OVARIAN STROMAL AND UTERIN ARTERY BLOOD FLOW PATTERN IN HYPERTENSIVE PATIENTS DIAGNOSED ON ULTRASOUND
DOI:
https://doi.org/10.71000/33ban706Keywords:
Hypertension, Uterine artery, Vascular resistance, Reproductive health, Blood Flow Velocity, Doppler Ultrasonography, , Ovarian ArteryAbstract
Background: Hypertension is a chronic systemic disorder that induces vascular remodeling, endothelial dysfunction, and elevated resistance across various organs, including the reproductive system. Despite extensive studies on hypertensive disorders in pregnancy, the hemodynamic effects of hypertension on uterine and ovarian circulation in non-pregnant women remain insufficiently explored. Understanding these vascular alterations is crucial, as compromised pelvic perfusion may contribute to menstrual irregularities, ovulatory dysfunction, and infertility.
Objective: To evaluate and compare the Doppler indices—Resistive Index (RI), Pulsatility Index (PI), and Peak Systolic Velocity (PSV)—of uterine and ovarian arteries between hypertensive and normotensive women.
Methods: A comparative cross-sectional study was conducted at Bahawalpur MRI & CT Scan Center over four months, enrolling 74 women aged 18–59 years. Participants were equally divided into hypertensive (n = 37) and normotensive (n = 37) groups. Transabdominal Doppler ultrasonography was performed using a 3–5 MHz curvilinear transducer to record RI, PI, and PSV of bilateral uterine and ovarian arteries. Data were analyzed using the independent samples t-test in SPSS version 26, and a p-value < 0.05 was considered statistically significant.
Results: Hypertensive women exhibited significantly higher mean RI and PI with reduced PSV in both uterine and ovarian arteries (p < 0.001). Specifically, the right uterine artery showed RI = 0.91 vs 0.69, PI = 2.45 vs 1.45, and PSV = 20.28 vs 28.41 cm/s in hypertensive versus normotensive participants, respectively. The left uterine artery demonstrated RI = 0.91 vs 0.69, PI = 2.52 vs 1.53, and PSV = 20.58 vs 26.57 cm/s, showing a similar trend. Comparable differences were observed in the ovarian stromal arteries, and 27% of hypertensive women reported menstrual irregularities.
Conclusion: Hypertension significantly increases vascular resistance and decreases blood flow velocity in uterine and ovarian arteries, indicating compromised pelvic perfusion. Doppler ultrasonography serves as a valuable, non-invasive diagnostic tool for detecting early vascular alterations in hypertensive women of reproductive age.
References
Wang W, Xie X, Yuan T, Wang Y, Zhao F, Zhou Z, et al. Epidemiological trends of maternal hypertensive disorders of pregnancy at the global, regional, and national levels: a population‐based study. BMC pregnancy and childbirth. 2021;21(1):364.
Caraveo CA, Johnston EM. Perinatal Health among Medicaid Beneficiaries in North Carolina, 2018. JSTOR; 2023.
Ford ND. Hypertensive disorders in pregnancy and mortality at delivery hospitalization—United States, 2017–2019. MMWR Morbidity and mortality weekly report. 2022;71.
Battarbee AN, Sinkey RG, Harper LM, Oparil S, Tita AT. Chronic hypertension in pregnancy. American journal of obstetrics and gynecology. 2020;222(6):532-41.
Zhou B, Perel P, Mensah GA, Ezzati M. Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nature Reviews Cardiology. 2021;18(11):785-802.
Organization WH. Global report on hypertension: the race against a silent killer: World Health Organization; 2023.
Schutte AE, Jafar TH, Poulter NR, Damasceno A, Khan NA, Nilsson PM, et al. Addressing global disparities in blood pressure control: perspectives of the International Society of Hypertension. Cardiovascular research. 2023;119(2):381-409.
Chapman N, Ching SM, Konradi AO, Nuyt AM, Khan T, Twumasi-Ankrah B, et al. Arterial hypertension in women: state of the art and knowledge gaps. Hypertension. 2023;80(6):1140-9.
Babington EA, Amedu C, Anyasor E, Reeve R. Non-contrast ultrasound assessment of blood flow in clinical practice. Journal Of Ultrasonography. 2024;24(98):1-9.
Amin TN. Ultrasound studies of the uterine venous circulation: UCL (University College London); 2020.
Xu Y, Xie D. Prediction of factors associated with abnormal uterine bleeding by transvaginal ultrasound combined with bleeding pattern. Computational and Mathematical Methods in Medicine. 2022;2022(1):5653250.
Wojtowicz K, Góra T, Guzik P, Harpula M, Chechliński P, Wolak E, et al. Uterine myomas and sarcomas–clinical and ultrasound characteristics and differential diagnosis using pulsed and color Doppler techniques. Journal of Ultrasonography. 2022;22(89):100.
Choi YJ, Lee HK, Kim SK. Doppler ultrasound investigation of female infertility. Obstetrics & Gynecology Science. 2023;66(2):58-68.
Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nature Reviews Nephrology. 2020;16(4):223-37.
Kinnear HM, Tomaszewski CE, Chang AL, Moravek MB, Xu M, Padmanabhan V, et al. The ovarian stroma as a new frontier. Reproduction. 2020;160(3):R25-R39.
Kennedy KE, Onyeonwu C, Nowakowski S, Hale L, Branas CC, Killgore WD, et al. Menstrual regularity and bleeding is associated with sleep duration, sleep quality and fatigue in a community sample. Journal of Sleep Research. 2022;31(1):e13434.
Leung K-Y. Applications of advanced ultrasound technology in obstetrics. Diagnostics. 2021;11(7):1217.
de Ganzo Suárez T, de Paco Matallana C, Plasencia W. Spiral, uterine artery doppler and placental ultrasound in relation to preeclampsia. Best Pract Res Clin Obstet Gynaecol. 2024;92:102426.
Campbell NE, Deer EM, Herrock OT, LaMarca BB. The Role of Different Lymphoid Cell Populations in Preeclampsia Pathophysiology. Kidney360. 2022;3(10):1785-94.
Wang X, Shields C, Tardo G, Peacock G, Hester E, Anderson M, et al. IL-33 supplementation improves uterine artery resistance and maternal hypertension in response to placental ischemia. Am J Physiol Heart Circ Physiol. 2024;326(4):H1006-h16.
Kissas G, Hwuang E, Thompson EW, Schwartz N, Detre JA, Witschey WR, et al. Feasibility of Vascular Parameter Estimation for Assessing Hypertensive Pregnancy Disorders. J Biomech Eng. 2022;144(12).
Marek A, Stojko R, Drosdzol-Cop A. Copeptin in Patients with Pregnancy-Induced Hypertension. Int J Environ Res Public Health. 2021;18(12).
David AL, Spencer RN. Clinical Assessment of Fetal Well-Being and Fetal Safety Indicators. J Clin Pharmacol. 2022;62 Suppl 1(Suppl 1):S67-s78.
Lee CC, Chen CP, Chen CY, Wang LK, Chen YY. Clinical and sonographic risk factors for developing pre-eclampsia refractory to aspirin prophylaxis. Taiwan J Obstet Gynecol. 2024;63(6):874-9.
Kametas NA, Nzelu D, Nicolaides KH. Chronic hypertension and superimposed preeclampsia: screening and diagnosis. Am J Obstet Gynecol. 2022;226(2s):S1182-s95.
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Copyright (c) 2025 Iqra Shahbaz, Hafiza Fatima Naseem, Muhammad Nauman Saleem, Friha Yaseen, Aqsa Rao, Muhammad Yasir Aziz (Author)
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