Uterine artery blood flow velocity waveforms during uterine contractions

Objective No quantitative or qualitative Doppler velocimetry classification of vascular flow resistance covering all stages of forward and reversed flows exists. The objective of this study was to characterize uterine artery (UtA) flow velocity waveforms (FVWs) obtained during an oxytocin challenge test (OCT) and compare them to FVWs in spontaneous normal labor. Methods Uterine artery Doppler velocimetry was performed during and between uterine contractions in 61 high-risk pregnancies subjected to an OCT and in 20 normal pregnancies undergoing spontaneous labor. FVWs were classified relative to the Presence of forward/absent/reversed flow during systole and diastole, and the time-averaged flow velocity over the heart cycle. Results Eleven different FVW classes were identified. No relationship between FVWs recorded during uterine inertia and contractions was found (P greater than or equal to 0.2). In both groups, only forward FVWs were recorded between contractions, whereas during contractions flow reversal was more common in the OCT group (P less than or equal to 0.002). In cases of predominantly reversed flow, a reciprocal relationship to FVW classes recorded in the contralateral artery was found. Conclusions UtA FVW patterns recorded during uterine contractions were not predicted by flow patterns recorded during uterine inertia. Reversal of flow direction was more common during oxytocin-induced uterine contractions than during spontaneous contractions. In cases of predominantly reversed flow, domains of the uterus may be supplied by blood from the contralateral UtA. These observations give new insights into the circulatory dynamics of the uterus during labor, and also point to a possible vasoconstrictory effect in the UtAs of oxytocin at high concentrations. Copyright (C) 2003 ISUOG. Published by John Wiley Sons, Ltd.