METHODS: A prospective, longitudinal, observational study was conducted to quantify spiral artery distensibility (i.e. vessel luminal diameter at systole minus diameter at diastole) by B-flow/STIC M-mode ultrasonography during the first, second and third trimesters in 290 women exhibiting a normal pregnancy. Maternal serum levels of placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1), growth factors that modulate important events in spiral artery remodeling, were quantified in a subset of the women in the first, second and third trimesters of pregnancy.
RESULTS: Median (interquartile range (IQR)) spiral artery distensibility increased progressively between the first (0.17 (0.14-0.21) cm), second (0.23 (0.18-0.28) cm) and third (0.26 (0.21-0.35) cm) trimesters of pregnancy (P < 0.0001 for all). Median (IQR) spiral artery volume flow increased progressively between the first (2.49 (1.38-4.99) mL/cardiac cycle), second (3.86 (2.06-6.91) mL/cardiac cycle) and third (7.79 (3.83-14.98) mL/cardiac cycle) trimesters (P < 0.001 for all). In accordance with the elevation in spiral artery distensibility, the median (IQR) ratio of serum PlGF/sFlt-1 × 103 levels increased between the first (7.2 (4.5-10.0)), second (22.7 (18.6-42.2)) and third (56.2 (41.9-92.5)) trimesters (P < 0.001 for all).
CONCLUSIONS: The present study shows that B-flow/STIC M-mode ultrasonography provides an in-vivo imaging technology to quantify digitally the structural and physiological expansion of the walls of the spiral arteries during the cardiac cycle as a consequence of their transformation into compliant vessels during advancing stages of normal human pregnancy. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.
方法:进行了一项前瞻性纵向观察研究,以量化螺旋动脉扩张性,即收缩期血管腔直径减去舒张期血管腔直径,通过B流/STICM型超声检查,290名正常妊娠妇女的第二和第三三个月。母体血清胎盘生长因子(PlGF)和可溶性fms样酪氨酸激酶(sFlt-1)水平,调节螺旋动脉重塑中重要事件的生长因子,在第一次被量化的受试者的子集,第二和第三学期。
结果:中位数[第一个四分位数,第三四分]螺旋动脉扩张性在妊娠早期之间逐渐增加(P<0.0001)(0.17[0.14,0.21]),第二(0.23[0.18,0.28])和第三(0.26[0.21,0.35])妊娠三个月。螺旋动脉容积流量(ml/心动周期)逐渐增加(P<0.001)之间的第一个2.49[1.38,4.99],第二个3.86[2.06,6.91]和第三个7.79[3.83,14.98]三个月。伴随着螺旋动脉扩张性的升高,血清PlGF/sFlt-1水平的中位数比值增加(P<0.001)之间的第一个(7.2[4.5,10],第二(22.7[18.6,42.2])和第三(56.2[41.9,92.5]三个月。
结论:本研究表明,B流/STICM型超声检查提供了一种体内成像技术,以数字方式量化心动周期期间螺旋动脉壁的结构/生理扩张。在正常人怀孕的晚期阶段,螺旋动脉转化为顺应性血管。本文受版权保护。保留所有权利。