p=0.01), demonstrating a decrease of the UA PI when the QUtA increased. The same relationship was noted between the UtA mean PI and QUtA (r2=0.41, p=0.005). A weak correlation between the newborn weight and the QUtA was also noted (r2=0.31, p=0.048), with an elevated newborn weight when the QUtA was high.

Conclusion This study showed that UA, UtA PI, and birth weight seem to be linked to QUtA. QUtA had an inverse correlation with UA and UtA PI. In addition, increasing the QUtA showed a linear increase in fetal birth weight. These findings could be helpful in high-risk pregnancy management, but additional research is needed to identify how QUtA in the third trimester impacts labor and fetal outcomes.

Zusammenfassung

Ziel Untersuchung des Zusammenhangs zwischen dem Blut-Volumenfluss in den Uterin-Arterien und den fetalen Doppler-Indizes bei Schwangerschaften am Termin.

Material und Methoden Zwischen Dezember 2021 und Mai 2022 wurde eine prospektive Beobachtungsstudie in einer Universitätsklinik der Tertiärversorgung durchgeführt. Wir schlossen nur Schwangerschaften ein, bei denen bis eine Woche vor Partus genaue Ultraschall-Untersuchungen durchgeführt wurden. Der Durchmesser der Uterin-Arterien (UtA) und der UtA-Blut-Volumenfluss wurden abgeschätzt und aufgezeichnet. Die Volumen jeder Arterie wurden summiert, um den gesamten Blut-Volumenfluss der Uterin-Arterien (QUtA) zu erhalten. Die folgenden fetalen Doppler-Indizes wurden ausgewertet: A. umbilicalis (UA), A. cerebri media (MCA), Ductus venosus (DV) und cerebroplazentare Ratio (CPR). Eine lineare Regressionsanalyse wurde durchgeführt, um die Beziehung zwischen der QUtA und den fetalen Doppler-Indizes zu untersuchen.

Ergebnisse Es wurden 49 Schwangerschaften eingeschlossen. Die Analyse des UA-Pulsatilitätsindex (PI) zeigte einen signifikanten Zusammenhang mit dem QUtA (r2=0,40; p=0,01), der eine Abnahme des UA-PI zeigte, wenn der QUtA anstieg. Die gleiche Beziehung wurde zwischen dem mittleren UA-PI und dem QUtA festgestellt (r2=0,41; p=0,005). Eine schwache Korrelation wurde auch zwischen dem Geburtsgewicht und dem QUtA festgestellt (r2=0,31; p=0,048), wobei das Geburtsgewicht erhöht war, wenn der QUtA hoch war.

Schlussfolgerung Diese Studie zeigte, dass UA, UtA-PI und Geburtsgewicht mit dem QUtA in Verbindung zu stehen scheinen. QUtA hatte eine inverse Korrelation mit UA und UtA-PI. Darüber hinaus zeigte eine Erhöhung des QUtA einen linearen Anstieg des Geburtsgewichts an. Diese Ergebnisse könnten für das Management von Risikoschwangerschaften hilfreich sein. Es sind jedoch weitere Untersuchungen erforderlich, um zu ermitteln, wie sich der QUtA im dritten Trimester auf die Wehen und das fetale Outcome auswirkt.

Keywords

uterine artery volume blood flow - uterine arteries diameter - middle cerebral artery - uterine artery pulsatility index - fetal Doppler indices

Publication History

Received: 31 October 2022

Accepted after revision: 17 April 2023

Accepted Manuscript online:
17 April 2023

Article published online:
06 October 2023

• References

• 1 Foo FL, Mahendru AA, Masini G. et al. Association between prepregnancy cardiovascular function and subsequent preeclampsia or fetal growth restriction. Hypertension 2018; 72: 442-450
• 2 Melchiorre K, Giorgione V, Thilaganathan B. The placenta and preeclampsia: villain or victim?. American Journal of Obstetrics and Gynecology 2021;
• 3 Salman H, Shah M, Ali A. et al. Assessment of relationship of serum neurokinin-b level in the pathophysiology of pre-eclampsia: A case – control study. Advances in Therapy 2018; 35: 1114-1121
• 4 Ghosh G, Breborowicz A, Brązert M. et al. Evaluation of third trimester uterine artery flow velocity indices in relationship to perinatal complications. The Journal of Maternal-Fetal & Neonatal Medicine 2006; 19: 551-555
• 5 Salafia CM, Vogel CA, Bantham KF. et al. Preterm delivery: correlations of fetal growth and placental pathology. American journal of perinatology 1992; 9: 190-193
• 6 Blanco P. Volumetric blood flow measurement using Doppler ultrasound: concerns about the technique. Journal of ultrasound 2015; 18: 201-204
• 7 Acharya G, Sitras V, Erkinaro T. et al. Experimental validation of uterine artery volume blood flow measurement by Doppler ultrasonography in pregnant sheep. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology 2007; 29: 401-406
• 8 McKelvey A, Pateman K, Balchin I. et 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 2017; 49: 54-60
• 9 Shah M, Ali A, Malik MO. et al. Treatment with metformin and combination of metformin plus pioglitazone on serum levels of IL-6 and IL-8 in polycystic ovary syndrome: a randomized clinical trial. Hormone and Metabolic Research 2019; 51: 714-722
• 10 Cheema R, Dubiel M, Gudmundsson S. Fetal brain sparing is strongly related to the degree of increased placental vascular impedance. 2006; 318-322
• 11 Frusca T, Todros T, Lees C. et al. Outcome in early-onset fetal growth restriction is best combining computerized fetal heart rate analysis with ductus venosus Doppler: insights from the Trial of Umbilical and Fetal Flow in Europe. American journal of obstetrics and gynecology 2018; 218: S783-S789
• 12 Nomura RMY, Niigaki JI, Horigome FT. et al. Doppler velocimetry of the fetal middle cerebral artery and other parameters of fetal well-being in neonatal survival during pregnancies with placental insufficiency. Revista da Associação Médica Brasileira 2013; 59: 392-399
• 13 Unterscheider J, O’Donoghue K, Daly S. et al. Fetal growth restriction and the risk of perinatal mortality-case studies from the multicentre PORTO study. BMC Pregnancy Childbirth 2014; 14: 63
• 14 Riemma G, La Verde M, Schiattarella A. et al. Efficacy of hyoscine butyl-bromide in shortening the active phase of labor: systematic review and meta-analysis of randomized trials. European Journal of Obstetrics & Gynecology and Reproductive Biology 2020; 252: 218-224
• 15 De Heus R, Mulder EJ, Derks JB. et al. The effects of the tocolytics atosiban and nifedipine on fetal movements, heart rate and blood flow. The Journal of Maternal-Fetal & Neonatal Medicine 2009; 22: 485-490
• 16 La Verde M, De Falco L, Torella A. et al. Performance of Cell-Free DNA Sequencing-Based Non-invasive Prenatal Testing: Our Experience on 36456 both Singleton and Multiple Pregnancies. 2021; 93
• 17 Salomon L, Alfirevic Z, Da Silva Costa F. et al. ISUOG Practice Guidelines: ultrasound assessment of fetal biometry and growth. Ultrasound in obstetrics & gynecology 2019; 53: 715-723
• 18 Syngelaki A, Hammami A, Bower S. et al. Diagnosis of fetal non-chromosomal abnormalities on routine ultrasound examination at 11–13 weeks’ gestation. Ultrasound in Obstetrics & Gynecology 2019; 54: 468-476
• 19 Khalil A, Nicolaides K. How to record uterine artery Doppler in the first trimester. Ultrasound in Obstetrics & Gynecology 2013; 42: 478-479
• 20 Arneberg HC, Andersen TA, Lorås L. et al. Correlation between fetal weight gain and birth weight with blood flow in the uterine arteries calculated with the PixelFlux technique. Ultrasound International Open 2018; 4: E16-E22
• 21 Acharya G, Wilsgaard T, Berntsen GKR. et al. Reference ranges for serial measurements of umbilical artery Doppler indices in the second half of pregnancy. American journal of obstetrics and gynecology 2005; 192: 937-944
• 22 Ferrazzi E, Rigano S, Padoan A. et al. 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: 487-492
• 23 Maulik D, Mundy D, Heitmann E. et al. Evidence-based approach to umbilical artery Doppler fetal surveillance in high-risk pregnancies: an update. Clinical obstetrics and gynecology 2010; 53: 869-878
• 24 Divon MY. Umbilical artery Doppler velocimetry: clinical utility in high-risk pregnancies. American journal of obstetrics and gynecology 1996; 174: 10-14
• 25 Konje JC, Howarth ES, Kaufmann P. et al. Longitudinal quantification of uterine artery blood volume flow changes during gestation in pregnancies complicated by intrauterine growth restriction. BJOG: an international journal of obstetrics and gynaecology 2003; 110: 301-305
• 26 Jeffreys R, Stepanchak W, Lopez B. et al. Uterine blood flow during supine rest and exercise after 28 weeks of gestation. BJOG: An International Journal of Obstetrics & Gynaecology 2006; 113: 1239-1247
• 27 Toal M, Keating S, Machin G. et al. Determinants of adverse perinatal outcome in high-risk women with abnormal uterine artery Doppler images. American journal of obstetrics and gynecology 2008; 198: 330.e331-330.e337
• 28 Khong SL, Kane SC, Brennecke SP. et al. First-trimester uterine artery Doppler analysis in the prediction of later pregnancy complications. Disease markers 2015; 2015
• 29 Pedroso MA, Palmer KR, Hodges RJ. et al. Uterine artery Doppler in screening for preeclampsia and fetal growth restriction. Revista brasileira de ginecologia e obstetricia 2018; 40: 287-293
• 30 Prefumo F, Sebire N, Thilaganathan B. Decreased endovascular trophoblast invasion in first trimester pregnancies with high-resistance uterine artery Doppler indices. Human Reproduction 2004; 19: 206-209
• 31 Valensise H, Farsetti D, Lo Presti D. et al. Preterm delivery and elevated maternal total vascular resistance: signs of suboptimal cardiovascular adaptation to pregnancy?. Ultrasound Obstet Gynecol 2016; 48: 491-495
• 32 Mulder EG, de Haas S, Mohseni Z. et al. Cardiac output and peripheral vascular resistance during normotensive and hypertensive pregnancy – a systematic review and meta-analysis. BJOG 2022; 129: 696-707