Correlation Between Fetal Weight Gain and Birth Weight with Blood Flow in the Uterine Arteries Calculated with the PixelFlux Technique
received 11 January 2017
revised 07 November 2017
accepted 09 January 2018
18 April 2018 (online)
Introduction The aim was to investigate correlations between fetal weight gain/day and birthweight with blood flow estimates in the uterine arteries calculated with the PixelFlux technique and with measurements from TAmax. We also aimed to examine the agreement between estimates using the two methods.
Material and methods We conducted a prospective observational pilot study in pregnancy week 24–25 in women with risk pregnancies referred to the fetal medical centre at St. Olavs Hospital, Trondheim, Norway from March 2016 to June 2016. Blood flow in the uterine arteries was calculated using time-averaged peak velocity (TAmax) and the PixelFlux technique. PixelFlux is a method based on pixelwise calculation of spatially angle-corrected velocities and areas of all pixels inside a vessel during a heart cycle.
Results The mean flow calculated from PixelFlux and TAmax was 811 ml/minute and 787 ml/minute, respectively. The intra-class correlation coefficient was 0.83 (95% CI 0.72-0.90) and limits of agreement were −441 ml/minute (95% CI -558 to −324 ml/minute) to 489 ml/minute (95% CI 372 to 606 ml/minute). We observed a significant correlation between mean flow calculated from PixelFlux and birthweight (r=0.41; p<0.01) and between flow calculated from PixelFlux and weight gain/day (r=0.33; p=0.02). Calculation based on TAmax was significant correlated to birthweight (r=0.34; p=0.02), but not to weight-gain/day. Pulsatile index was not correlated to flow, birthweight or fetal weight-gain/day.
Conclusions We found significant correlations between estimated blood flow in the uterine arteries using the PixelFlux technique with fetal weight-gain/day and with birthweight. Estimates from two methods showed good agreement.
* The two first authors contributed equally to this work.
- 1 Khalil A, Garcia-Mandujano R, Maiz N, Elkhouli M, Nicolaides KH. Longitudinal changes in uterine artery Doppler and blood pressure and risk of pre-eclampsia. Ultrasound Obstet Gynecol. 2014; 43: 541-547
- 2 Olofsson P, Laurini RN, Marsal K. A high uterine artery pulsatility index reflects a defective development of placental bed spiral arteries in pregnancies complicated by hypertension and fetal growth retardation. Eur J Obstet Gynecol Reprod Biol 1993; 49: 161-168
- 3 van Asselt K, Gudmundsson S, Lindqvist P, Marsal K. Uterine and umbilical artery velocimetry in pre-eclampsia. Acta Obstet Gynecol Scand. 1998; 77: 614-619
- 4 Thuring A, Laurini R, Marsal K. Uterine venous blood flow in normal and complicated pregnancies: A methodological study. Ultrasound Obstet Gynecol. 2010; 35: 462-467
- 5 Hernandez-Andrade E, Brodszki J, Lingman G, Gudmundsson S, Molin J, Marsal K. Uterine artery score and perinatal outcome. Ultrasound Obstet Gynecol. 2002; 19: 438-442
- 6 Poon LC, Volpe N, Muto B, Yu CK, Syngelaki A, Nicolaides KH. Second-trimester uterine artery Doppler in the prediction of stillbirths. Fetal Diagn Ther. 2013; 33: 28-35
- 7 Orabona R, Donzelli CM, Falchetti M, Santoro A, Valcamonico A, Frusca T. Placental histological patterns and uterine artery Doppler velocimetry in pregnancies complicated by early or late pre-eclampsia. Ultrasound Obstet Gynecol. 2016; 47: 580-585
- 8 Flo K, Wilsgaard T, Acharya G. Agreement between umbilical vein volume blood flow measurements obtained at the intra-abdominal portion and free loop of the umbilical cord. Ultrasound Obstet Gynecol. 2009; 34: 171-176
- 9 Flo K, Wilsgaard T, Acharya G. Longitudinal reference ranges for umbilical vein blood flow at a free loop of the umbilical cord. Ultrasound Obstet Gynecol. 2010; 36: 567-572
- 10 Flo K, Wilsgaard T, Acharya G. A new non-invasive method for measuring uterine vascular resistance and its relationship to uterine artery Doppler indices: A longitudinal study. Ultrasound Obstet Gynecol. 2011; 37: 538-542
- 11 Konje JC, Kaufmann P, Bell SC, Taylor DJ. A longitudinal study of quantitative uterine blood flow with the use of color power angiography in appropriate for gestational age pregnancies. Am J Obstet Gynecol. 2001; 185: 608-613
- 12 Konje JC, Howarth ES, Kaufmann P, Taylor DJ. Longitudinal quantification of uterine artery blood volume flow changes during gestation in pregnancies complicated by intrauterine growth restriction. BJOG 2003; 110: 301-305
- 13 Bower S, Vyas S, Campbell S, Nicolaides KH. Color Doppler imaging of the uterine artery in pregnancy: Normal ranges of impedance to blood flow, mean velocity and volume of flow. Ultrasound Obstet Gynecol. 1992; 2: 261-265
- 14 Dickey RP, Hower JF. Ultrasonographic features of uterine blood flow during the first 16 weeks of pregnancy. Hum Reprod. 1995; 10: 2448-2452
- 15 McKelvey A, Pateman K, Balchin I, Peebles DM, Rodeck CH, David AL. Total uterine artery blood volume flow rate in nulliparous women is associated with birth weight and gestational age at delivery. Ultrasound Obstet Gynecol. 2017; 49: 54-60
- 16 Scholbach T, Heien C, Eggebo TM. Umbilical vein vasomotion detected in vivo by serial three-dimensional pixelwise spatially angle corrected volume flow measurements. Ultrasound Obstet Gynecol. 2015
- 17 Scholbach T, Fersis N, Stolle J. Significant differences of fetal blood supply in fetuses of different weight classes demonstrated by the novel method of three-dimensional pixelwise fetal volume flow measurements (PixelFlux-method). Ultrasound Obstet Gynecol. 2012; 40: 118
- 18 Scholbach J, Scholbach T.PixelFlux. Chameleon Software, Available online at: http://www.chameleon-software.de/en/home.php (accessed Novemeber 7, 2017)
- 19 Acharya G, Sitras V, Erkinaro T, Makikallio K, Kavasmaa T, Pakkila M. et al. Experimental validation of uterine artery volume blood flow measurement by Doppler ultrasonography in pregnant sheep. Ultrasound Obstet Gynecol. 2007; 29: 401-406
- 20 Gjessing HK, Grottum P, Okland I, Eik-Nes SH. Fetal size monitoring and birth-weight prediction: A new population-based approach. Ultrasound Obstet Gynecol. 2017; 49: 500-507
- 21 Bland JM, Altman DG. Applying the right statistics: analyses of measurement studies. Ultrasound Obstet Gynecol. 2003; 22: 85-93
- 22 Li N, Ghosh G, Gudmundsson S. Uterine artery Doppler in high-risk pregnancies at 23-24 gestational weeks is of value in predicting adverse outcome of pregnancy and selecting cases for more intense surveillance. Acta Obstet Gynecol Scand. 2014; 93: 1276-1281
- 23 Thoresen M, Wesche J. Doppler measurements of changes in human mammary and uterine blood flow during pregnancy and lactation. Acta Obstet Gynecol Scand. 1988; 67: 741-745
- 24 Ferrazzi E, Rigano S, Padoan A, Boito S, Pennati G, Galan HL. Uterine artery blood flow volume in pregnant women with an abnormal pulsatility index of the uterine arteries delivering normal or intrauterine growth restricted newborns. Placenta 2011; 32: 487-492
- 25 Rigano S, Ferrazzi E, Boito S, Pennati G, Padoan A, Galan H. Blood flow volume of uterine arteries in human pregnancies determined using 3D and bi-dimensional imaging, angio-Doppler, and fluid-dynamic modeling. Placenta 2010; 31: 37-43