Donald School Journal of Ultrasound in Obstetrics and Gynecology

Register      Login

VOLUME 17 , ISSUE 1 ( January-March, 2023 ) > List of Articles


Three-dimensional Power Doppler Ultrasonography Evaluation of Maternal Orbital Perfusion in Pregnancies with Gestational Diabetes Mellitus

Riko Takayoshi, Toshiyuki Hata, Yasunari Miyagi, Takahito Miyake, Kenji Kanenishi

Keywords : Gestational diabetes mellitus, Maternal orbital perfusion, Maternal orbital vascular sonobiopsy, Normal pregnancy, Three-dimensional power Doppler ultrasound

Citation Information : Takayoshi R, Hata T, Miyagi Y, Miyake T, Kanenishi K. Three-dimensional Power Doppler Ultrasonography Evaluation of Maternal Orbital Perfusion in Pregnancies with Gestational Diabetes Mellitus. Donald School J Ultrasound Obstet Gynecol 2023; 17 (1):5-10.

DOI: 10.5005/jp-journals-10009-1966

License: CC BY-NC 4.0

Published Online: 14-04-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Objective: Determine the level of maternal orbital perfusion in gestational diabetes mellitus (GDM) pregnant women using maternal orbital vascular sonobiopsy (MOVS) and three-dimensional (3D) power Doppler ultrasound methods. Methods: The use of 3D power Doppler ultrasonography (3D-PDUS) for maternal orbital perfusion, together with virtual organ computer-aided analysis (VOCAL) histogram analysis, was carried out in 33 pregnancies between 25 and 40 weeks of gestation, including 18 cases of normal pregnancy (control) and 15 cases of gestational diabetes. The 3D power Doppler indices, such as the vascularization index (VI), flow index (FI), and vascularization FI (VFI), were calculated in both orbits of the individual group. The average value of each index for the two orbits was evaluated for further investigation. Both inter and intraobserver agreements of 3D-PDUS were examined. Results: In the Bland–Altman test, the mean percentage difference and 95% limits of intra and interobserver agreements for VI, FI, and VFI were 0.0803% (7.3417, -7.181) and -0.6823% (10.8095, -12.1742), -0.4816% (6.0624, -7.0256) and 0% (9.0746, -8.8384), and 0.0058% (2.6937, -2.6821) and -0.2892% (3.8910, -4.4694), respectively. The correlation for all three 3D-PD indices, that is, VI, FI, and VFI, was higher than 0.75 (0.7832–0.9749). The VI, FI, and VFI levels between control and GDM pregnancies did not change significantly. Conclusion: Our findings suggest that MOVS, which was assessed using 3D-PDUS and VOCAL histogram analysis, can offer fresh perspectives on observing maternal orbital perfusion in both healthy and dysfunctional pregnancies.

  1. Hata T, Senoh D, Hata K, Kitao M. Ophthalmic artery velocimetry in pregnant women. Lancet 1992;340(8812):182–183. DOI: 10.1016/0140-6736(92)93268-r
  2. Hata T, Senoh D, Hata K, et al. Ophthalmic artery velocimetry in preeclampsia. Gynecol Obstet Invest 1995;40(1):32–35. DOI: 10.1159/000292298
  3. Hata T, Hata K, Moritake K. Maternal ophthalmic artery Doppler velocimetry in normotensive pregnancies and pregnancies complicated by hypertensive disorders. Am J Obstet Gynecol 1997;177(1):174–178. DOI: 10.1016/s0002-9378(97)70458-7
  4. Ohno Y, Kawai M, Wakahara Y, et al. Ophthalmic artery velocimetry in normotensive and preeclamptic women with or without photophobia. Obstet Gynecol 1999;94(3):361–363. DOI: 10.1016/s0029-7844(99)00294-x
  5. Takata M, Nakatsuka M, Kudo T. Differential blood flow in uterine, ophthalmic, and brachial arteries of preeclamptic women. Obstet Gynecol 2002;100(5 Pt 1):931–939. DOI: 10.1016/s0029-7844(02)02244-5
  6. Hata T, Miyazaki K. Maternal ophthalmic artery Doppler velocimetry in normotensive pregnancies with small-for-gestational-age infants. Ultrasound Obstet Gynecol 1998;11(5):328–331. DOI: 10.1046/j.1469-0705.1998.11050328.x
  7. Hata T, Yanagihara T, Tanaka H, et al. Maternal ophthalmic artery Doppler velocimetry in type 1 diabetes during pregnancy. Hum Reprod 2000;15(1):222–223. DOI: 10.1093/humrep/15.1.222
  8. Rodrigues S, Robinson EJ, Ghezzo H, et al. Interaction of body weight and ethnicity on risk of gestational diabetes. Am J Clin Nutr 1999;70(6):1083–1089. DOI: 10.1093/ajcn/70.6.1083
  9. Mrizak I, Arfa A, Fekih M, et al. Inflammation and impaired endothelium-dependant vasodilatation in non obese women with gestational diabetes mellitus: preliminary results. Lipids Health Dis 2013;12:93. DOI: 10.1186/1476-511X-12-93
  10. Stanley JL, Sankaralingam S, Baker PN, et al. Previous gestational diabetes impairs long-term endothelial function in a mouse model of complicated pregnancy. Am J Physiol Regul Integr Comp Physiol 2010;299(3):R862–R870. DOI: 10.1152/ajpregu.00200.2010
  11. Hanna FW, Peters JR, Harlow J, et al. Gestational diabetes screening and glycaemic management; national survey on behalf of the Association of British Clinical Diabetologists. QJM 2008;101(10):777–784. DOI: 10.1093/qjmed/hcn069
  12. Anastasiou E, Lekakis JP, Alevizaki M, et al. Impaired endothelium-dependent vasodilatation in women with previous gestational diabetes. Diabetes Care 1998;21(12): 2111–2115. DOI: 10.2337/diacare.21.12.2111
  13. Pleiner J, Mittermayer F, Langenberger H, et al. Impaired vascular nitric oxide bioactivity in women with previous gestational diabetes. Wien Klin Wochenschr 2007;119(15-16):483–489. DOI: 10.1007/s00508-007-0838-8
  14. Yu CH, Chang CH, Ko HC, et al. Assessment of placental fractional moving blood volume using quantitative three-dimensional power Doppler ultrasound. Ultrasound Med Biol 2003;29(1):19–23. DOI: 10.1016/s0301-5629(02)00695-6
  15. Merce LT, Barco MJ, Bau S. Reproducibility of the study of placental vascularization by three-dimensional power Doppler. J Perinat Med 2004;32(3):228–233. DOI: 10.1515/JPM.2004.043
  16. Merce LT, Barco MJ, Bau S, et al. Assessment of placental vascularization by three-dimensional power Doppler “vascular biopsy” in normal pregnancies. Croat Med J 2005;46(5):765–771.
  17. Noguchi J, Hata K, Tanaka H, et al. Placental vascular sonobiopsy using three-dimensional power Doppler ultrasound in normal and growth restricted fetuses. Placenta 2009;30(5):391–397. DOI: 10.1016/j.placenta.2009.02.010
  18. Hata T, Tanaka H, Noguchi J, et al. Three-dimensional ultrasound evaluation of the placenta. Placenta 2011;32(2):105–115. DOI: 10.1016/j.placenta.2010.11.001
  19. Noguchi J, Tanaka H, Koyanagi A, et al. Three-dimensional power Doppler indices at 18-22 weeks’ gestation for prediction of fetal growth restriction or pregnancy-induced hypertension. Arch Gynecol Obstet 2015;292(1):75–79. DOI: 10.1007/s00404-014-3603-z
  20. Sato M, Noguchi J, Mashima M, et al. 3D power Doppler ultrasound assessment of placental perfusion during uterine contraction in labor. Placenta 2016;45:32–36. DOI: 10.1016/j.placenta.2016.06.018
  21. Metzger BE, Gabbe SG, Persson B, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010;33(3):676–682. DOI: 10.2337/dc09-1848
  22. Okai T. Standard values of ultrasonic measurements in Japanese fetuses. J Med Ultrason 2003;30:J415–J440.
  23. Pairleitner H, Steiner H, Hasenoehrl G, et al. Three-dimensional power Doppler sonography: imaging and quantifying blood flow and vascularization. Ultrasound Obstet Gynecol 1999;14(2):139–143. DOI: 10.1046/j.1469-0705.1999.14020139.x
  24. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1(8476):307–310.
  25. Kalafat E, Laoreti A, Khalil A, et al. Ophthalmic artery Doppler for prediction of pre-eclampsia: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018;51(6):731–737. DOI: 10.1002/uog.19002
  26. Debs Diniz AL. Conflict in interpretation of ophthalmic artery Doppler waveform. Ultrasound Obstet Gynecol 2019;53: 135–138. DOI: 10.1002/uog.20156
  27. Bentley-Lewis R. Late cardiovascular consequences of gestational diabetes mellitus. Semin Reprod Med 2009;27(4):322–329. DOI: 10.1055/s-0029-1225260
  28. Stanley JL, Cheung CC, Rueda-Clausen CF, et al. Effect of gestational diabetes on maternal artery function. Reprod Sci 2011;18(4):342–352. DOI: 10.1177/1933719110393029
  29. Kremkau FW. Contemporary ultrasound technology. Ultrasound Obstet Gynecol 1995;6(4):233–236. DOI: 10.1046/j.1469-0705.1995.06040233.x
  30. AIUM. Medical Ultrasound Safety. (Laurel, Maryland:. American Institute of Ultrasound in Medicine). 1994.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.