正常妊娠和妊娠期合并急性肾损伤孕妇子宫动脉及胎儿脐动脉血流动态变化规律对妊娠结局的影响

目的:观察正常妊娠妇女和妊娠期合并急性肾损伤(AKI)孕妇子宫动脉及其胎儿脐动脉血流动态变化规律及妊娠结局的差异。方法选择2006年1月-2011年3月笔者所在医院收治的孕妇3553例,在孕期确诊为急性肾损伤的孕妇为急性肾损伤组,孕期未发生急性肾损伤的孕妇为正常妊娠组。采用彩色多普勒超声(彩超)检测孕妇子宫动脉和脐动脉血流动力学变化,并观察其妊娠结局。结果 3553例孕妇中共诊断AKI孕妇85例,发病率为2.39%。不同孕周AKI组孕妇子宫动脉和脐动脉的S/D值、阻力指数(RI)、搏动指数(PI)和子宫动脉舒张早期切迹均显著高于同期正常妊娠组(p<0.05)。两组孕妇妊娠结局有统计学差异(P<0.05)结论子宫动脉和脐动脉血流动力学指标作为一种无创检查方法,对AKI孕妇不良妊娠结局的预测有极大应用价值。     

前置胎盘孕妇孕中晚期子宫动脉血流动力学变化的研究

目的探讨前置胎盘患者孕中、晚期子宫动脉血流动力学变化规律。方法选取105例孕中、晚期胎盘距宫颈内口距离20 mm的孕妇作为观察对象,监测其21～26周、28～31周双侧子宫动脉收缩期与舒张末期最大血流速度比值(S/D)、搏动指数(PI)及阻力指数(RI)的平均值,根据孕末期胎盘位置分为前置胎盘组(观察组,31例)和对照组(74例)。结果观察组2次子宫动脉S/D(2.13±0.36、1.87±0.24)、PI(0.80±0.19、0.67±0.14)、RI(0.51±0.07、0.45±0.07)平均值均低于对照组[S/D(2.38±0.48、2.08±0.36)、PI(0.94±0.25、0.80±0.19)、RI(0.55±0.07、0.50±0.08)],差异均有统计学意义(P0.05)。结论妊娠中晚期子宫动脉血流动力学参数变化与前置胎盘发生有一定相关性。     

低分子肝素对妊娠早期复发性流产患者子宫动脉血流影响的自身对照前瞻性研究

目的:研究低分子肝素(LMWH)对复发性流产(RSA)患者妊娠早期子宫动脉血流的影响,以及PI值、RI值和S/D比值对LMWH的敏感性。方法:选取2016年1月至2017年12月在中国医科大学附属盛京医院门诊就诊的妊娠早期子宫动脉血流异常、皮下注射LMWH 8000IU/d的RSA患者255例。根据用药时长分为A组(2周)、B组(3周)、C组(4周)和D组(6周)。比较分析用药前后子宫动脉血流PI值、RI值、S/D比值和切迹的变化情况,通过绘制ROC曲线对各指标进行敏感度分析。结果:A组治疗前后的子宫动脉血流PI值、RI值、S/D比值无明显差异(P0.05),B、C、D组治疗前后有显著差异(P0.05)。治疗前,4组的子宫动脉血流PI值、RI值、S/D比值比较,差异无统计学意义(P0.05),随着治疗时间的增加,各项指标数值逐渐降低,PI值在3～4周稳定,RI值在4周左右稳定,S/D比值在4周时达到最低值,而到6周时又升高到3周水平。治疗后4组子宫动脉舒张期血流切迹均有部分转阴,治疗4周前后有明显差异(P0.05)。子宫动脉血流S/D比值对LMWH治疗的敏感度明显高于PI值和RI值,两侧数值之和的敏感度高于右侧和左侧。结论:对于早期妊娠的RSA患者,LMWH皮下注射8000IU/d,持续4周以上,可有效改善异常子宫动脉血流,子宫动脉血流双侧S/D比值之和对LMWH的敏感度更高。     

正常妊娠和妊娠期高血压疾病孕妇子宫动脉及其胎儿脐动脉血流动态变化规律的多中心研究

目的 探讨正常妊娠妇女和妊娠期高血压疾病(HDP)孕妇妊娠早、中、晚期子宫动脉及其胎儿脐动脉血流动态变化的规律.方法 选择2005年4月-2006年7月在四川大学华西第二医院、南京医科大学第一附属医院、首都医科大学附属北京妇产医院、华中科技大学同济医学院附属协和医院和上海交通大学医学院附属仁济医院,行产前检查的正常单胎孕妇1098例,平均年龄(28.3±3.3)岁.在妊娠早期(10～14周)、妊娠中期(20～26周)、妊娠晚期(30～36周)采用彩色多普勒超声(彩超)检测孕妇子宫动脉及其胎儿脐动脉的搏动指数(PI)、阻力指数(RI)和脐动脉收缩压最大血流速度(S)与舒张末期最大血流速度(D)比值(S/D).在孕期发生HDP的孕妇为HDP组,未发生HDP的孕妇为正常妊娠组.结果 (1)HDP发生率:1098例孕妇中,正常妊娠分娩者1054例(正常妊娠组),发生HDP44例(HDP组,其中妊娠期高血压20例,轻度子痫前期15例,重度子痫前期9例),发生率为4.01%(44/1098).(2)子宫动脉血流动态变化:正常妊娠组妊娠早、中、晚期孕妇子宫动脉RI分别为0.64、0.57及0.50,PI分别为1.24、0.98及0.80,S/D分别为3.26、2.58及2.20,3项指标随妊娠进展而逐渐降低,妊娠早、中、晚期分别比较,差异均有统计学意义(P<0.01).HDP组妊娠早、中、晚期孕妇子宫动脉RI分别为0.55、0.67及0.64,PI分别为1.22、1.36及1.20,S/D分别为3.18、3.41及3.05,3项指标中孕中期最高,妊娠早、中、晚期分别比较,差异均有统计学意义(P<0.01).HDP组孕妇妊娠中、晚期子宫动脉RI、PI及S/D均高于正常妊娠组,两组比较,差异有统计学意义(P<0.01).(3)胎儿脐动脉血流动态变化:正常妊娠组妊娠中、晚期胎儿脐动脉RI分别为0.71及0.58,PI分别为1. 16及0.87,S/D分别为3.58及2.48,3项指标随妊娠进展而逐渐降低,妊娠中期与晚期比较,差异有统计学意义(P<0.01).HDP组妊娠中、晚期胎儿脐动脉RI分别为0.71及0.63,PI分别为1.20及0.95,S/D分别为3.71及2.69,3项指标随妊娠进展虽有逐渐降低趋势,但与正常妊娠组比较,差异无统计学意义(P>0.05).结论 随着妊娠进展,正常妊娠妇女子宫动脉的血流阻力逐渐下降,舒张末期血流增加;而HDP孕妇随妊娠进展子宫动脉的血流阻力明显升高;正常妊娠妇女和HDP孕妇随妊娠进展其胎儿脐动脉血流阻力均明显下降.     

正常孕妇子宫动脉血流多普勒参数序贯研究

目的运用彩色多普勒超声序贯监测妊娠早、中和晚期子宫动脉血流特征并制定各个孕期相应的参考值。方法2005-04-2006-04随机对南京医科大学第一附属医院妇产科160例妊娠妇女通过彩色多普勒超声在孕10~14周、20~24周、30~34周以及50例非妊娠期妇女序贯监测子宫动脉血流动力学3项参数S/D(收缩期峰值流速/舒张末期流速)、PI(搏动指数)和RI(阻力指数)。结果(1)妊娠期血流动力学3项参数与非妊娠期相比显著性降低(P<0·01),并随孕周增加逐渐降低,不同孕期之间差异均有显著性(P<0·01)。(2)不同孕周的3项参数均为正态分布。其参考值范围(双侧95%的界限值)分别为:早孕期:RI(0·73±0·16)、PI(1·66±0·86)、S/D(4·12±2·69);中孕期RI(0·56±0·16)、PI(0·94±0·47)、S/D(2·36±1·06);晚孕期RI(0·51±0·18)、PI(0·82±0·45)、S/D(2·13±1·02)。结论随着妊娠进展,子宫动脉血流动力学3项参数逐渐降低。深入讨论这些参数的参考值范围有助于准确、全面地评估妊娠状态和预测妊娠结局。     

复发性流产患者子宫动脉血流的超声多普勒变化

目的:探讨复发性流产(RSA)患者子宫动脉血流超声的血流参数及频谱波形的特征。方法:共纳入87例早孕妇女,其中有RSA史妇女41例,无流产史早孕妇女(对照组)46例,所有对象均行阴道超声多普勒测量子宫动脉血流参数,测量指标有:收缩期峰值流速/舒张末期流速(S/D)、搏动指数(PI)、阻力指数(RI)。随访妊娠结局,排除无流产史妇女中发生难免流产者。根据受试者工作曲线(ROC)比较各参数诊断价值,另将子宫动脉波形进行分类,同时比较RSA组和对照组波形的分布差异。结果:正常对照组排除难免流产7例后为39例。RSA组患者平均年龄29.7±3.4岁,正常对照组28.2±4.2岁。RSA组的子宫动脉S/D、PI、RI分别为6.98±1.67、1.46±0.12、0.84±0.04;正常对照组分别为5.30±1.05、1.31±0.15、0.81±0.12。RSA组的子宫动脉S/D与PI均高于对照组,差异有统计学意义,RI值组间差异无统计学意义(P0.05)。ROC曲线下面积三者均0.8,其中以PI最大;血流频谱波形A、0型的发生率较对照组高。结论:RSA患者的S/D、PI明显高于正常早孕妇女,高阻力血流波形发生率明显高于正常早孕妇女。     

子宫动脉阻力评分法预测妊娠高血压综合征

目的建立子宫动脉阻力评分法(UARS)预测妊高征的发病。方法103例正常孕妇,于孕24～25周时用多普勒彩色超声诊断仪检测其左右两侧子宫动脉搏动指数(PI)、阻力指数(RI)、收缩期与舒张期流速比(S/D)和血流频谱中的舒张早期切迹等4项指标,并随访至产后,按照妊娠结局分为发生妊高征和未发生妊高征。先分别以PI、RI和S/D的第90百分位值、第95百分位值和第97.5百分位值作为候选界值进行各单项指标妊高征预测的研究,通过统计学检验比较预测结果,确定各单项指标的预测界值;再以各单项指标的预测界值作为评分标准建立UARS,并采用此综合评分方法进行妊高征的预测研究,确定其预测界值,评价其预测效果。结果103例孕妇中8例发生妊高征,95例血压始终维持正常。PI、RI和S/D的预测界值分别为1.458、0.728和3.550。舒张早期切迹的预测界值是单侧或双侧出现舒张早期切迹。分别根据PI值、RI值、S/D值和舒张早期切迹的4项单项指标预测妊高征方法均具有显著的统计学意义(P<0.01)。研究结果显示,以UARS≥4分作为预测界值预测妊高征具有显著的统计学意义(P<0.01),其预测效果明显优于各单项指标预测方法,其RR值达到19.60,预测特异性为98.9%,阳性预测值为80%,均明显提高。结论用综合子宫动脉阻力相关指标(PI值、RI值、S/D值和舒张?     

用超声多普勒法同时分析子宫动脉和脐动脉的血流判定胎儿的预后

近年来,开始用超声多普勒法评价母儿胎盘循环动态。常用的指标有:代表动脉末梢阻力的波动指数(PI)、收缩流速/舒张流速(S/D)比率及阻力指数(R I)等。笔者应用上述指标,对正常及高危妊娠的脐动脉、子宫动脉的血流进行分析,求出各孕周的正常范围,并对高危妊娠的预后进行探讨。共测定正常妊娠75例,高危妊娠者114例,其中妊高征42例,其他异常妊娠65例,既往有产科异常者7例。结果:(1)PI、S/D及RI的正常值和异常标准:正常妊娠的脐动脉及子宫动脉的血流波型为舒张期血流丰富,呈现特有的血流波型,而异常妊     

CLEC14A、VEGF在胚胎停育患者蜕膜组织中的表达及其与超声血流参数的相关性研究

目的:研究CLEC14A、VEGF及超声血流参数在胚胎停育组和正常妊娠组蜕膜组织中的表达差异及相互关系,探讨血管生成对胚胎停育的影响机制。方法:选取2016年5月至2017年2月于苏州大学附属第一医院接受清宫术的胚胎停育患者30例为胚胎停育组(胚停组),选取同期因个人原因要求实施人工流产且经B超证实为宫内胚胎存活的正常早期妊娠妇女50例为正常妊娠组(对照组)。Western blot和RT-PCR法检测两组孕妇蜕膜组织中CLEC14A和VEGF表达水平;多普勒超声技术检测两组孕妇双侧子宫动脉和孕囊周围螺旋小动脉的搏动指数(PI)、阻力指数(RI)、收缩期最大血流速度与舒张末期血流速度的比值(S/D)。结果:胚停组和对照组的年龄、停经天数等一般情况比较,差异无统计学意义(P0.05)。胚停组的子宫动脉优势侧RI、PI、S/D及双侧子宫动脉平均RI、PI均明显高于对照组(P0.05)。胚停组蜕膜组织中CLEC14A和VEGF蛋白和mRNA表达水平均明显低于对照组(P0.05)。蜕膜组织中CLEC14A与VEGF蛋白表达水平呈正相关(r=0.355,P=0.018);胚停组蜕膜组织中VEGF表达水平与优势侧子宫动脉S/D呈负相关(r=-0.731,P0.001)。结论:CLEC14A可能通过调节VEGF表达引起子宫动脉血流动力学改变,尤其是优势侧子宫动脉S/D升高,从而影响胚胎血供,参与胚胎停育的发病过程。     

早发子痫前期血清T-钙粘蛋白水平与子宫动脉血流关系研究

目的探讨早发子痫前期血清T-钙粘蛋白(T-cadherin)水平与子宫动脉血流的关系。方法选择2017年7月至2018年1月于中国医科大学附属盛京医院门诊及住院检查的孕28~34周单胎妊娠孕妇77例,其中39例子痫前期孕妇为研究组,38例正常孕妇为对照组。采用酶联免疫吸附法(ELISA)检测两组孕妇血清T-cadherin水平,抽血当日行彩色多普勒超声检测两组孕妇的双侧子宫动脉搏动指数(PI)、阻力指数(RI)及收缩期与舒张期血流速度比值(S/D)。比较两组孕妇血清T-cadherin水平的差异及血清T-cadherin水平与子宫动脉血流各个指标间的相关性。记录研究组孕妇分娩时的孕周及新生儿体重,研究T-cadherin水平与妊娠结局的关系。结果研究组T-cadherin为(3.93±0.99)μg/L,低于对照组的(5.03±0.73)μg/L(P0.01)。研究组子宫动脉S/D、PI及RI值明显高于对照组(P0.01)。相关性分析显示,研究组血清T-cadherin水平与子宫动脉PI值间r=-0.715,P0.001,与子宫动脉RI值间r=-0.725,P0.001,与子宫动脉S/D值间r=-0.63,P0.001;对照组孕妇血清T-cadherin的水平与子宫动脉PI、RI及S/D之间无相关性(P0.05)。研究组孕妇血清T-cadherin的水平与分娩孕周之间r=0.605,P0.001,与新生儿体重之间r=0.671,P0.001。结论早发子痫前期患者血清T-cadherin与子宫动脉血流呈负相关,并与早发子痫前期发病有关,可能在子痫前期的发病中处于主导地位,且与疾病进展和妊娠结局相关。     

The usefulness of uterine artery doppler velocimetry in high risk pregnancy diagnostic (PIH and/or IUGR)

OBJECTIVES: High risk pregnancy was defined as developing of pregnancy induced hypertension or/and growth retardation in the course of gestation. DESIGN: The main aim of the study is to analyze the usefulness of uterine artery doppler velocimetry in high risk pregnancy diagnostic. MATERIALS AND METHODS: 610 single pregnancies were included in the study. First group of normal pregnancies where -530 single normal pregnancies between 19 and 39 gestation weeks. S/D, RI & PI in both uterine arteries were assessed. There were assessed flow velocity waveforms also for detection of notches. At the next stage an examined group with 80 pregnant women was formed where in the course of gestation pregnancy induced hypertension and/or fetal growth retardation. 24 hour monitoring of the blood pressure in the examined group was performed. Obtained data from both groups was calculated and statistically analyzed. RESULTS: Mean values for flow velocity waveform indices were estimated for both groups: controls S/D 2,35 (SD 0,61), RI 0,56 (SD 0,11), PI 0,96 (SD 0,32), examined group S/D 2,99 (SD 1,16), RI 0,63 (SD 0,12), PI 1,26 (SD 0,51). There is significant difference between values for all flow parameters p < 0,001. In the control group we observed notches in 11,8% of all women and in the examined (hypertension and/or growth restriction) group in 81,3% (p<0,001). The sensitivity is 81,3% and specificity 88,2%. MoMRIs for both uterine arteries were calculated to compare data from control and examined group. In the examined group 41,3% RI results were above calculated MoM and there is significant difference between both groups (p <0,001). The sensitivity is 41,3% and specificity 89,5%. In the group of the hypertensive pregnant women where mean systolic blood pressure in 24 hour monitoring was above 130 mm Hg we observed notches in 61,1% of flow velocity waveforms in uterine arteries. In the group of normal pregnancies there were 11,8% notches and there is significant difference between both groups (p<0,001). CONCLUSIONS: The uterine artery velocimetry values of S/D, RI, PI decrease with the progression of gestation. There are no significant differences between right and left uterine artery doppler velocimetry. There are significant differences for values and percentage of notches in both groups. Extremely high rate of notches is observed in the group with most elevated blood pressure (daily mean value over 130mm Hg). It is possible to calculate obstetrical risk assessing values for blood flow in uterine arteries in pregnancy. It can be helpful to estimate methods detecting elevated risk for hypertension and/or growth retardation in pregnancy.     

窦卵泡计数及卵巢动脉血流变化与助孕术治疗结局的关系探讨

目的:探讨助孕术前子宫、卵巢的血流动力学变化及窦卵泡数与IVF-ET治疗后妊娠结局的关系。方法:129例拟采用IVF-ET助孕技术治疗的不育症患者,经阴道彩色多谱勒分别检测子宫体积、内膜厚度、血液动力学变化和卵巢体积、血液动力学以及窦卵泡数,比较分析上述指标与IVF-ET后成功妊娠的关系。结果:妊娠成功组的卵巢基质血流PI及RI、S/D指标显著小于妊娠失败组,而卵巢体积、窦卵泡数显著大于妊娠失败组,但是妊娠与否与子宫的相关参数无关。结论:卵巢动脉的PI、RI、S/D、卵巢体积和窦卵泡数数与妊娠结局有密切的关系。     

Prognostic Doppler ultrasound examination of fetal arteries blood flow

Early detection of fetal risk is one of the main issues in today obstetrics. Ultrasound diagnostics plays a significant role, as the introduction of Doppler imaging method in the evaluation of blood flow has enabled non-invasive assessment of uteroplacental circulation. Therefore, we have analysed foetal three arteries: umbilical artery, middle cerebral artery and renal artery after determining the normal range for the analysed parameters. AIM OF WORK: 1. Comparison of the obtained blood flow indices (S/D, RI, PI) in the umbilical artery, middle cerebral artery and renal artery of foetuses from normal and complicated full-term pregnancies. 2. Determination of indices: umbilical-cerebral and renal-cerebral in normal and pathological pregnancy. 3. Evaluation of feasibility of the analysed flow parameters for the detection of intrauterine foetal hypoxia. MATERIAL AND METHODS: We have examined 151 women, who were divided into control group--101 pregnant women with normal pregnancy and study group--50 pregnant women with complicated pregnancy. All pregnant women underwent ultrasound examination using the Hitachi EUB 515 C (Japan) scanner with 3.5 MHz convex probe, connected to the colour pulsed Doppler. The study consisted of the biometric measurements and evaluation of the spectrum of blood flow in the umbilical artery, middle cerebral artery and renal artery. We have determined following indices: a) systolic-diastolic ratio S/D, resistance index RI, pulsatility index PI, b) umbilical-cerebral ratio P/M. (PI ua/PI mca), renal--cerebral ratio N/M (PI ra/PI mca). RESULTS: Statistically significant difference was found between the study and control groups for all the flow indices assessed (S/D, RI, PI) for the middle cerebral artery, for the indices P/M and N/M. (p < 0.001) and pulsatility index in the renal artery (p < 0.01). Similar, although slightly smaller difference (p < 0.05) was seen for the values of flow parameters in the umbilical artery. CONCLUSIONS: 1) Evaluation of blood flow in the middle cerebral artery, and in particular pulsatility index PI, reflects the risk to foetus. Umbilical-cerebral index and renal-cerebral index demonstrate the mechanisms of circulation centralization in case of fetal distress. For the umbilical-cerebral index, the cut-off value is 1.0 and for the renal-cerebral index it is 2.5, 2) Evaluation of the blood flow in foetal vessels is a significant element of prenatal diagnostics. Due to its low sensitivity, it should be compared with the results of other biophysical tests, to achieve complex evaluation of the condition of the foetus.     

血液动力学指标预测胎儿缺氧及酸中毒的价值

目的：评价血液动力学指标预测胎儿缺氧及酸中毒的价值。方法：用彩色多普勒超声检测了４６例正常晚期妊娠（正常组）和３２例高危妊娠（高危组）妇女子宫动脉（ＵｔＡ）和胎儿脐动脉（ＵｍＡ）、大脑中动脉（ＭＣＡ）、肾动脉（ＲＡ）的血流速度波型，并且测定高危组脐动脉血气。结果：高危组ＵｔＡ、ＵｍＡ、ＲＡ的阻力指数（ＲＩ）、搏动指数（ＰＩ）及收缩期最大血流速度（Ｓ）与舒张末期血流速度（Ｄ）的比值（Ｓ／Ｄ值）均高于正常组，而ＭＣＡ的ＰＩ及Ｓ／Ｄ值均明显低于正常组（Ｐ＜０．０５）。与ＵｍＡＰＯ２＞２．５ｋＰａ的高危妊娠病例比较，ＵｍＡＰＯ２≤２．５ｋＰａ者ＵｔＡ的Ｓ／Ｄ值、ＵｍＡ的ＰＩ、Ｓ／Ｄ值以及ＲＡ的ＲＩ、ＰＩ、Ｓ／Ｄ值均明显增高，ＭＣＡ的ＰＩ明显降低（Ｐ＜０．０５）。ＵｍＡ及ＲＡ的ＰＩ与ＵｍＡＰＯ２和ｐＨ值呈负相关，与ＰＣＯ２呈正相关；ＭＣＡ的ＰＩ与ＵｍＡ的ｐＨ、ＰＯ２呈正相关，与ＰＣＯ２呈负相关。结论：高危妊娠胎儿缺氧时ＭＣＡ血流阻力降低，而周围血管，特别是肾血管血流阻力明显升高；胎儿血液动力学变化与缺氧及酸碱平衡失调呈良好相关性，可预测胎儿缺氧及酸中毒的程度。     

经阴道彩色多普勒监测子宫血流动力学变化评价IVF-ET中子宫内膜接受性

目的:探讨双侧子宫血流动力学参数变化在评价移植前子宫内膜接受性的价值。方法:在本中心就诊的104例不孕症妇女,根据hCG注射日子宫内膜厚度、妊娠与否将病人分组后,使用经阴道彩色多普勒超声测量子宫动脉血流的阻力指数、搏动指数,比较各参数在不同组间的差异。结果:hCG注射日子宫动脉PI和RI越高,子宫内膜越薄。妊娠组PI和RI显著低于非妊娠组。根据hCG注射日子宫动脉RI将病人分为0.61-0.80和0.81-0.93两组,比较两组妊娠率分别为48.08%和15.38%。结论:子宫动脉血流参数PI、RI对IVF璄T结局是有效的预测指标。     

Evaluation of third trimester uterine artery flow velocity indices in relationship to perinatal complications.

OBJECTIVE: Uterine artery Doppler is becoming a routine part of pregnancy surveillance in high-risk pregnancies. Which blood flow velocity waveform index to measure is debated and the 'notch' in early diastole is not widely accepted, as it is a subjective measure. The aim of the present study was to evaluate the different indices in the prediction of adverse outcome of pregnancies suspected for intrauterine fetal growth restriction (IUGR). METHODS: Uterine artery blood flow was recorded in 217 pregnancies admitted for Doppler ultrasound surveillance due to suspected IUGR. The median gestational age at examination was 38 weeks (range 25-42 weeks). Only cases having bilateral uterine artery notching were included in the evaluation. The uterine artery Doppler spectrum was analyzed for different indices, including evaluation of notch and end-diastolic velocities. Umbilical artery Doppler velocimetry was also performed. The outcome variables chosen were: a small-for-gestational-age (SGA) newborn, preterm birth, and abdominal delivery. ROC-curve calculations were used to compare the different indices. RESULTS: The uterine artery blood velocity pulsatility index (PI) and resistance indices (RI) were the best predictors of adverse outcome of pregnancy. Apart from premature birth, the systolic/end-diastolic ratio was less predictive of adverse outcome. The indices including only diastolic blood velocities were the least predictive of adverse outcome. The group with notch velocity above end-diastolic velocity was compared with those having notch velocity below the end-diastolic velocity. No difference in outcome was seen between the two groups. CONCLUSIONS: RI and PI as measures of third trimester utero-placental vascular impedance are the best predictors of adverse outcome of IUGR-suspected pregnancies.     

Misoprostol and dinoprostone therapy for labor induction: a Doppler comparison of uterine and fetal hemodynamic effects

OBJECTIVE: To compare the effect of misoprostol (PGE(1)) versus dinoprostone (PGE(2)) on blood flow in uteroplacental circulation during labor induction. STUDY DESIGN: Eighty-four women with indications for induction of labor were assigned to receive either misoprostol 50 microg per vagina every 4 h as needed or 0.5 mg doses of dinoprostone given intra-cervically every 6 h by means of a randomization table generated by computer. Doppler velocimetry of umbilical, uterine and arcuate arteries was performed immediately before and 2-3 h after the administration of misoprostol or dinoprostone. The SAS system was used to perform statistical analysis. RESULTS: There were no significant changes of pulsatility index (PI), resistance index (RI) and systolic/diastolic (S/D) ratio in umbilical arteries after both prostaglandin compounds. Vaginal application of misoprostol significantly increased all ratios in arcuate artery and S/D ratio in uterine artery. Intra-cervically dinoprostone significantly increased PI, RI and S/D ratio in arcuate and uterine arteries. CONCLUSIONS: Our results indicate that vaginal misoprostol and cervical dinoprostone administration increases uteroplacental resistance but does not affect umbilical blood flow. Misoprostol would be as safe and effective agent as dinoprostone for cervical ripening and labor induction.