Uterine arteries arterial collaterals

Case contributed by Dennis Odhiambo Agolah
Diagnosis almost certain


Patient for routine fetal surveillance at twenty one weeks gestation with chronic hypertension and bad obstetrics history (BOH) previously have had three miscarriages at approximately sixteen to seventeen weeks gestation due to cervical incompetence. currently a Mc Donald stitch in situ.

Patient Data

Age: 35 Years
Gender: Female

Bilateral maternal uterine arteries demonstrates multiple tortuous and kinking vessels (labeled ''c'') branching into their main course and showing bi-phasic Doppler wave-forms 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 is unremarkable.

Case Discussion

Multiple right and left uterine arteries arterial collaterals in a patient with chronic hypertension (clinically well controlled; currently BP = 131/87 mmHg) in pregnancy at 22 weeks maturity 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. Mac Donald stitch (not shown), is in situ.

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