Cerebral Artery Peak Systolic Velocity Research Articles

Parvovirus B19 in Pregnancy.

Although the risk of parvovirus B19 infection during pregnancy and subsequent risk of adverse fetal outcome are low, understanding management practices is essential for proper treatment of fetuses with nonimmune hydrops fetalis. In addition, continued investigation into delivery management, breastfeeding recommendations, and congenital abnormalities associated with pregnancies complicated by parvovirus B19 infection is needed. This review describes the risks associated with parvovirus B19 infection during pregnancy and the management strategies for fetuses with vertically transmitted infections. Original articles were obtained from literature search in PubMed, Medline, and OVID; pertinent articles were reviewed. Parvovirus B19 is a viral infection associated with negative pregnancy outcomes. Up to 50% of people of reproductive age are susceptible to the virus. The incidence of B19 in pregnancy is between 0.61% and 1.24%, and, overall, there is 30% risk of vertical transmission when infection is acquired during pregnancy. Although most pregnancies progress without negative outcomes, viral infection of the fetus may result in severe anemia, congestive heart failure, and hydrops fetalis. In addition, vertical transmission carries a 5% to 10% chance of fetal loss. In pregnancies affected by fetal B19 infection, Doppler examination of the middle cerebral artery peak systolic velocity should be initiated to surveil for fetal anemia. In the case of severe fetal anemia, standard fetal therapy involves an intrauterine transfusion of red blood cells with the goal of raising hematocrit levels to approximately 40% to 50% of total blood volume. One transfusion is usually sufficient, although continued surveillance may indicate the need for subsequent transfusions. There are fewer epidemiologic data concerning neonatal risks of congenital parvovirus, although case reports have shown that fetuses with severe anemia in utero may have persistent anemia, thrombocytopenia, and edema in the neonatal period. Parvovirus B19 is a common virus; seropositivity in the geriatric population reportedly reaches 85%. Within the pregnant population, up to 50% of patients have not previously been exposed to the virus and consequently lack protective immunity. Concern for parvovirus B19 infection in pregnancy largely surrounds the consequences of vertical transmission of the virus to the fetus. Should vertical transmission occur, the overall risk of fetal loss is between 5% and 10%. Thus, understanding the incidence, risks, and management strategies of pregnancies complicated by parvovirus B19 is essential to optimizing care and outcomes. Further, there is currently a gap in evidence regarding delivery management, breastfeeding recommendations, and the risks of congenital abnormalities in pregnancies complicated by parvovirus B19. Additional investigations into optimal delivery management, feeding plans, and recommended neonatal surveillance are needed in this cohort of patients.

Diagnostic Accuracy of Fetal Middle Cerebral Artery Peak Systolic Velocity in the Detection of Fetal Anaemia Keeping Neonatal Hae Moglobin Estimation at Birth as the Gold Standard

Objective: To assess whether monitoring the peak systolic velocity (PSV) in the middle cerebral artery (MCA) was a useful, non-invasive method for predicting anaemia in fetuses. Study Design: Cross-sectional study Place and Duration of Study: Armed Forces Institute of Radiology, Rawalpindi Pakistan, from Feb and Aug 2022. Methodology: Fifty pregnant women who did not have hydropic babies were included. The peak systolic velocity (PSV) was measured in the middle cerebral artery (MCA). A positive result was determined when the MCA-PSV value exceeded 1.5multiples of the median (MoM). The blood samples obtained from neonates were forwarded to the hospital laboratory to estimate haemoglobin levels shortly after birth. The outcome of the method (MoM) was observed and subsequently compared with neonatal haemoglobin levels. Results: 60% of neonates were anaemic according to middle MCA-PSV while the haematology laboratory reported 74% of neonates as anaemic according to cut-off haemoglobin of less than 13.5gm/dl. Sensitivity, specificity, positive predictive value(PPV), negative predictive value (NPV), and accuracy of the MCA-PSV in detecting the anaemia were 93.75%, 61.1%, 81.08%, 84.62%, and 82%, respectively. Conclusion: MCA-PSV Doppler is deemed valuable as a diagnostic technique for fetal anaemia, albeit secondary to the primary approach of neonatal haemoglobin estimation upon birth.

Risk stratification for donor twin fetal death by evaluating middle cerebral artery in twin-to-twin transfusion syndrome in absence of twin anemia polycythemia sequence.

To determine the association of high middle cerebral artery peak systolic velocity (MCA-PSV) with fetal demise in donor twins among pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) in the absence of twin anemia polycythemia sequence (TAPS). This prospective cohort study included TTTS cases that underwent laser surgery between 2011 and 2022 at a single center. TAPS cases were excluded from the study. The primary objective was to explore the association of high MCA-PSV (>1.5 multiples of the median) with fetal demise of the donor twin among pregnancies complicated by TTTS. Secondary objectives were: 1) to evaluate if donor or recipient MCA-PSV is associated with an increased risk for their corresponding fetal death using receiving operator characteristic curve analysis; and 2) to compare the proportion of fetuses with low MCA pulsatility index among donor twins with high MCA-PSV and in those with normal MCA-PSV to evaluate the contribution of blood flow redistribution to high MCA-PSV. Multivariable and Poisson regression analysis were performed to explore the association of isolated high donor MCA-PSV and fetal demise, adjusted for TTTS stage, selective fetal growth restriction (sFGR), and other confounders. p<0.05 was considered significant. Out of 660 TTTS cases, donor MCA-PSV was unavailable in 48 (7.3%) cases. Of the remaining 612 patients, 9 (1.5%) were lost to follow-up, and 96 TAPS cases were excluded. High donor MCA-PSV was seen in 6.5% (33/507) of the study population. High donor MCA-PSV was an independent risk factor for donor fetal demise (adjusted relative risk (aRR) of 4.52; 95% CI: 2.72-7.50), adjusted for confounders. Regression analysis restricted to each Quintero TTTS stage demonstrated that high donor MCA-PSV was an independent risk factor for donor fetal demise in Quintero stage II (aRR of 14.21; 95% CI: 1.09-186.2) and Quintero stage III (aRR of 3.41; 95% CI: 1.82-6.41). Donor MCA-PSV was associated with donor fetal demise (AUC: 0.69; p<0.001), but recipient MCA-PSV was not associated with its corresponding fetal demise (AUC: 0.54; p=0.44). A higher proportion of donor twins in the group with high MCA-PSV had a low MCA pulsatility index than in those with normal MCA-PSV (33.3% vs. 15.5%; p=0.016). Elevated donor MCA-PSV without TAPS prior to laser surgery is associated with a 4-fold increased risk for donor fetal demise, adjusted for sFGR, TTTS stage, and other confounders. Doppler evaluation of donor MCA-PSV prior to laser surgery can further stratify TTTS staging to evaluate the risk for donor fetal demise. This article is protected by copyright. All rights reserved.

Predictors of Poor Outcomes in Monochorionic Diamniotic Twin Pregnancies Complicated by Selective Fetal Growth Restriction

Introduction: The aim of the study was to identify predictors of poor outcomes in monochorionic diamniotic twin (MCDA) pregnancies with selective fetal growth restriction (sFGR), irrespective of the umbilical artery (UA) Doppler abnormalities. Methods: Single-center retrospective analysis of MCDA twins diagnosed with sFGR that opted for expectant management between 2010 and 2021. The presence of any of the following variables in the growth-restricted fetus: low amniotic fluid volume (DVP ≤2 cm), lack of a cycling bladder, absent or reversed flow in the ductus venosus (DV) with atrial contraction, and elevated middle cerebral artery peak systolic velocity (MCA-PSV) defined as ≥1.50 multiples of the median was categorized as complicated. sFGR cases were classified as simple in the absence of the above-mentioned variables. Results: Overall, 63.3% of cases qualified as simple, and 36.7% were complicated. Intertwin EFW discordance was higher in the complicated category (26 vs. 33%, p = 0.0002). The median gestational age at delivery was earlier (33 weeks vs. 30.5 weeks, p = 0.002), and the likelihood of survival was lower in the complicated category (p two survivors to discharge was lower in type I complicated cases (70% in complicated type I vs. 97.1% in simple type I, p = 0.0003). On logistic regression analysis, an increase in the “complicated” score negatively correlated with two survivors to discharge (p two survivors to discharge. Conclusion: The presence of oligohydramnios, lack of a cycling bladder, abnormal DV Doppler, and elevated MCA-PSV in the growth restricted fetus is associated with poor perinatal outcomes and a lower likelihood of having two survivors to discharge. The addition of intertwin EFW discordance to these variables helped improve the survival predictability.

Prevalence of unexpected red blood cell antibodies in pregnant women and follow-up of pregnancy outcome in pregnant women treated with intra-uterine transfusion

Abstract BACKGROUND: For the management of hemolytic disease of the fetus and newborn (HDFN), it is important to detect unexpected red cell antibody in pregnant women. We assessed the prevalence of unexpected red cell antibodies in consecutive pregnant women attending antenatal clinic (ANC). More importantly, cases with unexpected antibody causing severe anemia were followed-up for intervention (Intra-uterine transfusion {IUT}) and outcome of pregnancy (still-birth/live-healthy). AIMS AND OBJECTIVES: The study was conducted with an objective to find the prevalence of unexpected RBC antibodies in pregnant women, their specificity and to do the follow-up for IUT and outcome of pregnancy (still-birth, live-birth) in antibody positive women. MATERIALS AND METHODS: This was a prospective study from January 2021 to May 2022 at two tertiary care centres. All antenatal samples received by the laboratory were screened for unexpected red cell antibody. Whenever antibody screen was positive, antibody identification was performed. Patients, positive for unexpected antibody and anemia were followed up for any transfusion-based intervention and outcome of pregnancy. RESULTS: A total of 539 consecutive samples were worked up and among these, 10 samples (1.85%) were found to be antibody positive. The antibodies identified were Anti-D (n=6), anti-Leb (n=1), anti-M (n=1), anti-C (n=1) and anti-E (n=1).The prevalence of unexpected antibodies in Rh positive and Rh negative pregnant women was 0.83% and 10.9% respectively. Follow-up was done for all 10 cases with unexpected antibody and anemia was monitored by MCA PSV (middle cerebral artery peak systolic velocity).Two women developed severe anemia thus requiring single intrauterine transfusion (at 26 weeks and 28 weeks respectively) each, for correction of anemia. In both these cases, healthy male child was delivered. At 3-month follow-up both children were alive and healthy. CONCLUSION: The study found prevalence of unexpected RBC antibodies in pregnant women as 1.85%. The study also underlined importance of transfusion-based interventions contributing to successful outcome in couple of cases with severe anemia.

Massive fetomaternal hemorrhage: A case report.

We present a case with an incidental finding of abnormal cardiotocography (CTG) pattern as well as elevated middle cerebral artery peak systolic velocity (MCA-PSV) in an otherwise inconspicuous pregnancy. Massive fetomaternal hemorrhage (FMH) was detected as the cause by flow cytometry (FC), resulting in multiple cycles of fetal blood sampling (FBS) showing severe anemia, intrauterine transfusions (IUTs), a preterm delivery, and a healthy infant in follow-up examinations.

Middle cerebral artery peak systolic velocity monitoring of fetal anemia during chemotherapy in pregnancy.

Chemotherapy during pregnancy can increase the risk of fetal anemia. Severe fetal anemia can lead to the development of hydrops fetalis and potentially fetal demise. Hence, it is imperative to implement consistent monitoring methods in the context of chemotherapy treatment. This study aimed to diagnose and monitor fetal anemia using middle cerebral artery peak systolic velocity (MCA-PSV) as a diagnostic tool during chemotherapy in pregnant women. The study employed a prospective analysis involving a case series of 15 patients diagnosed with cancer during pregnancy and subsequently underwent chemotherapy. MCA-PSV was used to identify fetal anemia. The patients were scheduled for ultrasound examinations of the MCA-PSV. The first examination was performed on the same day as the administration of chemotherapy, while the second occurred on the 10th day after chemotherapy. The measurement technique used in the study was based on the methodology proposed by Mari and Barr. The multiples of the median were calculated using the calculators provided by Medicina Fetal Barcelona. Based on these values anemia severity was determined. When moderate or severe anemia was identified, chemotherapy was individually modified. Additionally, a blood count analysis was conducted immediately after the delivery of the newborn. Five patients were diagnosed with fetal or newborn anemia. With MCA-PSV, we identified moderate fetal anemia in two patients and severe fetal anemia in one. The complete blood count testing of newborns revealed mild anemia in three patients. One case was unrelated to chemotherapy-induced anemia. During treatment, fetal anemia did not corelate with maternal anemia. In four cases of anemia the combination of cisplatin and iphosphamide was used as a chemotherapy agent. No anemia was observed in other drug combinations. Our findings suggest that MCA-PSV is a reliable method for identifying anemia and should be included in the treatment protocol for chemotherapy-induced fetal anemia.

375 Elevated middle cerebral artery peak systolic velocity (MCA PSV) in fetuses with unexplained anemia

375 Elevated middle cerebral artery peak systolic velocity (MCA PSV) in fetuses with unexplained anemia

Latrogenic twin anemia: polycythemia sequence post-amnioreduction in twin-twin transfusion syndrome

We present a case of Iatrogenic twin anemia–polycythemia sequence (TAPS) post-amnioreduction in twin-twin transfusion syndrome at 32 gestational weeks. Slight middle cerebral artery (MCA) peak systolic velocity (PSV) discrepancy was present 3 days after the amnioreduction, with MCA PSV around 1.5 MoM of the doner and 1.0 MoM of the recipient. Eighteen days after the amnioreduction, though MCA PSV remained stable, placental dichotomy, starry-sky liver of the recipient and small amount of right pleural effusion of donor were noted. TAPS was diagnosed and postnatal examination of the twins and the placenta confirmed it. We conjectured that the decompression of the placenta after the sudden reduction of amniotic fluid volume may cause the patency of the tiny anastomoses, resulting in the TAPS.

The Need to Consider Pro-Active Treatment for Cerebral Artery Conditional Blood Velocity Determined By Transcranial Doppler Ultrasonography (TCD) in Sickle Cell Disease (SCD)

Introduction Cerebral artery peak systolic blood velocity (PSV) or timed average mean of the maximum blood velocity (TAMMV) determined by TCD in children of age 2-16 years with SCD is normal (NV) if TAMMV &amp;lt;170 cm/sec or PSV &amp;lt;200 cm/sec; abnormal (AV) if TAMMV &amp;gt; 200cm/s or PSV &amp;gt; 250 cm/sec; and conditional (CV) if TAMMV is 170-199cm/sec or PSV 200-249 cm/sec. Internal carotid (ICA) or middle cerebral (MCA) artery AV is associated with a stroke risk of 10% /year, CV a risk of 3-4% /year [Adams et al. Long-Term stroke risk in children with SCD screened with TCD. Ann Neurol 1997; 42: 699-704]. Blood transfusion or hydroxycarbamide is used to treat AV, but active treatment is currently not considered the standard of care for conditional velocity, although it could progress to abnormal values. ObjectiveTo evaluate the need for pro-active treatment of cerebral artery conditional blood velocity in children of age 2-16 years with SCD. Methods Following IRB approval and informed consent/assent, 308 children with SCD (126 girls and 182 boys, age 2-16 years) had TCD to determine PSV (n=193) or TAMMV (n=115) in the MCA, ICA and anterior cerebral arteries (ACA). This design was to make the research findings relevant to hospitals with TCD equipment that measure either PSV or TAMMV. Exclusion criteria were blood transfusion in the previous 4 months, therapy with hydroxycarbamide, omega-3 fatty acids or other agents that affect the severity of SCD, pregnancy, breast feeding, chronic disorders unrelated to SCD (such as diabetes mellitus) and stroke. Children with AV were started on a blood transfusion program. Those with conditional PSV were randomized in a 2:1 ratio to receive either standard care of SCD and active treatment with omega-3 fatty acids and potassium thiocyanate, or standard care only. After 3 months, measurement of PSV in the ICA, MCA and ACA was repeated. Study data were analysed with the Statistical Package for Social Sciences version 23 (IBM, USA). ResultsIn the TAMMV cohort of 115 children, 96 (84%) had NV, 7 (6%) AV, and 12 (10%) CV. Figure 1 shows the cumulative frequency of TAMMV in the MCA where most AV and CV occurred. In the PSV cohort of 193 children, 150 (77.7%) had NV, 7 (3.6%) AV, and 36 (18.7%) CV. There were no significant differences in gender or age distribution between the PSV and TAMMV cohorts. Altogether, cerebral artery blood velocity was normal in 246/308 children (80%), abnormal in 14 (4.5%) and conditional in 48 (15.5%). The PSV in 21 patients randomized to active treatment of conditional blood velocity or standard SCD care are shown in Table 1. After 3 months, PSV reduced to normal (&amp;lt;200cm/sec) in a significantly higher proportion (11/14 or 79%) of children on active treatment compared with 3/7 (43%) on standard care only, p = 0.04. Change in the right MCA median PSV showed a significant difference of 54cm/sec between children on active treatment who had a reduction from 201.5 cm/sec to 169.5 cm/s, and the standard care group with a rise from 184cm/s to 206 cm/sec (p = 0.018). One of 7 patients on standard care (14%) but none of 14 on active treatment (0%) had progression of PSV from conditional to abnormal. Reduction in conditional velocity following active treatment has been reported from other studies [Lagunju et al, Pediatr Blood Cancer 2015;62:1587-91; Estepp et al. Br J Haematol 2021;194:463-8]. Although not statistically significant, pre/post-treatment median steady state Hb level in actively treated patients showed an upward trend [6.8/7.3g/dl]; and the median platelet count a downward trend: 278/235 x10 9/l. The standard care group had opposite, but also not significant, trends: 7.45/7.0 g/dl, 224/261 x10 9/l. Discussion and Conclusion The 15.5% prevalence of conditional velocity translates to 15,500 /100,000 children born annually with SCD in our country, or 46,500 worldwide, of whom 1,860 (4%) may have stroke. If 14% of CV progress to AV, that is 6,510/year globally. If all are not treated, a reality in resource-limited places, any number up to 651 (10%) may develop stroke. The annual incidence, cumulative prevalence and progression rates of CV, and the significant difference in the proportion that revert to NV on active treatment compared to standard care only, suggest that there is need to consider CV for active treatment. This will prevent the cumulation of more than 1,860 children who develop stroke every year with its health, psychosocial and economic burden to the patients, their families and society.

Accuracy of a portable hemoglobinometer (HemoCue) to measure fetal hemoglobin values during in utero transfusion

Objectives The current recommended treatment for severe fetal anemia is in utero transfusion (IUT). During this procedure, the evaluation of the necessary volume of transfused blood is based on regular measurement of fetal hemoglobin (FHb) concentration. The gold standard measurement is performed in the biology laboratory. A rapid medical test such as HemoCue® is an effective way to predict FHb concentration. It would reduce the time to obtain results and therefore the procedure duration. To evaluate the accuracy of HemoCue® to measure FHb during IUT, we compared Hb levels obtained by HemoCue® and by our biology laboratory. Methods This retrospective study involved all pregnant women who had undergone an IUT in the university hospital of Clermont-Ferrand, France, during the period from 1 January 2010 to 6 June 2021. The FHb level was evaluated by two methods, a rapid medical test, HemoCue®, and a standard method in the biology laboratory. Results We obtained 244 pairs of results from HemoCue® and our laboratory, of 90 IUT procedures. The correlation between the two sets of results was excellent, with Lin’s concordance correlation coefficient of 0.979. However, we established that the measurements were not significantly modified by IUT number, puncture time, cause of fetal anemia, estimated fetal weight, gestational age, and delay between two IUT or middle cerebral artery peak systolic velocity values. Conclusion Our results allowed to extend the relevance of FHb measurements by HemoCue® during IUT.

It is time to include an image quality evaluation in alloimmunized mothers undergoing Doppler ultrasound assessment of middle cerebral artery peak systolic velocity?

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Early cerebral hemodynamic changes following unilateral carotid artery stenting in patients with different degrees of carotid stenosis.

Few studies have focused on cerebral hemodynamics in the early stage following carotid artery stenting (CAS). This retrospective cohort study aimed to investigate cerebral hemodynamic changes within 6 hours of unilateral CAS in patients with different degrees of carotid stenosis. A total of 104 patients who underwent CAS accompanied by transcranial color-code Doppler or transcranial Doppler were enrolled in the study. The participants were divided into the following 3 groups based on the degree of carotid stenosis: severe stenosis group, extreme stenosis group, and near occlusion group. Bilateral middle cerebral artery (MCA) peak systolic velocity (PSV) and pulsatility index (PI) were measured using transcranial color-code Doppler before and 1 and 3 hours following CAS. Blood pressure, MCA-PSV, and PI were compared among the 3 groups. At 1 hour following CAS, ipsilateral MCA-PSV increased compared to the baseline in the severe stenosis group [84±21 vs. 93±27 cm/s; 8.1%; interquartile range (IQR), 1.4-20.1%; P<0.001]. A similar hemodynamic change, but of a larger magnitude, was observed in the extreme stenosis group (83±24 vs. 100±29 cm/s; 20.8%; IQR, 5.3-33.1%; P<0.001) and near occlusion group (73±24 vs. 109±29 cm/s, 45.8%; IQR, 24.3-73.1%; P<0.001). At 3 hours after CAS, the hemodynamic changes were the same as those at 1 hour. PI increased in all 3 groups following CAS. A subgroup analysis was performed according to symptoms, sex, smoking status, history of hypertension, and presence of hyperlipidemia or diabetes, and the increase in ipsilateral MCA-PSV was not significant. In terms of adverse events, only 4 patients in the near occlusion group experienced transient post-CAS hyperperfusion. The ipsilateral MCA-PSV and PI in patients following unilateral CAS increased significantly in the initial hours. The increase in ipsilateral MCA-PSV was considerably higher in patients with a severe degree of stenosis. Near occlusion of the carotid artery was an independent risk factor for hyperperfusion after unilateral CAS.

Cerebral artery conditional blood velocity in sickle cell disease: a multicentre study and evidence for active treatment

ObjectiveTo obtain multicentre data on the prevalence of normal, high or conditional (intermediate) blood velocity in the cerebral arteries among children with sickle cell disease (SCD) in Nigeria.DesignA prospective observational...

Suspected twin anemia polycythemia sequence in a dichorionic, diamniotic twin pregnancy: a case report

BackgroundTwin anemia polycythemia sequence is a rare complication in monochorionic twin pregnancy.Case presentationWe describe a case of dichorionic twin pregnancy presenting with suspected twin anemia polycythemia sequence. A 31-year-old White female, on her third pregnancy, had a routine ultrasound scan at 12 weeks gestation, which demonstrated a dichorionic twin pregnancy with one placenta located in the anterior wall and the other in the posterior wall of the uterus. At 21 weeks, a scan demonstrated a 24% growth discordance between the two fetuses with normal Doppler studies and amniotic fluid. At 27 weeks, one twin showed signs of anemia and the other polycythemia; the fetal middle cerebral artery peak systolic velocity was high in the anemic fetus and low in the polycythemic twin (1.8 and 0.5 multiples of the median). An intrauterine blood transfusion was carried out and this increased the fetal hemoglobin concentration in the anemic twin from 3.5 to 12.5 g/dL. At 29 weeks, delivery by cesarean section was carried out because of evidence from middle cerebral artery peak systolic velocity of recurrence of anemia in one twin and worsening polycythemia in the co-twin; at birth the hemoglobin concentrations were 5.6 and 24.9 g/dL, respectively. Histopathological examination confirmed dichorionicity with no communicating vessels between the two placentas.ConclusionsThis is the first case of twin anemia polycythemia sequence in a dichorionic, diamniotic twin pregnancy where intrauterine blood transfusion was used to prolong the pregnancy by almost 2 weeks in a “twin anemia polycythemia sequence-like” setting.

75-g oral glucose tolerance testing does not affect fetal cardiac doppler parameters in low-risk pregnant women

The study aimed to examine whether acute hyperglycemia, caused by the 75-g oral glucose tolerance test (OGTT) can produce fetal cardiac adverse effects that are detectable with fetal cardiac Doppler ultrasound in healthy low-risk pregnancies. Healthy low-risk pregnant women who underwent 75-g OGTT during the gestational period of 24 to 28 weeks were considered eligible and during the test, they were examined with fetal ultrasound at the fasting and 1- and 2-h timepoints. The study findings included the parameters of umbilical artery pulsatility index, uterine artery, fetal heart rate, middle cerebral artery (MCA) peak systolic velocity (MCA-PSV), MCA pulsatility index, and fetal cardiac Doppler parameters including myocardial performance index, left isovolumetric contraction and relaxation times, K-index, filling time, mitral E- and A-wave velocities, and E/A ratio. The data of 53 women without gestational diabetes mellitus were used for statistical analyses. There was no statistical significance among the three-time points of OGTT regarding all the Doppler parameters (p&gt;0.05). The median MCA-PSV measured at the fasting of OGTT was significantly higher than the values measured at the first and second hour of OGTT [28 (22-42) vs. 26 (18-39) and 26 (18-38), respectively; p&lt;0.05]. This increase provided no relationship with other study parameters (p&gt;0.05). Overall, 75-g OGTT does not affect fetal cardiac Doppler parameters in healthy pregnant women except for abnormal findings of MCA-PSV. The results of the current study can provide significant support to clinicians in reducing the hesitations of women with low-risk pregnancies regarding gestational diabetes screening.

The Value of Delta Middle Cerebral Artery Peak Systolic Velocity for the Prediction of Twin Anemia-Polycythemia Sequence-Analysis of a Heterogenous Cohort of Monochorionic Twins.

Twin anemia-polycythemia sequence (TAPS) is a complication in monochorionic-diamniotic (MCDA) twin pregnancies. This study analyzes whether the prenatal diagnosis using delta middle cerebral artery-peak systolic velocity (MCA-PSV) &gt; 0.5 multiples of the median (MoM) (delta group) detects more TAPS cases than the guideline-based diagnosis using the MCA-PSV cut off levels of &gt;1.5 and &lt;1.0 MoM (cut-off group), in a heterogenous group of MCDA twins. A retrospective analysis of 348 live-born MCDA twin pregnancies from 2010 to 2021 with available information on MCA-PSV within one week before delivery and hemoglobin-values within 24 h postnatally were considered eligible. Among postnatal confirmed twin pairs with TAPS, the cut-off group showed lower sensitivity than the delta group (33% vs. 82%). Specificity proved higher in the cut-off group with 97% than in the delta group at 86%. The risk that a TAPS is mistakenly not recognized prenatally is higher in the cut-off group than in the delta group (52% vs. 18%). Our data shows that delta MCA-PSV &gt; 0.5 MoM detects more cases of TAPS, which would not have been diagnosed prenatally according to the current guidelines. In the collective examined in the present study, TAPS diagnostics using delta MCA-PSV proved to be a more robust method.

Pathophysiology, diagnosis, and management of twin anemia polycythemia sequence in monochorionic multiple gestations.

Twin anemia polycythemia sequence (TAPS) is a consequence of unequal sharing of red blood cells between monochorionic twins resulting in anemia in the donor and polycythemia in the recipient twin. Prenatally TAPS can occur spontaneously or complicate incomplete laser surgery for twin transfusion syndrome. While there may be clinical overlap with twin transfusion syndrome or selective fetal growth restriction, diagnosis relies on Doppler measurement of middle cerebral artery peak systolic velocities. Significantly discordant velocities are diagnostic, while severity staging is based on signs of cardiovascular compromise. Conservative management, fetoscopic laser coagulation, selective twin reduction, fetal blood and exchange transfusion, and delivery may be selected guided by the gestational age of diagnosis, the severity of the condition, the likelihood of success, and the patients' priorities. Prenatal curative treatment that minimizes the risk for prematurity and residual morbidity at birth is most likely to offer the greatest short-term and long-term benefits.

The effect of middle cerebral artery peak systolic velocity on prognosis in early and late-onset fetal growth restriction.

We aim to investigate the utility of middle cerebral artery peak systolic velocity (MCA PSV) Doppler in determining the perinatal mortality and morbidity in serial Doppler measurements from the time of diagnosis to the delivery of complicated cases with fetal growth restriction (FGR). At 24-38weeks of gestation, 65 pregnant women diagnosed with FGR were included in the study. The fetal biometry measurements, MCA pulsatility index (PI), and MCA PSV Doppler evaluation of the cases formed at the diagnosis and the delivery were recorded. Gestational weeks, birth weights, APGAR scores, cord pH values, NICU (neonatal intensive care unit) admission, NICU duration of stay, and perinatal morbidity parameters such as RDS (respiratory distress syndrome), BPD (bronchopulmonary dysplasia), NEC (necrotizing enterocolitis), sepsis and perinatal mortality were compared. The patients were divided into two groups: early and late-onset fetal growth restriction. Perinatal morbidity and mortality were accepted as adverse perinatal outcomes. MCA PSV above the 95th percentile at the diagnosis and delivery time was seen at a significantly higher rate with adverse perinatal outcomes. This study shows that evaluating MCA PSV with Doppler can be a helpful diagnostic method for early diagnosis of restriction and hypoxic fetuses. Also, it may be used in clinics as a noninvasive method to predict neonatal prognosis.

Decreased fetal movements—the utility of ultrasound to identify infants at risk and prevent stillbirth is poor

Despite a paucity of evidence, it is widely accepted that a perceived reduction in fetal movements is associated with an increased risk of stillbirth and poor obstetrical outcome. Consequently, many international guidelines recommend urgent ultrasound assessment of fetal well-being in women presenting with decreased fetal movements. This study aimed to compare rates of abnormal ultrasound findings reflective of fetal compromise between women presenting with decreased fetal movements and gestation-matched controls in the third trimester. This was a retrospective cohort study performed at the Mater Mothers' Hospital in Brisbane between 2017 and 2020. We undertook propensity score matching analysis comparing abnormal ultrasound parameters in women with singleton, nonanomalous pregnancies presenting with decreased fetal movements after 28 weeks' gestation. The primary outcome was a composite of any abnormal scan parameter: umbilical artery pulsatility index >95th centile, middle cerebral artery pulsatility index <5th centile, cerebroplacental ratio <10th centile, estimated fetal weight <10th centile for gestation, middle cerebral artery peak systolic velocity >1.5 multiples of the median, or deepest vertical pocket of amniotic fluid <2 or >8 cm. After propensity score matching, the study cohort comprised 1466 cases and 2207 controls. The rate of the primary composite outcome was not significantly different between the 2 cohorts (20.2% vs 21.3%; P=.42). There were 30 new cases of small-for-gestational-age detected in the decreased fetal movements cohort, giving a number needed to scan of 48 in the decreased fetal movements group to detect 1 case of small-for-gestational-age. However, the frequency of the composite outcome was higher (13.0% vs 5.4%) at the final scan before birth in women with multiple decreased fetal movement presentations. Despite this, there was no significant difference in clinical outcomes between the 2 cohorts. Ultrasound abnormalities are not increased in women with decreased fetal movements compared with controls.