Ultraschall Med 2012; 33(3): 258-264
DOI: 10.1055/s-0031-1281647
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Reference Values for Blood Flow Velocity in the Uterine Artery in Normal Pregnancies from 18 Weeks to 42 Weeks of Gestation Calculated by Automatic Doppler Waveform Analysis

Dopplersonografische Referenzkurven von der Arteria uterina in einer Normalpopulation zwischen 18 und 42 Schwangerschaftswochen berechnet anhand einer automatischen HüllkurvenanalyseF. Bahlmann1 , M. Fittschen1 , I. Reinhard2 , S. Wellek3 , E. Steiner4
  • 1Obstetrics and Gynecology, Bürgerhospital, Frankfurt
  • 2Department of Biostatistics, University of Mannheim
  • 3Biostatistics, University of Mannheim
  • 4Obstetrics and Gynecology, Klinikum Rüsselsheim
Further Information

Publication History

received: 17.10.2010

accepted: 16.6.2011

Publication Date:
24 January 2012 (online)

Zusammenfassung

Ziel: Die vorliegende Studie wurde mit dem Ziel durchgeführt, neue Normkurven für die mütterliche Herzfrequenz, die mittleren intensitätsgewichteten Flussgeschwindigkeiten (Vmean) und die Gefäßwiderständen (PI, RI) mithilfe einer automatisierten Hüllkurvenanalyse von der A. uterina zu erstellen. Material und Methoden: Eine prospektive Querschnittsstudie bei 921 normalen Schwangerschaften wurde zwischen 18 – 42 Schwangerschaftswochen durchgeführt. Die uterinen Blutflussgeschwindigkeiten wurden mittels farbkodierter gepulster Doppersonografie standardisiert abgeleitet. Die uterinen Dopplermessungen wurden 1 – 2 cm oberhalb der Kreuzungstelle der A. iliaca externa durchgeführt. Für die einzelnen Dopplerparameter der A. uterina erfolgte die Konstruktion von Referenzbändern basierend auf einer Wachstumsfunktion einer 4-parametrischen Klasse monotoner Funktionen, die durch kleinste Quadrateanpassung bestimmt wird. Ergebnisse: Ein signifikanter Anstieg der intensitätsgewichteten mittleren uterinen Blutflussgeschwindigkeiten wurden zwischen der 18. und 42. Schwangerschaftswoche beobachtet (Vmean = 43 cm/s bis 50 cm/s (p < 0,001). Die Pulsatilitäts- und Resistenzeindizes (PI, RI) zeigten mit zunehmendem Gestationsalter eine signifikante Abnahme (PI: 18. SSW: 0,89; 42. SSW: 0,65 und RI: 18. SSW: 0,45; 42. SSW: 0,35). Beim Vergleich der Plazentalokalisationen fanden sich keine signifikanten Unterschieden für den Pulsatilität- und den Resistenzindex. Die maternale Herzfrequenz fiel von 88 Spm auf 77 Spm (p < 0,001). Schlussfolgerung: Neue dopplersonografische Referenzkurven von den Blutflussgeschwindigkeiten der A. uterina und den Widerstandsindizes (PI, RI) konnten an einem Normalkollektiv errechnet werden. Die vorliegenden Normkurven können als Referenzwerte für den frühzeitigen Nachweis einer maternalen und fetalen Gefährdung herangezogen werden.

Abstract

Purpose: The goal of the present study was to establish new Doppler reference ranges for maternal heart rate, intensity-weighted mean blood flow velocities (Vmean) and impedance indices (PI, RI) for the uterine artery by automated waveform analysis. Materials and Methods: A cross-sectional prospective study of 921 low-risk pregnancies was performed at 18 – 42 weeks of gestation. Uterine blood flow velocities were derived with pulsed-wave color Doppler. Measurements were carried out 1 to 2 cm above the crossing of the uterine and external iliac arteries. Reference ranges for the individual measuring parameters were constructed based on a growth function from a four-parameter class of monotonic continuous functions according to the smallest square principle. Results: A significant increase in intensity-weighted mean uterine blood flow velocities was observed at 18 – 42 weeks of gestation (Vmean = 43 cm/s to 50 cm/s (p < 0.001)). Reference curves for the pulsatility and resistance indices (PI, RI) significantly decreased with progressing gestation (PI: 18 weeks: 0.89; 42 weeks: 0.65 and RI: 18 weeks: 0.45; 42 weeks: 0.35). No significant PI and RI differences were observed when different placental locations were compared. The maternal heart rate decreased from 88 bpm to 77 bpm. Conclusion: Normal ranges for blood flow velocities and impedance indices in the uterine artery were established by Doppler ultrasound antenatal examinations of a large population of low-risk pregnancies. The data are proposed as reference curves to allow the early diagnosis of maternal and fetal risks.

References

  • 1 Campbell S, Griffin D R, Pearce J M et al. New Doppler technique for assessing uteroplacental blood flow.  Lancet. 1983;  i 675-677
  • 2 Chien P FW, Arnott N, Gordon A et al. How useful is uterine artery Doppler flow velocimetry in the prediction of pre-eclampsia, intrauterine growth retardation and perinatal death? An overview.  Br J Obstet Gyneacol. 2000;  107 196-208
  • 3 Harrington K, Cooper D, Lees C et al. Doppler ultrasound of the uterine arteries: the importance of bilateral notching in the prediction of pre-eclampsia, placental abruption or delivery of a small-for-gestational-age baby.  Ultrasound Obstet Gynecol. 1996;  7 182-188
  • 4 Kurdi W, Campbell S, Aquilina J et al. The role of color Doppler imaging of the uterine arteries at 20 weeks gestation in stratifying antenatal care.  Ultrasound Obstet Gynecol. 1998;  12 339-345
  • 5 Papageorghiou A T, Yu C K, Erasmus I E et al. Assessment of risk for the development of pre-eclampsia by maternal characteristics and uterine artery Doppler.  Br J Obstet Gynaecol. 2005;  112 703-709
  • 6 Trudinger B J, Giles W B, Cook C M. Uteroplacental flow velocity-time waveforms in normal and complicated pregnancy.  Br J Obstet Gynaecol. 1985;  92 39-45
  • 7 Zimmermann P, Eiriö V, Koskinen J et al. Doppler assessment of the uterine and uteroplacental circulation in the second trimester in pregnancies at high risk for pre-eclampsia and/or intrauterine growth retardation: comparison and correlation between different Doppler parameters.  Ultrasound Obstet Gynecol. 1997;  9 330-338
  • 8 Deutinger J, Rudelstorfer R, Bernaschek G. Transvaginal pulsed Doppler measurement of the blood flow velocity in the pregnant uterus.  Ultraschall Klin Prax. 1988;  3 19-24
  • 9 Papageorghiou A T, Yu C K, Bindra R et al. Multicenter screening for pre-eclampsia and fetal growth restriction by transvaginal uterine artery Doppler at 23 weeks of gestation.  Ultrasound Obstet Gynecol. 2001;  18 441-449
  • 10 Bower S, Vyas S, Campbell S et al. Color Doppler imaging of the uterine artery in pregnancy: normal ranges of impedance to blood flow, mean velocity and volume of flow.  Ultrasound Obstet Gynecol. 1992;  2 261-265
  • 11 Bewley S, Campbell S, Cooper D. Uteroplacental Doppler flow velocity waveforms in the second trimester. A complex circulation.  Br J Obstet Gynaecol. 1989;  96 1040-1046
  • 12 Chan F Y, Pun T C, Lam C et al. Pregnancy screening by uterine artery Doppler velocimetry – wich criterion performs best?.  Obstet Gynecol. 1995;  85 596-602
  • 13 Hüneke B, Holst A, Schröder H J et al. Normal reference values for Doppler flow velocity wave form indices A/B-ratio, Resistance and Pulsatility index obtained from the uterine and umbilical arteries in uncomplicated pregnancies – a longitudinal study.  Geburtsh u Frauenheilk. 1995;  55 616-622
  • 14 Gudmundsson S, Marsal K. Umbilical artery and uteroplacental blood flow velocity waveforms in normal pregnancy: a cross sectional study.  Acta Obstet Gynecol Scand. 1988;  67 347-354
  • 15 Bower S, Bewley S, Campbell S. Improved prediction of pre-eclampsia by two-stage screening of uterine arteries using the early diastolic notch and color Doppler imaging.  Obstet Gynecol. 1993;  82 78-83
  • 16 Altman D G, Chitty L S. Charts of fetal size: 1. Methodology.  Br J Obstet Gynaecol. 1994;  101 29-34
  • 17 Altman D G, Chitty L S. Design and analysis of studies to derive charts of fetal size.  Ultrasound Obstet Gynecol. 1993;  3 378-384
  • 18 Bahlmann F, Wellek S, Reinhardt I et al. Reference values of fetal aortic flow velocity waveforms and associated intra-observer reliability in normal pregnancies.  Ultrasound Obstet Gynecol. 2001;  17 42-49
  • 19 Bahlmann F, Merz E, Weber G et al. Transvaginal sonographic biometry in early pregnancy – a growth model.  Ultraschall in Med. 1997;  18 196-204
  • 20 Merz E, Wellek S. Normal fetal development profiles – a model to obtain standard development graphs for the head and abdominal parameters and the long limb bones.  Ultraschall in Med. 1996;  17 153-162
  • 21 Barnett S, Maulik D. International Perinatal Doppler Society. Guidelines and recommendations for safe use of Doppler ultrasound in perinatal applications.  J Matern Fetal Med. 2001;  10 75-84
  • 22 Wellek S, Merz E. Age related reference ranges for growth parameters.  Meth Inform Med. 1995;  4 523-528
  • 23 Lees M M, Taylor S H, Scott D B et al. A study of cardiac output at rest throughout pregnancy.  J Obstet Gynaecol Br Commonw. 1967;  74 319-328
  • 24 Pijnenborg R. The placental bed.  Hypertens Pregnancy. 1996;  15 7-23
  • 25 Gomez O, Figueras F, Fernandez S et al. Reference ranges for uterine artery mean pulsatility index at 11 – 41 weeks of gestation.  Ultrasound Obstet Gynecol. 2008;  32 128-132
  • 26 Kurmanavicius J, Florio I, Wisser J et al. Reference resistance indices of the umbilical, fetal middle cerebral and uterine arteries at 24 – 42 weeks of gestation.  Ultrasound Obstet Gynecol. 1997;  10 112-120
  • 27 Bewley S, Chang T C, Campbell S. Uteroplacental resistance index: analysis of intra- and interobserver variability.  Ultrasound Obstet Gynecol. 1993;  3 417-421
  • 28 Pearce J M, Campbell S, Cohen-Overbeek T et al. References ranges and sources of variation for indices of pulsed Doppler flow velocity waveforms from the uteroplacental and fetal circulation.  Br J Obstet Gynaecol. 1988;  95 248-256
  • 29 Royston P, Wright E M. How to construct ‘normal ranges’ for fetal variables.  Ultrasound Obstet Gynecol. 1998;  11 30-38
  • 30 Papageorghiou A T, Yu C K, Cicero S et al. Second trimester uterine artery Doppler screening in unselected populations: a review.  J Matern Fetal Neonatal Med. 2002;  12 78-88
  • 31 Cnossen J S, Morris R K, terRiet G et al. Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis.  CMAJ. 2008;  178 701-711
  • 32 Giguere Y, Charland M, Bujold E et al. Combining biochemical and ultrasonographic markers in predicting preeclampsia: A systematic review.  Clin Chem. 2010;  56 361-374

Dr. Franz Bahlmann

Obstetrics and Gynecology, Bürgerhospital

Nibelungenallee 37 – 41

60318 Frankfurt

Phone:  ++ 49/69/1 50 04 12

Fax:  ++ 49/69/1 50 04 00

Email: f.bahlmann@buergerhospital-ffm.de