Umbilical Artery Doppler Studies Research Articles

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

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

Role of umbilical artery and fetal middle cerebral artery doppler study in prediction of pregnancy outcome in high-risk pregnancies

Role of umbilical artery and fetal middle cerebral artery doppler study in prediction of pregnancy outcome in high-risk pregnancies

Outcomes among Neonates after a Diagnosis of Persistent or Transient Fetal Growth Restriction Delivered at Term.

This study aimed to evaluate whether transient fetal growth restriction (FGR) that resolves prior to delivery confers a similar risk of neonatal morbidity as uncomplicated FGR that persists at term. This is a secondary analysis of a medical record abstraction study of singleton live-born pregnancies delivered at a tertiary care center between 2002 and 2013. Patients with fetuses that had either persistent or transient FGR and delivered at 38 weeks or later were included. Patients with abnormal umbilical artery Doppler studies were excluded. Persistent FGR was defined as estimated fetal weight (EFW) <10th percentile by gestational age from diagnosis through delivery. Transient FGR was defined as EFW <10th percentile on at least one ultrasound, but not on the last ultrasound prior to delivery. The primary outcome was a composite of neonatal morbidity: neonatal intensive care unit admission, Apgar's score <7 at 5 minutes, neonatal resuscitation, arterial cord pH <7.1, respiratory distress syndrome, transient tachypnea of the newborn, hypoglycemia, sepsis, or death. Baseline characteristics and obstetric and neonatal outcomes were compared using Wilcoxon's rank-sum and Fisher's exact test. Log binomial regression was used to adjust for confounders. Of 777 patients studied, 686 (88%) had persistent FGR and 91 (12%) had transient FGR. Patients with transient FGR were more likely to have a higher body mass index, gestational diabetes, diagnosed with FGR earlier in pregnancy, have spontaneous labor, and deliver at later gestational ages. There was no difference in the composite neonatal outcome (relative risk = 1.03, 95% confidence interval [CI] 0.72, 1.47) for transient versus persistent FGR after adjusting for confounders (adjusted relative risk = 0.79, 95% CI 0.54, 1.17). There were no differences in cesarean delivery or delivery complications between groups. Neonates born at term after transient FGR do not appear to have differences in composite morbidity compared with those where uncomplicated FGR persists at term. · No differences in neonatal outcomes in uncomplicated persistent versus transient FGR at term.. · Transient FGR pregnancies more likely to deliver at later gestational ages.. · No differences in mode of delivery or obstetric complications in persistent versus transient FGR at term..

Subchorionic Hemorrhage in the Second and Third Trimesters of Pregnancy: A Review

Subchorionic hemorrhage (SCH) in the second and third trimesters of pregnancy can be associated with maternal morbidity and fetal morbidity/mortality. Management of SCH in the second or third trimesters can be complicated, especially in the setting of a large SCH that requires hospitalization and blood transfusion. The aim of this review is to describe SCH in second and third trimesters, risk factors, diagnosis, maternal and fetal outcomes, and management of this uncommon pregnancy complication. A PubMed, Web of Science, and CINAHL search was undertaken with no limitations on the number of years searched. There were 123 abstracts and/or articles reviewed, with 48 articles being the basis of review. The only known risk factors for SCH are maternal factor deficiency and anticoagulation therapy. The diagnosis is usually made by ultrasound imaging. Subchorionic hemorrhage in second and third trimesters has been associated with several adverse fetal outcomes including preterm birth, preterm prelabor rupture of membranes, fetal growth restriction, fetal demise, and neonatal pulmonary morbidity. There is no proven treatment for SCH, although there are several investigational therapies reported. Subchorionic hemorrhage can be complex and difficult to manage in the second and third trimesters. There are no recommendations or guidelines for management; however, serial growth ultrasounds, umbilical artery Doppler studies, and antenatal fetal testing should be considered particularly if the SCH is large or treatment requires a maternal blood transfusion. Subchorionic hemorrhage in the second and third trimester is associated with poor fetal outcomes and maternal morbidity, especially if the SCH is significant.

Diagnosis of mid-second trimester fetal growth restriction and associated outcomes

Objective To evaluate maternal and neonatal outcomes of low-risk singleton pregnancies, without underlying maternal medical conditions or genetic and fetal anomalies associated with fetal growth restriction, that were diagnosed with fetal growth restriction (FGR) (EFW < 10th %) in the mid-second trimester (between 17 and 22 weeks and 6 days’ gestation). Methods A retrospective cohort study of all women who underwent a routine fetal anatomy ultrasound between 17 and 22 weeks and 6 days’ gestation at a community-based academic hospital was performed to identify subjects with an EFW <10th%. Pregnancies with inadequate dating, multiple gestations, preexisting maternal vascular disease (chronic hypertension and pregestational diabetes), lethal fetal anomalies, and abnormal prenatal genetic screening were excluded. Descriptive statistics were computed to describe the study population. Subjects were stratified into two groups, estimated fetal weight (EFW) <5th% and EFW 5th–9th%. The primary outcome was a small for gestational age neonate (SGA) at delivery. Secondary outcomes included a composite adverse neonatal outcome, perinatal death, hypertensive disorders of pregnancy, medically indicated delivery, and mode of delivery. A comparison of the two groups, EFW <5th% and EFW 5th–9th %, was performed. Continuous variables were compared utilizing Wilcoxon Rank Sum tests and categorical variables were compared using Fisher’s exact test or Chi-squared tests, and a dichotomous composite variable for adverse neonatal outcomes was also calculated. Results In total, 3,868 unique patient records were screened. Thirty-two patient records (0.8% of the total screened records) were eligible for inclusion. The primary outcome, SGA at delivery, occurred in 13/32 (41%) of the subjects. The secondary outcomes of the composite neonatal morbidity occurred in 9/32 (28%), hypertensive disorders of pregnancy in 10/32 (31%), and medically indicated delivery at <28 weeks gestation in 7/32 (22%) of the subjects. When comparing EFW <5th% and EFW 5th–9th%, EFW <5th% had a larger percentage of SGA newborns (66% vs. 25%, p = .02, OR = 8.0 95% CI 1.5–42.5). EFW <5th% was also significantly associated with a greater composite adverse neonatal outcome when compared to EFW 5th–9th% (54% vs. 10%, p = .015). The subgroup with an EFW <5th% also had higher rates of adverse outcomes including preeclampsia (42% vs. 10%, p = .073), abnormal umbilical artery Doppler studies (50% vs. 15%, p = .049), and medically indicated delivery <28 weeks (42% vs. 10%, p = .07). Conclusions Early onset FGR is a associated with high rates of SGA at delivery, as well as several adverse maternal and neonatal outcomes which include hypertensive disorders of pregnancy, a greater composite neonatal morbidity, perinatal death, and medically indicated preterm delivery. EFW <5th% was associated with worse outcomes when compared to those with an EFW 5th%–9th%.

Middle cerebral artery to uterine artery pulsatility index ratios in pregnancy with fetal growth restriction regarding negative perinatal outcomes

Background/Aim: Fetal growth restriction (FGR) causes a high risk of perinatal morbidity and mortality, and the timing of the correct delivery time decision remains controversial. Cerebroplacental ratio (CPR), umbilical artery, uterine artery (UA) and middle cerebral artery (MCA) Doppler studies are used to predict adverse perinatal outcomes in FGR. However, since there is insufficient reliability for each separately and together, the search for new methods continues. This retrospective study was conducted to determine the degree of neonatal morbidity in fetuses suspected of having FGR by evaluating the MCA to UA pulsatility index (PI) ratios together with frequently used Doppler examinations. Methods: This was a retrospective cohort study conducted in a single-center hospital with the approval of the Medical Institutional Ethics Committee. A total of 424 pregnant women admitted to a tertiary hospital and diagnosed with FGR between July 2020 and December 2021 who were informed and approved were included in the study. Gestational age was confirmed by first trimester sonographic measurements of pregnancy. All pregnant women were examined by Doppler USG and umbilical artery, mean UA, fetal MCA, ductus venosus, CPR (MCA/umbilical artery pulsatility index ratio) and cerebrouterine ratio (MCA/UA) PI values were measured. Negative perinatal outcomes were recorded as blood gas level of the newborn at 7.2 and below, Apgar score of 7 and below at the fifth minute, and needing neonatal intensive care (NICU). Adverse perinatal and postnatal outcomes were recorded and compared with Doppler findings. If there were no signs of a negative perinatal outcome, it was considered a positive outcome. If at least one of the symptoms of adverse perinatal outcomes was present, it was considered a negative outcome Results: Decreased CPR and decreased MCA to UA PI were significantly and positively associated with an increased likelihood of exhibiting negative perinatal outcomes in pregnancies with FGR (P &lt; 0.001, P &lt; 0.001, respectively). The receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off value for MCA to uterine artery PI was 1.41 to predict FGR with 57.37% sensitivity and 62.50% specificity (AUC: 0.629; 95% CI: 0.581–0.675). When the CPR cut-off value was taken as 1.2069, the sensitivity was 42.86% and the specificity 83.93% in predicting negative perinatal outcomes in CPR values below this value (P &lt; 0.001). Conclusion: CPR is the most successful criterion in distinguishing between positive and negative perinatal outcomes. It has been demonstrated that the MCA to uterine artery PI ratio values after CPR can also be used for this distinction. MCA to UA PI ratio sensitivity was higher than CPR and umbilical artery. This situation shows that MCA to uterine artery PI ratio (alone or when evaluated together with PPV and NPV ratios) is a criterion that can be added to other Doppler examinations in predicting negative perinatal outcomes.

Doppler Velocimetry of Umbilical Artery in Normal and Growth Restricted Pregnancy

Objectives: To evaluate the umbilical arterial blood flow velocity and its various indices during 3rd trimester of pregnancy and to compare these indices in normal and growth restricted pregnancies.&#x0D; Methods: In this study, 50 women with normal singleton pregnancy and 50 women with intrauterine growth restricted (IUGR) pregnancy with expected birth weight &lt;10th percentile of the normal for the gestational age were studied by Doppler evaluation of their umbilical artery, Pulsality Index (PI), Resistance Index (RI) and S/D ratio of the control group and IUGR group were calculated and reference range constructed. Values of Doppler indices of IUGR group were compared with those of the control group. Perinatal outcome was evaluated in relation to the indices.&#x0D; Results: Doppler velocimetry of umbilical artery showed elevated indices in 33 out of 50 cases of IUGR group showing its high sensitivity in diagnosing haemodynamically compromised growth restricted fetuses. Absent end diastolic velocily (AEDV) and reversed end diastolic velocily (REDV), were seen in 8 and 2 cases respectively and were associated with poor perinatal out come in terms of need for LSCS for fetal distress, Apgar score &lt;7 at 1 minute, admission to NICU (Neonatal Intensive Care Unit) and perinatal death.&#x0D; Conclusion: In normal pregnancy there is gestational age related fall in impedance in Umbilical arteries. Doppler study of umbilical artery is highly sensitive in the detection of IUGR and for the prediction of adverse perinatal outcome in small for gestational age.&#x0D; Bangladesh J Obstet Gynaecol, 2020; Vol. 35(2): 68-73

Importance of Doppler study of Umbilical Artery and FoetalMiddle Cerebral Artery in PIH and IUGR

Background: PIH is associated with increased vascular resistance and decreased utero -placental perfusion resulting in an increased incidence of foetal hypoxia and impaired foetalgrowth.The objective of this study was to assess the diagnostic performance of S/D ratio, resistance index(RI), pulsatility index (PI) and cerebro-placental ratio (CPR) in the prediction of adverse perinatal outcome in PIH and IUGR. Objective: is to determine S/D ratio, RI, PI, CPR and asses their diagnostic values in the prediction of adverse perinatal outcome.Material&amp; Methods:50 pregnant patients with PIH and IUGR, beyond 28 weeks of gestation, were prospectively studied at P k das institute of medical college,vaniyamkulamand subjected for Doppler study of the umbilical artery and foetal middle cerebral artery. The abnormality of above parameters was correlated with the major adverse perinatal outcome.Results:Patients with abnormal Doppler parameters had a poor perinatal outcome, compared to those who had normal Doppler study. The cerebro-placental ratios(CPR) had the sensitivity and specificity, positive and negative predictive values of 95%,76%,73%,95% respectively with Kappa value of o .68(good agreement) and p value of .000 which was statistically significant, for the prediction of major adverse perinatal outcome.Conclusions:This study shows that Doppler study of umbilical and foetal middle cerebral artery can reliably predict the neonatal morbidity and helpful in determining the optimal time of delivery in complicated pregnancies. The CPR is more accurate than the independent evaluation of S/D, RI, PI, in identifying foetus with adverse perinatal outcome.

Comparative analysis of umbilical artery doppler indices of normal and suspected IUGR fetuses in the third trimester

Intrauterine growth restriction (IUGR) is an important cause of perinatal morbidity and mortality, the prevalence of which is six times higher in developing countries. The sequelae of IUGR extend into adulthood with higher risk of neurodegenerative diseases for the patients. Umbilical artery (UA) Doppler is an affordable and noninvasive tool for predicting perinatal outcome in IUGR pregnancies. The objective of this study is to compare the predictive ability of UA Doppler ultrasonography in discriminating normal from growth-restricted pregnancies and to find out if there is any relationship between antenatal Doppler indices and perinatal outcomes. This is a cross-sectional study including 100 normal and 100 IUGR-suspected pregnancies, respectively. Each participant had a third trimester UA Doppler scan. Data were analyzed using SPSS version 18.0 (PASW Statistics for Windows, Version 18.0, Chicago: SPSS Inc.). Means were compared using Student's t-test and ANOVA. Tests of relationship and prediction were done using linear regression analysis and receiver operating characteristics. P ≤ 0.05 was considered statistically significant. As pregnancy advanced, the mean values of UA Doppler indices decreased in normal and IUGR fetuses; however, they were significantly higher in the latter. UA systolic/diastolic (S/D) ratio showed the highest sensitivity (0.80) and specificity (0.91) for predicting IUGR compared to PI and RI. Cutoff values for PI, RI, and S/D ratio were 0.93, 0.67, and 2.93, respectively. IUGR fetuses had higher UA flow velocimetric indices compared with normal fetuses. UA Doppler study is highly sensitive in the prediction of IUGR.

Umbilical Artery Doppler Reference Indices in Normal Pregnancy

Background: Umbilical artery Doppler (UAD) studies offer a noninvasive method of indirectly assessing the fetal and uteroplacental circulation. However, the umbilical artery (UA) velocimetry reference currently in use was established in developed countries and derived from pregnant women that are likely to have had different biophysical characteristics. There is a need to develop an UA index nomogram for the indigenous pregnant population. Aim: The aim of this study was to determine the UAD reference indices among women with normal singleton pregnancy. Materials and Methods: This was a cross-sectional descriptive study of 422 women with uncomplicated pregnancies who attended the antenatal clinic of the University of Abuja Teaching Hospital with pregnancy ages between 28 and 40 weeks' gestation. The systolic and diastolic (S/D) ratio, the resistance index (RI), and the pulsatility index (PI) of the UA were obtained. Results: The mean UAD showed a progressive decrease with increasing fetal gestational age with S/D ratio, PI, and RI being 3.05 ± 0.28, 1.07 ± 0.1, and 0.68 ± 0.05 at 28 weeks and 2.10 ± 0.17, 0.73 ± 0.09, and 0.52 ± 0.04 at 40 weeks, respectively. Estimated reference values for relatively normal singleton fetuses S/D ratio, PI, and RI were 2.98, 1.03, and 0.67 and 2.07, 0.72, and 0.52 at 28 and 40 weeks of gestation, respectively. The S/D ratio (r = [FIGURE DASH]0.741, P≤ 0.002), PI (r = [FIGURE DASH]0.694, P≤ 0.001), and RI (r = [FIGURE DASH]0.366, P≤ 0.001) were significantly different from the existing reference value of 3.02 (S/D ratio), 1.05 (PI), and 0.62 (RI) and 2.18 (S/D ratio), 0.82 (PI), and 0.52 (RI). The respective existing values were at 28 weeks and 40 weeks of gestation. Conclusion: The UA index nomogram obtained from this study showed significantly lower values compared with the existing values, and therefore, it is advocated for use among African pregnant population.

Role of Colour Doppler in High Risk Pregnancy

This was a prospective study conducted in pregnant patients with high risk factors who got admitted in the Department of Obstetrics and Gynaecology at Care Hospital, Jamnagar during the period from May 2018 to September 2020. Background: High-risk pregnancies causes many adverse perinatal outcomes. Doppler ultrasound is a non-invasive technique to study the feto-maternal circulation to guide the clinical management. Objective: This study aims at evaluating the role of colour Doppler in high-risk pregnancies and their perinatal outcome. Materials and Methods: This was a prospective study carried out for 29 months in the Department of Radiology with antenatal women in the age group of 18-35 years with singleton pregnancy of gestational age of &lt;28 weeks to &gt;35 weeks having high-risk factors considered in study. The risk factors considered were pregnancy induced hypertension (PIH), gestational diabetes, anemia, oligohydramnios, polyhydramnios and IUGR. Doppler study of umbilical artery and fetal middle cerebral artery (MCA) arteries was done and amniotic fluid index (AFI) was measured. Parameters in the form of resistive index, pulsatility index, and systolic/diastolic ratio were taken. obstetric history was taken with regular interval follow up. Results: The study was carried out with 50 patients. High-risk pregnancy was more common in the age group of 21-25 years. The most common high-risk factor in pregnancy was oligohydramnios which accounted for 30% of cases. Out of 50 high-risk pregnancies, 5 (10 %) of cases resulted in intrauterine growth restriction (IUGR). Out of 50 high-risk cases, in 36 cases, umbilical artery findings were abnormal. 3 patients had intrauterine death (IUD) and 27 patients had poor perinatal outcome. Umbilical artery abnormality showed significant sensitivity and negative predictive value for adverse (poor + IUD) perinatal. Correlation was seen between high risk pregnancy and need of emergency caesarean section and induction and associated adverse perinatal outcome. Conclusion: Combination of different arterial waveform study enhance the diagnostic accuracy in identifying those intrauterine growth restricted foetuses that were at risk. Keywords: Colour Doppler, high risk pregnancy, perinatal outcome.

Colour Doppler study of Fetomaternal and uteroplacental circulation in pregnancy induced hypertension and/or oligohydramnios

Purpose: To study the fetoplacental and uteroplacental circulation by evaluating uterine artery, umbilical artery and fetal MCA using color Doppler in hypertensive disorders of pregnancy and oligohydramnios in second and third trimester with comparing different parameters.Methodology: Total 62 antenatal patients in their second or third trimester, who were clinically diagnosed as having pregnancy-induced hypertension or oligohydramnios by department of obstetrics had been recruited. Color Doppler study of umbilical artery, uterine artery and fetal MCA was performed with measurement of umbilical artery PI and SV/DV ratio, MCA PI and SV/DV ratio, uterine artery RI and SV/DV ratio and CPR.At last, color Doppler prediction was correlated with fetal outcome.Results: Out of 62 patients, 27 had PIH, 14 had associated oligohydramnios with PIH and 21 had oligohydramnios. 56% patients with PIH and 47% patients with oligohydramnios had adverse fetal outcome. The percentages of abnormal parameters of uterine artery, umbilical artery and MCA in PIH patients were 61%, 46% and 51% respectively. The sensitivity and specificity for detecting fetal distress was 70% and 81%, 70% and 87% and 67% and 86% for uterine artery, umbilical artery and fetal MCA respectively. CPR was 100% sensitive and 92.3% specific in detecting severe fetal distress.Conclusion: Chances of fetal compromise inutero are high in PIH patients, also significant number of oligohydramnios patients show adverse fetal outcome. Color Doppler study of fetoplacental and uteroplacental circulation proved a useful and noninvasive technique in determining hypoxic fetus and planning timely management of delivery before severe hypoxic injury to fetus occurs. Uterine artery and umbilical artery are more sensitive followed by MCA in diagnosing fetal distress.

FIGO (international Federation of Gynecology and obstetrics) initiative on fetal growth: best practice advice for screening, diagnosis, and management of fetal growth restriction.

Fetal growth restriction (FGR) is defined as the failure of the fetus to meet its growth potential due to a pathological factor, most commonly placental dysfunction. Worldwide, FGR is a leading cause of stillbirth, neonatal mortality, and short- and long-term morbidity. Ongoing advances in clinical care, especially in definitions, diagnosis, and management of FGR, require efforts to effectively translate these changes to the wide range of obstetric care providers. This article highlights agreements based on current research in the diagnosis and management of FGR, and the areas that need more research to provide further clarification of recommendations. The purpose of this article is to provide a comprehensive summary of available evidence along with practical recommendations concerning the care of pregnancies at risk of or complicated by FGR, with the overall goal to decrease the risk of stillbirth and neonatal mortality and morbidity associated with this condition. To achieve these goals, FIGO (the International Federation of Gynecology and Obstetrics) brought together international experts to review and summarize current knowledge of FGR. This summary is directed at multiple stakeholders, including healthcare providers, healthcare delivery organizations and providers, FIGO member societies, and professional organizations. Recognizing the variation in the resources and expertise available for the management of FGR in different countries or regions, this article attempts to take into consideration the unique aspects of antenatal care in low-resource settings (labelled “LRS” in the recommendations). This was achieved by collaboration with authors and FIGO member societies from low-resource settings such as India, Sub-Saharan Africa, the Middle East, and Latin America.

951 The association between COVID19 infection and umbilical artery dopplers in growth-restricted pregnancies

The effect of COVID19 infection on pregnancies affected by fetal growth restriction (FGR) is unknown. We aim to determine whether COVID19 infection worsens the severity of fetal growth restriction as characterized by umbilical artery Doppler studies (UADs).

1070 Neonatal outcomes in patients with resolved versus persistent uncomplicated fetal growth restriction

When fetal growth restriction (FGR) resolves prior to delivery, antenatal testing is discontinued. The objective of this study was to evaluate if FGR that resolves confers a similar risk of neonatal morbidity compared to persistent uncomplicated FGR. This is a secondary analysis of a large, NIH-funded medical record abstraction study of singleton pregnancies delivered at a tertiary care center between 2002 and 2013. Women with either persistent or resolved FGR who delivered at 38 weeks or more were included. FGR was defined as persistent estimated fetal weight (EFW) < 10%ile. Resolved FGR was defined as EFW < 10%ile on at least one ultrasound (US), but EFW > 10%ile at last US prior to delivery. Women with abnormal umbilical artery Doppler studies were excluded. The primary outcome was a composite of neonatal morbidity: NICU admission, Apgar < 7 at 5 minutes, neonatal resuscitation, cord pH < 7.1, RDS, TTN, hypoglycemia, sepsis or death. Secondary outcomes were individual items in the composite. Baseline characteristics, obstetric and neonatal outcomes were compared using Wilcoxon rank-sum and Fisher’s exact test. Logistic regression was used to adjust for confounders. Of 777 women studied, 686 (88%) had persistent FGR and 91 (12%) had resolved FGR. Women with resolved FGR were more likely to have higher body mass index, gestational diabetes, preexisting diabetes, diagnosed with FGR earlier, had spontaneous labor and delivered at later gestational ages. There was no difference in the composite neonatal outcome (RR 1.03, 95% CI, 0.72, 1.47) for resolved versus persistent FGR even when adjusting for confounders (aRR 0.79, 95% CI 0.54, 1.17). There were no differences in cesarean delivery or delivery complications between groups. Though women with resolved FGR are managed differently than those with persistent FGR, resolved FGR fetuses do not have improved composite morbidity immediately after delivery compared to those where FGR persists. Future research is needed to determine whether additional surveillance results in improved outcomes in fetuses with resolved FGR.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Doppler evaluation of IUGR babies at a tertiary hospital

Intrauterine growth restriction is defined as the condition we're fetal weight is <10 percentile, in case fetal weight is < 3rd percentile it is severe IUGR. IUGR is divided into maternal, fetal and placental causes. It is further classified as symmetric IUGR and Asymmetrical IUGR. Diagnosis of IUGR is made on USG and Doppler. Doppler study of umbilical artery, middle cerebral artery and Ductus venosus is used for prognosis in IUGR babies and also helps in deciding time and mode of delivery.Methodology: Our study includes 100 subjects that includes 50 patients with normal Doppler and 50 patients with abnormal Doppler. If we see association of maternal diseases we can see maternal diabetes, maternal hypertension, heart diseases, are associated with IUGR. Similarly congenital malformation of baby were associated with IUGR. With regards to perinatal outcome we can see NICU admission, perinatal mortality, ventilatory support in more in IUGR babies with abnormal Doppler. Furthermore we can see that adverse perinatal outcome in more in babies with combined abnormal umbilical and middle cerebral artery Doppler and in those with abnormal ductus venosus Doppler. If we go towards mode of delivery we can see that LSCS is seen in 80% of patients with abnormal Doppler while those with Normal Doppler vaginal delivery is seen in 36% of patients. Regarding timing of delivery we can see that 52% of IUGR patients with abnormal Doppler and 50% of IUGR patients with normal Doppler were terminated between 34-37 weeks of gestation.

Perinatal outcome of growth restricted fetuses with abnormal umbilical artery Doppler waveforms compared to growth restricted fetuses with normal umbilical artery Doppler waveforms at a tertiary referral hospital in urban Ethiopia.

Intrauterine growth restriction is defined as a fetal weight below the 10th percentile for a given gestational age and can be identified using umbilical artery Doppler velocimetry which is a non-invasive technique. The objective of this study was to determine the perinatal outcome of growth-restricted fetuses with abnormal umbilical artery Doppler study compared to those with normal umbilical artery Doppler waveforms at a tertiary referral hospital in Ethiopia. A prospective cohort study was conducted among pregnant mothers with fetal growth restriction admitted for labour and delivery from September 2018-February 2019. The data were entered and analyzed using SPSS version 23. After conducting descriptive analysis, exploring the entire data, and checking for, statistical associations between abnormal umbilical artery Doppler and outcome variables, multiple logistic regression was conducted to control for confounders. A total of 170 pregnant mothers complicated with growth-restricted fetuses were included in the study, among which 133 were with normal umbilical artery Doppler studies and 37 were with abnormal umbilical artery Doppler studies. Four (3%) of normal and 9(24.3%) of abnormal umbilical artery Doppler studies ended in perinatal death-value = 0.001. Twenty (15%) of normal and 24(64.9%) of abnormal umbilical artery Doppler study neonates required neonatal intensive care admission-value = 0.002. Growth restricted fetuses complicated with abnormal Doppler were two times more likely to require neonatal intensive care unit admissions compared to growth-restricted fetuses with normal umbilical artery Doppler flow, P-value 0.002, (OR = 2.059,95%CI 1.449-2.926). Growth restricted fetuses complicated with abnormal Doppler were four times more likely to end in early neonatal death compared to growth-restricted fetuses with normal umbilical artery Doppler flow, P-value 0.001, (OR = 4.136, 95%CI 3.423-4.998). However, the study is unmatched and there is a possibility of gestational age confounding the result and should be seen with the context of preterm morbidity and mortality. The abnormal umbilical artery Doppler waveform is associated with cesarean section delivery, neonatal intensive care unit admission, respiratory distress syndrome, neonatal sepsis, neonatal hyperbilirubinemia, and early neonatal death compared to normal umbilical artery Doppler flow.

Maternal Amino Acid Profiles to Distinguish Constitutionally Small versus Growth-Restricted Fetuses Defined by Doppler Ultrasound: A Pilot Study.

Fetuses measuring below the 10th percentile for gestational age may be either constitutionally small for gestational age (SGA) or have pathologic fetal growth restriction (FGR). FGR is associated with adverse outcomes; however, identification of low-risk SGA cases is difficult. We performed a pilot study evaluating maternal markers of pathologic FGR, hypothesizing there are distinct amino acid signatures that might be used for diagnosis and development of new interventions. This was a cohort study of healthy women with sonographic fetal estimated fetal weight <5th percentile divided into two groups based upon umbilical artery (UmA) Doppler studies or uterine artery (UtA) Doppler studies. We collected maternal blood samples prior to delivery and used ion pair reverse phase liquid chromatography-mass spectrometry or gas chromatography-mass spectrometry to assess 44 amino acids. Among 14 women included, five had abnormal UmA, and three had abnormal UtA Doppler results. Those with abnormal UmA showed elevated ornithine. Those with abnormal UtA had lower dimethylglycine, isoleucine, methionine, phenylalanine, and 1-methylhistidine. We found several amino acids that might identify pregnancies affected by pathologic FGR. These findings support the feasibility of future larger studies to identify maternal metabolic approaches to accurately stratify risk for small fetuses.

1028: Utility of the cerebroplacental ratio (CPR) in marijuana exposed growth restricted fetuses

Severe fetal growth disorders are associated with an increased risk of adverse perinatal outcome (APO). The CPR represents the interaction of alterations in blood flow to the fetal brain and placenta. It is calculated by dividing the Doppler indices of the middle cerebral artery (MCA) by those of the umbilical artery (UA). CPR has been toted as a superior reflection of fetal hypoxia/acidemia and therefore a better predictor of APO. We sought to determine the role of CPR as a predictor of severe fetal growth restriction (FGR), defined as an estimated fetal weight (EFW) less than the 5th percentile, in a study population of marijuana (MJ) exposed FGR fetuses. This was a retrospective cohort study of high-risk singleton pregnancies over a four-year period. Self-identified daily MJ users with FGR fetuses, defined as fetuses with an EFW less than the 10th percentile, in the 3rd trimester were isolated. Fetal biometry, amniotic fluid indices, and CPRs were calculated. A CPR < 1 was considered abnormal. FGR fetuses with normal and abnormal CPRs were then compared. 26 /192 (13.5%) of MJ exposed fetuses were diagnosed with FGR in 3rd trimester. 12/26 (46%) had an abnormal CPR and 14 had a normal CPR (mean CPR 0.60 vs 1.57, p = 0.0001). The mean EFW percentile was lower in the abnormal CPR group in comparison to the group with normal CPR (3.33 vs 7.64, p=0.0001). Both groups showed evidence of brain sparing with an overall mean head circumference of 17.55 in comparison to a mean abdominal circumference of 5.63. A CPR < 1 was associated with more severe FGR, oligohydramnios, and abnormal UA Doppler studies (see table 1). Approximately half of the MJ exposed FGR fetuses had an abnormal CPR. In this subset of patients, > 90% had severe FGR, a higher proportion had absence/reversal of end diastolic flow in the UA, and a higher proportion had oligohydramnios. This demonstrates that an abnormal CPR identifies a group of FGR fetuses at a greater risk for severe FGR and possibly APO.

Umbilical artery pulsatility index and half-peak systolic velocity deceleration time in fetuses with trisomy 21

Objective: To analyze placental vascular resistance and the role of placental insufficiency in the etiology of reduced fetal growth in fetuses with trisomy 21 as determined by umbilical artery (UA) Doppler velocimetry.Methods: Second- and third-trimester UA Doppler ultrasound studies were performed in fetuses with trisomy 21 at the time of clinically indicated obstetric ultrasound assessment. The UA pulsatility index (PI) and half-peak systolic velocity deceleration time (hPSV-DT) were measured and recorded. Perinatal outcome was reviewed and the results from UA Doppler velocimetry were compared with birthweight according to gestational age at the time of the delivery.Results: A total of 60 fetuses with trisomy 21 were studied and information from 147 UA Doppler studies was analyzed. Overall, at least one of the UA PI and hPSV-DT values was abnormal in 82% (n = 49) and 90% (n = 54) of the cases, respectively. The incidence of abnormal UA PI values increased with gestational age from 39% (7/18) before 21 weeks to 78% (18/23) after 35 weeks (p < .05). The increase was even more evident for UA hPSV-DT values from 28% (5/18) before 20 weeks to 91% (21/23) after 35 weeks (p < .01). After exclusion of four fetuses with hydrops or isolated hydrothorax/ascites, 16 (29%) were classified at birth as small for gestational age (SGA), 34 (61%) as adequate for gestational age, and six (11%) as large for gestational age, with a mean birthweight z-score of −0.36. When only considering the last Doppler ultrasound assessment prior to delivery, UA PI and hPSV-DT values were abnormal in 73% (41/56, mean z-score = +1.72) and 82% (46/56; mean z-score = −2.18) of the cases, respectively. Mean gestational age at delivery and birth weight were significantly lower in the group with abnormal compared to normal UA PI and hPSV-DT values. Similarly, the incidence of SGA fetuses was significantly higher in the group with abnormal compared to normal UA PI and hPSV-DT values, with 94 (n = 15) and 100% of the 16 SGA newborn infants having abnormal UA PI and hPSV-DT values prior to delivery, respectively.Conclusions: Trisomy 21 fetuses have a progressively higher incidence of abnormal UA impedance indices throughout pregnancy, which suggests developing placental vascular resistance as the pregnancy progresses. This alteration likely begins around the mid second trimester and increases with gestational age; however, increasing placental vascular resistance seems to produce a discrete decrease in fetal growth, despite severe alteration of the UA Doppler impedance indices. As a general hypothesis, we postulate that trisomy 21 fetuses have increasing placental vascular resistance but there may be some factors that protect these fetuses from severe fetal growth restriction.