Pulmonary Artery Doppler Research Articles

Effect of maternal asthma on fetal pulmonary artery Doppler parameters: a case-control study.

To compare fetal pulmonary artery Doppler parameters between pregnant women with asthma and healthy pregnant women. This prospective, cross-sectional study was conducted on 50 pregnant women diagnosed with asthma and 61 healthy pregnant women. Fetal pulmonary artery Doppler parameters and the fetal main pulmonary artery acceleration time/ejection time (PATET) ratio were compared between the study and control groups. Thereafter, the study group was divided into two subgroups as non-severe and severe asthma. PATET ratio was compared between the subgroups. The fetal main pulmonary artery acceleration time was 25 ms in pregnant women with asthma and 33 ms in the healthy group, indicating a statistically significant difference (p=0.001). The acceleration time/ejection time ratio was statistically lower in the asthma group (0.185 vs. 0.240, p<0.001). The acceleration time/ejection time ratio was 0.172 in patients with severe asthma and 0.195 ms in the non-severe study group (p=0.156). In the maternal asthma group, the PATET ratio of those who went to the NICU due to respiratory distress was also 0.188, and the PATET ratio of those who went to the NICU for other reasons was 0.269 (p=0.053). Fetal pulmonary artery acceleration time and PATET decreased statistically in pregnant women with severe or non-severe asthma. Maternal asthma is associated with changes in pulmonary Doppler parameters in the fetus.

Fetal pulmonary artery Doppler's predictive usefulness in newborn respiratory distress syndrome

Fetal pulmonary artery Doppler's predictive usefulness in newborn respiratory distress syndrome

Association of maternal serum vitamin D level with fetal pulmonary artery Doppler indices and neonatal respiratory distress syndrome.

Respiratory distress syndrome (RDS) is potentially fatal in infants. The present study investigated the association of maternal serum vitamin D level with fetal pulmonary artery Doppler indices and neonatal RDS. This cross-sectional-analytical study was conducted on 260 mothers admitted for delivery. The maternal serum 25-hydroxyvitamin D level was measured and fetal main pulmonary artery Doppler indices were evaluated. The neonate's weight, apgar score, RDS, Umbilical cord arterial pH and neonatal intensive care unit admission were recorded. There was a significant relationship between RDS and the low level of vitamin D in the mother's serum. Mothers with low vitamin D had higher fetal pulmonary artery pulsatility index (PI) and peak systolic velocity (PSV) and lower acceleration time (AT) to ejection time (ET) ratio. Also, in neonates with RDS, pulmonary artery PI was higher, and PSV and the ratio of AT to ET were significantly lower than neonates without RDS. Neonates with lower one and 5-min apgar scores were born from mothers with lower vitamin D levels. Serum levels of vitamin D in pregnant mothers as well as fetal pulmonary artery Doppler indices are correlated to RDS. There is a significant relationship between the serum level of vitamin D in pregnant mothers and fetal pulmonary artery Doppler indices.

Predictive Value of Fetal Pulmonary Artery Doppler in Neonatal Respiratory Distress Syndrome

Predictive Value of Fetal Pulmonary Artery Doppler in Neonatal Respiratory Distress Syndrome

Shape of Pulmonary Artery Doppler Flow Profile and Right Ventricular Hemodynamics in Neonates

To characterize pulmonary artery Doppler flow profile (PAFP) patterns among infants receiving care in neonatal intensive care units (NICUs) and to examine the association of PAFP patterns with pulmonary and right ventricular (RV) hemodynamics. This is a retrospective study at two tertiary NICUs over 4 years that included neonates who demonstrated a complete tricuspid regurgitation envelope on targeted neonatal echocardiography (TNE). Separate personnel reviewed TNEs to characterize PAFP patterns, divide cohort into PAFP groups, and measure quantitative indices of RV hemodynamics (RV systolic pressure [RVSP], pulmonary artery acceleration time [PAAT] and its ratio with RV ejection time [RVET/PAAT], tricuspid annular plane systolic excursion [TAPSE] and RV output [RVO]), for intergroup comparisons. We evaluated TNEs from 186 neonates with median (IQR) gestational age of 28.5 weeks (25.9-35.9) weeks. Four distinct PAFP patterns were identified: A. near-isosceles triangle (22%), B. right-angled triangle (29%), C. notching (40%), and D. low peak velocity (<0.4 m/s; 9%). Groups A-C demonstrated a stepwise worsening in all indices of PH, while pattern D was associated with lower TAPSE and RVO. Using common definitions of pulmonary hypertension (PH), pattern A performed best to rule out PH [sensitivity range 81-90%] and pattern C for diagnosing PH [specificity range 63-78%]. Inspection of PAFP is a simple bedside echocardiography measure that provides clinically meaningful information on underlying RV hemodynamics and may aid in screening and monitoring of patients for PH in NICUs.

Correlation between Pulmonary Artery Doppler with Neonatal Outcome in Patients with Placenta Accreta Spectrum Disorders

Objective: The purpose of this study was to correlate fetal main pulmonary artery (PA) Doppler indices with the neonatal outcome in the late preterm and early term pregnancies in placenta accreta spectrum (PAS) patients Methods: A prospective cross-sectional study was conducted on 71 patients with PAS disorders singleton pregnancies undergoing elective or emergency termination of pregnancy under general anesthesia at or after 34 weeks. A full obstetrics ultrasound scan was performed within 24 hours before delivery and after corticosteroids administration to confirm the eligibility criteria and to measure PA Doppler indices in the main PA (pulsatility index (PI), resistance index (RI), systolic to diastolic (S/D) ratio, peak systolic velocity (PSV) and acceleration to ejection time (At/Et) ratio). Results: Twenty-three neonates needed respiratory support and neonatal intensive care unit (NICU) admission. Fetuses that needed respiratory support had a significantly lower gestational age at delivery (36±1.2 versus 36.8±0.5), lower estimated fetal weight (EFW) (2770±475 versus 3096±328), lower birth weight (2782±595 versus 3152±337) and also lower Apgar score than those who did not need. None of the PA Doppler parameters correlated with the neonatal need for respiratory support. The need for respiratory support was more in the neonates who were terminated on emergency basis (39.1% versus 60.9%). The depth of placental invasion correlated with maternal morbidity. Conclusions: PA Doppler parameters do not correlate with the need for respiratory support in patient with PAS disorders.

Prediction of Fetal Lung Maturity in Diabetic Women by Pulmonary Artery Doppler study (Controlled Clinical Trial)

Prediction of Fetal Lung Maturity in Diabetic Women by Pulmonary Artery Doppler study (Controlled Clinical Trial)

Assessment of fetal pulmonary artery Doppler indices in pregnant women with rheumatoid arthritis and ankylosing spondylitis.

To investigate fetal pulmonary artery Doppler parameters in pregnant women with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). This case-control study included 24 pregnant women diagnosed with 13 AS and 11 RA and 48 healthy pregnant women at 29-30 weeks of gestation. The demographic and clinical features were recorded, including disease type and duration, attacks during pregnancy, and medications. Pulmonary artery acceleration time (AT), ejection time (ET), and pulmonary artery acceleration time to ejection time (PATET) ratio were measured by manual trace with spectral Doppler ultrasound. A shorter pulmonary AT and lower PATET ratio were found in the case group (34.8 ± 2.3, p < 0.001, 0.18 ± 0.02, p < 0.001, respectively). When comparing the groups that had an attack during pregnancy and had not, there were no significant differences in the pulmonary artery indices. We also demonstrated a moderate correlation between maternal disease years and the PATET ratio (r = -0.562, p = 0.004). This is the first study to evaluate the effect of RA and AS on fetal pulmonary indices. Maternal inflammation might affect pulmonary development and circulation. Fetal pulmonary Doppler indices can be used to obtain further information about neonatal respiratory morbidities in rheumatological disorders.

Sonographic prediction of fetal main pulmonary artery (MPA) Doppler indices of lung maturity and neonatal respiratory distress syndrome (RDS) development

PurposeThe aim of this study is to highlight the predictive role of perinatal fetal main pulmonary artery (MPA) Doppler measurements in neonatal respiratory distress syndrome development. Respiratory distress syndrome (RDS) is one of the lead causes of neonatal respiratory distress as well as neonatal death. Thus, it seems logic to evaluate fetal lung maturity before labour.MethodsThe study is a prospective cohort study performed in tertiary hospital over a period of one-year duration. 70 pregnant ladies between 34 and 38 weeks of gestation were referred for fetal echo, when pregnancy was considered a high risk. A trained radiologist using dedicated ultrasound machine with updated obstetric and fetal echo software performed the fetal echo. Doppler mode and curvilinear probe of 5.7 MHz transducer. Pediatric neonatologist observed the neonatal outcome post-natally.ResultsA total of 70 pregnant patients with risk factors underwent fetal echo, 26/70 (37.1%) were diagnosed with RDS conforming to the neonatal criteria. The mean acceleration time/ejection time ratio (At/Et ratio) of the fetal pulmonary artery was significantly reduced in fetuses that subsequently developed RDS than those without RDS. Contrarily, the mean pulsatility index (PI), resistance index (RI), and peak systolic velocity (PSV) of the fetal pulmonary artery were significantly high in fetuses who later developed RDS than in those who did not.ConclusionFetal MPA Doppler measurements have a major role in anticipating the development of neonatal RDS in preterm and early term neonates.

Effect of maternal autoimmune diseases on fetal pulmonary artery Doppler indices: A case-control study.

To compare the fetal pulmonary artery Doppler indices of pregnant women with autoimmune diseases such as systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), and antiphospholipid syndrome (APS) with healthy pregnant women. Thirty-nine pregnancies were included in the case group, 19 of them SLE, 12 with SS, and eight with APS. The gestational age-matched 54 healthy pregnant women were included in the control group. Peak systolic velocity, time-averaged velocity, systolic/diastolic ratio, pulsatility index, resistance index, acceleration time (AT), ejection time (ET), and AT/ET ratio were obtained from pulmonary artery waveform by using spectral Doppler ultrasound. Significantly shorter AT and lower AT/ET ratio were detected in the case group (p=<.001, p=<.001, respectively). The shortening of AT and decreasing of the AT/ET ratio were more predominant in the APS group. However, there was no significant difference between the SLE, SS, and APS groups in fetal pulmonary artery Doppler indices. Also, a moderate correlation was found between maternal disease duration (years) and fetal pulmonary artery AT (r=-.516, p=.001) and AT/ET ratio (r=-.558, p=<.001). Fetal pulmonary artery Doppler indices may be affected in maternal autoimmune diseases. Further studies are needed to evaluate fetal pulmonary Doppler indices such as AT and AT/ET ratio to predict neonatal respiratory morbidity and lung maturation in pregnant women with SLE, SS, and APS.

Combined Fetal Pulmonary Artery Doppler and Proximal Humeral Ossification center for prediction of Neonatal Respiratory Distress Syndrome at term: a Cohort Prospective Study

Background: Fetal lung maturity is one of the huge dilemmas since a long time ago. Timing of the delivery is crucial for safe fetal delivery since verification of pulmonary maturity diminishes the respiratory morbidity possibility. Recently Pulmonary artery indices have been used to predict the possibility of RDS especially in early term. Together with humeral ossification center which has a remarkable value in estimation of term gestation, both of them can help prediction of fetal lung maturity. Aim of the Work: utilizing PHE with pulmonary artery Doppler indices for accurate prediction of fetal respiratory distress syndrome. The use of PHE in prediction of term gestation. Patients and Methods: Our study included 115 uncomplicated singleton pregnant women with gestational age between 37 to 40 weeks patients from Al-Azhar University Ob/Gyn hospitals during the period from November 2019 to October 2020. The ultrasound scans were done inside a 24 hours interval before delivery with Cesarean section. After delivery, the neonatal APGAR score at 1, 5 minutes, fetal diagnosis with RDS, any NICU admission were recorded respectively. Results: Pulmonary artery RI and PHE had statistically significant diagnostic performance in predicting fetal distress. PHE of ≤1.95 had highest diagnostic characteristics in predicting fetal distress. Among Pulmonary Artery Doppler, RI of ≥0.79 had highest diagnostic characteristics. Conclusion: PHE and Pulmonary artery R.I could predict fetal distress. Pulmonary artery indices and PHE combination (sum) predicted fetal distress better than using pulmonary indices alone. Presence of PHE confirms term gestation.

Fetal main pulmonary artery Doppler and prediction of lung maturity

Background Respiratory distress syndrome (RDS) in newborns occurs owing to surfactant deficiency. Decrease in quantity and quality of surfactant in lungs results in diminished surfactant activity. It affects not only preterm neonates but also term ones. RDS is a serious condition as it can lead to many neonatal comorbidities and even death. Doppler ultrasound is a noninvasive tool used for assessment of fetal biometry, so Doppler of pulmonary artery can be used safely in assessment of fetal lung maturity. Aim The purpose of our study was to assess the significance of fetal pulmonary artery Doppler in predicting lung maturity. Patients and methods A total of 50 pregnant women participated in this study with gestational age ranging from 34 to 39 weeks who were referred to the Diagnostic Radiology Department at Tanta University Hospitals during the period between December 2019 and December 2021. Results From the 50 pregnant women included in this study, six fetuses developed RDS. The greatest correlation was found with acceleration time/ejection time (AT/ET) ratio and resistive index (RI) with high sensitivity and specificity (P=0.000 and P&lt;0.001, respectively). A cutoff value AT/ET less than 0.297 and RI more than 0.889 predicted RDS with sensitivity of 94.8 and 89.1%, respectively, and specificity of 83.5 and 78.2%, respectively. Conclusion Neonatal RDS can be predicted by pulmonary artery AT/ET ratio and RI with high sensitivity and specificity.

Retracted: The Role and Clinical Value of Optimized Fetal Main Pulmonary Artery Doppler Parameters in the Diagnosis and Prognosis Monitoring of Neonatal Respiratory Distress Syndrome.

[This retracts the article DOI: 10.1155/2022/1682225.].

Fetal pulmonary artery Doppler parameters in pregnancies complicated with intrahepatic cholestasis of pregnancy: a prospective case-control study

The primary aim of this study was to determine whether pulmonary artery acceleration time (AT) to ejection time (ET) ratio (PATET) was altered in fetuses of mothers with intrahepatic cholestasis of pregnancy (IHCP). The secondary aim was to investigate the association between fetal pulmonary artery Doppler parameters with neonatal outcomes in pregnancies complicated by IHCP. This prospective case control study was conducted in a tertiary perinatal-neonatal center. A total of 18 fetuses whose mothers’ pregnancies were complicated by IHCP were included as the study group and a total of 37 fetuses of mothers with healthy pregnancies were selected as controls. Fetal pulmonary artery Doppler parameters (AT; ET; AT/ET ratio) were assessed and neonatal outcomes were evaluated. Mean pulmonary artery AT, ET and PATET were significantly different between the groups (p=0.001, p=0.024 and p=0.003, respectively). The mean PATET value in the IHCP group was 0.217±0.029 while in the control group it was 0.180±0.020. While PATET values were correlated with gestational age at birth, respiratory distress and need for neonatal intensive care admission were not correlated with PATET. Higher values of PATET may be a useful biomarker of fetal lung damage, secondary to IHCP.

Prediction of Lung maturity with Fetal breathing movement and Pulmonary artery Doppler Indices

Prediction of Lung maturity with Fetal breathing movement and Pulmonary artery Doppler Indices

Validity of foetal Doppler indices in predicting postnatal respiratory distress syndrome: a prospective study

BackgroundRespiratory distress syndrome (RDS) is a potentially fatal condition of neonate occurring due to alveolar surfactant deficiency causing inefficient gaseous exchange and leading to hampered respiratory function. Purpose of our study is to investigate the role of Doppler indices in antenatal prediction of clinical Respiratory Distress Syndrome (RDS) in late preterm and early term foetuses using Main pulmonary artery (MPA) Doppler indices. The current study was conducted on 342 pregnant women between 34 and 39 weeks of gestational age, who came for routine third trimester ultrasound examination. The standard foetal biometric parameters, gestational age and estimated foetal weight were first obtained. The MPA Doppler indices like pulsatility index (PI), resistivity index (RI), peak systolic velocity (PSV), systolic/diastolic ratio and acceleration time/ejection time (At/Et) were recorded and correlated with the postnatal development of RDS.ResultsOf the 342 foetuses, neonatal RDS was diagnosed in 47 foetuses. Foetuses diagnosed with RDS had statistically higher PI and RI values, whereas At/Et ratio and PSV were lower. At/Et ratio, PI and RI, PSV showed significant correlation with gestational age and the most statistically significant correlation was found with At/Et ratio. A cut-off value of 0.2865 (sensitivity 89.45%, specificity 94.79%) and 0.3155 (sensitivity 93.22%, specificity 96.78%) correlated strongly with development of RDS in late preterm foetuses and early term infants.ConclusionFoetal MPA indices like PSV, RI, PI and especially Foetal At/Et ratio is a promising non-invasive tool which helps in identifying foetuses at risk and may be very useful to plan delivery in complicated pregnancies and also for better post-natal care of the neonate.

The Role and Clinical Value of Optimized Fetal Main Pulmonary Artery Doppler Parameters in the Diagnosis and Prognosis Monitoring of Neonatal Respiratory Distress Syndrome.

Objective A retrospective study was conducted to explore the role and clinical value of optimized fetal main pulmonary artery Doppler parameters in the diagnosis and prognosis monitoring of neonatal respiratory distress syndrome (NRDS). Methods Pregnant women admitted to our hospital for delivery from March 2019 to June 2021 were included in the study. There were 372 singleton pregnant women who voluntarily underwent ultrasound and Doppler examinations with informed consent for the study. The AT/ET ratio of the middle segment of the main pulmonary artery, the middle part of the left (or right) pulmonary artery, and the proximal segment of the intrapulmonary artery was measured by ultrasonic Doppler. According to the outcome of the newborn, it was divided into NRDS group (n =90) and non-NRDS group (n =282) to compare the differences of fetal AT/ET ratio at three Doppler sampling locations and the differences of fetal AT/ET ratio in different gestational weeks. Using Pearson's correlation analysis, the correlation among the Doppler parameters of fetal main pulmonary artery, the ratio of AT and AT/ET, gestational weeks, and the efficiency of prenatal prediction of NRDS was evaluated by receiver-operating characteristic (ROC). In addition, the diagnostic efficiency of fetal main pulmonary artery Doppler parameter AT/ET ratio and amniotic fluid method for prenatal prediction of NRDS was compared. Results Compared with the non-NRDS group, the gestational age, gestational age at delivery, and birth weight in the NRDS group were significantly lower than those in the non-NRDS group. The 1 min Apgar score of newborns was less than 7, and the proportion of newborns transferred to NICU was significantly higher than that in the control group. Compared with non-NRDS group, AT was significantly shortened, AT/ET ratio was significantly decreased, and ET was significantly prolonged in NRDS group. The fetal aortic blood flow parameters AT, ET, and AT/ET ratio in different gestational weeks were significantly different among the three groups. The AT/ET ratio in the middle segment of the aorta in NRDS group was lower than that in non-NRDS group. The ratio of AT/ET was still correlated with the occurrence of postpartum NRDS. The AUC value of NRDS predicted by AT/ET ratio was 0.984. In the combined determination of amniotic fluid Lh and S ratio and PG, the diagnostic accuracy of prenatal prediction of neonatal respiratory distress syndrome was 100.005%, 98.43%, and 95.56%, respectively. The accuracy of fetal aortic AT/ET ratio in prenatal prediction of neonatal respiratory distress syndrome was 100.005%, 95.28%, and 95.57%, respectively. The order of Kappa coefficient from high to low was amniotic fluid PG/L/S ratio, fetal main pulmonary artery blood flow parameter AT/ET ratio, amniotic fluid L/S ratio, OD650, amniotic fluid PG, and foam test. Conclusion Fetal main pulmonary artery Doppler AT/ET ratio may be a very potential parameter for prenatal noninvasive prediction of NRDS. The fetal main pulmonary artery Doppler flow spectrum may be a very potential alternative to amniocentesis to evaluate FLM.

Comparison between Amniotic Fluid Lamellar Body Count and Fetal Pulmonary Artery Doppler Indices in Predicting Fetal Lung Maturity in Cases of PPROM

Comparison between Amniotic Fluid Lamellar Body Count and Fetal Pulmonary Artery Doppler Indices in Predicting Fetal Lung Maturity in Cases of PPROM

Acceleration time to Ejection time ratio in fetal pulmonary artery system can predict neonatal respiratory disorders in gestational diabetic mellitus women

Few researches studied fetal pulmonary pulse wave doppler and the clinical end point disorders in gestational diabetic mellitus (GDM) cohort. To investigate fetal pulmonary artery acceleration time to ejection time ratio (PATET) in the prediction of neonatal respiratory disorders (NRD). 238 pregnant women diagnosed with GDM who attended our hospital between February 2018 and March 2020 were retrospectively included. Fetal pulmonary artery Doppler wave measurements were recorded, including main, left and right pulmonary artery blood flow, and left and right peripheral pulmonary artery blood flow. Acceleration time (At)/ejection time (Et) were calculated. 183 GDM pregnant women and neonates were divided into NRD(+)(n = 42) and NRD(-) group (n = 141). 16 cases were neonatal pneumonia (NP) within 28 days after birth in NRD(+) group. The area under curve (AUC) of left peripheral pulmonary artery acceleration time to ejection time (LPPATET) was 0.967 (95% CI: 0.927∼1.000, P < 0.001) and the AUC of right peripheral pulmonary artery acceleration time to ejection time (RPPATET) was 0.967 (95% CI: 0.927∼1.000, P < 0.001), indicating that LPPATET and RPPATET are both predictors for NRD. The results of interobserver variabilty and intraobserver variability showed a good consistency. The At/Et of fetal peripheral pulmonary artery (PPA) in GDM women may be predictors for NRD, and the indicator can provide assistance in clinical management of diabetes pregnant patients.

The Relationship between Pulmonary Artery Doppler and Non-Doppler Sonographic Parameters in the Fetal Lung Maturity According to Gestational Age

Background: The evaluation of ultrasonic parameters of the lungs, especially the pulmonary arteries for gestational age, is still the first assessment of fetal lung maturity. We aimed to assess the relationship between pulmonary artery Doppler and non-Doppler sonographic parameters in the lung maturation of a fetus according to gestational age. Methods: This cross-sectional study was performed on pregnant women at different gestational ages that were indicated for Doppler ultrasonography as an indication for assessing fetal lung maturity. The correlation between non-Doppler sonographic indices and fetal pulmonary artery Doppler indices was evaluated. Results: Epiphyseal ossification centers, BPD, pulmonary echogenicity and free particles immersed in amniotic fluid were significantly higher in the group with a gestational age of 34 to 40 weeks than the group with a gestational age of 25 to 32 weeks. There was a significant difference in the mean of peak systolic velocity (PSV), ejection time (ET), acceleration time (AT) as well as acceleration time/ejection time (AT/ET) ratio between the two groups with a gestational age of 34 to 40 weeks and the group with a gestational age of 25 to 32 weeks. PSV, AT, ET, and AT/ET ration could predict fetal lung maturity with high sensitivity and specificity. Conclusion: With increasing gestational age, an increase in PSV, increase in AT, decrease in ET, and increase in AT/ ET indices are expected. In this regard, PSA, AT, ET, and AT/ET values are able to predict neonatal lung maturity with acceptable sensitivity and specificity.