Understanding abnormal uterine artery Doppler waveforms: a novel computational model to explore potential causes within the utero-placental vasculature
Open accessAbstract
Introduction Uterine artery (UtA) Doppler indices are one of the most commonly employed screening tests for pre-eclampsia worldwide. Abnormal indices appear to result from increased uterine vascular resistance, but anatomical complexity and lack of appropriate animal models mean that little is known about the relative contribution of each of the components of the uterine vasculature to the overall UtA Doppler waveform. Previous computational models suggested that trophoblast-mediated spiral artery remodeling has a dominant effect on the UtA Doppler waveform. However, these models did not incorporate the myometrial arterio-venous anastomoses, which have significant potential to affect utero-placental haemodynamics.Methods We present a more anatomically complete computational model, explicitly incorporating a structural description of each component of the uterine vasculature, and crucially including myometrial arterio-venous anastomoses as parallel pathways for blood-flow away from the placental bed. Wave transmission theory was applied to the network to predict UtA waveforms.Results Our model shows that high UtA resistance indices, combined with notching, reflect an abnormal remodeling of the entire uterine vasculature. Incomplete spiral artery remodeling alone is unlikely to cause abnormal UtA Doppler waveforms as increased resistance in these arteries can be 'buffered' by upstream anastomoses. Critically, our results indicate that the radial arteries, may have a more important effect on utero-placental flow dynamics, and the UtA Doppler waveform than previously thought.Conclusions This model suggests that to appropriately interpret UtA Doppler waveforms they must be considered to be reflecting changes in the entire system, rather than just the spiral arteries.
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The observed changes in uterine artery Doppler indices cannot be a direct result of inadequate spiral artery remodelling because the waveform does not change immediately after delivery of the placenta, when the spiral arteries are completely closed.
“However, the observed changes in uterine artery Doppler indices cannot be as a direct result of inadequate spiral artery remodelling as the waveform does not change immediately after delivery of the placenta, when the spiral arteries are completely closed [48].”
From Volume and vascularity: Using ultrasound to unlock the secrets of the first trimester placenta (2019) · cites this paper as [48]
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- Authors
- Clark, A. R., James, J. L., Stevenson, G. N., & Collins, S. L.
- Affiliations
- University of Auckland (NZ)
- UNSW Sydney (AU)
- John Radcliffe Hospital (GB)
- Corresponding author
- Clark, Alys R.
- Venue
- Placenta
- Publisher
- Elsevier BV
- Published
- 2018-06
- Volume
- 66
- Pages
- 74-81
- ISSN
- 0143-4004 (ISSN-L)
- PMC
- PMC6511649
- OpenAlex
- W2800510715
- Cited by
- 86
- References
- 49
- Citations by year
- 2026: 13 · 2025: 11 · 2024: 10 · 2023: 8 · 2022: 14 · 2021: 10 · 2020: 9 · 2019: 9 · 2018: 1 · 2017: 1
- FWCI
- 8.14
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Placenta (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- ResearchSpace (University of Auckland) (submittedVersion)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
- Funders
- Royal Society of New Zealand (13-UOA-032, 14-UOA-019)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (UO1 HD 087209)
- Leslie Stevens' Fund
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Psychiatry and Mental health › Neurological Complications and Syndromes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- preeclampsia screening, spiral artery remodeling, radial artery, uterine vascular resistance, uterine vasculature
- MeSH terms
- Animals, Arteriovenous Anastomosis, Blood Flow Velocity, Computer Simulation, Female, Hemodynamics, Humans, Models, Cardiovascular, Placenta, Pre-Eclampsia, Pregnancy, Vascular Resistance, Ultrasonography, Doppler, Computational Biology, Placental Circulation, Uterine Artery
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