Uteroplacental circulation in patients with first-trimester threatened abortion.

OBJECTIVE: To assess uteroplacental circulation in patients with first-trimester threatened abortion with a living embryo. DESIGN: Prospective, cross-sectional study. SETTING: Tertiary care university hospital. PATIENT(S): Forty-nine patients with first-trimester threatened abortion and a living embryo and 129 women with singleton, low-risk, normally developing first-trimester pregnancies recruited as controls. INTERVENTION(S): Transvaginal color Doppler ultrasound measurement of the peak systolic velocity and pulsatility index of the uterine arteries and the spiral arteries. MAIN OUTCOME MEASURE(S): Uteroplacental blood flow and pregnancy outcome. RESULT(S): There was a significant relation between gestational age and the peak systolic velocity and pulsatility index in the uterine arteries and between gestational age and the peak systolic velocity and pulsatility index in the spiral arteries in controls. There were no differences in any Doppler parameter assessed between the study group and the controls, even in those pregnancies that ended in spontaneous abortion. CONCLUSION(S): No apparent alteration occurs in the early uteroplacental circulation in patients with threatened abortion with a living embryo. The use of transvaginal color Doppler ultrasound is not helpful for predicting pregnancy outcome in these cases.

Transvaginal color Doppler assessment of fetal circulation in normal early pregnancy.

A prospective cross-sectional study was performed in 81 consecutive patients with low-risk singleton pregnancies and gestational age from 9 to 12 weeks of gestation in order to assess the fetal circulation at this stage of pregnancy. Patients' mean age was 29.8 +/- 3.8 (SD) years. Mean gestational age was 10.5 +/- 1.1 weeks. All patients underwent transvaginal color velocity imaging and pulsed Doppler ultrasound to obtain the blood flow velocity waveforms (FVWs) from three fetal vessels: umbilical artery, abdominal aorta, and intracranial vessels. The peak systolic velocity (PSV) and pulsatility index (PI) were analyzed. Optimal FVWs from each vessel were obtained in 98.8, 75.3 and 91.3% of fetuses, respectively. Linear regression analysis showed a significant progressive increase in PSV in the umbilical artery (r = 0.49, p < 0.0001) and intracranial vessels (r = 0.36, p = 0.018) simultaneous to a significant decrease in PI in both vessels (umbilical artery r = -0.37, p = 0.0007; intracranial vessels r = -0.56, p < 0.0001). No significant change was noted in the abdominal aorta in PSV (r = 0.06, p > 0.05) or in PI (r = -0.15, p > 0.05).

Transvaginal color Doppler sonography in adnexal masses: which parameter performs best?

The aim of this study was to establish which of several commonly used parameters performs best in the evaluation of adnexal masses by transvaginal color Doppler sonography. A total of 79 adnexal masses in 73 consecutive patients were included in the study. There were 43 (58.9%) premenopausal and 30 (41.1%) postmenopausal patients. The median age was 45 years (range 20-78 years). The parameters compared were: number of vessels detected in each tumor, tumor vessel location (central vs. peripheral), peak systolic velocity (PSV), lowest resistance index (RIlowest), mean resistance index (RImean), lowest pulsatility index (PIlowest) and mean pulsatility index (PImean). Receiver operating characteristic (ROC) curves were plotted to analyze the test performance of the parameters, except for tumor vessel location, and to estimate the best cut-off value of the parameters studied to differentiate between malignant and benign tumors. Definitive histopathological diagnosis was obtained in every case and used as the 'gold standard'. There were 20 (25.3%) malignant and 59 (74.7%) benign masses. Color Doppler signals were detected in 100% of the malignant masses (20 out of 20) and 74.6% (44 out of 59) of the benign masses, and the difference was found to be statistically significant (p < 0.001). Tumor vessel location was central in 18 out of 20 (90%) malignant masses, whereas it was peripheral in 39 out of 44 (88.6%) benign masses. ROC analysis showed that the best cut-off values for number of vessels, PSV, RIlowest, RImean, PIlowest and PImean were three vessels, 25 cm/s, 0.45, 0.55, 0.90 and 1.50, respectively. However, for all these parameters except RIlowest, there was a considerable overlap between benign and malignant tumors, with a high false-positive rate. In conclusion, in our experience, the parameters that performed best were the RIlowest with a cut-off value of 0.45 (sensitivity 100%; false-positive rate 11.4%) and central tumor vessel location (sensitivity 90%; false-positive rate 11.4%).