Spiral artery blood flow during pregnancy: a systematic review and meta-analysis
| العنوان: | Spiral artery blood flow during pregnancy: a systematic review and meta-analysis |
|---|---|
| المؤلفون: | Laura Evers, Chahinda Ghossein-Doha, Sander de Haas, Veronique M.M.M. Schiffer, Salwan Al-Nasiry, Marc E. A. Spaanderman |
| المصدر: | BMC Pregnancy and Childbirth, Vol 20, Iss 1, Pp 1-15 (2020) BMC Pregnancy and Childbirth |
| بيانات النشر: | BMC, 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | Spiral artery, medicine.medical_specialty, PREDICTION, Placenta, Hemodynamics, UTEROPLACENTAL CIRCULATION, lcsh:Gynecology and obstetrics, Preeclampsia, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, REPRODUCIBILITY, medicine, Humans, Placental Circulation, 030212 general & internal medicine, OXIDATIVE STRESS, Adaptation, 1ST TRIMESTER UTERINE, lcsh:RG1-991, 030219 obstetrics & reproductive medicine, TROPHOBLASTIC INVASION, business.industry, Obstetrics, Uterus, Doppler, Obstetrics and Gynecology, Ultrasonography, Doppler, Arteries, Blood flow, medicine.disease, Remodeling, DOPPLER MEASUREMENTS, Pregnancy Trimester, First, PREECLAMPSIA, medicine.anatomical_structure, HEMODYNAMICS, Pregnancy Trimester, Second, Meta-analysis, Gestation, Female, Vascular Resistance, business, Blood Flow Velocity, RESTRICTION, Research Article |
| الوصف: | Background Downstream remodeling of the spiral arteries (SpA) decreases utero-placental resistance drastically, allowing sustained and increased blood flow to the placenta under all circumstances. We systematically evaluated available reports to visualize adaptation of spiral arteries throughout pregnancy by ultra-sonographic measurements and evaluated when this process is completed. Methods A systematic review and meta-analysis of spiral artery flow (pulsatility index (PI), resistance index (RI) and peak systolic velocity (PSV)) was performed. English written articles were obtained from Pubmed, EMBASE and Cochrane Library and included articles were assessed on quality and risk of bias. Weighted means of Doppler indices were calculated using a random-effects model. Results In healthy pregnancies, PI and RI decreased from 0.80 (95% CI: 0.70–0.89) and 0.50 (95% CI: 0.47–0.54) in the first trimester to 0.50 (95% CI: 0.45–0.55, p p p = 0.752) and 0.36 (95% CI: 0.35–0.38, p = 0.037) in the third trimester, respectively. In parallel, PSV altered from 0.22 m/s (95% CI: 0.13–0.30 m/s) to 0.28 m/s (95% CI: 0.17–0.40 m/s, p = 0.377) and to 0.25 m/s (95% CI: 0.20–0.30 m/s, p = 0.560) in the three trimesters. In absence of second and third trimester Doppler data in complicated gestation, only a difference in PI was observed between complicated and healthy pregnancies during the first trimester (1.49 vs 0.80, p p = 0.349). Conclusions This review and meta-analysis concludes that an observed decrease of SpA PI and RI from the first towards the second trimester parallels the physiological trophoblast invasion converting SpA during early gestation, a process completed in the midst of the second trimester. Higher PI was found in SpA of complicated pregnancies compared to healthy pregnancies, possibly reflecting suboptimal utero-placental circulation. Longitudinal studies examining comprehensively the predictive value of spiral artery Doppler for complicated pregnancies are yet to be carried out. |
| اللغة: | English |
| تدمد: | 1471-2393 |
| DOI: | 10.1186/s12884-020-03150-0 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::6b0f7037f8cb9124a2347130746a3fc6 http://link.springer.com/article/10.1186/s12884-020-03150-0 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....6b0f7037f8cb9124a2347130746a3fc6 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14712393 |
|---|---|
| DOI: | 10.1186/s12884-020-03150-0 |