Pulsatility Index Ratio Research Articles

Role Of Middle Cerebral Artery / Umbilical Artery Pusatility Index Ratio (cerebro-placental ratio CPR) For Prediction Of Fetal Outcome In Preeclamptic Patients

Objective: The aim of this prospective observational study is to assess the accuracy of Doppler indices of umbilical and middle cerebral especially fetal middle cerebral artery/umbilical artery pulsatility index ratio during the third trimester in predicting acidemia and low Apgar score at 5 minutes after birth in neonates of women with preeclampsia. To provide basis for use of Doppler tests in directing treatment protocol for preeclamptic patients. Methods: Study design: Cohort observational study among women with preeclampsia. Study setting: One hundred cases who were at 32 to 40 weeks of gestation with preeclampsia(from March 2017 to March 2018) attended antenatal clinic and emergency room at obstetrics and gynecology department, faculty of medicine, Sohag University Hospital. Ultrasound was performed at fetal care unit at Sohag University Hospital. Results: This observational cross-sectional study was designed to assess Doppler indices of umbilical artery as predictor of neonatal outcomes among women with preeclampsia.A total 100 pregnant women with preeclampsia were recruited in the study Conclusion: We recommend adding MCA (PI)/ UA (PI) ratio to routine antepartum fetal surveillance from 32 weeks gestation for women with preeclampsia as there is a strong correlation between it and poor neonatal outcomes.

Fetal Medicine Foundation reference ranges for umbilical artery and middle cerebral artery pulsatility index and cerebroplacental ratio.

To develop gestational age-based reference ranges for the pulsatility index in the umbilical artery (UA-PI) and fetal middle cerebral artery (MCA-PI) and the cerebroplacental ratio (MCA-PI/UA-PI), and to examine the maternal characteristics and medical history that affect these measurements. This was a cross-sectional study of 72 387 pregnancies undergoing routine ultrasound examination at 20 + 0 to 22 + 6 weeks' gestation (n= 3712), 31 + 0 to 33 + 6 weeks (n= 29 035), 35 + 0 to 36 + 6 weeks (n= 37 252) or 41 + 0 to 41 + 6 weeks (n= 2388). For the purpose of this study, we included data for only one of the second- or third-trimester visits. The inclusion criteria were singleton pregnancy, dating by fetal crown-rump length at 11 + 0 to 13 + 6 weeks' gestation, live birth of a morphologically normal neonate and ultrasonographic measurements by sonographers who had received the Fetal Medicine Foundation Certificate of Competence in Doppler ultrasound. Since the objectives of the study were to establish reference ranges, rather than normal ranges, and to examine factors from maternal characteristics and medical history that affect these measurements, we included all pregnancies having routine ultrasound examinations, irrespective of whether the mother had a pre-existing medical condition, such as diabetes mellitus, or a pregnancy complication, such as pre-eclampsia or suspected fetal growth restriction. Median and SD models were fitted between UA-PI, MCA-PI and CPR and gestational age. Assessment of goodness of fit of the models was by inspection of quantile-to-quantile (Q-Q) plots of Z-scores calculated using the mean and SD models. The distributions of MCA-PI, UA-PI and CPR Z-scores were examined in relation to maternal characteristics and medical history. The relationship between the median and gestational age was linear for UA-PI and cubic for MCA-PI and CPR and the SD was log quadratic for all three. MCA-PI and CPR increased with gestational age from 20 weeks' gestation to reach a peak at around 32 and 34 weeks, respectively, and decreased thereafter, whereas UA-PI decreased linearly with gestational age from 20 to 42 weeks. Compared to the general population, significant deviations in multiples of the median values of UA-PI, MCA-PI and CPR were observed in subgroups of maternal age, body mass index, racial origin, method of conception and parity. This study established new reference ranges for UA-PI, MCA-PI and CPR, according to gestational age, and reports maternal characteristics and medical history that affect these measurements. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Transcranial Doppler and Hematoma Expansion in Acute Spontaneous Primary Intracerebral Hemorrhage.

Context:The data on the role of Transcranial Doppler (TCD) in the management of acute primary intracerebral hemorrhage (ICH) is meager.Aims:To study TCD variables associated with hematoma expansion in acute primary ICH.Settings and Design:The study was carried out in the neurosciences department of Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh from July 2010 to September 2011 employing a prospective, double blinded non randomized study design.Materials and Methods:Acute ICH patients within 24 h of symptom onset were recruited. Baseline neuroimaging study (Computerized tomography, CT scan of brain) was performed to assess the pure hematoma volume by AXBXC/2 method. Baseline TCD parameters were obtained from both the middle cerebral arteries (MCAs; affected and unaffected hemisphere): Peak Systolic velocity, End Diastolic velocity, Mean Flow velocity, Resistance Index, and Pulsatility Index. Follow up (24 h) assessment of hematoma volume and TCD were carried out. Each of the TCD variables were compared in hematoma expansion (>33% increase in hematoma volume on the follow-up CT) and non-expansion group.Statistical analysis:On univariate analysis, the Student's t-test and contingency tables with the X2 test were used. A forward stepwise multivariate logistic regression analysis with hematoma expansion at 24 h as the dependent variable and ROC analysis was carried out, using SPSS software version 16 (Chicago, IL). P value < 0.05 was considered significant.Results:Twenty-five patients completed the study. Ten patients (40%) had hematoma expansion. Multivariate analysis revealed unaffected hemisphere MCA Pulsatility Index ratio [unaffected hemisphere MCA Follow up Pulsatility Index/baseline Pulsatility Index] of > 1.055 as the lone correlate of hematoma expansion (sensitivity of 90% and specificity of 60%).Conclusion:Frequent assessment with TCD could aid in prediction of hematoma expansion by measuring unaffected hemisphere Pulsatility Index ratios.

Effects of pelvic floor bioelectrical stimulation on frozen embryo transfer patients with thin endometrium

This study was to observe the effects of pelvic floor bioelectrical stimulation on pregnancy outcome and serum estradiol (E2) and progesterone (P) levels in frozen embryo transfer patients with thin endometrium. 120 cases frozen embryo transfer patients with thin endometrium in our hospital from March 2016 to April 2017 were selected. These patients received artificial cycle replacement plan before embryo transfer. According to whether pelvic floor bioelectrical stimulation therapy was accepted, 120 cases of thin endometrial frozen embryo transfer were divided into control group and observation group. 50 cases of the control group received artificial cycle to prepare for embryo transplantation, while 70 cases of observation group received bioelectrical stimulation as intervention treatment on the basis of artificial cycle. The intima thickness, subintimal hemodynamic parameters, embryo implantation rate, and clinical pregnancy rate were compared between the two groups before and after treatment. There was no significant difference in endometrial thickness between the two groups on the 10th day of menstruation ( P &gt; 0.05). The thickness of endometrium and the index of intima growth in the observation group were significantly higher than those in the control group ( P &lt; 0.05). The pulsatility index, resistance index, and systolic and diastolic blood flow velocity ratio of subintimal blood flow in the observation group were significantly higher than those in the control group ( P &lt; 0.05). Before treatment, there was no significant difference in serum E2 and P between the two groups ( P &gt; 0.05). After treatment, the improvement of serum E2 and P in the observation group was significantly better than that of the control group ( P &lt; 0.05). The embryo implantation rate (25.7%) in the observation group was significantly higher than that in the control group (17.0%) ( P &lt; 0.05). The clinical pregnancy rate (47.1%) in the observation group was significantly higher than that in the control group (30%) ( P &lt; 0.05). In conclusion, the intervention of pelvic floor bioelectrical stimulation can improve the blood perfusion of thin endometrium, improve the endometrial receptivity, increase the implantation rate of frozen embryo transfer in patients with thin endometrium, and improve the level of serum estradiol and progesterone.

935: Can cerebroplacental ratios predict perinatal and delivery outcomes for viable fetuses?

To evaluate the relationship between fetal ultrasound assessments and perinatal and delivery outcomes in singleton term pregnancies. A retrospective cohort study of singleton deliveries ≥ 24 weeks’ gestation was conducted at a community hospital between January 2016 and January 2018. The fetal cerebroplacental ratio (CPR) is the ratio of the fetal middle cerebral artery (MCA) pulsatility index (PI) to umbilical artery (UA) PI. CPR is gaining momentum to be a proxy for suboptimal fetal growth as it quantifies suboptimal placental function and subsequent fetal circulatory adaptations. We hypothesize the use of CPR as a generalized marker and potential screening tool as it looks as placental resistance and fetal physiologic response to reach growth potential for Small for Gestational Age (SGA) fetuses and Appropriate for Gestational Age (AGA) fetuses. The UA PI, MCA PI, and CPR were compared to maternal BMI, fetal weight at birth, delivery outcomes, and APGAR scores. Logistic regression analysis was performed to identify, and adjust for, potential confounders using SAS version 9.4 with a p < 0.05 considered as significant. The study cohort included 1732 singleton pregnancies. CPR had a linear association with fetal weight and gestational age (p < 0.0001). The average CPR ratio of spontaneous vaginal deliveries was higher than of caesarean-sections (C-sections) (p= 0.0193). The average UA PI of spontaneous vaginal deliveries was lower than of C-sections (p= 0.0150). The CPR had a weak positive and UA PI ratio had a weak negative correlation with APGAR score at 1 and 5 minutes. CPR and UA PI had no significant association with maternal BMI (p= 0.2330). Our study shows that lower fetal CPR is associated with higher C-section rates in both SGA and AGA fetuses. Since low CPR is directly correlated with an elevated UA PI Doppler, this surveillance may be independently associated with delivery outcomes. These fetal ultrasound assessments may be valuable in predicting delivery outcomes of pregnancies at risk of operative deliveries, potential placental hypoxemia and cerebral redistribution affecting long-term neurodevelopmental disability.

Using cerebroplacental ratio in non-SGA fetuses to predict adverse perinatal outcome: caution is required.

The CPR is the ratio of the fetal Middle Cerebral Artery Pulsatility index (MCA PI) to the Umbilical Artery Pulsatility index (UA PI) with gestation specific reference centiles available. A low CPR is now generally accepted as a proxy for late fetal growth restriction (FGR). This article is protected by copyright. All rights reserved.

OP13.03: Reference centiles for the middle cerebral artery and umbilical artery pulsatility index and cerebroplacental ratio from a low‐risk population: a generalised additive model for location, shape and scale (GAMLSS) approach

OP13.03: Reference centiles for the middle cerebral artery and umbilical artery pulsatility index and cerebroplacental ratio from a low‐risk population: a generalised additive model for location, shape and scale (GAMLSS) approach

Reference centiles for the middle cerebral artery and umbilical artery pulsatility index and cerebro-placental ratio from a low-risk population – a Generalised Additive Model for Location, Shape and Scale (GAMLSS) approach

Objective: The primary aim of this study was to create reference ranges for the fetal Middle Cerebral artery Pulsatility Index (MCA PI), Umbilical Artery Pulsatility Index (UA PI) and the Cerebro–Placental Ratio (CPR) in a clearly defined low-risk cohort using the Generalised Additive Model for Location, Shape and Scale (GAMLSS) method.Methods: Prospectively collected cross-sectional biometry and Doppler data from low-risk women attending the Mater Mother’s Hospital, Maternal and Fetal Medicine Department in Brisbane, Australia between January 2010 and April 2017 were used to derive gestation specific centiles for the MCA PI, UA PI and CPR. All ultrasound scans were performed between 18 + 0 and 41 + 6 weeks gestation with recorded data for the MCA PI and/or UA PI. The GAMLSS method was used for the calculation of gestational age-adjusted centiles. Distributions and additive terms were assessed and the final model was chosen on the basis of the Global Deviance, Akaike information criterion (AIC) and Schwartz bayesian criterion (SBC), along with the results of the model and residual diagnostics as well as visual assessment of the centiles themselves.Results: Over the study period 6013 women met the inclusion criteria. The MCA PI was recorded in 4473 fetuses, the UA PI in 6008 fetuses and the CPR was able to be calculated in 4464 cases. The centiles for the MCA PI used a fractional polynomial additive term and Box-Cox t (BCT) distribution. Centiles for the UA PI used a cubic spline additive term with BCT distribution and the CPR used a fractional polynomial additive term and a BCT distribution.Conclusion: We have created gestational centile reference ranges for the MCA PI, UA PI and CPR from a large low-risk cohort that supports their applicability and generalisability.

Abstract WMP67: Arterial Velocity on Carotid Ultrasonography Can Predict the Stenosis Progression in Patients With Vertebro-basillar Dissection

Purpose: Morphological changes of affected arteries in intracranial artery dissection often occur in the acute phase. The usefulness of carotid ultrasonography (CU) to evaluate the changes is not well investigated. The purpose of this study was to assess the value of CU indexes to detect artery stenosis progression on magnetic resonance angiography (MRA). Methods: This is a retrospective, single-center, observational study. We enrolled patients with intracranial vertebro-basilar artery dissection diagnosed based on criteria by the expert group (Debette S, et al: Lancet Neurol 2015) who were admitted within 30 days after onset from 2011 January to 2017 June. Carotid ultrasonography was performed on admission (median 0 days after onset) and follow-up (median, 40 days after onset; interquartile range, 11-106) to examined the flow velocity of both vertebral arteries. MRA was done on admission and follow-up just before or after the follow-up CU. Two stroke neurologists who were blinded to patients’ information assessed the change of vessel forms on MRA; stenosis progression was defined as an follow-up arterial diameter of &lt;50% as compared to that at baseline on MRA. Patients were divided into two groups: those with stenosis progression (P group ) and the others (non-P group). Peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (MV) and pulsatility index (PI) were measured by CU and each baseline to follow-up ratio (follow-up/baseline) was compared between the two groups. Result: Of 26 patients (11 women, 53±8 years old) who were enrolled, 10 (28%) showed stenosis progression (P group). The P group had lower EDV ratio (0.34±0.63 vs 1.05±0.39, P&lt;0.01) and higher PI ratio (1.95±0.76 vs 0.85±0.30, P&lt;0.01) than the non-P group. Using Receiver Operating Characteristic (ROC) curve analysis, the area under the curve (AUC) of EDV ratio to predict stenosis progression was 0.87 (P&lt;0.01) with the cut-off value of 0.54, sensitivity of 87.5% and specificity of 93.3% and that of PI ratio was 0.93 (P&lt;0.01) with 1.17, 88.9% and 82.3%, respectively. Conclusion: Carotid ultrasonography is useful to predict the chrocnic stenosis progression of vertebra-basilar artery dissection.

Impact of maternal body mass index on umbilical artery indices and neonatal outcome

Objectives: This study was designed to clarify the relationship between maternal body mass index (BMI) and umbilical artery (U.A) indices and to evaluate the effect of maternal BMI on the neonatal outcome. Study Design: This was a prospective cohort study. Patients and Methods: This study included 121 pregnant women with uncomplicated, singleton pregnancy between 18 and 35 years, at 32 weeks of gestation, seen in Al-Yarmouk Teaching Hospital antenatal care. Women were divided according to the BMI into underweight (BMI Results: Obese women had significantly higher pulsatility index, resistance index, and systolic-diastolic ratio compared to overweight and normal weight groups ( P P P Conclusion: The current study showed the negative impact of increasing BMI on fetoplacental circulation and increased risk of C/S. Neonates of obese mothers had low 5 min Apgar score.

Role of Color Doppler Flowmetry in Prediction of Intrauterine Growth Retardation in High-Risk Pregnancy

Objective: To evaluate the usefulness of Color Doppler flowmetry in the prediction of intrauterine growth restriction (IUGR) in high-risk pregnancies.Materials and method: A total of 62 high-risk pregnant women underwent Color Doppler flowmetric umbilical artery pulsatility index (PI), resistive index (RI) and systolic/diastolic (S/D) ratio, middle cerebral artery PI, RI and S/D ratio, Ductus venosus S-wave/isovolumetric A-wave index (SIA) and vertebral artery RI at 23-27 weeks, 28-32 weeks and 32-36 weeks of their pregnancy. Cerebral-umbilical C/U PI, RI and S/D were evaluated at the third visit. All the pregnancies were followed up till delivery. Ponderal index <10 was considered to be indicative of IUGR. Data were analyzed using IBM Statistical Package for Social Sciences (SPSS) 21.0.Results: Thirty-nine (62.9%) deliveries were IUGR. On all the three visits, umbilical artery, mean PI, RI and SD values were significantly higher while MCA PI, RI and SD values were significantly lower in IUGR as compared to non-IUGR cases. Third visit C/U PI, RI and SD ratio values were also significantly lower in IUGR as compared to non-IUGR cases. Ductus venosus SIA values did not show a significant difference between IUGR and non-IUGR groups. The vertebral artery resistive index was significantly higher in non-IUGR as compared to IUGR on all the visits. Umbilical artery PI was the most sensitive and specific for the prediction of IUGR at all the three visits, with the maximum sensitivity and specificity at the third visit (82.1% and 87%). Third visit C/U PI was most sensitive (82.1%) and specific (96.7%) for the prediction of IUGR.Conclusion: This showed that Doppler flowmetry is a useful method for the prediction of IUGR in high-risk pregnancies.

Prediction of fetal growth restriction using estimated fetal weight vs a combined screening model in the third trimester

To compare the performance of third-trimester screening, based on estimated fetal weight centile (EFWc) vs a combined model including maternal baseline characteristics, fetoplacental ultrasound and maternal biochemical markers, for the prediction of small-for-gestational-age (SGA) neonates and late-onset fetal growth restriction (FGR). This was a nested case-control study within a prospective cohort of 1590 singleton gestations undergoing third-trimester (32 + 0 to 36 + 6 weeks' gestation) evaluation. Maternal baseline characteristics, mean arterial pressure, fetoplacental ultrasound and circulating biochemical markers (placental growth factor (PlGF), lipocalin-2, unconjugated estriol and inhibin A) were assessed in all women who subsequently delivered a SGA neonate (n = 175), defined as birth weight < 10th centile according to customized standards, and in a control group (n = 875). Among SGA cases, those with birth weight < 3rd centile and/or abnormal uterine artery pulsatility index (UtA-PI) and/or abnormal cerebroplacental ratio (CPR) were classified as FGR. Logistic regression predictive models were developed for SGA and FGR, and their performance was compared with that obtained using EFWc alone. In SGA cases, EFWc, CPR Z-score and maternal serum concentrations of unconjugated estriol and PlGF were significantly lower, while mean UtA-PI Z-score and lipocalin-2 and inhibin A concentrations were significantly higher, compared with controls. Using EFWc alone, 52% (area under receiver-operating characteristics curve (AUC), 0.82 (95% CI, 0.77-0.85)) of SGA and 64% (AUC, 0.86 (95% CI, 0.81-0.91)) of FGR cases were predicted at a 10% false-positive rate. A combined screening model including a-priori risk (maternal characteristics), EFWc, UtA-PI, PlGF and estriol (with lipocalin-2 for SGA) achieved a detection rate of 61% (AUC, 0.86 (95% CI, 0.83-0.89)) for SGA cases and 77% (AUC, 0.92 (95% CI, 0.88-0.95)) for FGR. The combined model for the prediction of SGA and FGR performed significantly better than did using EFWc alone (P < 0.001 and P = 0.002, respectively). A multivariable integrative model of maternal characteristics, fetoplacental ultrasound and maternal biochemical markers modestly improved the detection of SGA and FGR cases at 32-36 weeks' gestation when compared with screening based on EFWc alone. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Color Doppler Imaging of Cerebral-Umbilical Pulsatility Ratio in Intrauterine Growth Retardation

Background: Intrauterine growth retardation (IUGR) refers to a condition in which a fetus is unable to achieve its genetically determined potential size. IUGR may also be defined as growth at the 10th or less percentile for weight of the all fetuses at that gestational age. It has long been recognized that impaired fetoplacental perfusion is associated with intrauterine growth retardation. Ultrasonography with Color Doppler has provided a new tool for this purpose.Objective: To evaluate the role of Color Doppler ultrasonography in the diagnosis of IUGR.Materials and Methods: This prospective study was carried out in the department of Radiology &amp; Imaging of Dhaka Medical College Hospital within a period of January 2010 to September 2011 on 90 patients aged between 17?35 years who were clinically suspected as cases of IUGR or previously USG diagnosed cases of IUGR.Results: The highest incidence of IUGR was found in the age group between 21?25 years. The mean gestational age at birth was 33.2 ± 3.5 weeks and mean birth weight 1.3 ± 6.2 kg in case of abnormal cerebral-umbilical (C/U) ratio group. According to cerebral-umbilical pulsatility index (PI) value 65 cases (72.2%) were diagnosed as abnormal and 25 (27.8%) as normal flow pattern. Perinatal findings showed that 67 were small for gestational age (SGA) and 23 had normal birth weight. The validity of cerebral-umbilical PI ratio for diagnosis of IUGR was studied by calculating sensitivity, specificity, accuracy, PPV and NPV.Conclusion: In this study Color Doppler findings of cerebral-umbilical vessels and the validity tests reveal that Color Doppler evaluation of middle cerebral artery (MCA) and umbilical artery (UA) PI ratio is an useful modality in diagnosis of IUGR.J Enam Med Col 2017; 7(3): 140-145

Three‐Dimensional Power Doppler Evaluation of Cerebral Vascular Blood Flow: A Novel Tool in the Assessment of Fetal Growth Restriction

To determine whether fetuses with fetal growth restriction (FGR) are more likely to have abnormal cerebral vascular flow patterns compared to fetuses who are appropriate for gestational age (AGA) when quantified by using 3-dimensional (3D) power Doppler ultrasound. We conducted a prospective cohort study of singleton gestations presenting for growth ultrasound examination between 24 and 36 weeks' gestation. Patients with FGR (estimated fetal weight < 10th percentile) were enrolled and matched 1:1 for gestational age (±7 days) with AGA fetuses. A standardized 3D power Doppler image of the middle cerebral artery territory was obtained from each patient. The vascularization index (VI), flow index (FI), and vascularization-flow index (VFI) were calculated by the Virtual Organ computer-aided analysis technique (GE Healthcare, Milwaukee, WI). These indices were compared between FGR and AGA fetuses and correlated with 2-dimensional Doppler parameters. Neonatal outcomes were also compared with respect to the 3D parameters. Of 306 patients, there were 151 cases of FGR. There was no difference in the VI (6.0 versus 5.7; P = .65) or VFI (2.0 versus 1.8; P = .31) between the groups; however, the FI was significantly higher in FGR fetuses compared to AGA controls (33.9 versus 32.3; P = .009). There was a weak, but significant, negative correlation between the FI and both the middle cerebral artery pulsatility index (r = -0.34; P < .001) and cerebroplacental ratio (r = -0.29; P < .001). Within the FGR group, there was no difference in any of the 3D vascular indices with regard to neonatal outcomes. Three-dimensional power Doppler measurement of cerebral blood flow, but not the vascularization pattern, is significantly altered in FGR. This measurement may play a future role in distinguishing pathologic FGR from constitutionally small growth.

Intraoperative graft verification in coronary surgery.

Transit-time flow measurement (TTFM) is a reliable method to check the graft function intraoperatively in coronary surgery. The given parameters are: Mean Graft Flow (MGF); Pulsatility Index (PI) and Insufficiency Ratio (%BF). Some cutoffs of these parameters have been identified as predictors for unfair 1-y clinical outcome: mean graft flow (MGF) less than 20 ml/min and high pulsatility index greater than 5. Other cutoffs have been found as related to postoperative angiography: MGF 15 ml/min or less and pulsatility index at least 3 (sensitivity 94%; specificity 61%); MGF less than 15 ml/min and pulsatility index greater than 3 for left coronary artery or pulsatility index greater than 5 for right coronary artery (sensitivity 96%; specificity 77%); MGF 15 ml/min or less and pulsatility index at least 5.1 left coronary artery (sensitivity 98%; specificity 26%). Hence, with the need to improve the diagnostic accuracy of TTFM, high-resolution epicardic coronary ultrasound module has been added to graft flow evaluation providing 2D ultrasound imaging (either in short-axis or long-axis) and color-flow mapping, allowing an accurate morphological evaluation of body graft and anastomosis. An intraoperative method aimed to verify coronary grafts should be easy to handle, not time consuming, minimally invasive, easily meaningful and relatively cheap; in addition, it should offer objective parameters more than qualitative criteria. We herein report the results of our experience with intraoperative graft verification with TTFM and high-resolution imaging along with a systematic review of the literature in this field with the aim to provide a road map to be followed.

Color Doppler Evaluation of Cerebral - Umbilical Pulsatility Ratio and its Usefulness in the Diagnosis of Intrauterine Growth Retardation and Prediction of Adverse Perinatal Outcome

The purpose of this study is Evaluation of cerebral umbilical pulsatility ratio by color Doppler and to estimate the value of pulsatility index ratio of cerebral umbilical vessels in the diagnosis of small-for-gestational-age (SGA) fetuses and in the prediction of adverse perinatal outcome . Validity of the test were confirmed by determining sensitivity, specificity, accuracy, positive predictive value, negative predictive value. The study population comprised 40 pregnancies of 30-41 weeks gestation that had been diagnosed clinically as intrauterine growth retardation (IUGR) over a period of 1 year. The cerebral - umbilical pulsatility ratio (C/U ratio) were calculated. The pregnancies were followed up and the final perinatal outcome of each case were noted. Various intraparum and neonatal indicators were used to assess the outcome, with an adverse outcome being defined as the presence of one or more of these indicators. The most common adverse perinatal outcome was birth asphyxia, low apgar score, stay at NICU, still birth and caesarean section for fetal distress. Of the 40 pregnancies in the study, 30 (75%) showed abnormal C/U ratio. Among these, 32 (80%) were SGA and 32 (80%) had adverse perinatal outcome. Of the 30 out of 40 pregnancies that showed abnormal C/U ratio (&lt;1.08), all 30 (80%) were SGA and had adverse perinatal outcome. The results were correlated with parameters of fetal outcome. Inferences drawn from the study was that C/U ratio is a tools for prediction of SGA fetuses and adverse perinatal outcome.J Bangladesh Coll Phys Surg 2016; 34(3): 145-150

The relationship between transcranial Doppler ultrasound measured pulsatility index and P2 ratio of the middle cerebral artery after sports related concussion (P5.209)

The relationship between transcranial Doppler ultrasound measured pulsatility index and P2 ratio of the middle cerebral artery after sports related concussion (P5.209)

The Serial Duplex Index Improves Differential Diagnosis of Acute Renal Transplant Dysfunction.

Renal duplex sonography represents a standard noninvasive diagnostic procedure to demonstrate morphologic changes in acute kidney transplant dysfunction. We investigated whether a newly developed serial duplex index (SDI) can differentiate between acute cellular rejection and acute vascular rejection more effectively than the established Doppler parameters of the resistive index (RI) and pulsatility index (PI) in recently transplanted patients. Serial duplex scans of patients with histologically proven acute tubular necrosis (n = 25), acute cellular rejection (n = 28), acute vascular rejection (n = 18), and normal graft function (n = 50, partially protocol biopsied) were retrospectively analyzed. For each patient, the RI, PI, and cortex-pelvis proportion (CPP) were included from the day of biopsy (t0) and 3 to 7 days before biopsy (t-1). The sequential CPP ratio (CPPt0 /CPPt-1 ), RI ratio (RIt0 /RIt-1 ), and PI ratio (PIt0 /Pit-1 ) were determined. The SDI was calculated as: RI ratio × PI ratio/CPP ratio. The diagnostic accuracy of the SDI was compared with that of the RI and PI ratios. Selected groups were statistically comparable in all routinely determined transplant parameters. The SDI was significantly different between patients with normal graft function, acute cellular rejection, and acute vascular rejection (P < .01, analysis of variance on ranks), whereas the RI and PI ratios were only significantly different between patients with normal graft function and acute vascular rejection (P < .05, analysis of variance on ranks). The indices' ranges were defined by the 95% confidence intervals between the allograft functions. The developed SDI was able to detect acute renal transplant rejection with greater sensitivity and specificity than the RI and PI ratios. Since the SDI distinguishes between acute tubular necrosis, acute cellular rejection, and acute vascular rejection, it might be a supportive tool to indicate renal biopsy.

Effects of Plasmodium falciparum infection on umbilical artery resistance and intrafetal blood flow distribution: a Doppler ultrasound study from Papua New Guinea

BackgroundDoppler velocimetry studies of umbilical artery (UA) and middle cerebral artery (MCA) flow help to determine the presence and severity of fetal growth restriction. Increased UA resistance and reduced MCA pulsatility may indicate increased placental resistance and intrafetal blood flow redistribution. Malaria causes low birth weight and fetal growth restriction, but few studies have assessed its effects on uteroplacental and fetoplacental blood flow.MethodsColour-pulsed Doppler ultrasound was used to assess UA and MCA flow in 396 Papua New Guinean singleton fetuses. Abnormal flow was defined as an UA resistance index above the 90th centile, and/or a MCA pulsatility index and cerebroplacental ratio (ratio of MCA and UA pulsatility index) below the 10th centile of population-specific models fitted to the data. Associations between malaria (peripheral infection prior to and at ultrasound examination, and any gestational infection, i.e., ‘exposure’) and abnormal flow, and between abnormal flow and birth outcomes, were estimated.ResultsOf 78 malaria infection episodes detected before or at the ultrasound visit, 62 (79.5%) were Plasmodium falciparum (34 sub-microscopic infections), and 16 were Plasmodium vivax. Plasmodium falciparum infection before or at Doppler measurement was associated with increased UA resistance (adjusted odds ratio (aOR) 2.3 95% CI 1.0–5.2, P = 0.047). When assessed by ‘exposure’, P. falciparum infection was significantly associated with increased UA resistance (all infections: 2.4, 1.1–4.9, P = 0.024; sub-microscopic infections 2.6, 1.0–6.6, P = 0.051) and a reduced MCA pulsatility index (all infections: 2.6, 1.2–5.3, P = 0.012; sub-microscopic infections: 2.8, 1.1–7.5, P = 0.035). Sub-microscopic P. falciparum infections were additionally associated with a reduced cerebroplacental ratio (3.64, 1.22–10.88, P = 0.021). There were too few P. vivax infections to draw robust conclusions. An increased UA resistance index was associated with histological evidence of placental malaria (5.1, 2.3–10.9, P < 0.001; sensitivity 0.26, specificity 0.93). A low cerebroplacental Doppler ratio was associated with concurrently measuring small-for-gestational-age, and with low birth weight.Discussion/conclusionBoth microscopic and sub-microscopic P. falciparum infections impair fetoplacental and intrafetal flow, at least temporarily. Increased UA resistance has high specificity but low sensitivity for the detection of placental infection. These findings suggest that interventions to protect the fetus should clear and prevent both microscopic and sub-microscopic malarial infections.Trial Registration ClinicalTrials.gov NCT01136850. Registered 06 April 2010

Prediction of neonatal outcome of TTTS by fetal heart and Doppler ultrasound parameters before and after laser treatment.

To determine the prognostic value of fetal Doppler and echocardiographic parameters for neonatal survival up to 30 days after laser coagulation in monochorionic pregnancies complicated by twin-twin transfusion syndrome (TTTS). Fetal echocardiography and outcome data of consecutive cases of TTTS treated by laser were retrospectively reviewed. Hemodynamic and cardiac function parameters were collected before and after laser. Between February 2006 and January 2015, 106 fetoscopic laser were performed. The final analysis was limited to cases with ultrasound within 2 days before laser (n = 77) and 4 weeks after laser (n = 86). Overall neonatal survival rate was 64.9% (135/208) and 77.9% of pregnancies (81/104) had at least one baby alive. For the recipient twin, the preoperative predictors of neonatal survival were umbilical artery (UA) pulsatility index (PI), cerebro-placental PI ratio, UA end diastolic flow (EDF), ductus venosus a-wave, right ventricular myocardial performance index (RV-MPI) and CHOP score. The postoperative predictors of donor survival were donor RV-MPI and recipient UA EDF, umbilical vein pulsations, tricuspid regurgitation, cardiac hypertrophy and CHOP score. The hemodynamic predictors of postnatal survival after laser were preoperative signs of recipient cardiomyopathy and postoperative signs of cardiac overload in both twins. © 2016 John Wiley & Sons, Ltd.