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Background Abnormal umbilical, cerebral and uterine artery Doppler findings and fetal biometry below the 3rd percentile have been proposed as risk factors for perinatal complications in late-onset fetal growth restriction (FGR). Recent evidence has allowed to reach a consensus on the clinical use of Doppler ultrasound for the monitoring and timing of delivery in early-onset FGR, however there is limited data on the relationship between abnormal Doppler and severity of the growth restriction and adverse outcome when a diagnosis of late-onset FGR is made. Objective To evaluate the relationship between the ultrasound parameters measured at diagnosis and perinatal adverse outcome within a cohort of late-onset FGR fetuses. Methods This is a multicentre retrospective study between 2014 and 2019 including non-anomalous singleton pregnancies complicated by late-onset FGR, which was defined either by abdominal circumference (AC), estimated fetal weight (EFW) Results Overall, 468 cases with full biometry and umbilical, middle cerebral, and uterine artery (UtA) Doppler data were included, among whom CAO was recorded in 53 (11.3%). At logistic regression analysis, only the EFW percentile proved to be independently associated with CAO (p=0.01) and NICU admission (p 95th percentile at diagnosis proved to be independently associated with obstetric intervention due to intrapartum distress (p Conclusions Retrospective data on a large cohort of late-onset FGR fetuses shows that at diagnosis the EFW is the only sonographic parameter independently associated with the occurrence of adverse perinatal outcomes, while a mean UtA PI MoM >95th percentile at diagnosis is independently associated with intrapartum distress leading to obstetric intervention. This article is protected by copyright. All rights reserved.

The study aimed to investigate whether serum sFlt-1 (soluble fms-like tyrosine kinase-1) at 11-13 weeks’ gestation in pregnancies that subsequently developed preeclampsia was different from those without preeclampsia and compare screening performance of the International Prediction of Pregnancy Complications (IPPIC) reported models, which include various combinations of maternal factors, systolic blood pressure, diastolic blood pressure, PlGF (placental growth factor) and sFlt-1 and the competing risk (CR) models, which include various combinations of maternal factors, mean arterial pressure (MAP) and PlGF for predicting any-onset, early-onset, and late-onset preeclampsia. This was a prospective multicenter study in 7877 singleton pregnancies. The differences of the predictive performance between the IPPIC and CR models were compared. There were 141 women (1.79%) who developed preeclampsia, including 13 cases (0.17%) of early-onset preeclampsia and 128 cases (1.62%) of late-onset preeclampsia. In pregnancies that developed preeclampsia compared to unaffected pregnancies, median serum sFlt-1 levels and its MoMs were not significantly different ( p >0.05). There was no significant association between gestational age at delivery and log 10 sFlt-1 and log 10 sFlt-1 MoM ( p >0.05). The areas under the curve of CR models were significantly higher than the IPPIC models for the prediction of any-onset and late-onset preeclampsia but not for early-onset preeclampsia. In conclusion, there are no significant differences in the maternal serum sFlt-1 levels at 11-13 weeks’ gestation between women who subsequently develop preeclampsia and those who do not. Moreover, the CR models for the prediction of any-onset and late-onset preeclampsia perform better than the IPPIC reported model.

Objective To observe the effect of the combined therapy of electroacupuncture (EA) and ginger-isolated moxibustion on endometrial receptivity in the patients with polycystic ovarian syndrome (PCOS). Methods A total of 70 subjects of PCOS were randomized into two groups, 35 cases in each one. In the western medication group, letrozole and human chorionic gonadotropin (HCG) were administered. In the combined therapy group, on the base of the treatment as the western medication group, the artificial cycle therapy with EA and ginger-isolated moxibustion was provided. The treatment duration was 3 menstrual cycles in two groups. After treated for 3 menstrual cycles, the symptom score of traditional Chinese medicine (TCM), endometrial thickness, the number of ovulation cycle, endometrial morphology, bilateral uterine artery pulsatility index (PI), resistance index (RI), the sum of peak systolic velocity/end diastolic velocity (S/D) and pregnancy were compared in the patients between two groups. Results (1) After treatment, the endometrial thickness was better (0.21 ± ± 0.13 vs 0.14 ± 0.08, P Conclusion The combined treatment of electroacupuncture and ginger-isolated moxibustion with western medication effectively improves endometrial receptivity, increases clinical pregnancy rate and reduces early abortion rate in the patients with PCOS.

To examine the performance of a model combining maternal risk factors, uterine artery pulsatility index (UtA-PI) and estimated fetal weight (EFW) at 19-24 weeks' gestation, for predicting all antepartum stillbirths and those due to impaired placentation, in a training dataset used for development of the model and in a validation dataset.The data for this study were derived from prospective screening for adverse obstetric outcome in women with singleton pregnancy attending for routine pregnancy care at 19 + 0 to 24 + 6 weeks' gestation. The study population was divided into a training dataset used to develop prediction models for placental dysfunction-related antepartum stillbirth and a validation dataset to which the models were then applied. Multivariable logistic regression analysis was used to develop a model based on a combination of maternal risk factors, EFW Z-score and UtA-PI multiples of the normal median. We examined the predictive performance of the model by, first, the ability of the model to discriminate between the stillbirth and live-birth groups, using the area under the receiver-operating-characteristics curve (AUC) and the detection rate (DR) at a fixed false-positive rate (FPR) of 10%, and, second, calibration by measurements of calibration slope and intercept.The study population of 131 514 pregnancies included 131 037 live births and 477 (0.36%) stillbirths. There are four main findings of this study. First, 92.5% (441/477) of stillbirths were antepartum and 7.5% (36/477) were intrapartum, and 59.2% (261/441) of antepartum stillbirths were observed in association with placental dysfunction and 40.8% (180/441) were unexplained or due to other causes. Second, placental dysfunction accounted for 80.1% (161/201) of antepartum stillbirths at 32 weeks' gestation, 54.2% (52/96) at 32 + 0 to 36 + 6 weeks and 33.3% (48/144) at ≥ 37 weeks. Third, the risk of placental dysfunction-related antepartum stillbirth increased with increasing maternal weight and decreasing maternal height, was 3-fold higher in black than in white women, was 5.5-fold higher in parous women with previous stillbirth than in those with previous live birth, and was increased in smokers, in women with chronic hypertension and in parous women with a previous pregnancy complicated by pre-eclampsia and/or birth of a small-for-gestational-age baby. Fourth, in screening for placental dysfunction-related antepartum stillbirth by a combination of maternal risk factors, EFW and UtA-PI in the validation dataset, the DR at a 10% FPR was 62.3% (95% CI, 57.2-67.4%) and the AUC was 0.838 (95% CI, 0.799-0.878); these results were consistent with those in the dataset used for developing the algorithm and demonstrate high discrimination between affected and unaffected pregnancies. Similarly, the calibration slope was 1.029 and the intercept was -0.009, demonstrating good agreement between the predicted risk and observed incidence of placental dysfunction-related antepartum stillbirth. The performance of screening was better for placental dysfunction-related antepartum stillbirth at 37 weeks' gestation compared to at term (DR at a 10% FPR, 69.8% vs 29.2%).Screening at mid-gestation by a combination of maternal risk factors, EFW and UtA-PI can predict a high proportion of placental dysfunction-related stillbirths and, in particular, those that occur preterm. Such screening provides poor prediction of unexplained stillbirth or stillbirth due to other causes. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Hysterectomy (i.e., surgical removal of the uterus) requires severing the main blood supply to the uterus (i.e., the uterine arteries) while preserving the nearby, often overlapping, ureters. In this paper, we investigate dual-wavelength and audiovisual photoacoustic imaging-based approaches to visualize and differentiate the ureter from the uterine artery and to provide the real-time information needed to avoid accidental ureteral injuries during hysterectomies. Dual-wavelength 690/750 nm photoacoustic imaging was implemented during laparoscopic and open hysterectomies performed on human cadavers, with a custom display approach designed to visualize the ureter and uterine artery. The proximity of the surgical tool to the ureter was calculated and conveyed by tracking the surgical tool in photoacoustic images and mapping distance to auditory signals. The dual-wavelength display showed up to 10 dB contrast differences between the ureter and uterine artery at three separation distances (i.e., 4 mm, 5 mm, and 6 mm) during the open hysterectomy. During the laparoscopic hysterectomy, the ureter and uterine artery were visualized in the dual-wavelength image with up to 24 dB contrast differences. Distances between the ureter and the surgical tool ranged from 2.47 to 7.31 mm. These results are promising for the introduction of dual-wavelength photoacoustic imaging to differentiate the ureter from the uterine artery, estimate the position of the ureter relative to a surgical tool tip, map photoacoustic-based distance measurements to auditory signals, and ultimately guide hysterectomy procedures to reduce the risk of accidental ureteral injuries.

Pregnancy and VEGF (vascular endothelial growth factor) stimulate uterine artery endothelial cell (UAEC) hydrogen sulfide production via selectively upregulating CBS (cystathionine β-synthase) but not CSE (cystathionine γ-lyase) expression. This study was conducted to determine the mechanisms by which VEGF utilizes to stimulate pregnancy-dependent upregulation of CBS and hydrogen sulfide production in human UAEC. The proximal human CBS promoter contains 4 Sp1 (specificity protein 1; a/b/c/d) sites and 1 YY1 (Yin Yang 1) site; luciferase assays using reporter genes driven by human CBS promoter with a series of 5′-deletions identified a promoter sequence (−574 to −394) containing Sp1d and the YY1 sites critical for basal and VEGF-stimulated CBS promoter activation. VEGF stimulated pregnancy-dependent recruitment of Sp1 to Sp1d and YY1 to YY1 and also recruited YY1 to Sp1c and increased Sp1/YY1 association in pregnant human UAEC, suggesting formation of a Sp1/YY1 complex at the Sp1c site. Endothelial Sp1 and YY1 proteins were significantly greater in pregnant than nonpregnant human uterine artery. VEGF stimulated pregnancy-dependent Sp1 and YY1 protein expression in vitro. Treatment with Sp1 and YY1 siRNAs completely blocked Sp1/YY1-mediated pregnancy-dependent CBS protein upregulation and hydrogen sulfide production by VEGF in human UAEC. VEGF did not trans -activate CSE promoter or increase CSE expression, and Sp1/YY1 knockdown did not affect CSE expression in human UAEC. Thus, pregnancy augments EC Sp1 and YY1 expression and promotes the recruitment of Sp1/YY1 to their DNA-binding sequences in proximal human CBS promoter to upregulate CBS transcription, underlying a novel mechanism to mediate VEGF-stimulated pregnancy-dependent endothelial hydrogen sulfide production in the human uterine artery.

Objectives To evaluate, in pregnancies complicated by hypertensive disorders of pregnancy (HDP), the predictive role of uterine artery (UtA) Doppler for pregnancy outcome compared to the definition of preeclampsia (PE) established by ISSHP recommendations. Study design Retrospective cohort study including singleton pregnancies diagnosed with HDP, who underwent UtA Doppler assessment at admission in 2011–2017. The study population was classified considering the presence or absence of PE and according to the presence or absence of abnormal UtA Doppler (mean pulsatility index > 95th percentile). Main outcome measures Pregnancy outcome, maternal and fetal complications, evaluated as composite outcomes (CO), and duration of pregnancy (from admission to delivery). Results A total of 311 mother-infant couples was included. The diagnostic ability of the two classifications was analysed comparing the relative likelihood ratio in the Biggerstaff graph. ISSHP definition turned out to be more efficient in detecting maternal adverse CO in comparison to UtA Doppler, relative positive likelihood ratio 1.50 (1.35–1.66) and 1.31 (1.07–1.60). UtA Doppler classification resulted more efficient in predicting adverse neonatal CO than PE definition, relative positive likelihood ratio 2.21 (1.77–2.75) and 1.61 (1.37–1.90). UtA Doppler was significantly associated with delivery at earlier gestational ages both for patients affected by PE and for women affected by HDP without superimposed PE (respectively p = 0.009 and p = 0.037). Conclusions UtA Doppler at HDP diagnosis is a useful bedside marker of fetal/neonatal complications, and is associated with pregnancy duration.

Purpose: To evaluate the accuracy of the uterine artery pulsatility index (PI) for the diagnosis of pubertal onset in girls. Methods: Cross-sectional study of girls with normal pubertal development. Puberty was diagnosed by the presence of Tanner breast development score ≥2. All girls underwent pelvic ultrasound and Doppler imaging of the uterine arteries. We evaluated the uterine artery PI and uterine, endometrial, and ovarian measurements. We used ROC curves with cutoffs determined by Youden index for data analysis. Results: We included 169 girls aged 5-16 years who underwent 202 pelvic ultrasound examinations. Prepubertal girls had a significantly higher mean PI (mean, 6.70; SD, 2.15) than girls in initial puberty (mean, 4.14; SD, 1.55) and in late puberty (mean, 2.81; SD, 1.05) (P3.75 cm³ had a sensitivity of 73%, specificity of 95%, PPV of 97%, and accuracy of 79% to detect initial puberty. Conclusions: The significant reduction in the PI during pubertal development combined with increasing uterine volume can be a valuable, highly specific, noninvasive tool to confirm the onset of puberty.

OBJECTIVES To assess the impact of marginal (MCI) or velamentous (VCI) cord insertion on uterine artery pulsatility index (UtA PI), preeclampsia (PE), and offspring's birthweight (BW). METHODS A retrospective cohort study of singleton pregnancies, undergoing routine anomaly scan at 20+0 -23+6 gestational weeks, was conducted between 2016 and 2020. The effect of placental cord insertion on BW and UtA mean PI z-scores was assessed using the t test or analysis of variance and post-hoc tests; their association with PE was evaluated with the chi-square test. A multivariate logistic regression model was employed to assess the independent association of placental cord insertion and UtA PI z-score with PE, BW

In the gynecological literature, a limited number of studies have reported intraperitoneal bleeding due to abdominal blunt trauma. In this report, we describe a rare case of massive intraabdominal hemorrhage from the uterine artery triggered by a fall injury without apparent abdominal bruising in the presence of severe endometriosis and a uterine fibroid. A 28-year-old woman who fell from a railway platform was transported to an emergency hospital. Although she did not sustain abdominal bruising and initially had no abdominal symptoms, she complained of gradually worsening abdominal pain. Abdominal CT identified intraabdominal massive hematoma, and emergency exploratory laparoscopy revealed active bleeding from the right uterine artery eroded by endometriosis, which was treated with laparoscopic electrocoagulation. The cause of the intraabdominal bleeding was associated with avulsion of the endometriosis adhesion between the right perimetrium and the right uterine artery due to inertial forces of the uterus during the fall injury. A uterine fibroid discovered during laparoscopy was suspected to strengthen the inertial forces of the uterus. In the case of hemoperitoneum after trauma, gynecological sources of bleeding must be kept in mind, especially for patients with a known history of fibroids or endometriosis.

Objective: The present study assessed the safety and benefits of laparoscopic-assisted adenomyomectomy compared to laparoscopic or laparotomic adenomyomectomy. Materials and methods: This study was a retrospective comparative study. A total of 277 patients underwent adenomyomectomy between January 2016 and January 2019 at the Department of Obstetrics and Gynaecology, Ulsan University Hospital, including 25 with laparoscopic-assisted adenomyomectomy, 82 with laparoscopic adenomyomectomy, and 170 with laparotomic adenomyomectomy. Laparoscopic-assisted adenomyomectomy consisted of a laparoscopic uterine artery procedure to reduce blood loss and a minimal incisional for laparotomic adenomyomectomy. An additional laparoscopic surgery was performed for possible pelvic pathology. Results: Data on patient demographics, surgical indications, operative times, estimated blood loss (EBL), short-term complications, and postoperative hospital stays were compared. The laparoscopic-assisted surgery (LAS) and laparotomic groups were comparable in average EBL (208.0 ± 128.8 vs. 193.6 ± 193.0 ml, p = 0.11), weight of removed mass (85.5 ± 71.7 vs. 108.2 ± 91.9 g, p = 0.39), and postoperative hospital days (HDs) (4.5 ± 1.0 vs. 4.7 ± 0.8 days, p = 0.27). These values were lower in the laparoscopic group (EBL 119.5 ± 79.6 ml, mass weight 39.3 ± 25.9 g, HD 3.6 ± 0.8 days). Additional procedures, including myomectomy and combined severe endometriosis surgery, were more frequently performed in the LAS group than the laparotomic group. The mean operating time was longer in the LAS group (179.8 ± 36.6 min) than the other groups (laparoscopy 99.9 ± 40.6 min, p

OBJECTIVES The aims of the study were to evaluate the effects of two types of intrauterine contraceptive device (IUCD) on uterine artery Doppler indices. METHODS A multicentre randomised clinical trial was conducted between November 2019 and August 2020. Sixty-six multiparous women aged 18-45 years seeking intrauterine contraception were randomly assigned to receive either the levonorgestrel-releasing intrauterine system (LNG-IUS) or the copper intrauterine device (Cu-IUD). Each group comprised 33 participants. Primary outcome measures were menstrual changes and changes in uterine artery Doppler indices 3 and 6 months after IUCD insertion. Secondary outcomes measures were the relation between Doppler indices and menstrual changes, adverse effects of the assigned contraceptive method and user acceptability of the method. RESULTS Uterine artery pulsatility index (PI) and resistance index (RI) were significantly higher among women in the LNG-IUS group (p

An alternative surgical technique with closure of the uterine artery at its origin, known as lateral approach prior to TLH, has been proposed and it may offer important benefits to both patients and surgeons. Our objectives were to review the current literature regarding surgical outcomes between lateral and conventional approach in relation to TLH. We followed the 'PRISMA' guidelines and conducted a systematic review, which involved searching PubMed and Embase databases for RCTs evaluating the topic. We identified four RCTs including 585 patients. Three of the four studies reported a significant lower bleeding during TLH with prior lateral approach. Operative time was also shorter in the lateral approach group compared to the conventional approach group in three studies.Our review provides evidence that lateral occlusion of the uterine arteries prior to total laparoscopic hysterectomy may be beneficial due to less blood loss and shorter perioperative time without compromising patient safety.

OBJECTIVES Clinical assessment of uterine artery (UtA) hemodynamics is currently limited to Doppler ultrasound (US) velocimetry. We have demonstrated previously the feasibility of applying four-dimensional (4D) flow magnetic resonance imaging (MRI) to evaluate UtA hemodynamics during pregnancy, allowing flow quantification of the entire course of the vessel. In this study, we sought to further validate the physiological relevance of 4D flow MRI measurement of UtA blood flow by exploring its association with pregnancy outcome relative to US-based metrics. METHODS Recruited into this prospective, cross-sectional study were 87 women with a singleton pregnancy who underwent 4D flow MRI between May 2016 and April 2019 to measure the UtA pulsatility index (MRI-PI) and blood flow rate (MRI-flow, in mL/min). UtA-PI was also measured using US (US-PI). The primary outcome was a composite (COMP) of pre-eclampsia (PE) and/or small-for-gestational-age (SGA) neonate, and secondary outcomes were PE and SGA neonate individually. We assessed the ability of MRI-flow, MRI-PI and US-PI to distinguish between outcomes, and evaluated whether MRI-flow changed as gestation progressed. RESULTS Following 4D flow postprocessing and exclusions from the analysis, 74 women had 4D flow MRI data analyzed for both UtAs. Of these, 18 developed a COMP outcome: three developed PE only, 11 had a SGA neonate only and four had both. A comparison of the COMP group vs the no-COMP group found no differences in maternal age, body mass index, nulliparity, gravidity or race. For 66 of the 74 subjects, US data were also available. In these subjects, both median MRI-PI (0.95 vs 0.70; P

Background: Many women all around the world use the Cu T 380A for contraception as it is cheap and effective way for contraception. Menorrhagia is the most common cause of removal of the intra uterine contraceptive device (IUCD) and it is a very annoying side effect for IUCD users. Finding a way to avoid such a complaint is important to find a proper way for contraception. Objective: To prove the correlation between the Cu IUCD-induced menorrhagia and the findings of the transvaginal Doppler ultrasound. Patients and Method: It was a prospective cross-sectional study and it was conducted on eighty four women who were referred to the family planning clinic of Zagazig University Hospital and Zagazig General Hospital for Cu T-380A IUCD insertion. The study was conducted in the period from 1/1/2019 to 30/7/2019. Then, all specimen had been classified into 2 groups:Group 1 (n =37): with menorrhagia, and group 2 (n = 47) without menorrhagia. Results: Uterine artery pulsatility index (PI) and resistance index (RI) after one month of insertion were significantly lower than at time of insertion among women with IUCD-induced menorrhagia. Endometrial thickness after one month of insertion was significantly higher than at time of insertion among women with IUCD-induced menorrhagia. PI and RI at time of insertion were significantly lower in women with IUD-induced menorrhagia than in those using IUD with normal menstrual bleeding. Uterine artery PI ≤ 1.99 and RI ≤ 0.82 have been associated with menorrhagia at time of insertion. Conclusions: The transvaginal Doppler ultrasound is very helpful in prediction of menorrhagia among IUCD users.

Objective Adenomyosis usually causes dysmenorrhea and anemia. Clinically, it is difficult to be treated with medicine or by traditional surgery, however, hysterectomy is always performed for radical treatment. In this article, we introduce a new method that could control the dysmenorrhea and the anemia through laparoscopic uterine artery occlusion (LUAO) combined with uterine-sparing pelvic plexus block and partial adenomyomectomy for uterus preservation. Design Surgical video article. Local institutional review board approval for the video reproduction was obtained. Setting A 42-year-old patient, who had a history of a previous cesarean delivery, was admitted to our department with complaints of progressive dysmenorrhea for more than 5 years and aggravated with anemia for 1 year. The patient had failed treatment with traditional Chinese medicine and gonadotropin-releasing hormone and had to take painkillers for nearly half a year. The patient had no desire for another pregnancy. After careful consideration, the patient strongly rejected hysterectomy and demanded the preservation of the uterus, insisting on the integrity of the organs. A gynecologic examination showed that the uterus was hard and enlarged similar to one that is more than 8 gestational weeks, without tender nodules in the rectouterine pouch. The visual analog scale pain score was 7, and her hemoglobin was 93 g/L (after correction). The preoperative magnetic resonance imaging implied that there was 1 lesion in the posterior wall and the maximum diameter of the lesion was 7.8 cm. Interventions We performed laparoscopic partial adenomyomectomy combined with occlusion of uterine artery to limit the amount of intraoperative bleeding, dissected the uterine branch of pelvic plexus nerve, and performed electrocoagulation blocking to relieve the dysmenorrhea. The specific operation procedures are as follows ( Video ): Firstly, we opened the peritoneum through Cheng's triangle, which contained the external iliac blood vessels, the round ligament, and the infundibulopelvic ligament ( Fig. 1 ). Secondly, we separated the lateral rectal space and exposed the ureter, the internal iliac artery, the uterine artery, and the deep uterine vein. Thirdly, we found that the pelvic plexus was located on the outside of the sacral ligament and was approximately 2 to 3 cm below the ureter, going against the sacral ligament and passing through below the deep uterine vein ( Supplemental Video 1 ). Fourthly, we separated the 4 layers of the paracervix [1] . The first layer included the internal iliac artery and the uterine artery. The second layer was the ureter. The third layer was the deep uterine vein. The last layer was the pelvic plexus, which involved the forward-going bladder branch, the inward-going uterine branch, and the downward-going rectal branch ( Supplemental Video 2 ). These anatomic structures are similar to the complex architecture of an overpass called the Cheng's Cross [2] ( Fig. 2 ). In this operation, only the uterine artery and the uterine branch would be blocked. Finally, we performed the partial adenomyomectomy. The endometrium, the myometrial tissues, and the serosa were repaired in some layers with continuous suture, depending on the depth of incision. The operation time was 92 minutes, and the intraoperative hemorrhage was approximately 50 mL. The patient was able to get out of bed on the first day after the operation and urinate after removing the catheter. On the second day after the surgery, the patient had exhaustion and defecation. From the third day after the surgery, gonadotropin-releasing hormone (Goserelin Acetate Sustained-Release Depot,3.6mg each, subcutaneous injection, name of the enterprise: AstraZeneca UK Limited) was used every 4 weeks, with a total of 3 times. Menstruation began on the 67th day after withdrawal of the drug. The results of postoperative condition of the patient followed up at 6 months after surgery were collected as follows: dysmenorrhea was significantly relieved (visual analog scale score was 2), hemoglobin was 123 g/L, and uterine volume was reduced to 43% of preoperative volume. The comparison of the patient's preoperative and postoperative magnetic resonance imaging showed that the uterus was approximately the same size as that of a woman of the same age, and the incision healed well ( Fig. 3 ). Conclusion Adenomyosis is a common gynecologic disease, mainly occurring in women of childbearing age. Adenomyosis is defined as endometrial glands and stroma that invade the myometrium and is surrounded by chronical inflammation in the endometrium [3] . Secondary dysmenorrhea and menorrhagia are the most common chief complaints in patients with adenomyosis, among which dysmenorrhea is the most unbearable symptom [2] . In the past, we had always treated adenomyosis by hysterectomy [4] . With the continuous pursuit of quality of life, it is difficult to meet clinical needs through drugs and traditional surgical methods. Uterine sparing surgery is a current trend in the treatment of adenomyosis, which enables women to maintain fertility and avoid the effects of hysterectomy on sexual function and mental discomfort. Dysmenorrhea can be divided into peripheral dysmenorrhea and central dysmenorrhea. According to our previous studies on dysmenorrhea, the uterine branch nerve has a controlling effect on dysmenorrhea [2] . The purpose of pelvic plexus uterine branch ablation is to further relieve dysmenorrhea by blocking nerve conduction pathways. Therefore, we selectively blocked the uterine branch nerve to alleviate the dysmenorrhea of adenomyosis. The uterine artery controls 90% of uterine blood flow. According to our team research, LUAO is an effective method to treat symptomatic uterine myomas and adenomyosis. We investigated the morphologic change and apoptosis occurring in myomal and adjacent myometrial tissues after LUAO. We concluded that apoptosis through mitochondrial pathways may lead to reduction of the volume of myoma and myometrium and eventually relief of symptoms [ 5 , 6 ]. We speculated “single organ shock uterine” to explain uterine artery occlusion (UAO) mechanism, which was different from uterine artery embolization. The single organ shock theory of UAO can still inhibit the growth of myomas effectively. It is difficult to completely remove adenomyosis lesions during surgery, especially for diffuse adenomyosis. Therefore, in our team, we performed UAO combined with resection of focal lesions in key areas for patients with diffuse adenomyosis, instead of pursuing radical resection [ 7 , 8 ]. The purpose of UAO is to reduce the amount of bleeding during surgery and further atrophy of residual and scattered adenomyosis lesions in utero [ 5 , 6 ]. The intraoperative blocking of the uterine artery can reduce intraoperative bleeding and operation time, improve operation quality, and decrease recurrence rate. In our team, this technique has been used in clinic for more than 10 years. Our previous studies have shown that LUAO combined with pelvic plexus uterine branch nerve block and resection of most of the adenomyosis has achieved satisfactory clinical efficacy as a treatment for adenomyosis [ 2 , 3 ]. With this procedure, we can help patients with adenomyosis retain their uterus and relieve the anxiety caused by hysterectomy. In conclusion, UAO and uterine branch ablation in uterine sparing laparoscopic treatment is a safe and effective method, which may be considered as a good choice for symptomatic adenomyosis.

Background: Hysterectomy is one of the most commonly widespread gynecologic surgeries. Total Laparoscopic Hysterectomy (TLH) being a minimally invasive surgical technique has become the new trend.Aim of the work: The study aims at comparing TLH with previous ligation of the uterine artery at its origin, with conventional TLH regarding operative time, bleeding, intra-operative complications and postoperative follow up.Patients and Methods: Among 60 women, who are planned for TLH, 30 women experienced TLH with previous ligation of the uterine artery (group A) and the other 30 women underwent conventional TLH (group B).Results: The operative time of TLH in group A was significantly less than that in group B. Both blood loss and post-operative hospital stay in group A were less than those in group B, and there were no statistically significant differences between both groups. No major intra-operative or post-operative complications occurred in both groups.Conclusion: Total Laparoscopic Hysterectomy with Prior Uterine Artery Ligation at its origin is safe effective procedure and reducing the duration of surgery.

Objective To describe a stepwise surgical approach for conservative management of placenta previa accreta to preserve the uterus and to evaluate the efficacy and safety of this approach in controlling postpartum hemorrhage including intrapartum hemorrhage. Methods A prospective case series study conducted on 62 pregnant women with one or more cesarean deliveries diagnosed with placenta previa accreta between January 2018 and June 2019 at Ain Shams University Maternity Hospital. All participants underwent a conservative stepwise surgical approach through Pfannenstiel skin incision with fetal delivery through a uterine incision just above the upper border of the placenta, followed by bilateral uterine artery ligation with myometrial excision of the remaining adherent placenta and cervico-isthmic sutures by MMG (the main surgeon) and MS. Results Among 62 women, the surgical approach was successful in controlling postpartum hemorrhage and preserving the uterus in 50 (80.64%) participants. Three women (4.83%) had urinary bladder injuries, all were managed intraoperatively during the cesarean section. Five women (8%) had postpartum pyrexia and five women (8%) had postpartum endometritis, all were managed conservatively with broad-spectrum antibiotics. Conclusion The stepwise surgical approach can be applied to the conservative management of placenta previa accreta to avoid unnecessary cesarean hysterectomy.

OBJECTIVE To compare the screening performance of serum pregnancy-associated plasma protein-A (PAPP-A) vs placental growth factor (PlGF) in routine first-trimester combined screening for pre-eclampsia (PE), small-for-gestational age (SGA) at birth and trisomy 21. METHODS This was a retrospective study nested in pregnancy cohorts undergoing first-trimester combined screening for PE and trisomy 21 using The Fetal Medicine Foundation (FMF) algorithm based on maternal characteristics, nuchal translucency thickness, PAPP-A, free beta-human chorionic gonadotropin, blood pressure and uterine artery Doppler. Women at high risk for preterm PE (≥ 1 in 50) received 150 mg of aspirin per day, underwent serial fetal growth scans at 28 and 36 weeks and were offered elective birth from 40 weeks of gestation. PlGF was quantified retrospectively from stored surplus first-trimester serum samples. The performance of combined first-trimester screening for PE and SGA using maternal history, blood pressure, uterine artery pulsatility index and either PAPP-A or PlGF was calculated. Similarly, the performance of combined first-trimester screening for trisomy 21 was calculated using either PAPP-A or PlGF in addition to maternal age, nuchal translucency thickness and free beta-human chorionic gonadotropin. RESULTS Maternal serum PAPP-A was assayed in 1094 women, including 82 with PE, 111 with SGA (birth weight

Outward remodeling of the maternal uterine circulation during pregnancy is essential for normal uteroplacental perfusion and pregnancy outcome. The physiological mechanism by which this process is regulated is unknown; we hypothesized that it involved the normalization of wall shear stress (WSS). Pregnant Sprague–Dawley rats underwent unilateral ligation of the main uterine artery and vein at the cervical end of the uterus on gestational day 10, thus restricting inflow/outflow of blood into that uterine horn to a single point at the ovarian end; the contralateral sham‐operated side provided an internal control. This procedure alters uterine hemodynamics by increasing WSS, since the entire uterine horn is supplied by one rather than two vessels. Arterial diameter and blood flow velocity values were measured by intravital ultrasonographic pulse‐wave Doppler on gestational day 20 and used to calculate WSS. Although both ovarian artery lumen diameter and blood velocity increased, WSS was similar in both horns. These data support the concept that increased WSS secondary to hemochorial placentation is the primary physiological stimulus for uterine vascular remodeling and that its normalization may be the primary mechanism that regulates the extent of arterial circumferential growth required to maintain placental perfusion. We further hypothesize that shallow spiral artery invasion, such as occurs in preeclampsia, limits the increase in upstream shear stress and results in attenuated remodeling and placental under‐perfusion.

Female sexual dysfunction (FSD) may be a mirror of a poor cardiometabolic state. In a small pilot study enrolling 71 women with FSD, we previously demonstrated that clitoral Pulsatility Index (PI) evaluated by using color Doppler ultrasound (CDU), reflecting vascular resistance, was associated with cardiometabolic risk factors. Data on uterine CDU in this context are lacking. First, to confirm previously reported data on the direct association between clitoral PI and cardiometabolic risk factors on a larger study population of women consulting for sexual symptoms; second, to investigate eventual similar correlations between cardiometabolic risk factors and CDU parameters of the uterine artery. We also ascertained whether uterine artery PI, similarly to what had previously been observed for clitoral artery PI, was directly related to body image uneasiness and psychopathological symptoms, assessed by validated questionnaires. N = 230 women consulting our clinic for sexual symptoms were examined with clitoral CDU and blood sampling and were asked to fill out the Female Sexual Function Index, the Middlesex Hospital Questionnaire (MHQ) and the Body Uneasiness Test (BUT). In a subgroup of women (n = 164), we also performed transvaginal CDU with measurement of uterine artery parameters. At multivariate analysis, we found a direct association between clitoral PI and body mass index (BMI) (p = 0.004), waist circumference (WC) (p = 0.004), triglycerides (p = 0.006), insulin (p = 0.029) and HOMA-IR (p = 0.009). Furthermore, a correlation between obesity and Metabolic Syndrome (MetS) and a higher clitoral PI was observed (p = 0.003 and p = 0.012, respectively). Clitoral PI was also correlated with MHQ-S (p = 0.010), a scale exploring somatized anxiety symptoms, and BUT-B Positive Symptom Distress Index (p = 0.010), a measure of body image concerns. Similarly, when investigating the uterine artery, we were able to demonstrate an association between its PI and BMI (p p = 0.001), insulin (p = 0.006), glycated haemoglobin (p = p = 0.009). Women diagnosed with obesity and MetS showed significantly higher uterine PI values vs. those without obesity or MetS (p = 0.001 and p = 0.004, respectively). Finally, uterine PI was associated with BUT-A Global Severity Index (p

Background: Fetus growing restriction (FGR) or intra-uterine growth restriction (IUGR) is definite nowadays as the fetal failures of growing possibility and represented as one of the most discussed problems in obstetrics, which was in nonstop searching for improvements in term of definitions, classifications, diagnosing and managements. Aim and objectives; was how to assess the consequence of Sildenafil and Aspirin in Doppler indices and the neonatal outcome in cases with placental non-sufficiency and FGR? Subjects and methods; this work was a randomized clinical study performed at Samalot General Hospital from March 2020 till March 2021. Result; There is significant change among studied groups regarding RI and significant change among studied groups regarding PI of uterine artery whereas there is nonsignificant change among 2 groups regarding RI or PI middle cerebral artery. In Group-A there were 1(2.2%) with Failure of intervention. In Group-B there were 3(6.7%) with Failure of intervention. There is nonsignificant change among study groups. Conclusion: from the findings of our work, we reported that sildenafil has advantageous impacts in the treating plan of growing limited fetus rather than aspirin alone with improvement of fetus growing parameters.

The objectives of this study were to assess alterations in, echogenic appearance, size and blood flow in the corpus luteum, the placentomes and the blood flow in umbilical and uterine arteries that heat stress can cause in cooled pregnant dairy cows. Pregnant cows were allocated in two groups and the gravid uteri, along with the ipsilateral corpora lutea were examined during the winter (group W, n = 9) or the summer (group S, n = 10). The grey-scale ultrasound and colour flow imaging of the corpus luteum and placentome were performed. In addition, the umbilical and uterine artery diameters and haemodynamic parameters in the vessels were calculated. At the time of ultrasonographic examination, cortisol concentrations were higher, and progesterone levels tended to be lower in group S compared to group W. The grey-scale ultrasound evaluation of corpora lutea and placentomes was lower in group S compared to group W. The diameter of umbilical artery and the blood volume in the vessel were less in group S than in group W. We infer that heat stress affects foetal blood supply and possibly the structure of placentomes and corpora lutea, but it differently affects the blood flow characteristics in the umbilical and uterine arteries.

Objective Uterine artery impedance is known to have an effect on first trimester aneuploidy screening biomarkers. In this study we aim to compare first trimester screening parameters in women with and without uterine artery diastolic notches. Methods This retrospective case control study was conducted in a single tertiary center by obtaining medical records of women that admitted for first trimester pregnancy follow-up. Singleton pregnancies without structural anomalies, chromosomal anomalies and obstetric complications were included in the study. 268 women with first trimester unilateral uterine artery diastolic notches are constituted study group 1, 149 women with bilateral uterine artery diastolic notches constituted study group 2. 200 women were randomly selected as control group. Results Significantly decreased PAPP-A levels were found in both study groups. PAPP-A levels were even lower in women with bilateral notches in comparison to unilateral notches. Fetal birth weights and gestational ages at birth were also found significantly lower in study groups. Beta human chorionic gonadotropin levels and nuchal translucency measurements were found similar. Prevalence of false positive first trimester aneuploidy screening test results were significantly higher in women with bilateral uterine artery diastolic notches. Conclusion Presence of first trimester uterine artery diastolic notches, particularly the presence of bilateral diastolic notches, is related with decreased PAPP-A levels in first trimester aneuploidy screening and lead to higher false positive rates in first trimester aneuploidy screening and consequently more unnecessary invasive procedures.

Objective To investigate the role of glycemic control in development of preeclampsia (PE) in women with type 1 diabetes mellitus (T1DM). Methods An observational case-control study comparing 244 women with type 1 diabetes and 488 controls was conducted. Among women with T1DM HbA1c, average daily glucose values, fasting, preprandial, 1-hour and 2-hour postprandial glucose levels, and daily 3 meals postprandial glucose areas were evaluated. Uterine artery pulsatility indices (PI) at 16, 20, 24 weeks‘ gestation were obtained. Data analysis included rates of PE in both groups, and association between glycemic control, uterine artery PI and development of PE among women with T1DM. Results PE developed in 13.1% of diabetic women and in 3.5% of women in the control group (odds ratio 4.2; 95% CI 2.2–8.1). In multivariate logistic regression analysis, HbA1c in the 1st trimester, mean daily glucose level in the 1st and 2nd trimester, daily 3 meal postprandial glucose area in the 1st and 2nd trimester, and the uterine arteries PI at 24 weeks’ gestation were found to be associated with development of PE. The uterine arteries PI showed a significant positive correlation with the 3 meal postprandial glucose area at 16, 20, 24 weeks. Conclusion In women with T1DM, poor glycemic control early in pregnancy is associated with an increased risk of subsequent PE. An association between poor placentation, as indicated by the increased PI of uterine arteries, and a maternal metabolic factor, that is the 3 meal post-prandial glucose area, has been shown, supporting the increased rate of PE among women with T1DM.

Objectives: Maternal serum inhibin-A, pregnancy associated plasma protein-A (PAPP-A) and PAPP-A2 together with placental growth factor (PlGF), maternal risk factors and uterine artery pulsatility index (UtA PI) were analysed to study their ability to predict pre-eclampsia (PE). Study design: Serial serum samples for the nested case-control study were collected prospectively at 12–14, 18–20 and 26–28 weeks of gestation from 11 women who later developed early-onset PE (EO PE, diagnosis < 34 + 0 weeks of gestation), 34 women who developed late-onset PE (LO PE, diagnosis ≥ 34 + 0 weeks) and 89 controls. Main outcome measures: Gestational age -adjusted multiples of the median (MoM) values were calculated for biomarker concentrations. Multivariate regression analyses were performed to combine first trimester biomarkers, previously reported results on PlGF, maternal risk factors and UtA PI. Area under curve (AUC) values and 95% confidence intervals (CIs) for the prediction of PE and its subtypes were calculated. Results: A high first trimester inhibin-A predicted PE (AUC 0.618, 95%CI, 0.513–0.724), whereas PAPP-A and PlGF predicted only EO PE (0.701, 0.562–0.840 and 0.798, 0.686–0.909, respectively). At 26–28 weeks PAPP-A2 and inhibin-A predicted all PE subtypes. In the multivariate setting inhibin-A combined with maternal pre-pregnancy body mass index, prior PE and mean UtA PI predicted PE (0.811,0.726–0.896) and LO PE (0.824, 0.733–0.914). Conclusions: At first trimester inhibin-A show potential ability to predict not only EO PE but also LO PE whereas PlGF and PAPP-A predict only EO PE. At late second trimester inhibin-A and PAPP-A2 might be useful for short-term prediction of PE. publishedVersion

We recently reported that adoptive transfer of cytolytic Natural Killer cells (cNKs) from the Reduced Uterine Perfusion Pressure (RUPP) rat induces a preeclampsia (PE)-like phenotype in pregnant rats, accompanied by increased TNF-α. The purpose of this study was to investigate a role for increased TNF-α to induce oxidative stress (ROS), decrease nitric oxide (NO) bioavailability, and induce vascular dysfunction as mechanisms of hypertension (HTN) and intrauterine growth restriction (IUGR) in RUPPs. Pregnant Sprague Dawley rats underwent the RUPP or a Sham procedure on gestation day (GD) 14. On GDs 15 and 18, a subset of Sham and RUPP rats received i.p.injections of vehicle or 0.4 mg/kg of Etanercept (ETA), a soluble TNF-α receptor (n = 10/group). On GD18, Uterine Artery Resistance Index (UARI) was measured, and on GD19, mean arterial pressure (MAP), fetal and placental weights were measured, and blood and tissues were processed for analysis. TNF-α blockade normalized the elevated MAP observed RUPP. Additionally, both fetal and placental weights were decreased in RUPP compared to Sham, and were normalized in RUPP + ETA. Placental ROS was also increased in RUPP rats compared to Sham, and remained elevated in RUPP + ETA. Compared to Sham, UARI was elevated in RUPPs while plasma total nitrate was reduced, and these were normalized in ETA treated RUPPs. In conclusion, TNF-α blockade in RUPPs reduced MAP and UARI, improved fetal growth, and increased NO bioavailability. These data suggest that TNF-α regulation of NO bioavailability is a potential mechanism that contributes to PE pathophysiology and may represent a therapeutic target to improve maternal outcomes and fetal growth.

Objectives To evaluate the outcomes, and predictive value of uterine artery pulsatility index (UtA-PI) and second-trimester maternal serum alpha-fetoprotein (MSAFP) for adverse obstetric outcomes in cases with morphologically confirmed circumvallate placenta by comparison with normal pregnancies. Study design This prospective study was conducted in a tertiary referral hospital between January 2017 and December 2019. During the study period, 77 patients with a circumvallate placenta and 77 patients without any placental or feto-maternal diseases or abnormalities were evaluated. The final diagnosis was made based on macroscopic examination of the placenta soon after birth. Demographic characteristics, MSAFP, obstetric complications, haemoglobin after delivery, gestational week of birth, fetal sex, 1- and 5-min Apgar scores, postnatal complications and type of delivery were retrieved from hospital records. Bilateral mean transabdominal UtA-PI and MSAFP were evaluated for the prediction of adverse outcomes. SPSS Version 21.0 for Windows was used for statistical analysis, and receiver operating characteristic (ROC) curves were used for the prediction model of adverse outcomes. Results Smoking rate, MSAFP, preterm birth and intrauterine growth restriction (IUGR) were higher in the patients with a circumvallate placenta (p = 0.005, 0.00, 0.025 and 0.027, respectively). The cut-off value of MSAFP was 1.41 (0.60–3.32) and the cut-off value of UtA-PI was 1.2 using the ROC curves, and had sensitivity of 73.7 % and specificity of 71.9 %, and sensitivity of 73.7 % and specificity of 76.3 %, respectively (p Conclusions Circumvallate placenta was associated with a higher rate of IUGR, preterm birth and bleeding at the time of delivery. In patients with a circumvallate placenta, UtA-PI and MSAFP may be valuable as predictors of IUGR.

Background: Preeclampsia (PE) is still a major obstetrical problem world-wide. First trimester prediction of PE is of great clinical importance, as it would allow clinicians to focus on high-risk groups and initiate prophylactic medical treatment. The first stage of pre-eclampsia begins in the first trimester by impaired placentation. High-resistant spiral arteries can be detected from the 11th week of gestation by uterine artery (UtA) Doppler examination. Objective: To assess the relationship between 1st trimester uterine artery pulsatility index (UtA PI) and the development of early onset PE.Patients and Methods: Prospective observational study was performed at Mansoura University Hospital. This study was conducted on 109 pregnant women who attended their routine antenatal care visits at the Outpatient Obstetrics and Gynecology Clinic of Mansoura University Hospital. Results: There were statistically high significant difference between both groups in the BMI (p = 0.003), and no statistically significant difference as regards the age, gravidity and gestational age (p > 0.05). Statistically significant difference was evident between two groups in the mean values of UtA PI (p = 0.028). The best cutoff value of UtA PI for the prediction of early onset preeclampsia was ≥ 2.03 with accuracy of 0.79, and that of BMI was ≥ 35 with accuracy of 0.93. Conclusion: This study revealed that first trimester uterine artery Doppler can be used as a reliable screening test for prediction of preeclampsia in high risk women. It is a reliable, noninvasive method of examining uteroplacental perfusion. Abnormal UA Doppler ultrasonography (elevated PI) in 11–14 weeks' gestation can predict pre-eclampsia.

Background: Preeclampsia is a multisystem disorder of pregnancy defined by the combination of new-onset hypertension and proteinuria that contribute substantially to perinatal morbidity and mortality worldwide. Ultrasound can currently be used in the detection of adverse pregnancy outcome for example in Pre-eclampsia where Doppler indices and spectral wave forms are used. Objective: To use Doppler ultrasound for evaluation on of placental volume changes using 3-D USS, as well as abnormalities in uterine and umbilical artery Doppler indices in prediction of pre-eclampsia. Patients and Methods: This study was conducted in Department of Obstetrics and Gynecology of Al-Hussein Hospital, Al-Azhar University during the periods May 2016 till April 2017. This was a prospective observational study that carried on two hundred pregnant women enrolled into two equal groups. Group "A" consisted of 50 primipara and 50 multipara women with known risk factor to develop pre-eclampsia like previous history or medical disorder such as chronic hypertension and Group "B" consisted of 50 primipara and 50 multipara women without any risk factor to develop pre-eclampsia. Results: There was no statistically significant difference between both groups as regard to umbilical artery pulsatility index (PI), while umbilical artery resistance index (RI) and abnormality have higher statistically significant values in group A. There was a statistically significant difference between both groups as regards uterine artery PI, RI, abnormality and persistent notch (p value= 0.025, 0.037, 0.001 and 0.001 respectively). There was statistically significant difference between PC and MG as regards to uterine artery abnormality and persistent notch. There was no statistically significant difference between both groups as regards to placental volume. ROC results revealed that umbilical artery RI, uterine RI, and placental volume cutoff values were higher than 0.67, 0.56, and 43 and the area under the ROC curve was equal to 0.672, 0.851 and 0.527. The sensitivity values of umbilical artery RI, uterine RI, and placental volume were 83.0, 86.5 and 79.2 respectively and the specificity values were 73.3, 60.0 and 62.5 respectively. Conclusion: Three-dimensional Doppler ultrasound results, as well as resistance index from umbilical artery and uterine artery pulsatility index, resistance index, abnormality and persistent notch, could be considered as tools to determine hemodynamic repercussion caused by preeclampsia.

Background: Pregnancy loss is the interruption and/or termination of pregnancy, either spontaneously or intentionally, before the fetus develops sufficiently to survive. About 80% of abortions occur in the first 12 weeks of pregnancy. Objective: To determine the accuracy of U/S parameters in predicting early pregnancy failure in pregnant with history of 1st trimesteric recurrent pregnancy loss. Patients and methods: This was a prospective study that included 120 pregnant females with history of first trimesteric recurrent pregnancy loss. It was conducted in Obstetrics and Gynecology Department, Menoufia University Hospitals, and Rashid General Hospital, Al-Bahira, Egypt during the period from April 2019 until August 2020. Results: There is no significant difference between miscarriage group and ongoing pregnancy group regarding risk factors and demographic data (p > 0.05). In addition, crown-rump length (CRL) below 5th percentile for gestational age (GA) category more significantly prevalent in the miscarriage group compared to the ongoing pregnancy group. While, mean gestational sac diameter (MGSD) below 5th percentile for GA, caudal displacement of gestational sac (GS) or irregular GS could predict subsequent miscarriage. Embryonic heart rate/Fetal heart rate (EHR/FHR) below 5th percentile for GA was statistically significantly more prevalent in the miscarriage group than in ongoing pregnancy group. Abnormally large YSD (> 95th percentile for GA), absent yolk sac (YS), floating YS, deformed, irregular or hypo-echoic YS could predict subsequent miscarriage. Uterine artery resistance index (RI), pulsatile index (PI) and systolic/diastolic (S/D) ratio did not differ significantly between the miscarriage group compared to the ongoing pregnancy group across the various gestational ages. Conclusion: 1st trimester U/S parameters are useful diagnostic tool to prognosis pregnancy outcome among patients with history of recurrent 1st trimester pregnancy loss.

Background: Recurrent pregnancy loss is still a challenging obstetric condition. It linked to impaired uterine blood, and vasodilators seem to prevent recurrent pregnancy loss. The aim of the work: The current study aimed to compare between investigate the Doppler uterine artery indices in females with recurrent pregnancy loss [unexplained]. It also aimed to study the effect of intravaginal isosorbide mononitrate, on the pattern of uterine blood flow. Materials and Methods: This observational, nested case control study had been completed at Al-Azhar University Hospitals. Two groups of females [each 50 females] were studied. The control group [females with no previous pregnancy loss and have a viable child or more]. The study group [females with history of unexplained recurrent pregnancy loss]. Vaginal color Doppler ultrasound was done to assess pulsation and resistance indices of uterine arteries in the mid-luteal phase of the cycle. Then, 20 mg of isosorbide mononitrate was applied vaginally and measurement of the vascular indices were registered after two hours again. Both groups were compared and the effect of isosorbide mononitrate on the uterine artery vascular indices the study group was documented. Results: Higher uterine artery resistance and pulsation indices are noticed in females with recurrent pregnancy. A significant reduction in these indices was found after vaginal application of Isosorbide mononitrate. Both groups were comparable regarding patient demographics. Doppler indices were significantly lower in control than study group. The endometrial thickness was negatively correlated with right RI and left PI (r = -0.328, -0.342, p = 0.039 and 0.031, respectively). Conclusion: Poor uterine perfusion is associated with spontaneous abortion. The vaginal application of isosorbide mononitrate, nitric oxide donor could be an effective treatment for the correction of uterine vasculature in patients with recurrent pregnancy loss.

INTRODUCTION: In this study, we aimed at quantifying placental concentrations of 22 chemical elements in small fetuses (SGA) as compared with normally grown fetuses (AGA), and to assess the relationship with Doppler markers of placental function. METHODS: Prospective cohort study, including 71 SGA fetuses (estimated fetal weight 10th percentile), recruited in the third trimester of gestation. The placental concentration of 22 chemical elements was determined by inductively coupled plasma optical emission spectrophotometer (ICP-OES, ICAP 6500 Duo Thermo): aluminum (Al), beryllium (Be), bismuth (Bi), calcium (Ca), cadmium (Cd), cobalt (Co), chrome (Cr), copper (Cu), magnesium (Mg), manganese (Mn), molybdenum (Mo), nickel (Ni), phosphorus (P), lead (Pb), rubidium (Rb), sulfur (S), strontium (Sr), titanium (Ti), thallium (Tl), antimony (Sb), selenium (Se), and zinc (Zn). Placental function was assessed by measuring the following fetal-maternal parameters: Uterine artery Pulsatility Index (UtA PI), Umbilical artery Pulsatility Index (UA PI) and Middle Cerebral artery Pulsatility Index (MCA PI). The association between the chemical elements concentration and study group and the association with Doppler measures were evaluated. RESULTS: SGA was associated with significantly (p

Background: The intrauterine contraceptive device (IUCD) is a frequently used method of contraception all-over the world. The most common side effect of IUCD is menorrhagia which is accountable for increased removal rate in the first year of its use. Objective: To test the hypothesis that initial uterine artery pulsatility index (PI) and resistance index (RI) before insertion of Tcu 380A IUCD could predict IUCD-related heavy menstrual bleeding or not. Methodology: A cohort study was performed on 300 women who demanded copper IUCD insertion as a method of contraception. Full history, detailed examination and investigations were done. Hemoglobin (Hb) concentration and PI and RI of uterine artery were measured using voluson B6 equipment before IUCD insertion and 3 and 6 months after insertion. Results: 162 participants who suffered from heavy menstrual bleeding (group II) had significantly lower uterine artery PI and RI than 138 participants who did not suffer from heavy menstrual bleeding (group I) before IUCD insertion and 3 and 6 months after insertion (p-value 0.05). 64 participants in group II with severe heavy menstrual bleeding required removal of the IUCD at the 3 months follow up visit. A cut-off levels for Doppler indices of uterine artery were PI ≤1.52 and RI ≤0.66. Conclusion: PI and RI of uterine artery are lower in patients with IUCD-induced heavy menstrual bleeding before IUCD insertion. Initial measurement of Doppler indices of uterine artery could predict IUCD-related heavy bleeding.

Through searching the literature on the mechanism of acupuncture for primary dysmenorrhea in the last 15 years, this paper summarizes systematically the current study progress on the analgesic mechanism of acupuncture for primary dysmenorrhea, from the perspectives of animal experiment and human trials. In terms of research methods, the behavioral observation, evaluation of central and peripheral biochemical indexes, and molecular biological techniques were mainly used in the animal experiments; whilst the clinical symptoms and evaluation of peripheral serum biochemical indexes were focused on in human trials. As for the research results, the animal experiments showed that acupuncture may play an analgesic role by regulating endocrine, promoting the release of central and peripheral neurotransmitters, regulating immune function, and relieving uterine smooth muscle spasm. However, the human trials have found that acupuncture can produce analgesic effects by regulating serum prostaglandin and ovarian hormone levels, promoting the release of peripheral β-endorphin, improving the uterine artery flow status, and relieving uterine smooth muscle spasm. Although different research methods were used in animal and human studies, the similar results were obtained in acupuncture regulating endocrine levels, promoting release of peripheral neurotransmitters, and alleviating uterine smooth muscle spasms. In addition, at present stage, animal experiments are more than human trials in numbers, and there are relatively few studies on the central mechanism of acupuncture analgesia in human trials. Therefore, in view of this phenomenon, this paper proposes to use functional magnetic resonance imaging (fMRI) technology to explore the central mechanism of acupuncture analgesia in human body, so as to provide a new idea for further exploring the mechanism of acupuncture analgesia in treating primary dysmenorrhea.

Objective Acute hyperglycemia affects the fetoplacental circulation. This study aims to investigate the possible effect of acute hyperglycemia induced by 50 g oral glucose tolerance test (OGTT) on fetoplacental circulation in women between 24 and 28 weeks of gestation. Materials and methods Between January 2019 and April 2019, a total of 29 women who were between 24 and 28 weeks of gestation with a singleton gestation and were in low-risk group were included in this prospective study. All patients underwent fetal biometric measurements using ultrasonography (USG) and were administered 50 g OGTT. Before and 1 h after the test, Doppler USG was used to measure uterine artery, umbilical artery (UA), middle cerebral artery (MCA), pulsatility index (PI), resistance index (RI), and systolic/diastolic (S/D) ratio. The cerebroplacental ratio (CPR) was calculated as the ratio of the MCA-PI/UA-PI. Results There was a decline in the MCA-RI (p = 0.008) and UA-PI (p = 0.021) at 1 h after the administration of 50 g OGTT. Z-scores of the mean UA-PI, MCA-PI, and CPR were calculated and a statistically significant increase in the Z-scores of the mean UA-PI was observed (p = 0.028). Conclusion Our study results show that acute hyperglycemia induced by OGTT significantly increases the Z-scores of the UA-PI, affecting the fetoplacental circulation.

Background: Sildenafil is a phosphodiesterase-5 inhibitor considered for antenatal use for a variety of indications. We sought to assess sildenafil pharmacokinetics in the pregnant ewe and fetus and evaluate its physiological fetal effects. Methods: Twelve fetal lambs (127–133 days GA, term 145) were chronically catheterized in utero. Ewes received different doses of sildenafil, either via subcutaneous injection (1.6, 2.0 mg/kg/day) or intravenous (IV) infusion (3, 5, 7, 10, and 12 mg/kg/day). Maternal and fetal sildenafil concentrations and metabolic status (blood gas analysis) were measured at given intervals. The fetal heart rate, pulmonary blood flow, systemic and aortic pressure, and maternal uterine artery pressure were continuously monitored. Results: The transplacental sildenafil transfer was 2.9% (range: 1.4–7.8%), preventing attainment of fetal target concentrations without toxic maternal levels. IV sildenafil infusion induced an immediate, temporary, dose-dependent reduction of pulmonary vascular resistance (38–78%) and increased both pulmonary blood flow (32–132%) and heart rate (13–49%), with limited nonlinear dose-dependent effects on systemic and pulmonary pressures. Fetal and maternal blood gases and maternal uterine artery pressures were unaffected by sildenafil infusion. Conclusion: In sheep, transplacental transfer of sildenafil is extremely low. Though, minimal fetal sildenafil concentrations induce an acute transient pulmonary vasodilation, well-tolerated by the fetus and ewe.

This study aimed to compare the performance of non-contrast-enhanced magnetic resonance angiography (NCE-MRA) at 1.5 T and 3 T for the visualization of uterine and ovarian arteries (OAs) before uterine artery embolization (UAE). Preprocedural pelvic NCE-MRA images of 85 symptomatic patients undergoing UAE for the treatment of uterine leiomyomas were reviewed by two specialists in pelvic MRI. Left and right uterine arteries (UAs) were judged separately and scored on a 5-point scale. Score 5 was the highest, in which the UA could be visualized inside the musculature, forming a peritumoral plexus. Score 1 was the lowest, where visualization was limited to the descending segment. The detection of enlarged OAs was also compared. The Mann–Whitney U and Fisher exact tests were used for statistical analysis. p < 0.05 was considered to be statistically significant. Of the 170 UAs, 110 were classified at 1.5 T and 60 were classified at 3 T. Median (interquartile range [IQR]) score was 3 (IQR: 2–4) for visualization at 1.5 T vs 5 (IQR: 4–5) for 3 T. The scores for UA visualization were significantly higher at 3 T (p < 0.05). For enlarged OAs, NCE-MRA at 1.5 T and 3 T visualized 7 and 5 enlarged OAs, respectively; there was no significant difference between the two field strengths (p = 0.36). NCE-MRA performed at 3 T can visualize UAs over a greater range than at 1.5 T. No difference was found regarding the detection of enlarged OAs. • Preprocedural MRA can provide interventional radiologists with valuable information, including the origin and course of the uterine arteries and the existence of collateral feeders to the tumor. • This study demonstrates the superiority of non-contrast-enhanced MRA performed at 3 T over that performed at 1.5 T in the visualization of the uterine arteries in patients undergoing uterine artery embolization for the treatment of uterine leiomyomas. • Non-contrast-enhanced MRA is a useful imaging modality for patients with symptomatic leiomyoma undergoing uterine artery embolization in whom contrast administration is unfeasible. If available, it is preferable to perform the examination with a 3 T MR unit rather than a 1.5 T MR unit.

Background: Primary ovarian insufficiency (POI) is a common cause of infertility and usually defined by the triad of amenorrhea, estrogen deficiency, and elevated luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in women < 40 years of age. The aim of the present study was to investigate the relationship between uterine and ovarian blood flow with acupuncture and fertility ratio in patients of the Firoozgar Hospital Infertility Clinic. Methods: Twenty-nine patients with POI were included in this clinical trial. FSH, LH, estradiol (E2), and anti-Müllerian hormone (AMH) levels were measured. Patients with Turner syndrome were identified and excluded from the study. Selected patients were evaluated using transvaginal color Doppler sonography used to measure ovarian volume, endometrial thickness, flow rates, and uterine and ovarian artery indexes. Patients were treated with acupuncture twice a week for 5 weeks. After the end of treatment, hormonal assays and an ultrasound examination were repeated to check the changes. Results: Indexes of the uterine arteries (Resistance Index, Pulsatility Index) before versus after the intervention were significantly different (P < 0.00) and uterine vascularity increased after treatment in 22 patients (75.8%). LH and FSH hormone levels were significantly decreased after the intervention (P < 0.00), while AMH and E2 levels were significantly increased after treatment (P < 0.00). The post-intervention right ovarian reserve was significantly increased (P = 0.02), whereas there was no significant difference in left ovarian reserve before vs. after treatment (P = 0.39). Spontaneous menstruation was detected after acupuncture in 16 patients. Conclusions: Our study demonstrated changes in vascularity, hormone levels, menopausal symptoms, and menstrual induction in patients after acupuncture intervention. Keywords: POI, acupuncture, arterial indexes.

Preeclampsia is a multi-system disorder manifested primarily by hypertension and proteinuria during second half of pregnancy. It is a major cause of maternal morbidity and mortality worldwide. Despite decades of research into the condition, the ability of clinicians to predict preeclampsia prior to the onset of symptoms has not improved significantly. In this review we will look at potential biomarkers for early prediction and diagnosis of preeclampsia. To evaluate the efficacy of different biochemical and biophysical markers in the early weeks of gestation as screening tools for early prediction of preeclampsia. This hospital-based prospective observational study conducted on 52 pregnant women, at less than 13 weeks of gestation were recruited. Maternal urine microalbumin, urinary albumin to creatinine ratio, and USG uterine artery PI levels were analyzed among the pregnant women who subsequently developed PE and compare with those who did not develop PE. Methods used for the detection of markers are: immunoturbidimetric method for urine albumin, modified kinetic Jaffe reaction without deproteinization for Urine creatinine and Uterine artery Doppler velocimetry was done by PHILIPS HD11XE transabdominal ultrasound machine using a 4-6 MHz probe with the same sonographer. In the present study, spot urine microalbumin and spot urine albumin to creatinine ratio (UACR) at 11-13 were significantly higher in women who developed PE subsequently when compared to nonpreeclamptic women.(P Study concluded that the women who are prone to develop PE subsequently, had high levels of MAP, UAPI, microalbuminuria and urine albumin to creatinine ratio than the normotensive women. In our setting, MAP, UAPI, microalbuminuria, and UACR markers appeared to be better screening modalities. The combination of biochemical markers with the biophysical markers, demographic characteristics, and other novel markers will establish the effective screening models for early prediction of PE. Early identification of high-risk cases will offer an opportunity for prophylactic therapy, such as Low- dose Aspirin in selected groups of high-risk women screened in the first trimester, thus improving the maternal and perinatal outcome.

Decreased secretion of melatonin was reported to be associated with an enhanced risk of hypertension and diabetes. However, the effect of melatonin on gestational hypertension (GH) and the underlying mechanism remain unclear. A GH mouse model was established via electrical stimulation. The hypertensive phenotypes were indicated by systolic blood pressure (SBP) and urinary protein levels. Uterine artery (UtA) endothelial function was detected by relaxation, peak systolic velocity (PSV), end-diastolic velocity (EDV), resistance index (RI) and pulsatility index (PI). Protein expression levels were determined using immunochemistry and Western blots. Pregnancy outcomes were indicated by the fetal live ratio, fetal weight and placental weight. Melatonin supplementation ameliorated hypertensive phenotypes in the mice with GH and enhanced UtA endothelial response to acetylcholine. The BKCa potassium channel was involved in the effect of melatonin on UtA endothelial function, and melatonin promoted BKCa potassium channel expression and function in UtAs. Finally, melatonin improved pregnancy outcomes in pregnant mice. In conclusion, melatonin ameliorates hypertension in hypertensive pregnant mice and suppresses hypertension-induced decreases in Ca2+-activated K+ channels in uterine arteries.

To describe the perinatal outcome of a prospective cohort of late-onset small-for-gestational-age (SGA) fetuses and to test adverse perinatal outcome (APO) prediction using Doppler measurements. Singleton pregnancies from 32 weeks with suspicion of SGA (followed-up each 2 weeks) and randomly selected healthy controls at a university hospital were included. The whole SGA group was divided into the FGR subgroup or SGA percentile 3-10 subgroup. The following Doppler measurements were evaluated prospectively: umbilical artery (UA) pulsatility index (PI), middle cerebral artery (MCA) PI, cerebro-placental ratio (CPR), and mean uterine artery (mUtA) PI. APO was defined as arterial cord blood pH ≤ 7.15 and/or 5-minute Apgar ≤ 7 and/or emergency operative delivery and/or admission to the neonatal unit. Induction of labor was indicated according to a stage-based protocol. A total of 149 SGA and 143 control fetuses were included. The number of operative deliveries was similar between both groups (control: 29 %, SGA: 28 %), especially the cesarean delivery rate after the onset of labor (11 % vs. 10 %). Most SGA cases ended up in induction of labor (61 % vs. 31 %, p 0.001). The areas under the curve (AUC) for APO prediction were similar using the last UA PI, MCA PI, CPR, and mUtA PI and barely reached 0.60. The AUC was best for the FGR subgroup, using the minimal CPR or maximum mUtA PI z-score of all longitudinal measurements (AUC = 0.63). SGA fetuses do not have a higher rate of operative delivery if managed according to a risk stratification protocol. Prediction of APO is best for SGA and FGR using the "worst" CPR or mUtA PI but it remains moderate.ZIEL: Beschreibung des perinatalen Outcomes einer prospektiven Kohorte von „small for gestational age“ (SGA)-Feten sowie Vorhersage eines schlechten perinatalen Outcomes (APO) mittels longitudinaler Dopplermessungen. Eingeschlossen wurden Einlingsschwangerschaften ab 32 + 0 Schwangerschaftswochen mit Verdacht auf SGA (Untersuchungen alle 2 Wochen) und gesunde Kontrollen. Die folgenden Dopplermessungen wurden ermittelt: Pulsatilitätsindex (PI) der Nabelschnurarterie (UA), PI der mittleren Zerebralarterie (MCA-PI), die zerebroplazentare Ratio (CPR) und mittlerer PI der Uterinarterien (mUtA-PI). APO wurde definiert als arterieller Nabelschnurblut-pH-Wert ≤ 7,15 und/oder 5-Minuten-Apgar ≤ 7 und/oder operative Notfall-Entbindung und/oder Aufnahme auf die Neugeborenenstation. Eine Geburtseinleitung bei SGA wurde nach Protokoll indiziert. Insgesamt wurden 149 SGA- und 143 Kontrollfeten eingeschlossen. Die Anzahl der operativen Entbindungen war in beiden Gruppen ähnlich, insbesondere die sekundäre Sectiorate (11 % vs. 10 %). Bei den meisten SGA-Fällen wurde die Geburt eingeleitet (61 % vs. 31 %; p 0,001). Die Fläche unter der Kurve (AUC) für die APO-Vorhersage war unter Verwendung des letzten UA, MCA-PI, CPR und mUtA PI ähnlich und erreichte kaum 0,60; am besten war sie für die FGR-Subgruppe unter Verwendung der minimalen CPR oder des maximalen mUtA-PI (AUC = 0,63). SGA-Feten haben keine erhöhte operative Entbindungsrate, wenn sie nach einem Risikostratifizierungsprotokoll überwacht und entbunden werden. Die Vorhersage des APO ist am besten mit der „schlechtesten“ CPR oder mUtA-PI, aber sie ist insgesamt moderat.

Fibroid is the most common tumor encountered during cesarean section. Cesarean myomectomy is a potential option in such cases but it was discouraged in the past due to the fear of intractable intraoperative hemorrhage. We report 3 cases of fibroid uterus during pregnancy in which cesarean myomectomy was performed successfully with no intraoperative and postoperative complications. To minimise intraoperative hemorrhage during myomectomy, diluted vasopressin was used with routine oxytocin infusion. Cesarean myomectomy is a safe procedure and can be performed in selected cases by expert obstetricians at a tertiary care centre. The most worrisome complication is intraoperative hemorrhage which can be minimised with vasopressin, uterotonics, bilateral uterine artery ligation or uterine artery embolisation, and/or bilateral internal iliac artery ligation. Furthermore, it is cost effective being one-time surgery.

Background: Morbidly adherent placenta is considered one of the most life-threatening obstetric complications and may cause severe intra operative bleeding requiring massive blood transfusion. The challenge is how to preserve the uterus with less complications? Aim of Study: This study aimed to present an alternative applicable surgical technique to save the uterus in cases with MAP by application of stepwise devascularization and resection of the placenta with adherent uterine wall. Material and Methods: It is a retrospective study in which 75 patients with morbidly adherent placenta, who delivered by cesarean section, were selected. Bilateral uterine artery ligation was done after downward dissection of the bladder, followed by upper uterine segment incision, downward step-wise clamping and resection of the whole lower uterine segment with adherent placenta till the cervix by vertical and transverse clamps. Finally reconstruction of the uterus was done. The amount of blood loss, operative time, post-operative hospital stay and operative complications were analyzed. Results: In all cases the placenta was adherent to the lower uterine segment and involving the posterior wall of the bladder in four cases. In all cases the mean estimated blood loss was 1156.3±403.2mL, the mean operative time was 76.3 ±24.5min, and the mean post-operative hospital stay was 3.8± 1.6 days. The four cases, in which the placenta was invading the bladder wall, underwent bladder repair due to bladder injury during dissection. In all cases, the uterus had been preserved. No other intra operative complications were reported. Conclusion: Stepwise devascularization and resection of the placenta with adherent uterine wall is an effective and applicable technique to preserve the uterus in patients with morbidly adherent placenta with excellent operative results, less blood loss, blood transfusion was needed in limited cases.

Miscarriage is the most frequent cause of pregnancy loss, affecting 15-20% of clinically recognized pregnancies. Early uterine vascular insufficiency (EUVI), defined as abnormal uterine artery (UA) Doppler impedance indices in early pregnancy, is present in two-thirds of pregnancies ending in miscarriage after embryonic cardiac activity has been detected. There is currently no available therapy for reducing the risk of miscarriage in these cases.To determine whether vasodilator therapy with hydralazine can reduce abnormally high UA impedance indices and miscarriage rates in pregnancies with EUVI when administered from before 9 weeks' gestation until completing 13 weeks' gestation.A total of 253 consecutive singleton pregnancies with a live embryo and scanned before 9 weeks' gestation were included in the study. Ninety-two pregnancies (36.3%) were classified as having EUVI. Hydralazine was administered in daily doses of 50 mg, starting 24-36 h after the initial diagnosis of EUVI and continuing throughout the first trimester. The miscarriage rate in the hydralazine-treated EUVI group was compared with the one observed in our previously reported untreated cohort and the pregnancies with EUVI that declined treatment with hydralazine.The miscarriage rate among the hydralazine-treated EUVI group was significantly lower than the previously reported untreated cohort (7.8% versus 26.2%,Hydralazine therapy in pregnancies with EUVI was associated with a significant decrease in the rate of miscarriage. We suggest a sequence of events leading to a higher risk of miscarriage in pregnancies with EUVI and propose a potential mechanism through which hydralazine may reduce this risk.

Background: To introduce the surgical procedure based on special space anatomy that can safely and efficiently complete the dissociation of the ureter and uterine artery during laparoscopic radical trachelectomy with uterine artery preservation. Methods: We introduce the key technique elements of this surgical procedure using a patient we treated as an example. A 27-year-old patient was diagnosed as well-differentiated cervical adenocarcinoma, stage IB1, and had a strong desire for future fertility. Laparoscopic radical trachelectomy with uterine artery preservation was performed in this patient by using this new surgical technique based on space anatomy. Results: The ureteral space that needs to be dealt with during laparoscopic radical trachelectomy is actually a potential avascular space located medial to the ureter between the anterior leaf (from the axillary space to the fourth space of Yabuki) and posterior leaf (between the paravesical space and paravaginal space) of the vesicouterine ligament. Exposure of the axillary space can help to separate the ureter from the lower uterine segment and uterine artery (uterine side), which is necessary for radical trachelectomy with uterine artery preserved. Multiple "shafts" called potential avascular space can be drilled on the anterior leaf of vesicouterine ligament, and the connective tissue and blood vessels between the "shafts" were cutoff with ultrasonic scalpel. After the paravesical space and paravaginal space were developed, the posterior leaf was isolated and congealed completely by Ligasure. Conclusions: In brief, this new surgical procedure consists of four spaces that can safely and efficiently perform complete excision of the vesicouterine ligament, reduce blood loss, avoid ureteral injury, and shorten the operation time.

Objective: We report 2 cases of haemoperitoneum due to a bleeding of the uterine artery caused by infiltrating endometriosis. We have also conducted a literature review on endometriosis-related intra-abdominal haemorrhage and wrote a practical guideline on how this entity can be recognized and handled. Patients: Case 1: A 49-year-old multiparous woman presented with intense stabbing pain in the lower abdomen during her menstruation. CT angiography showed a bleeding from a side branch of the internal iliac artery. Laparoscopy was performed and an active bleeding from the right uterine artery was confirmed, clearly caused by infiltrating endometriosis lesions. Haemostasis was achieved by bipolar coagulation. Case 2: A 29-year-old nulliparous woman was admitted for observation because of heavy stabbing pain in the right lower quadrant and presence of free fluid on CT abdomen. The day after the admission, laparoscopy was performed because of a decreasing haemoglobin level. An arterial bleeding from the right parametrium was observed, probably originating from the right uterine artery. Histopathological examination of a biopsy of the right parametrium proved the presence of endometriosis. Haemostasis was achieved by bipolar coagulation. Conclusion: Although endometriosis-related haemoperitoneum is a rare entity, this diagnosis should be considered when a patient presents with an intra-abdominal haemorrhage during menstruation or withdrawal bleeding - especially in case of a history or suspicion of endometriosis. Laparoscopy is the cornerstone of the treatment.

Aim of the work: To assess maternal and fetal vascular indices in SLE patients during pregnancy, and the impact of disease activity on these vascular indices. Patients and methods: 30 pregnant SLE patients and 30 age -matched healthy females with uncomplicated pregnancies were assessed during the third trimester using ultrasonography (US) and Doppler study to detect fetal biometry, the uterine, umbilical (UA) and fetal middle cerebral (MCA) arterial resistance (RI) and pulsatility (PI) indices, as well as cerebro-placental ratio (CPR). Disease activity was determined using the SLE Disease Activity Index (SLEDAI). Results: The mean uterine artery PI, RI and the UA-PI in SLE group were significantly higher than controls (p value 0.05). Conclusion: Pregnancies in SLE are associated with abnormal maternal and fetal vascular indices. Doppler US can identify at-risk pregnancies and optimize the time of delivery; confirming a good pregnancy outcome.