Prediction Of Adverse Fetal Outcomes Research Articles

Measurement of Cerebro-Placental Doppler Ratio and Amniotic Fluid Index as a Predictor of Perinatal Outcome in Prolonged Pregnancy

Background: The terms post-term, prolonged, postdates and post mature are often loosely used interchangeably to signifypregnancies that have exceeded a duration considered to be the upper limit of normal.Objective: The aim of this work was to study the role of Doppler velocimetry of the umbilical and middle cerebral arteriesrepresented by the cerebroplacental ratio and amniotic fluid volume in the prediction of adverse fetal outcome in post-termpregnancies.Materials and Methods: This is a prospective case control study conducted at Ain-Shams University Teaching Hospitalfor Obstetrics and Gynecology, Egypt. The study included 50 pregnant patients who were divided into two groups; group1included 25 pregnant ladies with gestational age of 41 weeks attending the casuality department in labour or in prodromaof labor. while, group 2 included 25 pregnant ladies with gestational age of 41 weeks not in labor and reaching thehospital for ANC, who were selected for termination based on the biophysical profile and poor Doppler indices or CTGchanges. All patients were submitted to antenatal fetal surveillance tests including modified biophysical profile (MBPP)which consists of the non-stress test (NST), amniotic fluid index (AFI), and color Doppler velocimetry of fetoplacentaland fetal vessels including MCA PI, UA PI, and CPR. The accuracy of cerebroplacental ratios (the middle cerebral arteryPI divided by the umbilical artery PI) and amniotic fluid volume as a means of predicting intrauterine fetal distress andadverse perinatal outcome in post-term pregnancies.Results: Cerebroplacental ratio showed the highest sensitivity (95%) in comparison with other parameters, so it is a goodtest to reassure the obstetricians of the fetal well being. Prominent changes in AFI (i.e. 5.0 cm. Asignificant association with FHR decelerations and presence of meconium is proved to exist when AFI is <5.0 cm.Conclusion: The addition of cerebral/umbilical ratios to antenatal surveillance protocols is expected to improve the perinataloutcome. It should be tried in the various high risk pregnancies whenever uteroplacental insufficiency is suspected.

The Prediction of Adverse Perinatal Outcomes in Intrauterine Growth Restriction using the Doppler Indices of Myocardial Performance and Aortic Isthmus

Background: Intrauterine growth restriction [IUGR] represented a challenging health problem, faced during daily clinical practice. Early diagnosis is of crucial importance. Aim of the work: To determine the value of the aortic isthmic flow index and the left mod-myocardial performance index [MPI] in the prediction of adverse perinatal outcomes in fetuses affected by IUGR. Patients and Methods: Forty Singleton fetuses with IUGR between 28 and 34 weeks were recruited. The left mod-MPI and the isthmic flow index [IFI] were calculated. Ultrasound indices had been correlated with perinatal outcome. Results: There was a statistically significant association between abnormal aortic isthmus diastolic flow and low 1-minute Apgar score and neonatal intensive care unit [NICU] admission. There was a statistically significant association between the left mod-MPI and the meconium stained amniotic fluid [AF], the need for Neonatal resuscitation, NICU admission, neonatal sepsis, and neonatal death. When considering cutoff value for prediction of adverse fetal outcome by Left MPI, a cutoff of 0.53 confers 85.2% sensitivity, 80% specificity, PPV 92%, NPV 66.7%, and accuracy of 83.8%. In addition, 85% of fetuses had normal Aortic isthmus [AoI] waveform [IFI type I] and 15% had abnormal AoI waveform, and there was a statistically significant association between abnormal AoI diastolic flow and each of [IFI of II, III, V], [low 1-minute Apgar score] and [NICU admission]. Conclusion: AoI IFI and left mod-MPI could be considered valuable for the assessment of chronic placental insufficiency, and play a role in prediction of adverse perinatal outcome associated with IUGR.‎

Relation of VEGF to the risk, severity and prognosis of preeclampsia

Objective: The aim of this work was to find out if serum level of vascular endothelial growth factor shows changes with the onset of preeclampsia that could be used as predictor for preeclampsia. Patients and Methods: This study included 60 primigravidae women divided into three groups, group (I) included 20 normal women, group (II) included 20 women with mild preeclampsia and group (III) included 20 women with severe preeclampsia.VEGF was measured in all groups and compared Results: VEGF concentrations measured in severe preeclampsia group were significantly higher than mild preeclampsia group and control group. Thus, VEGF concentrations could be used as a predictor for diagnosis and follow up of severity of preeclampsia. VEGF had significant value for discrimination between patients with PE (mild and severe) and controls with cutoff value >632.4 ng/l which had a sensitivity of (82.5%) and specificity of (85%). Also, serum VEGF concentration for discrimination between patients with severe PE and those with mild or no PE was >1335.5 ng/l with specificity of (92.5%) and sensitivity of (90%). VEGF had significant value for prediction of adverse fetal outcomes with cutoff value >741.5 ng/l which had a sensitivity of (95.65%) and specificity of (72.97%). Conclusion: According to the previous data obtained, serum VEGF level can be used as a predictor for preeclampsia.

EP04.09: The value of fetal umbilical Doppler study in prediction of adverse fetal outcome in early‐versus late‐onset intrauterine growth restriction

EP04.09: The value of fetal umbilical Doppler study in prediction of adverse fetal outcome in early‐versus late‐onset intrauterine growth restriction

Circulating Maternal Total Cell-Free DNA, Cell-Free Fetal DNA and Soluble Endoglin Levels in Preeclampsia: Predictors of Adverse Fetal Outcome? A Cohort Study.

The diagnosis of preeclampsia (PE) is based on the measurement of maternal blood pressure and proteinuria; however, these parameters are not used in the prediction of adverse fetal outcomes that may occur due to fetal stress. The plasma concentrations of total cell-free DNA (cf-DNA), cell-free fetal DNA (cff-DNA) and soluble endoglin (sEng) are higher in women with established PE than in normotensive controls, and the increase is particularly marked in those with severe PE. We aimed to evaluate the levels of cf-DNA, cff-DNA and sEng in pregnant Egyptian women with PE in order to assess the severity of the disease and to detect their potential utility in the future prediction of time of delivery and adverse fetal outcome. The study included 107 pregnant females with established PE during their third trimester (51 with mild PE and 56 with severe PE), together with 93 normotensive pregnant women. Absolute quantitation of the hemoglobin subunit beta (HBB) and testis-specific protein, Y-linked 1 (TSPY1) genes for the measurement of cf-DNA and cff-DNA in maternal blood, respectively, was carried out using real-time polymerase chain reaction (PCR) together with the measurement of serum sEng using ELISA. An almost twofold increase in cf-DNA and cff-DNA was detected in the severe PE group over the mild group, and both were significantly different from the control group. Significantly higher levels of cf-DNA, cff-DNA and sEng, with variable magnitudes, were detected in the preterm labor and unfavorable fetal outcome groups compared with the term and favorable outcome groups, respectively. The three markers were almost equivalent with regard to the area under the curve for predicting adverse fetal outcome in the severe PE group. The same was also true for cf-DNA and cff-DNA within the mild PE group. Incorporation of cf-DNA, cff-DNA and sEng into the prenatal care service should be considered as a serious addition for the screening and detection of adverse pregnancy outcomes in view of their significant elevations in cases of preeclamptic women whose babies ultimately suffered a poor outcome.

Is prenatal volumetric evaluation of aneurysm of the vein of Galen important in the prediction of adverse fetal outcome?

Aneurysm of the vein of Galen is a rare congenital vascular malformation of the central nervous system. There are controversies in the literature regarding the possible prognostic value of aneurysmal volume estimation with 3-dimensional US for the prediction of fetal outcome. In this report, we present a case of prenatally diagnosed large aneurysm of the vein of Galen complicated by heart failure in a fetus. The volume of the malformation was calculated as 17.8 cm(3) and the fetal outcome was poor.

A comparison between umbilical artery velocimetry and standard antepartum surveillance in hospitalized high-risk patients

One hundred forty-six women admitted to the high-risk obstetric unit between November 1987 and December 1988 participated in a study designed to compare Doppler umbilical artery flow studies with standard antepartum testing in the prediction of adverse fetal outcome. A Doppler ultrasound examination was considered abnormal when the average systolic/ diastolic ratio was greater than or equal to 4. The antepartum testing consisted of a combined use of nonstress testing and contraction stress testing. If both the Doppler systolic/ diastolic ratio and the antepartum testing were abnormal, there was a significantly increased incidence of intrauterine growth retardation (47%), fetal distress necessitating cesarean section (67%), and admission to neonatal intensive care (86%). Doppler umbilical artery flow studies are an important adjunct to antepartum fetal surveillance in high-risk patients but should not determine clinical management when standard antepartum surveillance remains normal.

Review: The value of fetal umbilical artery flow velocity waveforms in the prediction of adverse fetal outcome in high risk pregnancies

(1990). Review: The value of fetal umbilical artery flow velocity waveforms in the prediction of adverse fetal outcome in high risk pregnancies. Journal of Obstetrics and Gynaecology: Vol. 10, No. 4, pp. 261-270.