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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (4): 584-589    DOI: 10.31083/j.ceog.2020.04.5349
Original Research Previous articles | Next articles
Detection of uterine artery hemodynamic changes in patients with gestational hypertension based on Doppler ultrasonography
Y. Wang1, 2, X.Y. Lu2, F. Xu2, H.M. Huang2, Y. Xu1, *(), X.W. Xi3
1Key Laboratory of Cardiovascular Disease and Department of Pathophysiology, Nanjing Medical University, Nanjing, Jiangsu 211166, P.R. China
2Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
3Shanghai General Hospital of Nanjing Medical University, Shanghai 200080, P.R. China
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Abstract  

Doppler ultrasonography has great value in detecting the changes in uterine artery hemodynamics in patients with pregnancy-induced hypertension. In the present study, 50 women with gestational hypertension and 50 normal pregnant women were selected. The comparison of the general data and laboratory examination revealed that the pre-pregnancy body mass index (BMI) and mean arterial pressure were significantly higher in the gestational hypertension group, when compared to the normal group (P < 0.05), while the serum albumin value was significantly lower in the gestational hypertension group, when compared to the normal group (P < 0.05). The Doppler ultrasonography revealed that the S/D, PI and RI values were significantly higher in the gestational hypertension group, when compared to the normal group (P < 0.05). In comparing the pregnancy outcome, the gestational hypertension group had shorter pregnancy termination time, lower birth weight, and more adverse outcomes, such as premature delivery, fetal distress and fetal growth restriction (FGR) (P < 0.05). The multi-variate regression analysis suggested that only the hemodynamic changes of the uterine artery can be used for predicting the outcome of pregnancy. These results revealed that the uterine artery hemodynamics of patients with gestational hypertension present with significant changes, when compared to normal women, which can be used in predicting adverse pregnancy outcomes. Targeted intervention can be provided to women with gestational hypertension to reduce the adverse pregnancy outcomes, according to the ultrasonography results.

Key words:  Gestation period      Hypertension      Uterine artery      Doppler ultrasonography      Hemodynamics     
Submitted:  02 August 2019      Accepted:  31 October 2019      Published:  15 August 2020     
Fund: JCZ18098/Nantong Municipal Health Commission
*Corresponding Author(s):  Y. Xu     E-mail:  pianolq@126.com

Cite this article: 

Y. Wang, X.Y. Lu, F. Xu, H.M. Huang, Y. Xu, X.W. Xi. Detection of uterine artery hemodynamic changes in patients with gestational hypertension based on Doppler ultrasonography. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(4): 584-589.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.04.5349     OR     https://ceog.imrpress.com/EN/Y2020/V47/I4/584

Table 1  — Comparison of the general data of pregnant women.
General data Gestational hypertension group Normal group t value P value
Age (years) 27.68 ± 3.45 26.84 ± 3.68 -1.732 0.087
Gestational weeks (week) 32.13 ± 2.22 31.67 ± 1.31 -1.256 0.668
Gravidity (time) 1.92 ± 0.71 1.81 ± 1.23 -1.948 0.059
Pre-pregnancy BMI (kg/m2) 24.56 ± 4.12 20.97 ± 3.68 -4.268 < 0.001
Heart rate (bpm) 84.62 ± 11.34 85.67 ± 10.67 1.214 0.264
Mean arterial pressure (mmHg) 116.43 ± 10.67 84.51 ± 9.21 -23.648 < 0.001
Table 2  — The comparison of laboratory examinations of pregnant women.
Laboratory examination Gestational hypertension group Normal group t value P value
Fasting blood glucose (mmol/L) 4.63 ± 0.82 4.62 ± 0.76 -0.362 0.763
Blood urea nitrogen (mmol/L) 3.51 ± 1.28 3.48 ± 0.97 -2.286 0.026
Blood albumin (g/L) 31.29 ± 5.62 38.74 ± 5.73 7.626 < 0.001
Hemoglobin (g/L) 118.78 ± 15.61 118.62 ± 16.24 -0.152 0.861
Figure 1.  — The spectrogram of the uterine artery in the gestational hypertension group.

Figure 2.  — The spectrogram of the uterine artery in the normal group.

Table 3  — Comparison of hemodynamic indicators.
Index Gestational hypertension group Normal group t value P value
AT (s) 0.12 ± 0.02 0.11 ± 0.03 0.964 0.347
S/D 2.46 ± 0.79 1.86 ± 0.51 5.637 < 0.001
PI 0.98 ± 0.42 0.63 ± 0.27 6.412 < 0.001
RI 0.55 ± 0.13 0.42 ± 0.07 6.814 < 0.001
Figure 3.  — The comparison of hemodynamic indicators. *, indicates that P < 0.05, and the difference was statistically significant.

Table 4  — Comparison of pregnancy outcomes.
The gestational hypertension group The normal group t value P value
Termination time of gestation (week) 37.46 ± 2.67 39.61 ± 2.53 4.658 < 0.001
Birth weight of newborns (g) 2505.67 ± 542.36 3368.92 ± 543.67 5.621 < 0.001
Figure 4.  — Comparison of pregnancy outcomes.

Table 5  — The multivariate regression analysis results.
Variable Odd ratio 95% confidence interval Value of P
General data (X1) 0.246 0.026-2.125 0.486
Laboratory examination (X2) 0.314 0.045-2.085 0.321
Uterine arterial hemodynamics (X3) 10.698 2.896-41.325 0.000
[1] Clark S.M., Dunn H.E., Hankins G.D.: “A review of oral labetalol and nifedipine in mild to moderate hypertension in pregnancy”. Semin Perinatol, 2015, 39, 548-555.
doi: 10.1053/j.semperi.2015.08.011 pmid: 26344738
[2] Kintiraki E., Papakatsika S., Kotronis G., Goulis D.G., Kotsis V.: “Pregnancy-Induced hypertension”. Hormones (Athens), 2015, 14, 211-223.
[3] Muti M., Tshimanga M., Notion G.T., Bangure D., Chonzi P.: “Prevalence of pregnancy induced hypertension and pregnancy outcomes among women seeking maternity services in Harare., Zimbabwe”. BMC Cardiovasc Disord, 2015, 15, 111.
doi: 10.1186/s12872-015-0110-5 pmid: 26431848
[4] Yakasai I., Tabari M., Rabiu A.: “Pattern of fetal arterial blood flow in selected vessels in patients with pregnancy induced hypertension in Aminu Kano Teaching Hospital Kano., Nigeria”. West African Journal of Radiology, 2013, 20, 9.
doi: 10.4103/1115-1474.117902
[5] Goswami G.: “Uterine artery doppler study for prediction of adverse outcome in high risk pregnancy”. 2015, 4, 9735-9742.
[6] Mitsui T., Masuyama H., Maki J., Tamada S., Hirano Y., Eto E., et al.: “Differences in uterine artery blood flow and fetal growth between the early and late onset of pregnancy-induced hypertension”. J Med Ultrason (2001), 2016, 43, 509-517.
[7] Arakaki T., Hasegawa J., Nakamura M., Hamada S., Muramoto M., Takita H., et al.: “Prediction of early- and late-onset pregnancy-induced hypertension using placental volume on three-dimensional ultrasound and uterine artery Doppler”. Ultrasound Obstet Gynecol, 2015, 45, 539-543.
doi: 10.1002/uog.14633 pmid: 25042564
[8] Aprile F.T., Luca G.D., Bruno M.G.: “Arterial hypertension during pregnancy, An appraisal on risk factors”. Italian Journal of Gynaecology & Obstetrics, 2010, 22, 202-226.
[9] Hu X.Q., Xiao D., Zhu R., Huang X., Yang S., Wilson S., et al.: “Pregnancy upregulates large-conductance Ca(2+)-activated K(+) channel activity and attenuates myogenic tone in uterine arteries”. Hypertension, 2011, 58, 1132-1139.
doi: 10.1161/HYPERTENSIONAHA.111.179952 pmid: 22042813
[10] Ampey B.C., Morschauser T.J., Ramadoss J., Magness R.R.: “Domain-Specific Partitioning of Uterine Artery Endothelial Connexin43 and Caveolin-1”. Hypertension. 2016, 68, 982-988.
doi: 10.1161/HYPERTENSIONAHA.116.08000 pmid: 27572151
[11] Foo L., Tay J., Lees C.C., McEniery C.M., Wilkinson I.B.: “Hypertension in pregnancy, natural history and treatment options”. Curr Hypertens Rep., 2015, 17, 36.
doi: 10.1007/s11906-015-0545-1 pmid: 25833457
[12] Ehrenthal D.B., Jurkovitz C., Hoffman M., Jiang X., Weintraub W.S.: “Prepregnancy body mass index as an independent risk factor for pregnancy-induced hypertension”. J Womens Health (Larchmt), 2011, 20, 67-72.
doi: 10.1089/jwh.2010.1970
[13] Ogueh O., Clough A., Hancock M., Johnson M.R.: “A longitudinal study of the control of renal and uterine hemodynamic changes of pregnancy”. Hypertens Pregnancy, 2011, 30, 243-259.
doi: 10.3109/10641955.2010.484079
[14] Thuring A., Marsal K., Laurini R.: “Placental ischemia and changes in umbilical and uteroplacental arterial and venous hemodynamics”. J Matern Fetal Neonatal Med., 2012, 25, 750-755.
doi: 10.3109/14767058.2011.594466 pmid: 21827369
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