A longitudinal study of quantitative uterine blood flow with the use of color power angiography in appropriate for gestational age pregnancies

doi:10.1067/mob.2001.117187

American Journal of Obstetrics and Gynecology

Volume 185, Issue 3, September 2001, Pages 608-613

https://doi.org/10.1067/mob.2001.117187 Get rights and content

Abstract

Objective: The purpose of this study was to examine longitudinally changes in quantified blood volume flow in the uterine arteries during pregnancy with the use of color power angiography. Study Design: Color power angiography was used to quantify volume flow in the uterine arteries of 57 women with singleton uncomplicated pregnancies between 20 and 38 weeks’ gestation. Comparisons were made between blood flow in the 2 arteries in relation to the location of the placenta. Linear regression models were used to estimate gestational age derived volumetric changes in these vessels. Results: The diameter of the uterine arteries increased from 2.6 mm (SD, 0.2 mm) at 20 weeks to 4.8 mm (SD, 0.7 mm) at 38 weeks of gestation. The total uterine artery blood volume flow increased from 513 mL/min (SD, 127 mL/min) at 20 weeks to 970 mL/min (SD, 193 mL/min) at 38 weeks. The rate of increase was maximum between 20 and 24 weeks (39 mL/min per week). The laterality of the placenta significantly affected the diameter and blood volume flow in each uterine artery. The diameters on the ipsilateral side were significantly greater (by 10.8% ± 2.4%) than the diameters on the contralateral side at all gestations (P <.05). Similarly, blood volume flow was significantly greater (by 17.8% ± 2.2%) on the ipsilateral side at all gestations (P <.05). There were, however, no statistically significant differences between the vessel diameters and blood volume flow in those cases in which the placenta was central. Total uterine artery volume flow per kilogram of estimated fetal weight decreased from 1544 mL/kg per minute at 20 weeks to 296 mL/kg per minute at 38 weeks of gestation. Conclusion: Total quantified uterine artery blood volume flow increases while blood flow per kilogram of fetal weight decreases with gestation. Blood volume flow in the ipsilateral artery to the placenta was significantly higher than that in the contralateral artery. Calculating total uterine artery volume flow by doubling the blood flow from 1 artery (as was previously done) may therefore either result in an over or underestimation, depending on the relationship between the vessel and the laterality of the placenta. Color power angiography is a simple noninvasive tool for determining uterine artery blood volume flow. (Am J Obstet Gynecol 2001;185:608-13.)

Section snippets

Subjects and methods

Sixty-five women with singleton pregnancies, which were accurately dated by ultrasound scans that were performed between 10 and 12 weeks, were recruited into the study after a 20-week anomaly scan and a normal uterine artery Doppler velocimetry (defined by the absence of the following: a raised systolic/diastolic (A/B) ratio [> 2.6] with or without a notch on the uterine artery blood flow velocity waveform or a normal AB [<2.6] ratio with either a unilateral or bilateral notch on the uterine

Results

Of the 65 patients who were recruited, only 57 patients satisfied the inclusion criteria. Eight patients were excluded for various reasons: failure to identify both uterine arteries and/or delivery before 38 weeks’ gestation (n = 5) and only 2 to 3 measurements made (n = 3). Of the 57 newborns, 30 were female and 27 were male. The mean gestational age at delivery was 40.7 weeks (SD, 1.6 weeks), and the mean birth weight was 3316 g (SD, 245 g).

Proximal uterine artery diameter and quantified

Comment

The metabolic demands of the uteroplacental unit during pregnancy are high. To meet such demands, blood flow to the uterus must be increased. Because the uterine artery provides approximately 80% of the uteroplacental blood flow,¹³ quantification of blood flow through this vessel reflects most of the uteroplacental circulation.

Although our quantified blood volume flow values are greater than those reported by Thaler et al⁹ and Palmer et al,¹⁴ they are similar to those of Huckabee.¹⁵ The pattern

References (24)

JF Clapp et al.
The uterine hemodynamic response to repetitive unilateral vascular embolization in the pregnant ewe
Am J Obstet Gynecol
(1982)
I Thaler et al.
Changes in uterine blood flow during human pregnancy
Am J Obstet Gynecol
(1990)
NS Assali et al.
Uterine and fetal blood flow and oxygen consumption in early human pregnancy
Am J Obstet Gynecol
(1960)
H Schulman et al.
Rochelson B, Grunfeld L. Development of uterine artery compliance in pregnancy as detected by Doppler ultrasound
Am J Obstet Gynecol
(1986)
FC Greiss
Pressure-flow relationship in the gravid uterine vascular bed
Am J Obstet Gynecol
(1966)
JF Clapp
Cardiac output and uterine blood flow in the pregnant ewe
Am J Obstet Gynecol
(1978)
JC Konje et al.
The application of color power angiography to the longitudinal quantification blood flow volume in the fetal middle cerebral arteries, ascending aorta, descending aorta, and renal arteries during gestation
Am J Obstet Gynecol
(2000)
CV Steer et al.
The use of transvaginal color flow imaging after in vitro fertilization to identify optimal conditions before embryo transfer
Fertil Steril
(1992)
J Barcroft et al.
The rate of blood flow and gaseous metabolism of the uterus during pregnancy
J Physiol
(1933)
J Barcroft et al.
The direct determination of oxygen consumption of the foetal sheep
J Physiol
(1939)

J Metcalfe et al.

Estimation of uterine blood flow in normal human pregnancy at term

J Clin Invest

(1955)

CL Maini et al.

Non-invasive radioisotopic evaluation of placental blood flow

Gynecol Obstet Invest

(1985)

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^☆: Reprint requests: Justin Konje, MD, Fetal Growth and Development Research Unit, Department of Obstetrics & Gynaecology, Robert Kilpatrick Clinical Sciences Bldg, University of Leicester, Leicester Royal Infirmary, Leicester, LE2 7LX England; e-mail: [email protected]

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ObstetricsA longitudinal study of quantitative uterine blood flow with the use of color power angiography in appropriate for gestational age pregnancies☆

Abstract

Section snippets

Subjects and methods

Results

Comment

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

The use of transvaginal color flow imaging after in vitro fertilization to identify optimal conditions before embryo transfer

Fertil Steril

The rate of blood flow and gaseous metabolism of the uterus during pregnancy

J Physiol

The direct determination of oxygen consumption of the foetal sheep

J Physiol

Estimation of uterine blood flow in normal human pregnancy at term

J Clin Invest

Non-invasive radioisotopic evaluation of placental blood flow

Gynecol Obstet Invest

Obstetrics
A longitudinal study of quantitative uterine blood flow with the use of color power angiography in appropriate for gestational age pregnancies☆