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Vaginal azygos artery: commonly unrecognized finding during transvaginal ultrasound in pregnancy

We describe here the characteristics of the Doppler waveform of the vaginal azygos arteries1 during pregnancy and their association with the uterine arteries. Transvaginal ultrasound was used to evaluate the cervix of 123 women with uncomplicated pregnancy between 11 and 40 weeks of gestation. Cervical length was measured using standardized methodology. Color directional Doppler was activated and adjusted to include the complete cervix and part of the vaginal wall. The posterior vaginal azygos artery was identified in all women (n = 123) in the midsagittal plane as a straight vessel located in the posterior vaginal wall anterior to the external cervical os (Figure 1). The spectral Doppler sample gate was placed in the segment of the posterior vaginal azygos artery that allowed optimal angle of insonation, and three to five regular waveforms were obtained in the absence of visible fetal movements and with the mother in temporary voluntary apnea. The procedure was repeated once and the mean value was calculated and considered to be representative of the patient. In 44 patients, the anterior vaginal azygos artery was evaluated in the midsagittal plane of the anterior vaginal wall. Doppler waveforms of the uterine arteries were also obtained. The Doppler waveform of the two vaginal azygos arteries showed low resistance and a notable diastolic component, with no significant changes observed during pregnancy and no notching seen at any gestational age. The posterior azygos artery pulsatility index (PI) ranged from 0.43 to 2.9 (mean, 1.2) and the peak systolic