Umbilical Artery Doppler Ultrasonography Research Articles

Frequency of third trimester umbilical artery Doppler for improving neonatal outcomes in high-risk pregnancies: a randomized trial.

Umbilical artery Doppler ultrasonography is useful for high-risk prenatal surveillance. However, according to a systematic review and meta-analysis by the Cochrane pregnancy and childbirth group, the optimal frequency with which such surveillance should occur remains unclear. In the current study, we aimed to investigate whether performing umbilical artery Doppler on a weekly basis enables earlier detection of changes in utero-placental blood flow than the recommended bi-weekly (i.e., fortnightly) regimen and its impact on perinatal outcomes. This randomized controlled study included 292 high-risk pregnant women in their third trimester who attended the Ain Shams University Maternity Hospital in Egypt from January 2018 to September 2019. The women were randomly assigned to two groups to undergo either bi-weekly or once-weekly umbilical artery Doppler ultrasound. In the primary analysis performed according to the intention-to-treat basis, we observed no difference in the primary outcome of fetal admission to the neonatal intensive care unit (NICU) within the first 24 hours (risk difference, -2.63; 95% confidence interval, -12.92 to 7.65). Furthermore, no significant differences in secondary outcomes were observed (apart from stillbirth). Weekly umbilical artery Doppler is not superior to bi-weekly surveillance in preventing admission to the NICU and most other studied outcomes. Therefore, the bi-weekly regiment may be more convenient for women and more cost-effective for health care organizations (trial registration: NCT03584763 at clinicaltrials.gov).

The relationship between postnatal hypoglycemia and umbilical artery Doppler ultrasonography in neonates with intrauterine growth restriction: A longitudinal follow-up study

BackgroundIntrauterine growth restriction (IUGR) refers to fetuses with an estimated ultrasonography weight below the 10% percentile. Hypoglycemia is a major concern in neonates with IUGR.ObjectiveTo investigate the relationship between umbilical artery (UA) Doppler ultrasonography and neonate hypoglycemia and IUGR.Materials and MethodsThis was a longitudinal follow-up study consisting of 114 neonates (gestational age of 28-40 wk) born with IUGR in the third trimester of pregnancy at Shahid Sadoughi Hospital, Yazd, Iran between May 2016 and October 2017. The neonates were assigned into three subgroups of normal UA Doppler, absent end-diastolic flow (EDF) in UA Doppler, and reverse EDF in UA Doppler. The blood glucose of the neonates was checked one, two, three, six, 12, 24 and 48 hr after birth, and the neonates were placed in the hypoglycemia or euglycemia groups according to guidelines.ResultsOut of the 114 neonates included in the study, 75 (65.8%) had normal UA Doppler, 29 (25.4%) had absent EDF in UA Doppler, and 10 (8.8%) had reverse EDF in UA Doppler. There was a significant difference in the mean blood glucose in the first hr between the normal UA Doppler group and the reverse EDF in UA Doppler group (p 0.01).ConclusionPostnatal hypoglycemia in neonates with IUGR is associated with the result of UA Doppler ultrasonography during pregnancy.

An Unusual Monochorionic Pregnancy.

An Unusual Monochorionic Pregnancy.

“Early Screening Test for High Risk Pregnancies by Second Trimester Color Doppler Imaging Of the Feto-Placental Circulation”

Objective: To examine the diagnostic value of umbilical artery velocity waveforms for the early detection of pregnancy induced hypertension and fetal growth restriction. To determine the utility of color Doppler Sonography of the fetoplacetal circulation for early detection of high risk pregnancies. Methods: This prospective study was conducted in the Department of Obstetrics & Gynecology, Sir Sallimullah Medical Collage & Mitford Hospital Dhaka in collaboration with radiology and imaging department of Dhaka hospital in 1st July, 2006 to 30 June, 2008. 126 randomly selected patients from 17-35 years of ages whose umbilical artery Doppler sonography was done between 16-22 weeks of gestation. All the patient were taken umbilical artery Doppler ultrasonography. Informed consent was taken from all patients. Results: A total 126 subjects of 16 to 22 weeks of gestation were included in this series. On application of the student‘t’ test for S/D ratio between normal and abnormal waveforms of the umbilical artery was found significant difference (P<.0001). Distribution of patient according to umbilical artery systolic / diastolic ratio (n=126). Normal UA waveform 76 (60%), abnormal UA waveform 50(40%), Age (Mean ±SD) in year, normal UA waveform 25.63 ± 4.47 and abnormal UA waveform 25.86±3.75. Para: Primiparous normal UA waveform 36 (60%) & abnormal UA waveform 24 (40%), multiparous normal UA waveform 40 (60.6%) & abnormal UA waveform 26 (39.4%). Gestation age at scan in weeks (Mean± SD), normal UA waveform 19.5 ±2.5, abnormal UA waveform 19±2.0. Gestation age at delivery in weeks (Mean± SD), normal UA waveform 39.03±1.61, abnormal UA waveform 35.78 ±1.53, P value 0.0001. Birth wt. in Kg. (Mean ±SD), normal UA waveform 3.10 ±0.38, abnormal UA waveform 2.42 ±0.53, P value 0.0001. S/D ratio (Mean ±SD), normal UA waveform 2.40 ±0.31, abnormal UA waveform 5.46±1.62, P value 0.0001. Cases with an abnormal outcome in relation to whether the umbilical artery waveform was classified as normal or abnormal (n=126). Abnormal outcome in PIH normal UA waveform (n=76) 4%, PIH abnormal UA waveform (n=50) 14%, P value 0.001. In PIH/FGR, normal UA waveform (n=76) 1% & abnormal UA waveform (n=50) 5%, P value 0.024. FGR normal UA waveform (n=76) 5% & abnormal UA waveform (n=50) 13%, P value 0.002. Asphyxia normal UA waveform (n=76) 0% & abnormal UA waveform (n=50) 3%, P value 0.017. PIH /IUD normal UA waveform (n=76) 0% & abnormal UA waveform (n=50) 1%. A significant association was found when the Chi Square (X 2) test was used to examine the relationship between umbilical artery blood flow and the outcome of patient (i.e FGR, PIH, fetal asphyxia). The screening test had a sensitivity of 78.26% & specificity of 82.5% and accuracy 80.95%. The predictive value of a positive test was 72% and of a negative test 86.84%. Conclusion : A close linear relationship between diagnosis of high risk pregnancy & umbilical artery Doppler velocity waveforms was observed .As umbilical artery Doppler is easy to perform and it is done in between 16 to 22 weeks of gestation can be done along with anomaly scan which is also done at 20-22 week of gestation. So, UA Doppler does not cause additional USG scan. Along with anomaly scan UA Doppler will help to screen out high risk pregnancy.

Hypertensive disorders of pregnancy associated with adverse pregnant outcomes in patients with systemic lupus erythematosus: a multicenter retrospective study.

Hypertension disorders in pregnancy (HDP) were common complications in women with systemic lupus erythematosus (SLE). However, the impact of HDP and the measures to prevent HDP-related fetal adverse pregnancy outcomes (APOs) remained to be explored. A multicenter retrospective study of 342 pregnant women with SLE was performed. Variables related to SLE and APOs were recorded. Fetal development was evaluated by umbilical artery Doppler ultrasonography. HDP was diagnosed in 45 (13.2%) patients, including pre-eclampsia in 42 and gestational hypertension in 3. Patients with HDP had higher incidence of preterm birth (71.1% vs 20.9%, P < 0.001), intrauterine growth retardation (IUGR) (37.8% vs 11.8%, P < 0.001), low-birth-weight infants (62.2% vs 17.2%, P < 0.001), and very-low-birth-weight infants (37.8% vs 2.7%, P < 0.001), compared with lupus patients without HDP. A total of 35 (77.8%) HDP patients had disease activation during pregnancy. All the events occurred during the second and third trimesters, mainly presenting as moderate-to-high activity (65.7%). Active disease [odds ratios (OR) = 3.9, 95% confidential interval (CI) 1.5-9.7, P = 0.004] and positive anticardiolipin (aCL) antibody (OR = 7.6, 95% CI 2.7-18.6, P < 0.001) were independent risk factors for HDP in lupus patients. Doppler RI and S/D ratio predicted APOs in patients with HDP. The optimal cut-off values for RI and S/D ratio were 0.7 (sensitivity 48.1%, specificity 53.3%) and 3.4 (sensitivity 66.7%, specificity 100%), respectively. HDP was a common pregnant complication and caused various fetal and maternal adverse outcomes in patients with SLE. Umbilical artery Doppler ultrasonography was effective in predicting fetal APOs in lupus patients with HDP.Key Points• HDP induced preterm birth, IUGR, low-birth-weight infants, and very-low-birth-weight infants in patients with SLE.• HDP led to lupus activation during the second and third trimesters.• Disease activation and aCL positivity were predictors for HDP.• RI and S/D ratio from umbilical artery Doppler predicted APOs in patients with HDP.

The Role of Second and Third Trimester Umbilical Artery Doppler Ultrasonography in Determining Chorionicity of Twin Pregnancies

Introduction: Determining the chorionicity in monozygotic twins is of pivotal importance, because it has been shown that monochorionic fetuses compared to dichorionic counterparts bear a higher risk f morbidity and mortality. Using conventional ultrasonography in this regard is along with accurate results provided that it is conducted before 14 weeks’ gestation. It has been suggested that differences between color Doppler ultrasonographic indices obtained from the umbilical arteries of twins may result in the prediction of chorionicity. Nevertheless, relevant available data are very scarce. This study aimed to examine the role of umbilical artery Doppler ultrasound in the second and third trimesters in determining chorionicity in twin pregnancies Methods : A total 20 monochorionic monozygotic pregnancies and 30 dichorionic monozygotic pregnancies between 28 and 39 weeks’ gestation were examined by color Doppler study of the umbilical arteries. The pulsatility index (PI), resistive index (RI) and the S to D ratio (S/D) of the umbilical arteries and their differences in each group independently were compared between twins. Results: The mean PI difference between the two umbilical arteries did not differ significantly between the two groups; however, the mean differences of RI and S/D were significantly higher in the dichorionic group (0.006 ± 0.01 vs. 0.04 ± 0.01, P = 0.02, and 0.54 ± 0.09 vs. 0.33 ± 0.05, P = 0.04, respectively). When the difference between the two fetuses in terms of the umbilical artery RI difference exceeded 0.05 and over, the probability of dichorionic pregnancy was present (sensitivity, 60% and specificity, 65%). The difference of S/D was not acceptable as to the diagnostic accuracy in this regard. Conclusions: On the basis of our findings, the results of umbilical artery color Doppler study in twin pregnancies aged 28-39 weeks’ gestation could be used for determining chorionicity. To reach more solid conclusions, further studies with larger sample sizes are recommended to be carried out.

Umbilical Artery Doppler Ultrasound for the Determination of Chorionicity in Twin Pregnancies

Background: Maternal and perinatal complications are higher in twins than in singleton pregnancies. This complications rate is directly related to placental chorionicity in twin pregnancies. Early diagnosis of twins and their chorionicity is necessary to reduce the perinatal mortality. It can be determined by different methods in the first trimester. Ultrasonography is a valuable tool in management of twin pregnancy. Ultrasound in evaluation of the chorionicity decreases later in gestational weeks. The aim of this study is to determine the chorionicity by using Doppler ultrasonography in second and third trimesters. Methods: Patients were divided into two groups according to their chorionicity. Pregnancies with dichorionic placentas were included into group 1, while with monochorionic placentas were included into group 2. In both groups, PI, RI and S/D indices of umbilical artery were measured in each fetus. Whether there is a significant difference between the groups in the Doppler parameters was evaluated. Results: The PI, RI and S/D indices of umbilical artery doppler ultrasonography were different between the twins with dichorionic placentas (p < 0.05), but they were similar in twins with monochorionic placentas. Conclusions: Based on our study results, we suggest that the Doppler ultrasonography can be useful method for chorionicity determination of twin pregnancies at second and third trimesters, if chorionicity has not determined until the end of second trimester. doi:10.4021/ jcgo29w

The use of umbilical artery Doppler ultrasonography in modern obstetrics

In contrast to the reduction in perinatal mortality in high-risk pregnancies, screening of low-risk pregnancies with umbilical artery Doppler ultrasonography has shown no benefit. Advances in pathophysiology question the assumption that the placenta is hypoxic in fetal growth restriction, with absent end-diastolic frequencies in the umbilical artery. The timing of delivery in relation to Doppler findings is uncertain, and so trials that relate Doppler findings to neurodevelopmental outcome are necessary to refine the role of this technique in obstetric practice.

Antenatal screening for intrauterine growth retardation with umbilical artery Doppler ultrasonography

Antenatal screening for intrauterine growth retardation with umbilical artery Doppler ultrasonography

Antenatal screening with umbilical artery Doppler ultrasonography: Authors' reply

Antenatal screening with umbilical artery Doppler ultrasonography: Authors' reply

Antenatal screening with umbilical artery Doppler ultrasonography.

Antenatal screening with umbilical artery Doppler ultrasonography.

Antenatal screening with umbilical artery Doppler ultrasonography

Antenatal screening with umbilical artery Doppler ultrasonography

Antenatal screening with umbilical artery Doppler ultrasonography

Antenatal screening with umbilical artery Doppler ultrasonography

Antenatal screening for intrauterine growth retardation with umbilical artery Doppler ultrasonography.

To assess the usefulness of continuous wave Doppler ultrasonography as an antenatal screening tool for the detection of intrauterine growth retardation and fetal compromise 2097 singleton pregnancies were studied. Umbilical artery velocity waveforms were obtained at 28, 34, and 38 weeks of gestation, from which the pulsatility index, A/B ratio, and resistance parameter were calculated. No abnormal features or indices of neonatal outcome were adequately predicted. The most sensitive index for being delivered of a growth retarded infant (less than 5th centile birth weight for gestation) was an A/B ratio at 34 weeks (sensitivity 40%, specificity 84%). Other measures that show poor neonatal nutritional state (ponderal index, skinfold thickness, and ratio of mid-arm circumference to head circumference) were even less well predicted. Acute and chronic hypoxia as determined by Apgar score, pH in blood from the cord artery, and packed cell volume correlated poorly with umbilical artery waveform indices, and there was no obvious difference between the indices of those who subsequently required operative or instrumental delivery for fetal distress and those requiring no intervention. There were three unexplained stillbirths in the series, in each of which the fetus had shown waveform patterns that suggested increased peripheral resistance, though the technique did not appear to be useful for predicting the time of subsequent death. Screening for small for dates babies in a three stage programme was of no value regardless of the threshold or index chosen. Obstetricians should resist the temptation to introduce screening with Doppler ultrasonography until its proper role has been determined.