Altered Doppler Research Articles

Neurodevelopmental outcomes of very preterm infants born following early foetal growth restriction with absent end-diastolic umbilical flow

This study aims to assess the impact of time of onset and features of early foetal growth restriction (FGR) with absent end-diastolic flow (AEDF) on pregnancy outcomes and on preterm infants’ clinical and neurodevelopmental outcomes up to 2 years corrected age. This is a retrospective, cohort study led at a level IV Obstetric and Neonatal Unit in Bologna, Italy. Pregnant women were eligible if having singleton pregnancies, with no major foetal anomaly detected, and diagnosed with early FGR + AEDF (defined as FGR + AEDF detected before 32 weeks gestation). Early FGR + AEDF was further classified according to time of onset and specific features into very early and persistent (VEP, FGR + AEDF first detected at 20–24 weeks gestation and persistent at the following scans), very early but transient (VET, FGR + AEDF detected at 20–24 weeks gestation and progressively improving at the following scans) and later (LA, FGR + AEDF detected between 25 and 32 weeks gestation). Pregnancy and neonatal outcomes and infant follow-up data were collected and compared among groups. Neurodevelopment was assessed using the revised Griffiths Mental Developmental Scales (GMDS-R) 0–2 years. A regression analysis was performed to identify early predictors of preterm infants’ neurodevelopmental impairment. Fifty-two pregnant women with an antenatal diagnosis of early FGR + AEDF were included in the study (16 VEP, 14 VET, 22 LA). Four intrauterine foetal deaths occurred, all in the VEP group (p = 0.010). Compared to LA infants, VEP infants were born with lower gestational age and lower birth weight, had lower arterial cord blood pH and were at higher risk for intraventricular haemorrhage and periventricular leukomalacia (p < 0.05 for all comparisons). At 12 months, VEP infants had worse GMDS-R scores, both in the general quotient (mean [SD] 91.8 [12.4] vs 104.6 [8.7] in LA) and in the performance domain (mean [SD] 93.3 [15.4] vs 108.8 [8.8] in LA). This latter difference persisted at 24 months (mean [SD] 68.3 [17.0] vs 92.9 [17.7] in LA). In multivariate analysis, at 12 months corrected age, PVL was found to be an independent predictor of impaired general quotient, while the features and timing of antenatal Doppler alterations predicted worse scores in the performance domain. Conclusion: Timing of onset and features of early FGR + AEDF might impact differently on neonatal clinical and neurodevelopmental outcomes. Shared awareness of the importance of FGR + AEDF features between obstetricians and neonatologists may offer valuable tools for antenatal counselling and for tailoring pregnancy management and neonatal follow-up in light of specific antenatal and neonatal risk factors.What is Known:• Foetal growth restriction (FGR), together with antenatal umbilical Doppler abnormalities, is known to affect maternal and neonatal outcomes.• Infants born preterm and growth-restricted face the highest risk for neurodevelopmental impairment, especially when FGR occurs early during pregnancy (early FGR, before 32 weeks gestation).What is New:• The timing of onset and features of FGR and antenatal umbilical Doppler abnormalities impact differently on maternal and neonatal outcomes; when FGR and Doppler abnormalities occur very early, at the limit of neonatal viability, and persist until delivery, infants face the highest risk for neurodevelopmental impairment.• Shared knowledge between obstetricians and neonatologists about timing of onset and features of FGR would provide a valuable tool for informed antenatal counselling in high-risk pregnancies.

Late-onset fetal growth restriction management: a national survey.

Fetal growth restriction (FGR) is an obstetric condition that increases the risk of adverse neonatal outcomes. FGR antenatal care aims to decrease fetal morbidity and mortality through optimal fetal monitoring. However, no univocal strategies for late-onset FGR outpatient management are available, and this survey investigated gynaecologists' attitudes concerning outpatient frequency tests. We mailed a survey to 429 Italian gynaecologists. The primary purpose was the ambulatory care of late-onset FGR without doppler alterations evaluation. The queries estimated the self-reported medical practice regarding cardiotocography (CTG) and obstetric ultrasound exams before hospitalization. Statistical analysis was performed with Stata 14.1 (Stata corp., College Station, TX, USA) for symmetrically distributed continuous variables, and the mean differences were analyzed using the t-test. Where appropriate, the proportions between the groups were evaluated using Fisher's exact or χ2 test. All P value <0.05 were considered statistically significant. 128 responses (29.8%) from the 429 SCCAL members were available for the survey. 39.9% of respondents had a late FGR standardized protocol. Regarding non-severe FGR with normal fetal doppler, 70.8% suggested a fetal doppler study after one week (92/128), 13.8% (18/128) and 6.9% (9/128) proposed the exam, respectively, two and three times for a week. 0.8% (1/128) of respondents had a daily doppler exam, 7.7% (10/128) did not answer, and 3.1% (4/128) repeated the ultrasound exam to time for a week. The antenatal CTG was offered: 70.8% (92/128) of gynaecologists recommended one weekly CTG, whereas 13.8% (18/128) suggested two. 6.9% (9/128) recommended three weekly tests and 0.8% a daily test. 7.7% (10/128) of gynaecologists did not respond. At least, we investigated the gynaecologist's recommendations for outpatient EFW evaluation: 59.4% (76/128) repeated EFW after two weeks, 31.3% (40/128) after one week. 3.9% (4/128) and 3.1 (4/128) recommended EFW after three weeks and twice a week. Gynaecologists recommend unnecessary cardiotocography and ultrasound Doppler exams for non-severe late-onset FGR with normal doppler. However, additional studies and comprehensive surveys are needed to support a standardized protocol and assess the feto-maternal outcomes impact.

Maternal hemodynamics for the identification of early fetal growth restriction in normotensive pregnancies

We aimed at testing systemic vascular resistance (SVR) for the correct identification of early fetal growth restriction (FGR). 61 normotensive patients, gestational age 29 + 0–32 + 0, with suspected diagnosis of early FGR, were submitted to USCOM and to an ultrasound evaluation. 24 patients met the criteria of FGR, and 9 patients developed umbilical artery Doppler alterations. SVR>1006 dyn s·cm−5 correctly identified patients with a subsequent diagnosis of FGR, whereas SVR>1222 dyn s·cm−5 was related to FGR with subsequent umbilical artery Doppler alterations. These data might be important to introduce USCOM in the clinical practice to identify and treat FGR.

Brain-Derived Neurotrophic Factor Levels in Cord Blood from Growth Restricted Fetuses with Doppler Alteration Compared to Adequate for Gestational Age Fetuses.

Background and Objectives: Fetal growth restriction (FGR) is a severe obstetric disease characterized by a low fetal size entailing a set of undesired consequences. For instance, previous studies have noticed a worrisome association between FGR with an abnormal neurodevelopment. However, the precise link between FGR and neurodevelopmental alterations are not yet fully understood yet. Brain-derived neurotrophic factor (BDNF) is a critical neurotrophin strongly implicated in neurodevelopmental and other neurological processes. In addition, serum levels of BDNF appears to be an interesting indicator of pathological pregnancies, being correlated with the neonatal brain levels. Therefore, the aim of this study is to analyze the blood levels of BDNF in the cord blood from fetuses with FGR in comparison to those with weight appropriate for gestational age (AGA). Materials and Methods: In this study, 130 subjects were recruited: 91 in group A (AGA fetuses); 39 in group B (16 FGR fetuses with exclusively middle cerebral artery (MCA) pulsatility index (PI) < 5th percentile and 23 with umbilical artery (UA) PI > 95th percentile). Serum levels of BDNF were determined through ELISA reactions in these groups. Results: Our results show a significant decrease in cord blood levels of BDNF in FGR and more prominently in those with UA PI >95th percentile in comparison to AGA. FGR fetuses with exclusively decreased MCA PI below the 5th percentile also show reduced levels of BDNF than AGA, although this difference was not statistically significant. Conclusions: Overall, our study reports a potential pathophysiological link between reduced levels of BDNF and neurodevelopmental alterations in fetuses with FGR. However, further studies should be conducted in those FGR subjects with MCA PI < 5th percentile in order to understand the possible implications of BDNF in this group.

Evaluation of Fetal Renal Artery Doppler Indices in Pregnancies Complicated with Preeclampsia

Objective: Preeclampsia, characterized by endothelial dysfunction, is associated with maternal and fetal Doppler alterations. This study aimed to evaluate fetal renal artery Doppler indices in pregnancies complicated with preeclampsia and compare them with normotensive pregnancies. Design: This cross-sectional study enrolled 46 pregnancies complicated with preeclampsia between weeks 24 and 37 of gestation as the study group and 48 normotensive pregnancies as the control group. Materials and Methods: The abdominal aorta, its bifurcation, and the renal arteries were visualized in the coronal view of the fetal abdomen using color Doppler. Renal artery Doppler indices were measured after arising from the abdominal aorta. The angle of insonation was ≤30° from the direction of blood flow, and the sample volume was 2 mm. Fetal renal artery pulsatility index, resistance index, systolic/diastolic ratio, and peak systolic velocity (PSV) were measured. All Doppler measurements were performed in the absence of fetal movements. Moreover, demographic characteristics and the perinatal outcome data of patients were recorded. Results: The values of fetal renal artery pulsatility and resistance indices were found to be significantly lower in the study group than those in the control group (p < 0.001 and p = 0.013, respectively). The fetal renal artery systolic/diastolic ratio and PSV values were also significantly lower in the study group compared with those in the control group (p = 0.007 and p < 0.001, respectively). Renal artery pulsatility and resistance indices were negatively correlated with mean arterial pressure (r = −0.381, p < 0.001 and r = −0.267, p = 0.009, respectively). The renal artery systolic/diastolic ratio was also significantly negatively correlated with the mean arterial pressure (r = −0.257, p = 0.013). Limitations: The main limitations of this study are its cross-sectional design and the small number of participants. Another limitation of the study is that preeclamptic pregnancies complicated with fetal growth restriction were not included. Conclusion: The observed decrease in fetal renal artery Doppler impedance may be caused by the unique response of the fetal renal artery to the factors involved in the etiopathogenesis of preeclampsia than other fetal peripheral vessels. These changes in fetal renal artery indices in pregnancies complicated with preeclampsia could be taken into account in the assessment of fetal health.

Splanchnic oximetry in small for gestational age neonates in relation to prenatal Doppler study

IntroductionAmong small for gestational age neonates, foetal Doppler enables the identification of placental insufficiency aetiology and the classification of severity in small for gestational age neonates. There are studies that associate the Doppler data with alterations in the intestinal flow of the newborn, but its relationship with intestinal oximetry has been little studied. ObjectiveTo assess whether there is a relationship between prenatal Doppler data and abdominal oximetry in small for gestational age neonates. Material and methodsA prospective observational study carried out on neonates >32 weeks with a birth weight <P10. The severity of placental insufficiency was classified according to prenatal Doppler criteria. Splanchnic oximetry was monitored during the first three days of life and a comparative analysis of the oximetry data was performed according to the prenatal Doppler alteration severity. ResultsA total of 53 patients were evaluated. Significant differences were observed in the mean regional oximetry (rSO2) between patients with moderate or severe placental failure and those with normal or slightly altered prenatal Doppler: 42±10 vs. 71.3±10 (P<.001). These differences were maintained during the first 3 days of life. Standard patterns of splanchnic oximetry were identified depending on the degree of placental insufficiency. ConclusionsThere is a correlation between the foetal Doppler and the splanchnic oximetry pattern during the first days of life. Neonates with moderate or severe placental insufficiency have more altered abdominal oximetry patterns, making it a useful technique to evaluate the degree of placental insufficiency and the risk of oral intolerance in small for gestational age neonates.

Diastolic Determinants of Excess Mortality in Heart Failure With Reduced Ejection Fraction

ObjectivesThe objective of this study was to determine short- and long-term excess mortality associated with diastolic echocardiographic measures (primarily E/e′ ratio) in patients with HF with reduced ejection fraction. BackgroundIn patients with heart failure (HF), Doppler echocardiography diastolic alterations are frequently but not convincingly linked to survival. Consequently, they are not included in risk-score algorithms or substantially mentioned in HF guidelines. MethodsConsecutive patients with HF Stage B to C, diagnosed between 2003 and 2011, with ejection fraction <50%, Doppler diastolic characterization, complete clinical evaluation, and estimated pulmonary pressure, were analyzed. Outcome measure was mortality under medical management. ResultsThe 12,421 eligible patients were 69 ± 14 years of age, 32% were women, 72% had Stage C HF, with ejection fraction 36 ± 10% and E/e′ ratio of 17 ± 9. During median follow-up 4.0 (1.1 to 7.0) years, 1-year and 5-year mortality were 17 ± 0.4% and 42 ± 0.5%. E/e′ ratio >20 was linked to elevated 1-year mortality (adjusted odds ratio: 1.45 [95% confidence interval (CI): 1.16 to 1.83]; p = 0.001). Long-term E/e′ ratios >20 and >14 to 20 were associated with reduced survival (adjusted hazard ratio: 1.21 [95% CI: 1.07 to 1.37]; p = 0.003, and adjusted hazard ratio: 1.15 [95% CI: 1.02 to 1.29]; p = 0.02), independent of all HF characteristics and in all patients’ subsets, including HF Stage B and Stage C. Guideline-based diastolic-grade algorithm also independently predicted mortality (p < 0.0001) but was definable less frequently (70%). ConclusionsIn reduced ejection fraction HF, diastolic Doppler alterations entail considerable mortality independent of all presentation characteristics. Elevated E/e′ ratio, associated with worse HF at diagnosis, is also, independent of presentation, linked to substantial short-term reduced survival and long-term sustained excess mortality and should be incorporated into HF risk assessment.

Prognostic value of the aortic isthmus Doppler assessment on late onset fetal growth restriction.

Background As conflicting results have been reported about the association of reversed flow on the aortic isthmus (AoI) and adverse perinatal results in fetal growth restriction (FGR), we aim to compare perinatal outcomes (including tolerance to labor induction) of late-onset FGR between those with anterograde and reversed AoI flow. Methods This was an observational retrospective cohort study on 148 singleton gestations diagnosed with late-onset FGR (diagnosis ≥32+0 weeks), with an estimated fetal weight (EFW) <10th centile and mild fetal Doppler alteration: umbilical artery (UA) pulsatility index (PI) >95th centile, middle cerebral artery (MCA)-PI <5th centile or cerebral-placental ratio <5th centile. Anterograde AoI flow was present in n=79 and reversed AoI flow in n=69. Delivery was recommended from 37 weeks in both groups. Perinatal results were compared between the groups. Results The global percentage of vaginal delivery of fetuses with anterograde and reversed blood flow was 55.7% vs. 66.7% (P=0.18) and the percentage of cesarean section (C-section) for non-reassuring fetal status was 12.7% vs. 15.9% (P=0.29), respectively. When evaluating those that underwent labor induction, the vaginal delivery rate was 67.9% vs. 77.2% (P=0.17), respectively. There were no significant differences regarding any other perinatal variables and there were no cases of severe morbidity or mortality. Conclusion We observed that the presence of reversed AoI flow does not worsen perinatal outcomes on fetuses with late-onset growth restriction with mild Doppler alterations. Attempt of labor induction is feasible in these fetuses regardless of the direction of AoI flow.

Implications of Doppler Alterations on Outcomes After Liver Transplantation. Our Experience in the Last Seven Years

Implications of Doppler Alterations on Outcomes After Liver Transplantation. Our Experience in the Last Seven Years

Fetal Biometry and Doppler Study for the Assessment of Perinatal Outcome in Stage I Late-Onset Fetal Growth Restriction

Objective: To compare perinatal outcomes on fetuses classified as stage I late-onset fetal growth restriction (FGR) depending on the estimated fetal weight (EFW) centile category and the fetal and maternal Doppler study. Material and Methods: Retrospective cohort study on 131 cases of stage I late-onset FGR (diagnosis ≥32⁺⁰ weeks), defined as: EFW < 3rd centile and normal Doppler (G1) or EFW < 10th centile and mean uterine artery pulsatility index (PI) > 95th centile (G2) or EFW < 10th centile and mild fetal Doppler alteration: umbilical artery PI > 95th centile, middle cerebral artery PI < 5th centile, or cerebroplacental ratio < 5th centile (G3). All groups were compared to their perinatal results. Results: There were 37, 30, and 64 cases in G1, G2, and G3, respectively. G1 and G2 showed lower percentages of cesarean section when compared with G3 (18.4, 22.5, and 45.3% (p < 0.01), respectively), being attributable to an excess of cesarean sections for non-reassuring fetal status. These differences remained when definitive birth weight centile was above that considered to define FGR, being 5.9, 12.5, and 41.8% (p < 0.01), respectively. Discussion: In stage I late-onset FGR fetuses, abnormal fetal Doppler is associated with a poorer tolerance to vaginal delivery, even when the birth weight is > 10th centile.

Learning and memory disabilities in IUGR babies: Functional and molecular analysis in a rat model.

1IntroductionIntrauterine growth restriction (IUGR) is the failure of the fetus to achieve its inherent growth potential, and it has frequently been associated with neurodevelopmental problems in childhood. Neurological disorders are mostly associated with IUGR babies with an abnormally high cephalization index (CI) and a brain sparing effect. However, a similar correlation has never been demonstrated in an animal model. The aim of this study was to determine the correlations between CI, functional deficits in learning and memory and alterations in synaptic proteins in a rat model of IUGR.2MethodsUtero‐placental insufficiency was induced by meso‐ovarian vessel cauterization (CMO) in pregnant rats at embryonic day 17 (E17). Learning performance in an aquatic learning test was evaluated 25 days after birth and during 10 days. Some synaptic proteins were analyzed (PSD95, Synaptophysin) by Western blot and immunohistochemistry.3ResultsPlacental insufficiency in CMO pups was associated with spatial memory deficits, which are correlated with a CI above the normal range. CMO pups presented altered levels of synaptic proteins PSD95 and synaptophysin in the hippocampus.4ConclusionsThe results of this study suggest that learning disabilities may be associated with altered development of excitatory neurotransmission and synaptic plasticity. Although interspecific differences in fetal response to placental insufficiency should be taken into account, the translation of these data to humans suggest that both IUGR babies and babies with a normal birth weight but with intrauterine Doppler alterations and abnormal CI should be closely followed to detect neurodevelopmental alterations during the postnatal period.

The usefulness of fetal Doppler evaluation in early versus late onset intrauterine growth restriction. Review of the literature.

Intrauterine growth restriction (IUGR) represents a serious condition that can lead to increased perinatal morbidity, mortality and postnatal impaired neurodevelopment. There are two distinct phenotypes of IUGR: early onset and late onset IUGR with different onset, patterns of evolution and fetal Doppler profile. In early onset preeclampsia the main Doppler modifications are at the level of umbilical artery, with progressive augmentation of the pulsatility index to absent or reverse end diastolic flow. The modifications of the cerebral, cardiac and ductus venosus circulation are generally present, but with different sequences. The late onset IUGR is determined by third trimester placental insufficiency that entails fetal hypoxia. The cerebro-placental ratio (CPR) and the pulsatility index of the middle cerebral artery (PI MCA) seems to be the main markers for both diagnosis and obstetrical management while umbilical Doppler PI is frequently normal. Also the sequence of Doppler alterations is neither specific nor complete. New protocols for the diagnosis and management of late onset IUGR need to be implemented.

Impaired uterine artery flow associated with the presence of ovarian endometrioma: preliminary results of a prospective study.

BackgroundAim of this prospective, case–control study was to evaluate uterine arteries’ blood flow before and after laparoscopic surgery in patients with ovarian endometriosis and its possible correlation with infertility.MethodsWe prospectively enrolled 110 women of reproductive age; 69 with ovarian endometriomas and scheduled for surgery, and 41 controls. At enrolment, a detailed medical, gynecologic and obstetric history was collected. Fertility and pregnancy desire were assessed. All patients underwent complete physical and gynecologic examination. Transvaginal ultrasound with Doppler color flow was performed to evaluate Resistance Index (RI) of uterine arteries during the secretory phase, at enrolment (T0) and 3 months after laparoscopic surgery (T1).ResultsAmong cases, 27 patients were excluded because they did not meet the inclusion criteria. At enrolment (T0) unilateral or bilateral flow alterations (RI ≥ 0.8) were found in 38 out of 42 patients with ovarian endometriosis (90%), whereas in the control group only 17 women (41%) had Doppler alterations. The difference in uterine artery RI values between cases and controls was statistically significant (P < 0.0001). A statistically significant improvement in uterine artery flow (P <0.0001) was found 3 months after surgical treatment of endometriosis. Nineteen patients with endometriosis (45%) were infertile before surgery; all of them presented uterine artery Doppler alterations at T0. After surgery the pregnancy rate was significantly higher in patients who presented uterine artery flow normalization than in those with persistent uterine artery flow alterations (p = 0.002).ConclusionsA strong correlation was found between uterine artery flow abnormalities and ovarian endometriosis. Uterine artery flow improvement following surgery seems to increase the probabilities of achieving pregnancy.

P08.16: Systematic thickness analysis of the adipose tissue around the fetal arm across gestation using 2D ultrasound images

year. Results: Three cases of intrauterine growth restriction (IUGR) at 35 and 29 weeks presented an aorta abdominal intima thickening and a condensation of the elastic fibers forming an evident internal elastic membrane with the presence of inflammatory elements, such as macrophages and activated endothelial cells. Two monochorionic twin pregnancies hesitated with the death of triplets at 25 weeks (IUGR and twin-to-twin transfusion syndrome); they presented an aortic hemorrhagic peri-adventitial dissociation. In both cases were present fetal Doppler abnormalities, in particular an increase of the systolic velocity of umbilical artery in presence of IUGR and an absent diastolic flow and ductus venosus alterations in twins. A Down fetus at 22 weeks showed a sub occlusive thrombosis of the abdominal aorta with delamination of the aortic wall and the presence of media-intimal foamy macrophages, without Doppler alterations in utero. Finally, a fetus with Potter’s syndrome at 23 weeks showed a partially organized thrombosis of the abdominal aorta and renal arteries with delamination of the wall and the presence of media-intimal foamy macrophages, as in IUGR ones. Conclusions: all the fetal intrauterine diseases described might be associated to a specific histological arterial findings which could represent underlying conditions predisposing of hypertension and vascular damage in adult life.

Cardiac evaluation after experimental intoxication by Amorimia rigida (Malpighiaceae) extracts in rabbits

Clinical and laboratory changes were evaluated in rabbits after intoxication by Amorimia rigida, a plant that causes sudden death. Nine New Zealand male rabbits, averaging 3.54 kg, were categorized into three groups (n = 3) and received, for eight consecutive days, the equivalent of 30 g/kg dry matter of A. rigida water-soluble (SG) and water-insoluble (IG) extracts via nasoesophageal route. The control group received water. There were no alterations in creatine kinase enzyme (CK), CK myocardial fraction (CKMB) or troponine I (cTnI). None of the animals had clinical or electrocardiographic (conventional and Holter) alterations. There were progressive decreases in the left ventricular ejection fraction and systolic fractional shortening. Doppler echocardiography alterations suggested a systolic dysfunction in the SG and IG groups and diastolic dysfunction in IG group. It was concluded that the soluble and insoluble extracts of A. rigida cause deficit of cardiac function.

P22.05: Prenatal diagnosis and treatment of placental choriangioma: different spectrum of the same pathological situation

Placental chorioangiomas are malformations of the primitive angioblastic tissue. We present four different cases with different clinical spectrum. The first case is a 27 yo, G1P0, with 26 wo single pregnancy. Ultrasound examination showed posterior placenta with echogenic mass 4 × 4.5 cm located 2 cm to cord insertion. Power Doppler revealed vascular composition, and nutritious vessel was identified. Fetus was hydropic with venous Doppler alteration. Patient underwent to Fetoscopy and laser ablation of the communicant vessel. Three weeks later no Hidrops was identified and female infant was delivery at 37 weeks of gestation. Second case, was a 25 yo, G2P1C1, 22 wo pregnancy. Anterior placenta was identified with a mass located in the superior pole. Power Doppler showed vascular pattern and cord insertion 5 mm next to the mass. Polihydramnios and fetal normal anatomy were identified. Fetal surveillance was begun and three weeks later no polihydramnios was seen. Cesarean section at 38 week was performed and a healthy newborn was obtained. Third case was a 35 yo G2P0A1, with a 32 wo pregnancy. Fetal Hidrops was diagnosed and ultrasound revealed a chorioangioma of the posterior placenta. Patient was scheduled for laser ablation, but she developed gestational hypertension and proteinuria. Maternal severe edema was identified and mirror syndrome was diagnosed. Patient underwent to emergency c section and baby died two hours later. Fourth case was a 32 yo patient with 28 wo pregnancy. Placental chorionangioma was identified but no fetal compromise was seen. At 35 weeks, fetal Doppler with central dilation was diagnosed and pulsatile umbilical vein indicated emergency c section. Male infant 2300 grams was delivered and went to neonatal intensive care unit. Pathological correlation was obtained in all cases. In spite of benign pattern of placental choriangiomas as a tumor, fetal compromise should be considered for decision making and improving prognosis.

P01.06: The value of Doppler alterations in IUGR premature babies' neonatal outcome from preeclamptic women

P01.06: The value of Doppler alterations in IUGR premature babies' neonatal outcome from preeclamptic women

Doppler de arterias uterinas y preeclampsia: Experiencia en el Hospital de San José

Los cambios en la circulación uteroplacentaria mediante la evaluación de las arterias uterinas con Doppler ha despertado el interés de investigadores, convirtiéndose en el método de elección para el tamizaje de pacientes con alto riesgo de desarrollar preeclampsia. Objetivos: describir los hallazgos del DPau en cuanto a índice de resistencia arterial (IR) e índice de pulsatilidad (IP) en el segundo trimestre de gestación y su asociación con PRE-E y/o restricción del crecimiento intrauterino en una población seleccionada del servicio de ginecología y obstetricia del Hospital de San José en Bogotá, DC. Colombia. Materiales y métodos: asistieron 109 pacientes con edad gestacional de 22 a 25 semanas entre marzo 2004 y diciembre 2007, se indagaron factores de riesgo para PRE-E y se practicó DPau. Se realizó seguimiento en las semanas 28, 32 y 36 hasta obtener información del parto. Resultados: 43 presentaron alteración del Doppler, 15 (13%) se complicaron con PRE-E y 10 (2%) con RCIU. El IR se encontró alterado con mayor frecuencia en PRE-E y el IP en RCIU. Los antecedentes de PRE-E (60%), nuliparidad (33%) e hipertensión crónica (26%) fueron los factores de riesgo observados con mayor frecuencia en pacientes con PRE-E. Conclusiones: los resultados obtenidos nos permiten observar que las alteraciones del DPau junto con los factores de riesgo de la población, podrían tener algún tipo de relación con el desenlace de PRE-E y RCIU. Se esperan futuras investigaciones que ayuden a dilucidar con claridad la asociación del DPau y los factores de riesgo con el desarrollo de eventos obstétricos adversos. Abreviaturas: PRE-E, preeclampsia; DPau Doppler de arterias uterinas; IR, índice de resistencia arterial; IP, índice de pulsatilidad; RCIU, retardo en el crecimiento intrauterino.

OP23.08: Perinatal outcome does not differ in IUGR fetuses born from normotensive women versus IUGR from preeclamptic women: a multicenter study

Objective: To assess the difference in perinatal outcome in IUGR fetuses from normotensive women versus IUGR because maternal preeclampsia Methods: A multicenter observational study on IUGR fetuses delivered <32 weeks for fetal indications and without a significative difference in gestational age and weight at birth IUGR because isolated placental insufficiency and maternal preeclampsia. Perinatal outcome, pH and base excess at birth were compared. Neonatal outcome was correlated to Doppler velocimetry alteration of the fetus, divided into early (umbilical artery and middle cerebral artery alterations) and late Doppler alterations (reversed flow in the umbilical artery and ductus venosus abnormality). Results: The study group consisted of 150 IUGR fetuses because of isolated placental insufficiency and 98 because maternal preeclampsia. Mean gestational age at delivery was 29.4 ± 1.7 weeks and mean birth weight 895.7 ± 224.6 gr. in the first group; 29.4 ± 1.7 weeks and 929.6 ± 182.7 gr. in the second group. There were no significative difference in morbidity and mortality rate among the groups. Considering separately, all the variables but preeclampsia appeared significant in determining neonatal morbidity and mortality. Late Doppler alterations and gestational age were the most relevant variables determining neonatal morbidity (p = 0.005) and mortality (p = 0.003) considering fetus before birth. Considering the newborn the most important variable determining neonatal morbidity was birth weight (p = 0.001) and for neonatal mortality were late Doppler alterations (p = 0.038), neonatal weight (p = 0.002), low pH (p = 0.001) and BE (p = 0.005) Conclusions: The present study highlights that IUGR fetuses because of isolated placental insufficiency or maternal preeclampsia did not differ in perinatal outcome addressing that late Doppler alterations and weight at birth are predictors for adverse outcome.

Left ventricular non-compaction cardiomyopathy in children: Is segmental fibrosis the cause of tissue Doppler alterations and of EF reduction?

Noncompaction of the ventricular myocardium (LVNC) is a rare congenital cardiomyopathy resulting from an arrest in normal endomyocardial embryogenesis. In 2002 Jenni et al. [Jenni R, Wyss CA, Oechslin EN, Kaufmann PA. Isolated ventricular noncompaction is associated with coronary microcirculatory dysfunction. J Am Coll Cardiol 2002; 39:450-454.] reported a microvascular dysfunction in 12 patients affected by non compaction: areas of restricted myocardial perfusion have been documented by scintigraphy, suggesting a reduction of Coronary flow reserve. McMahon et al reported in a recent article a reduction of TD velocities in children with noncompaction of the left ventricle, compared with normal controls. The authors concluded their work saying that the reduction of lateral mitral Ea velocity helps to predict children with LVNC who are at risk of adverse clinical outcomes including death and need for cardiac transplantation. In a precedent report our group reported a strong correlation between pathological tissue Doppler and reduction of ejection fraction. Recently we scanned with a Signa HD 1.5 T (GE, Milwaukee, USA) 8 patients affected by non compaction. Transmural Gd-enhancement was detected in 5/8 patients (62%). In all patients with late enhancement a reduction of EF has demonstrated. In our opinion the late enhancement can depend on a CFR, and is the determinant of the tissue Doppler alterations. So the TD alteration is associated with EF, and is an indirect index of poor clinical outcome, like EF.