Abnormal Doppler Indices Research Articles

The First Fetal Case of Shwachman-Diamond Syndrome Mimicking Vascular Growth Restriction.

Shwachman-Diamond Syndrome (SDS) is a rare autosomal recessive genetic condition with 90% of cases associated with biallelic pathogenic variants in the Shwachman-Bodian-Diamond Syndrome (SBDS) gene on chromosome 7q.11.21. SDS belongs to ribosomopathies since SBDS gene encodes a protein involved in ribosomal maturation. Its phenotypic postnatal hallmark features include growth delay, bone marrow failure, exocrine pancreatic insufficiency, and skeletal abnormalities. We report a first fetal case of Shwachman-Diamond syndrome and extend its phenotype before birth. The clinical features mimicked vascular growth restriction with FGR and shortened long bones, associated with abnormal Doppler indices. Non-restricted fetal autopsy after termination of pregnancy allowed deep phenotyping disclosing the features of fetal skeletal dysplasia. Post-fetopathological trio exome sequencing identified biallelic pathogenic variants in the SBDS gene. Genotype-phenotype correlations confirmed the diagnosis and enabled an adequate genetic counseling of the parents. Our case is another example of the positive impact of fetal autopsy coupled with post-fetopathological genomic studies, even in the cases that were hitherto classified as maternal or fetal vascular malperfusion.

Placental growth factor and fetoplacental Doppler indices in combination predict preterm birth reliably in pregnancies complicated by fetal growth restriction.

To assess the association between placental biomarkers (placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1)/PlGF ratio) and fetoplacental Doppler indices (umbilical artery (UA) pulsatility index (PI) and uterine artery (UtA) PI) in various combinations for predicting preterm birth (PTB) in pregnancies complicated by fetal growth restriction (FGR). This was a prospective observational cohort study, performed at Mater Mother's Hospital in Brisbane, Queensland, Australia, from May 2022 to June 2023, of pregnancies complicated by FGR and appropriate-for-gestational-age (AGA) pregnancies. Maternal serum PlGF levels, sFlt-1/PlGF ratio, UA-PI and UtA-PI were measured at 2-4-weekly intervals from recruitment until delivery. Harrell's concordance statistic (Harrell's C) was used to evaluate multivariable Cox proportional hazards regression models featuring various combinations of placental biomarkers and fetoplacental Doppler indices to ascertain the best combination to predict PTB (< 37 weeks). Multivariable Cox regression models were used with biomarkers as time-varying covariates. The study cohort included 320 singleton pregnancies, comprising 179 (55.9%) affected by FGR, defined according to a Delphi consensus, and 141 (44.1%) with an AGA fetus. In the FGR cohort, both low PlGF levels and elevated sFlt-1/PlGF ratio were associated with significantly shorter time to PTB. Low PlGF was a better predictor of PTB than was either sFlt-1/PlGF ratio or a combination of PlGF and sFlt-1/PlGF ratio (Harrell's C, 0.81, 0.78 and 0.79, respectively). Although both Doppler indices were significantly associated with time to PTB, in combination they were better predictors of PTB than was either UA-PI > 95th centile or UtA-PI > 95th centile alone (Harrell's C, 0.82, 0.75 and 0.76, respectively). Predictive utility for PTB was best when PlGF < 100 ng/L, UA-PI > 95th centile and UtA-PI > 95th centile were combined (Harrell's C, 0.88) (hazard ratio, 32.99; 95% CI, 10.74-101.32). Low maternal serum PlGF level (< 100 ng/L) and abnormal fetoplacental Doppler indices (UA-PI > 95th centile and UtA-PI > 95th centile) in combination have the greatest predictive utility for PTB in pregnancies complicated by FGR. Their assessment may help guide clinical management of these complex pregnancies. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Color Doppler ultrasound in high-low risk pregnancies and its relationship to fetal outcomes: a cross-sectional study.

To calculate the multivessel color Doppler indices in high-risk and low-risk pregnancies and relate these to fetal outcomes. The investigation involved 60 patients who were pregnant. The patients were separated into groups according to assessment of low and high risk. The patients underwent color Doppler ultrasonography to detect the maternal and fetal blood vessels, and the measured Doppler indices were then analyzed for any association with fetal outcomes. The gestational stages (in weeks) of the participants at the respective times of investigation and delivery were 32.06 ± 2.98 and 36.2 ± 1.78 in the low-risk group and 29.21 ± 1.95 and 29.83 ± 1.86 in the high-risk group. The pulsatility index (PI), resistive index (RI), and systolic/diastolic ratio (SD) decreased with gestation length in the low-risk group, whereas in the high-risk group, these values increased in the uterine and umbilical arteries. With increased gestational stage, MCA-PSV (peak systolic velocity) in the middle cerebral artery (MCA) increased, while PI decreased. Pulsatile and reversal flow of the uterine vein, the vein of Galen, and the umbilical vein were noted in high-risk pregnancies, and these negatively affected the fetal outcome. The fetal venous parameters were more specific and sensitive for predicting an unfavorable fetal outcome than the arterial factors, with a greater negative predictive value. The results of our study indicate that abnormal Doppler indices of the blood vessels in high-risk pregnant patients will result in adverse clinical outcomes. Therefore, the patients can be monitored and managed accordingly using Doppler ultrasonography.

Umbilical Artery Doppler Indices in Hypertensive Disorders of Pregnancy: Impact on Fetal Outcomes.

Background Hypertensive disorders of pregnancy (HDP) are associated with increased maternal and fetal risks. Doppler ultrasound indices of the umbilical artery have shown promise in predicting adverse fetal outcomes in HDP patients. This observational study investigated the correlation between abnormal umbilical artery Doppler indices and adverse fetal outcomes in HDP patients. Methodology Over a two-year period from2020 to 2022, in Acharya Vinoba Bhave Rural Hospital, central India, we enrolled 138 pregnant women with HDP beyond 28 weeks of gestation and singleton pregnancies. Comprehensive clinical assessments, laboratory investigations, and Doppler studies of the umbilical artery were performed. Doppler indices assessed included the systolic/diastolic (S/D) ratio, resistance index (RI), and pulsatility index (PI). Adverse fetal outcomes were defined based on birth weight and neonatal intensive care unit admissions. Chi-square or Fisher's exact test was used for analyzing the relationship between qualitative data, while an independent-sample t-test was employed for quantitative data. Results Abnormal umbilical artery Doppler indices, including an elevated S/D ratio, RI, and PI, demonstrated a positive correlation with adverse fetal outcomes in HDP patients. These findings highlight the significance of umbilical artery Doppler indices as reliable indicators for anticipating adverse fetal outcomes in HDP patients. Conclusions Abnormal Doppler indices in the umbilical artery, including an elevated S/D ratio, RI, and PI, appear to be valuable predictors for adverse fetal outcomes in patients with HDP. Monitoring these indices can aid in risk stratification and improve the management of pregnancies complicated by HDP.

Fetal Renal Artery Doppler in Cases of Isolated Oligohydramnios: Can it Predict Adverse Neonatal Outcome?

Aims and Objectives: This study compares the fetal renal artery flow velocity waveforms of pregnancies complicated by oligohydramnios with normal pregnancies and to detect any statistically significant difference between the two Groups and to further determine the relationship of these findings with neonatal outcome. Method: All pregnant women in IIIrd trimester with gestational age between 32 weeks to 36 weeks with isolated oligohydramnios were included as cases (Group-A). Normal IIIrd trimester pregnancies (Group-B) with gestational age between 32 weeks to 36 weeks served as controls between the study period of Jan 2018 to Dec 2019. Results: The mean umbilical artery pulsatility index (PI; mean ± SD) in patients of Group-A was 1.0730 ± 0.0637 and that of patients in Group-B was 1.0012 ± 0.1400 with P = 0.0023. The mean umbilical artery S/D ratio (mean ± SD) in patients of Group-A, was 2.9120 ± 0.2476 and that of patients in Group-B was 2.5135 ± 0.2751 with P &lt; 0.0001. The mean renal artery PI (mean ± SD) in patients of Group-A was 2.5863 ± 0.2608 and that of patients in Group-B was 2.4737 ± 0.2648 with P = 0.0240. The mean birth weight and Apgar Score were also found to be statistically significant between the two Groups. Conclusion: The distribution of mean renal artery PI and umbilical artery PI, in oligohydramnios cases, was higher in comparison to normal cases. As the Neonatal intensive care unit (NICU) admission was higher in the oligohydramnios group with abnormal renal artery doppler indices, our recommendation is that abnormal fetal renal artery Doppler indices are an indication for early referral to tertiary care setup, as the majority of these neonates will require NICU care postdelivery.

Doppler velocimetry discordance between paired umbilical artery vessels and clinical implications in fetal growth restriction

Studies revealing a discrepancy in umbilical artery Dopplers between the two umbilical arteries in normally-grown fetuses necessitates further evaluation of the paired umbilical arteries in the setting of fetal growth restriction as this is a critical component in the surveillance of this population. Umbilical artery Doppler sampling in fetal growth restriction is typically assessed in 1 umbilical artery in a free loop of cord. Although discrepancies of >20% between the 2 umbilical arteries occur in 1 of 3 normal pregnancies, this has not been assessed in fetal growth restriction. Our objectives were to determine the frequency of discordant Doppler pulsatility indices between paired umbilical arteries in a fetal growth restriction cohort and to determine if sampling of 1 or both arteries alters surveillance or timing of delivery. A cohort of 425 growth-restricted fetuses between 25 and 39 weeks of gestation had umbilical artery Doppler pulsatility indices determined from both umbilical arteries in a midsegment of the cord to determine: (1) the discrepancy percentage between paired umbilical artery pulsatility indices and (2) the frequency of both arteries being normal, abnormal, or discordant (pulsatility index < and >95th percentile). To determine what sampling method increased the detection of an abnormal Doppler index, 3 sampling methods were compared: (1) average pulsatility index from both umbilical arteries, (2) pulsatility index from 1 umbilical artery chosen randomly, and (3) highest pulsatility index of the 2 umbilical arteries. The mean percentage difference between umbilical artery pulsatility indices was 11.7%, and in 15.8% of cases, it exceeded 20%. Both umbilical artery pulsatility indices were normal in 71.1% (302/425), abnormal in 12.2% (52/425), and discordant in 16.7% (71/425) of cases (P<.0001). Of the 3 sampling methods, the pulsatility index was abnormal in: (1) 19.2% (82/425) of cases when averaged from both umbilical arteries, (2) 22.1% (94/425) of caseswhen choosing 1 umbilical artery at random, and (3) 28.9% (123/425) of cases when the highest umbilical artery pulsatility index was used (P=.003). In this large fetal growth restriction cohort, the overall discrepancy between the 2 umbilical artery pulsatility indices was 11.7%. Among fetuses with at least 1 abnormal umbilical artery pulsatility index, 71 of 123 (57.7%) had 1 normal pulsatility index and 1 abnormal. Thus, the number of arteries sampled and the sampling method used may alter clinical decision-making, including frequency of surveillance and timing of delivery.

Association Between Fetal Thymus Size and Intrauterine Growth Restriction

Objective: The objective of this study was to evaluate the association between reduced fetal thymus size and intrauterine growth restriction (IUGR). This study was devised to determine the association between thymus size and any abnormal Doppler indices within the fetal umbilical artery (UA), as well as the middle cerebral artery (MCA). Materials and Methods: Forty-six pregnancies between 20 and 38 weeks of gestation with IUGR and 46 normal pregnancies within similar gestational age (GA) range were included. The transverse diameter of fetal thymus was measured. In the IUGR group, the fetal umbilical artery (UA) and middle cerebral artery (MCA) Doppler flow velocities were recorded. Results: The mean GA of fetuses with IUGR (33.5 weeks) was higher than control group (30.3 weeks). To adjust for the effect of GA, analysis of covariance (ANCOVA) was performed. The adjusted mean thymus diameters were 19.02 mm in IUGR and 21.25 within the control group (mean difference = 2.23 mm; P = .02). The mean (±SD) thymus size in 16 fetuses, with abnormal Doppler findings, was significantly lower than in the group with normal Doppler findings, 17.45 (±2.50) vs 22.02 (±5.39) mm; P &lt; .001. Conclusion: IUGR may be associated with reduced fetal thymus size, especially when coupled with abnormal Doppler findings. The thymus size in a group of IUGR fetuses, with abnormal Doppler findings, was smaller than IUGR fetuses, with normal Doppler findings.

Perinatal Outcomes in Premature Placental Calcification and the Association of a Color Doppler Study: Report from a Tertiary Care Hospital in Eastern India.

Introduction: Placental calcification, identified before the 36th week of gestational age, is known as premature placental calcification (PPC). PPC could be a clue for the poor fetal outcome. However, its association with adverse perinatal outcomes is yet to be confirmed. Objective: The primary objective was to determine and compare the perinatal outcomes in pregnancies with and without documented premature placental calcification. Methodology: The present study was a prospective cohort study performed from October 2017 to September 2019. We consecutively enrolled 494 antenatal women who presented to our antenatal OPD after taking consent to participate in our study. Transabdominal sonographies were conducted between 28–36 weeks of gestation to document placental maturity. We compared maternal and fetal outcomes between those who were identified with grade III placental calcification (n = 140) and those without grade III placental calcification (n = 354). Results: The incidence of preeclampsia, at least one abnormal Doppler index, obstetrics cholestasis, placental abruption, and FGR (fetal growth restriction) pregnancies were significantly higher in the group premature placental calcification. We also found a significantly increased incidence of Low APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) scores, NICU (Neonatal Intensive Care Unit) Admission, Abnormal CTG (cardiotocography), meconium-stained liquor, and low birth weight babies in those with grade III placental calcification. Conclusion: Clinicians should be aware of documenting placental grading while performing ultrasonography during 28 to 36 weeks. Ultrasonographically, the absence of PPC can define a subcategory of low-risk pregnant populations which probably need no referral to specialized centers and can be managed in these settings.

A study on neurosonography in neonates with hypoxic–ischemic encephalopathy and its correlation with neurodevelopmental outcome

Abstract Background: Hypoxic–ischemic encephalopathy (HIE) is a devastating condition causing severe neurologic deficits and deaths in children, occurring in about 1.5 out of 1000 live births. The pattern of brain injury depends on the severity and duration of hypoxia as well as the degree of brain maturation at the time of insult. The prognosis can depend largely on diagnosing the early screening of suspected cases, assessment of severity of the injury, and timely intervention. Aims and Objectives: This study is aimed at signifying the importance of neurosonography in neonates with HIE as a diagnostic tool and screening modality in the neonatal intensive care unit (NICU) and at establishing the role of neurosonography and Doppler sonography as an investigatory modality for predicting the neurological damage and influencing their neurodevelopmental outcome. Design: This is a prospective longitudinal-type study. Materials and Methods: A total of 50 neonates admitted in the NICU were included in the study from January 2017 to August 2018 with FUJIFILM SONOSITE (Bothell, Washington, USA) machine using a high-frequency linear probe (6–12 MHz) and convex probe (2–5 MHz). A total of 50 neonates admitted to the NICU were selected and enrolled in the study after fulfilling the selection criteria. The first scans were obtained within 72 h of birth, and subsequent follow-up scans were done between the 8th and 10th day and on the 30th day. The infants were then followed up after 6 to 12 months for a detailed neurological assessment. Statistical Analysis Used: All the statistical analyses were carried out using Fisher’s exact test. Results: Out of the eight neurosonographic (NSG) findings analyzed in our study that were found to be associated with hypoxemic brain changes, four of them showed a statistically significant correlation with high positive predictive value (PPV) with poor clinical outcome at 6 to 12 months of age. The PPV of neonates with ventriculomegaly, multicystic leukomalacia, abnormal Doppler indices, and intraventricular hemorrhage (IVH) was found to be 78%, 80%, 82%, and 87%, respectively. Conclusions: Neurosonography was found to be highly significant to predict the clinical outcome in neonates with HIE, and it should be used as the initial screening modality.

Evaluation of pregnancy outcome in cases of intrauterine growth restriction in relation to placenta apoptosis and doppler indices of the umbilical and uterine arteries

Objective: To assess apoptotic changes in trophoblastic cells in normal term placentae and term placentae complicated by either preeclampsia or intrauterine growth restriction (IUGR). Additionally, we aim to examine the correlation between these apoptotic changes and the Doppler velocity of the umbilical and uterine arteries. Methods: This prospective observational study was conducted on 150 pregnant women, including 100 cases with preeclampsia and 50 controls. Placentas were collected at delivery, and apoptotic changes were examined using light microscopy and immunohistochemical staining. Doppler velocimetries were performed to assess umbilical and uterine artery resistance indices. Pregnancy outcomes and neonatal data were recorded. Results: The incidence of apoptosis in placentae was significantly higher in the preeclampsia group compared to the control group (p&lt;0.001). The umbilical and uterine resistance indices were also significantly higher in the preeclampsia group (p&lt;0.001). There was a positive correlation between the incidence of apoptosis and Doppler resistance indices in the preeclampsia group. Fetal birth weight, Apgar scores at 1 and 5 minutes, and gestational age at delivery were significantly lower in the preeclampsia group (p&lt;0.001). Conclusions: Increased placental apoptosis and abnormal Doppler indices are associated with preeclampsia and adverse pregnancy outcomes.

Multimodality cardiac evaluation in children and young adults with multisystem inflammation associated with COVID-19.

AimsFollowing the peak of the UK COVID-19 epidemic, a new multisystem inflammatory condition with significant cardiovascular effects emerged in young people. We utilized multimodality imaging to provide a detailed sequential description of the cardiac involvement.Methods and ResultsTwenty consecutive patients (mean age 10.6 ± 3.8 years) presenting to our institution underwent serial echocardiographic evaluation on admission (median day 5 of illness), the day coinciding with worst cardiac function (median day 7), and the day of discharge (median day 15). We performed cardiac computed tomography (CT) to assess coronary anatomy (median day 15) and cardiac magnetic resonance imaging (CMR) to assess dysfunction (median day 20). On admission, almost all patients displayed abnormal strain and tissue Doppler indices. Three-dimensional (3D) echocardiographic ejection fraction (EF) was <55% in half of the patients. Valvular regurgitation (75%) and small pericardial effusions (10%) were detected. Serial echocardiography demonstrated that the mean 3D EF deteriorated (54.7 ± 8.3% vs. 46.4 ± 8.6%, P = 0.017) before improving at discharge (P = 0.008). Left main coronary artery (LMCA) dimensions were significantly larger at discharge than at admission (Z score –0.11 ± 0.87 vs. 0.78 ± 1.23, P = 0.007). CT showed uniform coronary artery dilatation commonly affecting the LMCA (9/12). CMR detected abnormal strain in all patients with global dysfunction (EF <55%) in 35%, myocardial oedema in 50%, and subendocardial infarct in 5% (1/20) patients.ConclusionsPancarditis with cardiac dysfunction is common and associated with myocardial oedema. Patients require close monitoring due to coronary artery dilatation and the risk of thrombotic myocardial infarction.

Comparison of Gray Scale and Color Doppler Sonography with Cytopathology Findings in Cervical Lymphadenopathy in Tertiary Level Hospital

Introduction: Cervical region is the commonest area of lymphadenopathy which is easily accessible to ultrasound and Doppler study. The morphological and vascular-architectural differences among various nodal diseases aids in differentiating benign from malignant causes.&#x0D; Methods: The study was done on the 108 patients referred to Department of Radiology andImaging, TUTH for ultrasound of cervical lymphadenopathy who subsequently underwentFNAC examination. Gray scale evaluation for morphology of the nodes along with Doppler evaluation for resistive index (RI), pulsatility index (PI) and Peak systolic velocity (PSV) were done and correlated with FNAC findings.&#x0D; Results: Among the 108 lymph nodes, 24 were proven to be malignant on FNAC. Features such as S/L ratio &gt;0.5, absence of echogenic hilum, and abnormal vascular pattern demonstrated sensitivities of 96%, 92%, and 87%, specificities of 74%, 65% and 77% and positive predictive values (PPVs) of 51%, 43%, and 55% respectively. The cutoff values for RI, PI and PSV were found to be 0.705, 1.34 and 17.5 cm/s with sensitivities of 96%, 96% and 87%, specificities of 95%, 99% and 88% and positive predictive values (PPVs) of 85%, 95% and 70% respectively.&#x0D; Conclusion: Ultrasound findings of S/L ratio, absence of echogenic hilum, abnormal vascular pattern and Doppler indices revealed good sensitivity, specificity, and accuracy in differentiating benign and malignant lymph nodes.

Relationship Between Placental Calcification and Estimated Fetal Weight Percentile at 30-34 Weeks of Pregnancy

Objectives: The identification of at-risk fetus is considered as one of the most difficult challenges for clinicians and researchers although the clinical significance of placental calcifications (PCs) and its relation to adverse pregnancy outcome are controversial. Therefore, the present study aimed to evaluate the relationship between PC and estimated fetal weight (EFW) percentile at 30-34 weeks of pregnancy. Materials and Methods: This prospective cross-sectional study was carried out on all pregnant women except for multiple pregnancy subjects who were admitted to an outpatient perinatal center from October 2016 to September 2018. Several parameters were measured at 30-34 weeks of pregnancy, including EFW, umbilical artery pulsatility index (PI), middle cerebral artery PI, cerebroplacental ratio (CPR), right and left uterine artery PI, along with right and left uterine artery notch. Finally, the calcification of the placenta with any shape and degree was determined as well. Results: In this study, 739 pregnant women were evaluated for PC, including patients with PC (9.87%), small-for-gestational age (SGA, 3.65%), and those with at least one abnormal Doppler index (23.95%). Patients with PC and those with at least one abnormal Doppler index had significantly higher SGA (29.62% and 12.42%, respectively). In addition, there were 55.55% and 30.13% patients with SGA and PC in the group with at least one abnormality in terms of Doppler indices. Conclusions: In general, the findings showed that PC is more common in SGA. Based on the results, at least one abnormality in Doppler indices was more common in PC and SGA, and uterine artery Doppler abnormality was the most prevalent abnormal findings in the arterial Doppler. Thus, PC may be an important marker for adverse pregnancy outcomes.

An abnormal cerebroplacental ratio (CPR) is predictive of early childhood delayed neurodevelopment in the setting of fetal growth restriction

Fetal growth restriction accounts for a significant proportion of perinatal morbidity and death. The cerebroplacental ratio is gaining much interest as a useful tool in differentiating the "at-risk" fetus in both fetal growth restriction and appropriate-for-gestational-age pregnancies. The Prospective Observational Trial to Optimize Pediatric Health in Fetal Growth Restriction group has demonstrated previously that the presence of this "brain-sparing" effect is associated significantly with adverse perinatal outcomes in the fetal growth restriction cohort. However, data about neurodevelopment in children from pregnancies that are complicated by fetal growth restriction are sparse and conflicting. The aim of the Prospective Observational Trial to Optimize Pediatric Health in Fetal Growth Restriction NeuroDevelopmental Assessment Study was to determine whether children born after fetal growth-restricted pregnancies are at additional risk of adverse early childhood developmental outcomes compared with children born small for gestational age. The objective of this secondary analysis was to describe the role of cerebroplacental ratio in the prediction of adverse early childhood neurodevelopmental outcome. Participants were recruited prospectively from the Perinatal Ireland multicenter observational Prospective Observational Trial to Optimize Pediatric Health in Fetal Growth Restriction study cohort. Fetal growth restriction was defined as birthweight <10th percentile with abnormal antenatal umbilical artery Doppler indices. Small for gestational age was defined similarly in the absence of abnormal Doppler indices. Cerebroplacental ratio was calculated with the pulsatility indices of the middle cerebral artery and divided by umbilical artery with an abnormal value <1. Children (n=375) were assessed at 3 years with the use of the Ages and Stages Questionnaire and the Bayley Scales of Infant and Toddler Development, 3rd edition. Small-for-gestational-age pregnancies with normal Doppler indices were compared with (1) fetal growth-restricted cases with abnormal umbilical artery Doppler and normal cerebroplacental ratio or (2) fetal growth restriction cases with both abnormal umbilical artery and cerebroplacental ratio. Statistical analysis was performed with statistical software via 2-sample t-test with Bonferroni adjustment, and a probability value of .00625 was considered significant. Assessments were performed on 198 small-for-gestational-age children, 136 fetal growth-restricted children with abnormal umbilical artery Doppler images and normal cerebroplacental ratio, and 41 fetal growth-restricted children with both abnormal umbilical artery Doppler and cerebroplacental ratio. At 3 years of age, although there were no differences in head circumference, children who also had an abnormal cerebroplacental ratio had persistently shorter stature (P=.005) and lower weight (P=.18). Children from fetal growth restriction-affected pregnancies demonstrated poorer neurodevelopmental outcome than their small-for-gestational-age counterparts. Fetal growth-restricted pregnancies with an abnormal cerebroplacental ratio had significantly poorer neurologic outcome at 3 years of age across all measured variables. We have demonstrated that growth-restricted pregnancies with a cerebroplacental ratio <1 have a significantly increased risk of delayed neurodevelopment at 3 years of age when compared with pregnancies with abnormal umbilical artery Doppler evidence alone. This study further substantiates the benefit of routine assessment of cerebroplacental ratio in fetal growth-restricted pregnancies and for counseling parents regarding the long-term outcome of affected infants.

111: An abnormal Cerebro-Placental-Ratio is predictive of early childhood delayed neurodevelopment in fetal growth restricted infants

The aim of the PORTO- NeuroDevelopmental Assessment Study (PANDA) was to determine if children born after fetal growth restriction (FGR) pregnancies are at additional risk of early childhood development delays compared to children born small for gestational age (SGA). The objective of this secondary analysis was to describe the role of the cerebroplacental ratio (CPR) in the prediction of adverse early childhood neurodevelopmental outcome. Participants were prospectively recruited from the Perinatal Ireland multicenter observational PORTO study cohort. FGR was defined as birth weight <10th with abnormal antenatal Doppler indices. SGA was similarly defined in the absence of abnormal Doppler indices. CPR was calculated using the pulsatility indices of the middle cerebral and divided by umbilical artery (UA) with an abnormal value <1. Children (n=375) were assessed at three years using the Ages and Stages Questionnaire and the Bayley Scales of Infant and Toddler Development, III. SGA pregnancies with normal Doppler indices were compared with: 1) FGR cases with abnormal UA Doppler and normal CPR; or 2) FGR cases with both abnormal UA & CPR. Statistical analysis was performed using SAS version 9.2 via two-sample t-test with Bonferroni adjustment and p-value of 0.00625 significant. Assessments were performed on 198 SGA children; 136 FGR children with abnormal UA Doppler and normal CPR and 41 FGR children with both abnormal UA Doppler and CPR. At three years of age, while there were no differences in head circumference, children who also had an abnormal CPR had persistently shorter stature (p=0.005) and lower weight (p=0.18). Children from FGR affected pregnancies demonstrated poorer neurodevelopmental outcome than their SGA counterparts. FGR pregnancies with an abnormal CPR had significantly poorer neurological outcome at three years of age across all measured variables (Tables 1 & 2). We have demonstrated that growth restricted pregnancies with a CPR <1, have significantly increased risk of delayed neurodevelopment at three years of age when compared to pregnancies with abnormal UA Doppler alone. This study further substantiates the benefit of routine assessment of CPR in FGR pregnancies and for counseling parents regarding the long-term outcome of affected infants.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Maternal hemodynamics, fetal biometry and Doppler indices in pregnancies followed up for suspected fetal growth restriction.

To assess whether, in a cohort of patients with a small-for-gestational-age (SGA) fetus with estimated fetal weight ≤ 10th percentile, maternal hemodynamics, fetal biometry and Doppler indices at presentation can predict the subsequent development of an abnormal fetal Doppler index or delivery of a baby with birth weight < 3rd percentile. This was a prospective observational cohort study conducted at a specialist clinic for the management of pregnancies with a SGA fetus at King's College Hospital, London, UK. The study population comprised 86 singleton pregnancies with a SGA fetus, presenting at a median gestational age of 32 (range, 26-35) weeks. We measured maternal cardiac function using a non-invasive transthoracic bioreactance monitor, as well as mean arterial pressure, fetal biometry, and umbilical artery (UA), fetal middle cerebral artery (MCA) and uterine artery (UtA) pulsatility indices (PI), and the deepest vertical pool of amniotic fluid. Z-scores of these variables were calculated based on reported reference ranges and the values were compared between pregnancies with evidence of an abnormal fetal Doppler index at presentation (Group 1), those that had developed an abnormal Doppler index at a subsequent visit (Group 2) and those that did not develop an abnormal Doppler index throughout pregnancy (Group 3). Abnormal fetal Doppler was defined as UA-PI > 95th percentile and/or MCA-PI < 5th percentile. Differences in measured variables at presentation were also compared between pregnancies delivering a baby with birth weight < 3rd percentile and those delivering a baby with birth weight ≥ 3rd percentile. Multivariate logistic regression analysis was used to determine significant predictors of birth weight < 3rd percentile and evolution from normal to abnormal fetal Doppler. In the study population, 14 (16%) cases were in Group 1, 19 (22%) in Group 2 and 53 (62%) in Group3. Birth weight was < 3rd percentile in 39 (45%) cases and ≥ 3rd percentile in 47 (55%). There was decreased cardiac output and stroke volume and increased peripheral vascular resistance compared with a normal population, and the deviations from normal were most marked in Group 1. Pregnancies with birth weight < 3rd percentile, compared with those with birth weight ≥ 3rd percentile, had greater deviations from normal in fetal biometry, maternal cardiac output, stroke volume, heart rate, peripheral vascular resistance and UtA-PI. Multivariate logistic regression analysis demonstrated that, in the prediction of birth weight <3rd percentile, maternal hemodynamic profile provided significant improvement to the prediction provided by maternal demographics, fetal biometry, UtA-PI, UA-PI and MCA-PI (difference between areas under receiver-operating characteristics curves, 0.18 (95% CI, 0.06-0.29); P= 0.002). In contrast, there was no significant independent contribution from maternal hemodynamics in the prediction of the subsequent development of abnormal fetal Doppler. In pregnancies with a SGA fetus, there is decreased maternal cardiac output and stroke volume and increased peripheral vascular resistance, and the deviations from normal are most marked in cases of redistribution in the fetal circulation and reduced amniotic fluid volume. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Combined Doppler ultrasound and platelet indices for prediction of preeclampsia in high-risk pregnancies

Objectives: To evaluate Doppler ultrasound and platelet indices for the prediction of preeclampsia (PE). Design: Prospective observational study. Methods: The study included 270 normal pregnancy primigravida <20 years at 20–24-week gestation. Doppler ultrasound was done to detect uterine artery diastolic notch and to measure the pulsation index (PI) and the resistance index (RI). The platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW) and platelet large cell ratio (Plcr) was measured by automated blood picture. Outcome: Validity of combined tests in prediction of PE. Results: Patients who developed PE had significant higher percentage of diastolic notch, higher mean PI, RI, and significant increase of MPV and PDW than normotensive women (p < .001). Patients with abnormal Doppler and abnormal platelet indices had significant higher incidence of severe PE (p < .001). Conclusion: Abnormal platelet indices combined with abnormal Doppler is a predictor of severity rather than the rate of development of PE.

Utility of prenatal Doppler ultrasound to predict neonatal impaired cerebral autoregulation.

Determine if abnormal prenatal Doppler ultrasound indices are predictive of postnatal impaired cerebral autoregulation. Prospective cohort study of 46 subjects, 240-296 weeks' gestation. Utilizing near-infrared spectroscopy and receiver-operating characteristic analysis, impaired cerebral autoregulation was defined as >16.5% time spent in a dysregulated state within 96 h of life. Normal and abnormal Doppler indices were compared for perinatal outcomes. Subjects with abnormal cerebroplacental ratio (n = 12) and abnormal umbilical artery pulsatility index (n = 13) were likely to develop postnatal impaired cerebral autoregulation (p ≤ 0.02). Abnormal cerebroplacental ratio was associated with impaired cerebral autoregulation between 24 and 48 h of life (p = 0.016). These subjects have increased risk for fetal growth restriction, lower birth weight, lower Apgar scores, acidosis, and severe intraventricular hemorrhage and/or death (p < 0.05). Abnormal cerebroplacental ratio and umbilical artery pulsatility index are associated with postnatal impairment in cerebral autoregulation and adverse outcome.

EP16.18: Pregnancy association of abnormal Doppler indices with inherited thrombophilia

Thrombophilia reflects a hypercoagulable condition with an increased thrombogenic potential during pregnancy. The most frequent causes of inherited thrombophilia are the factor V Leiden mutation and the prothrombin gene mutation. Repetitively, it has been hypothesised that thrombophilic mutations associate an increased risk of thrombosis at the low flow maternal-placental interface resulting in placenta-mediated complications, such as miscarriage, fetal loss, pre-eclampsia, fetal growth impairment, and abruption. Our prospective study aimed to determine the impact of thrombophilic mutations on second and third trimester umbilical and uterine artery Doppler parameters. Four hundred and forty-eight pregnant women were tested for the presence of factor V Leiden mutation, prothrombin gene mutation and also for a series of minor thrombophilic mutations. Each patient included in the study has been examined by ultrasound corresponding to its gestational age with the measurement of umbilical and uterine artery velocity. The measured parameters (pulsatility index and resistivity index) were interpreted consistent with gestational age nomograms. The incidence of factor V Leiden mutation was 10.4% in the studied group and the incidence of the prothrombin gene mutation was 4.46%; 11 cases (2.4%) expressed both major mutation. In 6.6% of cases corresponding to second trimester pregnancies with factor V Leiden mutation an increased pulsatility index of umbilical artery was found and 11% of these cases had a high pulsatility index of the uterine artery. For the cases with both major thrombophilic mutations present, Doppler parameters were increased in 4 from 6 cases. Even if inherited thrombophilia is not considered a major risk factor for most adverse pregnancy outcomes, Doppler assessment of fetal status is imperative for high-risk population. In our study, the impact of thrombophilia on Doppler indices was modest and limited to major mutations.

Association of maternal and umbilical cord blood leptin concentrations and abnormal color Doppler indices of umbilical artery with fetal growth restriction

Fetal growth restriction (FGR) is a condition with heterogeneous pathophysiology which characterized by fetal weight less than the tenth percentile for gestational age. Several factors have impact on maternal, placental and fetal due to growth restriction. The aim of this study was to investigate the relationship between levels of leptin in the cord, and serum leptin of mothers also abnormal color Doppler indices of umbilical artery with fetal growth restriction. This is a cross sectional study conducted in Isfahan, Iran, 2015-2016. We recruited 40 women with singleton pregnancies complicated by fetal growth restriction (Group I) and 40 pregnant women with normal fetal growth (Group II) with matched age. Maternal serum and umbilical artery leptin levels were determined with Enzyme-Linked immunosorben method. Also, color Doppler ultrasound of umbilical artery was performed. Mean maternal and fetal leptin levels were lower in the FGR group compared to the normal group (36.58±(20.99) and 7.42 ±(4.08)vs. 47.32±(22.50) and 30.49±(14.50) respectively). Also, mean fetal leptin level was lower in the group with abnormal color Doppler sonographic indices compared to the normal group (7. 40 ±(4.10)vs 27.06±(15.80), respectively). This study indicated that maternal and fetal leptin levels are correlated with FGR originating from damaged placental function; also fetal leptin level can indicate changes in color Doppler sonographic indices.