Normal Doppler Group Research Articles

Role of the brain-sparing effect on retinopathy of prematurity in newborns with fetal growth restriction

Introduction This study aimed to investigate the role of the brain-sparing effect (BSE) on retinopathy of prematurity (ROP) in fetal growth restriction (FGR). Methods In this retrospective study, 127 pregnant women were divided into two groups considering the cerebroplacental ratio (CPR): FGR with abnormal CPR group (n = 74) and the appropriate for gestational age with normal Doppler group (n = 53). CPR was computed using the pulsatility index (PI) and resistance index (RI) to quantitate the waveforms [middle cerebral artery (MCA) PI/umbilical artery (UA) PI and MCA RI/UA RI: a result <1 was taken into account as abnormal]. ROP screening results of newborns were recorded from electronic files. Results After adjusting for co-variants, BSE was not related to ROP (adjusted odds ratio [aOR], 1.06; 95% confidence interval [CI], 0.23–4.95). Gestational age at delivery <30 weeks (aOR, 2.55; 95% CI, 1.04–6.93) and birth weight <1500 g (aOR, 5.15; 95% CI, 1.15–25.2) were independently associated with ROP. Preeclampsia, emergency cesarean section birth, or forty-eight hours completion after the first steroid administration were not associated with ROP. Conclusions Gestational age at delivery <30 weeks and birth weight <1500g are independent risk factors for ROP in FGR whereas the BSE is not a risk factor.

Neonatal outcome of abnormal versus normal antenatal Doppler in high-risk pregnancies

Background: Umbilical Doppler flow abnormalities occur in 6% of high-risk pregnancies. Preterm infants born with abnormalities in the umbilical artery Doppler waveforms is at a risk of various complications. The objective of this study were to understand and compare the neonatal outcome of normal verses abnormal antenatal Doppler.Methods: 100 newborns each with normal antenatal Doppler and abnormal antenatal Doppler, born to women with singleton pregnancies of 28 weeks and above, were enrolled for the study after taking informed written consent from the parents. All the newborns enrolled were followed up for various neonatal outcomes and complications. Results: Majority of fetal Doppler abnormalities were seen in mothers with PIH (50% verses 21%) and Intra uterine growth restriction (59% verses 29%) which was statistically significant. Majority of babies in abnormal Doppler group were delivered by LSCS compared to normal Doppler group (72% verses 36%). Neonates in the abnormal Doppler had more risk of becoming SGA (52% verses 24%), more risk of developing NEC (32% verses 18%) and thrombocytopenia (34% verses 17%). The need for longer duration of NICU stay (22 days verses 14 days) and need for mechanical ventilation were more in them (17% verses 7%) compared to normal Doppler group.Conclusions: Colour Doppler is a useful modality to predict fetal outcome in high-risk pregnancies. It allows better understanding of hemodynamic changes in feto-placental and utero-placental circulation and helps pediatrician to anticipate the complications and helps in early intervention and thus results in decreased neonatal morbidity and mortality.

The role of the brain-sparing effect of growth-restricted fetuses in newborn germinal matrix/intraventricular hemorrhage.

The aim of the study was to evaluate the effect of the brain-sparing effect (BSE) of fetal growth restriction (FGR) in newborn germinal matrix/intraventricular hemorrhage (GM/IVH). A total of 320 patients who delivered prior to the 34th gestational week were analyzed from data records. 201 patients were divided into two groups according to cerebro-placental ratio (CPR): early fetal growth restriction (FGR) with abnormal CPR group (n=104) and appropriate for gestational age with normal Doppler group (control) (n=97). Using the normal middle cerebral artery (MCA) Doppler as a reference, multivariate logistic regression analysis was used to assess the association between the BSE and the primary outcome. The rate of Grade I-II germinal matrix/intraventricular hemorrhage (GM/IVH) was 31(29.8%) in the group possessing early FGR with abnormal CPR and 7(7.2%) in the control group, showing a statistically significant difference. The rate of grade III-IV GM/IVH was 7(6.7%) in the group possessing early FGR with abnormal CPR and 2 (2.1%) in the control group, showing no statistically significant difference. We found that gestational age at delivery <32weeks was an independent risk factor for GM/IVH. In addition, we found that other variables such as the presence of preeclampsia, fetal weight percentile <10, emergency CS delivery, 48-h completion after the first steroid administration and 24-h completion rate after MgSO4 administration were not independently associated with the primary outcome. Our results indicate that the rate of GM-IVH was increased in the group possessing early FGR with abnormal CPR; however, multivariate logistic regression analysis showed that BSE was not an independent risk factor for GM/IVH.

Placental pathology and neonatal outcome in small for gestational age pregnancies with and without abnormal umbilical artery Doppler flow

ObjectiveTo compare neonatal outcome and placental pathology in cases of small for gestational age (SGA) according to umbilical artery (UA) Doppler flow. Study designPregnancy and placental reports of SGA neonates (birth-weight <10th), born between 2008 and 2017 were compared between cases with normal and abnormal UA Doppler indices. Placental lesions were classified to malperfusion lesions and inflammatory responses. ResultsThe abnormal Doppler group (n = 66) delivered at an earlier gestational age, compared to the normal Doppler group (n = 92). Placentas from the abnormal Doppler group were characterized by a higher rate of maternal malperfusion lesions, while placentas from the normal Doppler group exhibited a higher rate of chronic villitis. Neonatal outcome was independently associated with abnormal Doppler, gestational age and birth weight <5th percentile. ConclusionSGA may involve a vascular mechanism, associated with abnormal Doppler flow and placental malperfusion, and an inflammatory mechanism, with normal Doppler flow and chronic villitis.

Abnormal umbilical artery Doppler velocimetry and placental histopathological correlation in fetal growth restriction

Background . Doppler velocimetry (DV) is widely used to assess the vascular formation of the placenta in fetal growth restriction (FGR) and to estimate the haemodynamic condition of the growth-restricted fetus. Umbilical artery (UA) flow is essentially placental, rather than fetal. Hence, DV provides information about the fetal side of the placenta and, alongside placental histopathology, it could possibly help to decipher aetiopathogenesis in FGR cases. Objective . To correlate UA DV findings occurring in FGR with placental findings. Methods. The study was prospective and conducted in a low-income setting. A total of 130 non-anomalous singleton FGR pregnancies (≥24 weeks) were included in the study. All pregnancies were confirmed to be small for gestational age (SGA) after the birth of the neonate. The placental lesions and neonatal outcomes were correlated with DV findings before delivery: 65 cases with normal DV results constituted group 1, and group 2 had 65 cases with abnormal DV results such as reduced flow, absent UA end diastolic flow or reversal of UA end diastolic flow. Results . Group 2 had significantly lower mean (standard deviation) birth weights of 1.59 (0.4) kg v. 1.87 (0.23) kg for group 1 ( p <0.001). Considerably higher NICU mortality was seen in group 2 (30.5%) compared with group 1 (6.7%) ( p <0.001). The group 2 placentas weighed less, had a higher number of maternal underperfusion (MUP) lesions, higher levels of calcification. Among lesions of MUP, 4 lesions i.e. villous infarction ( p <0.001), villous agglutination ( p <0.001), syncytial knots ( p =0.003) and intervillous fibrin deposition ( p =0.001) were present in significantly higher numbers in the abnormal Doppler group compared with the normal Doppler group. Abnormal Doppler had a sensitivity of 80% and specificity of 92.3% for abnormal placental pathology (placental lesions ≥3). Conclusions. There was a significantly higher number of MUP lesions and neonatal morbidity in SGA patients with abnormal DV findings

Significance of Umbilical Artery Velocimetry in Perinatal Outcome of Growth Restricted Fetuses

Objectives: To study pregnancy outcomes in growth restricted fetuses with normal umbilical artery velocimetry, low end-diastolic umbilical flow, and absent or reversed diastolic flow. Methods: Fifty pregnant women with growth restricted fetuses were evaluated by umbilical artery velocimetry between 28 and 39 weeks of pregnancy. Outcome of pregnancy was recorded for the normal Doppler group (n=17; 34%), the low end diastolic flow group (n=23; 46%), the group with absent diastolic flow (n=8; 16%) and the group with reversed diastolic flow (n=2; 4%). Results: The average birth weight, diagnosis to delivery interval and gestational age at delivery were comparatively lower in case of abnormal umbilical Doppler velocimetry group. Again there was higher incidence of LSCS for fetal distress, Apgar score &lt;7 at 1 minute, admission to neonatal intensive care unit and perinatal death with those of the abnormal umbilical Doppler velocimetry. Conclusion: Doppler study of umbilical artery allows a noninvasive assessment of uteroplacental insufficiency and is an accurate method for diagnosis and management of fetal growth retardation.J Bangladesh Coll Phys Surg 2015; 33(1): 12-17

Significance of umbilical artery Doppler velocimetry in the perinatal outcome of the growth restricted fetuses

ObjectivesTo evaluate the role of umbilical artery Doppler in growth restricted fetuses.MethodsIn a prospective observational study, 100 pregnant women with growth restricted fetuses confirmed by ultrasound were evaluated by umbilical artery Doppler velocimetry after 28 weeks of gestation. Outcome of the pregnancy was recorded for the normal Doppler group (n=54) and abnormal Doppler group (n=46). Abnormal Doppler group consisted of low end diastolic flow group (n=29) and absent or reversed end diastolic flow (REDF) group (n=17).ResultsFetuses with abnormal umbilical flow velocimetry had higher incidence of oligohydramnios and abnormal NST compared to the fetuses with normal umbilical flow. The average birth weight and gestational age at delivery were lower in the abnormal Doppler group. Neonates with abnormal umbilical artery velocimetry had increased incidence of caesarean delivery, low apgar scores at birth, increased NICU admissions, increased requirement of positive pressure ventilation, and higher perinatal morbidity and mortality.ConclusionUmbilical artery Doppler velocimetry should be used in the management of the intrauterine growth restricted fetuses, as it helps in differentiating fetus with pathological growth restriction at risk for perinatal complications from small and healthy fetuses.

The value of umbilical artery Doppler velocimetry in the antenatal surveillance of uncomplicated monochorionic twin pregnancies

To investigate the predictive value of abnormal umbilical artery Doppler findings on outcome in uncomplicated monochorionic (MC) twin pregnancies. Sixty-seven MC twin pregnancies, with antenatal care and delivery at the University Medical Center, Utrecht, The Netherlands, between 1999 and 2004, were studied. Pregnancies with antenatal signs of twin-to-twin transfusion syndrome were excluded. We analyzed the data according to both the last Doppler measurement of the umbilical artery before delivery and the presence of any abnormal Doppler measurement during the course of pregnancy. Risks of mortality and total neonatal morbidity were stratified according to the Doppler findings in one or both fetuses at the time of each standard ultrasound assessment in order to estimate the risk associated with an abnormal Doppler finding at or before that specific gestational age. Mortality rates were similar in the normal and abnormal Doppler groups. Using both group definitions, total neonatal morbidity was higher in the abnormal Doppler group; this was significant at > 32 weeks' gestation, and was due to lower birth weight and earlier gestational age at delivery. There was no mortality at > or = 36 weeks in the abnormal Doppler group, but there were four perinatal deaths in the normal Doppler group. Gestational age at delivery was significantly lower when one or more abnormal Doppler findings had been present (median, 34 + 1 weeks vs. 36 + 3 weeks) and infants with abnormal Doppler findings weighed on average 261 g (95% CI, 21-502 g) less than those with normal findings. In MC twins, abnormal Doppler flow of the umbilical artery identifies a subgroup at risk for preterm delivery, low birth weight and neonatal morbidity, but with a similar mortality risk to those with normal Doppler flow. At term, mortality occurred only in the group with normal Doppler findings, suggesting that fetal surveillance is insufficient in uncomplicated term MC twin pregnancies.

Lung maturation in small for gestational age fetuses from pregnancies complicated by placental insufficiency or maternal hypertension

Background Clinical studies suggest that respiratory outcome of infants born preterm may be influenced by placental insufficiency and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. If so, one could expect to see differences in lung maturation indices (lecithin/sphingomyelin (L/S) ratio and lamellar body count (LBC)) in the amniotic fluid. The present study investigates lung maturation indices of preterm small for gestational age (SGA) fetuses with or without abnormal Doppler ultrasound examination and with or without maternal hypertension/HELLP syndrome. Study design Retrospective cohort study of 76 neonates born in our center between 1997 and 2003 with gestational age (GA) < 34 weeks, birth weight < p10 for GA and available results from amniocentesis. All analyses were corrected for potential confounders. Results The L/S ratio was significantly higher in the abnormal Doppler group as compared to the normal Doppler group ( p = 0.02). The L/S ratio was significantly lower in hypertensive pregnancies as compared to normotensive pregnancies ( p = 0.02). Subdivision of the maternal hypertension group showed a significantly lower L/S ratio in the HELLP syndrome group as compared to the normotension group ( p = 0.04). Conclusion The L/S ratio of SGA fetuses is significantly higher in cases with presumed placental insufficiency and significantly lower when pregnancies are complicated by HELLP syndrome. These observations are in line with the hypothesis that placental insufficiency accelerates lung maturation and with recent reports of poorer respiratory outcome in infants from mothers with HELLP syndrome.

Umbilical artery Doppler flow velocimetry in intrauterine growth restriction and its relation to perinatal outcome

Objective: The purpose of this retrospective analysis was to compare pregnancy outcomes in growth-restricted fetuses retaining normal umbilical artery Doppler flow and the outcomes of pregnancies with end-diastolic velocity either diminished or severely reduced/absent. Methods: One hundred pregnant women with growth-restricted fetuses were followed with Doppler velocimetry of the umbilical artery between weeks 28 and 41 of pregnancy. Outcomes were compared for the normal Doppler group (16%), the less-severely abnormal group (77%), and the group with severely reduced or absent end-diastolic velocity waveforms (7%). Results: The diagnosis-to-delivery interval was significantly shorter, and the average birth weight and gestational age at delivery were significantly lower, for fetuses with abnormal Doppler velocimetry (showing diminished or severely reduced/absent end-diastolic velocity) than for those in the normal Doppler group. Fetuses with abnormal Doppler velocimetry also had a significantly higher incidence of oligohydramnios, low-birth weight (<10th percentile), and admission to the Neonatal Intensive Care Unit. There were no perinatal deaths among the normal Doppler patients. Conclusions: Growth-restricted fetuses with normal umbilical artery velocimetry are at significantly lower risk than those with abnormal velocity waveforms, and immediate delivery of the fetus with diminished end-diastolic flow may be unnecessary. Knowing this relationship may be useful in the clinical management of such pregnancies. Doppler surveillance of growth-restricted fetuses supplemented with cardiotocography, preferably combined with biophysical profile testing, results in a prolonged gestational age and acceptable fetal outcome.

The effect of an abnormal umbilical artery Doppler on the management of fetal growth restriction: a survey of maternal-fetal medicine specialists who perform fetal ultrasound.

The purpose of this survey was to determine if an abnormal Doppler ultrasound scan of the umbilical artery alters the management of patients with fetuses with varying degrees of asymmetrical growth restriction remote from term. A survey was conducted of Maternal-Fetal Medicine specialists who practiced in the United States. Three cases of increasing severity of asymmetrical growth restriction (abdominal circumference > 2 standard deviations below the mean) were presented, each with a normal or abnormal Doppler of the umbilical artery. The estimated fetal weights were between the 15th and 25th centiles (Case 1), 10th and 15th centiles (Case 2), and less than the 10th centile (Case 3). Each physician was asked to respond to questions regarding the frequency (none, 2 weeks, 3 weeks, 4 weeks) of repeat ultrasound scans, the recommendation for maternal bed rest and its duration (none, 5 hours, 12 hours), and the choice of antepartum testing (none, nonstress test, non-stress test plus amniotic fluid index, contraction stress test, biophysical profile).A completed survey was returned by 199 of 900 (22%) Maternal-Fetal Medicine specialists who practiced in 33 of 50 states. Of respondents, 95% performed fetal ultrasound. Over 98% of respondents repeated the ultrasound examination irrespective of the degree of growth restriction. Comparing the affect of a normal versus an abnormal Doppler for Case 1, there was a significant increase in the following: repeat ultrasound at the 2-week interval (46 vs. 68%, p < 0.00002); recommendation for maternal bed rest (55 vs. 80%, p < 0.00002); the duration of bed rest for 12 h (17 vs. 46%, p < 0.000001); recommendation for antepartum testing (82 vs. 96%, p < 0.00002); utilization of the contraction stress test (1 vs. 7%, p < 0.004); and the biophysical profile (17 vs. 27%, p < 0.02). Comparing the effect of a normal versus an abnormal Doppler on management for Case 2, there was a significant increase in the following: recommendation for maternal bed rest (80 vs. 89%, p < 0.02); duration of bed rest for 12 h (34 vs. 63%, p < 0.000001); and the recommendation for antepartum testing (95 vs. 99%, p < 0.04). Comparing the effect of a normal versus an abnormal Doppler on management for Case 3, the only significant increase was the recommendation for 12 h of bed rest (72 vs. 84%, p < 0.006). Comparison of the trends in management as the cases became more severe (Case 1 through Case 3) in the normal Doppler group demonstrated a significant increase in recommendation for repeat ultrasound at the 2-week interval (46 to 76%, p < 0.000001); recommendation for bed rest (55 to 92%, p < 0.000001); the duration of bed rest for 12 h (17 to 72%, p < 0.00001); recommendation for antepartum testing (82 to 100%, p < 0.000001); use of the contraction stress test (1 to 10%, p < 0.0004); and the biophysical profile (17 to 46%, p < 0.00009). Comparison of the trends in management as the cases became more severe (Case 1 through Case 3) in the abnormal Doppler group demonstrated a significant increase in recommendations for bed rest (80 to 96%, p < 0.000007); the duration of bed rest for 12 h (46 to 84%, p < 0.000002); and use of the biophysical profile (27 to 55%, p < 0.000001). An abnormal Doppler ultrasound scan of the umbilical artery appears to alter the recommendations for management of fetuses with varying degrees of growth restriction.

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

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

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

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