Umbilical Artery Doppler Flow Velocity Research Articles

Effect of a standardized maternal meal on fetal middle cerebral artery Doppler indices: A single-blinded crossover study.

ObjectiveMeasures of Doppler blood flow velocity profiles are an integral part of monitoring fetal well-being during pregnancy. These examinations are performed at different times of the day and at different maternal meal states. In uncomplicated pregnancies, we assessed the effect of a standardized maternal meal on middle cerebral artery (MCA) and umbilical artery (UA) Doppler blood flow velocity pulsatility indices (PIs) and MCA peak systolic velocity (PSV).MethodsIn this prospective single-blinded crossover study 25 healthy women were examined at 36 weeks of pregnancy. The first examination was performed in the morning following overnight fast, and repeated after extended fast (state A), and after a standard breakfast meal (state B).ResultsIrrespective of maternal prandial status, the MCA-PI values were lower in the 2nd compared to the 1st examination (-0.187; p = 0.071, and -0.113; p = 0.099, state A and B, respectively). Compared to the values in the 1st examination, the UA-PI values, were higher after extended fast (0.014; p = 0.436), and lower post-prandially (-0.036; p = 0.070). The difference (state B minus state A) between the meal states were not significant (0.074; p = 0.487 and -0.050; p = 0.058, for MCA-PI and UA-PI, respectively). Adjusting for the possible influence of fetal heart rate on MCA-PI and UA-PI, the differences between meal states remained non-significant (p = 0.179, p = 0.064, respectively). The MCA-PSV values increased after the meal (6.812; p = 0.035), whereas no increase was observed following extended fast (0.140; p = 0.951). The difference in MCA-PSV values between the two meal states was not significant (6.672; p = 0.055).ConclusionOur results demonstrate possible diurnal variations in MCA-PI and UA-PI, with and without adjustment for fetal heart rate, that seem to be unaffected by maternal meal intake in healthy pregnancies.

Doppler abnormalities in monochorionic diamniotic twin pregnancies with discordant growth.

We studied whether abnormal umbilical artery (UA) Doppler flow velocity waveforms occur with higher frequency in monochorionic diamniotic (MCDA) twin gestations with discordant fetal growth and whether this impacted neonatal outcome. We performed a retrospective study of MCDA twin pairs. We collected data from an electronic medical record. We classified pregnancies as discordant if there was at least 20% birth weight discordance. Abnormal UA Doppler velocity waveforms included absent or reversed end diastolic flow. We analyzed the data with chi square, Student's t-test and analysis of variance as appropriate. Seventy-three twin pairs met criteria for inclusion, including 16 with discordant growth. The discordant group was significantly more affected with twin-to-twin transfusion syndrome (TTTS) (P=0.02). The smaller fetuses in discordant pairs were more likely to display abnormal UA Doppler flow velocity waveforms (P<0.01). These neonates also had lower Apgar scores (P=0.03) and were more likely to require care in a neonatal intensive care unit. Our findings persisted after excluding pregnancies with TTTS. In MCDA twin gestations complicated by discordant growth, there is an increased frequency of abnormal UA Doppler flow velocity waveforms in small fetuses, and these neonates face clinical challenges after birth.

Cardiac surgery during pregnancy: Continuous fetal monitoring using umbilical artery Doppler flow velocity indices

The fetal death rate associated with cardiac surgery with cardiopulmonary bypass (CPB) is as high as 9.5-29%. We report continuous monitoring of fetal heart rate and umbilical artery flow-velocity waveforms by transvaginal ultrasonography and their analyses in relation to events of the CPB in two cases in second trimester of pregnancy undergoing mitral valve replacement. Our findings suggest that the transition of circulation from corporeal to extracorporeal is the most important event during surgery; the associated decrease in mean arterial pressure (MAP) at this stage potentially has deleterious effects on the fetus, which get aggravated with the use of vasopressors. We suggest careful management of CPB at this stage, which include partial controlled CPB at initiation and gradual transition to full CPB; this strategy maintains high MAP and avoids the use of vasopressors. Maternal and fetal monitoring can timely recognize the potential problems and provide window for the required treatment.

Thymic volume in healthy, small for gestational age and growth restricted fetuses

The aim of this study was to verify the hypothesis that a difference in thymic size exists between small for gestational age (SGA) fetuses, likely constitutional, and intrauterine growth restricted (IUGR) fetuses because of placental causes. We studied 27 SGA and 36 control fetuses. SGA was defined as fetal abdominal circumference (AC) and birthweight <10th percentile for gestational age. We defined as constitutional SGA those with normal uterine and umbilical artery Doppler flow velocity waveforms (FVW), and as IUGR those with abnormal uterine FVW. IUGR were further divided based on normal or abnormal umbilical FVW. Fetal thymic volume (TV) was acquired by three-dimensional ultrasound and reconstructed with virtual organ computer-aided analysis. To correct for the influence of fetal size on thymic dimension, TV/AC ratio was calculated. Controls presented a higher TV/AC compared with each group of SGA (p < 0.001). TV/AC was significantly lower in IUGR with abnormal umbilical FVW compared with both constitutional SGA (p = 0.01) and IUGR with normal umbilical FVW (p = 0.01). The differences in TV/AC between constitutional SGA and IUGR with abnormal umbilical FVW suggest that, in the latter, a specific 'trigger' might compromise trophoblastic invasion and thymic development; however, some kind of alteration of the immune system might occur in all SGA fetuses.

Is three‐dimensional power Doppler ultrasound useful in the assessment of placental perfusion in normal and growth‐restricted pregnancies?

To investigate three-dimensional (3D) power Doppler ultrasound indices in the assessment of placental perfusion and their relationship to gestational age (GA), placental position and umbilical artery Doppler flow velocity waveform (FVW) patterns in normal and intrauterine growth-restricted (IUGR) pregnancies. Forty-five pregnant women at 23-37 weeks' gestation were studied, of whom 30 had IUGR and 15 were controls. Nine of the IUGR group had normal umbilical FVWs (NED), nine had abnormal patterns but positive end-diastolic velocities (PED) and 12 had absent or reversed end-diastolic velocities (AED). Placental position was assessed as being posterior, anterior or lateral. 3D power Doppler indices related to placental perfusion (vascularization index (VI), vascularization flow index (VFI) and flow index (FI)) were obtained from five different sampling sites in each placenta. VI, VFI and FI were not significantly dependent on GA or placental position. VI and VFI were significantly lower in PED and AED cases compared with controls, while FI was reduced in the AED group only. VI and VFI showed high variability between different sampling sites within each placenta, while the variability of FI was much lower. 3D power Doppler sonography can provide new insights into placental pathophysiology. FI, which identifies the most severe cases of placental impairment, appears to be the most reliable index because of its low intraplacental variability. Further studies are needed to verify its accuracy when applied in clinical practice as a substitute for or an adjunct to umbilical artery Doppler studies.

Infants of women with severe early pre-eclampsia: the effect of absent end-diastolic umbilical artery Doppler flow velocities on neurodevelopmental outcome

Umbilical artery Doppler flow velocity waveform studies were performed over a period of 4 y on 242 women with severe pre-eclampsia before 34 wk gestation. Sixty-eight (28%) had absent end-diastolic umbilical artery Doppler flow velocities. One hundred and ninety-three infants survived to hospital discharge and were followed at 6-monthly intervals until 48 mo of age. Fhe mean corrected developmental quotient was 94 ± 8 at 24 mo of age and 87 ± 9 at 48 mo. Ninety-two percent of the infants had a developmental quotient of >80 at 24 mo and 72% at 48 mo of age. Fhis decline is thought to be due to the impact of social circumstances. Fhere were no differences between the developmental quotients of the infants with normal and those with absent end-diastolic umbilical artery Doppler flow velocities at either 24 or 48 mo of age. At 24 mo of age, infants with absent end-diastolic umbilical artery Doppler flow velocities scored lower in the Performance subscale test (p= 0.03). developmental quotients of infants from poorer socioeconomic backgrounds were significantly lower than those living in more privileged circumstances. At 48 mo, 153 (97%) of the children presented with normal gross motor development. Four infants had cerebral palsy. No differences were noted in the motor outcomes between the infants of women with normal umbilical artery waveforms and those with absent end-diastolic umbilical artery Doppler flow velocities.

Correlations of placental perfusion and PlGF protein expression in early human pregnancy

The purpose of this study was to investigate temporal correlations between maternal serum placenta growth factor levels and placental perfusion in early human pregnancies. Systolic umbilical artery Doppler blood flow velocity indices at fetal and placental insertion sites were measured between 7 and 22 weeks of gestation from normal singleton pregnancies. Maternal serum placenta growth factor levels were determined by enzyme-linked immunosorbent assay. Maternal serum placenta growth factor levels showed an exponential increase at approximately 14 weeks of gestation. Placenta perfusion, as estimated by systolic Doppler blood flow indices, significantly increased with gestational age (P < .0001). There was a close association between placenta growth factor expression levels and evidence of increased placenta perfusion (P < .033). The significant increase in serum placenta growth factor coincides with the increased perfusion of the maternal/fetal interface at approximately 12 to 14 weeks of gestation. Correlation of placenta growth factor expression and placental perfusion suggests that placenta growth factor may contribute to assuring adequate vascular development/function of the placenta early in gestation.

Placental vascular disease and toll-like receptor 4 gene expression

Vascular disease in the placenta, which is identified by the study of umbilical artery Doppler flow velocity waveforms, is associated with endothelial cell activation and a proinflammatory cytokine response in the villous placental circulation. We studied toll-like receptor 4 expression (the ligand is lipopolysaccharide) to examine whether infection may cause these inflammatory components of placental vascular disease through an innate immune response. Microvessel endothelial cells were isolated from human placentae with collagenase digestion and then extracted with Dynabeads that were coated with monoclonal antibody against CD31. We studied 13 placentae from normal pregnancies that were delivered at term and 15 pregnancies with umbilical placental vascular disease that was defined by an abnormal umbilical artery Doppler study. We extracted RNA from the isolated endothelial cells. The messenger RNA expression of toll-like receptor 4 production was assessed by reverse transcriptase-polymerase chain reaction and factored relative to the glyceraldehyde-3-phosphate dehydrogenase and 18S ribosomal RNA genes. Microvessel endothelial cells from placental villi with placental vascular disease showed up-regulation of toll-like receptor 4 expression (toll-like receptor 4/18S, 1.92 +/- 0.37 vs 0.99 +/- 0.19; P < .05; toll-like receptor 4/glyceraldehyde-3-phosphate dehydrogenase, 2.20 +/- 0.36 vs 1.25 +/- 0.22; P < .05) in comparison with normal pregnancy. Up-regulation of toll-like receptor 4 gene in the endothelium of the placental villi is present in placental vascular disease, which may result from exposure of this endothelium to the toll-like receptor 4 ligand lipopolysaccharide in vivo. Directly extracted endothelial cells were used to avoid the possibility for change in behavior in tissue culture. We conclude that Gram-negative infection and lipopolysaccharide stimulation may cause placental vascular disease.

Effects of repeated prenatal ultrasound examinations on childhood outcome up to 8 years of age: follow-up of a randomised controlled trial

Despite the widespread use of prenatal ultrasound studies, there are no published data from randomised controlled trials describing childhood outcomes that might be influenced by repeated ultrasound exposures. We previously undertook a randomised controlled trial to assess the effects of multiple studies on pregnancy and childhood outcomes and reported that those pregnancies allocated to receive multiple examinations had an unexplained and significant increase in the proportion of growth restricted newborns. Our aim was to investigate the possible effects of multiple prenatal ultrasound scans on growth and development in childhood. Here, we provide follow-up data of the childrens' development. Physical and developmental assessments were done on children whose pregnant mothers had been allocated at random to a protocol of five studies of ultrasound imaging and umbilical artery Doppler flow velocity waveform between 18 and 38 weeks' gestation (intensive group n=1490) or a single imaging study at 18 weeks' gestation (regular group n=1477). We used generalised logistic and linear regression models to assess the group differences in developmental and growth outcomes over time. Primary data analysis was done by intention-to-treat. Examinations were done at 1, 2, 3, 5, and 8 years of age on children born without congenital abnormalities and from singleton pregnancies (intensive group n=1362, regular group n=1352). The follow-up rate at 1 year was 85% (2310/2714) and at 8 years was 75% (2042/2714). By 1 year of age and thereafter, physical sizes were similar in the two groups. There were no significant differences indicating deleterious effects of multiple ultrasound studies at any age as measured by standard tests of childhood speech, language, behaviour, and neurological development. Exposure to multiple prenatal ultrasound examinations from 18 weeks' gestation onwards might be associated with a small effect on fetal growth but is followed in childhood by growth and measures of developmental outcome similar to those in children who had received a single prenatal scan.

Application of FFT-Analyzed Umbilical Artery Doppler Signals to Fuzzy Algorithm

Doppler signals, recorded from the umbilical artery of 60 women with pregnancy, were transferred to personal computer via a 16-bit sound card. The fast Fourier transform (FFT) method was applied to the recorded signal from each patient. Because FFT method inherently cannot offer a good spectral resolution at highly turbulent blood flows, it sometimes causes wrong interpretation of Doppler signals. In order to avoid this problem, umbilical artery Doppler blood flow velocity parameters were introduced to a fuzzy algorithm. It is observed that the fuzzy algorithm gives true results for interpretation of umbilical artery blood flow velocity parameters. Forty-five blood flow velocity parameters of 60 women with pregnancy and 15 parameters in training data have been used in a fuzzy system as testing data. The overall success ratio in training data and the testing data were 95.55 and 93.35% respectively.

Maternal plasma from pregnant women with umbilical placental vascular disease does not affect endothelial cell mRNA expression of nitric oxide synthase.

In placental vascular disease identified by umbilical artery Doppler study we have shown the existence of a factor in fetal plasma that causes activation of endothelial cells in culture with expression of cell adhesion molecules and nitric oxide synthase, apoptosis, and proinflammatory cytokine production. The present work was carried out to investigate a maternal origin for this factor active in the fetal circulation. We collected maternal plasma from pregnant women with Doppler-defined umbilical placental vascular disease and examined its effect on endothelial cells in culture. Aliquots from a common culture of human umbilical vein endothelial cells (HUVEC) were incubated with maternal plasma from women with normal pregnancy (n = 23), umbilical placental vascular disease defined by abnormal umbilical artery Doppler (n = 30, with or without preeclampsia), and preeclampsia with normal umbilical artery Doppler (n = 14). The expression of mRNA for inducible and endothelial constitutive nitric oxide synthase (iNOS and ecNOS, respectively) was assessed by reverse transcriptase polymerase chain reaction. There was no significant increase in either the iNOS or the ecNOS mRNA expression by HUVEC cultured with maternal plasma from pregnancies with umbilical placental vascular disease compared with normal pregnancy (iNOS 1.49 +/- 0.35 versus 1.38 +/- 0.25; ecNOS 1.51 +/- 0.35 versus 1.25 +/- 0.27; P >.05). In the placental vascular disease group the results were similar for the presence or absence of maternal preeclampsia. In the samples from women with preeclampsia with normal umbilical Doppler, both iNOS and ecNOS mRNA expression (iNOS 1.42 +/- 0.53; ecNOS 1.46 +/- 0.39; P >.05) did not differ from normal. Maternal plasma from pregnancies with umbilical placental vascular disease did not affect endothelial cell expression of nitric oxide synthase. This finding does not support a maternal origin for the factor demonstrated in fetal plasma. These results suggest separate pathogenic pathways for the endothelial cell activation seen in preeclampsia and fetal growth restriction associated with abnormal umbilical artery Doppler flow velocity waveforms. These findings are also consistent with the concept that the vascular pathology in the fetal placenta may be primary and that the uteroplacental circulation is reduced in response rather than acts as a constraint.

Infection, innate immunity, and placental vascular disease

Thrombotic vascular disease in the placenta has been associated with stillbirth, neonatal death, organ thrombosis, and cerebral palsy. Vascular disease in the placenta can be identified by the study of umbilical artery Doppler flow velocity waveforms, and a high resistance pattern predicts adverse outcome. We have shown that endothelial cell activation and a proinflammatory cytokine response are present in the villous placental circulation in these cases. Activation of the Toll-like receptors, central to innate immunity and the most primitive host defense against infection, causes these responses. We studied TLR4 receptor activation (the ligand is LPS) to examine whether infection may cause placental vascular disease.

A proinflammatory cytokine response is present in the fetal placental vasculature in placental insufficiency

Objective Vascular disease in the umbilical placental circulation is associated with fetal growth restriction and adverse outcome. It may be identified antenatally by the study of umbilical artery Doppler flow velocity waveforms. The cause of this vascular disease is unknown. We have previously provided indirect evidence for endothelial cell activation and a proinflammatory cytokine response. Recently, a family of inhibitors of cytokine signaling has been identified, referred to as the suppressors of cytokine signaling (SOCS). Activation of SOCS occurs when cytokines are produced in stimulated cells. We tested the hypothesis that endothelial cell activation was present in umbilical placental vascular disease and was associated with production of proinflammatory cytokines and members of the family of SOCS. Study design Placentas were collected at delivery and microvascular endothelial cells were isolated. We studied 13 normal pregnancies and 10 with umbilical placental vascular disease identified by an abnormal umbilical artery Doppler study. Placental pieces were digested with collagenase and purified by adherence to Dynabeads coated with monoclonal antibody against CD31. The RNA was extracted from isolated endothelial cells. The messenger RNA expression of cytokine production (interleukin-6 and interleukin-8) and the members of SOCS family (CIS, SOCS1, SOCS2, and SOCS3) were assessed by use of semiquantitative reverse transcriptase–polymerase chain reaction. Results In the microcirculation of the placenta, endothelial cell expression of interleukin-6 messenger RNA (2.50±0.60 vs 1.25±0.26) and interleukin-8 messenger RNA (2.83±0.55 vs 1.58±0.27) was up-regulated in umbilical placental vascular disease in comparison to normal pregnancy. The endothelial cell mRNA expression of SOCS2 (3.36±0.77 vs 1.76±0.29) and SOCS3 (2.77±0.60 vs 1.48±0.26) was enhanced in placental vascular disease. There was no significant difference in expression of CIS and SOCS1 in microvessel endothelial cells. Conclusion We have demonstrated that microvessel endothelium of the fetal placental vasculature produces both the proinflammatory cytokines (interleukin-6 and interleukin-8) and members of SOCS family (SOCS2 and SOCS3) in umbilical placental vascular disease. This cytokine production may play a key role in the interaction of endothelial cells of the placenta villi with neighboring cells. The up-regulation of SOCS2 and SOCS3 indicates these are the major negative regulators in umbilical placental microvessel endothelial cell activation pathways. By its occurrence, this also confirms the presence of a proinflammatory cytokine response.

Immunohistochemical localization of endothelin-1 in human placenta from normal and growth-restricted pregnancies.

The purpose of this study was to investigate whether the localization of endothelin-1 (ET-1) immunoreactivity differs in human placental tissues from third-trimester normal and intrauterine growth restricted (IUGR) pregnancies. Immunohistochemistry for ET-1 was performed on human placentas from 30 IUGR and 30 uncomplicated pregnancies matched for gestational age. The distribution and intensity of ET-1 immunoreactivity was assessed by a semiquantitative scoring system. Doppler flow velocity waveform analysis of the umbilical artery was performed in each patient before delivery. ET-1 was localized diffusely in placental specimens from normal and IUGR pregnancies. The localization of ET-1 immunoreactivity was significantly higher in the capillary endothelial cells of villi as well as in the endothelial, decidual, and trophoblastic cells of the basal plate in placentas from normal pregnancies than from IUGR pregnancies. There was no significant difference in placental ET-1 immunoreactivity between IUGR pregnancies with normal and abnormal umbilical artery Doppler flow velocity waveforms. Placental ET-1 immunoreactivity was significantly higher in the decidual and trophoblastic cells of the basal plate and the capillary endothelial cells of villi in normal pregnancies than in IUGR pregnancies with normal umbilical artery Doppler flow velocity waveforms. However, only the decidual and trophoblastic cells of the basal plate demonstrated significantly higher abundant localization of ET-1 immunoreactivity in normal pregnancies than in IUGR pregnancies with abnormal umbilical artery Doppler flow velocity waveforms. In conclusion, our findings suggest that the lower expression of ET-1 in placental tissues from IUGR pregnancies might be secondary to an adaptive mechanism to reduce the vasoconstrictor effect of ET-1.

Umbilical artery Doppler flow velocity waveforms after transplacental amniocentesis

Objective To assess the influence of transplacental versus nontransplacental needle passage during genetic amniocentesis on umbilical artery (UA) pulsatility index (PI) and fetal heart rate (FHR). Methods Genetic amniocentesis was performed in 205 women with no major fetal malformations detected by prenatal ultrasound at a median gestational age of 14 weeks and 3 days (range 13 weeks and 1 day to 18 weeks and 6 days). Chromosomal abnormalities were observed in five fetuses. These pregnancies were excluded from further analyses. The study group consisted of 56 of the remaining 200 women in whom amniocentesis had been performed transplacentally. As controls two patients with nontransplacental needle passage were chosen for each woman in the study group, matched for gestational age (± 3 days) and as far as possible for the indication for amniocentesis. The UA PI and the FHR were measured immediately before and after the amniocentesis. Results Amniocentesis did not cause significant changes in UA PI and FHR within or between the two groups. Division of the study population into three subgroups dependent on gestational age did not alter the results. Pregnancy outcome was similar in the two groups. Conclusion Transplacental needle passage during amniocentesis did not induce any changes in UA PI or FHR relative to a group with nontransplacental amniocentesis.

Maternal glycemic control and umbilical artery Doppler velocimetry

Objective: To determine whether information from umbilical artery Doppler flow velocity waveforms significantly improves the prediction of adverse perinatal outcome, independently of maternal glycemic control, in pregnancies complicated by diabetes. Study design: The medical records of 277 pregnant women with diabetes were reviewed. Glycemic control was determined by glycosylated hemoglobin concentration and umbilical artery Doppler velocimetry by using systolic/diastolic ratios (S : D), both obtained during the third trimester. Pregnancies with adverse perinatal outcome were compared to those with good outcome. Logistic regression analysis was used to adjust for glycemic control, and to test whether an elevated umbilical artery Doppler S : D ratio was independently associated with pregnancy outcome. Results: Adverse pregnancy outcome occurred in 51.6% of these pregnancies (143/277). The mean third-trimester glycosylated hemoglobin (7.7 ± 1.9% vs. 6.7 ± 1.3%, p < 0.001) and the umbilical artery S : D ratio were significantly higher (2.6 ± 0.6 vs. 2.4 ± 0.3, p < 0.001) in the pregnancies with adverse outcome. Logistic regression analysis showed that umbilical artery S : D ratio was an independent predictor of adverse perinatal outcome after adjusting for the third-trimester glycosylated hemoglobin level. Forty per cent of patients with normal Doppler findings (S : D ratio of < 3.0) and normal glycemic control values (glycosylated hemoglobin level of < 7.5%) had an adverse pregnancy outcome. Sixty-three per cent of patients with an abnormal result for one of these tests had an adverse pregnancy outcome. Ninety-six per cent of patients with both abnormal Doppler findings and abnormal glycemic control had an adverse pregnancy outcome. Conclusion: Umbilical artery Doppler velocimetry improves the predictive value for adverse perinatal outcome, independently of glycemic control, in pregnancies complicated by diabetes. The combination of an abnormal umbilical artery S : D ratio and abnormal glycosylated hemoglobin was strongly associated with adverse pregnancy outcome.

Association of Umbilical Placental Vascular Disease With Fetal Acute Inflammatory Cytokine Responses

We examined the hypothesis that fetal proinflammatory cytokine release is a feature of placental vascular disease causing fetal compromise. We measured the concentrations of fetal proinflammatory cytokines interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha), and interleukin-8 (IL-8) in the presence of vascular disease in the umbilical placental villous circulation. Vascular disease was identified by high-resistance umbilical artery Doppler flow velocity waveform studies. We measured levels of the inflammatory cytokines IL-6 and TNF-alpha and the chemokine IL-8 in fetal blood. Blood was collected from the umbilical vein at delivery, and serum was stored at -70C until assayed using chemiluminescent and enzyme-linked immunosorbent assay methods. We studied 36 normal pregnancies delivered by elective cesarean at term and 50 pregnancies with a high-resistance umbilical artery Doppler flow velocity waveform pattern indicative of fetal placental vascular disease delivered by elective cesarean because of potential fetal compromise. In the presence of umbilical placental vascular disease there were significantly higher levels of IL-6 (median 5.3 pg/mL, P <.05) and IL-8 (median 26.5 pg/mL, P <.01) compared with normal pregnancies (median value of IL-6 and IL-8 were below assay threshold). There was no difference for TNF-alpha, with the median results undetectable in both groups. We found higher concentrations of IL-6 and IL-8 in the fetal circulation in the presence of umbilical placental vascular disease.

Maternal glycemic control and umbilical artery Doppler velocimetry

Objective: To determine whether information from umbilical artery Doppler flow velocity waveforms significantly improves the prediction of adverse perinatal outcome, independently of maternal glycemiccontrol, in pregnancies complicated by diabetes.Study design: The medical records of 277 pregnant women with diabetes were reviewed. Glycemic control was determined by glycosylated hemoglobinconcentration and umbilical artery Doppler velocimetry by using systolic/diastolic ratios (S : D), both obtained during the third trimester. Pregnancies with adverse perinatal outcome were compared to thosewith good outcome. Logistic regression analysis was used to adjust for glycemic control, and to test whether an elevated umbilical artery Doppler S : D ratio was independently associated with pregnancyoutcome.Results: Adverse pregnancy outcome occurred in 51.6% of these pregnancies (143/277). The mean third-trimester glycosylated hemoglobin (7.7 ± 1.9% vs. 6.7 ± 1.3%, p< 0.001) and the umbilical artery S : D ratio were significantly higher (2.6 ± 0.6 vs. 2.4 ± 0.3, p < 0.001) in the pregnancies with adverse outcome. Logistic regression analysisshowed that umbilical artery S : D ratio was an independent predictor of adverse perinatal outcome after adjusting for the third-trimester glycosylated hemoglobin level. Forty per cent of patients withnormal Doppler findings (S : D ratio of < 3.0) and normal glycemic control values (glycosylated hemoglobin level of < 7.5%) had an adverse pregnancy outcome. Sixty-three per cent of patients withan abnormal result for one of these tests had an adverse pregnancy outcome. Ninety-six per cent of patients with both abnormal Doppler findings and abnormal glycemic control had an adverse pregnancy outcome.Conclusion: Umbilical artery Doppler velocimetry improves the predictive value for adverse perinatal outcome, independently of glycemic control, in pregnancies complicated by diabetes. The combinationof an abnormal umbilical artery S : D ratio and abnormal glycosylated hemoglobin was strongly associated with adverse pregnancy outcome.

Infants of Women With Severe Early Pre-Eclampsia: The Effect of Absent End-Diastolic Umbilical Artery Doppler Flow Velocities on Neurodevelopmental Outcome

Umbilical artery Doppler flow velocity waveform studies were performed over a period of 4 y on 242 women with severe pre-eclampsia before 34 wk gestation. Sixty-eight (28%) had absent end-diastolic umbilical artery Doppler flow velocities. One hundred and ninety-three infants survived to hospital discharge and were followed at 6-monthly intervals until 48 mo of age. The mean corrected developmental quotient was 94 +/- 8 at 24 mo of age and 87 +/- 9 at 48 mo. Ninety-two percent of the infants had a developmental quotient of >80 at 24 mo and 72% at 48 mo of age. This decline is thought to be due to the impact of social circumstances. There were no differences between the developmental quotients of the infants with normal and those with absent end-diastolic umbilical artery Doppler flow velocities at either 24 or 48 mo of age. At 24 mo of age, infants with absent end-diastolic umbilical artery Doppler flow velocities scored lower in the Performance subscale test (p = 0.03). The developmental quotients of infants from poorer socioeconomic backgrounds were significantly lower than those living in more privileged circumstances. At 48 mo, 153 (97%) of the children presented with normal gross motor development. Four infants had cerebral palsy. No differences were noted in the motor outcomes between the infants of women with normal umbilical artery waveforms and those with absent end-diastolic umbilical artery Doppler flow velocities.

Infants of women with severe early pre-eclampsia: the effect of absent end-diastolic umbilical artery doppler flow velocities on neurodevelopmental outcome.

Umbilical artery Doppler flow velocity waveform studies were performed over a period of 4 y on 242 women with severe pre-eclampsia before 34 wk gestation. Sixty-eight (28%) had absent end-diastolic umbilical artery Doppler flow velocities. One hundred and ninety-three infants survived to hospital discharge and were followed at 6-monthly intervals until 48 mo of age. The mean corrected developmental quotient was 94 +/- 8 at 24 mo of age and 87 +/- 9 at 48 mo. Ninety-two percent of the infants had a developmental quotient of >80 at 24 mo and 72% at 48 mo of age. This decline is thought to be due to the impact of social circumstances. There were no differences between the developmental quotients of the infants with normal and those with absent end-diastolic umbilical artery Doppler flow velocities at either 24 or 48 mo of age. At 24 mo of age, infants with absent end-diastolic umbilical artery Doppler flow velocities scored lower in the Performance subscale test (p = 0.03). The developmental quotients of infants from poorer socioeconomic backgrounds were significantly lower than those living in more privileged circumstances. At 48 mo, 153 (97%) of the children presented with normal gross motor development. Four infants had cerebral palsy. No differences were noted in the motor outcomes between the infants of women with normal umbilical artery waveforms and those with absent end-diastolic umbilical artery Doppler flow velocities.