Abnormal Doppler Indices Research Articles

Protein S100β in Late-Pregnancy Fetuses with Low Birth Weight and Abnormal Cerebroplacental Ratio

Objective: To evaluate the umbilical cord venous S100β levels in late-pregnancy fetuses with abnormal growth and cerebral redistribution. Methods: The pulsatility index of the umbilical and middle cerebral arteries and the cerebroplacental ratio (CPR) were measured in 132 fetuses at ≥34 weeks, and the CPR was converted into multiples of the median (MoM). A blood sample from the umbilical vein was collected at birth, and the umbilical venous S100β levels were evaluated in small and non-small for gestational age (SGA) fetuses, with and without abnormal Doppler indices. The levels of S100β were correlated with birth weight (BW) centile, CPR MoM and cord venous pH. Results: While CPR MoM correlated with BW centile, S100β showed no correlation with any of the studied fetal parameters. In addition, no differences were observed in S100β level according to BW centile or Doppler parameters, neither was there any difference between SGA with low CPR MoM and non-SGA with normal CPR MoM. Conclusion: Late-pregnancy fetuses with abnormal growth or cerebral redistribution have normal cord blood levels of S100β at birth. In these fetuses, the potential consequences of chronic hypoxemia on the fetal brain might not be detectable using tissue necrosis markers.

Evaluating the Optimal Definition of Abnormal First-Trimester Uterine Artery Doppler Parameters to Predict Adverse Pregnancy Outcomes.

To investigate the optimal definition of abnormal first-trimester uterine artery Doppler parameters associated with adverse pregnancy outcomes. A prospective cohort of women with singleton gestations between 11 and 14 weeks consented to uterine artery Doppler measurements. Doppler parameters were measured bilaterally, and mean pulsatility index (PI) and resistive index (RI) values were calculated. The presence of notching was also determined. Each parameter was evaluated for prediction of preeclampsia, early preeclampsia (<34 weeks), preterm birth (<37 weeks), early preterm birth (<34 weeks), and small for gestational age (SGA; birth weight <10th percentile). Descriptive statistics evaluated the association between abnormal Doppler indices and outcomes. A receiver operating characteristic (ROC) analysis was used to define the best cutoff points for mean PI and RI. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) were calculated for bilateral notching and mean PI and RI percentiles. Of 1192 patients with complete outcome data, preeclampsia was seen in 8.4%, early preeclampsia in 1.8%, preterm birth in 12.9%, early preterm birth in 5.6%, and SGA in 8.5%. A mean PI above the 75th percentile (>1.91) was the best index for predicting early preeclampsia (sensitivity, 45.0%; specificity, 75.5%; NPV, 98.7%; ROC area, 0.65). A mean PI above the 75th percentile was also the best index for predictive early preterm birth (sensitivity, 40.0%; specificity, 76.0%; NPV, 95.5%; ROC area, 0.65). None of the parameters were significant for predicting SGA. A mean uterine PI above the 75th percentile is the most discriminative abnormal uterine artery Doppler parameter for predicting both early preeclampsia and early preterm birth.

Do Doppler studies enhance surveillance of uncomplicated monochorionic diamniotic twins?

To determine whether isolated abnormal Doppler indices before 28 weeks predict adverse pregnancy outcomes in uncomplicated monochorionic diamniotic (MCDA) twins. A retrospective cohort study of MCDA twin pregnancies receiving antenatal testing at a single center between 2007 and 2013 was conducted. Sonographic surveillance, including Doppler velocimetric studies of the umbilical artery, ductus venosus, and middle cerebral artery of each twin, was initiated by 28 weeks and repeated at least every 2 weeks. All pregnancies were deemed "uncomplicated" at initial sonography, without evidence of polyhydramnios, oligohydramnios, intrauterine growth restriction, twin growth discordance of at least 20%, structural or chromosomal anomalies, or unclear chorionicity. Pregnancies were divided into 2 groups: those with isolated Doppler abnormalities before 28 weeks and those with normal Doppler indices. The primary outcome was a composite including twin-twin transfusion syndrome, intrauterine growth restriction of more than 1 twin, growth discordance of at least 20%, preterm delivery before 34 weeks for fetal indications, or demise of more than 1 fetus. Ninety-six patients were included, with 22 (22.9%) having isolated Doppler abnormalities before 28 weeks. The incidence of the primary outcome did not differ between groups (36.4% versus 28.4%; P = .47). The abnormal Doppler group underwent a greater number of sonographic examinations (15 versus 10; P= .001) and more antenatal admissions for fetal concerns (50.0% versus 12.2%; P < .001). Isolated Doppler abnormalities are commonly encountered in uncomplicated MCDA pregnancies before 28 weeks yet are not clearly predictive of twin-specific complications. Doppler abnormalities were associated with increased sonographic surveillance and antenatal hospitalizations, suggesting an influence on physician practice patterns. Data may not support Doppler studies before 28 weeks for routine MCDA twin monitoring.

Clinical utility of third-trimester uterine artery Doppler in the prediction of brain hemodynamic deterioration and adverse perinatal outcome in small-for-gestational-age fetuses.

To assess the clinical value of third-trimester uterine artery (UtA) Doppler ultrasound in the prediction of hemodynamic deterioration and adverse perinatal outcome in term small-for-gestational-age (SGA) fetuses. UtA Doppler parameters, cerebroplacental ratio (CPR) and fetal middle cerebral artery (MCA) pulsatility index (PI) were evaluated weekly, starting from the time of SGA diagnosis until 24 h before induction of labor, in a cohort of 327 SGA fetuses with normal umbilical artery PI (< 95th centile), delivered at > 37 weeks' gestation. Differences in the sequence of CPR and MCA-PI changes < 5th centile, between the group with normal UtA Doppler indices at diagnosis and those with abnormal UtA indices, were analyzed by survival analysis. In addition, the use of UtA Doppler value, alone or in combination with a brain Doppler scan before delivery, to predict the risk of Cesarean section, Cesarean section for non-reassuring fetal status (NRFS), neonatal acidosis and neonatal hospitalization was evaluated by logistic regression analysis, adjusted for gestational age at birth and birth-weight percentile. Abnormal UtA Doppler at diagnosis of SGA was associated with a higher risk of developing abnormal brain Doppler indices before induction of labor than in those with a normal UtA at diagnosis (62.7% vs 34.6%, respectively; P < 0.01). Compared to those with normal UtA Doppler indices, those with abnormal UtA Doppler findings were associated with a higher risk of intrapartum Cesarean section (52.2% vs 37.3%, respectively; P = 0.03), Cesarean section for NRFS (35.8% vs 23.1%, respectively; P = 0.03), neonatal acidosis (10.4% vs 7.7%, respectively; P = 0.47) and neonatal hospitalization (23.9% vs 16.5%, respectively; P = 0.16). Logistic regression analysis indicated that UtA Doppler findings were not significantly associated with adverse perinatal outcome independent of brain Doppler findings. UtA Doppler indices predict adverse perinatal outcome, but do not help to improve the predictive value of brain Doppler indices. However, at the time of SGA diagnosis they identify the subgroup of fetuses at highest risk of progression to abnormal brain Doppler findings.

The Role of Uterine and Umbilical Arterial Doppler in High-risk Pregnancy: A Prospective Observational Study from India.

AIMTo study the role of Doppler imaging in prediction of high-risk pregnancies and their outcomes.METHODS AND MATERIALThis prospective study in a setup of tertiary-level care center includes 500 high-risk pregnant women from rural and urban sectors and evaluates the predictive values of various Doppler indices.RESULTSOut of 500 patients, 110 patients had abnormal Doppler among them, 70 patients had abnormal uterine artery Doppler, and 50 patients had abnormal umbilical artery Doppler flow indices. In all, 10 patients had both umbilical artery and uterine artery abnormal Doppler indices. When uterine artery was abnormal (70 patients), 20 patients had preeclampsia, 10 patients had pregnancy-induced hypertension (PIH), and 25 patients had intrauterine growth restriction (IUGR). Systolic/diastolic (S/D) ratio and notch had sensitivity of 60% and positive predictive value of 33.3% and 37.5%, respectively. When umbilical artery was abnormal (50 patients), 10 had preeclampsia, 15 had PIH, and 15 had IUGR. S/D ratio had the highest positive predictive value of 40%; sensitivity is same for all. In uterine artery, combination of parameters had the best sensitivity of 80%, followed by notch and S/D ratio. In umbilical artery, combination of parameters, S/D ratio, and RI (resistance index) had sensitivity of 40%; specificity of all the indices was 91–96%. In all, 20 patients had bilateral notch, and among them 15 developed preeclampsia and 15 developed IUGR. When both uterine and umbilical artery Doppler were abnormal (10 patients), all patients had preeclampsia and IUGR.CONCLUSIONTherefore, Doppler study may be used for the prediction of preeclampsia and IUGR to reduce the maternal and perinatal morbidity and mortality.

Fetal cardiac function measured by myocardial performance index of small-for-gestational age fetuses.

The aim of this study was to demonstrate the changes of right and left myocardial performance indices (MPI) in small-for-gestational age (SGA) fetuses during 28-40 weeks of gestation. Singleton pregnant women during 28-40 weeks of gestation were enrolled. Estimated fetal weight was used to classify the subjects into appropriate-for-gestational age (AGA) and SGA groups. The Doppler indices of umbilical and middle cerebral arteries, including amniotic fluid index, were used to distinguish constitutional SGA (both normal Doppler indices and amniotic fluid index) from intrauterine growth restriction (IUGR) fetuses (abnormal Doppler indices and/or oligohydramnios). MPI was obtained and compared between the groups. Inter- and intra-observer variations were also assessed. Fifty women had AGA fetuses whereas another 50 cases had SGA fetuses (41 constitutional SGA and nine IUGR). Right MPI in AGA fetuses was constant whereas left MPI was slightly increased. The MPI of SGA fetuses were significantly greater than those of AGA fetuses starting from 30 weeks gestation until delivery (P < 0.01 and <0.05 in right and left side, respectively). Subgroup analysis demonstrated right and left MPI of IUGR fetuses increased with advancing gestation and were significantly greater than those of constitutional SGA and AGA fetuses, which appeared to be similar. The reproducibility of the test was high. In SGA fetuses, the MPI of right and left ventricles was significantly increased with advancing gestation compared to AGA cases.

UNDERSTANDING THE PLACENTAL AETIOLOGY OF FETAL GROWTH RESTRICTION; COULD THIS LEAD TO PERSONALIZED MANAGEMENT STRATEGIES?

Fetal growth restriction (FGR) is defined as the failure of a fetus to attain its full genetic growth potential. It is a leading cause of stillbirth, prematurity, cerebral palsy and perinatal mortality. Small size at birth increases surviving infants’ lifelong risk of adverse health outcomes associated with the metabolic syndrome. The pathophysiology of abnormal fetal growth is extremely complex and incompletely understood, with a plethora of genetic, signalling and metabolic candidates under investigation, many of which may result in abnormal structure and function of the placenta. In contrast to, or maybe because of, the underlying complexities of FGR, the strategies clinicians have for identifying and managing this outcome are conspicuously limited. Current clinical practice is restricted to identifying pregnancies at risk of FGR, and when FGR is detected, using intensive monitoring to guide the timing of delivery to optimise fetal outcomes. Abnormal Doppler indices in the umbilical artery are strongly associated with poor perinatal outcomes and are currently the “gold standard” for clinical surveillance of the growth-restricted fetus.

The Disappearing Brain-Sparing Effect in Early-Onset Fetal Growth Restriction Fetuses Revisited

Objective: To evaluate the association between the brain-sparing situation and perinatal outcomes in fetuses with early-onset fetal growth restriction (EO-FGR) with absent or reverse end-diastolic flow in the umbilical artery (UA A/REDF). Methods: We evaluated fetuses with EO-FGR who had patterns of UA A/REDF without abnormal venous Doppler indices. Participants were divided into two groups according to measurements of mid-cerebral artery pulsatility index (MCA PI) just before delivery. Group 1 (n = 45) included those with a brain-sparing effect (BSE) (a MCA PI <5th percentile for the gestational age) and group 2 (n = 14) included those with a disappearing BSE, defined as an MCA PI increase towards normal values after the BSE detected at the initial evaluation. Short-term perinatal outcomes were analyzed. Results: Compared to group 1, group 2 had a significantly low birth weight (p = 0.018) and high rates of extended neonatal intensive care unit hospitalization (p = 0.049 respectively). Conclusion: On the basis of longitudinal measurements of MCA PI, increases after the reduction <5th percentile might be related to poor perinatal outcomes in fetuses with EO-FGR who had UA A/REDF without abnormal venous flow patterns.

Clinical and ultrasound assessment in patients with placenta previa to predict the severity of intrapartum hemorrhage

ObjectivesEvaluate whether maternal history and ultrasound can predict massive hemorrhage during cesarean section in placenta praevia. Study designSixty singleton pregnant women with persistent placenta praevia (after 28weeks’ gestation) were prospectively enrolled in this study.Comprehensive maternal history and findings obtained by antenatal ultrasound, including placental location, presence of lacunae, lack of a clear zone, abnormal color Doppler indices were reviewed, and their effect on the severity of maternal hemorrhage during cesarean section was analyzed. ResultsTwenty two cases had massive intra operative hemorrhage, among them 20 patients were confirmed to have placenta accreta and its variants (including increta and percreta) at the time of cesarean delivery.For diagnosis of severe bleeding (>1500ml), the sensitivity of previous uterine surgery, abnormal color Doppler and lack of clear zone was high (95.5%, 81.8%, 81.8% respectively) while sensitivity of presence of lacunae was low (36.4%). And the specificity of abnormal color Doppler, lack of clear zone and presence of lacunae was high (94.7%, 94.7%, 97.4% respectively) while of previous uterine surgery was low (36.8%). ConclusionPrenatal maternal history and ultrasound examination can predict the amount of intraoperative hemorrhage and reduced the morbidity and mortality in patients with placenta previa.

Cord blood oxidative stress markers correlate with umbilical artery pulsatility in fetal growth restriction

Objective: To compare cord blood oxidative stress markers (OSM) between intrauterine small fetuses with high umbilical artery (UA) Doppler indices and normal indices. Methods: Forty women who had oligohydramnios and intrauterine growth-restricted fetuses with abnormal (n = 20, group I) or normal Doppler indices (n = 20, group II) were included. All patients underwent fetal Doppler ultrasound studies. Cord blood was collected at birth and six OSMs (ischemia-modified albumin (IMA), hepatocyte growth factor (HGF), malondialdehyde (MDA)) levels, total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) were studied. Results: The mean cord blood IMA, MDA, TOS, and OSI values for group I were significantly increased when compared to the group II (p < 0.001 for IMA, MDA, TOS, and OSI). However the mean cord blood HGF and TAS values were statistically significantly decreased in group I, compared with group II (p < 0.001 for HGF, and TAS). A significant positive (for IMA, MDA,TOS levels, and OSI ratio) and negative (for HGF and TAS levels) correlations between UA pulsatility index (PI) and cord blood OSM were found. Conclusion: The correlation between cord blood OSM and Doppler blood flow changes shown in this study may contribute to understanding the underlying oxidative stress-related mechanisms.

N-terminal pro-B-type natriuretic peptide in the circulation of fetuses with cardiac malformations

Cardiac malformations with impact on loading patterns have the potential to progress to irreversible loss of ventricular function during human fetal life. N-terminal pro-B-type natriuretic peptide (nt-proBNP) is a marker of cardiac dysfunction and involved in cardiac remodeling and fibrosis. We evaluated nt-proBNP levels in the circulation of human fetuses with cardiac defects. A total of 45 cases and 75 controls during the second half of gestation were recruited. Nt-proBNP concentrations were determined in venous specimens obtained by fetal blood sampling. Results were correlated to echocardiography and Doppler studies. Mean gestational age was 26.9weeks (range 21.0-33.4weeks). Levels of circulating nt-proBNP were elevated in fetuses with cardiac defects (mean 6,896ng/L (range 595-42,479ng/L) vs. 1,867ng/L (73-3,751ng/L), p<0.001). In the presence of abnormal Doppler indices a further increase was detected (mean 11,287ng/L (range 1,403-42,479ng/L) vs. 4,659ng/L (595-30,848ng/L), p=0.021). No difference was found in fetuses with co-existing growth restriction. Malformations were classified according to their hemodynamic effect. Compared to shunt defects nt-proBNP concentrations were significantly higher in left or right ventricular outflow tract obstruction with intact ventricular septum (mean 15,639ng/L (range 2,301-42,479ng/L) vs. 3,891ng/L (595-13,752ng/L), p=0.013), and corresponded to the degree of ventricular dysfunction. In the circulation of human fetuses with cardiac defects levels of circulating nt-proBNP are elevated. Concentrations correlate with the type of myocardial wall stress. This finding supports a role for nt-proBNP as early indicator of intrauterine cardiovascular dysfunction and cardiac remodeling.

Ductus venosus velocimetry in monitoring pregnancy in women with pregestational diabetes mellitus

The purpose of this research was to assess the ability of ductus venosus (DV) Doppler velocimetry to predict adverse perinatal outcome in pregnancies complicated by pre-existing diabetes mellitus. This was a prospective study conducted at a tertiary referral obstetric facility in Brisbane, Australia. The study group included women with pregestational diabetes mellitus who delivered in the hospital between 1 January 1995 and 31 December 2006. The DV Doppler index was defined as abnormal if the DV peak velocity index for veins (PVIV) was equal to or greater than the 95(th) percentile for gestation. Adverse perinatal outcome included one or more of the following criteria: small-for-gestational-age infant; Cesarean section for non-reassuring fetal status; fetal acidemia at delivery; a 1-min Apgar score of <or= 3; a 5-min Apgar score of < 7; hypoxic ischemic encephalopathy; and stillbirth or neonatal death. The maternal characteristics and perinatal outcomes of pregnancies with normal or abnormal DV Doppler indices were compared. Eighty-two pregestational diabetic pregnancies were studied and an abnormal DV-PVIV was identified in 25 (30.5%). Adverse perinatal outcome was identified in eight of 25 (32.0%) pregnancies with an abnormal DV-PVIV compared to seven of 57 (12.3%) pregnancies with a normal DV-PVIV (P < 0.05). The sensitivity of the DV-PVIV in predicting adverse perinatal outcomes in pregestational diabetic pregnancies was 53.3%, the specificity was 74.6%, the positive predictive value was 32.0% and the negative predictive value was 87.7%. It may be useful to include DV-PVIV in the antenatal screening of pregnancies complicated by pregestational diabetes.

Triple vessel wave pattern by Doppler studies in normal and high risk pregnancies and perinatal outcome

To evaluate the role of triple vessel (umbilical, middle cerebral and uterine artery) color Doppler study in normal and high risk pregnancy in relation to perinatal outcome. Aprospective study was done including fifty women with high risk pregnancy and 50 normal pregnant women during the year 2006–2007. Doppler examination was done after recording patients’ history, clinical examination and ultrasound. Mode of delivery, perinatal outcome including birth weight, perinatal death, Apgar score at 1 and 5 minutes and admission to nursery were compared. There was significant difference between the Doppler indices of the three vessels in the study and the control group. In women with abnormal Doppler indices, there was high incidence of cesarean section (78%), low birth weight babies, low Apgar score, higher admission rate to nursery (36%) and high incidence of neonatal deaths as compared to that of the control group. Triple vessel color Doppler sonography is very useful in high risk pregnancy diagnosis and in predicting perinatal outcome.

Abnormal antenatal Doppler velocimetry and cognitive outcome in very‐low‐birth‐weight infants at 2 years of age

To study neurodevelopmental outcome at 2 years of corrected age in very-low-birth-weight (VLBW) (< or = 1500 g) preterm infants with abnormal fetoplacental flow. A total of 258 VLBW infants were born at Turku University Hospital between 2001 and 2006. Of these, 99 had undergone, within 1 week of delivery, antenatal Doppler assessment of blood flow in the umbilical artery (UA), fetal middle cerebral artery (MCA), descending aorta (DAo), aortic isthmus and ductus venosus and were eligible for inclusion in the study. Postnatally brain pathology was assessed by serial ultrasound and magnetic resonance imaging in 86 of the neonates and brain volume was measured in 80. Cognitive development was evaluated at 2 years of corrected age in 83 infants using the Bayley Scales of Infant Development-II. Motor development was assessed using the Hammersmith Infant Neurological Examination. On univariate analysis, abnormal pulsatility index (PI) in the UA and an abnormal UA-PI/MCA-PI ratio (P = 0.04 and P = 0.003, respectively) as well as increases in both the DAo-PI and in the DAo-PI/MCA-PI ratio (P = 0.03 and P = 0.02, respectively), were associated with adverse cognitive outcome at 2 years of age. However, when controlling for cerebral volume using multivariate analysis, the association between abnormal antenatal Doppler characteristics and cognitive outcome became statistically non-significant, which indicated the determinant role of the volume reduction. Motor development was not associated with antenatal Doppler indices. Abnormal antenatal Doppler indices are associated with adverse cognitive outcome at 2 years in VLBW infants. Our findings suggest that this association may be mediated through brain volume.

Placental size and the prediction of severe early‐onset intrauterine growth restriction in women with low pregnancy‐associated plasma protein‐A

Screening studies for trisomy 21 demonstrate that low maternal serum pregnancy-associated plasma protein-A (PAPP-A) at 11-13 weeks' gestation is associated with stillbirth, intrauterine growth restriction (IUGR) and pre-eclampsia in chromosomally normal fetuses. However, the strength of these associations is too weak to justify screening for these placental insufficiency syndromes. Our objective was to evaluate placental size and uterine artery (UtA) Doppler imaging as second-stage screening tests for women with low PAPP-A. We prospectively studied 90 normal singleton pregnancies with first-trimester PAPP-A </= 0.30 multiples of the median. Maternal serum alpha-fetoprotein (AFP) at 15-18 weeks' gestation, and second-trimester placental size and UtA Doppler indices were assessed as predictors of pregnancy outcome. The risks of IUGR, preterm delivery before 32 weeks' gestation and stillbirth were significantly associated with small placental size (relative risk (RR), 3.96; 95% CI, 2.21-5.98; RR, 3.96; 95% CI, 2.21-5.98; and RR, 6.44, 95% CI, 2.74-14.54, respectively) and elevated AFP (RR, 3.67; 95% CI, 1.78-7.71; RR, 2.48; 95% CI, 1.23-4.94; and RR, 5.14; 95% CI, 1.66-16.85, respectively), but not with abnormal UtA Doppler indices. The combination of elevated AFP and small placental size further increased the risk of IUGR (RR, 4.88; 95% CI, 2.88-5.31), delivery before 32 weeks' gestation (RR, 4.25; 95% CI, 2.38-4.98) and stillbirth (RR, 7.44; 95% CI, 3.04-3.75). Small placental size and elevated AFP, but not UtA Doppler indices, identify women with low PAPP-A at high risk of IUGR, extreme preterm delivery and stillbirth. These additional screening tests may directly improve perinatal outcomes in women with low PAPP-A.

First‐trimester uterine artery Doppler indices in the prediction of small‐for‐gestational age pregnancy and intrauterine growth restriction

To assess the relationship of first-trimester uterine artery Doppler indices with subsequent delivery of small-for-gestational age (SGA) neonates or intrauterine growth restriction (IUGR). This was a prospective study in which uterine artery Doppler assessment was performed at 11-14 weeks in 3010 women with singleton pregnancies. Resistance indices (RI) and incidence of bilateral notching were compared between women with normal pregnancies (n = 2445) and those who delivered: SGA neonates (birth weight < 10th centile) (n = 377); SGA neonates who had been affected by pre-eclampsia (n = 27); IUGR neonates (birth weight < 10th centile and abnormal Doppler indices) with delivery > or = 37 weeks (n = 62); and IUGR neonates requiring preterm delivery (delivery < 37 weeks) (n = 36). The first-trimester uterine artery mean RI and prevalence of bilateral notching were significantly higher in women destined to deliver SGA neonates than in women with normal pregnancies (median uterine artery RI, 0.74 vs. 0.70, P < 0.001; prevalence of bilateral notches, 56% vs. 43%, P < 0.001). The areas under the receiver-operating characteristics curves for the prediction of SGA without pre-eclampsia, IUGR, preterm IUGR and SGA with pre-eclampsia were 0.602, 0.687, 0.776 and 0.708, respectively. There was a statistically significant inverse relationship between mean uterine artery RI and gestational age at delivery in the SGA pregnancies without pre-eclampsia (R = - 0.329, P = 0.01). There is a significant relationship between first-trimester uterine artery Doppler RI and the subsequent development of SGA. The sensitivity of first-trimester uterine artery Doppler is greater for SGA with pre-eclampsia than it is for IUGR alone. This could be because these two entities may have different underlying placental abnormalities that are detected variably on first-trimester uterine artery Doppler evaluation.

Correlation of placental pathology with prenatal ultrasound findings

There have been recent major advances in obstetric ultrasound, regarding both improved technologies and sonographer expertise, which have resulted in changes in antenatal obstetric management. The placenta is routinely examined...

Transabdominal uterine arteries doppler between 11-14 weeks of gestation for prediction of outcome in high risk pregnancies

ObjectiveTo assess the value of early transabdominal uterine arteries Doppler ultrasound for prediction of gestational outcomes in pregnancies at high risk for preeclampsia.Study designObservational study. Doppler ultrasound of uterine arteries at 11-14 weeks' gestation was performed in 76 women. Presence of diastolic notch and resistance index (RI) were investigated. Abnormal uterine Doppler was defined by presence of bilateral notching or by mean RI > 0.80. Adverse outcomes evaluated were preeclampsia, fetal growth restriction, placental abruption, intrauterine death and complications associated with impaired placentation requiring delivery before 34 weeks of gestation.ResultsAmong 76 women 30 had abnormal uterine Doppler indices and 46 had normal RI and normal Doppler waveform configuration at 11-14 weeks' gestation. Abnormal uterine flow was related to a significantly higher incidence of preeclampsia (16.6% vs 0%; p= 0.0041), fetal growth restriction (26.6% vs 0%; p= 0.0002), intrauterine death (13.3% vs 0%; p= 0.0109) and iatrogenic preterm delivery (20% vs 2.15% ; p= 0.0087).Among pregnancies with normal Doppler indices no one was complicated by preeclampsia or fetal growth restriction. Normal waveform configuration had 97.8% of negative predictive value for complications requiring elective delivery before 34 weeks.ConclusionNormal Doppler indices in the first trimester are strongly related to normal outcome of pregnancy in women at high risk for preeclampsia. Results of this study support a change in the antepartum care of already identified high risk women with normal uterine Doppler waveform configuration at 11-14 weeks of gestation. ObjectiveTo assess the value of early transabdominal uterine arteries Doppler ultrasound for prediction of gestational outcomes in pregnancies at high risk for preeclampsia. To assess the value of early transabdominal uterine arteries Doppler ultrasound for prediction of gestational outcomes in pregnancies at high risk for preeclampsia. Study designObservational study. Doppler ultrasound of uterine arteries at 11-14 weeks' gestation was performed in 76 women. Presence of diastolic notch and resistance index (RI) were investigated. Abnormal uterine Doppler was defined by presence of bilateral notching or by mean RI > 0.80. Adverse outcomes evaluated were preeclampsia, fetal growth restriction, placental abruption, intrauterine death and complications associated with impaired placentation requiring delivery before 34 weeks of gestation. Observational study. Doppler ultrasound of uterine arteries at 11-14 weeks' gestation was performed in 76 women. Presence of diastolic notch and resistance index (RI) were investigated. Abnormal uterine Doppler was defined by presence of bilateral notching or by mean RI > 0.80. Adverse outcomes evaluated were preeclampsia, fetal growth restriction, placental abruption, intrauterine death and complications associated with impaired placentation requiring delivery before 34 weeks of gestation. ResultsAmong 76 women 30 had abnormal uterine Doppler indices and 46 had normal RI and normal Doppler waveform configuration at 11-14 weeks' gestation. Abnormal uterine flow was related to a significantly higher incidence of preeclampsia (16.6% vs 0%; p= 0.0041), fetal growth restriction (26.6% vs 0%; p= 0.0002), intrauterine death (13.3% vs 0%; p= 0.0109) and iatrogenic preterm delivery (20% vs 2.15% ; p= 0.0087).Among pregnancies with normal Doppler indices no one was complicated by preeclampsia or fetal growth restriction. Normal waveform configuration had 97.8% of negative predictive value for complications requiring elective delivery before 34 weeks. Among 76 women 30 had abnormal uterine Doppler indices and 46 had normal RI and normal Doppler waveform configuration at 11-14 weeks' gestation. Abnormal uterine flow was related to a significantly higher incidence of preeclampsia (16.6% vs 0%; p= 0.0041), fetal growth restriction (26.6% vs 0%; p= 0.0002), intrauterine death (13.3% vs 0%; p= 0.0109) and iatrogenic preterm delivery (20% vs 2.15% ; p= 0.0087).Among pregnancies with normal Doppler indices no one was complicated by preeclampsia or fetal growth restriction. Normal waveform configuration had 97.8% of negative predictive value for complications requiring elective delivery before 34 weeks. ConclusionNormal Doppler indices in the first trimester are strongly related to normal outcome of pregnancy in women at high risk for preeclampsia. Results of this study support a change in the antepartum care of already identified high risk women with normal uterine Doppler waveform configuration at 11-14 weeks of gestation. Normal Doppler indices in the first trimester are strongly related to normal outcome of pregnancy in women at high risk for preeclampsia. Results of this study support a change in the antepartum care of already identified high risk women with normal uterine Doppler waveform configuration at 11-14 weeks of gestation.

Detection of subclinical LV dysfunction by tissue Doppler imaging

in a murine model of LV dysfunction suggests that abnormal tissue Doppler and strain rate indices may predict late cardiac dysfunction and death, at a time when conventional echocardiographic parameters are still normal. In this context, the study eludes the next step whether those new technologies may predict clinical endpoints such as heart failure and cardiac death, which is a crucial information for the clinical relevance of new technologies currently invading cardiology. To confirm the toxic impact of doxorubicin on the investigated myocardium, invasive haemodynamic measurements and also histological studies on cardiac apoptosis were taken as the gold standard of cardiac assessment. Tissue Doppler data were related to those haemodynamic and histological abnormalities and even of more importance to clinical outcome. This supports the concept to use tissue Doppler imaging for monitoring cardiac effects of new therapeutic strategies to prove cardiac efficacy or side effects. Another importantaspect of this study isthe fact that tissue Doppler imaging was used in a small animal model (mice). Currently, murine models of cardiac diseases play an increasingly important role in the understanding of the disease process and the evaluation of different therapies. In this respect, it is interesting to see that tissue Doppler imaging is also applicable in the experimental environment even in the presence of heart rates up to 500/min. 9 Although the original recordings of Doppler traces which were presented in this paper look reliable, the spatial resolution in mice hearts remains a matter of discussion, especially when endocardial velocitiesaregivenandtransmyocardialstrainratesarecalculated. In clinical application, we currently try to compensate for false measurements by tracking the region of interest throughout the cardiac cycle. It remains unclear how to do this technically in mice with high heart rates and thin LV walls. Maybe automated algorithms based on raw data measurements with speckle tracking facilities will solve this probleminthe future. First,applications havebeen presented and are under evaluation. 10

Validation of a new method of detecting peripheral artery disease by determination of ankle-brachial index using an automatic blood pressure device.

Peripheral artery disease (PAD) is a predictor of total and cardiovascular mortality; its most valuable simple index is the ankle-brachial index (ABI). The present study was designed to assess whether a commercially available automatic device could be used to determine ABI in comparison with the classical Doppler method. The ABI was defined as the ratio of systolic blood pressure at each ankle to the maximal brachial systolic pressure, a pathological index being defined for a ratio <0.90. The ABI were calculated in 219 consecutive patients (aged 55 +/-19 years) with systolic blood pressure measured either by using a mercury sphygmo-manometer and a continuous-wave Doppler probe or an automatic manometer Omron M4. This device has been validated for measurements in upper limbs, and so the authors undertook validation in the lower limbs versus intraarterial measurements. There was an excellent correlation between intraarterial measurements and automatic readings in the range of 70-220 mm Hg, r=0.99, p<0.001. The systolic pressures measured in upper limbs correlated well in the right (r=0.87, p<0.001) and the left (r=0.89, p<0.001) upper limbs; and in the left (r=0.72, p<0.001) and the right (r=0.68, p<0.001) lower limbs. Correlations between ABI in both methods were good in the left (r=0.66, p<0.001) and the right (r=0.61, p<0.001) lower limbs. The sensitivity (76%), specificity (95%), positive predictive value (86%), negative predictive value (90%), and global accuracy (89%) of a pathological automatic index to predict an abnormal Doppler index were good. The use of a simple, automatic blood pressure device to determine ABI appears feasible, easy, and precise. It would provide a practical tool for physicians not trained in Doppler to detect PAD.