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Published in: Archives of Gynecology and Obstetrics 6/2015

01-06-2015 | Maternal-Fetal Medicine

Uterine artery impedance during puerperium in normotensive and chronic hypertensive pregnant women

Authors: Luís Guedes-Martins, Joaquim Saraiva, Óscar Felgueiras, Mariana Carvalho, Ana Cerdeira, Filipe Macedo, Rita Gaio, Henrique Almeida

Published in: Archives of Gynecology and Obstetrics | Issue 6/2015

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Abstract

Purpose

The present study compared the Doppler flow pulsatility indices (PI) in the uterine arteries (UtA) during the puerperium between healthy women and those with stage-1 essential hypertension who had uncomplicated pregnancies and delivered by elective caesarean section. The change in the mean arterial pressure (MAP) and body mass index (BMI) over time was also assessed.

Methods

A longitudinal and prospective study was performed in singleton pregnancies of 28 normotensive (NT) and 24 hypertensive (HT) women. The UtA-PI was measured immediately before caesarean section (time 0) and at 1 week (time 1) and 4 weeks (time 2) postpartum. The presence or absence of early diastolic notches was recorded. The change in the MAP, BMI, and UtA-PI over time and between the two populations was modelled through multivariate linear regression using the generalised least squares.

Results

In both groups, the UtA-PI significantly increased from time 0 to time 1 (p < 0.05) and time 2 (p < 0.05). Stage-1 hypertension did not change the trend but did increase the UtA-PI magnitude (p < 0.05). The presence of uterine artery notching increased over time, from 6 to 98 %, in both groups (p < 0.001); however, in the HT group, at time 1, the majority of women exhibited positive notching [92 % (HT) vs 57 % (NT), p = 0.013].

Conclusions

Chronic stage-1 hypertensive women with normal pregnancy outcomes exhibited a progressively increasing postpartum UtA impedance. This trend also occurred in normotensive women, albeit at a significantly lower magnitude.
Literature
1.
go back to reference Gómez O, Figueras F, Fernández S, Bennasar M, Martínez JM, Puerto B, Gratacós E (2008) Reference ranges for uterine artery mean pulsatility index at 11–41 weeks of gestation. Ultrasound Obstet Gynecol 32:128–132CrossRefPubMed Gómez O, Figueras F, Fernández S, Bennasar M, Martínez JM, Puerto B, Gratacós E (2008) Reference ranges for uterine artery mean pulsatility index at 11–41 weeks of gestation. Ultrasound Obstet Gynecol 32:128–132CrossRefPubMed
2.
go back to reference Schulman H, Fleischer A, Farmakides G, Bracero L, Rochelson B, Grunfeld L (1986) Development of uterine artery compliance in pregnancy as detected by Doppler ultrasound. Am J Obstet Gynecol 155:1031–1036CrossRefPubMed Schulman H, Fleischer A, Farmakides G, Bracero L, Rochelson B, Grunfeld L (1986) Development of uterine artery compliance in pregnancy as detected by Doppler ultrasound. Am J Obstet Gynecol 155:1031–1036CrossRefPubMed
3.
go back to reference Tan SL, Zaidi J, Campbell S, Doyle P, Collins W (1996) Blood flow changes in the ovarian and uterine arteries during the normal menstrual cycle. Am J Obstet Gynecol 175:625–631CrossRefPubMed Tan SL, Zaidi J, Campbell S, Doyle P, Collins W (1996) Blood flow changes in the ovarian and uterine arteries during the normal menstrual cycle. Am J Obstet Gynecol 175:625–631CrossRefPubMed
4.
go back to reference Guedes-Martins L, Saraiva J, Gaio R, Macedo F, Almeida H (2014) Uterine artery impedance at very early clinical pregnancy. Prenat Diagn 34:719–725CrossRefPubMed Guedes-Martins L, Saraiva J, Gaio R, Macedo F, Almeida H (2014) Uterine artery impedance at very early clinical pregnancy. Prenat Diagn 34:719–725CrossRefPubMed
5.
go back to reference Cooley SM, Donnelly JC, Walsh T, MacMahon C, Gillan J, Geary MP (2011) The impact of umbilical and uterine artery Doppler indices on antenatal course, labor and delivery in a low-risk primigravid population. J Perinat Med 39:143–149CrossRefPubMed Cooley SM, Donnelly JC, Walsh T, MacMahon C, Gillan J, Geary MP (2011) The impact of umbilical and uterine artery Doppler indices on antenatal course, labor and delivery in a low-risk primigravid population. J Perinat Med 39:143–149CrossRefPubMed
6.
go back to reference Fratelli N, Prefumo F, Andrico S, Lorandi A, Recupero D, Tomasoni G, Frusca T (2011) Effects of epidural analgesia on uterine artery Doppler in labour. Br J Anaesth 106:221–224CrossRefPubMed Fratelli N, Prefumo F, Andrico S, Lorandi A, Recupero D, Tomasoni G, Frusca T (2011) Effects of epidural analgesia on uterine artery Doppler in labour. Br J Anaesth 106:221–224CrossRefPubMed
7.
go back to reference Steer CV, Campbell S, Pampiglione JS, Kingsland CR, Mason BA, Collins WP (1990) Transvaginal colour flow imaging of the uterine arteries during the ovarian and menstrual cycles. Hum Reprod 5:391–395PubMed Steer CV, Campbell S, Pampiglione JS, Kingsland CR, Mason BA, Collins WP (1990) Transvaginal colour flow imaging of the uterine arteries during the ovarian and menstrual cycles. Hum Reprod 5:391–395PubMed
8.
go back to reference Pijnenborg R, Vercruysse L, Hanssens M (2006) The uterine spiral arteries in human pregnancy: facts and controversies. Placenta 27:939–958CrossRefPubMed Pijnenborg R, Vercruysse L, Hanssens M (2006) The uterine spiral arteries in human pregnancy: facts and controversies. Placenta 27:939–958CrossRefPubMed
9.
go back to reference Pijnenborg R, Vercruysse L, Brosens I (2011) Deep placentation. Best Pract Res Clin Obstet Gynaecol 25:273–285CrossRefPubMed Pijnenborg R, Vercruysse L, Brosens I (2011) Deep placentation. Best Pract Res Clin Obstet Gynaecol 25:273–285CrossRefPubMed
10.
go back to reference Harrington K, Goldfrad C, Carpenter RG, Campbell S (1997) Transvaginal uterine and umbilical artery Doppler examination of 12–16 weeks and the subsequent development of pre-eclampsia and intrauterine growth retardation. Ultrasound Obstet Gynecol 9:94–100CrossRefPubMed Harrington K, Goldfrad C, Carpenter RG, Campbell S (1997) Transvaginal uterine and umbilical artery Doppler examination of 12–16 weeks and the subsequent development of pre-eclampsia and intrauterine growth retardation. Ultrasound Obstet Gynecol 9:94–100CrossRefPubMed
11.
go back to reference Papageorghiou AT, Yu CK, Bindra R, Pandis G, Nicolaides KH, Fetal Medicine Foundation Second Trimester Screening Group (2001) Multicenter screening for pre-eclampsia and fetal growth restriction by transvaginal uterine artery Doppler at 23 weeks of gestation. Ultrasound Obstet Gynecol 18:441–449CrossRefPubMed Papageorghiou AT, Yu CK, Bindra R, Pandis G, Nicolaides KH, Fetal Medicine Foundation Second Trimester Screening Group (2001) Multicenter screening for pre-eclampsia and fetal growth restriction by transvaginal uterine artery Doppler at 23 weeks of gestation. Ultrasound Obstet Gynecol 18:441–449CrossRefPubMed
12.
go back to reference Harrington K, Cooper D, Lees C, Hecher K, Campbell S (1996) 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 7:182–188CrossRefPubMed Harrington K, Cooper D, Lees C, Hecher K, Campbell S (1996) 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 7:182–188CrossRefPubMed
13.
go back to reference Schwarze A, Nelles I, Krapp M, Friedrich M, Schmidt W, Diedrich K, Axt-Fliedner R (2005) Doppler ultrasound of the uterine artery in the prediction of severe complications during low-risk pregnancies. Arch Gynecol Obstet 271:46–52CrossRefPubMed Schwarze A, Nelles I, Krapp M, Friedrich M, Schmidt W, Diedrich K, Axt-Fliedner R (2005) Doppler ultrasound of the uterine artery in the prediction of severe complications during low-risk pregnancies. Arch Gynecol Obstet 271:46–52CrossRefPubMed
14.
go back to reference Coleman MA, McCowan LM, North RA (2000) Mid-trimester uterine artery Doppler screening as a predictor of adverse pregnancy outcome in high-risk women. Ultrasound Obstet Gynecol 15:7–12CrossRefPubMed Coleman MA, McCowan LM, North RA (2000) Mid-trimester uterine artery Doppler screening as a predictor of adverse pregnancy outcome in high-risk women. Ultrasound Obstet Gynecol 15:7–12CrossRefPubMed
15.
go back to reference Axt-Fliedner R, Schwarze A, Nelles I, Altgassen C, Friedrich M, Schmidt W, Diedrich K (2005) The value of uterine artery Doppler ultrasound in the prediction of severe complications in a risk population. Arch Gynecol Obstet 271:53–58CrossRefPubMed Axt-Fliedner R, Schwarze A, Nelles I, Altgassen C, Friedrich M, Schmidt W, Diedrich K (2005) The value of uterine artery Doppler ultrasound in the prediction of severe complications in a risk population. Arch Gynecol Obstet 271:53–58CrossRefPubMed
16.
go back to reference Cnossen JS, Morris RK, ter Riet G, Mol BW, van der Post JA, Coomarasamy A, Zwinderman AH, Robson SC, Bindels PJ, Kleijnen J, Khan KS (2008) Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis. CMAJ 178:701–711CrossRefPubMedCentralPubMed Cnossen JS, Morris RK, ter Riet G, Mol BW, van der Post JA, Coomarasamy A, Zwinderman AH, Robson SC, Bindels PJ, Kleijnen J, Khan KS (2008) Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis. CMAJ 178:701–711CrossRefPubMedCentralPubMed
17.
go back to reference Kirkinen P, Dudenhausen J, Baumann H, Huch A, Huch R (1988) Postpartum blood flow velocity waveforms of the uterine arteries. J Reprod Med 33:745–748PubMed Kirkinen P, Dudenhausen J, Baumann H, Huch A, Huch R (1988) Postpartum blood flow velocity waveforms of the uterine arteries. J Reprod Med 33:745–748PubMed
18.
go back to reference Van Schoubroeck D, Van den Bosch T, Scharpe K, Lu C, Van Huffel S, Timmerman D (2004) Prospective evaluation of blood flow in the myometrium and uterine arteries in the puerperium. Ultrasound Obstet Gynecol 23:378–381CrossRefPubMed Van Schoubroeck D, Van den Bosch T, Scharpe K, Lu C, Van Huffel S, Timmerman D (2004) Prospective evaluation of blood flow in the myometrium and uterine arteries in the puerperium. Ultrasound Obstet Gynecol 23:378–381CrossRefPubMed
19.
go back to reference Mulic-Lutvica A, Eurenius K, Axelsson O (2007) Longitudinal study of Doppler flow resistance indices of the uterine arteries after normal vaginal delivery. Acta Obstet Gynecol Scand 86:1207–1214CrossRefPubMed Mulic-Lutvica A, Eurenius K, Axelsson O (2007) Longitudinal study of Doppler flow resistance indices of the uterine arteries after normal vaginal delivery. Acta Obstet Gynecol Scand 86:1207–1214CrossRefPubMed
20.
go back to reference Matthys LA, Coppage KH, Lambers DS, Barton JR, Sibai BM (2004) Delayed postpartum preeclampsia: an experience of 151 cases. Am J Obstet Gynecol 190:1464–1466CrossRefPubMed Matthys LA, Coppage KH, Lambers DS, Barton JR, Sibai BM (2004) Delayed postpartum preeclampsia: an experience of 151 cases. Am J Obstet Gynecol 190:1464–1466CrossRefPubMed
22.
go back to reference Macdonald-Wallis C, Lawlor DA, Fraser A, May M, Nelson SM, Tilling K (2012) Blood pressure change in normotensive, gestational hypertensive, preeclamptic, and essential hypertensive pregnancies. Hypertension 59:1241–1248CrossRefPubMedCentralPubMed Macdonald-Wallis C, Lawlor DA, Fraser A, May M, Nelson SM, Tilling K (2012) Blood pressure change in normotensive, gestational hypertensive, preeclamptic, and essential hypertensive pregnancies. Hypertension 59:1241–1248CrossRefPubMedCentralPubMed
23.
go back to reference Romundstad PR, Magnussen EB, Smith GD, Vatten LJ (2010) Hypertension in pregnancy and later cardiovascular risk: common antecedents? Circulation 122:579–584CrossRefPubMed Romundstad PR, Magnussen EB, Smith GD, Vatten LJ (2010) Hypertension in pregnancy and later cardiovascular risk: common antecedents? Circulation 122:579–584CrossRefPubMed
24.
go back to reference R Development Core Team (2013) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. http://www.r-project.org. Accessed 18 Dec 2013 R Development Core Team (2013) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. http://​www.​r-project.​org. Accessed 18 Dec 2013
25.
go back to reference Bland JM, Altman DG (2003) Applying the right statistics: analyses of measurement studies. Ultrasound Obstet Gynecol 22:85–93CrossRefPubMed Bland JM, Altman DG (2003) Applying the right statistics: analyses of measurement studies. Ultrasound Obstet Gynecol 22:85–93CrossRefPubMed
26.
go back to reference Weydert JA, Benda JA (2006) Subinvolution of the placental site as an anatomic cause of postpartum uterine bleeding: a review. Arch Pathol Lab Med 130:1538–1542PubMed Weydert JA, Benda JA (2006) Subinvolution of the placental site as an anatomic cause of postpartum uterine bleeding: a review. Arch Pathol Lab Med 130:1538–1542PubMed
27.
go back to reference Morris R, Sunesara I, Rush L, Anderson B, Blake PG, Darby M, Sawardecker S, Novotny S, Bofill JA, Martin JN Jr (2014) Maternal hemodynamics by thoracic impedance cardiography for normal pregnancy and the postpartum period. Obstet Gynecol 123:318–324CrossRefPubMed Morris R, Sunesara I, Rush L, Anderson B, Blake PG, Darby M, Sawardecker S, Novotny S, Bofill JA, Martin JN Jr (2014) Maternal hemodynamics by thoracic impedance cardiography for normal pregnancy and the postpartum period. Obstet Gynecol 123:318–324CrossRefPubMed
28.
go back to reference Mabie WC, DiSessa TG, Crocker LG, Sibai BM, Arheart KL (1994) A longitudinal study of cardiac output in normal human pregnancy. Am J Obstet Gynecol 170:849–856CrossRefPubMed Mabie WC, DiSessa TG, Crocker LG, Sibai BM, Arheart KL (1994) A longitudinal study of cardiac output in normal human pregnancy. Am J Obstet Gynecol 170:849–856CrossRefPubMed
29.
go back to reference Andrew A, Bulmer JN, Morrison L, Wells M, Buckley CH (1993) Subinvolution of the uteroplacental arteries: an immunohistochemical study. Int J Gynecol Pathol 12:28–33CrossRefPubMed Andrew A, Bulmer JN, Morrison L, Wells M, Buckley CH (1993) Subinvolution of the uteroplacental arteries: an immunohistochemical study. Int J Gynecol Pathol 12:28–33CrossRefPubMed
30.
go back to reference Guedes-Martins L, Cunha A, Saraiva J, Gaio R, Macedo F, Almeida H (2014) Internal iliac and uterine arteries Doppler ultrasound in the assessment of normotensive and chronic hypertensive pregnant women. Sci Rep 4:3785CrossRefPubMedCentralPubMed Guedes-Martins L, Cunha A, Saraiva J, Gaio R, Macedo F, Almeida H (2014) Internal iliac and uterine arteries Doppler ultrasound in the assessment of normotensive and chronic hypertensive pregnant women. Sci Rep 4:3785CrossRefPubMedCentralPubMed
31.
go back to reference Nakai Y, Imanaka M, Nishio J, Maeda T, Ozaki A, Sun TT, Ogita S (1997) Uterine blood flow velocity waveforms during early postpartum course following caesarean section. Eur J Obstet Gynecol Reprod Biol 74:121–124CrossRefPubMed Nakai Y, Imanaka M, Nishio J, Maeda T, Ozaki A, Sun TT, Ogita S (1997) Uterine blood flow velocity waveforms during early postpartum course following caesarean section. Eur J Obstet Gynecol Reprod Biol 74:121–124CrossRefPubMed
32.
go back to reference Lewis PR, Galvin PM, Short RV (1987) Salivary oestriol and progesterone concentrations in women during late pregnancy, parturition and the puerperium. J Endocrinol 115:177–181CrossRefPubMed Lewis PR, Galvin PM, Short RV (1987) Salivary oestriol and progesterone concentrations in women during late pregnancy, parturition and the puerperium. J Endocrinol 115:177–181CrossRefPubMed
34.
go back to reference Wilson MJ, Lopez M, Vargas M, Julian C, Tellez W, Rodriguez A, Bigham A, Armaza JF, Niermeyer S, Shriver M, Vargas E, Moore LG (2007) Greater uterine artery blood flow during pregnancy in multigenerational (Andean) than shorter-term (European) high-altitude residents. Am J Physiol Regul Integr Comp Physiol 293:R1313–R1324CrossRefPubMed Wilson MJ, Lopez M, Vargas M, Julian C, Tellez W, Rodriguez A, Bigham A, Armaza JF, Niermeyer S, Shriver M, Vargas E, Moore LG (2007) Greater uterine artery blood flow during pregnancy in multigenerational (Andean) than shorter-term (European) high-altitude residents. Am J Physiol Regul Integr Comp Physiol 293:R1313–R1324CrossRefPubMed
35.
go back to reference Sibai BM (2012) Etiology and management of postpartum hypertension-preeclampsia. Am J Obstet Gynecol 206:470–475CrossRefPubMed Sibai BM (2012) Etiology and management of postpartum hypertension-preeclampsia. Am J Obstet Gynecol 206:470–475CrossRefPubMed
36.
go back to reference Al-Safi Z, Imudia AN, Filetti LC, Hobson DT, Bahado-Singh RO, Awonuga AO (2011) Delayed postpartum preeclampsia and eclampsia: demographics, clinical course, and complications. Obstet Gynecol 118:1102–1107CrossRefPubMed Al-Safi Z, Imudia AN, Filetti LC, Hobson DT, Bahado-Singh RO, Awonuga AO (2011) Delayed postpartum preeclampsia and eclampsia: demographics, clinical course, and complications. Obstet Gynecol 118:1102–1107CrossRefPubMed
37.
go back to reference Conti E, Zezza L, Ralli E, Caserta D, Musumeci MB, Moscarini M, Autore C, Volpe M (2013) Growth factors in preeclampsia: a vascular disease model. A failed vasodilation and angiogenic challenge from pregnancy onwards? Cytokine Growth Factor Rev 24:411–425CrossRefPubMed Conti E, Zezza L, Ralli E, Caserta D, Musumeci MB, Moscarini M, Autore C, Volpe M (2013) Growth factors in preeclampsia: a vascular disease model. A failed vasodilation and angiogenic challenge from pregnancy onwards? Cytokine Growth Factor Rev 24:411–425CrossRefPubMed
Metadata
Title
Uterine artery impedance during puerperium in normotensive and chronic hypertensive pregnant women
Authors
Luís Guedes-Martins
Joaquim Saraiva
Óscar Felgueiras
Mariana Carvalho
Ana Cerdeira
Filipe Macedo
Rita Gaio
Henrique Almeida
Publication date
01-06-2015
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 6/2015
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-014-3560-6

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