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Current Medical Imaging

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ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

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Research Article

Can Uterine Artery Pulsatility Index Predict Fetal Chromosomal Abnormality in Early Pregnancy Loss? A Retrospective Cohort Study

Author(s): Yunyun Cao, Yiyao Chen, Guanjie Wang, Shuyuan li and Zhiwei Liu*

Volume 20, 2024

Published on: 14 September, 2023

Article ID: e140723218741 Pages: 7

DOI: 10.2174/1573405620666230714122732

open_access

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Abstract

Background: Early pregnancy loss (EPL) or spontaneous loss of an intrauterine pregnancy within the first trimester occurs commonly worldwide. It is useful to predict the possibility of fetal chromosomal abnormalities using other cheap and easily available markers.

Objective: This study aimed to evaluate whether the uterine artery pulsatility index (UtA-PI) can predict fetal chromosomal abnormality in early pregnancy loss (EPL).

Methods: This was a retrospective cohort study including 148 women who underwent dilation and curettage for missed abortion. The UtA-PI was measured and evaluated by transvaginal ultrasound. Abnormal UtA-PI was identified through the mean of left and right UA-PI ≥ 90th percentiles of the relevant values for the corresponding gestational age. Copy number variation sequencing (CNV-seq) was performed on EPL cases without maternal cell contamination.

Results: 107 (72.3%) cases were classified with normal UtA-PI, while 41 (27.7%) cases were classified with abnormal UtA-PI. The fetal chromosomal abnormality rate was significantly higher in cases with normal UtA-PI than in those with abnormal UtA-PI (67.3% vs 22.0%, P = 7.1 × 10-7). Compared to cases with abnormal UtA-PI, the risk of fetal chromosomal abnormalities in cases with normal UtA-PI increased with an odds ratio of 7.3 (95% confidence interval [CI]: 3.2‒17.0, P = 4 × 10-7). The predictive value of normal UtA-PI alone for fetal chromosomal abnormalities was shown to have an area under the curve of 0.67‒0.71 in our population.

Conclusion: The UtA-PI seems to be lower and less likely to be elevated in EPL with fetal chromosomal abnormalities compared to those without aneuploidies. We suggest that UtA-PI should be examined in all EPL patients.

Keywords: Early pregnancy loss, Fetal chromosomal abnormality, Uterine artery pulsatility index, Recurrent pregnancy loss, Chromosomes, Ultrasonography.

[1]
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology ACOG Practice Bulletin No. 200: Early Pregnancy Loss. Obstet Gynecol 2018; 132(5): e197-207.
[http://dx.doi.org/10.1097/AOG.0000000000002899] [PMID: 30157093]
[2]
Wilcox AJ, Weinberg CR, O’Connor JF, et al. Incidence of early loss of pregnancy. N Engl J Med 1988; 319(4): 189-94.
[http://dx.doi.org/10.1056/NEJM198807283190401] [PMID: 3393170]
[3]
Wang X, Chen C, Wang L, Chen D, Guang W, French J. Conception, early pregnancy loss, and time to clinical pregnancy: a population-based prospective study. Fertil Steril 2003; 79(3): 577-84.
[http://dx.doi.org/10.1016/S0015-0282(02)04694-0] [PMID: 12620443]
[4]
Ohno M, Maeda T, Matsunobu A. A cytogenetic study of spontaneous abortions with direct analysis of chorionic villi. Obstet Gynecol 1991; 77(3): 394-8. [PMID: 1992406].
[PMID: 1992406]
[5]
Romero ST, Geiersbach KB, Paxton CN, et al. Differentiation of genetic abnormalities in early pregnancy loss. Ultrasound Obstet Gynecol 2015; 45(1): 89-94.
[http://dx.doi.org/10.1002/uog.14713] [PMID: 25358469]
[6]
Bender Atik R, Christiansen OB, Elson J, et al. ESHRE guideline: recurrent pregnancy loss. Hum Reprod Open 2018; 2018(2): hoy004.
[http://dx.doi.org/10.1093/hropen/hoy004] [PMID: 31486805]
[7]
Hennessy M, Dennehy R, Meaney S, et al. Clinical practice guidelines for recurrent miscarriage in high-income countries: a systematic review. Reprod Biomed Online 2021; 42(6): 1146-71.
[http://dx.doi.org/10.1016/j.rbmo.2021.02.014] [PMID: 33895080]
[8]
Coulam CB, Goodman C, Dorfmann A. Comparison of ultrasonographic findings in spontaneous abortions with normal and abnormal karyotypes. Hum Reprod 1997; 12(4): 823-6.
[http://dx.doi.org/10.1093/humrep/12.4.823] [PMID: 9159449]
[9]
Yoneda S, Shiozaki A, Yoneda N, et al. A Yolk Sac Larger Than 5 mm Suggests an Abnormal Fetal Karyotype, Whereas an Absent Embryo Indicates a Normal Fetal Karyotype. J Ultrasound Med 2018; 37(5): 1233-41.
[http://dx.doi.org/10.1002/jum.14467] [PMID: 29090486]
[10]
Huang J, Zhu W, Tang J, Saravelos SH, Poon LCY, Li TC. Do specific ultrasonography features identified at the time of early pregnancy loss predict fetal chromosomal abnormality? – A systematic review and meta-analysis. Genes Dis 2019; 6(2): 129-37.
[http://dx.doi.org/10.1016/j.gendis.2018.10.001] [PMID: 31193979]
[11]
Leible S, Canals A, Walton R, et al. First-trimester miscarriage rate decreases with hydralazine therapy in pregnancies with early uterine vascular insufficiency: a cohort study. J Matern Fetal Neonatal Med 2022; 35(25): 6988-97.
[http://dx.doi.org/10.1080/14767058.2021.1932809] [PMID: 34074216]
[12]
Taylor TJ, Quinton AE, de Vries BS, Hyett JA. First‐trimester ultrasound features associated with subsequent miscarriage: A prospective study. Aust N Z J Obstet Gynaecol 2019; 59(5): 641-8.
[http://dx.doi.org/10.1111/ajo.12944] [PMID: 30724337]
[13]
Dane B, Batmaz G, Ozkal F, Bakar Z, Dane C. Effect of parity on first-trimester uterine artery Doppler indices and their predictive value for pregnancy complications. Gynecol Obstet Invest 2014; 77(1): 24-8.
[http://dx.doi.org/10.1159/000355698] [PMID: 24216636]
[14]
Habara T, Nakatsuka M, Konishi H, Asagiri K, Noguchi S, Kudo T. Elevated blood flow resistance in uterine arteries of women with unexplained recurrent pregnancy loss. Hum Reprod 2002; 17(1): 190-4.
[http://dx.doi.org/10.1093/humrep/17.1.190] [PMID: 11756386]
[15]
Lazzarin N, Vaquero E, Exacoustos C, Romanini E, Amadio A, Arduini D. Midluteal phase Doppler assessment of uterine artery blood flow in nonpregnant women having a history of recurrent spontaneous abortions: correlation to different etiologies. Fertil Steril 2007; 87(6): 1383-7.
[http://dx.doi.org/10.1016/j.fertnstert.2006.11.049] [PMID: 17270182]
[16]
Yang W, Wu Z, Yu M, et al. Characteristics of midluteal phase uterine artery hemodynamics in patients with recurrent pregnancy loss. J Obstet Gynaecol Res 2019; 45(7): 1230-5.
[http://dx.doi.org/10.1111/jog.13944] [PMID: 30977230]
[17]
Prodan N, Wagner P, Sonek J, et al. First trimester uterine artery pulsatility index levels in euploid and aneuploid pregnancies. Arch Gynecol Obstet 2019; 300(6): 1559-64.
[http://dx.doi.org/10.1007/s00404-019-05328-0] [PMID: 31616987]
[18]
Doubilet PM, Benson CB, Bourne T, et al. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med 2013; 369(15): 1443-51.
[http://dx.doi.org/10.1056/NEJMra1302417] [PMID: 24106937]
[19]
Guedes-Martins L, Saraiva J, Gaio R, Macedo F, Almeida H. Uterine artery impedance at very early clinical pregnancy. Prenat Diagn 2014; 34(8): 719-25.
[http://dx.doi.org/10.1002/pd.4325] [PMID: 24431243]
[20]
Ye M, Shi W, Hao Y, et al. Associations of mitochondrial DNA copy number and deletion rate with early pregnancy loss. Mitochondrion 2020; 55: 48-53.
[http://dx.doi.org/10.1016/j.mito.2020.07.006] [PMID: 32738357]
[21]
Li H, Durbin R. Fast and accurate short read alignment with Burrows–Wheeler transform. Bioinformatics 2009; 25(14): 1754-60.
[http://dx.doi.org/10.1093/bioinformatics/btp324] [PMID: 19451168]
[22]
Kearney HM, Thorland EC, Brown KK, Quintero-Rivera F, South ST. American College of Medical Genetics standards and guidelines for interpretation and reporting of postnatal constitutional copy number variants. Genet Med 2011; 13(7): 680-5.
[http://dx.doi.org/10.1097/GIM.0b013e3182217a3a] [PMID: 21681106]
[23]
Riggs ER, Andersen EF, Cherry AM, et al. Technical standards for the interpretation and reporting of constitutional copy-number variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics (ACMG) and the Clinical Genome Resource (ClinGen). Genet Med 2020; 22(2): 245-57.
[http://dx.doi.org/10.1038/s41436-019-0686-8] [PMID: 31690835]
[24]
DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988; 44(3): 837-45.
[http://dx.doi.org/10.2307/2531595] [PMID: 3203132]
[25]
Alijotas-Reig J, Garrido-Gimenez C. Current concepts and new trends in the diagnosis and management of recurrent miscarriage. Obstet Gynecol Surv 2013; 68(6): 445-66.
[http://dx.doi.org/10.1097/OGX.0b013e31828aca19] [PMID: 23942472]
[26]
Gómez O, Figueras F, Fernández S, et al. Reference ranges for uterine artery mean pulsatility index at 11-41 weeks of gestation. Ultrasound Obstet Gynecol 2008; 32(2): 128-32.
[http://dx.doi.org/10.1002/uog.5315] [PMID: 18457355]
[27]
Gómez O, Figueras F, Martínez JM, et al. Sequential changes in uterine artery blood flow pattern between the first and second trimesters of gestation in relation to pregnancy outcome. Ultrasound Obstet Gynecol 2006; 28(6): 802-8.
[http://dx.doi.org/10.1002/uog.2814] [PMID: 17063456]
[28]
Cnossen JS, Morris RK, ter Riet G, et al. Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis. CMAJ 2008; 178(6): 701-11.
[http://dx.doi.org/10.1503/cmaj.070430] [PMID: 18332385]
[29]
Bakalis S, Peeva G, Gonzalez R, Poon LC, Nicolaides KH. Prediction of small-for-gestational-age neonates: screening by biophysical and biochemical markers at 30-34 weeks. Ultrasound Obstet Gynecol 2015; 46(4): 446-51.
[http://dx.doi.org/10.1002/uog.14863] [PMID: 25826154]
[30]
Poon LC, Lesmes C, Gallo DM, Akolekar R, Nicolaides KH. Prediction of small-for-gestational-age neonates: screening by biophysical and biochemical markers at 19-24 weeks. Ultrasound Obstet Gynecol 2015; 46(4): 437-45.
[http://dx.doi.org/10.1002/uog.14904] [PMID: 25988293]
[31]
Valiño N, Giunta G, Gallo DM, Akolekar R, Nicolaides KH. Uterine artery pulsatility index at 30-34 weeks’ gestation in the prediction of adverse perinatal outcome. Ultrasound Obstet Gynecol 2016; 47(3): 308-15.
[http://dx.doi.org/10.1002/uog.14898] [PMID: 25970847]
[32]
Khong SL, Kane SC, Brennecke SP, da Silva Costa F. First-trimester uterine artery Doppler analysis in the prediction of later pregnancy complications. Dis Markers 2015; 2015: 1-10.
[http://dx.doi.org/10.1155/2015/679730] [PMID: 25972623]
[33]
Taylor TJ, Quinton AE, de Vries BS, Hyett JA. Uterine Artery Pulsatility Index Assessment at <11 Weeks’ Gestation: A Prospective Study. Fetal Diagn Ther 2020; 47(2): 129-37.
[http://dx.doi.org/10.1159/000500776] [PMID: 31280268]
[34]
Wang T, Kang X, Zhao A, He L, Liu Z, Liu F. Low‐dose aspirin improves endometrial receptivity in the midluteal phase in unexplained recurrent pregnancy loss. Int J Gynaecol Obstet 2020; 150(1): 77-82.
[http://dx.doi.org/10.1002/ijgo.13160] [PMID: 32293031]
[35]
Ogasawara M, Aoki K, Okada S, Suzumori K. Embryonic karyotype of abortuses in relation to the number of previous miscarriages. Fertil Steril 2000; 73(2): 300-4.
[http://dx.doi.org/10.1016/S0015-0282(99)00495-1] [PMID: 10685533]
[36]
Marquard K, Westphal LM, Milki AA, Lathi RB. Etiology of recurrent pregnancy loss in women over the age of 35 years. Fertil Steril 2010; 94(4): 1473-7.
[http://dx.doi.org/10.1016/j.fertnstert.2009.06.041] [PMID: 19643401]
[37]
Ozawa N, Ogawa K, Sasaki A, Mitsui M, Wada S, Sago H. Maternal age, history of miscarriage, and embryonic/fetal size are associated with cytogenetic results of spontaneous early miscarriages. J Assist Reprod Genet 2019; 36(4): 749-57.
[http://dx.doi.org/10.1007/s10815-019-01415-y] [PMID: 30739229]
[38]
Papaioannou GKI, Syngelaki A, Maiz N, Ross JA, Nicolaides KH. Sonographic markers of aneuploidies at 6–10weeks of gestation. Early Hum Dev 2011; 87(7): 453-6.
[http://dx.doi.org/10.1016/j.earlhumdev.2011.01.045] [PMID: 21592687]
[39]
Angiolucci M, Murru R, Melis G, Carcassi C, Mais V. Association between different morphological types and abnormal karyotypes in early pregnancy loss. Ultrasound Obstet Gynecol 2011; 37(2): 219-25.
[http://dx.doi.org/10.1002/uog.7681] [PMID: 20503243]
[40]
Ouyang Y, Tan Y, Yi Y, et al. Correlation between chromosomal distribution and embryonic findings on ultrasound in early pregnancy loss after IVF-embryo transfer. Hum Reprod 2016; 31(10): 2212-8.
[http://dx.doi.org/10.1093/humrep/dew201] [PMID: 27614356]

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