Absent End-diastolic Velocity Research Articles

PERINATAL OUTCOME OF EARLY PRETERM STAGE II IUGR AT TWO HOSPITALS IN ADDIS ABABA: A RETROSPECTIVE CROSS SECTIONAL STUDY

Abstract Background: Intrauterine growth restriction is a common obstetric complication. Based on the severity it is classified into stage 0-IV. Stage II IUGR is defined as ultrasound estimated fetal weight less than 10th percentile for gestational age with absent end diastolic velocity on umbilical artery Doppler ultrasound. Studies focusing on perinatal outcome of specific class of IUGR are limited. Objective: The aim of this study is to show the magnitude of stage II IUGR and see the perinatal outcome of early preterm stage II IUGR at two public hospitals in Addis Ababa, Ethiopia. Method: A retrospective cross sectional study conducted from January 2019 to August 2022. Data was collected from medical records using a structured pre-tested questionnaire. Data was coded, entered and analyzed using SPSS version 25. Result: There were 49,338 deliveries at the two study hospitals. Of these 192 pregnancies were complicated by stage II IUGR; 151 of which were diagnosed at the early preterm gestational age. The prevalence of stage II IUGR was 0.39% where as the prevalence of early preterm stage II IUGR was 0.3% out of the total deliveries. Preeclampsia was the leading obstetric complication diagnosed in 107 (70.9%) of the cases. Mode of delivery for all of the neonates was by cesarean section and all required NICU admission. The single most common perinatal morbidity was RDS, which accounted for 42 (27.8%) of the cases. Half of the 151 pregnancies diagnosed with early preterm stage II IUGR, 75 (50 %), ended up in perinatal death. Majority of the perinatal losses were during early neaonalal period, 56 % (42/75). Compared to those with birth weight of <1000gm those with birth weight of 1500-2499gm had more than 37 times chance of survival in the perinatal period (AOR=37.67 (7.05, 201.36), p<0.000). Conclusion and recommendations: The prevalence of stage II IUGR was 0.39% where as the prevalence of early preterm stage II IUGR was 0.3%. Early preterm stage II IUGR was associated with significant perinatal morbidity and mortality. Birth weight was a determinant factor significantly associated with perinatal survival. Antenatal interventions that can help delay the onset of disease may help improve perinatal outcome. Key terms: IUGR, Stage II IUGR, perinatal death, perinatal outcome.

Clinical significance of umbilical artery intermittent vs persistent absent end-diastolic velocity in growth-restricted fetuses

Umbilical artery absent end-diastolic velocity indicates increased placental resistance and is associated with increased risk of perinatal demise and neonatal morbidity in fetal growth restriction. However, the clinical implications of intermittent vs persistent absent end-diastolic velocity are unclear. We compared umbilical artery Doppler velocimetry changes during pregnancy and neonatal outcomes between pregnancies with fetal growth restriction and intermittent absent end-diastolic velocity and those with persistent absent end-diastolic velocity. In this retrospective study of singletons with fetal growth restriction and absent end-diastolic velocity, umbilical artery Doppler abnormalities were classified as follows: intermittent absent end-diastolic velocity (<50% of cardiac cycles with absent end-diastolic velocity) and persistent absent end-diastolic velocity (≥50% of cardiac cycles with absent end-diastolic velocity). The primary outcome was umbilical artery Doppler progression to reversed end-diastolic velocity. Secondary outcomes included sustained umbilical artery Doppler improvement, latency to delivery, gestational age at delivery, neonatal morbidity composite, rates of neonatal intensive care unit admission, and length of neonatal intensive care unit stay. Outcomes were compared between intermittent absent end-diastolic velocity and persistent absent end-diastolic velocity. Multivariate logistic regression was used to adjust for confounders. A receiver operating characteristic curve was generated to assess the sensitivity and specificity of the percentage of waveforms with absent end-diastolic velocity in predicting the neonatal composite. The Youden index was used to calculate the optimal absent end-diastolic velocity percentage cut-point for predicting the neonatal composite. Of the 77 patients included, 38 had intermittent absent end-diastolic velocity and 39 had persistent absent end-diastolic velocity. Maternal characteristics, including age, parity, and preexisting conditions did not differ significantly between the 2 groups. Progression to reversed end-diastolic velocity was less common in intermittent absent end-diastolic velocity than in persistent absent end-diastolic velocity (7.9% vs 25.6%; odds ratio, 0.25; 95% confidence interval, 0.06-0.99). Sustained umbilical artery Doppler improvement was more common in intermittent absent end-diastolic velocity than in persistent absent end-diastolic velocity (50.0% vs 10.3%; odds ratio, 8.75; 95% confidence interval, 2.60-29.5). Pregnancies with intermittent absent end-diastolic velocity had longer latency to delivery than those with persistent absent end-diastolic velocity (11 vs 3 days; P<.01), and later gestational age at delivery (33.9 vs 28.7 weeks; P<.01). Composite neonatal morbidity was less common in the intermittent absent end-diastolic velocity group (55.3% vs 92.3%; P<.01). Neonatal death occurred in 7.9% of intermittent absent end-diastolic velocity cases and 33.3% of persistent absent end-diastolic velocity cases (P<.01). The differences in neonatal outcomes were no longer significant when controlling for gestational age at delivery. The percentage of cardiac cycles with absent end-diastolic velocity was a modest predictor of neonatal morbidity, with an area under the receiver operating characteristic curve of 0.71 (95% confidence interval, 0.58-0.84). The optimal percentage cut-point for fetal cardiac cycles with absent end-diastolic velocity observed at the sentinel ultrasound for predicting neonatal morbidity was calculated to be 47.7%, with a sensitivity of 65% and specificity of 85%. Compared with persistent absent end-diastolic velocity, diagnosis of intermittent absent end-diastolic velocity in the setting of fetal growth restriction is associated with lower rates of progression to reversed end-diastolic velocity, higher likelihood of umbilical artery Doppler improvement, longer latency to delivery, and higher gestational age at delivery, leading to lower rates of neonatal morbidity and death. Our data support using an absent end-diastolic velocity percentage cut-point in 50% of cardiac cycles to differentiate intermittent absent end-diastolic velocity from persistent absent end-diastolic velocity. This differentiation in growth-restricted fetuses with absent end-diastolic velocity may allow further risk stratification.

Considering evidence in the management of fetal growth restriction.

Considering evidence in the management of fetal growth restriction.

Percent Absent End-Diastolic Velocity in the Umbilical Artery and Donor Twin Demise after Laser Surgery for Twin-Twin Transfusion Syndrome

Introduction: To examine the association of preoperative absent end-diastolic velocity (AEDV) and percent AEDV (%AEDV) in the umbilical artery (UA) with donor twin intrauterine fetal demise (IUFD) after laser surgery for twin-twin transfusion syndrome (TTTS). Methods: We performed a retrospective study of stage III/IV TTTS patients who underwent laser surgery from 2006 to 2016. Donors were classified as having preoperative persistent AEDV (yes/no). %AEDV was calculated for those with AEDV as 100× the proportion of the total cardiac cycle in AEDV. Using multiple logistic regression, we tested for an association between the outcome donor IUFD and AEDV risk factors (part 1) and %AEDV (part 2). We stratified these analyses by estimated fetal weight (EFW) discordance ≥20 versus <20%. Results: Of 344 cases, 153 (44.5%) donors had AEDV. Part 1 did not confirm an independent association between AEDV and donor IUFD. In the part 2 analysis of the 153 patients with AEDV, %AEDV was a positive risk factor for donor IUFD only in those with discordance (n = 129) (OR 1.04, 95% CI 1.01–1.08, p = 0.0278) when adjusting for %EFW discordance, presence of arterioarterial anastomoses, and multiparity. Discussion: Among stage III/IV TTTS patients with AEDV, %AEDV was a risk factor for donor IUFD only in the presence of EFW discordance.

Indication for Doppler evaluation in the management of intrauterine growth restriction of vascular origin in Sub-Saharan Africa

Objective: To assess the contribution of Doppler in foetal monitoring and decision-making during delivery in case of in-utero vascular growth retardation.&#x0D; Design: We conducted a retrospective cohort study from January 2015 to December 2017 in the Gynaecology and Obstetrics Department of the Yopougon University Hospital (Abidjan, Ivory Coast). It included 130 patients who gave birth in a setting of pre-eclampsia with intrauterine growth restriction (IUGR) from 28 weeks of amenorrhoea.&#x0D; Results: The average age of patients was 31years. Nulliparous (33% of our patients) and pauciparous (41% of our patients) women were the group most affected. The mean gestational age at the first Doppler examination was 32 weeks of amenorrhoea. Doppler abnormalities were 65% in uterine Doppler and 90% in umbilical Doppler. The meancerebrovascular ratio was reversed in 90% of the cases. Perinatal mortality was 22.3% (n = 29) with 21 foetal death in utero and 8 neonatal deaths. The time interval between absent end-diastolic or reverse flow velocity and in-utero foetal death was 3.8 days.&#x0D; Conclusion: Foetal and umbilical Doppler ultrasound greatly modified the management of intrauterine growth retardation related to hypertension.

Indication for Doppler evaluation in the management of intrauterine growth restriction of vascular origin in Sub-Saharan Africa

Objective: To assess the contribution of Doppler in foetal monitoring and decision-making during delivery in case of in-utero vascular growth retardation.&#x0D; Design: We conducted a retrospective cohort study from January 2015 to December 2017 in the Gynaecology and Obstetrics Department of the Yopougon University Hospital (Abidjan, Ivory Coast). It included 130 patients who gave birth in a setting of pre-eclampsia with intrauterine growth restriction (IUGR) from 28 weeks of amenorrhoea.&#x0D; Results: The average age of patients was 31years. Nulliparous (33% of our patients) and pauciparous (41% of our patients) women were the group most affected. The mean gestational age at the first Doppler examination was 32 weeks of amenorrhoea. Doppler abnormalities were 65% in uterine Doppler and 90% in umbilical Doppler. The meancerebrovascular ratio was reversed in 90% of the cases. Perinatal mortality was 22.3% (n = 29) with 21 foetal death in utero and 8 neonatal deaths. The time interval between absent end-diastolic or reverse flow velocity and in-utero foetal death was 3.8 days.&#x0D; Conclusion: Foetal and umbilical Doppler ultrasound greatly modified the management of intrauterine growth retardation related to hypertension.

The roles of superficial anastomoses in twin-twin transfusion syndrome

ObjectiveWe aimed to evaluate whether types of vascular anastomoses affect fetal demise (FD) in twin-twin transfusion syndrome (TTTS) after fetoscopic laser photocoagulation (FLP). MethodsAll TTTS patients who underwent FLP in our institution from 2005 to 2017 were included. We described vascular anastomoses during FLP as either arterio-arterial (AA), veno-venous (VV), or arterial-venous (AV), and abnormal fetal Doppler waveforms before FLP. We also analyzed risk factors for FD following FLP. ResultsIn total, 184 TTTS placentas following FLP were analyzed (36 cases of donor-only FD, 12 cases of recipient-only FD, 3 cases of double FD, and 133 cases of both alive). AA anastomoses prevalence, absent or reverse end-diastolic velocity of umbilical artery (UAAREDV) of donor before FLP, gestational age at the time of FLP and operation time of FLP were independent risk factors for donor FD. VV anastomoses prevalence and UAAREDV of recipient before FLP were independent risk factors for recipient FD. VV anastomoses prevalence was higher in double FD cases than in FD of one twin or both alive (p = 0.002). AV anastomoses number and number of cases with more AV anastomoses from donor to recipient were not significantly different between FD and non-FD cases. DiscussionAA anastomoses are associated FD of the donor following FLP and may protect the donor from hypovolemia before FLP. VV anastomoses are detected more frequently in FD of the recipient and double FD placentas following FLP and may rescue hypervolemia of the recipient or circulations of both fetuses before FLP.

Percent Absent End-Diastolic Velocity and Risk of Donor Twin Demise in Twin-Twin Transfusion Syndrome [19A

INTRODUCTION: We examined the association of percent absent end-diastolic velocity (%AEDV) in the umbilical artery with intrauterine fetal demise (IUFD) of the donor twin after laser surgery in patients with twin-twin transfusion syndrome (TTTS) Quintero stages III/IV. %AEDV was calculated as 100x the proportion of total cardiac cycle spent in AEDV. METHODS: Retrospective study of TTTS stage III/IV patients between 2006 and 2016. Donors were classified as having persistent AEDV (yes/no). In Part 1, we used multiple logistic regression analysis to test whether AEDV was associated with donor IUFD. We stratified these analyses by estimated fetal weight (EFW) discordance of ≥20% or <20%. In Part 2, we used similar models to test only those with AEDV to determine whether %AEDV was associated with IUFD. This was an IRB approved study. RESULTS: Of 344 stage III/IV TTTS cases, 153 (44.5%) donors had preoperative AEDV. In Part 1, we did not confirm an independent association between AEDV and donor IUFD. In Part 2, patients with AEDV who were discordant (N=129), had the following characteristics associated with donor IUFD: %AEDV (OR 1.04, 95% CI 1.01-1.08), %EFW discordance (OR 1.07, 95% CI 1.02-1.13), and presence of arterioarterial anastomoses (OR 5.15, 95% CI 2.06-12.89). In the non-discordant group (N=24), no association was found between %AEDV and donor IUFD. CONCLUSION: The presence of preoperative persistent AEDV was not an independent risk factor for donor IUFD in stage III/IV TTTS patients undergoing laser surgery. However, among donors with preoperative AEDV and EFW discordance ≥20%, %AEDV was positively associated with donor IUFD.

Relationship between arterial and venous Dopplar and perinatal outcome in pregnancy women with severe preeclampsia

The aim of this study was to assess the relationship between abnormal arterial and venous Doppler finding and the perinatal outcome of fetuses in severe preeclamptic pregnancy Methods: Dopplar velocimetry of the umbilical artery(UA) and ductus venosus(DV) was performed in 32 pregnancy women who with severe preeclampsia. Groups based on the Dopplar examination were: 1 = no absent end diastolic velocity of umbilical artery[UA AEDV(-)] (n = 25, 67.6%), 2 = absent end diastolic velocity of the umbilical artery noted [UA AEDV(+)] but no reverse of ductus venosus[DV(-)] (n = 7, 18.9%), 3 = absent end diastolic velocity of umbilical artery [UA AEDV(+)] and reverse of ductus venosus [DV(+)] were both noted (n = 5, 13.5%). Apgar score at delivery, respiratory distress (RDS), intraventricular hemorrhage(IVH), necrotizing enterocolitis (NEC), send to intensive care unit (ICU) or not were recored. Results: There were no significant difference about maternal age, gestational age at delivery, maternal blood pressure, mode of delivery,baby body weight at delivery, Apgar score at delivery between three group. There were no significance difference about the perinatal outcome, including perinatal death(p = 0.56), respiratory distress syndrome(p = 0.28), intraventricular hemorrahge (p = 1.00), in three group. We could noticed higher incidence of the baby send to ICU in group 2 and 3 (p = 0.28). Conclusions: According to this study, higher incidence of the baby send to ICU in severe preeclamtic pregnant women who with abnormal dopplar finding at umbilical artery and ductus venosus. The timing of delivery of severe preeclamptic pregnancy before absent end diastolic velocity of UA is needed to think about it. But further research or more sample size is needed to confirm this finding.

Simultaneous umbilical blood flow during normal pregnancy in sheep and goat foetuses using non-invasive colour Doppler ultrasound.

The characteristics of umbilical blood flow (UM) was investigated using 18 (25 foetuses) pregnant ewes and 20 (41 foetus) pregnant goats transrectal non-invasive color Doppler ultrasonographic examinations were done frequently between 2 and 8 week after breeding and then transabdominally until parturition. Colour Doppler velocimetery includes blood flow volume (BFV), time averaged maximum velocity (TAMV), resistance index (RI), pulsatility index (PI), time average of mean (TAMEAN) and impedance of blood flow (PS/ED or AB ratio). Also a qualitative evaluation of UM blood flow indicating increases (P < 0.001) in BFV, TAMV and TAMEAN were observed until 19 week of pregnancy in foetuses of sheep and goats and then those values decreased (P < 0.001) from 19 week until parturition. Conversely, UM-PI, RI and PS/ED decreased (P < 0.002-0.01) until 19 week and then increased (P < 0.01-0.0001). The umbilical artery BFV increased (P < 0.0001) during pregnancy from 7.27 ± 0.82 ml/min in sheep vs. 4.96 ± 0.54 ml/min in goats at 6 week of gestation to 700.51 ± 31.05 ml/min (~100 fold) in sheep vs. 665.56 ± 48.22 ml/min (~133 fold) in goats at 19 week and then decreased (P < 0.0001) to 350.561 ± 72.15 ml/min in sheep vs. 215.17 ± 35.06 ml/min in goats at 20 week. The absence of end diastolic velocity (EDV) of umbilical artery blood flow was detected in both species between 4 and 12 week of pregnancy. Results of this study clearly show that the non-invasive colour Doppler sonography can be used successfully to assess umbilical blood flow in foetuses of pregnant sheep and goats. These may provide guidelines for assessing the state of intrauterine fetal growth retardation in pregnancies of sheep and goats.

Risk of fetal death in growth-restricted fetuses with umbilical and/or ductus venosus absentor reversed end-diastolic velocities before 34 weeks of gestation: a systematic review and meta-analysis.

The objective of the study was to establish the risk of fetal death in early-onset growth-restricted fetuses with absent or reversed end-diastolic velocities in the umbilical artery or ductus venosus. A systematic search was performed to identify relevant studies published in English, Spanish, French, Italian, or German using the databases PubMed, ISI Web of Science, and SCOPUS, without publication time restrictions. The study criteria included observational cohort studies and randomized controlled trials of early-onset growth-restricted fetuses (diagnosed before 34 weeks of gestation), with information on the rate of fetal death occurring before 34 weeks of gestation and absent or reversed end-diastolic velocities in the umbilical artery and/or ductus venosus. For quality assessment, 2 reviewers independently assessed the risk of bias using the Newcastle-Ottawa Scale for observational studies and the Cochrane Collaboration's tool for randomized trials. For the meta-analysis, odds ratio for both fixed and random-effects models (weighting by inverse of variance) were used. Heterogeneity between studies was assessed using tau2, χ2 (Cochrane Q), and I2 statistics. Publication bias was assessed by a funnel plot for meta-analyses and quantified by the Egger method. A total of 31 studies were included in this meta-analysis. The odds ratios for fetal death (random-effects models) were 3.59 (95% confidence interval, 2.3-5.6), 7.27 (95% confidence interval, 4.6-11.4), and 11.6 (95% confidence interval, 6.3-19.7) for growth-restricted fetuses with umbilical artery absent end-diastolic velocities, umbilical artery reversed end-diastolic velocities, and ductus venosus absent or reversed end-diastolic velocities, respectively. There was no substantial heterogeneity among studies for any of the analyses. Early-onset growth-restricted fetuses with either umbilical artery or ductus venosus absent or reserved end-diastolic velocities are at a substantially increased risk for fetal death.

Ductus venosus Doppler and the postnatal outcomes of growth restricted fetuses with absent end-diastolic blood flow in the umbilical arteries

ObjectiveWe aimed to evaluate the outcomes of growth-restricted fetuses with absent end-diastolic velocity in the umbilical arteries (UA-AEDV), and investigate the relationship between Doppler flow velocity waveforms in the ductus venosus (DV) and the clinical features. Materials and methodsThis was a retrospective study of growth-restricted fetuses diagnosed with UA-AEDV delivered at our institution between 2013 and 2015. The time from diagnosis of UA-AEDV to delivery, postnatal survival, and developmental prognoses were the primary outcomes. The time lag between the occurrence of UA-AEDV and an abnormal increase in the DV pulsatility index (DV-PI) were investigated. We also examined the correlation between the DV-PI values immediately before birth and umbilical cord arterial pH at birth. ResultsThe median gestational age at birth among the 18 subjects was 28+2 (24+0–34+6) weeks, and the observation period between the first detection of UA-AEDV and delivery ranged from 0 to 35 days with a median of 8 days. Among the 18 infants, 15 (83%) survived, among whom 2 were diagnosed with a developmental disability. Gestational age at delivery was significantly lower in the poor outcome group. A positive correlation (correlation coefficient, 0.68) was observed between the umbilical artery pH and the last measured DV-PI. ConclusionThe time interval from initial detection of UA-AEDV to delivery is highly variable, and it is reasonable to manage these growth-restricted fetuses with UA-AEDV expectantly with careful surveillance for fetal well-being. Specifically, Doppler DV analysis is clinically valuable for their evaluation.

Is preterm placental calcification related to adverse maternal and foetal outcome?

This prospective cohort study aimed to evaluate the role of premature placental calcification in adverse pregnancy outcomes and identify its associated potential risk factors. We consecutively enrolled 293 women who presented to three academic medical centres from September 2011 to March 2013. Participants underwent transabdominal sonographies between 28–36 weeks of gestation in an attempt to determine placental maturity. We compared maternal and foetal outcomes between two groups of women, those with grade III placenta (n = 69) and those without grade III placenta (n = 224). Passive smoking was the only predictor of early placental calcification. There were more abnormal Doppler, low birth weight (LBW) and caesarean section (CS) deliveries observed in the preterm calcification group. No definite relationship existed between maternal hypertension (HTN), diabetes and other medical diseases with placental calcification. In conclusion, umbilical artery (UA) resistance index (RI) and absent or reversed end-diastolic velocity (AREDV) were observed more often in preterm placental calcification. Serious antepartum follow-up should be advised for these mothers.Impact Statement • Placental calcification is a physiological phenomenon but normally, a grade III placenta is not frequently found until 36 weeks of gestation (so is called preterm placental calcification – PPC). There is currently a lack of consistent evidence on the clinical significance of PPC and pregnancy outcome. The present study was designed to evaluate the role of PPC in adverse pregnancy outcomes. • In our study, although none of the pregnant women were smokers, we found that passive smoking was the only predictor of PPC. Abnormal umbilical artery Doppler waveforms considerably and absent end diastolic velocity pattern significantly were observed more often in the PPC group. • We observed that PPC can be a landmark for high-risk pregnancy and an alarm sign for placental dysfunction. So, close antepartum follow up should be advised for these mothers. Regular and frequent foetal wellbeing tests should be done to prevent pregnancy complications. Certainly larger and more extensive study can provide more valid results.

Relevance of routine Doppler sampling at the two umbilical arteries in the follow-up of dichorionic twin pregnancies with intrauterine growth-restricted fetuses

ObjectiveThe aim of this study is to assess if the presence of bilateral absent or reverse end-diastolic velocity (AREDV) indicates a poorer prognosis than unilateral AREDV in dichorionic-diamniotic twin pregnancies complicated by intrauterine growth restriction. MethodsA prospective observational study of 36 dichorionic-diamniotic twin pregnancies complicated by intrauterine growth restriction. One hundred and fifty seven ultrasound (US) examinations were performed. The pulsatility indexes (PI) of the two umbilical arteries (UA–perivesical site), the middle cerebral artery (MCA) and the ductus venosus (DV) were recorded. The fetal hemodynamic status was represented by the existence of a bilateral positive end-diastolic velocity (PEDV), a unilateral AREDV or a bilateral AREDV in the umbilical arteries. ResultsBilateral PEDV, unilateral AREDV and bilateral AREDV represented respectively 66.0%, 10.6% and 23.4% of the US examinations. Intervals between Doppler examinations and delivery were significantly longer (P<0.005) in the bilateral PEDV group (26.5 days±19.7) than in the unilateral AREDV group (11.8 days±11.7) and in the bilateral AREDV group (11.0 days±8.6). MCA-PI, DV-PI, IFI and early neonatal outcomes did not differ between the unilateral and bilateral AREDV groups. ConclusionThe routine measurement of the Doppler indices of the two umbilical arteries seems to be no more relevant than unilateral measurement in fetuses of dichorionic-diamniotic twin pregnancies complicated by intrauterine growth restriction.

Doppler waveform patterns and reference ranges of fetal renal artery blood flow indices in normal Thai fetuses during the second trimester

Abstract Background Fetal hemodynamics can be assessed by Doppler ultrasonography, but the normal Doppler waveform pattern and reference range of fetal renal artery blood flow indices in normal Thai fetuses during the second trimester have not been studied. Objectives To study the pattern and establish the normal reference range of fetal renal artery blood flow indices in the normal Thai fetus during the second trimester. Materials and methods This cross-sectional descriptive study included 512 normal singleton pregnant women, gestational age between 14(+0) and 28(+6) weeks. Ultrasonography was performed to assess the Doppler waveform pattern and estimate the normal reference range of fetal renal artery blood flow indices. All fetuses were delivered at term with normal outcomes at birth. The mean and 95th and 5th percentiles of the Doppler indices for each gestational week were estimated. Results Doppler patterns with absence of diastolic flow in the entire cardiac cycle (type I), and absence of diastolic flow at the end of cardiac cycle (type II) were presented in about 10.4% of normal fetuses during the second trimester of pregnancy. Values for pulsatility index, peak systolic velocity, systolic-to-diastolic ratio, and resistance index (with absent end-diastolic velocity (AEDV) removed) each increased significantly with gestational age. The increase in end-diastolic velocity (with AEDV removed) with gestational age was not significant. Conclusion These normative data could serve as a basis for evaluation of the fetal renal artery blood flow, which should be of benefit for pregnancy management, especially in situations that interfere with fetal renal perfusion.

Lípidos y lipoproteínas en restricción intrauterina del crecimiento con velocimetría Doppler anormal de la arteria umbilical

ObjectiveTo compare plasma lipids and lipoproteins concentrations in newborns with intrauterine growth restriction and alterations of umbilical artery end-diastolic velocity. Material and methodsA study was conducted on pregnant women with a diagnosis of intrauterine growth restriction who attended at Hospital Central Dr. Urquinaona, Maracaibo, Venezuela. The cases were divided into, reversed umbilical artery end-diastolic velocity (group A), absent umbilical artery end-diastolic velocity (group B), and umbilical artery end-diastolic velocity present and positive (groupC). Plasma concentrations of cholesterol, triglycerides, and low- and high-density lipoproteins were also measured in newborns. ResultsReversed umbilical artery end-diastolic velocity was present in 33 cases, with 71 cases of absent umbilical artery end-diastolic velocity, and 146 cases with umbilical artery end-diastolic velocity present. The newborns in groups A and B had significantly higher plasma concentrations of cholesterol and triglycerides compared with group C (p<.05). High-density lipoproteins were significantly lower in group A and B compared with group C (p<.05). There were no significant differences found in low-density lipoproteins between the three groups (p>.05). ConclusionNewborns with intrauterine growth restriction and absent or reversed umbilical artery end-diastolic velocity showed significant alterations in plasma lipids and lipoproteins concentrations.

Prognostic factors of perinatal short-term outcome in severe placental insufficiency using Doppler sonography to assess end-diastolic absent and reverse blood flow in umbilical arteries

Significant placental insufficiency, indicated by Doppler ultrasound findings of absent or reverse end-diastolic flow velocities (AREDV), is associated with increased morbidity and mortality. Analysis of blood flow in the ductus venosus should assist in early intrauterine recognition of threatened foetuses. 58 high-risk pregnancies with umbilical AREDV were repeatedly examined (n=364). Doppler findings were correlated with neonatal signs of deterioration (ratio of normoblasts to leukocytes, pH, base excess, Apgar score), as well as short-term morbidity [need for intubation, duration of assisted respiration, evidence of respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), necrotising enterocolitis (NEC), intraventricular haemorrhage (IVH grade III+IV)] against the analysis of the blood flow findings (normal or increased pulsitility, absence or reverse end-diastolic flow) in the umbilical arteries (AU), the middle cerebral arteries (ACM) and ductus venosus (DV) relating these to birth weight and the duration of the pregnancy. The median period of observation was 12.8 days, 48% of the foetuses showed an abnormal ductus venosus flow and 26% an absent venous or reverse end-diastolic flow. The median date of delivery was 30 weeks, with a mean birth weight of 816 g. 93% were live births with 12% dying postnatally. Although the criteria for postnatal morbidity (BPD, NEC, IVH III+IV) and mortality did not correlate with changes in arterial and venous Doppler parameters in our group, there was a significant relationship between the normoblast count, known to be a marker of chronic hypoxia. The Apgar 10 minte score, umbilical arterial pH and base excess were correlated with changes in the DV flow curves. Healthy survival started, irrespective of arterial or venous blood flow criteria, from 27+0 weeks of pregnancy. If born between 27.0 and 30+6 weeks, the infants were more likely to be healthy the less the blood flow had been compromised. A birth weight of 590 g (sensitivity 62.5%; specificity 93.5%) and gestational age of 28+5 weeks (sensitivity 87.5%; specificity 90.3%) were shown to be cut-off points between healthy survival and survival with serious neonatal complications.

Two-year neurological outcome of very-low-birth-weight children with prenatal absent or reversed end-diastolic flow velocity in the umbilical artery

ObjectiveThe aim of this study was to investigate the 2-year neurological outcome of very-low-birth-weight (VLBW) children who had abnormal umbilical blood flow velocity prenatally. Materials and MethodsWe performed a prospective collection of infants prenatally diagnosed with abnormal umbilical blood flow velocity at a tertiary referral center from January 1, 2001 to September 30, 2005. VLBW children with prenatal absent or reversed end-diastolic flow velocity (AREDV) in the umbilical artery were investigated and compared with two similar demographic control groups of VLBW children without AREDV: one group with fetal growth restriction and the other without it. A follow-up study at 2 years of age for Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) of the Bayley Scales among the three groups was analyzed. ResultsTwenty-four VLBW children were identified to have AREDV prenatally, of whom four died during the neonatal period. After 2 years, five children were lost to follow-up and 15 were rescued, of whom 11 had absent end-diastolic velocity and four reversed end-diastolic velocity. We compared the remaining 15 children with the two control groups [28 children in the matched control group with intrauterine fetal growth restriction (IUGR), and 38 children in the matched control group without IUGR], and no significant differences were found in MDI (p = 0.938) and PDI (p = 0.496) scores at 2 years of age. However, we also surveyed the children with a gestational age of ≤29 weeks and found a significant difference in MDI scores (p = 0.048), but not in PDI scores (p = 0.219), among the three groups. ConclusionVLBW children delivered earlier than 29 gestational weeks with abnormal umbilical blood flow velocity prenatally have greater mental developmental delay at 2 years of age.

Intermittent absent end diastolic velocity of the umbilical artery: antenatal and neonatal characteristics and indications for delivery

Objective: To check whether there is a difference in indications for delivery, antepartum and neonatal characteristics in intermittent absent end diastolic velocity (iAEDV) compared to persistent absent or reversed end diastolic velocity (pA/REDV).Methods: A retrospective study of 109 patients with iAEDV or pA/REDV from 19 to 39 weeks. The delivery indication was classified as maternal or fetal. The primary antepartum and maternal characteristics were age, parity, AMA, chronic hypertension, PEC, thrombophilia, lupus, diabetes, smoker, placenta previa, gestational age (GA) at diagnosis of IUGR and/or SGA, GA at diagnosis of elevated S/D, iAEDV or pA/REDV, GA at delivery, minimal/absent variability day of delivery, BPP ≤ 6 prior to delivery. The primary neonatal outcomes were birth weight, arterial cord pH, neonatal demise, necrotizing enterocolitis, intraventricular hemorrhage and length of stay in the NICU.Results: Fetuses with iAEDV were diagnosed with an elevated S/D at a later GA (29.6 vs. 27.5 weeks, p < 0.03), delivered at a later GA (31.6 vs. 29.7 weeks, p < 0.01), had a higher birth weight (1336.6 vs. 933 g, p < 0.0004), were more likely to be delivered for maternal indications (42.9% vs. 20.27%, p < 0.01), had a higher cord arterial pH (7.28 vs. 7.21, p < 0.002) and were less likely to have an arterial pH at birth <7.2 (0% vs. 34.1%, p < 0.002).Conclusions: Although fetuses with iAEDV have an improved antenatal course as compared with pA/REDV, indications for delivery are more likely to be maternal and adverse outcome is common.

Alterações do fluxo sanguíneo em artéria umbilical na síndrome hipertensiva gestacional e suas implicações nos resultados neonatais

To evaluate the anthropometric characteristics of morbidity and mortality of premature newborns (NB) of hypertensive mothers according to the presence or absence of flow (DZ) or reverse (DR) diastolic flow in the dopplervelocimetry of the umbilical artery. A prospective study was conducted on preterm newborns of pregnant women with hypertension between 25 and 33 weeks of gestational age, submitted to umbilical artery Doppler study during the five days before delivery. Delivery occurred at Hospital Regional da Asa Sul, Brasília - Federal District, between November 1st, 2009 and October 31st, 2010. The infants were stratified into two groups according to the results of Doppler velocimetry: Gdz/dr=absent end-diastolic velocity waveform or reversed end-diastolic velocity waveform, and Gn=normal Doppler velocimetry. Anthropometric measurements at birth, neonatal morbidity, and mortality were compared between the two groups. We studied 92 infants, as follows: Gdz/dr=52 infants and Gn=40 infants. In Gdz/dr, the incidence of infants small for gestational age was significantly greater, with a relative risk of 2.5 (95%CI 1.7 - 3.7). In Gdz/dr, infants remained on mechanical ventilation for a longer time: median 2 (0‒28) and Gn median 0.5 (0‒25) p=0.03. The need for oxygen at 28 days was higher in G dz/dr comparing to Gn (33 versus 10%; p=0.01). Neonatal mortality was higher in Gdz/dr compared to Gn (36 versus 10%; p=0.03; relative risk of 1.6; 95%CI 1.2‒2.2). Logistic regression showed that, with each 100 grams lower birth weight, the chance of death increased 6.7 times in G dz/dr (95%CI 2.0 - 11.3; p<0.01). In preterm infants of mothers with hypertensive changes in Doppler velocimetry of the umbilical artery, intrauterine growth restriction and neonatal prognosis are often worse, with a high risk of death related to birth weight.