Uterine artery doppler

1. Color Doppler in fetal surveillances
1 - uterine artery

2. Uterine artery Doppler
.uterine artery is a branch of internal iliac artery that is carry the
blood to the uterus
- ultrasound UTA. Measurement is used to check the blood
f
low
between mother and her baby .
..enters the myometrium at the junction of uterine corpus and cervix
Crossing the external lilac vessels (EIV).
- measurement at the ascending branch 1-2 cm above crossing piont .

3. Uterine artery interpretation
— predictive accuracy of
f
irst
trimester uterine Doppler is better in
the detection of early onset of
preeclampsia than late onset
diseases
- mean UTAPI 11 - 13 weeks gestation
measured trans abdominally was
lower than that measured trans
vaginally .
—Mean UTAPI is measured at 16 - 22
weeks,
— prediction of preeclampsia and
FGR by
1- increasing mean uterine PI and RI
of alue 2- persistent early diastolic
notch after 24 weeks of gestation

4. uterine artery
Doppler
How to measure
.Trans vaginal or trans
abdominal abdominal
approach .
. The bladder is semi
f
illed
(comfortable bladder) .
.mid sagittal view of the uterus
a n d c e r v i c a l c a n a l a r e
obtained ( US/ prob at the level
of iliac fossa right or left)
then followed by introduction
the color
f
low imaging at the
level of internal os .
.the prob tilted sideway
laterally and maintaining its
medial-- angulation ( lower
paracervical area ) till the
uterine artery is appear arise
from internal iliac artery .it
crosses the external iliac
artery .

5. Uterine artery
How to measure
- Apply PW 1-2 cm above the point of cross
over vessels، sample gate =2mm to cover
the whole vessel ,and the angle of
insinuation less than 30 .
- Three symmetrical consecutive waves are
obtained.
- Peak systolic velocity (PSV) > 60cm /s to
ensure that is uterine artery rather than
arcuate artery.
- Measure right and left uterine artery PI
mean utAPI= uterine artery (R+L)/2
- UTA PI value shows progressive decrease
until the late of pregnancy.
- UTA indices have a clinical value in
evaluation of placenta associated diseases
- Prediction of Preeclampsea and IUGR

6. Normal uterine artery wave in non
pregnant And early pregnancy
Normal
f
inding of of
uterine artery Doppler
in non pregnant and
early pregnancy
—high resistive with
low diastolic
f
low
—presence of early
diastolic notch
If the notch persists
after 24 weeks
It is abnormal
And associated with
adverse outcome..

7. The normal uterine artery Doppler
wave form During. pregnancy
Normal impedance to
f
low of the
uterine artery the
f
irst trimester
Normal impedance to
f
low in late second and
third trimester
Normal impedance to
f
low
in early second trimester

8. The normal Doppler indices Of uterine artery
During pregnancy
- At 11 -13 weeks the uterine artery indices that are measured by Trans
abdominal us are less than measured by trans vaginal US .
- Trans abdominal uterine PI 1.8 trans vaginal pi 1.9 and Ri 0.7 and 0.8
- .S/D. Are 2. 65 —2.57
- 16 — 22 weeks UAPI is 1.6or less ,UTA RI 0.58 or less were considered
normal
- the uterine artery indices are higher at
f
irst trimester of gestation than
the second and third trimester
- the uterine artery early diastolic notch had disappear at 22 weeks
of gestation at more than half of the pregnant women.
- -absence of the uterine artery early diastolic notch was related to
decrease RI and PI.

9. Uterine artery
Indices
Early
pregnancy
Early second
trimester indices
Late seond trimester
And third trimester

10. Abnormal uterine artery after
20- 24 weeks
Abnormal
pulsatile index
(PI)> 95 centile
Abnormal
high resistance to
f
low of UTA
With reversed
diastolic
f
low
Normal
impedance of
f
low of UTA
early diastolic
notch
Abnormal
Increase impedance of
f
low of UTA
With early diastolic
notch

11. Role of uterine artery in
recurrent pregnancy loss
—High uterine artery resistance is accounted
as one of of recurrent abortion reasons .
—Current studies approved that high PI more
than 2.5 in pts had recurrent abortion that’s
means defect of the uterine blood
f
low.
when we decrease the uterine A resistance
and improve the uterine blood
f
low by
impaction of aspirin and vitaminE
Leads to better pregnancy outcome.