Umbilical Artery Doppler Velocimetry Research Articles

A clinical study on Doppler velocimetry of umbilical artery and middle cerebral artery in post-dated pregnancy in the prediction of fetal outcome

A clinical study on Doppler velocimetry of umbilical artery and middle cerebral artery in post-dated pregnancy in the prediction of fetal outcome

EP15.02: Expectant management of preterm pre‐eclampsia: any benefit from umbilical artery Doppler velocimetry in a resource constrained setting?

EP15.02: Expectant management of preterm pre‐eclampsia: any benefit from umbilical artery Doppler velocimetry in a resource constrained setting?

Maternal PlGF and umbilical Dopplers predict pregnancy outcomes at diagnosis of early-onset fetal growth restriction.

BACKGROUNDSevere, early-onset fetal growth restriction (FGR) causes significant fetal and neonatal mortality and morbidity. Predicting the outcome of affected pregnancies at the time of diagnosis is difficult, thus preventing accurate patient counseling. We investigated the use of maternal serum protein and ultrasound measurements at diagnosis to predict fetal or neonatal death and 3 secondary outcomes: fetal death or delivery at or before 28+0 weeks, development of abnormal umbilical artery (UmA) Doppler velocimetry, and slow fetal growth.METHODSWomen with singleton pregnancies (n = 142, estimated fetal weights [EFWs] below the third centile, less than 600 g, 20+0 to 26+6 weeks of gestation, no known chromosomal, genetic, or major structural abnormalities) were recruited from 4 European centers. Maternal serum from the discovery set (n = 63) was analyzed for 7 proteins linked to angiogenesis, 90 additional proteins associated with cardiovascular disease, and 5 proteins identified through pooled liquid chromatography and tandem mass spectrometry. Patient and clinician stakeholder priorities were used to select models tested in the validation set (n = 60), with final models calculated from combined data.RESULTSThe most discriminative model for fetal or neonatal death included the EFW z score (Hadlock 3 formula/Marsal chart), gestational age, and UmA Doppler category (AUC, 0.91; 95% CI, 0.86-0.97) but was less well calibrated than the model containing only the EFW z score (Hadlock 3/Marsal). The most discriminative model for fetal death or delivery at or before 28+0 weeks included maternal serum placental growth factor (PlGF) concentration and UmA Doppler category (AUC, 0.89; 95% CI, 0.83-0.94).CONCLUSIONUltrasound measurements and maternal serum PlGF concentration at diagnosis of severe, early-onset FGR predicted pregnancy outcomes of importance to patients and clinicians.TRIAL REGISTRATIONClinicalTrials.gov NCT02097667.FUNDINGThe European Union, Rosetrees Trust, Mitchell Charitable Trust.

Comparing Non-Stress Test versus Umbilical Artery Doppler Velocimetry among Aample of High-risk Pregnant Women in Erbil City

Background: The mainstay of care for lowering maternal and perinatal mortality and morbidity is antepartum foetal surveillance. Numerous techniques are used, including fetal movements, Vibroacoustic stimulation tests, contraction stress tests, biophysical profiles of the fetus, modified biophysical profiles, non-stress testing and Doppler Umbilical artery of the fetus's. The fetal heart reaction to internal and extrinsic stimuli is seen on electronic fetal monitoring devices. The benefit of high resolution dynamic ultrasonography and Doppler imaging is that it allows for the visualization of the fetus and its surroundings as well as the monitoring of fetal health by measuring utero-placental circulation. Patients and techniques: The cross-sectional investigation including 120 pregnant women who visited the Maternity Teaching Hospital between 26 June and 31 August 2022 and complained of decreased uterine contractions have been included. The questionnaire included sociodemographic data, obstetrical data, information on the fetal outcome and method of delivery. In accordance with the American Academy of Obstetricians and Gynecologists, cardiotopography was utilized to conduct a non-stress test, and the outcomes were categorized as reactive and non-reactive. Cardiotopography was used to perform a non-stress test, and the results were classified as reactive or non-reactive in accordance with the American Academy of Obstetricians and Gynecologists. Also, during 32 weeks or more of gestation, the inferior vena cava was not compressed by the gravid uterus during ultrasonography of the umbilical arteries, which was performed in a semi-recumbent position with a slight lateral tilt. Result: Based on NST and Doppler velocimetry of the umbilical artery, all cases were classified into two groups. The outcomes of the two tests didn't significantly differ from one another. The rate of Cesarean section (CS) was 46.1% among women with non-reactive (abnormal) CTG, compared with 25% among women with normal CTG (p = 0.0316). Only one neonate (1.3%) died among women with normal CTG, while none of the neonates died among women with abnormal CTG. The rate of CS among women with abnormal ultrasonography was 80% compared to women (11%) with normal ultrasonography. Furthermore, one neonate (2.1%) in the group of abnormal doppler, compared with 0% in the normal group. Conclusion: NST and umbilical artery Doppler of are sensitive and specific tests with strong positive prognostic value to suggest a poor prognosis for the newborn. Doppler velocimetry of umbilical artery is more important than a non-stress test because it lowers the likelihood of a CS birth in non-reactive non-stress test situations without increasing the risk of perinatal morbidity and mortality. Bangladesh Journal of Medical Science Vol.22 (Special Issue) 2023 p.10-17

A Comparison of the Umbilical Artery Doppler Indices between Pregnancies with Advanced and Normal Maternal Age in the Second Trimester

Objective: To compare the pulsatile index (UA-PI), resistance index (UA-RI), and systolic/diastolic ratio (UA-S/D) of the umbilical artery between pregnant women with advanced maternal age (AMA) and normal maternal age. Materials and Methods: Participants were pregnant women who attended antenatal care at the maternal-fetal medicine unit at Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand. The present study was conducted between February and December 2022. Participants who met inclusion criteria were classified as study for the patients aged 35 years and older, and control groups for the patients younger than 35 years old. All participants underwent ultrasonography for umbilical artery Doppler velocimetry measurement including UA-PI, UA-RI, and UA-S/D. Demographic characters of both study and control groups were included for statistical calculation. Results: Five hundred pregnant women with gestational age between 18 and 24 weeks were enrolled. The mean age of the study and the control group were 37.9 and 26.0 years, respectively. Participants in the study group have higher BMI than the control group. The study and the control group had comparable diastolic and systolic blood pressure. The mean (standard deviation) of UA-PI, UA-RI, and S/D ratio of the study/control group were 1.33±0.21/1.27±0.22, 0.77±0.1/0.74±0.09, and 4.24±0.98/3.95±0.97, respectively, with statistical significance. The study group had a significantly higher number of large for gestational age (LGA), pregnancy induced hypertension (PIH), and gestational diabetes mellitus (GDM) than the control group. Conclusion: AMA pregnancy had higher UA-PI, UA-RI, UA-S/D, incidence of PIH, GDM, and LGA than those age less than 35 years. Keywords: Advanced maternal age; Umbilical artery Doppler indices; Second trimester

Obstetric vascular Doppler velocimetry: clinical applications and overuses.

A safe and non-intrusive assessment of fetal health is not only crucial in low-risk gestations, but it is also the standard of care in high-risk pregnancies. Therefore, measuring blood flow across different vessels with non-invasive ultrasound methods has been accurately and painstakingly studied and published. Amongst these state-of-the-art techniques, umbilical artery (blood flow) Doppler velocimetry (UADV) has allowed for fetal well-being follow-ups and assess uteroplacental function, which obtains a more complete and clearer picture; particularly in regard to complicated pregnancies. Additionally, there are other modalities with diverse clinical applications that have emerged, including their clinical and research utilization in conditions such as fetal growth restriction (FGR), preeclampsia, fetal anemia, monochorionic twins vascular blood flow mismatch such as is in twin-to-twin transfusion syndrome, twin anemia polycythemia sequence, and twin reverse arterial perfusion sequence. Nevertheless, their applications regarding various other maternal-fetal diagnoses in the same way as premature births and/or multiple gestation surveillance have not been reported to hold strong clinical evidence. With that in regard, the purpose of this unique study was to give update of the multiple clinical applications of this very important obstetrical tool. Additionally, to review the pathophysiology as well as revisit their reported significant valid uses and occasional overuses. We also delved into quality control measures as related to the application of Doppler in obstetrics. Lastly, it is essential to look through and reflect on the future developments of this valuable, non-invasive, high-risk marvelous modern device.

Comparative Assessment of the Umbilical Artery Doppler Velocimetry and Non-Stress Test in Evaluating the Fetal Well-Being among Women with Pre-Eclampsia

Background: Pre-eclampsia is defined as a systemic syndrome characterized by the new onset of raised blood pressure >140/90 mm Hg and proteinuria after 20 weeks of gestation in a previously normotensive woman. Reduction of neonatal complications of pre-eclampsia is feasible by assessment of fetal well-being. Both fetal Doppler and NST are used for the screening of high-risk pregnancies. Methods: It was a prospective comparative tertiary care hospital based study of pre-eclamptic women admitted in department of Obstetrics and Gynaecology, Lalla Ded hospital over a period of 18 months from March 2020 to September 2021. Written informed consent was obtained from the subjects prior to recruitment to the study. A total of 232 patients who were known case of pre-eclampsia or those who develop pre-eclampsia during hospital stay were included in our study. Results: Both NST and fetal UA Doppler velocimetry were significantly correlated with the perinatal outcome. However; UA Doppler velocimetry had more sensitivity than NST. In contrast, NST had slightly more specificity than UA Doppler velocimetry. Conclusion: The fetal umbilical artery Doppler velocimetry improves the sensitivity for the prediction of poor perinatal outcome when it is combined with the non-stress test. Both the tests are complimentary to one another in fetal surveillance of high risk pregnancies like pre-eclampsia. Keywords: Pre-eclampsia, Umbilical arteries, Ultrasonography, Doppler, NST, Prenatal diagnosis

Maternal plasma syndecan-1: a biomarker for fetal growth restriction

Objective The identification of fetal growth disorders is an important clinical priority given that they increase the risk of perinatal morbidity and mortality as well as long-term diseases. A subset of small-for-gestational-age (SGA) infants are growth-restricted, and this condition is often attributed to placental insufficiency. Syndecan-1, a product of the degradation of the endothelial glycocalyx, has been proposed as a biomarker of endothelial damage in different pathologies. During pregnancy, a “specialized” form of the glycocalyx—the “syncytiotrophoblast glycocalyx”—covers the placental villi. The purpose of this study was to determine whether the concentration of maternal plasma syndecan-1 can be proposed as a biomarker for fetal growth restriction. Study design A cross-sectional study was designed to include women with normal pregnancy (n = 130) and pregnant women who delivered an SGA neonate (n = 50). Doppler velocimetry of the uterine and umbilical arteries was performed in women with an SGA fetus at the time of diagnosis. Venipuncture was performed within 48 h of Doppler velocimetry and plasma concentrations of syndecan-1 were determined by a specific and sensitive immunoassay. Results (1) Plasma syndecan-1 concentration followed a nonlinear increase with gestational age in uncomplicated pregnancies (R2 = 0.27, p < .001); (2) women with a pregnancy complicated with an SGA fetus had a significantly lower mean plasma concentration of syndecan-1 than those with an appropriate-for-gestational-age fetus (p = .0001); (3) this difference can be attributed to fetal growth restriction, as the mean plasma syndecan-1 concentration was significantly lower only in the group of women with an SGA fetus who had abnormal umbilical and uterine artery Doppler velocimetry compared to controls (p = .00071; adjusted p = .0028). A trend toward lower syndecan-1 concentrations was also noted for SGA with abnormal uterine but normal umbilical artery Doppler velocimetry (p = .0505; adjusted p = .067); 4) among women with an SGA fetus, those with abnormal umbilical and uterine artery Doppler findings had a lower mean plasma syndecan-1 concentration than women with normal Doppler velocimetry (p = .02; adjusted p = .04); 5) an inverse relationship was found between the maternal plasma syndecan-1 concentration and the umbilical artery pulsatility index (r = −0.5; p = .003); and 6) a plasma syndecan-1 concentration ≤ 850 ng/mL had a positive likelihood ratio of 4.4 and a negative likelihood ratio of 0.24 for the identification of a mother with an SGA fetus who had abnormal umbilical artery Doppler velocimetry (area under the ROC curve 0.83; p < .001). Conclusion Low maternal plasma syndecan-1 may reflect placental diseases and this protein could be a biomarker for fetal growth restriction. However, as a sole biomarker for this condition, its accuracy is low.

Isolated abdominal circumference vs. estimated fetal weight, which matters more?

Fetal growth restriction (FGR) is a leading cause of neonatal morbidity and mortality. In 2020, the Society of Maternal Fetal Medicine and the American College of Obstetricians and Gynecologists redefined fetal growth restriction from estimated fetal weight (EFW) less than the 10th percentile to EFW or abdominal circumference (AC) less than the 10th percentile. In our study, we seek to assess the rate of abnormal umbilical artery Doppler velocimetry in fetuses with FGR diagnosed by isolated AC less than the 10th percentile versus those diagnosed by EFW less than the 10th percentile.

Abnormal umbilical artery pulsatility index in appropriately grown fetuses in the early third trimester: an observational cohort study

Objective The aim of this study was to determine if appropriately grown fetuses (those that are not small-for-gestational-age) with a raised umbilical artery pulsatility index (>95th centile) in the early third trimester are at increased risk of placental dysfunction and adverse outcome. Methods This is a 5-year retrospective cohort study using routinely collected data. Inclusion criteria were singleton, non-anomalous pregnancies having a growth scan with umbilical artery Doppler velocimetry between 28 + 0 and 33 + 6 weeks’ gestation. Small-for-gestational-age fetuses were excluded. Cases were classified as group 1 (those with an umbilical artery pulsatility index >95th centile at any scan during target window) or group 2 (those where the umbilical artery pulsatility index was ≤95th centile at all scans). p-Values and odds ratios were calculated. Logistic regression was used to compute odds ratios adjusted for baseline estimated weight z-score, gestational age at delivery, and labor induction. Results After exclusions, there were 202 pregnancies in group 1 and 7950 in group 2. Differences in baseline characteristics between the groups include age (median age was 30 for group 1 and 32 for group 2, p < .001), smoking (group 1 were more likely to smoke, p < .001) and labor induction (more common in group 1, p = .03). Among those delivering ≥34 + 0, group 1 were more likely to be small-for-gestational-age and have an abnormal cerebro-placental ratio at the final scan (OR 6.76, CI 4.23–10.80 and OR 5.07, CI 3.37–7.63 respectively), and to develop features of growth restriction (OR 9.85, CI 6.27–15.49). Group 1 were also more likely to deliver <37 + 0 weeks’ gestation (OR 1.71, CI 1.13–2.58) and to have birthweight <10th or <3rd centile (OR 5.26, CI 3.65–7.58 and OR 6.13, CI 3.00–12.54 respectively). These associations remained significant when adjusted for estimated weight at the initial scan. Conclusions These data suggest that raised umbilical artery pulsatility index in an appropriately grown fetus at 28 + 0 to 33 + 6 weeks’ gestation is associated with subsequent development of growth restriction markers and an increased risk of moderate and severe small-for-gestational-age at birth. This is independent of the estimated weight of these babies at the index scan.

Intrauterine growth restriction and perinatal outcome among oligohydramnios pregnancies

Background: Successful outcome of obstetric well-being is to assess by obtaining healthy mother and child in modern obstetrics. Assessment of fetal well-being is important in timely diagnosis of fetal compromise and management. Amniotic fluid serves a major role in the development of the fetus. Aims and Objectives: The present study aims to evaluate the oligohydramnios pregnancies admitted in IPD of G &amp; O, Bankura Sammilani Medical College &amp; Hospital in terms of intrauterine growth restriction (IUGR) and perinatal outcomes. Materials and Methods: The study was conducted at Bankura Sammilani Medical College and Hospital, West Bengal, in terms of IUGR and perinatal outcomes from April 2020 to September 2021 among 80 antenatal mothers diagnosed to have oligohydramnios and subsequently admitted in-patients-department. Thorough history taking and clinical examination was done. Template was generated in MS Excel sheet and analysis was done on SPSS software. Results: Among 80 antenatal mothers diagnosed with oligohydramnios, the mean age of patients was 22.0750±4.1484. 21 (26.25%) patients had NICU admission and 56 (70.0%) patients had IUGR. In the study, 1 (1.25%) patient was perinatal death and 79 (98.75%) patients survived. In without IUGR, the mean birth weight (mean±SD) of patients was 2.7483±0.2222. In without IUGR, 1 (4.2%) patient had NICU admission. In with IUGR, 20 (35.7%) patients had NICU admission. Conclusion: Ultrasonography plays a major role in early diagnosis of IUGR. IUGR was associated with cesarean section for fetal distress, and NICU admission among oligohydramnios can be predicted using umbilical artery Doppler velocimetry.

Clinical significance of umbilical artery intermittent vs persistent absent end-diastolic velocity in growth-restricted fetuses

Umbilical artery absent end-diastolic velocity indicates increased placental resistance and is associated with increased risk of perinatal demise and neonatal morbidity in fetal growth restriction. However, the clinical implications of intermittent vs persistent absent end-diastolic velocity are unclear. We compared umbilical artery Doppler velocimetry changes during pregnancy and neonatal outcomes between pregnancies with fetal growth restriction and intermittent absent end-diastolic velocity and those with persistent absent end-diastolic velocity. In this retrospective study of singletons with fetal growth restriction and absent end-diastolic velocity, umbilical artery Doppler abnormalities were classified as follows: intermittent absent end-diastolic velocity (<50% of cardiac cycles with absent end-diastolic velocity) and persistent absent end-diastolic velocity (≥50% of cardiac cycles with absent end-diastolic velocity). The primary outcome was umbilical artery Doppler progression to reversed end-diastolic velocity. Secondary outcomes included sustained umbilical artery Doppler improvement, latency to delivery, gestational age at delivery, neonatal morbidity composite, rates of neonatal intensive care unit admission, and length of neonatal intensive care unit stay. Outcomes were compared between intermittent absent end-diastolic velocity and persistent absent end-diastolic velocity. Multivariate logistic regression was used to adjust for confounders. A receiver operating characteristic curve was generated to assess the sensitivity and specificity of the percentage of waveforms with absent end-diastolic velocity in predicting the neonatal composite. The Youden index was used to calculate the optimal absent end-diastolic velocity percentage cut-point for predicting the neonatal composite. Of the 77 patients included, 38 had intermittent absent end-diastolic velocity and 39 had persistent absent end-diastolic velocity. Maternal characteristics, including age, parity, and preexisting conditions did not differ significantly between the 2 groups. Progression to reversed end-diastolic velocity was less common in intermittent absent end-diastolic velocity than in persistent absent end-diastolic velocity (7.9% vs 25.6%; odds ratio, 0.25; 95% confidence interval, 0.06-0.99). Sustained umbilical artery Doppler improvement was more common in intermittent absent end-diastolic velocity than in persistent absent end-diastolic velocity (50.0% vs 10.3%; odds ratio, 8.75; 95% confidence interval, 2.60-29.5). Pregnancies with intermittent absent end-diastolic velocity had longer latency to delivery than those with persistent absent end-diastolic velocity (11 vs 3 days; P<.01), and later gestational age at delivery (33.9 vs 28.7 weeks; P<.01). Composite neonatal morbidity was less common in the intermittent absent end-diastolic velocity group (55.3% vs 92.3%; P<.01). Neonatal death occurred in 7.9% of intermittent absent end-diastolic velocity cases and 33.3% of persistent absent end-diastolic velocity cases (P<.01). The differences in neonatal outcomes were no longer significant when controlling for gestational age at delivery. The percentage of cardiac cycles with absent end-diastolic velocity was a modest predictor of neonatal morbidity, with an area under the receiver operating characteristic curve of 0.71 (95% confidence interval, 0.58-0.84). The optimal percentage cut-point for fetal cardiac cycles with absent end-diastolic velocity observed at the sentinel ultrasound for predicting neonatal morbidity was calculated to be 47.7%, with a sensitivity of 65% and specificity of 85%. Compared with persistent absent end-diastolic velocity, diagnosis of intermittent absent end-diastolic velocity in the setting of fetal growth restriction is associated with lower rates of progression to reversed end-diastolic velocity, higher likelihood of umbilical artery Doppler improvement, longer latency to delivery, and higher gestational age at delivery, leading to lower rates of neonatal morbidity and death. Our data support using an absent end-diastolic velocity percentage cut-point in 50% of cardiac cycles to differentiate intermittent absent end-diastolic velocity from persistent absent end-diastolic velocity. This differentiation in growth-restricted fetuses with absent end-diastolic velocity may allow further risk stratification.

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

A study of fetal umbilical artery and middle cerebral artery doppler velocimetry before and after treatment of severe maternal iron deficiency anaemia

A study of fetal umbilical artery and middle cerebral artery doppler velocimetry before and after treatment of severe maternal iron deficiency anaemia

The diagnosis and management of suspected fetal growth restriction: an evidence-based approach

This study reviewed the literature about the diagnosis, antepartum surveillance, and time of delivery of fetuses suspected to be small for gestational age or growth restricted. Several guidelines have been issued by major professional organizations, including the International Society of Ultrasound in Obstetrics and Gynecology and the Society for Maternal-Fetal Medicine. The differences in recommendations, in particular about Doppler velocimetry of the ductus venosus and middle cerebral artery, have created confusion among clinicians, and this review has intended to clarify and highlight the available evidence that is pertinent to clinical management. A fetus who is small for gestational age is frequently defined as one with an estimated fetal weight of <10th percentile. This condition has been considered syndromic and has been frequently attributed to fetal growth restriction, a constitutionally small fetus, congenital infections, chromosomal abnormalities, or genetic conditions. Small for gestational age is not synonymous with fetal growth restriction, which is defined by deceleration of fetal growth determined by a change in fetal growth velocity. An abnormal umbilical artery Doppler pulsatility index reflects an increased impedance to flow in the umbilical circulation and is considered to be an indicator of placental disease. The combined finding of an estimated fetal weight of <10th percentile and abnormal umbilical artery Doppler velocimetry has been widely accepted as indicative of fetal growth restriction. Clinical studies have shown that the gestational age at diagnosis can be used to subclassify suspected fetal growth restriction into early and late, depending on whether the condition is diagnosed before or after 32 weeks of gestation. The early type is associated with umbilical artery Doppler abnormalities, whereas the late type is often associated with a low pulsatility index in the middle cerebral artery. A large randomized clinical trial indicated that in the context of early suspected fetal growth restriction, the combination of computerized cardiotocography and fetal ductus venosus Doppler improves outcomes, such that 95% of surviving infants have a normal neurodevelopmental outcome at 2 years of age. A low middle cerebral artery pulsatility index is associated with an adverse perinatal outcome in late fetal growth restriction; however, there is no evidence supporting its use to determine the time of delivery. Nonetheless, an abnormality in middle cerebral artery Doppler could be valuable to increase the surveillance of the fetus at risk. We propose that fetal size, growth rate, uteroplacental Doppler indices, cardiotocography, and maternal conditions (ie, hypertension) according to gestational age are important factors in optimizing the outcome of suspected fetal growth restriction.

A study of fetal umbilical artery and middle cerebral artery doppler velocimetry before and after treatment of severe maternal iron deficiency anaemia

Background: Despite maternal iron deficiency anemia being a worldwide medical complication, very few studies have been performed to evaluate the efficacy of iron supplementations for treating and preventing adverse pregnancy sequelae. This study attempts to show the impact of maternal iron deficiency anemia on the mother and the fetus and whether treatment can reverse the physiological and pathological effects of anemia on the mother as well as the fetus. Objective: To evaluate the effect of vascular adaptation and extent of compensatory changes in the fetus with the change in maternal hemoglobin (Hb) levels and to study maternal and perinatal outcomes after treatment of maternal iron deficiency anemia. Methodology: The present study was an observational prospective study conducted on 50 pregnant women in GMC, Srinagar from January 2016 to June 2017. The study population was divided into two groups-Group A-Patients with moderate anemia – Hb 7–9 g/dl and Group B-Patients with severe anemia – Hb <7 g/dl. Group A received parenteral iron preparation and Group B received blood transfusion or packed red blood cells until Hb exceeded 7 g/dL, then parenteral iron was used. Maternal Hb and color Doppler were performed before and after treatment of anemia. Results: There was a decrease in the umbilical artery resistivity index (RI) after treatment of maternal anemia in both the groups and the decrease was more in those who received blood transfusion. There was an improvement in middle cerebral artery RI in both the groups after treatment and the increase was statistically significant. The C/U ratio was normalized to >1.1 in both the study groups after treatment of anemia. Conclusion: Our data support the fact that maternal Hb content of <7 g/dl is strongly associated with marked fetal hemodynamic adaptation and must be treated with acute red cell transfusion. Moderate anemia (>7 g/dl) is not sufficient to trigger fetal blood flow redistribution and can be treated with parenteral iron. Close monitoring of the fetal umbilical and cerebral circulation by Doppler examination in anemic pregnancies allows the measurement of the amplitude of fetal vascular response, early assessment of fetal damage and helps in improving fetal outcome as well.

Umbilical artery Doppler changes in fetal growth restriction with intermittently absent umbilical artery end-diastolic flow

Absent or reversed end-diastolic flow (A/REDF) are umbilical artery Doppler (UAD) velocimetry abnormalities associated with increased risk of perinatal demise and neonatal morbidity in pregnancies with fetal growth restriction (FGR). However, the clinical implications of intermittent (iAEDF) versus persistent (pAEDF) absent end-diastolic flow are unclear. This study compared changes in UAD velocimetry and latency to delivery in FGR pregnancies with iAEDF versus pAEDF at diagnosis.

Significance of intermittent absent end-diastolic flow in the umbilical artery in predicting neonatal morbidity

Umbilical artery Doppler (UAD) velocimetry is utilized to assess fetal status in fetal growth restriction (FGR). Absent end-diastolic flow (AEDF) is indicative of increased placental resistance and is associated with poor fetal/neonatal outcomes. However, there is a dearth of data regarding the significance of intermittent AEDF (iAEDF) compared to persistent AEDF (pAEDF). This study compared the fetal and neonatal outcomes in FGR with iAEDF and pAEDF.

Umbilical artery pulsatility index and half-peak systolic velocity in second- and third-trimester fetuses with trisomy 18 and 13.

To analyze umbilical artery (UA) Doppler velocimetry and its possible role in placenta-mediated fetal growth restriction (FGR) in second- and third-trimester fetuses with trisomy 18 and 13. UA pulsatility index (PI) and half-peak systolic velocity deceleration time (hPSV-DT) were measured in fetuses with trisomy 18 and 13. Correlation with gestational age, birthweight, and perinatal outcome was analyzed. A total of 80 measurements were taken from 33 fetuses with trisomy 18 and 19 with trisomy 13. Overall, there was a high prevalence of abnormal UA Doppler velocimetry. In fetuses with trisomy 18, 54% (27/50) of the UA PI values and 58% (29/50) of the UA hPSV-DT values were abnormal. In fetuses with trisomy 13, 80% (24/30) of the UA PI values and 87% (26/30) of the UA hPSV-DT values were abnormal. The prevalence of abnormal UA Doppler velocimetry increased with gestational age in both types of aneuploidy. However, this trend was only significant for trisomy 13 (p<0.05). All fetuses with trisomy 18 and 86% of fetuses with trisomy 13 were classified at birth as FGR. There were no perinatal survivors in this series. A high prevalence of abnormal UA Doppler velocimetry was found in second- and third-trimester fetuses with trisomy 18 and 13, which further increased with gestational age. These results may well correlate with alterations described previously in the placenta, suggesting placental insufficiency has an important role in the development of FGR in these autosomal aneuploid fetuses.

Doppler Velocimetry evaluation in high-risk pregnancy for prediction of Preeclampsia

Background: The uterine and umbilical artery Doppler scan is a valuable tool for evaluation of utero-placental blood flow in pregnancy. They help in detecting uteroplacental insufficiency thus predicting preeclampsia and other effects of faulty placentation which increase the risk of adverse effects on both mother and fetus. Aims and Objective: This study aimed to evaluate and compare the uterine artery and umbilical artery Doppler indices in second and third trimester for prediction of preeclampsia in high-risk pregnancies. Materials and Methods: In this prospective observational study done over a years’ time, 50 high-risk pregnant mothers were recruited and the Doppler scans were done at 21-25 weeks and 31-35 weeks. The necessary clinical observations were recorded throughout the antenatal period and the data analysis was done. Results: Majority (56%) were in 20-29 years range with mean age of 24±6.1 years. Out of the 50 women, 21 had abnormal uterine artery Doppler and 12 had umbilical artery abnormality along with uterine derangement. Preeclampsia developed in 3 of them. The hypertensive disorders of pregnancy were diagnosed in 13 women, preeclampsia in 3, eclampsia in 1and other HDPs in 9. The persistence of notch in uterine artery was observed in 7 women, of these 2 developed PIH. Only one patient had uterine artery PI&gt;1.45 at 24 weeks who subsequently developed preeclampsia. Among 4 patients of preeclampsia and eclampsia, 3 had 2nd trimester uterine and 3rd trimester umbilical Doppler abnormalities and only 1 had normal doppler indices. In 2nd trimester the sensitivity, specificity and PPV are higher for uterine artery PI as compared to umbilical artery PI. Hence, uterine artery doppler seems to be a better screening tool for early prediction of PIH. The third trimester umbilical artery PI with higher specificity (96%) and PPV (50%) can diagnose preeclampsia better. One patient had absent diastolic flow and she developed preeclampsia and IUGR. The combined uterine and umbilical artery doppler is a better screening modality as it has a higher sensitivity (75%) and NPV (99.26%). Conclusion: The uterine and umbilical artery Doppler velocimetry are potential tools for uteroplacental surveillance of high-risk pregnancies which can identify patients at risk and help in taking timely action to prevent complications.