A Comparison of Changes in the Mean Arterial Blood Pressure and Mean Uterine Artery Pulsatility Index from 11–14 to 19–24 + 6 Gestation Weeks in Low-Risk and High-Risk Asian Indian Pregnant Women

Akanksha Baghel; Tejashree Y. Patekar; Rijo M. Choorakuttil; Lalit K. Sharma; Shilpa R. Satarkar; Anjali Gupta; Kavita Aneja; Sandhya Dhankhar; Gulab Chhajer; Somya Dwivedi; Mansi Jain; Srinivas Shentar; Praveen K. Nirmalan

doi:10.1055/s-0043-1761250

Indian Journal of Radiology and Imaging, Table of Contents

CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2023; 33(02): 195-200
DOI: 10.1055/s-0043-1761250

Original Article

A Comparison of Changes in the Mean Arterial Blood Pressure and Mean Uterine Artery Pulsatility Index from 11–14 to 19–24 + 6 Gestation Weeks in Low-Risk and High-Risk Asian Indian Pregnant Women

Authors

Akanksha Baghel

¹Department of Clinical Radiology, Baghel Sonography Center, Harda, Madhya Pradesh, India
Tejashree Y. Patekar

²Department of Clinical Radiology, Innovision Sonography and Imaging Center, Gangapur, Nashik, Maharashtra, India
Rijo M. Choorakuttil

³Department of Clinical Radiology, AMMA Center for Diagnosis and Preventive Medicine Pvt Ltd, Kochi, Kerala, India
Lalit K. Sharma

⁴Department of Clinical Radiology, Raj Sonography & X-Ray Clinic, Guna, Madhya Pradesh, India
Shilpa R. Satarkar

⁵Department of Clinical Radiology, Antarang Sonography and Colour Doppler Center, Satarkar Hospital, Tilaknagar, Aurangabad, Maharashtra, India
Anjali Gupta

⁶Department of Clinical Radiology, Anjali Ultrasound and Colour Doppler Centre, Shanti Madhuban Plaza, Delhi Gate, Agra, Uttar Pradesh, India
Kavita Aneja

⁷Department of Clinical Radiology, Images Ultrasound Center, Naveda Healthcare Centre, Rohini, New Delhi, India
Sandhya Dhankhar

⁸Department of Clinical Radiology, Faith Diagnostic Center, Chandigarh, India
Gulab Chhajer

⁹Department of Clinical Radiology, Kushal Imaging & Diagnostic Center, Pali, Rajasthan, India
Somya Dwivedi

¹⁰Department of Clinical Radiology, Qura Diagnostics & Research Center, Janki Nagar, Kolar Road, Bhopal, Madhya Pradesh, India
Mansi Jain

¹¹Department of Clinical Radiology, IRIS Imaging Centre, Shahpura, Bhopal, Madhya Pradesh, India
Srinivas Shentar

¹²Department of Clinical Radiology, Delta Diagnostic Services, Bengaluru, Karnataka, India
Praveen K. Nirmalan

¹³Department of Research, AMMA Healthcare Research Gurukul, AMMA Center for Diagnosis and Preventive Medicine Pvt Ltd, Kochi, Kerala, India

Abstract

Aim The aim of this study was to determine the changes in the mean arterial blood pressure (MAP) and mean uterine artery (UtA) pulsatility index (PI) from 11-14 to 19-24 + 6 gestation weeks in Asian Indian pregnant women.

Methods Clinical and demographic details, MAP, and mean UtA PI measures were ascertained for pregnant women at 11 to 14 gestation weeks and 19–24 + 6 gestation weeks. Women were categorized as a high-or-low risk for preterm preeclampsia using the Fetal Medicine Foundation algorithm and 1 in 150 cutoff. High-risk pregnant women were recommended low-dose aspirin 150 mg daily at bedtime. Changes in MAP and mean UtA PI were compared for gestational age intervals and high-and-low risk women using nonparametric tests.

Results The study analyzed the results of 1,163 pregnant women. Both MAP (mean difference: 5.14, p < 0.001) and mean UtA PI (mean difference: 0.14, p < 0.001) remained significantly higher at the second-trimester assessment in high-risk pregnant women compared to low-risk pregnant women. Seventy-seven (35.16%) of the 219 pregnant women with abnormal mean UtA PI in the first trimester had an abnormal mean UtA PI in the second-trimester assessment. One hundred (10.59%) of the 944 pregnant women with normal mean UtA PI in the first trimester had an abnormal mean UtA PI in the 19-24 + 6 weeks assessment. Seventy-seven pregnant women (6.62% of 1,163 women, 95% confidence interval: 5.33, 8.20) had an abnormal mean UtA PI at both gestation age intervals. High-risk pregnant women taking low-dose aspirin daily showed a larger reduction in mean UtA PI compared to high-risk pregnant women that did not report the use of low-dose aspirin (0.89 vs. 0.62, p <0.001)

Conclusion MAP and mean UtA PI decreased significantly from the first to the second trimester of pregnancy. Sequential assessment of the MAP and mean UtA PI in the first and second trimesters of pregnancy will be useful for fetal radiologists in India to identify a subgroup of women with abnormal mean UtA PI at both trimesters that may need more intense surveillance and follow-up till childbirth.

Keywords

mean arterial blood pressure - mean uterine artery pulsatility index - Doppler ultrasonography - fetal ultrasonography - pregnancy

Full Text

References

References
1 Choorakuttil RM, Patel H, Bavaharan R. et al. Samrakshan: an Indian Radiological and Imaging Association program to reduce perinatal mortality in India. Indian J Radiol Imaging 2019; 29 (04) 412-417
2 Poon LC, Zymeri NA, Zamprakou A, Syngelaki A, Nicolaides KH. Protocol for measurement of mean arterial pressure at 11-13 weeks' gestation. Fetal Diagn Ther 2012; 31 (01) 42-48
3 Sotiriadis A, Hernandez-Andrade E, da Silva Costa F. et al; ISUOG CSC Pre-eclampsia Task Force. ISUOG Practice Guidelines: role of ultrasound in screening for and follow-up of pre-eclampsia. Ultrasound Obstet Gynecol 2019; 53 (01) 7-22
4 Martin AM, Bindra R, Curcio P, Cicero S, Nicolaides KH. Screening for pre-eclampsia and fetal growth restriction by uterine artery Doppler at 11-14 weeks of gestation. Ultrasound Obstet Gynecol 2001; 18 (06) 583-586
5 Gómez O, Martínez JM, Figueras F. et al. Uterine artery Doppler at 11-14 weeks of gestation to screen for hypertensive disorders and associated complications in an unselected population. Ultrasound Obstet Gynecol 2005; 26 (05) 490-494
6 Kurdi W, Campbell S, Aquilina J, England P, Harrington K. The role of color Doppler imaging of the uterine arteries at 20 weeks' gestation in stratifying antenatal care. Ultrasound Obstet Gynecol 1998; 12 (05) 339-345
7 Albaiges G, Missfelder-Lobos H, Lees C, Parra M, Nicolaides KH. One-stage screening for pregnancy complications by color Doppler assessment of the uterine arteries at 23 weeks' gestation. Obstet Gynecol 2000; 96 (04) 559-564
8 Becker R, Vonk R, Vollert W, Entezami M. Doppler sonography of uterine arteries at 20-23 weeks: risk assessment of adverse pregnancy outcome by quantification of impedance and notch. J Perinat Med 2002; 30 (05) 388-394
9 Papageorghiou AT, Yu CK, Bindra R, Pandis G, Nicolaides KH. Fetal Medicine Foundation Second Trimester Screening Group. Multicenter screening for pre-eclampsia and fetal growth restriction by transvaginal uterine artery Doppler at 23 weeks of gestation. Ultrasound Obstet Gynecol 2001; 18 (05) 441-449
10 Harrington K, Fayyad A, Thakur V, Aquilina J. The value of uterine artery Doppler in the prediction of uteroplacental complications in multiparous women. Ultrasound Obstet Gynecol 2004; 23 (01) 50-55
11 Campbell S, Black RS, Lees CC, Armstrong V, Peacock JL. Doppler ultrasound of the maternal uterine arteries: disappearance of abnormal waveforms and relation to birthweight and pregnancy outcome. Acta Obstet Gynecol Scand 2000; 79 (08) 631-634
12 Prefumo F, Güven M, Ganapathy R, Thilaganathan B. The longitudinal variation in uterine artery blood flow pattern in relation to birth weight. Obstet Gynecol 2004; 103 (04) 764-768
13 Kurdi W, Fayyad A, Thakur V, Harrington K. Delayed normalization of uterine artery Doppler waveforms is not a benign phenomenon. Eur J Obstet Gynecol Reprod Biol 2004; 117 (01) 20-23
14 Carbillon L, Uzan M, Largillière C. et al. Prospective evaluation of uterine artery flow velocity waveforms at 12-14 and 22-24 weeks of gestation in relation to pregnancy outcome and birth weight. Fetal Diagn Ther 2004; 19 (04) 381-384
15 Tayyar A, Guerra L, Wright A, Wright D, Nicolaides KH. Uterine artery pulsatility index in the three trimesters of pregnancy: effects of maternal characteristics and medical history. Ultrasound Obstet Gynecol 2015; 45 (06) 689-697
16 Gómez O, Figueras F, Martínez JM. et al. Sequential changes in uterine artery blood flow pattern between the first and second trimesters of gestation in relation to pregnancy outcome. Ultrasound Obstet Gynecol 2006; 28 (06) 802-808
17 Kaminopetros P, Higueras MT, Nicolaides KH. Doppler study of uterine artery blood flow: comparison of findings in the first and second trimesters of pregnancy. Fetal Diagn Ther 1991; 6 (1-2): 58-64
18 Hafner E, Schuchter K, Metzenbauer M, Philipp K. Uterine artery Doppler perfusion in the first and second pregnancies. Ultrasound Obstet Gynecol 2000; 16 (07) 625-629
19 Aardema MW, Saro MC, Lander M, De Wolf BT, Oosterhof H, Aarnoudse JG. Second trimester Doppler ultrasound screening of the uterine arteries differentiates between subsequent normal and poor outcomes of hypertensive pregnancy: two different pathophysiological entities?. Clin Sci (Lond) 2004; 106 (04) 377-382
20 Prefumo F, Sebire NJ, Thilaganathan B. Decreased endovascular trophoblast invasion in first trimester pregnancies with high-resistance uterine artery Doppler indices. Hum Reprod 2004; 19 (01) 206-209