Establishment and verification of reference range of parameters related to uterine artery measured by ultrasound at 11~40 weeks of pregnancy

doi:10.16150/j.1671-2870.2023.04.007

Abstract

Abstract:

Objective: To establish and verify the normal reference range of uterine artery mean pulsatility index (mPI) between 11-40 weeks of pregnancy in low-risk population. Methods: Pregnant women registered in our hospital from January 2019 to July 2023 and underwent ultrasound examination at 11 to 40 weeks were enrolled. By Ultrasound diagnosis, the pulsatility index (PI) of bilateral uterine arteries were measured, and whether there was a notch in the early diastolic period was checked. Following up the pregnancy, basic clinical data and fetal birth information were collected. Results: A total of 1365 low-risk people with normal pregnancy outcomes were included. The 104 cases of adverse pregnancy outcomes were wed to verify the refernce range, including pregnancy included hypertension (n=41) and fetalgrowth restriction (n=23). With the increase of gestation age, mPI showed a gradual downward trend. There was a rapid decline before 20 weeks of gestation (mPI 95th percentile at 11 weeks and 20 weeks of gestation were 2.35 and 1.54, respectively), then declined slowly, and mPI stabilized after 32 weeks of gestation (95th percentile mPI at 32 weeks and 39 weeks of gestation were 0.91 and 0.87, respectively). With the increase of gestation age, the detection rate of early diastolic notch in bilateral uterine arteries decreased gradually. The detection rate was 69.20% at 11-15 weeks of gestation, 27.01% at 21-25 weeks of gestation, then stabilized and decreased to 6.31% at 36-40 weeks of gestation. The results of receiver operating characteristic (ROC) curve analysis showed that the sensitivity and specificity of mPI ≥95^th precentile in predicting hypertensive disorder complicating pregnancy were 30.11% and 93.21%, respectively; The sensitivity and specificity in predicting fetal growth restriction were 61.9% and 92.85%, respectively. Conclusions: Establishing the reference range of uterine artery mPI at 11-40 weeks of pregnancy in low-risk population may be used for prospective exclusion of gestational hypertension and fetal growth restriction.

Key words: Ultrasound, Uterine artery, Doppler, Pulsatility index

CLC Number:

GONG Xiaoping, CAO Yunyun, WANG Haifei, WANG Guanjie, ZENG Min. Establishment and verification of reference range of parameters related to uterine artery measured by ultrasound at 11~40 weeks of pregnancy[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(04): 374-378.

Figures/Tables 4

Table 1

Table 2

Figure 1

Table 3

References 17

[1]	CELIK O Y, OBUT M, KELES A, et al. Outcomes of pregnancies diagnosed with circumvallate placenta, and use of uterine artery pulsatility index and maternal serum alpha-fetoprotein for prediction of adverse outcomes[J]. Eur J Obstet Gynecol Reprod Biol, 2021, 262:57-61. doi: 10.1016/j.ejogrb.2021.05.008 pmid: 33989943
[2]	LU Y, WU Y, YANG L, et al. Uterine artery Doppler velocimetry at mid-term gestation as a potential predictive factor for the resolution of placenta previa at the end of third trimester of pregnancy[J]. J Obstet Gynaecol Res, 2020, 46(6):883-889. doi: 10.1111/jog.v46.6 URL
[3]	MCLAUGHLIN K, HOBSON S R, CHANDRAN A R, et al. Circulating maternal placental growth factor responses to low-molecular-weight heparin in pregnant patients at risk of placental dysfunction[J]. Am J Obstet Gynecol, 2022, 226(2S):S1145-S1156.e1. doi: 10.1016/j.ajog.2021.08.027 URL
[4]	SONG W L, ZHAO Y H, SHI S J, et al. First trimester Doppler velocimetry of the uterine artery ipsilateral to the placenta improves ability to predict early-onset preeclampsia[J]. Medicine (Baltimore), 2019, 98(16):e15193. doi: 10.1097/MD.0000000000015193 URL
[5]	何碧媛, 周毓青. 妊娠早期联合母血清妊娠相关蛋白A与子宫动脉超声多普勒预测胎儿生长受限的价值探讨[J]. 诊断学理论与实践, 2017, 16(3):320-323.
	HE B Y, ZHOU Y Q. Prediction of fetal growth restriction by uterine artery Doppler and level of PAPP-A at 11-13+6 weeks of gestation[J]. J Diagn Concepts Pract, 2017, 16(3):320-323.
[6]	JONES S L, AVIRAM A, PORTO L, et al. Uterine artery Doppler to predict growth restriction in cases of abnormal first trimester analytes[J]. Placenta, 2021, 106:22-24. doi: 10.1016/j.placenta.2021.02.004 pmid: 33607403
[7]	GÓMEZ O, FIGUERAS F, FERNÁNDEZ S, et al. Reference ranges for uterine artery mean pulsatility index at 11-41 weeks of gestation[J]. Ultrasound Obstet Gynecol, 2008, 32(2):128-132. doi: 10.1002/uog.5315 pmid: 18457355
[8]	CAVORETTO P I, SALMERI N, CANDIANI M, et al. Reference ranges of uterine artery pulsatility index from first to third trimester based on serial Doppler measurements: longitudinal cohort study[J]. Ultrasound Obstet Gynecol, 2023, 61(4):474-480. doi: 10.1002/uog.v61.4 URL
[9]	MARTIN A M, BINDRA R, CURCIO P, et al. Screening for pre-eclampsia and fetal growth restriction by uterine artery Doppler at 11-14 weeks of gestation[J]. Ultrasound Obstet Gynecol, 2001, 18(6):583-586. doi: 10.1046/j.0960-7692.2001.00594.x URL
[10]	SAVASAN Z A, GONCALVES L F, BAHADO-SINGH R O. Second- and third-trimester biochemical and ultrasound markers predictive of ischemic placental disease[J]. Semin Perinatol, 2014, 38(3):167-176. doi: 10.1053/j.semperi.2014.03.008 pmid: 24836829
[11]	潘义, 孙丽洲, 姜海风, 等. 正常孕妇子宫动脉血流多普勒参数序贯研究[J]. 中国实用妇科与产科杂志, 2006, 22(12):933-934.
	PAN Y, SUN L Z, JIANG H F, et al. Sequential study of uterine artery blood flow Doppler parameters in normal pregnant women[J]. Chin J Pract Gynecol Obstet, 2006, 22(12):933-934.
[12]	杨怡珂, 林建华, 林其德, 等. 妊娠早中晚期相关动脉血流参数及其规律[J]. 中国实用妇科与产科杂志, 2009, 25(9):677-680.
	YANG Y K, LIN J H, LIN Q D, et al. Parameter and its regularity of pregnancy woman's related artery in the first, second and third trimester[J]. Chin J Pract Gynecol Obstet, 2009, 25(9):677-680.
[13]	AXT-FLIEDNER R, SCHWARZE A, NELLES I, et al. The value of uterine artery Doppler ultrasound in the prediction of severe complications in a risk population[J]. Arch Gynecol Obstet, 2005, 271(1):53-58. doi: 10.1007/s00404-004-0648-4 URL
[14]	SCHWARZE A, NELLES I, KRAPP M, et al. Doppler ultrasound of the uterine artery in the prediction of severe complications during low-risk pregnancies[J]. Arch Gynecol Obstet, 2005, 271(1):46-52. pmid: 15185101
[15]	LEES M M, TAYLOR S H, SCOTT D B, et al. A study of cardiac output at rest throughout pregnancy[J]. J Obstet Gynaecol Br Commonw, 1967, 74(3):319-328. pmid: 6026611
[16]	KILLAM A P, ROSENFELD C R, BATTAGLIA F C, et al. Effect of estrogens on the uterine blood flow of oophorectomized ewes[J]. Am J Obstet Gynecol, 1973, 115(8):1045-1052. pmid: 4734886
[17]	吴莉莉, 吕燕, 沈悦. 超声评估心肌做功指数和血流频谱对胎儿生长受限及妊娠结局的预测价[J]. 中国临床研究, 2021, 34( 8 ):1039-1044.
	WU LL, LV Y, SHEN Y. Ultrasound evaluation of MPI and related blood flow spectrum in fetal growth restriction and pregnancy outcome[J]. Chin J Clin Res, 2021, 34(8): 1039-1044.

Characteristics	Data
Age （y）	31.07±3.65
Primiparous （n/%）	733（53.70）
Prepregnant BMI (kg/cm²）	21.56±2.69
Fetal sex （n/%）
Female	645(47.30)
Male	720(52.70)
Delivery way （n/%）
Vaginal delivery	718(52.60)
Cesarean section	647(47.40)
Birth weight （g）	3319±345
Gestational age (w)	39.20±0.95

GA(w)	mPI
GA(w)	5 th	50 th	95 th
11	1.18	1.75	2.35
12	1.04	1.61	2.26
13	0.99	1.59	2.20
14	0.96	1.45	1.94
15	0.88	1.30	1.91
16	0.82	1.24	1.77
17	0.81	1.21	1.74
18	0.79	1.19	1.70
19	0.75	1.10	1.69
20	0.73	1.04	1.54
21	0.72	0.99	1.41
22	0.68	0.82	1.31
23	0.57	0.77	1.29
24	0.55	0.74	1.27
25	0.55	0.72	1.10
26	0.52	0.69	1.09
27	0.49	0.68	1.04
28	0.47	0.68	0.95
29	0.46	0.67	0.95
30	0.43	0.67	0.93
31	0.43	0.67	0.92
32	0.43	0.65	0.91
33	0.43	0.65	0.90
34	0.41	0.65	0.90
35	0.38	0.65	0.89
36	0.35	0.65	0.88
37	0.35	0.64	0.88
38	0.34	0.64	0.87
39	0.33	0.64	0.87

GA（w）	detection ratio [%，(n/N）]
11-15	69.20（301/435）
16-20	42.18(54/128)
21-25	27.01(57/211)
26-30	16.09(47/292)
31-35	12.76(24/188)
36-40	6.31(7/111)