Doppler Pulsatility Index Research Articles

106: Doppler of one or both umbilical arteries in fetal growth restriction and clinical decision making

Umbilical artery (UA) Doppler is integral in the management of fetal growth restriction (FGR). Doppler sampling technique recommendations sampling the UA in a free loop of cord (Archaya 2005). Yet, when both UAs are sampled, Doppler index discrepancies >20% may occur between the two UA in up to 1/3 of normal pregnancies (Predanic 1998). This has led to variation in sampling methodology across institutions which may influence clinical management. Objectives: 1) to determine the frequency of discrepant Doppler pulsatility indices (PI) between paired UAs, and 2) to establish how varying UA analysis approaches affect the diagnosis of abnormal UA PI. In this prospective cohort of 121 fetuses with an EFW < 10th%ile, the final ultrasound prior to delivery was used to obtain UA PI from both UAs in a mid-segment of cord. We first determined the percent discrepancy between the two UA PI. Using an ANOVA, we compared differences between commonly used UA PI analysis methods: 1) mean UA PI calculated as the average PI from both UA vessels, 2) UA PI obtained from one UA chosen at random (by random number generator), and 3) UA PI using the highest of the two UA PIs. We then determined whether UA PI evaluation method altered the detection rate of abnormal PI within our cohort. Fig. 1 depicts the percent discrepancies in UA PIs between patients. The ANOVA revealed that all three analysis methods yielded significantly different absolute UA PI values (Table 1). When the PIs from each approach were converted to PI %ile, the difference in the number of patients diagnosed with abnormal UA PI (>95th %ile) trended towards significance (Table 1). While different UA Doppler analysis approaches result in significantly different absolute UA PI values, they do not impact the percentage of patients diagnosed with clinically abnormal UA PI %ile. Though this cohort was under-powered to evaluate for such a difference, we speculate that in a larger cohort of FGR fetuses, using the higher of two UA PIs may increase detection of abnormal UA PI %ile and affect clinical management.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Ultrasound angiology reference standards of fetal cerebroplacental flow in normal Egyptian gestation: statistical analysis of one thousand observations

BackgroundDoppler velocity assessment is the most frequently used method in clinical practice to identify fetal well-being, as it is considered as a non-invasive estimation of the fetus and feto-placental circulation. The aim of the current study is to establish longitudinal reference ranges for MCA and UA Doppler velocities, systolic-to-diastolic (S/D) ratio, resistive index (RI) and PI, and cerebroplacental ratio. The current study was a multicentric longitudinal study of 428 singleton pregnancies and 1284 observations. Doppler ultrasound, middle cerebral artery (MCA) and umbilical artery (UA) peaked velocities, and pulsatility index (PI) were evaluated three times throughout a single session over gestational age range of 13–40 weeks.ResultsBased on 1284 observations, new longitudinal reference ranges for fetal middle cerebral peak systolic velocity (PSV), PI, RI, and S/D; reference ranges for umbilical artery PSV, PI, RI, and S/D; and reference ranges for cerebroplacental ratio PSV, PI, RI, and S/D were established. MCA PI, RI, PSV, and S/D curves are of parabolic pattern, and UA PI, RI, and S/D curves are decreased by age while UA PSV curve is of parabolic pattern; furthermore, cerebroplacental ratio (CPR) PI, RI, and S/D curves increased by age while CPR PSV curve decreased then increased by age. The reference ranges were at nearly variant from earlier studies and close to other studies.ConclusionsIn the Doppler data combining both umbilical and cerebral velocimetry, MCA/UA ratio incorporates information not only on placental station but also on fetal response; it is possibly more beneficial in anticipating perinatal outcome.

Establishing a Differential Marker Profile for Pregnancy Complications Near Delivery

Objective: The aim of this work was to define a differential marker profile for pregnancy complications near delivery. Methods: We enrolled pregnant women who were referred to the outpatient pregnancy clinic of the University Medical Center, Ljubljana, Slovenia, due to symptoms of pregnancy complications and women with a history of pregnancy complications attending the high-risk hospital clinic for close surveillance. They were evaluated for prior risk and were tested for biophysical and biochemical markers at the time of enrolment. Biochemical markers included the pro- and anti-angiogenic markers, along with additional previously reported markers of potential value, all tested by various formats of immuno-diagnostics. Biophysical markers included blood pressure, sonographic markers, and EndoPAT. Statistical differences were determined with Kruskal-Wallis and Mann-Whitney tests for continuous parameters, and Pearson χ² for categorical values. p < 0.05 was considered significant. Results: The cohort included 125 pregnant patients, 31 developed preeclampsia (PE) alone (13 were <34 weeks’ gestation), 16 had intrauterine growth restriction (IUGR) alone (12 were <34 weeks), 42 had both IUGR and PE (22 were <34 weeks), and 15 had an iatrogenic preterm delivery (PTD; 6 were <34 weeks). Twenty-one were unaffected and delivered a healthy baby at term. Mean arterial blood pressure and proteinuria were significantly higher in PE and PE+IUGR but not in pure IUGR or PTD. In PE, IUGR, and PE+IUGR, the levels of soluble fms-like tyrosine kinase 1 (sFlt-1) and soluble endoglin (sEng) were significantly higher, while placental growth factor (PlGF) was very low compared to unaffected controls and PTD. PE, IUGR, and PE+IUGR also had a high anti-angiogenic ratio (sFlt-1/PlGF) and a low proangiogenic ratio of PlGF/(sFlt-1+Eng). Levels of inhibin A were significantly higher in pure PE across subgroups but had many extreme values, which made it a poor differentiator. Higher uterine artery Doppler pulsatility indexes were detected in PE, IUGR, and PE+IUGR, with similar resistance indexes and peaks of systolic velocity. A significantly different marker level between PE and IUGR was found using arterial stiffness that was 10 times higher in PE; concurrently with an increase of the reactive hyperemia index, both were accompanied by a slight increase in placental protein 13. Higher tumor necrosis factor alpha (TNFα) differentially identified iatrogenic very early PTD (<34 weeks). Conclusion: Arterial stiffness can serve as a major marker to differentiate PE (with/without IUGR) from pure IUGR near delivery. TNFα can differentiate iatrogenic early PTD from other complications of pregnancy and term IUGR.

Diagnosis of elevated intracranial pressure in critically ill adults: systematic review and meta-analysis

ObjectivesTo summarise and compare the accuracy of physical examination, computed tomography (CT), sonography of the optic nerve sheath diameter (ONSD), and transcranial Doppler pulsatility index (TCD-PI) for the diagnosis of...

Is The Combination of Glasgow Coma Scale and Transcranial Doppler Pulsatility Index Improving The Prediction of Outcome in Traumatic Brain Injury Patients?

Background: Glasgow coma scale (GCS) is a familiar scoring system with a standard statistical association with neurological outcome, it has many limitations that minimize its ability in prediction of Traumatic brain injury (TBI) patients' outcome. Transcranial Doppler (TCD) is a noninvasive aid in this field that can improve outcome prediction. Objective: This study aims to explore the effect of combination of GCS and Pulsatility Index (PI) in the prediction of outcome of TBI patients. Patients and Method: This study was performed in Zagazig University Hospital (ZUH). 103 traumatic brain injured patients were engaged in the investigations with hospital days of 1, 2, 3, and 7 or until patient discharge. The study was performed by TCD along with GCS recordings. Prognosis was also assessed by the Glasgow outcome scale (GOS). Results: The sensitivity and negative predictive value of PI was more than GCS in TBI patients (GCS 3-15), as they were (67.5% versus 50%) and (81.1% versus 74.3%), respectively. The combination of both PI and GCS increased the sensitivity and the negative predictive value up to 70% and 83.3%, respectively. PI had higher sensitivity, positive and negative predictive values than GCS in the identification of secondary neurologic deterioration (SND) in mild and moderate TBI patients (73.3% versus 40.0%, 61.1% versus 50.0%, and 92.0% versus 83.9%, respectively), while the combined value of both PI and GCS increased both sensitivity and positive predictive value up to 76.7% and 66.7%, respectively. Conclusion: The combination of GCS and PI would improve the prediction of outcome.

Perinatal outcomes after intrauterine growth restriction and umbilical artery Doppler pulsatility index of less than the fifth percentile

Objective: To analyze perinatal morbidity and stillbirth after intrauterine growth restriction (IUGR) with an umbilical artery Doppler pulsatility index (UA PI) less than the fifth centile.Study design: This retrospective cohort study included nonanomalous singleton, IUGR pregnancies receiving UA PI testing at a tertiary-care prenatal diagnostic center. Women with persistently elevated UA PI, absent or reversed end-diastolic flow on UA PI, or who had only one UA PI result were excluded. Low UA PI was defined as having ≥1 UA PI <5%. Women with low UA PI were matched by gestational age at IUGR diagnosis in a random 1 case: 4 control computer-generated algorithm to those with normal UA PI (≤95% and ≥5%). The primary outcome was composite neonatal morbidity and mortality (stillbirth, mechanical ventilation, sepsis, intraventricular hemorrhage, and necrotizing enterocolitis). Secondary outcomes included 5-minute Apgar, umbilical artery pH, delivery type, and interval from IUGR diagnosis to delivery. We compared outcomes after low UA PI to those after normal UA PI with multivariable logistic regression, adjusting for gestational age at delivery, betamethasone use, infant gender, and maternal factors.Results: Of the 1893 IUGR pregnancies, 25 (1.3%) had low UA PI <5% and were randomly matched via computer algorithm to 100 controls. There were no stillbirths in either group; the odds of composite neonatal morbidity was similar among IUGR pregnancies with UA PI <5% versus normal (adjusted odds ratio 0.89 (95% confidence interval 0.27–2.75)). There was no difference in 5-minute Apgars, umbilical artery pH, rate of cesarean delivery for fetal distress, or interval from IUGR diagnosis to delivery between the two groups.Conclusion: Among IUGR pregnancies, UA PI <5% is uncommon and not associated with improved neonatal outcomes compared to normal UA PI. These findings suggest low UA PI can continue to be managed as normal UA PI.

Essential variables for reporting research studies on fetal growth restriction: a Delphi consensus.

To determine, by expert consensus using a Delphi procedure, a minimum reporting set of study variables for fetal growth restriction (FGR) research studies. A panel of experts, identified based on their publication record as lead or senior author of studies on FGR, was asked to select a set of essential reporting study parameters from a literature-based list of variables, utilizing the Delphi consensus methodology. Responses were collected in four consecutive rounds by online questionnaires presented to the panelists through a unique token-secured link for each round. The experts were asked to rate the importance of each parameter on a five-point Likert scale. Variables were selected in the three first rounds based on a 70% threshold for agreement on the Likert-scale scoring. In the final round, retained parameters were categorized as essential (to be reported in all FGR studies) or recommended (important but not mandatory). Of the 100 invited experts, 87 agreed to participate and of these 62 (71%) completed all four rounds. Agreement was reached for 16 essential and 30 recommended parameters including maternal characteristics, prenatal investigations, prenatal management and pregnancy/neonatal outcomes. Essential parameters included hypertensive complication in the current pregnancy, smoking, parity, maternal age, fetal abdominal circumference, estimated fetal weight, umbilical artery Doppler (pulsatility index and end-diastolic flow), fetal middle cerebral artery Doppler, indications for intervention, pregnancy outcome (live birth, stillbirth or neonatal death), gestational age at delivery, birth weight, birth-weight centile, mode of delivery and 5-min Apgar score. We present a list of essential and recommended parameters that characterize FGR independent of study hypotheses. Uniform reporting of these variables in prospective clinical research is expected to improve data quality, study consistency and ultimately our understanding of FGR. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

The Role of Uterine Artery Doppler Ultrasound in the Second Trimester in Predicting Preeclampsia

Background Preeclampsia is a specific pregnancy syndrome. Early diagnosis and proper administration of preeclampsia can lead to improved maternal and neonatal outcome. We aimed to investigate the uterine artery Doppler ultrasound in predicting the preeclampsia in women with a high-risk pregnancy. Materials and Methods This analytic study was conducted on 160 primigravida women with gestational age of 18 to 26 weeks referring to Ali-IEbne Abi Taleb hospital of Zahedan (Iran). The uterine artery Doppler was considered as abnormal if mean Pulsatility Index (PI) was higher as 95% for gestational age or bilateral notching was observed. All uterine artery sonography was performed by one expert sonographer and with one machine. Then the pregnancy outcomes (such as placenta abruption, postpartum hemorrhage, death, Neonatal Intensive Care Unit admission, low birth weight, preterm labor, etc.) were compared between the two groups. Results The mean age of pregnant women was 25.4±5.6 years old. Preeclampsia was seen in 37 (24.7%) of the women and healthy was seen in 113 (75.3%) of the women. A statistically significant difference was seen between the women with normal and abnormal Doppler sonography (P=0.001). The sensitivity of Doppler ultrasonography in predicting early onset, late onset and severe preeclampsia was 73.3 %, 62.5 %, and 100%, respectively. The specificity of Doppler ultrasonography in predicting early onset, late-onset, and severe preeclampsia was 64.4%, 66.1%, and 74.3%, respectively. Conclusion The findings of the study showed that uterine artery Doppler (Pulsatility Index) is useful in predicting the occurrence of preeclampsia in second trimester.

Placental ESRRG-CYP19A1 Expressions and Circulating 17-Beta Estradiol in IUGR Pregnancies.

Introduction: Sex steroids are regulating factors for intrauterine growth. 17-β Estradiol (E2) is particularly critical to a physiological pregnancy, as increased maternal E2 was correlated to lower fetal weight at delivery. The placenta itself is a primary source of estrogens, synthetized from cholesterol precursors. Cytochrome P450 aromatase (encoded by CYP19A1 gene) is a rate-limiting enzyme for E2 biosynthesis. CYP19A1 transcription is supported by Estrogen Related-Receptor Gamma (ERRγ- ESRRG gene), which thus has an indirect role in placental steroidogenesis. Here we investigated maternal E2 levels and placental CYP19A1 and ESRRG expressions in pregnancies with IntraUterine Growth Restriction (IUGR).Methods: Singleton pregnancies were studied. E2 was measured in maternal plasma by electrochemiluminescence in 16 term controls and 11 IUGR (classified by umbilical artery doppler pulsatility index) at elective cesarean section, and also in 13 controls during pregnancy at a gestational age comparable to IUGR. CYP19A1 and ESRRG expressions were analyzed in placental tissue. Maternal/fetal characteristics, placental and molecular data were compared among study groups and tested for correlations.Results: Maternal E2 plasma concentrations were significantly decreased in IUGR compared to controls at delivery. When analyzing normal pregnancies at a gestational age similar to IUGR, E2 levels were not different to pathological cases. However, E2 levels at delivery positively correlated with placental efficiency. Placental CYP19A1 levels were significantly higher in IUGR placental tissue vs. controls, and specifically increased in female IUGR placentas. ESRRG expression was not different among groups.Discussion: We report a positive correlation between 17-β Estradiol levels and placental efficiency, that might indicate a disrupted steroidogenesis in IUGR pregnancies. Moreover, we show alterations of CYP19A1 expression in IUGR placentas, possibly indicating a compensatory effect to the adverse IUGR intrauterine environment, also depending on fetal sex. Further studies are needed to deeper investigate IUGR alterations in the complex interaction among molecules involved in placental steroidogenesis.

“ROLE OF UTERINE ARTERY DOPPLER AND LATE FIRST TRIMESTER MATERNAL SERUM PREGNANCY_ASSOCIATED PLASMA PROTEIN A IN PREDICTION OF PREECLAMPSIA”

background: PE with a high prevalence in the first pregnancy is associated with the highest maternal and foetal morbidity and mortality, The possibility of prediction of preeclampsia (PE) at 11-14 weeks of pregnancy is a fairly new concept in recent years,the objective of this study to assess role of uterine artery Doppler and late first trimester maternal serum pregnancy associated plasma protein A in early prediction of preeclampsia. Material &Methods: prospective observational clinical study was done at the Department of Obstetrics & Gynecology , Benha university,with200 pregnant women attending OPD at 11-14 weeks of gestation,approved by IRP,blood pressure was recorded, uterine aretery Doppler was done, blood sample for PAPP-A was drawn, uterine artery Doppler pulsatility index (pI) at 11-14 weeks of pregnancy was found to be agood screening method for prediction of preeclampsia. The data was analyzed using STATA/SE version 11.2 statistical analysis software. Results: uterine artery Doppler pulsatility index (pI) at 11-14 weeks of pregnancy was found to be agood screening method (sensitivity 87%, specificity 96%) for prediction of preeclampsia.Conclusion:This study concluded that uterine artery Doppler was good screening method at 11-14 weeks of gestation for prediction of development of pre-eclampsia & mean pulsatility index was more valid than PAPP-A in prediction of pre-eclampsia.Key words: preeclampsia ,PAPP-A, uterine artery Doppler.Abbreviations: preeclampsia (PE),pregnancy associated plasma protein –A ( PAPP-A), pulsatility index (pi) , outpatient department (OPD).

Is the Combination of Glasgow Coma Scale and Transcranial Doppler Pulsatility Index Improve the Prediction of Outcome in Traumatic brain injury Patients?

Is the Combination of Glasgow Coma Scale and Transcranial Doppler Pulsatility Index Improve the Prediction of Outcome in Traumatic brain injury Patients?

Maternal and fetal Leptin and interleukin 33 concentrations in pregnancy complicated by obesity and preeclampsia

Objectives: To evaluate maternal and fetal Leptin and IL33 concentrations in pregnancy complicated by obesity and preeclampsia.Study design: A case-control study including 35 subjects with obesity (18 normotensive and 17 preeclamptic) and 47 normal weight controls (42 normotensive and 5 preeclamptic).Main outcome measures: Leptin and IL33 concentrations in maternal serum during pregnancy and in cord blood; uterine artery and umbilical artery Doppler velocimetry.Results: Subjects with obesity who developed preeclampsia had higher first trimester maternal (41.5, interquartile range (IQR) = 15.7–65.1 ng/ml) Leptin concentrations compared to either normal weight with (25, IQR = 20.4–25.8 ng/ml) and without hypertension (14.26, IQR = 8.2–22.8) (p < .05) or normotensive subjects with obesity (30.3, IQR = 10.4–38.4) (p < .05). Subjects with obesity who developed preeclampsia (2.4, IQR = 1.7–3.2 pg/ml) or not (1.4, IQR = 0.8–2 pg/ml) had lower first trimester maternal IL33 levels when compared to controls without hypertension (4.8, IQR = 2.9–5.9 pg/ml) (p < .001). Cord blood Leptin and IL33 concentrations were significantly correlated to third trimester maternal concentrations (Spearman rho = 0.51, p < .001 and Spearman rho = 0.68, p < .001, respectively). Uterine artery pulsatility index (PI) were significantly and directly correlated with maternal Leptin levels (p < .002) and inversely and statistically correlated with maternal IL33 concentrations (p < .001).Conclusions: Compared to lean controls, pregnant subjects with obesity had higher serum Leptin and lower IL33 concentrations at first trimester and during pregnancy. This difference persisted also for those who later developed preeclampsia. The relationship between maternal serum levels of Leptin and IL33 with uterine artery Doppler pulsatility index strongly suggests a role of these two markers in early placentation.

Accuracy of Second Trimester Prediction of Preterm Preeclampsia by 3 Different Screening Algorithms

(Aust N Z J Obstet Gynaecol. 2018;58:192–196) Preeclampsia (PE) is a major risk factor for maternal and perinatal morbidity and mortality. Thus, early screening in the first trimester to identify patients at high risk for PE allows the initiation of early preventive measures, such as low-dose aspirin therapy begun before 16 weeks gestation. Many women, though, do not have their first prenatal visit until after 16 weeks, and identifying high-risk patients in the second trimester can still be beneficial, especially for identifying early signs of PE and providing timely treatment. Currently, the National Institute for Health and Clinical Excellence (NICE) in the United Kingdom has guidelines for identifying at risk women using maternal demographics and medical history. Likewise in the United States, the American College of Obstetricians and Gynecologists (ACOG) have recommendations for screening that uses demographics and medical history to define those women considered at high risk for PE. In contrast, the Fetal Medicine Foundation (FMF) has published an algorithm for identifying women at risk for early PE that includes measurement of mean arterial pressure and uterine artery Doppler pulsatility index in addition to medical history. This prospective nonintervention study aimed to compare the efficacy of these three screening methods used during the second trimester to predict the occurrence of PE.

Reference charts for umbilical Doppler pulsatility index in fetuses with isolated two-vessel cord.

To determine reference values for umbilical Doppler pulsatility index in fetuses with isolated two-vessel cord and to compare these values with standard umbilical Doppler pulsatility index curves from 23 to 40 gestational weeks. A retrospective longitudinal cohort study was conducted between January 2014 and December 2017 in a tertiary referral hospital and included 62 pregnant women with isolated single umbilical artery (two-vessel cord) and 174 measurements. Only uncomplicated term pregnancies were included. A reference curve for umbilical Doppler pulsatility index was built up and compared with a standard curve commonly used for fetuses with three-vessel cord. Umbilical Doppler pulsatility index values were much lower than expected in cases with two-vessel cord compared to 3-vessel cord: mean of the regression equations was 1.02 ± 0.23 vs. 0.86 ± 0.19, respectively (p value < 0.001). This difference was quite constant across the gestational weeks considered, showing that the slopes of the two regressions were very similar. Reference curves for umbilical Doppler pulsatility index in two-vessel cord pregnancies were determined. Pulsatility index values were significantly different compared with those commonly used for three-vessel cord. Using lower reference values for umbilical pulsatility index in cases with two-vessel cord may allow a better identification of fetuses affected with intrauterine growth restriction, thus improving fetal surveillance.

Middle cerebral artery Doppler pulsatility index as a predictor of intrapartum meconium release in prolonged pregnancies.

The aim of this study was to asses the correlation of middle cerebral artery pulsatility index (MCA-PI) and perinatal outcomes in prolonged pregnancies. This was a prospective study of all consecutive pregnant women beyond 41 weeks' gestation attending for obstetric surveillance during a two years period. We evaluated the predictive value of MCA-PI lower than the 5th percentile (<p5) and the occurrence of: cesarean delivery for fetal distress, 5-min Apgar score <7, arterial cord pH < 7.15, presence of thick meconium at delivery, need for admission to the neonatal intensive care and/or neonatal death. Three hundred and one pregnancies met the inclusion criteria and were managed expectantly. Of them, 31 (10.3%) fetuses had an MCA-PI < p5, which showed a significant relationship with the presence of thick meconium at birth (p < 0.001), but was not related to any of the other perinatal outcomes. In prolonged pregnancies, the finding of MCA-PI < p5 is related to meconium emission at the time of delivery, but is not associated with an increased risk of adverse perinatal outcome.

The Impact of Aspirin on Ultrasound Markers of Uteroplacental Flow in Low-Risk Pregnancy: Secondary Analysis of a Multicenter RCT.

This article evaluates the effect of low-dose aspirin on uterine artery (UtA) Doppler, placental volume, and vascularization flow indices in low-risk pregnancy. In this secondary analysis of the TEST randomized controlled trial, low-risk nulliparous women were originally randomized at 11 weeks to: (1) routine aspirin 75 mg; (2) no aspirin; and (3) aspirin based upon the preeclampsia Fetal Medicine Foundation screening test. UtA Doppler, three-dimensional (3D) placental volume, and vascularization flow indices were assessed prior to and 6 weeks postaspirin commencement. A total of 546 women were included (aspirin n = 192, no aspirin n = 354). Between first and second trimesters, aspirin use was not associated with a change in UtA Doppler, placental volume, or vascular flow indices. There was no significant difference in the change in UtA Doppler pulsatility index (PI) Z-scores or notching (PI Z-score -0.2 vs. -0.2, p = 0.17), nor was there a significant change in placental volume Z-score and vascular flow indices (volume Z-score change: 0.74 vs. 0.62, p = 0.34). Low-dose aspirin commenced at 11 weeks in low-risk women does not appear to improve uterine and placental perfusion or placental volume. Any perceived effect on uteroplacental vasculature is not reflected in changes in placental volume nor uteroplacental flow as assessed by two-dimensional and 3D ultrasound.

Peri-follicular blood flow in the follicle from which ovulation occurs in cows

The hypothesis of the study was that the vascularity of ovulatory follicles (OF) determines the ovulatory status. The peri-follicular blood flow characteristics of OF were sequentially recorded using Color Doppler Imaging ultrasonography from the onset of induced estrus (Day 0) to ovulation at 12 h intervals. The OFs were categorized into two groups based on the timing of ovulation (i) Normal ovulation (OFN) - When ovulation occurred within 36 h after the onset of estrus (n = 18) and (ii) Delayed ovulation (OFD) - When ovulation occurred after 36 h (n = 15). The blood flow velocity, Doppler pulse duration (DPD) and Pulsatility index (PI) of the OF were recorded during each examination. The OF was well vascularized with a detectable blood flow signals, while the subordinate or atretic follicles were devoid of detectable blood flow. On Day 0, the DPD (874.33 ± 56.99 ms) and PI (0.62 ± 0.01) values were less in the OFN when compared to OFD (1140.56 ± 27.54 ms and 1.28 ± 0.15 respectively) group. In the OFD group, ovulation occurred between 36 and 60 h after onset of estrus when the DPD value reduced to 878.17 ms. Based on ROC analysis, it was evident that the DPD value of < 929 ms is a necessary factor for induction of ovulation. The decreased DPD and PI values of the OF on the day of estrus are positive indicators of a normal ovulation process.

First trimester screening for preterm and term pre-eclampsia by maternal characteristics and biophysical markers in a low-risk population.

To develop a combined predictive model for preterm and term pre-eclampsia (PE) during the first trimester of pregnancy. This investigation was a nested case-control study in singleton pregnancies at the Maternal-Fetal Medicine Unit, University of Chile Hospital. A priori risks for preterm and term PE were calculated by multivariate logistic regression analyses. Biophysical markers were log10 -transformed and expressed as multiples of the median. A multivariate logistic regression analysis was used to estimate a combined predictive model of preterm and term PE. Detection rates at different cut-off points were determined by a receiver operator curve analysis of a posteriori risks. First trimester mean arterial pressure and uterine artery Doppler pulsatility index were significantly higher in women who develop PE than in the unaffected group. The detection rate of preterm PE based on maternal characteristics and biophysical markers was 72% at a 10% false-positive rate, corresponding to a cut-off risk of 1 in 50. The detection rate for term PE was 30% at a 10% false-positive rate. Preterm PE can be predicted by a combination of maternal characteristics and biophysical markers. However, first trimester screening is less valuable for term PE.

The impact of fetal umbilical artery Doppler pulsatility index on childhood respiratory function and atopy: a prospective case-control study

Objective: To determine if an elevated fetal umbilical artery Doppler pulsatility index is associated with abnormal respiratory function and atopy in children aged 12 years.Methods: This prospective case-control study compared children that had an elevated fetal umbilical artery Doppler pulsatility index (>90th centile) to those with a normal pulsatility index (<90th centile). All subjects were delivered at full-term and with appropriate growth for gestational age. Outcome measures included; (i) presence of asthma and/or atopy; (ii) spirometry measurements and (iii) serum C-reactive protein and leptin. Multiple regression was used to account for parental smoking, childhood age, gender and socioeconomic status.Results: 174 children with an average age of 12.1 (±0.6 SD), 48% of who were male were included in the analysis. Of the 174, 99 (57%) were in the normal umbilical artery Doppler pulsatility index group and 75 (43%) elevated umbilical artery Doppler pulsatility index groups. The overall proportion of subjects with asthma was 28% (48/174) and atopy 56% (98/174). No association was found between elevated fetal umbilical artery Doppler pulsatility index and asthma (p = .47) or atopy (p = .75) at age 12 years. Similarly there was no association between FEV1(%) (p = .96), forced vital capacity (FVC)(%) (p = .98), elevated serum C-reactive protein (p = .69) or leptin (p = .20) and an elevated fetal umbilical artery Doppler pulsatility index.Conclusions: An elevated umbilical artery Doppler at 28-weeks gestation in the absence of prematurity or fetal growth restriction is not associated with altered respiratory function or the presence of atopy in children aged 12 years. These findings support the theory that such disease has a multifactorial pathophysiology.

Ultrasound Measures of Brain Pulsatility Correlate with Subcortical Brain Volumes in Healthy Young Adults

Increasing evidence suggests that brain pulsatility is involved in the pathophysiology of various neurological and psychiatric disorders. However, it remains unclear whether high brain pulsatility is damaging to or protective of the brain in normal conditions, and this could depend on the age of the individual and the methods used to measure brain pulsatility. The goal of our study was to investigate associations between subcortical volumes and brain pulsatility as assessed with ultrasound in healthy young adults using both a conventional method (transcranial Doppler pulsatility index [TCD-PI]) and the innovative method of tissue pulsatility imaging (TPI), which allows a high level of detection of small brain movements (micrometers). Twenty-five females aged 18–55 with no history of significant medical disorder underwent magnetic resonance imaging and ultrasound assessment. The volumes of six subcortical regions known to be particularly sensitive to change in cerebral blood flow were measured and compared with brain pulsatility as assessed with TCD-PI and TPI. TCD-PI and TPI measures positively correlated with all subcortical regions, with the caudate nucleus having the strongest association. Linear regressions found that TCD-PI and TPI measures of brain pulsatility explained 16% to 67% of the variance of the subcortical volumes. Our results suggest that a greater pulsatility as assessed with ultrasound in healthy young adults may constitute a protective factor for brain structure. Ultrasound measures of brain pulsatility may be appropriate to provide costless, non-invasive, portable and highly sensitive markers of cerebral blood flow pulsatility related to brain structure.