Artery Doppler Velocimetry In Pregnancies Research Articles

P15.03: Placental pathology and neonatal outcome in relation to uterine artery Doppler velocimetry in pregnancies complicated by placenta syndrome

P15.03: Placental pathology and neonatal outcome in relation to uterine artery Doppler velocimetry in pregnancies complicated by placenta syndrome

152. Placental pathology and neonatal outcome in relation to uterine artery Doppler velocimetry in pregnancies complicated by placenta syndrome

Objectives High resistance utero-placental circulation leads to placenta insufficiency related complications for both mother and fetus. The objective of this study was to evaluate the relationship between abnormal uterine artery pulsatility index (UtAPI) Doppler measurements, neonatal outcome and placental histological findings in placenta syndrome (PS) pregnancies. Methods A retrospective pilot study was performed on singleton pregnancies complicated by PS (pre-eclampsia and/or foetal growth restriction). UtA, umbilical (UmbA) and middle cerebral artery (MCA) Doppler measurements were collected within the last two weeks prior to delivery. Patients were divided into two groups according to UtAPI values, in which UtAPI > p95 was considered abnormal. Histological lesions were classified according to the criteria of the Society for Pediatric Pathology. Statistical analysis was performed using independent T-, Mann-Whitney U- and Fisher’s exact test. Multivariate analysis was used to correct UtAPI for gestational age (GA) at delivery and parity. Results The UtA-PI > p95 group (n = 25) showed a higher rate of premature delivery (p = 0,025), caesarean section (p = 0,007) and NICU-admission (p = 0,001) compared to the UtA-PIp95 group showed a significantly higher UmbA-PI (p = 0,004) with absent or reversed flow (p = 0,002), a lower MCA-PI (p = 0,010) and cerebro-placental ratio (p Conclusions In pregnancies complicated by PS, UtA-PI > p95 showed a moderate predictive ability for placental underperfusion independently of GA at delivery and parity. Furthermore, neonatal outcome and Doppler measurements were poorer.

Re: Placental histological patterns and uterine artery Doppler velocimetry in pregnancies complicated by early or late pre-eclampsia. R. Orabona, C. M. Donzelli, M. Falchetti, A. Santoro, A. Valcamonico and T. Frusca. Ultrasound Obstet Gynecol 2016; 47: 580-585.

Re: Placental histological patterns and uterine artery Doppler velocimetry in pregnancies complicated by early or late pre-eclampsia. R. Orabona, C. M. Donzelli, M. Falchetti, A. Santoro, A. Valcamonico and T. Frusca. Ultrasound Obstet Gynecol 2016; 47: 580-585.

Placental histological patterns and uterine artery Doppler velocimetry in pregnancies complicated by early or late pre-eclampsia.

To study placental patterns in pregnancies complicated by pre-eclampsia (PE) and to verify whether the findings are related to gestational age (GA) at PE onset and second-trimester uterine artery (UtA) Doppler. For all pre-eclamptic women who delivered between January 2010 and December 2013, we collected retrospectively data related to placental findings and UtA Doppler velocimetry performed at PE onset. The study cohort was divided into groups according to early-onset (EO) or late-onset (LO) PE. Regression analysis was performed to test the ability of UtA Doppler velocimetry to predict subsequent development of placental lesions, after correcting for possible confounders. Placental abnormalities occurred with a significantly lower incidence in the LO-PE group (n = 72) than in the EO-PE group (n = 105) (P = 0.02). Irrespective of GA at PE onset, UtA pulsatility index (PI) was able to predict macroscopic infarctions (P = 0.001), distal villous hypoplasia (P = 0.03), decidual arteriolopathy (P = 0.03), villous infarcts (P < 0.001), syncytiotrophoblast 'knots' (P = 0.02), microcalcifications (P = 0.02), perivillous fibrin deposition (P = 0.02) and placental hemorrhage (P = 0.01). Similar placental abnormalities were present in both EO-PE and LO-PE groups, although with quantitative differences according to GA and UtA Doppler velocimetry at PE onset. Histological patterns were predicted by UtA-PI, independently of GA, supporting the use of UtA Doppler velocimetry as the key criterion in PE classification. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Placental histopathological correlates of umbilical artery Doppler velocimetry in pregnancies complicated by fetal growth restriction

The objective of the study was to evaluate the association between placental histological patterns and umbilical artery (UA) Doppler velocimetry in pregnancies complicated by fetal growth restriction (FGR). A cohort of 126 FGR pregnancies was followed according to a standard protocol. Placental lesions were diagnosed according to consensus nomenclature and standardized criteria. Pulsatility index was normal in 45 (35.7%) and increased in 44 (34.9%) women. End-diastolic UA Doppler flow was absent in 27 (21.4%) and reversed in 10 (7.9%). Fifty-four women (42.9%) had preeclampsia. In preeclampsia, increasing Doppler abnormalities, from normal to reversed UA end-diastolic flow, were directly associated only with an increased number of placental syncytial knots. In normotensive pregnancies, Doppler abnormalities were associated with increased intervillous fibrin deposits, villous hypoplasia, syncytial knots, placental site giant cells, immature intermediate trophoblast, and with pattern of lesions indicating superficial implantation and maternal vascular underperfusion. In the whole cohort, increase of syncytial knots [odds ratio (OR) = 28.7; 95% confidence interval (CI) = 2.75-298.5], intervillous fibrin deposits (OR = 2.1; 95% CI = 1.04-4.28), placental site giant cells (OR = 3.0; 95% CI = 1.05-8.84), and patterns suggesting maternal underperfusion (OR = 2.9; 95% CI = 1.0-7.1) were independently associated with increased rates of absent/reversed UA end-diastolic flow. In pregnancies complicated by FGR, abnormalities of UA Doppler velocimetry were associated with placental lesions indicating superficial implantation and maternal vascular underperfusion.

P77 Maternal ophthalmic artery Doppler velocimetry in pregnancies complicated by hypertension disorders

To examine nicotine (N) and cotinine (C) effects on trophoblast cells (TCs) and human umbilical vein endothelial cells (HUVEC) secretion of soluble fms-like tyrosine kinase (sFlt-1), soluble endoglin (sENG), placental growth factor (PlGF), transforming growth factor-beta (TGF-beta) and vascular endothelial growth factor (VEGF).Human placentas and umbilical cords were collected from uncomplicated pregnancies at term from a total of 24 non-smoking women with a history of normal blood pressure. TCs and HUVEC were cultured for 24 h with C or N (from 10−12 to 10−7 M).sFlt-1, sENG, PlGF, TGF-beta and VEGF release and messenger RNA (mRNA) expression were evaluated by ELISA and real-time polymerase chain reaction (PCR), respectively.N and C reduced sFlt-1, sENG and PlGF release by TCs and TGF-beta release by HUVEC. Conversely, N and C increased PlGF secretion, while N alone increased sFlt-1 release by HUVEC. N and C were able to modulate VEGF mRNA expression in HUVEC.Our results suggest that N and C affect the balance of some important vasoactive factors released by TCs and HUVEC. This might be one of the possible mechanism through which smoke reduces the risk of hypertensive disorders during pregnancy as well as contributes to the well known detrimental effects of smoking on fetal development.

Prognostic significance of the interaction between abnormal umbilical and middle cerebral artery Doppler velocimetry in pregnancies complicated by fetal growth restriction

To evaluate the prognostic significance of the interaction between umbilical artery (UA) and middle cerebral artery (MCA) Doppler measurements in pregnancies complicated by fetal growth restriction (FGR). Cohort study. Third-level Perinatology Center in Northern Italy. A study of 184 singleton pregnancies at 24-35 weeks' gestational age complicated by FGR and abnormal UA Doppler measurements. FGR was diagnosed by serial ultrasonograms. Neonatal brain damage was defined as the presence of cystic leukomalacia or grade III-IV intraventricular hemorrhage. Perinatal death and neonatal brain damage. The prevalence of fetal/neonatal death or brain damage was 18.2% (16/88) in pregnancies with UA absent/reversed diastolic flow and 4.2% (4/96) in those with increased UA Doppler pulsatility. Stepwise logistic regression identified decreasing gestational age (OR=1.75, 95% confidence interval, CI=1.35-2.22) and absent/reversed UA blood flow (OR=3.34, 95% CI=1.1-10.9) as predictors of fetal/neonatal death or brain damage. A MCA pulsatility index below the 10th percentile was a risk factor for fetal/neonatal death or brain damage among women with absent/reversed UA diastolic flow (14/53 as compared to 2/35; OR=5.9, CI =1.4-40.3) but not in pregnancies with forward velocity (1/33 as compared to 3/63; OR=0.63, 95% CI=0.02-6.13, Synergy index=27.7, p=0.007). In pregnancies complicated by FGR and absent/reversed UA end diastolic flow, vasodilatation of the MCA is a risk factor for neonatal death or brain damage.

Umbilical Artery Doppler Velocimetry in Pregnancies Complicated by Oligohydramnios

OBJECTIVE: To determine the role of umbilical artery Doppler velocimetry in the management of oligohydramnios. STUDY DESIGN: In a retrospective chart review covering a two-year period, pregnancies with oligohydramnios evaluated by Doppler velocimetry of the umbilical artery were identified. Those patients with ruptured membranes and complex congenital anomalies were excluded from analysis. In the remainder, various measures of perinatal morbidity, including delivery of a small-for-gestational-age infant, preterm delivery, hyperbilirubinemia, requirement for blood transfusion, and other cardiovascular or pulmonary complications, were correlated with recorded values of the systolic/diastolic (S/D) ratio. RESULTS: Seventy-six subjects were identified for study. Forty-six had normal S/D ratios; 17 (37%) were associated with identifiable perinatal morbidity. When prematurity due to delivery for the sole indication of oligohydramnios was excluded, morbidity occurred in five patients (11%). Conversely, of the 30 patients with abnormal Doppler indices, 80% had an adverse outcome. CONCLUSION: Pregnancies with oligohydramnios and normal umbilical artery Doppler velocimetry were significantly (P <.001) less likely to experience an abnormal perinatal outcome as compared to those with abnormal Doppler indices. An elevated S/D ratio identified an increased risk of an adverse perinatal outcome in women with oligohydramnios. Avoiding intervention in pregnancies with oligohydramnios and normal umbilical artery Doppler velocimetru mau decrease iatrogenic morbidity due to prematurity by as much as 26%.

Doppler velocimetry, placental morphology and outcome in insulin-dependent diabetes.

The purpose of this study was to determine the underlying cause of abnormal umbilical artery Doppler velocimetry in pregnancies complicated by insulin-dependent diabetes, by evaluating placental morphology and correlating Doppler results with pregnancy outcome. Our study population consisted of 14 pregnancies with normal Doppler results and 11 pregnancies with abnormal Doppler results. Quantitative placental examinations were performed. Maternal and perinatal characteristics were analyzed. Infants from the abnormal Doppler group had a statistically significantly higher incidence than those from the normal Doppler group of hyperbilirubinemia, Cesarean delivery for fetal distress, and neonatal intensive care stay of 2 or more days. Women with abnormal Doppler results delivered earlier (36 vs. 38 weeks) and had infants of lower birth weight (3079 vs. 3629 g). They were also three times more likely to have poor glycemic control (relative risk = 3.2; p = 0.0067). The placentae of both groups showed no statistically significant differences in placental weight, number of tertiary stem villi, number of small muscular arteries, or mean arterial width. Our findings suggest a functional rather than structural placental process as the cause of the abnormal Doppler results in pregnancies complicated by diabetes. An association between glycemic control and Doppler velocimetry is suggested.

Umbilical artery Doppler velocimetry in pregnancies of less than 21 weeks' duration.

Most Doppler ultrasound investigations of the umbilical artery circulation have been confined to beyond 16 weeks' gestation. The purpose of this study is to explore the evolution of this circulation in human pregnancies of less than 21 weeks' gestation. We studied 169 low-risk pregnant women (125 longitudinally and 44 cross-sectionally) with a pulsed Doppler system on 357 separate occasions between 9 and 20 weeks of gestation. Systolic/diastolic (S/D) ratios were used for waveform analysis. We obtained umbilical waveforms as early as 9 weeks. Before 13 weeks, all fetuses had absent end-diastolic velocity (AEDV), then progressive development of end-diastolic velocity (EDV) appeared from 13 to 18 weeks. At 18 weeks, all fetuses had developed EDV. S/D ratios progressively declined from 13 to 20 weeks (y = 17.67 - 1.26x + 0.3x2; r2 = .95). A cross-sectional evaluation of fetal heart rate in 136 fetuses revealed a significant negative second-order polynomial relationship with gestational age between 9 and 20 weeks y = 245.84 - 10.33x + 0.27x2; r2 = .93). In 136 fetuses, 185 measurements of S/D ratios and their corresponding fetal heart rate revealed no relationship (weighted linear regression, r2 = .005). Mean fetal heart rate was significantly higher when EDV was absent (164.6 +/- 10.8 standard deviation [SD], n = 74) than when EDV was present (150.1 +/- 5.8 SD; n = 62; P = .000). Thus, upstream factors may be of little importance in the generation of umbilical artery velocity waveforms in early pregnancy. Umbilical Doppler velocimetry in the first half of pregnancy gives a functional assessment of the vascular development of the umbilical-placental circulation.(ABSTRACT TRUNCATED AT 250 WORDS)

DOPPLER VELOCIMETRY, PLACENTAL MORPHOLOGY, AND OUTCOME IN INSULIN DEPENDENT DIABETES

The purpose of this study was to determine the underlying cause of abnormal umbilical artery Doppler velocimetry in pregnancies complicated by insulin-dependent diabetes, by evaluating placental morphology and correlating Doppler results with pregnancy outcome. Our study population consisted of 14 pregnancies with normal Doppler results and 11 pregnancies with abnormal Doppler results. Quantitative placental examinations were performed. Maternal and perinatal characteristics were analyzed. Infants from the abnormal Doppler group had a statistically significantly higher incidence than those from the normal Doppler group of hyperbilirubinemia, Cesarean delivery for fetal distress, and neonatal intensive care stay of 2 or more days. Women with abnormal Doppler results delivered earlier (36 vs. 38 weeks) and had infants of lower birth weight (3079 vs. 3629 g). They were also three times more likely to have poor glycemic control (relative risk = 3.2; p = 0.0067). The placentae of both groups showed no statistically significant dtfferences in placental weight, number of tertiary stem villi, number of small muscular arteries, or mean arterial width. Our findings suggest a functional rather than structural placental process as the cause of the abnormal Doppler results in pregnancies complicated by diabetes. An association between glycemic control and Doppler velocimetry is suggested. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology