Introduction: Inadequate trophoblastic invasion of spiral arteries is associated with intrauterine growth retardation, pregnancy induced hypertension, preeclampsia, and abruptio placentae. The ability to accurately identify pregnant women who will develop these complications is limited. Predictive tests are further challenged by difficulty in the timing of the measurements, because the structural and biochemical characteristics of the placenta change with increasing gestational age. Improvements in ultrasound technology provide potentially useful novel tools for evaluating placental structure.
Aim of our study: To develop methods for early screening of high-risk pregnancies (studying the circulation in the utero-placental arteries — impedance to flow).
Material and methods: We have followed-up pregnant women in their first and second trimesters, who presented for pregnancy care in our unit. Results were calculated using Student-test and Chi-test (for the presence or absence of prothodiastholic notch). Results: Impedance to flow and the frequency of the prothodiastholic notch decrease in the uterine arteries with the evolution of pregnancy. Changes in the resistance of uterine arteries during pregnancy show different patterns in certain obstetrical risk groups: obesity, smoking in pregnancy, uterus with previous interventions (scar from C-section) with the placenta on the anterior wall, pregnancies with „Vanishing Twin Syndrome”. In these groups we noticed a greater resistance in the uterine arteries.
Conclusions: These pregnancies should have an intensified follow-up.
Tag Archives: Doppler
Analysis of Doppler Criteria in the Diagnosis of IUGR
Introduction: The assessment of the Doppler velocimetric indices of the uterine, umbilical and middle cerebral artery helps in diagnosing and monitoring pregnancies with fetal growth disorder.
Material and method: Two groups were studied: the 1st group SGA (small for gestational age) including 22 fetuses whose birth weight was below the 10th percentile for gestational age and the 2nd group AGA (appropriate for gestational age) comprising 58 fetuses whose birth weight was between the 10th and 90th percentile. According to Doppler changes we could identify fetuses with intra uterine growth restriction (IUGR) and perform a comparative analysis of Doppler changes according to frequency and also assessed the predictive accuracy of some abnormal velocimetric indices for diagnosing SGA.
Results: In the SGA group we found 8 fetuses with IUGR (36.3%), based on the fetal brain-sparing phenomenon indicated by Doppler changes. In the AGA group Doppler changes were observed in only 1 pregnancy (1.7%). The frequency of Doppler changes was significantly higher in the SGA group. The highest predictive accuracy for SGA was found for a cerebroplacental ratio (CPR) below 1.08 (88.89% PPV; 80.28% NPV; 36.36% Se and 98.28% Sp) with p <0.0001.
Conclusions: Many cases of IUGR occur in pregnancies without evident risk factors as shown in this study. The most effective parameter for diagnosing SGA was found to be the CPR below 1.08.