Fetal Umbilical Artery Research Articles

Comparison of foetal growth in singleton and twin pregnancies byB-mode and Doppler ultrasonography in Karya ewes

Foetal growth and haemodynamic features were investigated in singleton and twin pregnancies in Karya ewes with B-mode/Doppler ultrasonography. Nineteen healthy singleton (n = 9) and twin (n = 10) pregnant Karya ewes were used. Foetal biometric and haemodynamic measurements were made at 15-day intervals on the 29 foetuses during pregnancy. Biparietal head diameter (BPD), thoracic diameter (TD), umbilical cord diameter (UCD), foetal heart rate (FHR), peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI), and resistance index (RI) were recorded. The BPD was higher in twins on days 55 and 130 of pregnancy (P < 0.05), and the TD was higher in singletons on day 115 of pregnancy (P < 0.01). UCD was higher in twins on day 55 of pregnancy (P < 0.01). On day 130 of pregnancy, PSV and EDV were higher in twin foetuses (P < 0.05). PI and RI were lower in twins on day 40 of pregnancy (P < 0.05). Foetal growth and umbilical artery blood flow show some differences depending on the numbers of foetuses and the gestational stage. Additionally, BPD, TD, and FHR were reliable for estimation of gestational age during twin pregnancies.

Smoking Out Fetal Growth Restriction

Researchers have uncovered a mechanism behind one of the most damaging effects of maternal smoking—fetal growth restriction [1]. It seems that smoking boosts expression of a signaling molecule—secreted frizzled-related protein 1 (sFRP1)—that suppresses placental growth and development. The findings may help explain why infants of mothers who smoke weigh, on average, 200–400 g less than the infants of nonsmokers. Alice Wang et al. first found that sFRP1 mRNA levels were highly elevated in the placentas from smoking mothers who gave birth to babies with severe growth restriction. An extracellular antagonist of WNT signaling, sFRP1 is known to be involved in placental development. The researchers next overexpressed sFRP1 in pregnant mice, and observed defects in the placenta and decreased proliferation of labyrinthine trophoblasts. Exposing a trophoblast cell line to a carbon monoxide analog reduced WNT signaling, increasing sFRP1 mRNA expression and decreasing cellular proliferation. The researchers also exposed pregnant mice to the carbon monoxide analog, and found that these mice gave birth to underweight pups—though the effects on WNT and sFRP1 signaling remain to be explored. Other studies have hinted at other mechanisms behind fetal growth restriction in smoking mothers. Carbon monoxide has a great affinity for hemoglobin and can cause fetal hypoxia, and uterine and umbilical arteries constrict in response to tobacco smoke. Perhaps some of these factors may also affect sFRP1 expression. Smoking during pregnancy is a growing public health threat, and can also cause lung problems, cognitive effects, and other health issues in children. While smoking rates in the United States are on the decline, tobacco companies are tapping into the vast potential market in undeveloped countries—some of which, like Indonesia, currently have high rates of smoking in males but very low rates in females. The United States has yet to ratify the World Health Organization Framework Convention on Tobacco Control, which provides some counterweight to the growing number of lawsuits by tobacco companies claiming that country-wide efforts at tobacco control violate trade laws (http://www.nytimes.com/ 2013/12/13/health/tobacco-industry-tactics-limit-poorernations-smoking-laws.html).

Doppler changes as the earliest parameter in fetal surveillance to detect fetal compromise in intrauterine growth-restricted fetuses.

It is estimated that 3-10% of infants are growth restricted. Growth disturbances may have long-term issues. Doppler allows insight into the fetal response to intrauterine stress. The aim of this study was to detect fetal compromise in intrauterine growth-restricted (IUGR) fetuses by means of biophysical profile (BPP) vis-à-vis Doppler velocimetry studies of the fetal umbilical artery, and to find out which of the two is a better and earlier predictor of fetal compromise. A prospective study was conducted on a total of 50 singleton pregnancies with IUGR between 28 and 42 weeks of gestation. Study patients were managed expectantly with nonstress testing and amniotic fluid assessment, BPP and Doppler velocimetry studies of the fetal umbilical artery. Fetal outcome was poor in 5/50 (10%) of the fetuses, defined as presence of all of the following: poor Apgar test score, neonatal intensive care unit stay, necrotizing enterocolitis, and low birth weight. Of the four with abnormal BPP, 50% had poor fetal outcomes. Out of 46 with normal BPP, 6.5% had poor fetal outcomes. Inference drawn from the study is that the Doppler technology provides us the opportunity for repetitive noninvasive hemodynamic monitoring in IUGR pregnancies.

Does fetal macrosomia affect umbilical artery Doppler velocity waveforms in pregnancies complicated by gestational diabetes?

Objectives: We aimed to establish whether macrosomic fetuses in pregnancies complicated by gestational diabetes (GDM) show different Pulsatility Index (PI) values in umbilical artery (UA) than in non-macrosomic fetuses.Methods: We considered 106 pregnant women with GDM. Doppler recordings of UA-PI were performed at 34–41 weeks and related to neonatal birthweight. Pregnancies were divided in two groups according to birthweight, macrosomic group (>4000 g) and controls (<4000 g), and according to birthweight centile, >90th centile and <90th centile. Differences in UA-PI and maternal and fetal characteristics between groups were tested.Results: Mean UA-PI was significantly lower in newborns with birthweight >4000 g than in controls (PI = 0.69; 95% CI 0.64–0.74 versus PI = 0.87; 95% CI 0.84–0.90, p < 000.1). Mean UA-PI was significantly lower in newborns with birthweight centile >90th centile than in controls (PI = 0.79; 95% CI 0.74–0.84 versus PI = 0.87; 95% CI 0.83–0.90; t = 2.653; p = 0.01). Linear regression analysis revealed a significant correlation between UA-PI and neonatal birthweight and between UA-PI and neonatal birthweight centile.Conclusions: Macrosomic fetuses of pregnancies complicated by GDM show lower values of UA-PI compared with controls. Despite UA-PI results, a variable related to macrosomia its role in the management of these pregnancies remains to be established.

Abnormal Middle Cerebral Artery Doppler Associates with Spontaneous Preterm Birth in Normally Grown Fetuses

Objective: Our aim was to evaluate whether Doppler changes in the fetal middle cerebral (MCA) and umbilical arteries (UA) suggesting fetal hypoxemia precede the onset of spontaneous preterm birth (PTB). Methods: We studied 2,340 appropriate-for-gestational-age singleton pregnancies that had MCA and UA pulsatility indices (PI) recorded at 28-32 weeks. Values including the cerebroplacental ratio (CPR) were converted into multiples of the median and evaluated according to both gestational age at the onset of labor and the interval between ultrasound and labor. ROC analysis was used to calculate the ability in the prediction of spontaneous PTB before 32, 34 and 37 weeks' gestation. Results: While no correlations were observed for the UA PI and CPR, lower MCA PI values were associated with an earlier onset of labor (p < 0.001) and a shorter ultrasound-labor interval (p = 0.028). The ROC analysis at different gestational ages and intervals to labor indicated that MCA PI values were poorly predictive of spontaneous PTB (all areas under the curve <0.7). Conclusions: Low MCA PI values at 28-32 weeks are associated with subsequent spontaneous PTB, indicating that fetal hypoxemia unrelated with placental disease might be implicated in the onset of labor. This association, however, is unlikely to be useful in the prediction of PTB.

Slow versus rapid enteral feed in preterm neonates with antenatal absent end diastolic flow

Objective: Incidence of feed intolerance (FI) and necrotizing enterocolitis (NEC) in preterm neonates with Doppler evidence of absent end diastolic flow (AEDF) velocities in the fetal umbilical artery when enteral feed volumes were started by 6–72 h and advanced either slowly or rapidly. Methods: Stable inborn neonates, 30–36 weeks gestation, weighing ≥1000 g and with antenatal evidence of AEDF were included in this pilot study. Infants (stratified in <1250 g and ≥1250 g birth weight categories) were allocated under randomized controlled trial, to receive either slow or rapid advancement of enteral feeding, while initiating the feeds after 6 h of birth if bowel sounds were present. Primary outcome measure was, FI and NEC till day 7 after reaching full feeds. Results: Of 159 eligible infants, 83 were randomized: 53 infants in the ≥1250 g category (28 in rapid and 25 in slow group) and 30 in the <1250 g category (15 in each group). FI was present in 11% versus 16% in ≥1250 g (p = 0.570) and 27% versus 33% in <1250 g (p = 0.690), NEC developed in 8.4% (3 versus 1) in ≥1250 g and (1 versus 2) in <1250 g, in slow versus rapid feeding. Conclusion: This trial did not find increase in incidence of feed intolerance with very early introduction and rapid advancement of enteral feeds in stable preterm neonates with AEDF and birth weight ≥1250 g.

Pre-gestational overweight in guinea pig sows induces fetal vascular dysfunction and increased rate of large and small fetuses.

In humans, obesity before and during pregnancy is associated with both fetal macrosomia and growth restriction, and long-term cardiovascular risk in the offspring. We aimed to determine whether overweighted pregnant guinea pig sows results in an increased fetal weight at term and the effects on the vascular reactivity in fetal systemic and umbilical arteries. Pregnant guinea pigs were classified as control (n=4) or high weight (HWS, n=5) according to their pre-mating weight, and their fetuses extracted at 0.9 gestation (~60 days). Segments of fetal femoral and umbilical arteries were mounted in a wire myograph, where the contractile response to KCl (5-125 mM), and the relaxation to nitric oxide synthase-dependent agents (insulin, 10-10-10-7 and acetylcholine, 10-10-10-5) and nitric oxide [sodium nitroprusside (SNP), 10-10-10-5] were determined. Fetuses from HWS (HWSF) were grouped according to their body weight as low (85 g) fetal weight, based on the confidence interval (76.5-84.9 g) of the control group. No HWSF were observed in the normal range. Umbilical arteries from HWSF showed a lower response to KCl and insulin compared with controls, but a comparable response with SNP. Conversely, femoral arteries from HWSF showed an increased response to KCl and acetylcholine, along with a decreased sensitivity to SNP. These data show that overweight sows have altered fetal growth along gestation. Further, large and small fetuses from obese guinea pig sows showed altered vascular reactivity at umbilical and systemic vessels, which potentially associates with long-term cardiovascular risk.

Effect of antenatal betamethasone administration on Doppler velocimetry of fetal and uteroplacental vessels: a prospective study.

To examine the effect of antenatal betamethasone administration on Doppler parameters of fetal and uteroplacental circulation. Seventy-six singleton pregnancies that received betamethasone therapy were prospectively evaluated. Doppler measurements of pulsatility indices (PI) in fetal umbilical artery (UA), middle cerebral artery (MCA), ductus venosus and maternal uterine arteries were performed before (0 h) and 24, 48, 72 and 96 h after the first dose of betamethasone. Women with positive end-diastolic flow (EDF) in UA and those with absent or reversed EDF in UA were evaluated separately. Fifty-two women with EDF in UA and 24 women with absent or reversed flow in UA were examined. Administration of maternal betamethasone was followed by a significant decrease in the PI of the MCA at 24 h (P<0.05). Additionally, return of absent to positive, reversed to absent or from reversed to positive diastolic flow in UA was detected within 24 h in 19 (79.2%) fetuses with absent or reversed UA-EDF. All alterations were transient and maintained up to 72 h. Antenatal administration of betamethasone is associated with significant but transient changes in the fetal blood flow. Hence, intensive surveillance of fetuses with Doppler ultrasonography is warranted following betamethasone therapy.

Intrahepatic cholestasis of pregnancy: observational study of the treatment with low-dose ursodeoxycholic acid.

BackgroundTo exam the biochemical, obstetric management and pregnancy outcome in women with intrahepatic cholestasis of pregnancy (ICP) and treatment with ursodeoxycholic acid (UDCA).MethodsPregnancy outcome in patients with ICP (N = 307) was studied and patients treated with UDCA (N = 208) vs. no UDCA were compared. The data of the antenatal visits, deliveries and neonatal outcome of 307 pregnancies with ICP was collected from the hospital computerized delivery room log book. UDCA was used in 208 pregnancies. The diagnosis was made by maternal pruritus and elevation of total fasting bile acid (BA) (>6 μmol/l) and elevation of serum alanine aminotransferases (ALT) (>45 U/l). Maternal and neonatal data was analysed and data of the patients who used UDCA during pregnancy was analysed separately and compared with the data from patients without medication.ResultsUDCA was well tolerated. Mothers receiving UDCA had ICP diagnosed five weeks earlier than mothers without medication. At the diagnosis, levels of total BA and ALT were higher in the group using UDCA compared to the group without medication. Most deliveries were induced and perinatal outcome was good. Apgar scores at 5 min were significantly lower in UDCA group (p < 0.05), but fetal umbilical artery pH values were similar in both groups (p > 0.05). There were 30 patients with total BA > 40 μmol/l at diagnosis, 24 with UDCA and 6 without medication and those deliveries were induced soon after diagnosis. The preterm labour was also more common in these patents (p < 0.05). Women with preterm babies had significantly early onset pruritus and ICP was diagnosed earlier. Serum ALT and total BA levels were significantly higher in those pregnancies at diagnosis and also at first control.ConclusionsPreterm labour was associated in severe ICP (total BA > 40 μmol/l), ALT levels were also significantly higher and ICP was diagnosed earlier (p < 0.05). Apgar scores were lower in preterm babies (p < 0.05), but umbilical artery pHvalues were not significantly lower. UDCA was well tolerated by pregnant women. With low-dose UDCA treatment the obstetric outcome was good. We still recommend careful obstetrical follow-up.

Professionals' views of fetal-monitoring support the development of devices to provide objective longer-term assessment of fetal wellbeing

Objective: Continuous longer-term fetal monitoring has been proposed to address limitations of current technologies in the detection of fetal compromise. We aimed to assess professionals' views regarding current fetal-monitoring techniques and proposed longer-term continuous fetal monitoring.Methods: A questionnaire was designed and validated to assess obstetricians' and midwives' use of current fetal-monitoring techniques and their views towards continuous monitoring. 125 of 173 received responses (72% obstetricians, 28% midwives) were analysed.Results: Professionals had the strongest views about supporting evidence for the most commonly employed fetal-monitoring techniques (maternal awareness of fetal movements, ultrasound assessment of fetal growth and umbilical artery Doppler). 45.1% of professionals agreed that a continuous monitoring device would be beneficial (versus 28.7% who disagreed); this perceived benefit was not influenced by professionals' views regarding current techniques or professional background. Professionals have limited experience of continuous fetal monitoring, but most respondents believed that it would increase maternal anxiety (64.3%) and would have concerns with its use in clinical practice (81.7%).Conclusion: Continuous fetal monitoring would be acceptable to the majority of professionals. However, development of these technologies must be accompanied by extended examination of professionals' and women's views to determine barriers to its introduction.

Does low-molecular-weight heparin influence fetal growth or uterine and umbilical arterial Doppler in women with a history of early-onset uteroplacental insufficiency and an inheritable thrombophilia? Secondary randomised controlled trial results.

Does low-molecular-weight heparin (LMWH) added to low-dose aspirin influence fetal growth and flow velocity in uterine and umbilical arteries in women with an inheritable thrombophilia and previous early-onset uteroplacental insufficiency? Secondary outcomes of the FRUIT-RCT. Multicentre, international. The FRUIT-RCT included 139 women with inheritable thrombophilia before 12weeks of gestation. Inclusion criteria were previous delivery before 34weeks of gestation with a hypertensive disorder of pregnancy and/or small-for-gestational-age infant and an inheritable thrombophilia. After randomisation to either daily LMWH with aspirin, or aspirin only, ultrasound measurements were performed at 22-24, 28-30 and 34-36weeks of gestation. Development during gestation of growth, birthweight and flow velocity of the umbilical artery was examined using the linear mixed model. Uterine artery flow velocity at a single time-point (22-24weeks) was examined using a chi-square test. Fetal growth over time including birthweight, using Scandinavian, Dutch and customised growth curves; and flow velocity within the uterine and umbilical arteries. No difference of fetal growth over time could be demonstrated between the study arms, regardless of which reference criteria were used. The flow velocity within the uterine artery and umbilical artery did not differ between study arms. The addition of LMWH to aspirin did not influence fetal growth or umbilical artery flow velocity over time; nor did it influence uterine artery flow velocity. LMWH does not influence fetal growth or uterine or umbilical flow velocities.

RELACIÓN DOPPLER CEREBROPLACENTARIA COMO PREDICTOR DE RESULTADOS PERINATALES ADVERSOS EN GESTANTES DE RIESGO ALTO

OBJETIVOS: evaluar la utilidad y la capacidad predictiva de la relación cerebroplacentaria (RCP) como prueba diagnóstica de resultados perinatales adversos (RPA) en gestantes de riesgo alto. DISEÑO: Se realizó un estudio longitudinal prospectivo con velocimetría Doppler pulsado en arterias umbilicales y cerebrales fetales. MATERIAL Y MÉTODOS: Se seleccionó 72 gestantes de riesgo alto, entre 28 y 41 semanas, excluyéndose a pacientes con embarazo múltiple y anomalía congénita fetal. En todas se determinó los índices de resistencia (IR) de la arteria umbilical (AU) y arteria cerebral media (ACM) fetal y se calculó la relación cerebro placentaria que consiste en el cociente de IR ACM/IR AU, considerándose como valor anormal =&lt; 1. Los resultados perinatales fueron categorizados y correlacionados con los previos índices Doppler. RESULTADOS: La incidencia de RPA fue 59,7%. El flujo de la ACM fue anormal en 25%, de AU en 38,9% encontrándose RCP anormal en 51,4% del total. En el grupo con RCP =&lt; 1, se encontró con alta significancia (p&lt; 0,01) incremento de riesgo de partos prematuros de &lt; 34 semanas. RCIU y peso bajo al nacer y significativamente (p &lt; 0,05) acidosis neonatal precoz, principalmente. La RCP anormal alcanzó mayor exactitud (88,9%), con valor predictivo positivo de 97,3% comparado con los IR anormales de AU y ACM solas, que alcanzaron 68,1% y 57% en exactitud de predicción, respectivamente. CONCLUSIONES: La relación cerebroplacentaria anormal posee alta capacidad predictiva de resultados perinatales adversos en gestantes de riesgo alto, siendo mucho más sensible que los índices de resistencia de las arterias umbilical y cerebral media, individualmente.

Fetal cardiac biometry and function in HIV-infected pregnant women exposed to HAART therapy.

Previous studies have suggested that antiretroviral therapy in human immunodeficiency virus (HIV)-infected pregnant women can cause alterations in cardiac structure and function in fetuses or children, although the results are not very clear. The aim of this study is to assess whether or not these alterations are present in the heart of fetuses of HIV-infected pregnant women, undergoing treatment with highly active antiretroviral therapy (HAART). We performed a prospective study on 29 consecutive HIV-positive pregnant women treated with HAART and 70 consecutive HIV-negative pregnant women as controls. Fetal cardiac biometry and function was evaluated by echocardiography at 30-32 weeks of gestation. Fetal biometry, estimated fetal weight and umbilical artery Doppler were also measured. We found E/A tricuspid ratio values slightly increased (0.84 vs 0.80, p = 0.03) and diastolic length shortened (49.7 vs 51.7%, p = 0.03) in the HIV-infected group. The rest of the biometric and functional cardiac parameters were not different between both groups. There were no cases of vertical transmission of HIV infection. In HIV-infected pregnant women treated with HAART, no significant changes are showed in fetal cardiac parameters.

Fetal middle cerebral artery and umbilical artery pulsatility index: effects of maternal characteristics and medical history.

To define the contribution of maternal variables which influence the measured fetal middle cerebral artery (MCA) and umbilical artery (UA) pulsatility index (PI) in the assessment of fetal wellbeing. Maternal characteristics and medical history were recorded and fetal MCA-PI and UA-PI (n = 36,818) were measured in women with singleton pregnancies attending a routine hospital visit at 30 + 0 to 37 + 6 weeks' gestation. For pregnancies delivering phenotypically normal live births or stillbirths ≥ 30 weeks' gestation, variables among maternal demographic characteristics and medical history that are important in the prediction of MCA-PI and UA-PI were determined by multiple linear regression analysis. Significant independent contributions to MCA-PI were provided by gestational age at assessment, East Asian racial origin, being parous and birth-weight Z-score of the neonate of the previous pregnancy. Significant independent contributions to UA-PI were provided by gestational age at assessment, Afro-Caribbean, East Asian and mixed racial origin, cigarette smoking, being parous and birth-weight Z-score of the neonate of the previous pregnancy. Multiple linear regression analysis was used to define the contribution of maternal variables that influence the measured MCA-PI and UA-PI and express the values as multiples of the median (MoMs). The cerebroplacental ratio (CPR) MoM was calculated by dividing MCA-PI MoM by UA-PI MoM. The model was shown to provide an adequate fit of MoM values for all covariates, both in pregnancies that delivered small-for-gestational-age neonates and in those without this pregnancy complication. A model was fitted to express MCA-PI, UA-PI and CPR as MoMs after adjusting for variables from maternal characteristics and medical history that affect this measurement.

Study on role of obstetrical Doppler in pregnancies with hypertensive disorders of pregnancy

Objectives: To study Doppler velocimetry of umbilical artery (UA) and middle cerebral artery (MCA) in hypertensive disorders of pregnancy (HDP) and analysis of association of abnormal Doppler waveform with perinatal outcome. Materials and Methods: Doppler velocimetry of fetal UA and MCA were studied in 100 pregnant women with hypertensive disorders of pregnancy. The results were analysed to find out perinatal outcome in those with abnormal Doppler studies. Results: The result of this study showed that fetuses with UA Systolic/Diastolic (SD) ratio >3 were associated with poor perinatal outcome in 89.65% with sensitivity and specificity of 80.00% and 82.86% respectively. Fetuses with cerebro-placental index (CPI) ≤1 have poor perinatal outcome in 95.74% with higher specificity (93.94%) and positive predictive value (95.74%). Conclusion: Fetuses with abnormal Doppler velocimetry had a significantly higher incidence of low birth weight babies, low apgar score, meconium stained liquor, intrauterine growth restriction (IUGR), admission to neonatal intensive care unit (NICU), intrauterine death (IUD)/still birth and shorter period of gestation at delivery.

Factores que influyen en la realización de una episiotomía selectiva en mujeres nulíparas.

Objective : To determinate factors affecting the performance of a selective episiotomy in nulliparous women. Methods : A descriptive cross-sectional study was conducted at the Miguel Servet University Hospital (HUMS) of Zaragoza within a sample of 568 nulliparous women. The performance of episiotomy was compared to postpartum variables such as: maternal age, nationality, gestational age, fetal weight, time of birth, fetal sex, analgesia used and professional attending the birth, as well as the existence of tears and pH results fetal umbilical cord artery. Results : The rate of episiotomy in nulliparous women at HUMS of Zaragoza is 62%. Factors influencing the performance of an episiotomy are greater fetal weight (p=0,000), as well as individual professional judgment attending childbirth. Other factors such as gestational age, fetal sex, epidural analgesia, time of birth or nationality do not affect the above mentioned performance. Lack of episiotomy increases first degree perineal tears and, to a lesser extent, the second degree, without causing an increased risk for fetal wellbeing. In addition, it allows the possibility of maintaining the full perineum after birth, mainly among younger women. Conclusions : It would be advisable to revise the protocols of selective policy for episiotomy rate decrease and equalize rates between different professionals.

Childhood kidney outcomes in relation to fetal blood flow and kidney size.

Impaired fetal abdominal blood flow may lead to smaller kidneys and subsequent impaired kidney function in later life. In a prospective cohort study among 923 pregnant women and their children, we measured fetal growth, kidney volumes, and umbilical and cerebral artery blood flow (median gestational age of 30.3 weeks; 95% range, 28.5-32.7 weeks). We used a higher umbilical/cerebral artery pulsatility index ratio as an indicator of preferential fetal blood flow to the upper body parts at the expense of the intra-abdominal organs. At a median age of 5.9 years (95% range, 5.7-6.6 years), we measured childhood kidney volumes, creatinine and cystatin C blood levels, microalbuminuria, BP, and eGFR. A preferential fetal blood flow to the upper body parts at the expense of the intra-abdominal organs associated only with a smaller combined kidney volume in childhood. Fetal combined kidney volume positively associated with childhood combined kidney volume and eGFR, and inversely associated with childhood creatinine and cystatin C levels (all P values <0.05), but did not associate with childhood microalbuminuria and BP. Children within the highest tertile of fetal umbilical/cerebral ratio and the lowest tertile of fetal combined kidney volume had the lowest eGFR (difference, -6.36 ml/min per 1.73 m(2); 95% confidence interval, -11.78 to -0.94 compared with children within the middle tertiles). These data suggest that impaired fetal blood to the abdominal organs and smaller fetal kidney size are associated with subclinical changes in kidney outcomes in school-aged children.

Amnioinfusion for third trimester preterm premature rupture of membranes.

Preterm premature rupture of membranes (PPROM) is a leading cause of perinatal morbidity and mortality. Amnioinfusion aims to restore amniotic fluid volume by infusing a solution into the uterine cavity. The objective of this review was to assess the effects of amnioinfusion for PPROM on perinatal and maternal morbidity and mortality. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (2 December 2013). Randomised trials of amnioinfusion compared with no amnioinfusion in women with PPROM. Three review authors independently assessed trials for inclusion. Two review authors independently assessed trial quality and extracted data. Data were checked for accuracy. We included five trials, of moderate quality, but we only analysed data from four studies (with a total of 241 participants). One trial did not contribute any data to the review.Transcervical amnioinfusion improved fetal umbilical artery pH at delivery (mean difference 0.11; 95% confidence interval (CI) 0.08 to 0.14; one trial, 61 participants) and reduced persistent variable decelerations during labour (risk ratio (RR) 0.52; 95% CI 0.30 to 0.91; one trial, 86 participants).Transabdominal amnioinfusion was associated with a reduction in neonatal death (RR 0.30; 95% CI 0.14 to 0.66; two trials, 94 participants), neonatal sepsis (RR 0.26; 95% CI 0.11 to 0.61; one trial, 60 participants), pulmonary hypoplasia (RR 0.22; 95% CI 0.06 to 0.88; one trial, 34 participants) and puerperal sepsis (RR 0.20; 95% CI 0.05 to 0.84; one trial, 60 participants). Women in the amnioinfusion group were also less likely to deliver within seven days of membrane rupture (RR 0.18; 95% CI 0.05 to 0.70; one trial, 34 participants). These results should be treated with circumspection as the positive findings were mainly due to one trial with unclear allocation concealment. These results are encouraging but are limited by the sparse data and unclear methodological robustness, therefore further evidence is required before amnioinfusion for PPROM can be recommended for routine clinical practice.

First-trimester prediction of small-for-gestational age neonates incorporating fetal Doppler parameters and maternal characteristics

First-trimester screening for subsequent delivery of a small-for-gestational-age (SGA) infant typically focuses on maternal risk factors and uterine artery (UtA) Doppler. Our aim is to test if incorporation of fetal umbilical artery (UA) and ductus venosus (DV) Doppler improves SGA prediction. Prospective screening study of singletons at 11-14 weeks. Maternal characteristics, serum concentrations of pregnancy-associated plasma protein-A (PAPP-A) and free β-human chorionic gonadotropin are ascertained and UtA Doppler, UA, and DV Doppler studies are performed. These parameters are tested for their ability to predict subsequent delivery of a SGA infant. Among 2267 enrolled women, 191 (8.4%) deliver an SGA infant. At univariate analysis women with SGA neonates are younger, more frequently African-American (AA), nulliparous, more likely to smoke, have lower PAPP-A and free β-human chorionic gonadotropin levels. They have a higher incidence of UtA Doppler bilateral notching, higher mean UtA Doppler-pulsatility index z-scores (P < .001) and UA pulsatility index z-scores (P= .03), but no significant difference in DV-pulsatility index z-scores or in the incidence of abnormal qualitative UA and DV patterns. Multivariate logistic regression analysis identifies nulliparity and AA ethnicity (P < .001), PAPP-A multiple of the median and bilateral notching (P < .05) as determinants of SGA infant. Predictive sensitivity was low; receiver operating characteristic curve analysis yields areas under the curve of 0.592 (95% confidence interval, 0.548-0.635) for the combination of UtA Doppler and UA pulsatility index z-scores. Delivery of a SGA infant is most frequent in nulliparous women of AA ethnicity. Despite the statistical association with UtA Doppler first-trimester SGA prediction is poor and not improved by the incorporation of fetal Doppler.

Postnatal systemic blood flow in neonates with abnormal fetal umbilical artery Doppler.

Objective. Abnormal umbilical artery Doppler (UAD) studies are associated with poor neonatal outcomes. We sought to determine if postnatal measures of systemic blood flow (SBF), as measured by functional echocardiography (fECHO), could identify which fetuses with abnormal UAD were at the highest risk of adverse outcomes. Study Design. This is a retrospective review of fetuses with abnormal UAD who received fECHO in the first 72 hours of life. Measures of SBF (right ventricular output (RVO) and superior vena cava (SVC) flow) were performed and compared with prenatal variables and postnatal outcomes. Result. 63 subjects had abnormal UAD, 20 of which also had fECHO. Six subjects had abnormal flow. Gestational age at delivery was similar between the two groups. Those with abnormal SBF had fewer days of abnormal UAD prior to delivery and developed RDS (P < 0.001). Conclusion. Postnatal measures of SBF were associated with poor postnatal outcomes in fetuses with abnormal UAD. Future studies incorporating antenatal measures of SBF may help obstetricians determine which pregnancies complicated by UAD are likely to have postnatal morbidity.