Abnormal Umbilical Artery Doppler Research Articles

Ca2+ signals in human umbilical endothelial cells derived from pregnancy with fetal growth restriction associated with hypertensive disorder.

Fetal growth restriction associated with hypertensive disorders of pregnancy (FGR-HDP) is a prevalent pathology with a higher risk of perinatal morbimortality. In this condition, placental insufficiency and endothelial dysfunction serve key roles. The present prospective cohort study monitored 11 patients with an FGR-HDP and 15 with full-term normotensive pregnancies and studied post-natal intracellular calcium concentration ([Ca2+]i) signals in human umbilical vein endothelial cells (HUVECs). Small fetuses with placental insufficiency were identified using fetal biometry with Doppler velocimetry. Mean gestational age and birth weight were 31.8±4.1 weeks and 1,260±646 g for FGR-HDP and 39.2±0.8 weeks and 3,320±336 g for normal births, respectively. Abnormal umbilical artery Doppler waveforms were found in 64% of neonates with FGR-HDP. A significant percentage (86%) of FGR newborns were admitted to the neonatal intensive care unit at Gustavo Fricke hospital, Viña del Mar, Chile, with one case of death after birth. [Ca2+]i signals were measured by microfluorimetry in Fluo-3-loaded HUVECs from primary cultures. Altered [Ca2+]i signals were observed in HUVECs from FGR-HDP, where the sustained phase of ATP-induced [Ca2+]i responses was significantly reduced compared with the normotensive group. Also, the [Ca2+]i signals induced with 10 mM Ca2+ after depletion of internal Ca2+ stores were significantly higher. The present study provides a better comprehension of the role of altered cytosolic Ca2+ dynamics in endothelial dysfunction and an in vitro model to assess novel therapeutic approaches for decreasing or preventing complications in FGR-HDP.

Perinatal outcomes according to umbilical artery Doppler assessment among fetuses with congenital heart disease.

To evaluate a cohort of fetuses with congenital heart disease (CHD) who underwent serial umbilical artery (UA) Doppler surveillance and assess perinatal outcome according to UA Doppler assessment. A retrospective cohort study of singleton fetuses with CHD at a single academic center was performed between 2018 and 2020. Fetuses with a chromosomal abnormality or growth restriction were excluded. We compared fetuses with normal versus abnormal UA Doppler assessment at any time in pregnancy. Abnormal UA Doppler assessment was defined as decreased end diastolic flow, determined by an elevated systolic/diastolic ratio >95th percentile for gestational age, or absent/reversed end diastolic flow. Logistic regression assessed the odds of fetuses with CHD and abnormal UA Doppler assessment having a composite adverse perinatal (defined as fetal, neonatal, or infant death), adjusting for relevant covariates. We identified a cohort of 171 fetuses with CHD that met inclusion criteria. Of these, 154 (90%) had normal UA Doppler assessment and 17 (10%) had abnormal UA Doppler assessment throughout pregnancy. Maternal characteristics did not differ between groups except for maternal race and history of preeclampsia. There was no statistically significant difference in primary outcome between groups [14% (21/154) of fetuses with normal UA Doppler assessment had an adverse perinatal outcome compared to 24% (4/17) of those with abnormal UA Doppler assessment, p = 0.28]. UA Doppler assessment is unlikely to predict adverse perinatal outcome in normally grown, euploid singleton fetuses with CHD.

Perinatal outcomes following abdominoplasty: a retrospective study and review of current literature

BackgroundAbdominoplasty surgery is a common body contouring surgery to remove excess fat and skin and restore weakened or separated abdominal muscles caused by aging, pregnancy, or weight fluctuations. There is scant literature regarding patient and pregnancy outcomes following abdominoplasty. We sought to determine if there was a correlation between adverse pregnancy outcomes and a history of abdominoplasty. MethodsWe used a large federated de-identified national health research network with data sourced from 68 health care organizations within the United States (TriNetX, data accessed August 19, 2022). All patients with a record of pregnancy were identified using ICD-10/9 codes and were grouped into those with a history of abdominoplasty and those without. We evaluated the perinatal outcomes of fetal growth restriction, abnormal umbilical artery dopplers, gestational hypertension, pre-eclampsia, preterm delivery, preterm prelabor rupture of membranes, gestational diabetes, macrosomia, stillbirth, abnormal placentation, and wound disruption/infection occurring during a patient's pregnancy following abdominoplasty. Propensity matching was performed to account for potential confounders. An alpha level of < 0.05 was considered statistically significant. ResultsOf the 44,737 patients meeting our criteria, 304 had a history of abdominoplasty while 44,433 did not (Control). We found that patients with a history of abdominoplasty had significantly higher gravidity, were largely located in the Southern and Midwest region, and had higher counts of vaginal deliveries and cesarean sections, when compared to the Control cohort (Table 1). After propensity score matching, we found lower risk of pre-eclampsia and PPROM in patients with abdominoplasty (OR [95%CI] = 0.46 [0.32, 0.67], p < 0.0001, Table 2). Furthermore, abdominoplasty was associated with increased risk of preterm delivery (OR [95%CI] = 2.15 [1.48, 3.13], p = 0.0002, Table 2). We did not find significant differences in the other perinatal outcomes (Table 2). DiscussionOur data suggest that abdominoplasty may be associated with a relative increase in rates of preterm delivery and cesarean delivery, but other perinatal outcomes are not increased. This provides evidence that future desire for pregnancy need not be a relative contraindication to abdominoplasty.

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.

Slow verses rapid advancement of enteral feed in preterm neonates of 28-34 weeks of gestational age with abnormal antenatal umbilical artery Doppler: A randomised controlled trial

Background: Necrotising enterocolitis (NEC) is the commonest and most serious gastrointestinal neonatal emergency. In preterm infants with evidence of abnormal Doppler flow velocities in the fetal umbilical artery, suboptimal intestinal perfusion is postulated to increase the risk of feed intolerance and NEC.Objectives: To compare the effect of slow versus rapid enteral feeding in preterm neonates with abnormal antenatal umbilical artery Doppler.Method: This is a randomised controlled trial; we randomised into a slow and a fast group; we randomised separately into subcategories based on the weight. Sample size was calculated as 82. Data analysis was done using SPSS version 23. For group comparisons of categorical data, Chi-squared test was used. If expected frequency in the contingency tables was &lt;5 for more than 25% cells, Fisher’s exact test was used. For non-parametric continuous data Mann-Whitney test was applied. Statistical significance was kept at p&lt;0.05 and power at 80%.Results: In neonates with slow and rapid feeding with birth weight &lt;1250g, percentage of 2b (30% and 26.7% respectively) was more compared to other stages, whereas in group with birth weight ≥1250g rapid feeding group Ia (14.3%) was more in slow feeding group and 1a and 2a equal in rapid feeding group with no statistical significance. The mean duration of stay hospital was less in rapid feeding group in both birth strata. The sepsis percentage was more in the slow feeding group. Regarding mortality in both groups, there was no statistical difference.Conclusions: In this study the type of feeding did not affect NEC or feeding intolerance in preterm infants. Rapid feeding had a significant impact on sepsis and length of stay in preterm infants.

Infantile outcome at 3 years of age among monochorionic twins with Type-II or -III selective fetal growth restriction with isolated oligohydramnios who underwent fetoscopic laser photocoagulation.

This study aimed to examine infantile outcomes at 3 years of age with selective fetal growth restriction (sFGR) Types II and III with isolated oligohydramnios who underwent fetoscopic laser photocoagulation (FLP). This multicenter prospective cohort study included monochorionic diamniotic twins who underwent FLP for sFGR between 16 and 25 weeks of gestation. The indication for performing FLP was in cases of sFGR Type II or III with oligohydramnios, where the maximal vertical pocket was ≤2 cm among twins with FGR. This was done in the absence of a typical twin-twin transfusion syndrome diagnosis. The primary outcome was the intact survival (IS) rate of infants at the corrected age of 40 weeks and 3 years. IS at the corrected age of 40 weeks was defined as survival without grade III or IV intraventricular hemorrhage or cystic periventricular leukomalacia, and IS at 3 years of age was defined as survival without neurodevelopmental morbidity, including cerebral palsy, neurodevelopmental impairment with a total developmental quotient of ≤70, bilateral deafness, or bilateral blindness. Among 45 patients with sFGR, 30 (66.7%) were classified as having Type II and 15 (33.3%) as Type III sFGR. The prevalence of IS at the corrected age of 40 weeks was 51.1% (n=23) in FGR twins and 95.5% (n=42) in larger twins. The prevalence of IS at 3 years of age was 46.7% (n=21) in FGR twins and 86.4% (n=38) in larger twins. Among the 24 FGR twins who were not diagnosed with IS at 3 years of age, 91.7% (22 of 24 cases) suffered fetal or infantile demise other than miscarriage and neurodevelopmental impairment. All larger twins who were not diagnosed with IS at 3 years of age (n=6, 13.6%) had neurological morbidity, in addition to one case of miscarriage. FGR twins and larger twins, when subjected to FLP due to sFGR coupled with umbilical artery Doppler abnormalities and isolated oligohydramnios, exhibit low rates of neurological morbidity and low mortality, respectively. Therefore, FLP for Type II or III sFGR with oligohydramnios may be a feasible and preferable management option. This article is protected by copyright. All rights reserved.

Feeding Outcomes in Preterm Neonates with Antenatal Abnormal Umbilical Artery Doppler Profile: A Retrospective Cohort Study.

Neonates with absent-or-reversed umbilical artery end-diastolic flow (AREDF) are at an increased risk of feeding problems. In this retrospective study, authors evaluated the incidence of feed intolerance in 213 preterm neonates (January 2017-May 2022) with AREDF. The median (IQR) gestation and birth weight were 32 (30, 33) wk and 1120 (840, 1425) g, respectively. Of 213 neonates, 103 (48.4%; 95% CI 41.5%, 55.3%) neonates developed feed intolerance. Twelve of 213 neonates developed any stage necrotizing enterocolitis (NEC) (5.6%; 95% CI 2.9%, 9.6%) at a median age of 10 d. On multivariate regression, gestation was the only independent predictor of feed intolerance (OR 1.48; 95% CI 1.28, 1.70; for every 1 wk decrease below 36 wk).Almost 50% of preterm neonates with AREDF develop feed intolerance. Alternative feeding strategies warrant exploration to optimise nutrition in these neonates.

Fetal growth changes and prediction of selective fetal growth restriction following fetoscopic laser coagulation in twin-to-twin transfusion syndrome.

To investigate fetal growth changes and predictive factors for selective fetal growth restriction (sFGR) in patients with twin-to-twin transfusion syndrome (TTTS) after fetoscopic laser coagulation (FLC). This retrospective study included twin-pregnant women with fetal TTTS who underwent FLC at our institution between 2011 and 2020. Twin pairs who survived at least 28 days after FLC and at least 28 days after birth were included. A paired t-test was used to compare the mean discordance between the estimated fetal weights at the FLC and the birth weights. The predictive factors for sFGR after FLC were evaluated using univariate and multivariate logistic regression analyses. A total of 119 eligible pairs of patients who underwent FLC were analyzed. The weight percentile at birth significantly decreased after FLC in the recipients (53.7±30.4 percentile vs. 43.7±28.0 percentile; P<0.001), but increased in the donors (11.5±17.1 percentile vs. 20.7±22.8 percentile; P<0.001). Additionally, the mean weight discordance of twin pairs significantly decreased after FLC (23.9%±12.7% vs. 17.3%±15.7%; P<0.001). After FLC, Quintero stage ≥3, pre-FLC sFGR, abnormal cord insertion, and post-FLC abnormal umbilical artery Doppler (UAD) were all significantly higher in the sFGR group than the non-sFGR group. The prediction model using these variables indicated that the area under the receiver operating characteristic curve was 0.898. The recipient weight percentile decreased, whereas donor growth increased, resulting in reduced weight discordance after FLC. The Quintero stage, pre-FLC sFGR, and post-FLC abnormal UAD were useful predictors of sFGR after FLC in TTTS.

Maternal PlGF and umbilical Dopplers predict pregnancy outcomes at diagnosis of early-onset fetal growth restriction.

BACKGROUNDSevere, early-onset fetal growth restriction (FGR) causes significant fetal and neonatal mortality and morbidity. Predicting the outcome of affected pregnancies at the time of diagnosis is difficult, thus preventing accurate patient counseling. We investigated the use of maternal serum protein and ultrasound measurements at diagnosis to predict fetal or neonatal death and 3 secondary outcomes: fetal death or delivery at or before 28+0 weeks, development of abnormal umbilical artery (UmA) Doppler velocimetry, and slow fetal growth.METHODSWomen with singleton pregnancies (n = 142, estimated fetal weights [EFWs] below the third centile, less than 600 g, 20+0 to 26+6 weeks of gestation, no known chromosomal, genetic, or major structural abnormalities) were recruited from 4 European centers. Maternal serum from the discovery set (n = 63) was analyzed for 7 proteins linked to angiogenesis, 90 additional proteins associated with cardiovascular disease, and 5 proteins identified through pooled liquid chromatography and tandem mass spectrometry. Patient and clinician stakeholder priorities were used to select models tested in the validation set (n = 60), with final models calculated from combined data.RESULTSThe most discriminative model for fetal or neonatal death included the EFW z score (Hadlock 3 formula/Marsal chart), gestational age, and UmA Doppler category (AUC, 0.91; 95% CI, 0.86-0.97) but was less well calibrated than the model containing only the EFW z score (Hadlock 3/Marsal). The most discriminative model for fetal death or delivery at or before 28+0 weeks included maternal serum placental growth factor (PlGF) concentration and UmA Doppler category (AUC, 0.89; 95% CI, 0.83-0.94).CONCLUSIONUltrasound measurements and maternal serum PlGF concentration at diagnosis of severe, early-onset FGR predicted pregnancy outcomes of importance to patients and clinicians.TRIAL REGISTRATIONClinicalTrials.gov NCT02097667.FUNDINGThe European Union, Rosetrees Trust, Mitchell Charitable Trust.

Malaria Infections and Placental Blood Flow: A Doppler Ultrasound Study From a Preconception Cohort in Benin.

Malaria in pregnancy (MiP) has been associated with fetal growth restriction, the underlying pathogenic mechanisms of which remain poorly understood. Malaria in pregnancy is suspected to induce abnormalities in placental vascularization, leading to impaired placental development. Our study evaluated MIP's effect on uterine artery (UtA) and umbilical artery (UA) blood flow. The analysis included 253 Beninese women followed throughout pregnancy and screened monthly for submicroscopic and microscopic malaria. Uterine artery Doppler measurement was performed once between 21 and 25 weeks' gestation (wg), and UA Doppler measurement was performed 1-3 times from 28 wg. Linear and logistic regression models were used to assess the effect of malaria infections on UtA Doppler indicators (pulsatility index and presence of a notch), whereas a logistic mixed model was used to assess the association between malaria infections and abnormal UA Doppler (defined as Z-score ≥2 standard deviation or absent/reversed UA end-diastolic flow). Primigravidae represented 7.5% of the study population; 42.3% of women had at least 1 microscopic infection during pregnancy, and 29.6% had at least 1 submicroscopic infection (and no microscopic infection). Both microscopic and submicroscopic infections before Doppler measurement were associated with the presence of a notch (adjusted odds ratio [aOR] 4.5, 95% confidence interval [CI] = 1.2-16.3 and aOR 3.3, 95% CI = .9-11.9, respectively). No associations were found between malaria before the Doppler measurement and abnormal UA Doppler. Malaria infections in the first half of pregnancy impair placental blood flow. This highlights the need to prevent malaria from the very beginning of pregnancy.

External validation of a prediction model assessing risk of delivery in fetuses with growth restriction after diagnosis of abnormal umbilical artery Doppler.

We have previously described a model using maternal, antenatal and ultrasonographic characteristics to assess the risk of delivery within seven days following diagnosis of abnormal umbilical artery Doppler (UAD) in pregnancies affected by fetal growth restriction (FGR). Therefore, we sought to validate this model in an independent cohort. Retrospective, single referral center study of liveborn singleton pregnancies from 2016 to 2019 complicated by FGR and abnormal UAD (Systolic/diastolic ratio (S/D) >95th percentile for gestational age [GA]). Prediction probabilities were calculated by applying the original model (Model 1) to the current cohort (BWH cohort). The variables of this model include GA at first abnormal UAD, severity of first abnormal UAD, oligohydramnios, preeclampsia, and pre-pregnancy body mass index. Model fit was assessed with area under the curve (AUC). Two alternative models (Models 2 & 3) were created to identify a model with better predictive characteristics than Model 1. The receiver operating characteristics curves were compared using the DeLong test. A total of 306 patients were assessed for eligibility, 223 of whom were included in the BWH cohort. Median gestational age at eligibility was 31.3 weeks, and median interval from eligibility to delivery was 17 days (IQR 3.5-33.5 days). Eighty-two (37%) patients delivered within seven days of eligibility. Applying Model 1 to the BWH cohort resulted in an AUC of 0.865. Using the previously determined probability cutoff of 0.493, the model was 62% sensitive and 90% specific in predicting the primary outcome in this independent cohort. Models 2 and 3 did not perform better than Model 1 (p = 0.459). A previously described model predicting risk of delivery in patients with FGR and abnormal UAD performed well in an independent cohort. With high specificity, this model could assist in identifying low-risk patients and improve antenatal corticosteroid timing.

Outcomes among Neonates after a Diagnosis of Persistent or Transient Fetal Growth Restriction Delivered at Term.

This study aimed to evaluate whether transient fetal growth restriction (FGR) that resolves prior to delivery confers a similar risk of neonatal morbidity as uncomplicated FGR that persists at term. This is a secondary analysis of a medical record abstraction study of singleton live-born pregnancies delivered at a tertiary care center between 2002 and 2013. Patients with fetuses that had either persistent or transient FGR and delivered at 38 weeks or later were included. Patients with abnormal umbilical artery Doppler studies were excluded. Persistent FGR was defined as estimated fetal weight (EFW) <10th percentile by gestational age from diagnosis through delivery. Transient FGR was defined as EFW <10th percentile on at least one ultrasound, but not on the last ultrasound prior to delivery. The primary outcome was a composite of neonatal morbidity: neonatal intensive care unit admission, Apgar's score <7 at 5 minutes, neonatal resuscitation, arterial cord pH <7.1, respiratory distress syndrome, transient tachypnea of the newborn, hypoglycemia, sepsis, or death. Baseline characteristics and obstetric and neonatal outcomes were compared using Wilcoxon's rank-sum and Fisher's exact test. Log binomial regression was used to adjust for confounders. Of 777 patients studied, 686 (88%) had persistent FGR and 91 (12%) had transient FGR. Patients with transient FGR were more likely to have a higher body mass index, gestational diabetes, diagnosed with FGR earlier in pregnancy, have spontaneous labor, and deliver at later gestational ages. There was no difference in the composite neonatal outcome (relative risk = 1.03, 95% confidence interval [CI] 0.72, 1.47) for transient versus persistent FGR after adjusting for confounders (adjusted relative risk = 0.79, 95% CI 0.54, 1.17). There were no differences in cesarean delivery or delivery complications between groups. Neonates born at term after transient FGR do not appear to have differences in composite morbidity compared with those where uncomplicated FGR persists at term. · No differences in neonatal outcomes in uncomplicated persistent versus transient FGR at term.. · Transient FGR pregnancies more likely to deliver at later gestational ages.. · No differences in mode of delivery or obstetric complications in persistent versus transient FGR at term..

Predictors of adverse perinatal outcomes in fetal growth restriction using a combination of maternal clinical factors and simple ultrasound parameters.

To identify predictors of adverse perinatal outcomes in pregnancies with fetal growth restriction (FGR) using a combination of maternal clinical factors and simple ultrasound parameters and develop a risk-scoring model for predicting adverse perinatal outcomes. A retrospective study of 370 non-anomalous singleton pregnancies with FGR was conducted. Multivariate logistic regression analysis was used to identify factors associated with adverse perinatal outcomes; P< 0.05 was considered statistically significant. The discriminative ability was measured with the area under the receiver operating characteristic curve (AUC). A weighted score for each predictor was calculated. Adverse perinatal outcomes occurred in 165/370 (44.6%) cases. There were eight predictive factors, including a history of pregnancy-induced hypertension (PIH) (score=1), chronic hypertension (score=3), PIH (score=2), maternal weight gain less than 8kg (score=1), early-onset FGR (score=1), estimated fetal weight less than 5th percentile (score=2), amniotic fluid index less than 5cm (score=3), and abnormal umbilical artery Doppler (score=2), with total scores ranging from 0 to 15. AUC for the eight-item predictive model was 0.799 (95% confidence interval 0.753-0.845). A combination of maternal clinical factors and simple ultrasound parameters showed acceptable predictive performance for adverse perinatal outcomes in FGR.

Maternal plasma syndecan-1: a biomarker for fetal growth restriction

Objective The identification of fetal growth disorders is an important clinical priority given that they increase the risk of perinatal morbidity and mortality as well as long-term diseases. A subset of small-for-gestational-age (SGA) infants are growth-restricted, and this condition is often attributed to placental insufficiency. Syndecan-1, a product of the degradation of the endothelial glycocalyx, has been proposed as a biomarker of endothelial damage in different pathologies. During pregnancy, a “specialized” form of the glycocalyx—the “syncytiotrophoblast glycocalyx”—covers the placental villi. The purpose of this study was to determine whether the concentration of maternal plasma syndecan-1 can be proposed as a biomarker for fetal growth restriction. Study design A cross-sectional study was designed to include women with normal pregnancy (n = 130) and pregnant women who delivered an SGA neonate (n = 50). Doppler velocimetry of the uterine and umbilical arteries was performed in women with an SGA fetus at the time of diagnosis. Venipuncture was performed within 48 h of Doppler velocimetry and plasma concentrations of syndecan-1 were determined by a specific and sensitive immunoassay. Results (1) Plasma syndecan-1 concentration followed a nonlinear increase with gestational age in uncomplicated pregnancies (R2 = 0.27, p < .001); (2) women with a pregnancy complicated with an SGA fetus had a significantly lower mean plasma concentration of syndecan-1 than those with an appropriate-for-gestational-age fetus (p = .0001); (3) this difference can be attributed to fetal growth restriction, as the mean plasma syndecan-1 concentration was significantly lower only in the group of women with an SGA fetus who had abnormal umbilical and uterine artery Doppler velocimetry compared to controls (p = .00071; adjusted p = .0028). A trend toward lower syndecan-1 concentrations was also noted for SGA with abnormal uterine but normal umbilical artery Doppler velocimetry (p = .0505; adjusted p = .067); 4) among women with an SGA fetus, those with abnormal umbilical and uterine artery Doppler findings had a lower mean plasma syndecan-1 concentration than women with normal Doppler velocimetry (p = .02; adjusted p = .04); 5) an inverse relationship was found between the maternal plasma syndecan-1 concentration and the umbilical artery pulsatility index (r = −0.5; p = .003); and 6) a plasma syndecan-1 concentration ≤ 850 ng/mL had a positive likelihood ratio of 4.4 and a negative likelihood ratio of 0.24 for the identification of a mother with an SGA fetus who had abnormal umbilical artery Doppler velocimetry (area under the ROC curve 0.83; p < .001). Conclusion Low maternal plasma syndecan-1 may reflect placental diseases and this protein could be a biomarker for fetal growth restriction. However, as a sole biomarker for this condition, its accuracy is low.

An atypical case of edema of the umbilical cord and histological chorioamnionitis in a fetus with normal growth and abnormal umbilical artery Doppler: a case report

An atypical case of edema of the umbilical cord and histological chorioamnionitis in a fetus with normal growth and abnormal umbilical artery Doppler: a case report

Umbilical artery doppler abnormalities in fetal growth restriction defined by isolated lagging abdominal circumference

Umbilical artery doppler abnormalities in fetal growth restriction defined by isolated lagging abdominal circumference

Prevalence of abnormal umbilical arterial Doppler indices in apparently normal pregnancies in Calabar.

Intrauterine growth restriction (IUGR) may occur in the presence of normal fetal growth parameters, with resultant unanticipated perinatal morbidity and mortality. Umbilical arterial Doppler evaluation determines the fetuses susceptible to compromise by detecting IUGR early enough for successful intervention measures to be implemented. This study was aimed at determining the prevalence of abnormal umbilical arterial Doppler indices (UADI) in apparently normal pregnancies and to assess its correlation with amniotic fluid index (AFI). In this prospective cross-sectional study, obstetric sonographic examination and UADI evaluation were done on 310 apparently normal pregnant women between 26 to 40 weeks within a 6-months period. Abnormal UADI had a prevalence of 10.3%. Educational level (P = 0.000) and employment status (P = 0.000) were significantly associated with abnormal UADI. Abnormal umbilical arterial resistivity index (RI) had a significant correlation with EFW (P = 0.000) and HC/AC (P = 0.000) but no significant relationship with AFI (P = 0.593). The prevalence of abnormal umbilical arterial Doppler indices was high in apparently normal pregnancies mostly among women with low socio-economic status, with no demonstrable association with AFI.

Factors associated with latency duration in growth-restricted fetuses with absent end diastolic flow

Gestational latency after findings of abnormal umbilical artery doppler indices, such as absent end diastolic flow (AEDF), in the setting of fetal growth restriction (FGR), is important yet difficult to predict. Our objective was to describe latency and factors associated with prolonged latency in growth-restricted fetuses with AEDF.

Isolated abdominal circumference vs. estimated fetal weight, which matters more?

Fetal growth restriction (FGR) is a leading cause of neonatal morbidity and mortality. In 2020, the Society of Maternal Fetal Medicine and the American College of Obstetricians and Gynecologists redefined fetal growth restriction from estimated fetal weight (EFW) less than the 10th percentile to EFW or abdominal circumference (AC) less than the 10th percentile. In our study, we seek to assess the rate of abnormal umbilical artery Doppler velocimetry in fetuses with FGR diagnosed by isolated AC less than the 10th percentile versus those diagnosed by EFW less than the 10th percentile.

Machine learning of umbilical artery doppler flow improves prognostication in fetal growth restriction

Umbilical artery doppler (UAD) is an important tool in deciding appropriate delivery timing in fetal growth restriction (FGR) cases. UAD flow demonstrating absent or reversed end diastolic flow is associated with stillbirth, but early abnormal UAD are not clearly predictive of poor outcomes. Machine learning (ML) is a useful tool in detecting nuances in blood flow data that may more accurately predict outcomes. The purpose of this study is to determine if UAD ML improves FGR prognostication. UAD and clinical data were obtained from FGR affected pregnancies from the Iowa Intergenerational Health Knowledgebase containing data for pregnancies receiving prenatal care at a major midwestern academic medical center since 2009 (N >63000). UAD severity groups were determined (Normal, Elevated S/D [ > 95% percentile], Absent End Diastolic Flow [AEDF], and Reversed EDF [REDF]). The UAD images were optimized for ML analyses. Xception (Google) machine learning framework was used. Regression analyses were performed to identify important clinical covariates. Birth weight decreased with severity of UAD category (p < 0.001). Gestational age at delivery was shown to decrease with increasing severity of IUGR as well (p < 0.001). In line with clinical practices, diagnosis to delivery time (DDT) increased from Normal to Absent End Diastolic Flow, and then decreased for Reversed End Diastolic Flow (P = 0.03). Preeclampsia was associated with the higher categories of UAD severity (P = 0.0007). Poor neonatal outcomes were not more severe for one group, but high in all categories, ranging from 64-82 percent (p = 0.4). Machine learning of the UAD alone (R2 = 0.84) was more associated with DDT than clinical variables alone (R2 = 0.24) and clinical variables with UAD categorization (R2 = 0.75) ML of UAD alone was more associated with the diagnosis to delivery time then other traditional prediction factors in FGR pregnancies. We conclude that ML of UAD images will add additional predictive power to FGR prognostication.