Normal Doppler Research Articles

Reference values of normal fetal ductus venosus Doppler flow measurements at 11-14 weeks of gestation.

To establish the reference range of normal fetal ductus venosus pulsatility index (DV PI) and ductus venosus (DV) blood flow velocity at 11-14 weeks of gestation. Fetal ductus venosus Doppler flow was measured in singleton pregnancies attending our hospital for early pregnancy nuchal translucency (NT) screening between June 2021 and May 2022. All fetuses were followed up for pregnancy outcome using the following inclusion criteria: Singleton pregnancy; no maternal underlying diseases such as diabetes, hypertension, rheumatism, or other pregnancy complications; fetal crown-rump length (CRL) of 45 to 84 mm; normal NT screening ultrasound; no absent or reversed ductus venosus a-wave; no fetal structural abnormalities; no chromosomal abnormalities during follow-up; and good pregnancy outcome. DV PI, peak ventricular systolic velocity (S-wave), atrial systolic flow velocity (a-wave) and time-averaged maximum velocity (TAMXV) were recorded. The ductus venosus Doppler parameters of 224 fetuses which met the inclusion criteria were analysed. DV PI P5 and P95 ranged from 1.0007 and 1.3415 for a CRL of 45 mm to 0.9734 and 1.2115 for a CRL of 84 mm, indicating a statistically significant correlation with CRL. DV S-wave, a-wave, and TAMXV all increased as CRL increased, demonstrating a statistically significant correlation with CRL values. A reference range of normal fetal ductus venosus Doppler spectral parameters at 11-14 weeks was established to provide a basis for further research into the clinical value of normal and abnormal DV PI values in relation to adverse pregnancy outcomes.

Double umbilical artery converging into a single umbilical artery: A case report.

The normal structure and Doppler parameters of the umbilical cord are closely related to many diseases, including fetal infection, chromosomal abnormalities, hypoxia, and growth and development restrictions. We report a case of bilateral umbilical artery confluence resulting in the formation of a single umbilical artery in the free segment of the fetal umbilical cord, diagnosed at 24 weeks and 4 days gestation. The fetus was born prematurely after premature membrane rupture at 31 weeks and 3 days gestation. The Toxoplasma, Others, Rubellavirus, Cytomegalovirus, Herpesvirus test showed positive results for Toxoplasma gondii, rubella virus, and herpes simplex virus IgG antibodies. A 36-year-old woman had vaginal discharge for > 1 hour at 31 weeks + 3 days gestation and came to our obstetrics department for treatment. The pregnant woman sought treatment due to premature membrane rupture and vaginal discharge for > 1 hour. The vaginal discharge was caused by Escherichia coli. After cesarean section, the Toxoplasma, Others, Rubellavirus, Cytomegalovirus, Herpesvirus test revealed positive results for the following: T gondii, rubella virus, and herpes simplex virus IgG antibodies. The patient underwent 2 ultrasound examinations and was diagnosed with umbilical artery malformation (the free segment of the umbilical cord on the fetal side converged into a single umbilical artery), which may have been related to fetal infection. The patient received anti-inflammatory and fetal lung maturation treatment for 2 days before undergoing a cesarean section. The mother and newborn received anti-inflammatory, symptomatic, and supportive treatment and were discharged after 1 week of improvement. After 1 month, 6 months, and 1 year of follow-up after birth, the growth and development of the infant (height and weight) were significantly lower than those of her peers, and her responses to sound and light were slightly delayed. Umbilical artery malformation is extremely rare and may be related to intrauterine parasitic and viral infections. Ultrasound has the advantages of being noninvasive and cost-effective and can be used to dynamically observe umbilical artery structure. An abnormal change in umbilical artery structure found during ultrasound examination can indicate intrauterine infection risk, which provides clinical guidance for further examination of pregnant women, early diagnosis, timely targeted treatment, and fetal prognosis improvement.

Role of sonography in detection and evaluation of post liver transplant complications.

To evaluate the role of sonography in revealing and characterizing liver transplant complications based on gray scale and color Doppler, describe the normal Doppler findings, and discuss the significance of distinguishing normal transient changes in the spectral waveform from findings that may suggests ominous complications. We carried out a retrospective cross-sectional study at Prince Sultan Military Medical City, Riyadh, Saudi Arabia. The medical records and imaging studies of a total of 122 candidates who underwent transplantation between January 2016 to February 2022 were reviewed. Our results showed that most patients were males with the most frequent age group being those between 54-71 years. Hepatitis B virus and hepatic cellular carcinoma were the most common indications for transplants. A total of 95 patients received a graft from a living related donor. Regarding complications, biliary issues (including leaks and ducts dilation) were the second most frequent complication after collections. Vascular complications represented 7.4% of all complications and was the leading cause of death in 4.8% of cases. Among all vascular issues encountered during liver transplant, portal vein thrombosis was the most predominant. In respect to Doppler findings, portal vein velocities and resistive index of hepatic artery had re-averaged within 7-10 post-operative days in most patients. Ultrasound plays crucial role in the post-operative management of compilations, facilitating early detection, which is substantial for the graft survival.

Perinatal outcomes according to umbilical artery Doppler assessment among fetuses with congenital heart disease.

To evaluate a cohort of fetuses with congenital heart disease (CHD) who underwent serial umbilical artery (UA) Doppler surveillance and assess perinatal outcome according to UA Doppler assessment. A retrospective cohort study of singleton fetuses with CHD at a single academic center was performed between 2018 and 2020. Fetuses with a chromosomal abnormality or growth restriction were excluded. We compared fetuses with normal versus abnormal UA Doppler assessment at any time in pregnancy. Abnormal UA Doppler assessment was defined as decreased end diastolic flow, determined by an elevated systolic/diastolic ratio >95th percentile for gestational age, or absent/reversed end diastolic flow. Logistic regression assessed the odds of fetuses with CHD and abnormal UA Doppler assessment having a composite adverse perinatal (defined as fetal, neonatal, or infant death), adjusting for relevant covariates. We identified a cohort of 171 fetuses with CHD that met inclusion criteria. Of these, 154 (90%) had normal UA Doppler assessment and 17 (10%) had abnormal UA Doppler assessment throughout pregnancy. Maternal characteristics did not differ between groups except for maternal race and history of preeclampsia. There was no statistically significant difference in primary outcome between groups [14% (21/154) of fetuses with normal UA Doppler assessment had an adverse perinatal outcome compared to 24% (4/17) of those with abnormal UA Doppler assessment, p = 0.28]. UA Doppler assessment is unlikely to predict adverse perinatal outcome in normally grown, euploid singleton fetuses with CHD.

B-mode, Doppler, and Elastography abdominal ultrasound in Tamandua tetradactyla.

The aim of this study was to describe the normal B-mode, Doppler, and 2D Shear Wave Elastography ultrasonographic findings of some abdominal structures in a six-month-old male Southern Tamandua (Tamandua tetradactyla). The animal was found and rescued by the environmental police after being discovered in the wild near its mother, who had died in a car accident. For the ultrasonographic exams, the animal's abdominal region was shaved, and only physical restraint was used. In the B-mode exam, the urinary bladder, small intestine, kidneys, left adrenal gland, stomach, liver, and gallbladder were located and evaluated. Doppler examination obtained spectral tracings of the arcuate and renal arteries of both kidneys. Elastography assessed the stiffness of the renal cortex, liver, and spleen. The ultrasound examination provided an adequate evaluation and novel findings of the Southern Tamandua abdominal structures without invasiveness.

Umbilical Artery Doppler and Adverse Outcomes in Severe Preeclampsia Without Fetal Growth Restriction: A Retrospective Cohort Study.

Background and objective Severe preeclampsia may be managed expectantly before 34 weeks gestation with close surveillance.Utilized in fetal growth restriction (FGR), evidence supports umbilical artery (UA) Dopplerpreventing neonatal morbidity from hypertensive disease and predicting adverse outcomes in preeclampsia. We evaluated the association of abnormal UA Doppler waveforms with early delivery (before 34 weeks gestation) and adverse maternal-fetal outcomes in patients with early severe preeclampsia without FGR. Methodology This is a retrospective cohort study of singleton pregnancies with International Classification of Diseases (ICD) Ninth or Tenth Revision, defined severe preeclampsia diagnosed before 34 weeks gestation without FGR from January 1, 2018, through January 27, 2023, at a large tertiary care center where S/D ratios were calculated from UA Doppler interrogation of a free loop of cord at least once weekly. This study was approved by the IRB (ID:00002216) and granted a full Health Insurance Portability and Accountability Act (HIPAA) waiver of consent. Exclusion criteria were major congenital anomalies, congenital infection, aneuploidy, leaving against medical advice >24 hours, and patient instability on admission defined as condition(s) precluding expectant management by the American College of Obstetrics and Gynecology. The primary outcome was delivery before 34 weeks gestation. Secondary outcomes were the mode of delivery and maternal/fetal complications. Patient characteristics and outcomes for normal versus abnormal UA Doppler groups were compared with chi-square, t-tests, and Fisher's exact test. Odds ratios and relative risks were calculated to compare outcomes. Results Of 194 patients with severe preeclampsia, 107 met inclusion criteria. Thirty-four patients had abnormal UA Doppler studies. There were no differences in demographic and clinical data between patients with normal and abnormal UA Doppler studies. Patients with abnormal UA Doppler studies were more likely to deliver before 34 weeks (OR=3.91; 95%CI 1.24-12.33) for worsening severe features (OR=3.85; 95% CI 1.42-10.41), and were less likely to deliver vaginally (OR=0.12; 95% CI 0.03-0.54). Abnormal UA Doppler studies were associatedwith an increased risk of neonatal complications (OR=6.46; 95% CI 1.42-29.42) and respiratory distress syndrome (RDS) (OR=4.75; 95%CI 1.32-17.16). Abnormal UA Doppler subgroups were divided into patients with elevated S/D >95% Acharya (N=22) and absent end-diastolic flow (EDF) (N=10). The elevated S/D group tended to deliver before 34 weeks gestation for worsening severe features (OR=3.71, 95% CI 1.144-12.050) and had a higher risk of neonatal complications (RR 1.404; 95% CI 1.213-1.624). The absent EDF subgroup was more likely to deliver before 34 weeks (RR=1.52; 95%CI 1.29-1.79) for abnormal fetal testing (OR=6.92; 95%CI 1.71-28.08) and undergo primary cesarean delivery (OR=7.23; 95%CI 1.43-36.61). Conclusion Pregnancies with severe preeclampsia without FGR displayed a high incidence of abnormal UA Doppler waveforms associated with loss of clinical stability and adverse fetal outcomes. The groups with more impedance to umbilical artery flow tended to deliver earlier, and as the Doppler shifted from elevated S/D to absent end-diastolic flow, the mode of delivery shifted to cesarean delivery with increased risk of abnormal fetal testing. These results support the utility of UA Doppler surveillance in severe preeclampsia.

Normal M-mode, Pulsed Wave and Tissue Doppler Echocardiographic Studies in Healthy Working Police Dogs

Background: Physical activity alters the cardiovascular system of dogs depending on the exercise characteristics and the animal’s physical conditioning. Little is known about the cardiovascular changes in working police dogs. This study evaluated the cardiovascular responses of working Labradors to regular exercise and various workload. Methods: Twelve working Labradors of Tamil Nadu police department that were regularly trained and exercised 30 minutes morning and evening and twelve normal household pet Labradors brought for regular checkup to Madras Veterinary College Teaching hospital were taken for the study. All the animals were subjected to physical, clinical, hematobiochemical, electrocardiographic examinations and cardiac auscultation before performing echocardiography. Those animals which showed normal recordings in all the above tests were further subjected to M-mode, Pulsed wave and Tissue Doppler echocardiography. In this study, the resting heart rate values of working groups were lesser than that of normal pet dogs. Result: The results of echocardiography showed significant increase in Interventricular septal diameter during diastole, left atrial diameter, aortic artery diameter and the left atrium to aortic diameter ratio without impairing systolic and diastolic cardiac functions in working dogs. The present study indicated that there were few changes in the echocardiographic parameters which might be a response to physiological adaptation and regular exercise.

Midline structures and cortical development in late-onset fetal growth restriction according to Doppler status: prospective study.

Fetuses with late-onset growth restriction (FGR) have a higher risk of suboptimal neurocognitive performance after birth. Previous studies have reported that impaired brain and cortical development can start in utero. The primary aim of this study was to report midline structure growth and cortical development in fetuses with late-onset FGR according to its severity; the secondary aim was to elucidate whether the severity of FGR, as defined by the presence of abnormal Doppler findings, plays a role in affecting brain growth and maturation. This was a prospective observational study that included fetuses with late-onset FGR (defined according to the Delphi FGR criteria) undergoing neurosonography between 32 and 34 weeks' gestation. Midline structure (corpus callosum (CC) and cerebellar vermis (CV)) length and cortical development, including the depth of the Sylvian (SF), parieto-occipital (POF) and calcarine (CF) fissures, were compared between late-onset FGR, small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) fetuses. Subgroup analysis according to the severity of FGR (normal vs abnormal fetal Doppler) was also performed. Univariate analysis was used to analyze the data. A total of 52 late-onset FGR fetuses with normal Doppler findings, 60 late-onset FGR fetuses with abnormal Doppler findings, 64 SGA fetuses and 100 AGA fetuses were included in the analysis. When comparing AGA controls with SGA fetuses, late-onset FGR fetuses with normal Doppler findings and late-onset FGR fetuses with abnormal Doppler findings, there was a progressive and significant reduction in the absolute values of the following parameters: CC length (median (interquartile range (IQR)), 43.5 (28.9-56.1) mm vs 41.9 (27.8-51.8) mm vs 38.5 (29.1-50.5) mm vs 31.7 (23.8-40.2) mm; K = 26.68; P < 0.0001), SF depth (median (IQR), 14.5 (10.7-16.8) mm vs 12.7 (9.8-15.1) mm vs 11.9 (9.1-13.4) mm vs 8.3 (6.7-10.3) mm; K = 75.82; P < 0.0001), POF depth (median (IQR), 8.6 (6.3-11.1) mm vs 8.1 (5.6-10.4) mm vs 7.8 (6.1-9.3) mm vs 6.6 (4.2-8.0) mm; K = 45.06; P < 0.0001) and CF depth (median (IQR), 9.3 (6.7-11.5) mm vs 8.2 (5.7-10.7) mm vs 7.7 (5.2-9.4) mm vs 6.3 (4.5-7.2) mm; K = 46.14; P < 0.0001). Absolute CV length was significantly higher in AGA fetuses compared with all other groups, although the same progressive pattern was not noted (median (IQR), 24.9 (17.6-29.2) mm vs 21.6 (15.2-26.1) mm vs 19.1 (13.8-25.9) mm vs 21.0 (13.5-25.8) mm; K = 16.72; P = 0.0008). When the neurosonographic variables were corrected for fetal head circumference, a significant difference in the CC length and SF, POF and CF depths, but not CV length, was observed only in late-onset FGR fetuses with abnormal Doppler findings when compared with AGA and SGA fetuses. Fetuses with late-onset FGR had shorter CC length and delayed cortical development when compared with AGA fetuses. After controlling for fetal head circumference, these differences remained significant only in late-onset FGR fetuses with abnormal Doppler. These findings support the existence of a link between brain development and impaired placental function. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Male Sexual Dysfunction and Hypogonadism in Young Adults with Type 2 Diabetes Mellitus: A Cross Sectional Study

Background: Male sexual dysfunction (MSD) is a common occurrence in diabetic patients, which is not routinely assessed in clinical settings. Aim: The aim of the study was to assess the prevalence of MSD and hypogonadism in young type 2 diabetes mellitus (T2DM) patients aged between 20 and 40 years and its association with duration, glycaemic control and complications of diabetes. Settings and Design: This is a cross-sectional study involving 70 men with T2DM of 20–40 years of age visiting the endocrinology department in a tertiary care centre. This study was conducted from November 2021 to March 2023. Materials and Methods: Seventy subjects satisfying inclusion criteria were included in the study and assessed using the International Index of Erectile Function-15 questionnaire, intravaginal ejaculation latency time, androgen deficiency in ageing male questionnaire, hormonal parameters (Luteinising Hormone, Follicle stimulating hormone, Testosterone and sex hormone-binding globulin) and penile Doppler. Statistical Analysis Used: The statistical analysis was done using SPSS version 21. A P &lt; 0.05 is considered statistically significant. Data were checked for normality using Kolmogorov–Smirnov and Shapiro–Wilk tests. For determining statistical significance between continuous variables with non-normal data, the Mann–Whitney U test and Kruskal–Wallis tests were used. Pie charts, bar diagrams and scatter plots were used for descriptive statistics. Frequency, percentage, means, median, range and standard deviation were used for all quantitative data. The Chi-square test was used to find a significant association between categorical variables. Results: Sixty per cent of men had at least one form of MSD. Hypoactive sexual desire disorder (HSDD) - 44.28% was the most common MSD, followed by erectile dysfunction (ED) - 42.85% and ejaculatory disorders - 18.57%. Penile Doppler was done in 15 patients, of whom 9 patients had normal Doppler, venous incompetence was present in 3, followed by mixed (arterial and venous) in 2 and arterial insufficiency in 1 subject. Hypogonadism was present in 27.14% of men and secondary hypogonadism was the most common cause (84.21%). There was a significant association between neuropathy and ED and between hypogonadism and HSDD. There was also a significant association between fasting plasma glucose, post-prandial plasma glucose and MSD. Conclusion: MSD is common in young T2DM men, which should be given due importance in clinical practice to improve their quality of life. Glycaemic control is of utmost importance in these men.

Prospective, randomized, placebo-controlled, two-arm study to evaluate the efficacy of coadministration of garlic as a hydrogen sulfide donor and tadalafil in patients with erectile dysfunction not responding to tadalafil alone - A pilot study.

The objective is to evaluate the efficacy of coadministration of garlic (as a hydrogen sulfide [H2S] donor) and tadalafil for patients with ED using a placebo-controlled, prospective, randomized, two-arm pilot study in patients responding poorly to tadalafil alone. The patients with complaints of ED (with normal penile Doppler) who failed to maintain sustained improvement in erectile function with tadalafil were recruited after excluding those with comorbidities. The study sample was randomized into two groups. Group A received garlic 5 g twice a day orally and Group B received a placebo twice daily orally for 4 weeks. Both groups continued tadalafil 5 mg in the night for 4 weeks. Their erectile function was assessed at the beginning and at the end of 4 weeks using the International Index of Erectile Function (IIEF-EF), erectile function domain and compared. A value of P ≤ 0.05 was considered statistically significant. Nineteen patients in Group A (mean age 37.5 ± 10.6 years) and 16 patients in Group B (mean age 39.6 ± 9.6 years) participated in the pilot study conducted from May 2022 to August 2022. The participants treated with garlic (as an H2S donor) as a coadministrant had statistically significant improvement in IIEF-EF score (P ≤ 0.0001) at the end of 4 weeks compared to placebo. Garlic (as an H2S donor) as adjunctive therapy was beneficial in our study participants responding poorly to tadalafil alone.

Prenatal Diagnosis of Umbilical Cord Angiomyxoma: Case Studies and Literature Review of 45 Cases.

We describe two cases of umbilical cord (UC) angiomyxoma diagnosed prenatally by sonography in the second trimester of pregnancy. In both cases, a complex mass was detected at the placental insertion site, characterized by an echoic nodule surrounding the umbilical vessels and distal edematous Wharton's jelly. Follow-up scans showed that the mass grew mainly at the expense of its edematous component, with normal uteroplacental Dopplers throughout the remaining of the pregnancy. However, late-onset fetal growth restriction complicated the progress of pregnancy, requiring delivery by Cesarean section at 37 weeks' gestation in both cases. Neonatal courses were unremarkable. An extensive review of the English literature was also performed, collecting 45 similar cases including ours. Our experience as well as the review of the literature confirms that UC angiomyxoma is an uncommon, sporadic condition that is usually detected incidentally during prenatal sonography and presents as an isolated finding. Nevertheless, it represents a high-risk condition for pregnancy complications including prematurity, fetal growth restriction, and fetal demise.

The role of color doppler in high risk pregnancies: A prospective comparative study

Pregnancy can be considered as the most beautiful period of a woman’s life. The recent medical advances are helpful in taking very good care of the female throughout her pregnancy. The pregnancy is constantly observed by clinical examination, laboratory investigations, and radiographic examinations at specific intervals throughout its course.To study the role of doppler ultrasound in high-risk pregnancies.This is a prospective comparative study was conducted in department of Obstetrics and Gynaecology at Government medical college, Nagpur. The study period was 12 months. 232 patients were included in this study.In our study, 2 patients had Chronic hypertension, 2 patients had GDM, 1 patient had Gestational hypertension, 3 patients had Anaemia, 6 patients had Heart Disease, 5 patients had HIV positive,15 patients had Hypothyroidism, 2 patients had Increased BP, 1 patient had Overt DM,6 patients had Pre-eclampsia,1 patient had previous abortion, 4 patients had Rh negative, 5 patients had Sickle Cell Disease(SS) and 15 patients had Sickle Cell trait(AS). Distribution of normal doppler changes in cases according to high risk factor was statistically significant (p&amp;#60;0.0001).In our study, NICU Admission with doppler changes was statistically significant and Association of Baby weight in cases according to doppler changes in uterine artery and Baby weight in cases according to doppler changes in umbilical artery was not statistically significant.

Association of Low Levels of Placental Growth Factor With Abnormal Fetal Doppler Assessment [ID 2683423

INTRODUCTION: Placental growth factor (PlGF) is involved in placental angiogenesis and maturation. Low maternal serum PlGF levels predict placental dysfunction and associated conditions, such as preeclampsia, and fetal growth restriction. These pregnancy complications can lead to abnormal fetal Doppler assessment, indicating progressive fetal deterioration prompting preterm delivery. METHODS: We collected retrospective data from laboratory results of PlGF levels and fetal Dopplers (umbilical artery [UA], middle cerebral artery [MCA], and ductus venosus [DV]) from patients who had clinical indication for PlGF testing. Over 100 patients were identified to have results of all assessments between 2021 and 2023. Levels of PlGF were stratified in five categories according to gestational age and compared with normal and abnormal doppler results. For comparisons, the values were aggregated in normal and low PlGF. RESULTS: There were statistically significant associations between PlGF levels and Dopplers. Patients with low PlGF (less than 5th percentile for gestational age) were more likely to have abnormal dopplers than patients with normal PlGF (UA, P&lt;.001; MCA, P&lt;.001; DV, P&lt;.001). A normal PlGF had a high negative predictive value (NPV) for normal dopplers (UA, 88%; MCA, 94.3%; DV, 98.6%). CONCLUSION: The results show that normal PlGF is highly associated with normal Dopplers. Additional data will be required to account for confounding factors; however, our preliminary data suggest that PlGF could be a useful tool for patients in rural and remote locations, as normal PlGF has a statistically and clinically significant negative predictive value for normal Doppler assessment.

Role of soluble fms-like tyrosine kinase-1/placental growth factor ratio along with uterine artery Doppler for the prediction of pre-eclampsia – A case–control study

Role of soluble fms-like tyrosine kinase-1/placental growth factor ratio along with uterine artery Doppler for the prediction of pre-eclampsia – A case–control study

Doppler in High-Risk Pregnancy and Its Correlation With Feto-Maternal Outcomes: A Prospective Study.

In the current times, fetal growth monitoring has become readily available with the help of Doppler ultrasound. Identification of pregnancies that are at risk for perinatal morbidity and mortality has been a primary goal of obstetric care. Doppler study is a fast, non-invasive test that provides significant information about the hemodynamic status of the fetus. It is an efficient diagnostic modality to assess fetal compromise, which helps in timely intervention in high-risk pregnancies for better perinatal outcomes. The objectives of this study were to know the correlation between antenatal Doppler findings and perinatal outcomes, including preterm labor, cesarean section, birth weight, and rate of admission of neonates in the neonatal intensive care unit (NICU). Admission to NICU was taken as the primary outcome. This is a tertiary care hospital-based prospective study done at Maharaja Agrasen Medical College, Agroha, India. A hundred high-risk pregnant women with oligohydramnios, intrauterine growth restriction (IUGR), pregnancy-induced hypertension (PIH), diabetes mellitus (DM), anemia, or Rh incompatibility were included. Pregnancies in the first and second trimestersand congenital anomalies in babies were excluded from the study. The patients were examined for a Doppler study of the umbilical artery, fetal middle cerebral artery (MCA), and both maternal uterine arteries. Parameters in the form of a resistance index (RI), pulsatility index (PI), and systolic/diastolic ratio (S/D) of all the arteries were taken. Details of delivery and fetal outcomes were recorded. Data were correlated with Doppler findings. For comparing categorical data, the chi-square (X2) test and Fisher's exact test were performed. The comparison of continuous data between the two groups was done using an independent t-test. All statistical calculations were done using the computer programIBM SPSS Statistics for Windows, version 25 (released 2015; IBM Corp., Armonk, New York, United States). All the 100 cases with either normal or abnormal Dopplerwere comparable in terms of maternal age and parity. The prevalence of oligohydramnios was 27% (N = 27), PIH was seen in 20% (N = 20), anemia in 19% (N = 19), IUGR in 12% (N = 12), and oligohydramnios with IUGR in 13% (N = 13). In oligohydramnios, maternal anemia, Rh incompatibility, and DM, Doppler was found to be normal. In PIH, IUGR, and oligohydramnios with IUGR, abnormal Doppler was seen in four (20%), two (16%), and 10 (76%) cases, respectively. Among 84 candidates with normal Doppler, 49 (58%) got delivered by the vaginal route. Out of 16 abnormal Doppler cases, five were vaginally delivered (31%). Among 16 patients with abnormal Doppler, 15 patients, i.e., 93.75%, had low birth weight (LBW, <2.5 kg) (p-value < 0.001), 93.75% (N = 15) delivered before 37 weeks, and 13 (81.25%) newborns were admitted in the nursery. Abnormal Doppler was associated with an increased rate of low birth weight and admissions to the NICU with no effect on preterm delivery or cesarean section rates. The study strengthens the fact that Doppler studies in mothers can be used to plan the mode of delivery, predict the need for resuscitation, and anticipate the outcome of newborns.

Fetal anemia causes placental and maternal cellular damage: a lesson from fetal hemoglobin Bart's disease

IntroductionThe studies about effect of fetal anemia on placental and maternal molecular changes have rarely been published. This study aimed to compare oxidative stress levels and mitochondrial function in the placenta and maternal peripheral blood mononuclear cell (PMBCs) between anemic fetuses (using fetal Hb Bart's disease as a study model) and non-anemic fetuses. MethodsA cross-sectional study was conducted on pregnancies affected by Hb Bart's disease and non-anemic fetuses between 16 and 22 weeks of gestation. Placental tissue and maternal blood for PBMCs were collected after pregnancy termination for determination of oxidative stress and mitochondrial function. ResultsA total of 18 pregnancies affected by Hb Bart's disease and 12 non-anemic fetuses were enrolled. Placental thickness was significantly greater (p-value <0.001) in the affected pregnancies, whereas all Doppler indices of uteroplacental blood flow were comparable. Mitochondrial dysfunction was significantly increased (p-value <0.001) in the placenta of the affected fetuses. In the mothers of affected fetuses, there was an increase in mitochondrial oxidative stress levels with a significant increase in mitochondrial dysfunction in isolated PBMCs (p-value <0.001). DiscussionIn the presence of normal uteroplacental Doppler studies, fetal anemia can induce a significant increase in oxidative stress and mitochondrial dysfunction in the placentas and mothers. The findings support that the placenta can be a source of oxidative stress agents which are released into systemic circulation prior to development of maternal adverse outcomes, and may explain pathophysiology of subsequent preeclampsia in late gestation, as commonly seen in pregnancies affected by fetal Hb Bart's disease, if pregnancy is not terminated.

Intraoperative indocyanine green fluorescence imaging to predict early hepatic arterial complications after liver transplantation.

The purpose of this study was to propose an innovative intraoperative criterion in a liver transplantation setting that would judge arterial flow abnormality that may lead to early hepatic arterial occlusion, that is, thrombosis or stenosis, when left untreated and to carry out reanastomosis. After liver graft implantation, and after ensuring that there is no abnormality on the Doppler ultrasound (qualitative and quantitative assessment), we intraoperatively injected indocyanine green dye (0.01mg/Kg), and we quantified the fluorescence signal at the graft pedicle using ImageJ software. From the obtained images of 89 adult patients transplanted in our center between September 2017 and April 2019, we constructed fluorescence intensity curves of the hepatic arterial signal and examined their relationship with the occurrence of early hepatic arterial occlusion (thrombosis or stenosis). Early hepatic arterial occlusion occurred in 7 patients (7.8%), including 3 thrombosis and 4 stenosis. Among various parameters of the flow intensity curve analyzed, the ratio of peak to plateau fluorescence intensity and the jagged wave pattern at the plateau phase were closely associated with this dreaded event. By combining the ratio of peak to plateau at 0.275 and a jagged wave, we best predicted the occurrence of early hepatic arterial occlusion and thrombosis, with sensitivity/specificity of 0.86/0.98 and 1.00/0.94, respectively. Through a simple composite parameter, the indocyanine green fluorescence imaging system is an additional and promising intraoperative modality for identifying recipients of transplant at high risk of developing early hepatic arterial occlusion. This tool could assist the surgeon in the decision to redo the anastomosis despite normal Doppler ultrasonography.

Prenatal Features of MIRAGE Syndrome-Case Report and Review of the Literature.

MIRAGE syndrome is a recently described congenital condition characterized genetically by heterozygous gain-of-function missense mutations in the growth repressor sterile alpha domain containing 9 (SAMD9) located on the arm of chromosome 7 (7q21.2). The syndrome is rare and is usually diagnosed in newborns and children with myelodysplasia, infection, restriction of growth, adrenal hypoplasia, genital phenotypes, and enteropathy, hence the acronym MIRAGE. The aims of this paper are (1) to present fetal ultrasound features in a case where MIRAGE syndrome was diagnosed prenatally and (2) to review the existing literature records on prenatal manifestations of MIRAGE syndrome. In our case, the fetus had severe early fetal growth restriction (FGR) with normal Doppler studies, atypical genitalia, oligohydramnios, and hyperechogenic bowel at the routine mid-gestation anomaly scan. Amniocentesis excluded infections and numeric or structural chromosomal abnormalities while whole exome sequencing (WES) of the fetal genetic material identified the specific mutation. Targeted testing in parents was negative, suggesting the "de novo" mutation in the fetus. We could not identify other specific case reports in the literature on the prenatal diagnosis of MIRAGE syndrome. In cases reported in the literature where the diagnosis of MIRAGE syndrome was achieved postnatally, there are mentions related to the marked FGR on prenatal ultrasound. Severe early-onset FGR with no other apparent cause seems to be a central prenatal feature in these babies, and WES should be offered, especially if there are other structural abnormalities. Prenatal diagnosis of MIRAGE syndrome is possible, allowing for reproductive choices, improved counseling of parents, and better preparation of neonatal care.

Postnatal Genetic and Neurodevelopmental Assessment in Infants Born at Term With Severely Low Birth Weight of Non-placental Origin

ABSTRACT Small for gestational age (SGA) newborns are generally defined as those with a birth weight below the 10th percentile. Fetuses diagnosed with fetal growth restriction (FGR) are usually evaluated to determine if there is a pathological cause and thus a higher risk for adverse outcomes due to being small. Often when this diagnosis is made early in the third trimester, chromosomal microarray analysis is recommended to detect genetic disease. This study was designed to determine the frequency of monogenic disorders in term infants with severely low birth weight but normal Doppler results, as well as to estimate the frequency of neurodevelopmental impairment when a genetic etiology was ruled out. Inclusion criteria for this study were singleton pregnancy; term delivery; birth weight more than 2.5 SDs below the mean; normal Doppler studies of the umbilical artery, fetal middle cerebral artery, cerebroplacental ratio, and uterine artery; no maternal hypertensive disease; and no prenatal fetal structural or identified genetic anomalies or fetal infection. Exclusion criteria included incomplete data. Exome sequencing was completed using saliva sampling and blood sampling, and standard neurodevelopmental assessment techniques were used for children 2 to 3.5 and 6 to 8 years old. Children aged between 3.5 and 6 years were not included because of lack of standardized neurodevelopmental testing. A total of 63 families were contacted, and 7 (11%) reported that a genetic disorder had been diagnosed after birth. In addition, 18 individuals without a known genetic disorder who met all the criteria underwent exome sequencing and neurodevelopmental testing. Of the 7 who reported a postnatally diagnosed genetic syndrome, 5 were Mendelian monogenetic and 2 were epigenetic, including Cockayne syndrome; short stature, microcephaly, and endocrine dysfunction syndrome; Renpenning syndrome; Noonan syndrome; Russell-Silver syndrome; and Prader-Willi syndrome. Median birth weight among the children with genetic disorders was not different from children without. Exome sequencing was normal in the 18 children who were tested and who had not been previously diagnosed with a genetic syndrome. None of the children showed less than average neurodevelopment on overall assessment in the lower age group. In the higher age group, 2 children were classified as having low IQ, with one borderline and one extremely low, with low scores in all other domains as well. In addition, 6 individuals showed a low score in at least 1 of the 5 domains, with the largest deviations showing in the domains of verbal comprehension and working memory. Clinicians should be aware of the potential outcomes of FGR even when other complications are not present. Counseling about genetic analysis prenatally or within a short postnatal timeframe could save a lot of time and effort in evaluating children later. In addition, children should be carefully assessed in later childhood for neurodevelopmental differences that are treatable or that may require different resources. Future research should focus on further homogenizing the population to get more accurate results, as well as dealing with potential biases in this study.

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.