Prediction of Intrauterine Growth Restriction in High Pulsatility Index of Uterine Artery | Chapter 02 | Current Trends in Medicine and Medical Research Vol. 3
Introduction:
Intrauterine growth restriction is a significant cause of neonatal mortality.
The uterine artery Doppler waveform becomes transformed into a high flow with
low resistance at 22-24 weeks. The apt way
to reduce intrauterine
growth restriction is
to identify the
antenatal factors, which ascertain the uterine milieu and
nutrient bioavailability. This chapter highlights the relation between abnormal
uterine artery flow and resultant fetal growth restriction in a tertiary care
center. Presence of high pulsatility is a significant risk factor for early
onset IUGR as compared to late onset IUGR. Abnormal Doppler waveforms within
the uterine arteries are indicative of elevated resistance. The perfusion
at the trophoblast-maternal interphase is high
velocity, low volume
and intermittent, resulting in
intrauterine growth
retardation. This subsequently leads
to the damage
of fetal tertiary stem villi
floating in the intervillous space. The sensitivity is better for early onset
IUGR. This chapter concludes that high pulsatility index in uterine arteries
can lead to intrauterine growth restriction .The plausible explanation is
reduced Vascular Endothelial Growth Factor (VEGF) from maternal decidual
natural killer cells. This study concludes that high pulsatility index in
uterine arteries is associated with intrauterine growth restriction. This
occurs due to inadequate VEGF secretion from maternal decidua resulting inhigh
velocity, low volume diastolic flow in the uterine artery supplying the spiral
arterioles, that subsequently leads to the damage of fetal tertiary stem villi
floating in the intervillous space. As resistance increases in uterine
arteries, the velocity of blood flowing also increases from 10 cm/sec to 1-2
m/s. The uterine artery supplies both the trophoblast maternal interphase and
the uterine arterial venous
circulation. Most blood
increases uterine arterial
venous circulation and
helps in the development of uterine musculature and
local milieu of gestation and protects against post partum hemorrhage. Only a
partial amount of blood flowing through uterine arteries is pumped into the
dilated spiral arteries and sprinkled (cf shot) over tertiary fetal stem villi
in the intervillous space. The damage to placental bed may be ischemic,
hemodynamic, oxidative or immunological. The high velocity, low volume,
intermittent perfusion by the uterine artery supplying the intervillous space
at the trophoblast-maternal interphase can cause hemodynamic and oxidative damage
resulting in intrauterine growth retardation. The sensitivity and negative
predictive value are better for early onset IUGR.
Author(s) Details
Dr Nidhi Sharma
Department of Obstetrics and
Gynaecology, Saveetha Medical College, Chennai, India.
Dr Sunayana Srinivasan
Department of Obstetrics and
Gynaecology, Good Samaritan Hospital and Medical Center, New York, USA.
Dr Krishnamurthy Jayashree
Department of Obstetrics and
Gynaecology, Saveetha Medical College, Chennai, India.
Dr Kulasekaran Nadhamuni
Department of Radiology,
Saveetha Medical College, Chennai, India.
Dr Meenakshi Subbiah
Department of Radiology,
Saveetha Medical College, Chennai, India.
Dr P Vijayaraghavan
Department of Research,
Saveetha University, Chennai,India.
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