A New Perspective to Evaluate Doppler Vascular Impedance in Hypertensive Disorders Complicating Pregnancy: Multilevel Modeling Established in a Case Control Study


Background: There have been researches on the evaluation of Doppler vascular impedance in hypertensive disorders complicating pregnancy (HDCP). With respect to the method of analysis used and the conclusions drawn in previous studies, different vessels were usually viewed separately and independently. This study was designed to evaluate Doppler vascular impedance changes in HDCP from a new perspective, with original thought and insight into an ordinary issue. Methods: 273 pregnant women (110 hypertensive pregnancies and 163 normotensive pregnancies) were randomly included in a grouping case-control study conducted from February 10, 2011 to April 30, 2013. All women in the study underwent Doppler measurements of six different vessels including the umbilical artery, the uterine arteries, the placental bed spiral artery, the fetal middle cerebral artery and the fetal renal artery. Doppler vascular impedance was presented as pulsatility index (PI), resistance index (RI), and systolic and diastolic ratio (S/D). Doppler changes in the hypertensive and normotensive groups were assessed by the multilevel modeling approach with univariate and multivariate-adjusted analyses. Results: According to multilevel modeling approach with multivariate-adjusted analysis, a relatively average evaluation on Doppler vascular impedance was provided. Hypertension was significantly associated with positive effects on PI, RI and S/D values (coefficients were 0.10, 0.03 and 0.08, respectively; 95% CIs were 0.06 - 0.14, 0.02 - 0.04 and 0.04 - 0.11, respectively; P values were all less than 0.001) in comparison with normotensive group. Conclusion: According to an overall evaluation, Doppler vascular impedance in hypertensive disorders complicating pregnancy was higher than in normotensive pregnancy. The novel thought and approach applied in this research may bring about inspirations for better understanding and assessment of the disease.

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Yuan, T. , Zhang, T. , Li, C. and Han, Z. (2015) A New Perspective to Evaluate Doppler Vascular Impedance in Hypertensive Disorders Complicating Pregnancy: Multilevel Modeling Established in a Case Control Study. Open Journal of Obstetrics and Gynecology, 5, 350-359. doi: 10.4236/ojog.2015.56051.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Duley, L. (2009) The Global Impact of Pre-Eclampsia and Eclampsia. Seminars in Perinatology, 33, 130-137.
[2] Ye, C., Ruan, Y., Zou, L., Li, G., Li, C., Chen, Y., et al. (2014) The 2011 Survey on Hypertensive Disorders of Pregnancy (HDP) in China: Prevalence, Risk Factors, Complications, Pregnancy and Perinatal Outcomes. PLoS ONE, 9, e100180.
[3] Ghulmiyyah, L. and Sibai, B. (2012) Maternal Mortality from Preeclampsia/Eclampsia. Seminars in Perinatology, 36, 56-59.
[4] Jim, B., Sharma, S., Kebede, T. and Acharya, A. (2010) Hypertension in Pregnancy: A Comprehensive Update. Cardiology in Review, 18, 178-189.
[5] Papp, Z. and Fekete, T. (2003) The Evolving Role of Ultrasound in Obstetrics/Gynecology Practice. International Journal of Gynecology Obstetrics, 82, 339-346.
[6] Dikshit, S. (2011) Fresh Look at the Doppler Changes in Pregnancies with Placental-Based Complications. Journal of Postgraduate Medicine, 57, 138-140.
[7] Campbell, S., Vyas, S. and Nicolaides, K.H. (1991) Doppler Investigation of the Fetal Circulation. Journal of Perinatal Medicine, 19, 21-26.
[8] Moran, M. and McAuliffe, F.M. (2011) Imaging and Assessment of Placental Function. Journal of Clinical Ultrasound, 39, 390-398.
[9] Baschat, A.A., Gembruch, U., Reiss, I., Gortner, L., Weiner, C.P. and Harman, C.R. (2000) Relationship between Arterial and Venous Doppler and Perinatal Outcome in Fetal Growth Restriction. Ultrasound in Obstetrics Gynecology, 16, 407-413.
[10] Fardiazar, Z., Atashkhouei, S., Yosefzad, Y., Goldust, M. and Torab, R. (2013) Comparison of Fetal Middle Cerebral Arteries, Umbilical and Uterin Artery Color Doppler Ultrasound with Blood Gas Analysis in Pregnancy Complicated by IUGR. Iranian Journal of Reproductive Medicine, 11, 47-51.
[11] Brosens, I.A., Robertson, W.B. and Dixon, H.G. (1972) The Role of the Spiral Arteries in the Pathogenesis of Preeclampsia. Obstetrics Gynecology Annual, 1, 177-191.
[12] Prefumo, F., Sebire, N.J. and Thilaganathan, B. (2004) Decreased Endovascular Trophoblast Invasion in First Trimester Pregnancies with High-Resistance Uterine Artery Doppler Indices. Human Reproduction, 19, 206-209.
[13] Olofsson, P., Laurini, R.N. and Marsal, K. (1993) A High Uterine Artery Pulsatility Index Reflects a Defective Development of Placental Bed Spiral Arteries in Pregnancies Complicated by Hypertension and Fetal Growth Retardation. European Journal of Obstetrics & Gynecology and Reproductive Biology, 49, 161-168.
[14] Cunningham, F.G., Leveno, K.J., Bloom, S.L., Hauth, J.C., Rouse, D.J. and Spong, C.Y. (2010) Pregnancy Hypertension. In: Cunningham, F.G., Leveno, K.J., Bloom, S.L., Hauth, J.C., Rouse, D.J. and Spong, C.Y., Eds., Williams Obstetrics, 23rd Edition, McGraw-Hill, New York, 706-756.
[15] American College of Obstetricians and Gynecologists (2013) ACOG Practice Bulletin No. 134: Fetal Growth Restriction. Obstetrics & Gynecology, 121, 1122-1133.
[16] Ertan, A.K., Hendrik, H.J., Tanriverdi, H.A., Bechtold, M. and Schmidt, W. (2003) Fetomaternal Doppler Sonography Nomograms. Clinical and Experimental Obstetrics and Gynecology, 30, 211-216.
[17] Prefumo, F., Bhide, A., Sairam, S., Penna, L., Hollis, B. and Thilaganathan, B. (2004) Effect of Parity on Second-Trimester Uterine Artery Doppler Flow Velocity and Waveforms. Ultrasound in Obstetrics and Gynecology, 23, 46-49.
[18] Harman, C.R. and Baschat, A.A. (2003) Comprehensive Assessment of Fetal Wellbeing: Which Doppler Tests Should Be Performed? Current Opinion in Obstetrics and Gynecology, 15, 147-157.
[19] Goynumer, G., Yayla, M., Arisoy, R. and Durukan, B. (2009) The Effect of Parity on Midgestational Uterine Artery Doppler Findings in Uncomplicated and Low-Risk Pregnancies. Gynecologic and Obstetric Investigation, 68, 191-195.
[20] Pirhonen, J., Berqersen, T.K., Abdlenoor, M., Dubiel, M. and Gudmundsson, S. (2005) Effect of Maternal Age on Uterine Flow Impedance. Journal of Clinical Ultrasound, 33, 14-17.
[21] Fong, K., Ryan, M.L., Cohen, H., Amankwah, K., Ohlsson, A., Myhr, T., et al. (1996) Doppler Velocimetry of the Fetal Middle Cerebral and Renal Arteries: Interobserver Reliability. Journal of Ultrasound in Medicine, 15, 317-321.
[22] Figueras, F., Fernandez, S., Eixarch, E., Gomez, O., Martinez, J.M., Puerto, B. and Gratacos, E. (2006) Middle Cerebral Artery Pulsatility Index: Reliability at Different Sampling Sites. Ultrasound in Obstetrics and Gynecology, 28, 809-813.
[23] Nienhuis, S.J., van Vugt, J.M., Hooqland, H.J., Ruissen, C.J. and de Haan, J. (1988) Interexaminer Variability of Fetal Doppler Velocity Waveforms. Gynecologic and Obstetric Investigation, 25, 152-157.
[24] Gomez, O., Figueras, F., Martinez, J.M., del Rio, M., Palacio, M., Eixarch, E., et al. (2006) Sequential Changes in Uterine Artery Blood Flow Pattern between the First and Second Trimesters of Gestation in Relation to Pregnancy Outcome. Ultrasound in Obstetrics and Gynecology, 28, 802-808.

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