Presentation
Patient for routine fetal surveillance at twenty one weeks gestation with chronic hypertension and an obstetric history of three miscarriages at approximately sixteen to seventeen weeks gestation due to cervical incompetence. Currently a McDonald stitch in situ.
Patient Data
Bilateral maternal uterine arteries demonstrate multiple tortuous and kinking vessels (labeled ''c'') branching into their main course and showing bi-phasic Doppler waveforms on spectral Doppler analysis consistent with arterial collateral formations. There is delaying end diastolic flow (''dedf'') within the right uterine artery with mildly elevated pulsatility index at 1.90 and an ipsilateral resistive index of 0.70. The left main uterine artery shows early dicrotic notching (labeled ''d'') with mildly elevated pulsatility index at 1.47. The left uterine artery resistive index of 0.65 noted is within normal limits. Doppler indices within the mentioned arterial collaterals are unremarkable. McDonald stitch (not shown) is in situ.
Case Discussion
Multiple bilateral uterine arterial collaterals in a patient with chronic hypertension (clinically well controlled; currently BP = 131/87 mmHg) in a pregnancy at 22 weeks gestation by fetal ultrasound biometrics. No evidence of intrauterine growth restriction as yet as the maternal dates and the fundal height corresponds to 21 weeks gestation. No arterial or venous thrombosis in either side.
Delaying end diastolic flow on the right uterine artery and early dicrotic notch on the left resulting into mildly elevated pulsatility indices on both sides respectively noted is consistent with current hypertensive state and warrants follow-up scans and clinical monitoring.
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