Abnormal Doppler Velocimetry Research Articles

Comparative study of fetal doppler versus non stress test as predictor of perinatal outcome in high risk pregnancy between 36 to 42 weeks

Pregnancy is a unique physiologically event in a women’s life. The main aim of the study was to compare the efficacy of the Doppler velocimetry versus non stress test in relation to perinatal outcome in high risk pregnancies between 36 to 42 weeks.This comparative prospective study was carried out on 200 antenatal patients between 36-42 weeks of pregnancy in Department of Obstetrics & Gynaecology Smt Kashibai Navle Medical College and Hospital a tertiary care center from December 2016 to July 2018.All cases were divided into four groups based on NST and Doppler velocimetry of umbilical artery. Abnormal Doppler studies were found in 12% women. 14% had abnormal NST. Apgar score < 7 at 5 minutes were in 19 fetuses, out of these 15 had abnormal Doppler velocimetry. Average birth weight was low in Group D (1.2kg), where both the tests were abnormal. NICU admissions were 5% in Group A and 100% in Group B and D, where Doppler was abnormal. Mean gestational age was also low in group D. Highest perinatal mortality and neonatal morbidity was seen in women with abnormal umbilical artery Doppler. 6 neonatal deaths occur in Group D and 1 in Group B. In the present study, umbilical artery sensitivity for predicting perinatal morbidity and mortality is 46.1, specificity is 94, PPV is 93 and NPV is 54.Highest percentage of perinatal complications and perinatal deaths were seen in groups with abnormal Doppler velocimetry. Group D had the worst perinatal outcome.

Management of large placental chorioangioma: two-port laser approach for fetal intervention.

There is a paucity of literature providing evidence-based guidelines for the management of large placental chorioangioma (≥ 4 cm in diameter). The objectives of this study were to compare outcomes between patients managed expectantly and those undergoing in-utero intervention and to describe the different in-utero techniques used for cessation of blood flow to the tumor and the associated outcome. This was a retrospective cohort study of 34 patients referred for the management of large placental chorioangioma in a single center between January 2011 and December 2022, who were managed expectantly or underwent in-utero intervention. In-utero intervention was performed when the fetus developed any signs of impending compromise, including high combined cardiac output (CCO), worsening polyhydramnios or abnormal fetal Doppler velocimetry findings. Interventions included radiofrequency ablation (RFA), interstitial laser ablation (ILA) and single-port or two-port fetoscopic laser photocoagulation (FLP). Treatment selection was dependent on the proximity of the tumor to the umbilical cord insertion (UCI) and placental location. The two-port technique was performed in patients with a chorioangioma with large feeding vessels (≥ 3 mm) located in the posterior placenta, in which one port was used for occlusion using bipolar forceps and the other port was used for laser photocoagulation of the feeding vessels downstream. The single-port technique was used for chorioangioma with small feeding vessels (< 3 mm) located in the posterior placenta. ILA or RFA was performed in cases with an anterior placenta. Supportive treatments, including amnioreduction and intrauterine transfusion (IUT), were performed for worsening polyhydramnios and suspected fetal anemia based on middle cerebral artery Doppler flow studies, respectively. Comparative statistical analysis between cases undergoing expectant management vs in-utero intervention was performed. Descriptive details were provided for patients who underwent in-utero intervention. Thirty-four cases of large chorioangioma were evaluated, of which 25 (73.5%) were managed expectantly and nine (26.5%) underwent intervention. The frequency of polyhydramnios was significantly higher in the intervention group compared with the expectant-management group (66.7% vs 8.0%, P < 0.001). The live-birth rate among expectantly managed cases with large chorioangioma was significantly higher compared with that in cases that underwent in-utero intervention (96.0% vs 62.5%, P = 0.01). In the intervention group, preoperative CCO was elevated in all cases with available information and preoperative hydrops was present in 33.3% (3/9) of cases. One patient experienced fetal demise following IUT prior to planned FLP. Among the remaining eight patients, four underwent two-port FLP, two underwent single-port FLP, one underwent ILA and one underwent both ILA and RFA. All three cases in which hydrops was present at the time of intervention resulted in fetal demise. In-utero interventions aimed at cessation of blood flow in the feeding vessels are a therapeutic option for the management of cases with large chorioangioma. The two-port percutaneous technique appears to improve the efficiency of FLP when a large chorioangioma with large feeding vessels is located in the posterior placenta. We propose that in-utero interventions for large chorioangioma should be initiated prior to the development of fetal hydrops. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Comparison of modified biophysical profile and doppler ultrasonography studies in predicting perinatal outcome in high-risk pregnancies

In order to improve perinatal outcomes and reduce mother and foetal morbidity and mortality especially in high-risk pregnancies, there is an immense need to do thorough antepartum surveillance test. Aims and Objectives: To compare modified biophysical profile (MBPP) and Doppler studies results for prediction of perinatal outcome and to evaluate the association between the mode of delivery and abnormal Doppler and MBPP.Methodology: This is a prospective observational and comparative study. High-risk term patients were taken in this study, following which MBPP and Doppler studies were performed within 48 to 72 hours of delivery.The study population were divided as follows and perinatal outcome was assessed:A-Normal MBPP and normal Doppler velocimetryB-Normal MBPP and abnormal Doppler velocimetryC-Abnormal MBPP and normal Doppler velocimetryD-Abnormal MBPP and abnormal Doppler velocimetry.Results: The high-risk factor for the greatest number of patients, which accounted for 39.33% of patients, was pregnancy-induced hypertension. Age was less than 25 years in 88 patients (55%). 67 patients were primigravida (44.7%), LSCS was the mode of termination of pregnancy in 127 (84.7%) patients.Greatest prenatal complications occurred in individuals who had abnormal MBPP and Doppler, with a significant P value of < 0.05., Subsequently followed by MBPP, which had a significantly higher NPV than Doppler studies (63.64% vs. 59.41%), which makes it helpful for identifying healthy new-borns.Conclusion: In our study, it was determined that better prediction of adverse perinatal outcome was observed when both Doppler studies and MBPP was done in combination followed by MBPP.

The role of extracellular matrix proteins on placental angiogenesis in severe fetal growth restriction

Impaired vascular development is a central finding in severe fetal growth restriction (FGR) with abnormal Doppler velocimetry. Angiogenesis involves complex interactions between endothelial cells (ECs) and extracellular matrix (ECM). Our laboratory previously found that FGR ECs exhibit deficient angiogenic properties, a deficit that is further worsened in the presence of ECM generated from FGR placentae but partially rescued by control ECM. Our objective was to identify the effects of individual ECM substrates on EC function to better characterize the impaired angiogenic pathway characteristic of FGR. ECs were isolated from term control (n=8) or severe FGR (n=8) human placentae and plated on six individual ECM proteins: fibronectin; collagens I, III, and IV; laminin; and thrombospondin. Adhesion was assessed by colorimetric staining. Live cell microscopy was used to determine proliferation. Migration was analyzed via relative wound density following wound scratch. Apoptosis was evaluated by immunoblotting for cleaved caspase 3. T tests, ANOVAs, and nonlinear regressions were performed. There was no difference between adhesion of control and FGR ECs to individual ECM substrates. Control ECs proliferated more rapidly than FGR ECs (p< 0.01; figure 1). Deficient growth of FGR ECs was not rescued by any ECM substrate. Migration of FGR ECs was impaired relative to control ECs when accounting for all substrates (p=0.02). This finding persisted specifically in the presence of collagen I (p=0.03; figure 2) but not other substrates. Apoptosis was not detected for either type of ECs on any substrate. ECs from placentae affected by severe FGR display impaired proliferation and migration. This growth deficit appears to be independent of individual ECM substrates. FGR migratory defects persist on collagen I but not other substrates. Our data suggest that no singular ECM protein is responsible for the aberrant angiogenesis seen in severe FGR and rather there are likely multiple mechanisms underlying this pathology.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Altered Cord Blood Lipid Concentrations Correlate with Birth Weight and Doppler Velocimetry of Fetal Vessels in Human Fetal Growth Restriction Pregnancies.

Fetal growth restriction (FGR) is associated with short- and long-term morbidity, often with fetal compromise in utero, evidenced by abnormal Doppler velocimetry of fetal vessels. Lipids are vital for growth and development, but metabolism in FGR pregnancy, where fetuses do not grow to full genetic potential, is poorly understood. We hypothesize that triglyceride concentrations are increased in placentas and that important complex lipids are reduced in cord plasma from pregnancies producing the smallest babies (birth weight < 5%) and correlate with ultrasound Dopplers. Dopplers (umbilical artery, UA; middle cerebral artery, MCA) were assessed longitudinally in pregnancies diagnosed with estimated fetal weight (EFW) < 10% at ≥29 weeks gestation. For a subset of enrolled women, placentas and cord blood were collected at delivery, fatty acids were extracted and targeted lipid class analysis (triglyceride, TG; phosphatidylcholine, PC; lysophosphatidylcholine, LPC; eicosanoid) performed by LCMS. For this sub-analysis, participants were categorized as FGR (Fenton birth weight, BW ≤ 5%) or SGA “controls” (Fenton BW > 5%). FGRs (n = 8) delivered 1 week earlier (p = 0.04), were 29% smaller (p = 0.002), and had 133% higher UA pulsatility index (PI, p = 0.02) than SGAs (n = 12). FGR plasma TG, free arachidonic acid (AA), and several eicosanoids were increased (p < 0.05); docosahexaenoic acid (DHA)-LPC was decreased (p < 0.01). Plasma TG correlated inversely with BW (p < 0.05). Plasma EET, non-esterified AA, and DHA correlated inversely with BW and directly with UA PI (p < 0.05). Placental DHA-PC and AA-PC correlated directly with MCA PI (p < 0.05). In fetuses initially referred for inadequate fetal growth (EFW < 10%), those with BW ≤ 5% demonstrated distinctly different cord plasma lipid profiles than those with BW > 5%, which correlated with Doppler PIs. This provides new insights into fetal lipidomic response to the FGR in utero environment. The impact of these changes on specific processes of growth and development (particularly fetal brain) have not been elucidated, but the relationship with Doppler PI may provide additional context for FGR surveillance, and a more targeted approach to nutritional management of these infants.

Risks of Single Fetal Demise after Laser for Twin-Twin Transfusion Syndrome

Introduction: The aim of the study was to determine if markers of donor placental insufficiency and recipient cardiac dysfunction increase the risk for single fetal demise (SFD) after laser for twin-twin transfusion syndrome (TTTS). Methods: Single-center retrospective review of patients who had laser for TTTS. Risk factors for donor and recipient demise within 1 week were compared in pregnancies with SFD and pregnancies with dual survival using χ² or Fisher’s exact test. Multivariate logistic regression was then performed. Results: Of 398 procedures, 305 (76.6%) had dual survival, 36 (9.0%) had donor demise, 28 (7.0%) had recipient demise, and 9 (2.3%) had dual demise. The remaining 20 (5.0%) patients had complicated courses with pregnancy loss or further intervention. In the 64 pregnancies with SFD, 29 (81%) in the donor group and 20 (71%) in the recipient group occurred in the first postoperative week. For the donor demise group, estimated fetal weight (EFW) <10%, EFW <3%, EFW <1%, EFW discordance >25%, and EFW discordance >30% did not increase the risk for donor demise except in cases that also had umbilical artery absent or reversed end diastolic flow (AREDF). Donor AREDF was the only independent risk factor for early donor demise. For the recipient demise group, recipient abnormal venous Dopplers were associated with increased risk while EFW discordance >25% was associated with decreased risk of recipient loss. Discussion/Conclusion: In our cohort, donor growth restriction did not increase the risk of early donor demise after laser unless there was also donor AREDF. Donor AREDF was an independent risk factor for donor demise likely due to the severity of placental insufficiency. Abnormal recipient venous Doppler indices increased the risk of early recipient loss while a large intertwin discordance decreased the risk. This may be explained by profound overload in cases with recipient abnormal venous Doppler velocimetry and a lower risk of substantial fluid shifts from a relatively smaller donor territory when there is a large discordance.

Differences in body composition and growth persist postnatally in fetuses diagnosed with severe compared to mild fetal growth restriction.

Fetal growth restriction (FGR) is most commonly diagnosed in pregnancy if the estimated fetal weight (EFW) is < 10th%. Those with abnormal Doppler velocimetry, indicating placental insufficiency and pathological FGR, demonstrate reduced fat and lean mass compared to both normally growing fetuses and FGR fetuses with normal Dopplers. The aim of this study was to determine how severity of FGR and abnormal Doppler velocimetry impacts neonatal body composition. Among a cohort of fetuses with an EFW < 10th%, we hypothesized that those with abnormal Dopplers and/or EFW < 3rd% would have persistent reductions in lean body mass and fat mass extending into the neonatal period compared to fetuses not meeting those criteria. A prospective cohort of FGR fetuses with an estimated fetal weight (EFW) < 10th% was categorized as severe (EFW < 3rd% and/or abnormal Dopplers; FGR-S) versus mild (EFW 3-10th%; FGR-M). Air Displacement Plethysmography and anthropometrics were performed at birth and/or within the first 6-8 weeks of life. FGR-S versus FGR-M were born one week earlier (P = 0.0024), were shorter (P = 0.0033), lighter (P = 0.0001) with smaller weight-for-age Z-scores (P = 0.0004), had smaller head circumference (P = 0.0004) and lower fat mass (P = 0.01) at birth. At approximately 6-8 weeks postmenstrual age, weight, head circumference, and fat mass were similar but FGR-S neonates were shorter (P = 0.0049) with lower lean mass (P = 0.0258). Doppler velocimetry abnormalities in fetuses with an EFW < 10th% identified neonates who were smaller at birth and demonstrated catch-up growth by 6-8 weeks of life that favored fat mass accretion over lean mass and linear growth.

Does platelet aggregation have any importance in fetal growth restriction pregnancies?

The aim of the study was to evaluate platelet (PLT) concentration, mean platelet volume (MPV), PLT aggregation and its velocity in pregnancy complicated with fetal growth restriction (FGR) and to analyze the PLT aggregation according to the gestational age and Doppler velocimetry. The study group included 29 pregnant women diagnosed with FGR. The control group-consisted of 27 females in uncomplicated pregnancy. Then both groups were divided according to the gestational week (< and ≥ 36 weeks) and Doppler velocimetry results. The adenosine diphosphate (ADP) induced PLT aggregation was performed with the help of the electrical impedance. There was a significant positive correlation between gestational age and PLT aggregation and between gestational age and velocity of PLT aggregation in FGR. Patients with FGR ≥ 36 weeks of gestation had 73% higher PLT aggregation than control group. Within the FGR group, the PLT aggregation was 135% higher in pregnancies ≥ 36 weeks as compared to < 36 weeks of gestation. In FGR pregnancies ≥ 36 weeks with impaired flow in both uterine arteries (UtA), 2.3-fold higher PLT aggregation was found as compared to FGR patients with normal flow or abnormal flow in one UtA. The increased PLT aggregation in FGR is related to gestational week and occurs in pregnancies ≥ 36 weeks of gestation. The PLT hyperaggregability in growth-restricted pregnancies is associated with abnormal Doppler velocimetry in both UtA, comparing to patients with altered blood flow in one UtA or normal pulsatility index in both UtA, suggesting the PLT activation due to impaired uteroplacental circulation.

Исследование взаимосвязи состава микровезикул крови беременных с последующими плацента-ассоциированными осложнениями

Study Objective: To find the relationship between the levels of mitochondrial signal protein sequences in blood microvesicles of pregnant women and subsequent development of foetal growth retardation syndrome (FGRS), low birth-weight baby, preeclampsia (PE) or foetuses and newborns with normal weight and height. Study Design: Prospective comparative study. Materials and Methods. The microvesicular blood plasma fraction of women with placenta-associated complications in the outcome of previous pregnancies was studied as a risk group for their recurrence (n = 96). The study group was divided into 4 sub-groups: sub-group IА included 32 patients with pregnancies complicated with FGRS; sub-group IB comprised 20 patients with FGRS and PE; sub-group IC included 24 pregnant women, whose newborns were small for gestation age; sub-group ID was 20 pregnant women with a history of placenta-associated complications and abnormal Doppler velocimetry results, whose postnatal weight and height did not differ from normal values. The control group consisted of 20 women with a physiological course of pregnancy. The microvesicular fraction of the peripheral blood of the patients was obtained by differential plasma ultracentrifugation. Protein of the outer membrane of mitochondria (VDAC1), mitochondrial DNA transcription and replication activator (TFAM), recombinant protein of the outer membrane of mitochondria (MFN2), and TAZ protein encoding cardiolipin modelling in oxidative damage were measured by western blot analysis using a monoclonal antibody panel. Study Results. Plasma microvesicles in patients with subsequent placenta-associated complications demonstrated decreased levels of a number of mitochondrial proteins (VDAC1, TFAM, MFN2, OPA1). Levels of these proteins determine successful intercellular signaling on the adequate functional activity of mitochondria, their integrity and normal biogenesis. Conclusion. The obtained results allow to make a conclusion about a pronounced violation of mitochondrial biogenesis in the body of women with intrauterine growth restriction, which probably makes a serious contribution to the development of pathology and its progression. Keywords: foetal growth retardation syndrome, microvesicles, habitual abortion, placental insufficiency, preeclampsia, mitochondria, pregnancy.

Umbilical artery pulsatility index and half-peak systolic velocity in second- and third-trimester fetuses with trisomy 18 and 13.

To analyze umbilical artery (UA) Doppler velocimetry and its possible role in placenta-mediated fetal growth restriction (FGR) in second- and third-trimester fetuses with trisomy 18 and 13. UA pulsatility index (PI) and half-peak systolic velocity deceleration time (hPSV-DT) were measured in fetuses with trisomy 18 and 13. Correlation with gestational age, birthweight, and perinatal outcome was analyzed. A total of 80 measurements were taken from 33 fetuses with trisomy 18 and 19 with trisomy 13. Overall, there was a high prevalence of abnormal UA Doppler velocimetry. In fetuses with trisomy 18, 54% (27/50) of the UA PI values and 58% (29/50) of the UA hPSV-DT values were abnormal. In fetuses with trisomy 13, 80% (24/30) of the UA PI values and 87% (26/30) of the UA hPSV-DT values were abnormal. The prevalence of abnormal UA Doppler velocimetry increased with gestational age in both types of aneuploidy. However, this trend was only significant for trisomy 13 (p<0.05). All fetuses with trisomy 18 and 86% of fetuses with trisomy 13 were classified at birth as FGR. There were no perinatal survivors in this series. A high prevalence of abnormal UA Doppler velocimetry was found in second- and third-trimester fetuses with trisomy 18 and 13, which further increased with gestational age. These results may well correlate with alterations described previously in the placenta, suggesting placental insufficiency has an important role in the development of FGR in these autosomal aneuploid fetuses.

Early neonatal outcome of preterm babies with absent or reverse end diastolic flow in antenatal doppler velocimetry

Background: Preterm babies with abnormal doppler velocimetry during second and third trimesters of pregnancy pose various early neonatal morbidities like recurrent hypoglycaemia, feed intolerance and prolonged hospital stay. In our study we compared the incidence of hypoglycaemia, feed intolerance, risk of necrotising enterocolitis (NEC) and length of hospital stay among preterm babies with abnormal doppler flow to the gestational age matched preterm babies with normal umbilical artery doppler flow velocimetry.Methods: 30 preterm babies who had abnormal umbilical artery flow during their last antenatal doppler scan were included as study group and gestational age matched 30 preterm babies who had normal doppler study had been taken as controls. The incidence of hypoglycaemia, feed intolerance, NEC, length of hospital stay had been compared between two groups.Results: The case group with abnormal umbilical artery doppler had increased incidence of hypoglycaemia (15 of 30 babies in case versus 5 of 30 babies in control) which was statistically significant. Feed intolerance, necrotizing enterocolitis and length of hospital stay were all significantly increased in preterm babies with abnormal umbilical artery doppler when compared to preterm babies with normal umbilical artery doppler flow.Conclusions: Preterm babies with abnormal umbilical artery doppler were at increased risk of hypoglycaemia, feed intolerance, NEC and prolonged hospital stay. Knowledge on this is important to monitor closely for hypoglycaemia, gradually increase feeds and explain parents about expected morbidities which can increase the length of hospital stay in neonatal intensive care unit (NICU).

Ultrasound and Doppler findings in pregnant women withSARS-CoV-2 infection.

ABSTRACTObjectivesTo describe and compare ultrasound and Doppler findings in pregnant women who were positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) with findings in those who were SARS‐CoV‐2‐negative, evaluated during the pandemic period.MethodsIn this retrospective case–control study, we analyzed data from 106 pregnant women who tested positive for SARS‐CoV‐2 at the time of, or within 1 week of, an ultrasound scan between 1 May and 31 August 2020. Scans were either performed for routine fetal evaluation or indicated due to a positive SARS‐CoV‐2 test. Forty‐nine women were symptomatic and 57 were asymptomatic. For comparison, we analyzed data from 103 pregnant women matched for maternal age, parity, body mass index and gestational age at the time of the ultrasound scan. These control women did not report symptoms of SARS‐CoV‐2 infection at the time of the ultrasound scan or at the time of admission for delivery and had a negative SARS‐CoV‐2 test at admission for delivery. Fetal biometry, fetal anatomy, amniotic fluid volume and Doppler parameters, including umbilical and fetal middle cerebral artery pulsatility indices, cerebroplacental ratio and biophysical profile (BPP), were evaluated as indicated. Biometric and Doppler values were converted to Z‐scores for comparison. Our primary outcome, an adverse prenatal composite outcome (APCO) included any one or more of: small‐for‐gestational‐age (SGA) fetus, oligohydramnios, abnormal BPP, abnormal Doppler velocimetry and fetal death. Comorbidities, delivery information and neonatal outcome were compared between the two groups.ResultsEighty‐seven (82.1%) women who were positive for SARS‐CoV‐2 had a body mass index > 25 kg/m2. SARS‐CoV‐2‐positive women had a higher prevalence of diabetes (26/106 (24.5%) vs 13/103 (12.6%); P = 0.03), but not of pre‐eclampsia (21/106 (19.8%) vs 11/103 (10.7%); P = 0.08), compared with controls. The prevalence of APCO was not significantly different between SARS‐CoV‐2‐positive women (19/106 (17.9%)) and controls (9/103 (8.7%)) (P = 0.06). There were no differences between SARS‐CoV‐2‐positive women and controls in the prevalence of SGA fetuses (12/106 (11.3%) vs 6/103 (5.8%); P = 0.17), fetuses with abnormal Doppler evaluation (8/106 (7.5%) vs 2/103 (1.9%); P = 0.08) and fetuses with abnormal BPP (4/106 (3.8%) vs 0/103 (0%); P = 0.14). There were two fetal deaths in women who were positive for SARS‐CoV‐2 and these women had a higher rate of preterm delivery ≤ 35 weeks of gestation (22/106 (20.8%) vs 9/103 (8.7%); odds ratio, 2.73 (95% CI, 1.19–6.3); P = 0.01) compared with controls.ConclusionsThere were no significant differences in abnormal fetal ultrasound and Doppler findings observed between pregnant women who were positive for SARS‐CoV‐2 and controls. However, preterm delivery ≤ 35 weeks was more frequent among SARS‐CoV‐2‐positive women. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Human placental villous stromal extracellular matrix regulates fetoplacental angiogenesis in severe fetal growth restriction.

Pregnancies complicated by severe, early-onset fetal growth restriction with abnormal Doppler velocimetry (FGRadv) have a sparse villous vascular tree secondary to impaired angiogenesis. As endothelial cell (EC) and stromal matrix interactions are key regulators of angiogenesis, we investigated the role of placental stromal villous matrix on fetoplacental EC angiogenesis. We have developed a novel model of generating placental fibroblast (FB) cell-derived matrices (CDMs), allowing us to interrogate placenta-specific human EC and stromal matrix interactions and their effects on fetoplacental angiogenesis. We found that as compared with control ECs plated on control matrix, FGRadv ECs plated on FGRadv matrix exhibited severe migrational defects, as measured by velocity, directionality, accumulated distance, and Euclidean distance in conjunction with less proliferation. However, control ECs, when interacting with FGRadv CDM, also demonstrated significant impairment in proliferation and migratory properties. Conversely several angiogenic attributes were rescued in FGRadv ECs subjected to control matrix, demonstrating the importance of placental villous stromal matrix and EC-stromal matrix interactions in regulation of fetoplacental angiogenesis.

Adnexal torsion during pregnancy: A rare cause of acute abdomen

Ovarian torsion is caused by rotation of the ovary or adnexa with the vascular pedicle on its axis resulting in arterial and venous obstruction. Here we report a case of a pregnant woman presented to the emergency department in early second trimester with acute abdomen. History revealed the presence of an ovarian mass detected by ultrasonography 6 months before pregnancy. Sonographic examination showed right adnexal mass with abnormal Doppler velocimetry and thus immediate laparotomy was decided. Right salpingo-oophorectomy was performed and post-operative course of the patient was uneventful. According to this case, adnexal torsion should not be eliminated from differential diagnosis when it comes to pregnant women with acute abdomen.

Role of aspirin dose in reducing uterine artery resistance in 16-24 weeks pregnant women with abnormal uterine artery resistance

Objectives: To compare the decrease of resistance index (RI) from uterine artery in pregnant woman receiving low dose aspirin therapy between 80 mg/day and 125 mg/day who had abnormal doppler velocimetry (DV) ultrasound examination at 16-24 weeks.Materials and Methods: An experimental study using double blind randomized clinical trial design. Subjects were from Mulyorejo and Kalijudan public health service in Surabaya, that included pregnant women with 16-24 weeks of pregnancy with abnormal uterine artery velocimetry ultrasound. The results of ultrasound Doppler examination were divided into four levels; normal (RI&lt;0.58; (-) diastolic notching), level I (RI&gt; 0.58; (-) diastolic notching), level II (RI&lt;0.58; (+) disatolic notching) and level III (RI&gt; 0.58; (+) diastolic notching). Uterine doppler ultrasound examination was performed at Fetomaternal Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Hospital, Surabaya, Indonesia, by fetomaternal consultants before and after the admin-istration of low-dose aspirin of 125 mg/day and 80 mg/day for four weeks.Results: Ninety subjects were obtained and randomized into 2 groups, with 45 subject in each group. Before treatment, in 125 mg/day group those with level I were 34 subjects and level III 11 subjects. In 80 mg/day group, level I 41 subjects, level II 2 subjects and level III 2 subjects. After 4 weeks of treatment, a second DV USG was performed in Aspirin 125 mg/day group. Normal were 40 subjects, level I 4 subjects, and level III 1 subject. In aspirin group 80 mg/day, normal 22 subjects, level I 19 subjects and level III 4 subjects. The analysis was performed with Wilcoxon test before and after treatment in both aspirin treatment group 125 mg/day and 80 mg/day with p value respectively, p=0.001 and p=0.005.Conclusion: Compared with aspirin of 80 mg/day, aspirin of 125 mg/day is more superior to decrease uterine arterial resistance in pregnant women with ultrasound uterine arterial doppler velocimetry at 16-24 weeks gestational age.

Usefulness of uterine artery Doppler velocimetry as a predictor for hypertensive disorders in pregnancy in women with prehypertension before 20 weeks gestation.

Hypertensive disorders of pregnancy (HDP) is major complication of maternal-fetal outcomes in obstetric field. Although HDP is mainly defined by high blood pressure, the information about the relationship between prehypertension (preHTN, 120-139mmHg and 80-89mmHg) and HDP development is limited. The objective of this study is to determine the usefulness of preHTN before 20 weeks gestation and uterine artery (UtA) Doppler velocimetry as a predictor of HDP. A total of 2039 singleton pregnant women who had received continuous prenatal care were included in this study. The participants were classified into 2 groups based on the highest blood pressure (BP) under 20 gestational weeks as defined by the Joint National Committee 7: Normotensive (n = 1816) and preHTN pregnant women (n = 223). All preHTN pregnant women were assessed using UtA Doppler velocimetry, and the numbers of preHTN assessments were recorded. The risk of HDP was assessed in the PreHTN groups through patient history and Doppler velocimetry. Compared to normotensive patients, a total of 223 preHTN patients had a higher risk of preeclampsia (OR: 2.3; CI: 1.2–4.3), gestational hypertension (OR: 3.3; CI: 2.0–5.4) and any HDP (OR: 3.0; CI: 2.0–4.5). In the preHTN group, 134 (60.1%) patients had preHTN measured at least twice and 89 (39.9%) patients had preHTN. The results showed that two or more preHTN measurements have high sensitivity for predicting HDP (OR: 1.9; CI: 1.0–3.1; sensitivity: 83.8%; specificity: 47.2%). Additionally, the combination of abnormal UtA Doppler velocimetry results and at least two preHTN measurements showed a high accuracy in predicting HDP (OR: 2.9; CI: 1.1–4.1; sensitivity: 67.6%; specificity: 98.4%). In conclusion, close BP monitoring and recording of every preHTN event are important for pregnant women with preHTN history, and UtA Doppler examination in those women during the 2nd trimester can be a further aid in determining the risk of HDP.

Analysis of the Performance of 11 Formulae for Fetal Weight Estimation in Preterm Fetuses with Abnormal Doppler Velocimetry - A Retrospective Multicenter Study.

To assess 11 formulae commonly used to estimate fetal weight in a population of premature fetuses who had abnormal Doppler velocimetry due to early-onset placental insufficiency. The performance of each formula was evaluated in subgroups of fetuses with expected growth and intrauterine growth restriction. Data were collected from fetuses and mothers who delivered at three Brazilian hospitals between November 2002 and December 2013. We used the following formulae: Campbell; Hadlock I, II, III, IV and V; Shepard; Warsof; Weiner I and II; and Woo III. We analyzed 194 fetuses. Of these, 116 (59.8%) were considered appropriate for gestational age (AGA), and 103 (53.1%) were male. The amniotic fluid volume was reduced in 87 (44.8%) fetuses, and the umbilical artery Doppler revealed absence or inversion of diastolic flow in 122 (62.9%) cases, and the analysis of the ductus venosus revealed abnormal flow in 60 (34.8%) fetuses. The Hadlock formulae using three or four fetal biometric parameters had low absolute percentage error in the estimated fetal weight among preterm fetuses with abnormal Doppler studies who were born within 5 days of the ultrasound evaluation. The results were not influenced by the clinical and ultrasound parameters often found in early-onset placental insufficiency. In this study, the formulae with the best performance for fetal weight estimation in the analyzed population were Hadlock I and IV, which use four and three fetal biometric parameters respectively to estimate the weight of preterm fetuses with abnormal Doppler studies.

Abnormal umbilical artery Doppler velocimetry and placental histopathological correlation in fetal growth restriction

Background . Doppler velocimetry (DV) is widely used to assess the vascular formation of the placenta in fetal growth restriction (FGR) and to estimate the haemodynamic condition of the growth-restricted fetus. Umbilical artery (UA) flow is essentially placental, rather than fetal. Hence, DV provides information about the fetal side of the placenta and, alongside placental histopathology, it could possibly help to decipher aetiopathogenesis in FGR cases. Objective . To correlate UA DV findings occurring in FGR with placental findings. Methods. The study was prospective and conducted in a low-income setting. A total of 130 non-anomalous singleton FGR pregnancies (≥24 weeks) were included in the study. All pregnancies were confirmed to be small for gestational age (SGA) after the birth of the neonate. The placental lesions and neonatal outcomes were correlated with DV findings before delivery: 65 cases with normal DV results constituted group 1, and group 2 had 65 cases with abnormal DV results such as reduced flow, absent UA end diastolic flow or reversal of UA end diastolic flow. Results . Group 2 had significantly lower mean (standard deviation) birth weights of 1.59 (0.4) kg v. 1.87 (0.23) kg for group 1 ( p <0.001). Considerably higher NICU mortality was seen in group 2 (30.5%) compared with group 1 (6.7%) ( p <0.001). The group 2 placentas weighed less, had a higher number of maternal underperfusion (MUP) lesions, higher levels of calcification. Among lesions of MUP, 4 lesions i.e. villous infarction ( p <0.001), villous agglutination ( p <0.001), syncytial knots ( p =0.003) and intervillous fibrin deposition ( p =0.001) were present in significantly higher numbers in the abnormal Doppler group compared with the normal Doppler group. Abnormal Doppler had a sensitivity of 80% and specificity of 92.3% for abnormal placental pathology (placental lesions ≥3). Conclusions. There was a significantly higher number of MUP lesions and neonatal morbidity in SGA patients with abnormal DV findings

Endothelial Progenitor Cells of the Human Placenta and Fetoplacental Circulation: A Potential Link to Fetal, Neonatal, and Long-term Health.

The fetoplacental circulation plays a key role in both short- and long-term outcomes, and aberrant flow indices as manifested by abnormal fetal Doppler velocimetry within this compartment have been associated with significant adverse consequences. These include fetal growth restriction, which often coexists with preeclampsia, and long-lasting medical issues as a result of both the underlying pathology and prematurity such as bronchopulmonary dysplasia, chronic lung disease, and neurodevelopmental delay. Furthermore, it is also clear that exposure to an abnormal in utero environment increases risk for long-term, adulthood issues such as cardiovascular disease. Endothelial progenitor cells (EPCs) have been implicated in vasculogenesis and angiogenesis, and they have been isolated from both human placenta and umbilical cord blood. This review outlines the extensive nomenclature of EPCs, summarizes existing literature surrounding human placental and umbilical cord blood EPCs, explores their potential role in pregnancy complications and adverse perinatal outcome, and highlights key areas where future investigations are needed.

Acute-phase proteins in prediction of preeclampsia in patients with abnormal midtrimester uterine Doppler velocimetry.

Manifestation of preeclampsia is characterized by an inflammatory response and altered expression of acute-phase proteins. In this study, we examined the predictive value of serum amyloid A, progranulin, transthyretin, C-reactive protein and interleukin-6. Soluble endoglin was used as control. Maternal serum levels of the putative biomarkers were measured in 49 women with a midtrimester bilateral abnormal uterine artery Doppler velocimetry. Preeclampsia developed in 26.5%. 75.0% had an early-onset disease (<34+0weeks). Delivery <34+0weeks was indicated in 16.3%. 12.2% of patients developed a normotensive intrauterine growth restriction. All of the putative biomarkers were not predictive for preeclampsia. But serum levels of progranulin and also of soluble endoglin were increased in cases with development of a severe normotensive intrauterine growth restriction. Only soluble endoglin was predictive for the development of preeclampsia with an area under curve in the receiver operating curve analysis of 0.761 (P=0.006). Using a cut-off level of ≥9.14ng/mL, sensitivity, specificity, positive predictive value and negative predictive value were 53.9, 88.9, 63.6 and 84.2%, respectively. Inflammation is a late event during development of preeclampsia, and acute-phase proteins are not predictive for the disease in a high-risk population without clinical symptoms during the second trimester. Progranulin is a putative new biomarker for an early detection of intrauterine growth restriction in women without concomitant hypertensive disorders. Soluble endoglin improved predictive values for preeclampsia in patients with abnormal uterine Doppler.