Artery Doppler Flow Research Articles

Haemodynamic implications of VA-ECMO vs. VA-ECMO plus Impella CP for cardiogenic shock in a large animal model.

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) with profound left ventricular (LV) failure is associated with inadequate LV emptying. To unload the LV, VA-ECMO can be combined with Impella CP (ECMELLA). We hypothesized that ECMELLA improves cardiac energetics compared with VA-ECMO in a porcine model of cardiogenic shock (CS). Land-race pigs (weight 70kg) were instrumented, including a LV conductance catheter and a carotid artery Doppler flow probe. CS was induced with embolization in the left main coronary artery. CS was defined as reduction of ≥50% in cardiac output or mixed oxygen saturation (SvO2) or a SvO2<30%. At CS VA-ECMO was initiated and embolization was continued until arterial pulse pressure was <10mmHg. At this point, Impella CP was placed in the ECMELLA arm. Support was maintained for 4h. CS was induced in 15 pigs (VA-ECMO n=7, ECMELLA n=8). At time of CS MAP was <45mmHg in both groups, with no difference at 4h (VA-ECMO 64mmHg±11 vs. ECMELLA 55mmHg±21, P=0.08). Carotid blood flow and arterial lactate increased from CS and was similar in VA-ECMO and ECMELLA [239mL/min±97 vs. 213mL/min±133 (P=0.6) and 5.2±3.3 vs. 4.2±2.9mmol/ (P=0.5)]. Pressure-volume area (PVA) was significantly higher with VA-ECMO compared with ECMELLA (9567±1733 vs. 6921±5036mmHg×mL/min×10-3, P=0.014). Total diureses was found to be lower in VA-ECMO compared with ECMELLA [248mL (179-930) vs. 506mL (418-2190); P=0.005]. In a porcine model of CS, we found lower PVA, with the ECMELLA configuration compared with VA-ECMO, indicating better cardiac energetics without compromising systemic perfusion.

Factors Associated With Isolated Fallopian Tube Torsion in Pediatric Patients

BackgroundIsolated fallopian tube torsion (IFTT) is a rare form of adnexal torsion that is more difficult to diagnose, which may lead to delays in treatment. Our objectives were to identify clinical and radiologic factors associated with surgically-confirmed IFTT and compare them with those of patients without torsion and with adnexal torsion (AT) in a large pediatric population. MethodsWe conducted a retrospective chart review of all patients who underwent surgery for suspected adnexal torsion from 2016 to 2019. Torsion was determined intraoperatively, with IFFT defined as those with only tubal but no ovarian torsion and AT defined as those with ovarian torsion, with or without involvement of the ipsilateral fallopian tube. Clinical and radiologic variables were compared between patients with IFTT and those without torsion and with AT using descriptive statistics. A previously-described composite score to predict torsion based on the presence of vomiting and adnexal volume (VVCS) was calculated for each patient. ResultsOf 291 patients who underwent surgery for suspected torsion, 168 had confirmed torsion: 33 (19.6%) IFTT and 135 (80.4%) AT. Patients with IFTT were more likely to be younger (12.8 vs. 14.2 years, P = 0.02), premenarchal (29.0% vs. 10.7%, P = 0.009), experience nausea (90.6% vs. 70.9%, P = 0.02) and vomiting (81.3% vs. 32.8%, P < 0.001), have a paratubal cyst on imaging (18.8% vs. 2.5%, P = 0.003), and have larger adnexal volume (143.3 vs. 64.9 ml, P < 0.001) than those without torsion. Higher BMI (26.6 vs. 22.9 kg/m2, P = 0.03), a paratubal cyst on imaging (18.8% vs. 1.5%, P < 0.001), presence of arterial (65.5% vs. 44.1%, P = 0.04) and venous Doppler flow (79.3% vs. 55.9%, P = 0.02), and radiologic impression indicating lack of torsion (37.9% vs. 16.8%, P = 0.04) were more common in IFTT than AT. The accuracy of the VVCS in predicting torsion for the IFFT group was 83.9%. ConclusionsIFTT has a similar clinical presentation to AT but with a higher likelihood of a paratubal cyst and preserved Doppler flow on imaging. IFTT should be strongly considered in patients who present with pain, nausea, and vomiting and have an adnexal mass separate from the ovary on imaging, regardless of Doppler flow. Level of EvidenceLevel II. Type of StudyPrognosis study.

Correlation of uterine artery Doppler flow velocimetry and β-human chorionic gonadotropin levels during postmolar evacuation surveillance: A pilot study in a tertiary hospital

BACKGROUND: During postmolar evacuation surveillance, beta-human chorionic gonadotropin (β-hCG) regression levels can predict invasive disease while Doppler ultrasound can assess in vivo tumor neovascularization and quantify uterine blood supply. As an ancillary tool to β-hCG monitoring, ultrasound can detect the early presence of viable trophoblastic tissues and identify patients at risk of developing postmolar gestational trophoblastic Neoplasia (PMGTN). OBJECTIVE: The objective of this study was to correlate uterine artery Doppler ultrasound with β-hCG levels during pre- and postmolar evacuation surveillance among patients with complete mole. MATERIALS AND METHODS: A cohort of patients with sonographic diagnosis of complete hydatidiform mole and managed with suction curettage in the same institution were prospectively followed up after evacuation. The pre- and postmolar evacuation surveillance period was at days 1, 7, 14, 21, 28, and 35. Monitoring of serum β-hCG levels was based on the standard regression curve. For Doppler ultrasound parameters, monitoring of the systolic/diastolic (S/D) ratio, pulsatility index (PI), resistance index (RI), and peak systolic velocity (PSV) was based on its relationship with its serum β-hCG levels. The ultrasound images generated were archived and reviewed by the authors. Descriptive and inferential statistics were utilized to analyze median differences. For the correlation of uterine artery Doppler flow parameters, analysis for the test of difference used Pearson correlation and multiple linear regression analysis for the odds ratio. RESULTS: Sixteen of the 23 enrolled patients completed the protocol (16 of 23, 69.50%). A majority had spontaneous remission (13; 81%) while 3 cases (19%) presented increasing and plateauing β-hCG levels. The pre- and post evacuation median β-hCG levels showed a significant decrease (P = 0.001). As post evacuation β-hCG levels decreased, PSV also decreased (r = 0.478, P = 0.061) while Doppler parameters, RI, PI, and S/D ratio increased. However, when post evacuation β-hCG levels rose or plateaued, Doppler parameters decreased. These changes had statistical correlation (all P &lt; 0.05). Moreover, the magnitude of the relationship for β-hCG and Doppler parameters was moderate and ranged from 0.524 to 0.581. Among the Doppler parameters, the S/D ratio and RI of the right uterine artery strongly predicted a rise in β-hCG levels. The odds ratio of predicting increased β-hCG levels and risk of gestational trophoblastic neoplasia by the right S/D ratio were − 2683.67 (confidence interval [CI] = −271.692–5095.655; P = 0.034) and by the right RI − 66,193.34 (CI = −161,818.107–29,431.433; P = 0.046). Notably, Doppler parameter changes appeared early at day 14 up to day 35 and before the appearance of abnormal β-hCG regression patterns. CONCLUSION: There is a strong correlation between uterine artery Doppler flow changes and β-hCG levels during postmolar evacuation surveillance. The inverse relationship of the S/D ratio, PI and RI, and β-hCG regression patterns confirms spontaneous remission of the disease. For patients with abnormal β-hCG patterns, this relationship is altered. The Doppler changes become erratic, unpredictable, and significantly decreased. These changes were detected as early as 2 weeks post evacuation. Thus, the use of ultrasound as an adjunct to β-hCG post evacuation surveillance can predict abnormal β-hCG regression patterns and identify patients at risk of developing postmolar gestational trophoblastic neoplasia (PMGTN).

Shape of Pulmonary Artery Doppler Flow Profile and Right Ventricular Hemodynamics in Neonates

To characterize pulmonary artery Doppler flow profile (PAFP) patterns among infants receiving care in neonatal intensive care units (NICUs) and to examine the association of PAFP patterns with pulmonary and right ventricular (RV) hemodynamics. This is a retrospective study at two tertiary NICUs over 4 years that included neonates who demonstrated a complete tricuspid regurgitation envelope on targeted neonatal echocardiography (TNE). Separate personnel reviewed TNEs to characterize PAFP patterns, divide cohort into PAFP groups, and measure quantitative indices of RV hemodynamics (RV systolic pressure [RVSP], pulmonary artery acceleration time [PAAT] and its ratio with RV ejection time [RVET/PAAT], tricuspid annular plane systolic excursion [TAPSE] and RV output [RVO]), for intergroup comparisons. We evaluated TNEs from 186 neonates with median (IQR) gestational age of 28.5 weeks (25.9-35.9) weeks. Four distinct PAFP patterns were identified: A. near-isosceles triangle (22%), B. right-angled triangle (29%), C. notching (40%), and D. low peak velocity (<0.4 m/s; 9%). Groups A-C demonstrated a stepwise worsening in all indices of PH, while pattern D was associated with lower TAPSE and RVO. Using common definitions of pulmonary hypertension (PH), pattern A performed best to rule out PH [sensitivity range 81-90%] and pattern C for diagnosing PH [specificity range 63-78%]. Inspection of PAFP is a simple bedside echocardiography measure that provides clinically meaningful information on underlying RV hemodynamics and may aid in screening and monitoring of patients for PH in NICUs.

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.

Uterine Artery Doppler Indices as Predictor of Adverse Fetal Outcome in Hypertensive Disorders of Pregnancy: An Observational Study.

Background Hypertensive disorders of pregnancy (HDP) pose significant risks to maternal and fetal health. The utility of Doppler indices in predicting adverse fetal outcomes in HDP patients remains an area of active research. This observational study aimed to assess the correlation between abnormal uterine artery Doppler indices and adverse fetal outcomes in HDP patients. Methods Over a two-year period, we enrolled 138 pregnant women with HDP beyond 28 weeks of gestation and singleton pregnancies. Detailed clinical assessments, laboratory investigations, and Doppler studies of the uterine artery were conducted. The Doppler indices that were assessed included the systolic/diastolic (S/D) ratio, resistance index (RI), and pulsatility index (PI). Adverse fetal outcomes were classified based on appearance, pulse, grimace, activity, and respiration (APGAR) scores, birth weight, NICU admissions, and perinatal deaths. Statistical analyses were performed to evaluate the predictive value of Doppler indices. Results Abnormal uterine artery Doppler indices, specifically an elevated S/D ratio and the presence of a diastolic notchshowed a positive correlation with adverse fetal outcomes. However, Doppler indices such as PI and RI did not demonstrate a significant correlation with adverse fetal outcomes in HDP patients. These findings suggest that the S/D ratio and the presence of a diastolic notch in uterine artery Doppler studies hold potential as predictive markers for adverse fetal outcomes in HDP patients. Conclusion Uterine artery Doppler indices, specifically the S/D ratio and the presence of a diastolic notch, appear to be valuable predictors for adverse fetal outcomes in patients with hypertensive disorders of pregnancy. These findings underscore the importance of regular monitoring of uterine artery Doppler flow in the management of HDP to identify pregnancies at higher risk for adverse fetal outcomes.

Cardiac energetics and end-organ perfusion with veno-arterial extracorporeal membrane oxygenation versus ecmella for cardiogenic shock in a large animal model

Abstract Background The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is in severe cases of left ventricular (LV) failure associated with pulmonary edema due to inadequate LV emptying. In clinical practice VA-ECMO may be combined with Impella CP (ECMELLA), to unload the LV. We hypothesized that ECMELLA improves cardiac energetics without compromising end-organ perfusion compared to VA-ECMO alone in a porcine model of cardiogenic shock (CS). Methods Land-race pigs (weight 70 kg) were instrumented, including a LV conductance catheter and a carotid artery Doppler flow probe. Arterial blood samples were analyzed for lactate level. CS was induced with embolization in the left main coronary artery and was defined as a reduction of 50% or more in cardiac output (CO) or mixed oxygen saturation (SvO2) or a SvO2 &amp;lt; 30%. VA-ECMO was initiated at CS and embolization was continued until arterial pulse pressure was below 10 mmHg. At this point, Impella CP was placed in the ECMELLA arm. Support was maintained for four hours. Results CS was induced in 15 pigs (VA-ECMO n=7, ECMELLA n=8) and at CS the CO declined from 6.1 L/min (0.8) to 2.5 L/min (1.1) in the VA-ECMO arm and from 5.2 L/min (SD: 0.6) to 2.0 L/min (SD: 0.7) in the ECMELLA arm. The pressure-volume area (PVA) was comparable at CS, but significantly higher with VA-ECMO compared to ECMELLA after four hours (9567 SD: 1733 versus 6921 SD: 0536 mmHg*mL, p=0.014). Carotid blood flow increased from CS and was similar in VA-ECMO and ECMELLA (239 mL/min SD: 97 versus 213mL/min SD: 133) at four hours p=0.6. Arterial lactate was equally elevated in both groups at four hours (VA-ECMO 5.2 SD: 3.4 versus 4.2 SD: 2.9 mmol/l for ECMELLA), p=0.5). Conclusion In a porcine model of CS, we found lower PVA with the ECMELLA configuration compared to VA-ECMO, yet similar lactate levels after four hours of mechanical circulation. These findings indicate that ECMELLA better cardiac energetics without compromising systemic perfusion.Central hemodynamicsEnd-organ perfusion

Gebelikten önce COVID-19 geçirenlerde ilk trimester uterine arter direnci, plasental volüm ve gebelik sonuçlarının incelenmesi

Aim&#x0D; There are studies showing that acquiring Coronavirus Disease 2019 (COVID-19) while pregnant might cause vascular damage, affect uterine blood circulation, and worsen pregnancy outcomes. In this study, we looked at the first-trimester placental development and pregnancy outcomes in people who conceived after getting better from COVID-19. We also looked into the durability of the COVID-19's effects on pregnancy.&#x0D; Matherials and Methods&#x0D; This prospective case-control study investigates placental volume and uterine artery Doppler flow differences in pregnant women with COVID-19 exposure within a year prior to pregnancy versus healthy pregnant controls.&#x0D; Result&#x0D; In a study involving 50 patients and 50 controls, it was discovered that demographic traits like age, birth rate, and body mass index were comparable. There were statistically insignificant slight differences in these results when different outcomes, including as oligohydramnios, preterm, preeclampsia, and intrauterine growth retardation, were studied. While birth weight revealed similarity between the two groups, placental volume and uterine artery Doppler results did not reveal any appreciable variations.&#x0D; Conclusion&#x0D; No distinction between the groups' placental or Doppler readings was found in the investigation that was completed. This work has helped identify the impacts of COVID-19 contracted prior to pregnancy on gestation, whereas previous study has mainly focused on the impact of COVID-19 infected during pregnancy.

Fetal pulmonary artery Doppler blood flow velocity measures and early infant lung function. A prospective cohort study

Background Reduced lung function at birth has evident antenatal origins and is associated with an increased risk of wheezing and asthma later in life. Little is known about whether blood flow in the fetal pulmonary artery, may impact postnatal lung function. Objective Our primary aim was to investigate the potential associations between fetal Doppler blood flow velocity measures in the fetal branch pulmonary artery, and infant lung function by tidal flow-volume (TFV) loops at three months of age in a low-risk population. Our secondary aim was to explore the association between Doppler blood flow velocity measures in the umbilical and middle cerebral arteries, and the same lung function measures. Methods In 256 non-selected pregnancies from the birth cohort study Preventing Atopic Dermatitis and ALLergies in Children (PreventADALL) we performed fetal ultrasound examination with Doppler blood flow velocity measurements at 30 gestational weeks (GW). We recorded the pulsatility index, peak systolic velocity, time-averaged maximum velocity, acceleration time/ejection time ratio, and time velocity integral primarily in the proximal pulmonary artery close to the pulmonary bifurcation. The pulsatility index was measured in the umbilical and middle cerebral arteries and the peak systolic velocity in the middle cerebral artery. The cerebro-placental ratio (ratio between pulsatility index in the middle cerebral and umbilical arteries) was calculated. Infant lung function was assessed using TFV loops in awake, calmly breathing three months old infants. The outcome was the time to peak tidal expiratory flow to expiratory time ratio (t PTEF/t E), t PTEF/t E <25th percentile, and tidal volume per kg body weight (V T/kg). Potential associations between fetal Doppler blood flow velocity measures and infant lung function were assessed using linear and logistic regressions. Results The infants were born at median (min - max) 40.3 (35.6 − 42.4) GW, with a mean (SD) birth weight of 3.52 (0.46) kg, and 49.4% were females. The mean (SD) t PTEF/t E was 0.39 (0.1) and the 25th percentile was 0.33. Neither univariable nor multivariable regression models revealed any associations between fetal pulmonary blood flow velocity measures and t PTEF/t E, t PTEF/t E <25th percentile, or V T/kg at three months of age. Similarly, we did not observe associations between Doppler blood flow velocity measures in the umbilical and middle cerebral arteries and infant lung function measures. Conclusion In a cohort of 256 infants from the general population, fetal third-trimester Doppler blood flow velocity measures in the branch pulmonary, umbilical, and middle cerebral arteries were not associated with infant lung function measures at three months of age.

Erken Gebelikte Vajinal Kanamanın İlk Trimester Tarama Testi, Uterin Arter Doppler İndeksleri ve Perinatal Sonuçlara Etkisi

Aim: We aimed to prospectively investigate the effect of first trimester vaginal bleeding on first trimester screening test, uterine artery (UtA) Doppler results and perinatal outcomes. Material and Methods: Fifty cases that presented with vaginal bleeding in the first trimester between 2019 and 2020 constituted the early vaginal bleeding (abortus imminens-threatened abortion) group and fifty cases without a history of vaginal bleeding in pregnancy constituted the control group. Demographic datas were noted at the first visit. Both groups were followed up until birth. First trimester screening test (double screening test) between 11-14 weeks and UtA Doppler examination between 20-24 weeks of gestation was performed. Perinatal outcomes and values of nuchal translucency (NT), free β human chorionic gonadotropin (f β-hCG), pregnancy-associated plasma protein A (PAPP-A), and UtA Doppler were compared between the two groups. Results: There was no statistically significant difference was found between the two groups in terms of NT and PAPP-A among the first trimester screening test results (p=0.741 and p=0.937, respectively). In the group with threatened miscarriage, f β-hCG value was numerically higher, but there was no statistically significant difference (1.24±0.59 vs. 1.1±0.93, p=0.057). In the Doppler examination of the UtA, there was no statistically significant difference between the groups in terms of systolic/diastolic ratio, pulsatility index, resistive index and the presence of a notch (p=0.713, p=0.528, p=424, p=0.538, respectively). Perinatal complication rate was statistically significantly higher in the study group (p=0.013; Odds Ratio:3.2, 95% CI 1.2-8.3). Conclusion: Contrary to some different studies, we believe that first trimester screening test parameters or uterine artery Doppler flow indices do not have a place in predicting perinatal outcomes of pregnant women with a history of vaginal bleeding in the first trimester. In addition, early vaginal bleeding does not significantly affect screening parameters. Perinatal complication rate was found to be statistically significantly higher in the group with a history of threatened miscarriage.

Analysis of typing conversion and perinatal outcomes in twins with selective intrauterine growth restriction of different subtypes

Objective: To retrospectively analyze the clinical data of different types of selective intrauterine growth restriction (sIUGR) pregnant women under expectant management, including the natural evolution, typing conversion and perinatal outcomes. Methods: The clinical data of 153 pregnant women with sIUGR under expected treatment in Women's Hospital, Zhejiang University School of Medicine from January 2014 to December 2018 were collected. Maternal characteristics including maternal age, gravidity, parity, method of conception, pregnancy complication, gestational age at delivery, indication for delivery, birth weight, the rate of intrauterine and neonatal death and neonatal outcomes were recorded. Pregnant women with sIUGR were divided into three types according to end-diastolic umbilical artery flow Doppler ultrasonography, and the differences of typing conversion and perinatal outcomes of sIUGR pregnant women based on the first diagnosis were compared. Results: (1) Clinical characteristics and pregnancy outcomes: among 153 pregnant women with sIUGR, 100 cases (65.3%) were diagnosed with type Ⅰ, 35 cases (22.9%) with type Ⅱ, and 18 cases (11.8%) with type Ⅲ. There were no significant differences in age, conception mode, pregnancy complications, first diagnosis gestational age, characteristics of umbilical cord insertion, delivery indications, fetal intrauterine mortality and neonatal mortality among three types of sIUGR pregnant women (all P>0.05). The average gestational age at delivery of type Ⅰ sIUGR was (33.5±1.9) weeks, which was significantly later than those of type Ⅱ and Ⅲ [(31.3±1.8), (31.2±1.1) weeks, P<0.001]. The percentage disordance in estimated fetal weight (EFW) of type Ⅰ sIUGR was significantly lower than those of type Ⅱ and type Ⅲ (P<0.001). The incidence rate of neonatal intensive care unit (NICU) admission, cerebral leukomalacia and respiratory complications of both fetus and necrotizing enterocolitis of large fetus in type Ⅰ were significantly lower than those in type Ⅱ and type Ⅲ (all P<0.05). (2) Typing conversion: in 100 cases of type Ⅰ sIUGR, 18 cases progressed to type Ⅱ and 10 cases progressed to type Ⅲ. Compared with 72 stable type Ⅰ sIUGR, those with progressed type Ⅰ sIUGR had higher incidence of NICU admission and lung disease in both fetuses, and cerebral leukomalacia and necrotizing enterocolitis in large fetus (all P<0.05). The proportion of inconsistent cord insertion was significantly higher in those type Ⅰ progressed to type Ⅲ (6/10) than in those with stable type Ⅰ (19.4%, 14/72) and type Ⅰ progressed to type Ⅱ sIUGR [0 (0/18), P=0.001]. Four cases of type Ⅱ sIUGR reversed to type Ⅰ and 6 cases reversed to type Ⅲ. Compared with type Ⅱ reversed to type Ⅰ sIUGR, those stable type Ⅱ and type Ⅱ reversed to type Ⅲ sIUGR had a higher incidence of NICU admission in large fetus (P<0.05). Two cases of type Ⅲ sIUGR reversed to type Ⅰ and 6 cases progressed to type Ⅱ. There were no significant differences in fetal serious complications in type Ⅲ sIUGR with or without doppler changes (all P>0.05). Conclusions: The different types of sIUGR could convert to each other. The frequency of ultrasound examinations should be increased for patients with the type Ⅰ sIUGR, especially when the percentage discordance in EFW is substantial or with discordant cord insersion.

Uterine artery Doppler and endometrial blood flow in frozen embryo transfer: A cohort study.

The implantation rate after assisted reproductive technology depends on 2 important factors, good quality embryo and endometrial receptivity. Endometrial receptivity is mainly assessed by ultrasound measurement of endometrial thickness and morphology. This study aimed to investigate the relationship between uterine artery Doppler indices/endometrial perfusion and pregnancy rate. This cohort study was done on 250 women who were candidates for frozen embryo transfer from January to July 2022. For assessing endometrial receptivity, we performed a Doppler ultrasound of the uterus before embryo transfer with apparently desirable endometrium (endometrial thickness 7 mm and 3 line endometrial pattern). In addition, the women were divided into 2 groups according to assisted reproductive technology outcome (clinical pregnancy), group I positive clinical pregnancy, and group II negative clinical pregnancy, and uterine artery indices and endometrial perfusion were compared between these groups. Uterine artery Doppler showed that the pulsatility index was significantly different between positive and negative clinical pregnancy groups, but resistance index and peak systolic velocity (PSV) did not have statistically significant differences. Also, endometrial perfusion was significantly different between the 2 groups of clinical pregnancy. Endometrial perfusion was significantly better in positive clinical pregnancy groups. Doppler ultrasound can help to assess endometrial receptivity.

Uterine artery Doppler and Sub-Endometrial blood flow and Serum Progesterone level in patients with Unexplained Recurrent Miscarriage

Background: Unexplained Miscarriage that occurs repeatedly is still a difficult issue for couples and professionals. It affects 2–5% of females attempting to conceive and represents a considerable challenge for physicians. Aim of the Work: This study compares women who have unexplained recurrent miscarriages to healthy, fertile women in order to assess uterine artery blood flow, sub-endometrial blood flow, and serum progesterone levels in these women. Patients and Methods: At Al-Galaa Maternity Teaching Hospital, our research was carried out, and patients were divided into two groups. The case group: 50 individuals disclosed a history of recurrent, unexplained miscarriages, and the control group: 50 individuals who had at least one term birth and no history of miscarriage. Results: pulstility index of the uterine artery especially the mean value, and flow index, vascular index and vascular flow index of the endometrial and sub-endometrial area, in addition to the serum progesterone level are crucial factors in case of unexplained recurrent miscarriage. They affect unexplained recurrent miscarriage incidence significantly. The pulstility index of the uterine artery has its influence on unexplained recurrent miscarriage with 74% accuracy. The flow index has 95% accuracy, and the vascular flow index has 86% accuracy in case unexplained recurrent miscarriage. The serum progesterone level has 70% accuracy effect on unexplained recurrent miscarriage. Conclusion: the study documented that the uterine artery Doppler, endometrial and sub-endometrial blood flow level and serum progesterone level affect the incidence of unexplained recurrent miscarriage with accuracy ranging between 70% and 95%.

Vascular effects of gestational diabetes can be recognized by carotid intima-media thickness: a prospective case-control study

Gestational diabetes mellitus (GDM) is a systemic disease that has poor maternal and fetal health outcomes. Patients who are diagnosed with GDM are more likely to encounter cardiovascular system diseases during pregnancy and after birth. Carotid intima-media thickness (CIMT) is used as an early indicator of diseases such as coronary artery disease. This study aims to define the effects of hyperglycemia at an early term using CIMT, maternal and fetal doppler flows in patients diagnosed with GDM. The study included 132 pregnant women who had reached the 24th gestational week. (GDM group n=65, Control group n=67) Comparisons were performed between women with similar demographic characteristics who received a 100-gr oral glucose test (OGT) and GDM diagnosis and who did not. The participants’ routine hemograms and biochemical tests were done during OGT. Fetal biometrics, amniotic fluid index, uterine artery doppler flow, and bilateral CIMT measurements were performed during the obstetric examinations. Gravida, para, and live birth rates of the GDM group participants were higher than those of the control group (p=0.003, 0.002, 0.002 respectively). The amniotic fluid index was found to be higher in the GDM group (p&lt;0.001). Fasting glucose values and platelet counts were higher in the GDM group (p=0.031 and p&lt;0.001). Other laboratory data demonstrated no statistically meaningful differences between the groups (p&gt;0.05). When the doppler measurements were compared, umbilical artery pulsatility index values were discovered to be similar between the groups (p=0.509). While the right uterine artery (UtA) pulsatility index was higher in the GDM group (p&lt;0.001), no statistically significant differences were found between the groups in terms of the left UtA pulsatility index (p=0.485). Right and left CIMTs were higher in the GDM group (p=0.001, p&lt;0.001, p&lt;0.001 respectively). While in the GDM group there was a positive correlation between the thrombocyte level and uterine artery resistance (r=0.336, p=0.006; r=0.397, p=0.044 respectively), no similar correlations were found in the control group. This study found that GDM patients had inflammation, increased resistance in uterine artery flow, and increased CIMT. It has been shown, there is a correlation between CIMT and glucose levels and between thrombocytosis and UtA resistance in GDM patients. Uterine artery doppler data and CIMT measurements could be used as an indicator of systemic inflammation and cardiovascular disease in patients with GDM.

Anxiety and Uterine Artery Doppler Flow in A Population of Pregnant Women of High Risk Down Syndrome Fetus: A Prospective Cohort Study.

Fetal exposure to maternal anxiety is associated with low birth weight and maternal stress may be led to constriction of uterine arteries. This study compared the relation of anxiety and uterine artery doppler flow indices in pregnant women with the high and low-risk of Down syndrome. This prospective cohort study was conducted among pregnant women in the second trimester that were classified as having a high or low risk according to their prenatal aneuploidy screening outcome. The high risk group underwent amniocentesis. Anxiety was initially assessed using the Spielberger State-Anxiety Inventory (STAI) and uterine artery blood flow indices were evaluated 2 times for the both groups. For the high-risk group first: immediately before amniocentesis and second: after two weeks follow up, when receiving the karyotype results and for the low-risk group in the first admission and two weeks later. Totally, 375 pregnant women participated in our study that sorted into 2 risk populations based on the aneuploidy screening test, low-risk=176 and high-risk women=199. The high-risk group for Down syndrome amniocentesis showed abnormal results in the 23 cases (23/199). The mean state (P=0.003) and trait (P=0.033) of the Anxiety Inventory scores were significantly different between the groups. Baseline uterine artery indices were no significant difference between the groups. Baseline Uterine artery indices in the high-risk group was significantly different with follow-up (in both positive-amniocentesis and negative amniocentesis sub-groups) indices. Also, there was a weak and significant correlation in the uterine resistance index and STAI scores (P=0.008, r=0.137) during the follow-up period. All pregnant women experienced high level anxiety, especially in the high-risk group that may reduce after confirmation of prenatal aneuploidy screening test and also affects the Doppler indices. For all pregnant women; Stress management and emotional support training is recommended before and during pregnancy.

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.

Umbilical Artery Doppler Flow Velocimetry in Intrauterine Growth Restriction and its Relation to Perinatal Outcome

Umbilical Artery Doppler Flow Velocimetry in Intrauterine Growth Restriction and its Relation to Perinatal Outcome

Diagnostic Accuracy of Uterine Artery Doppler and Umbilical Artery Doppler Flow studies for Predicting IUGR

Objective: To determine the diagnostic accuracy of Uterine artery and Umbilical artery Doppler flow studies in predicting Intrauterine growth restriction taking birth weight as gold standard. Patients and methods: It was a Cross Sectional validation Study conducted at Department of Obstetrics and Gynaecology, Lady Willingdon Hospital, Lahore from 1st January 2021 to 30th April 2022. The uterine and umbilical arteries were analysed using Doppler. The newborn's weight in grammes was recorded right after birth. Results: In the diagnosis of intrauterine growth restriction, uterine artery Doppler has showed a sensitivity of 66%, specificity of 96.4%, diagnostic accuracy of 89%, PPV of 84.6%, and NPV of 90.4%. Conclusion: Uterine and umbilical arteries combined the greatest sign for predicting IUGR is Doppler. Keywords: Uterine artery Doppler, Intrauterine growth restriction, Diagnostic accuracy, Umbilical artery Doppler,

Clinical and radiologic factors associated with adnexal torsion in premenarchal and menarchal children and adolescents

BackgroundAdnexal torsion is a gynecologic emergency in children and adolescents but remains a challenging diagnosis, with no consistent clinical or radiologic diagnostic criteria. Our objective was to identify risk factors associated with adnexal torsion in premenarchal and menarchal patients with surgically confirmed torsion compared with those without torsion. MethodsWe conducted a retrospective chart review of all patients who underwent surgery between January 2016 and December 2019 for possible adnexal torsion. Data on demographics, clinical characteristics, radiologic variables, and operative findings were compared using descriptive statistics. Independent predictors of torsion were then examined in multivariate logistic regression models. ResultsOf the 291 patients who underwent surgery, 168 (57.7%) had torsion. Patients with torsion were younger than those without torsion (11.9 vs. 14.2 years, P < .01). Vomiting was significantly associated with torsion for all patients (P < .001). Large adnexal volume and absent arterial Doppler flow were associated with torsion for the total population and menarchal subgroup. A logistic regression model for the total population that controlled for age and menarchal status found that vomiting (adjusted odds ratio [aOR] 5.92, 95% confidence interval [CI] 2.87–12.22), highest adnexal volume category (aOR 4.92, 95% CI 2.25–10.75), and absent arterial Doppler flow (aOR 2.674, 95% CI 1.28–5.60) were associated with torsion. ConclusionsVomiting, enlarged adnexal volume, and absent arterial Doppler flow were associated with adnexal torsion. However, no single risk factor accurately diagnosed torsion, and multiple factors should be interpreted together. Level of evidenceStudy of Diagnostic Test, Level II.

The Role and Clinical Value of Optimized Fetal Main Pulmonary Artery Doppler Parameters in the Diagnosis and Prognosis Monitoring of Neonatal Respiratory Distress Syndrome.

Objective A retrospective study was conducted to explore the role and clinical value of optimized fetal main pulmonary artery Doppler parameters in the diagnosis and prognosis monitoring of neonatal respiratory distress syndrome (NRDS). Methods Pregnant women admitted to our hospital for delivery from March 2019 to June 2021 were included in the study. There were 372 singleton pregnant women who voluntarily underwent ultrasound and Doppler examinations with informed consent for the study. The AT/ET ratio of the middle segment of the main pulmonary artery, the middle part of the left (or right) pulmonary artery, and the proximal segment of the intrapulmonary artery was measured by ultrasonic Doppler. According to the outcome of the newborn, it was divided into NRDS group (n =90) and non-NRDS group (n =282) to compare the differences of fetal AT/ET ratio at three Doppler sampling locations and the differences of fetal AT/ET ratio in different gestational weeks. Using Pearson's correlation analysis, the correlation among the Doppler parameters of fetal main pulmonary artery, the ratio of AT and AT/ET, gestational weeks, and the efficiency of prenatal prediction of NRDS was evaluated by receiver-operating characteristic (ROC). In addition, the diagnostic efficiency of fetal main pulmonary artery Doppler parameter AT/ET ratio and amniotic fluid method for prenatal prediction of NRDS was compared. Results Compared with the non-NRDS group, the gestational age, gestational age at delivery, and birth weight in the NRDS group were significantly lower than those in the non-NRDS group. The 1 min Apgar score of newborns was less than 7, and the proportion of newborns transferred to NICU was significantly higher than that in the control group. Compared with non-NRDS group, AT was significantly shortened, AT/ET ratio was significantly decreased, and ET was significantly prolonged in NRDS group. The fetal aortic blood flow parameters AT, ET, and AT/ET ratio in different gestational weeks were significantly different among the three groups. The AT/ET ratio in the middle segment of the aorta in NRDS group was lower than that in non-NRDS group. The ratio of AT/ET was still correlated with the occurrence of postpartum NRDS. The AUC value of NRDS predicted by AT/ET ratio was 0.984. In the combined determination of amniotic fluid Lh and S ratio and PG, the diagnostic accuracy of prenatal prediction of neonatal respiratory distress syndrome was 100.005%, 98.43%, and 95.56%, respectively. The accuracy of fetal aortic AT/ET ratio in prenatal prediction of neonatal respiratory distress syndrome was 100.005%, 95.28%, and 95.57%, respectively. The order of Kappa coefficient from high to low was amniotic fluid PG/L/S ratio, fetal main pulmonary artery blood flow parameter AT/ET ratio, amniotic fluid L/S ratio, OD650, amniotic fluid PG, and foam test. Conclusion Fetal main pulmonary artery Doppler AT/ET ratio may be a very potential parameter for prenatal noninvasive prediction of NRDS. The fetal main pulmonary artery Doppler flow spectrum may be a very potential alternative to amniocentesis to evaluate FLM.