Umbilical Artery Doppler 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).

Machine learning of umbilical artery doppler flow improves prognostication in fetal growth restriction

Umbilical artery doppler (UAD) is an important tool in deciding appropriate delivery timing in fetal growth restriction (FGR) cases. UAD flow demonstrating absent or reversed end diastolic flow is associated with stillbirth, but early abnormal UAD are not clearly predictive of poor outcomes. Machine learning (ML) is a useful tool in detecting nuances in blood flow data that may more accurately predict outcomes. The purpose of this study is to determine if UAD ML improves FGR prognostication. UAD and clinical data were obtained from FGR affected pregnancies from the Iowa Intergenerational Health Knowledgebase containing data for pregnancies receiving prenatal care at a major midwestern academic medical center since 2009 (N >63000). UAD severity groups were determined (Normal, Elevated S/D [ > 95% percentile], Absent End Diastolic Flow [AEDF], and Reversed EDF [REDF]). The UAD images were optimized for ML analyses. Xception (Google) machine learning framework was used. Regression analyses were performed to identify important clinical covariates. Birth weight decreased with severity of UAD category (p < 0.001). Gestational age at delivery was shown to decrease with increasing severity of IUGR as well (p < 0.001). In line with clinical practices, diagnosis to delivery time (DDT) increased from Normal to Absent End Diastolic Flow, and then decreased for Reversed End Diastolic Flow (P = 0.03). Preeclampsia was associated with the higher categories of UAD severity (P = 0.0007). Poor neonatal outcomes were not more severe for one group, but high in all categories, ranging from 64-82 percent (p = 0.4). Machine learning of the UAD alone (R2 = 0.84) was more associated with DDT than clinical variables alone (R2 = 0.24) and clinical variables with UAD categorization (R2 = 0.75) ML of UAD alone was more associated with the diagnosis to delivery time then other traditional prediction factors in FGR pregnancies. We conclude that ML of UAD images will add additional predictive power to FGR prognostication.

Prevalence of abnormal umbilical arterial Doppler indices in apparently normal pregnancies in Calabar.

Intrauterine growth restriction (IUGR) may occur in the presence of normal fetal growth parameters, with resultant unanticipated perinatal morbidity and mortality. Umbilical arterial Doppler evaluation determines the fetuses susceptible to compromise by detecting IUGR early enough for successful intervention measures to be implemented. This study was aimed at determining the prevalence of abnormal umbilical arterial Doppler indices (UADI) in apparently normal pregnancies and to assess its correlation with amniotic fluid index (AFI). In this prospective cross-sectional study, obstetric sonographic examination and UADI evaluation were done on 310 apparently normal pregnant women between 26 to 40 weeks within a 6-months period. Abnormal UADI had a prevalence of 10.3%. Educational level (P = 0.000) and employment status (P = 0.000) were significantly associated with abnormal UADI. Abnormal umbilical arterial resistivity index (RI) had a significant correlation with EFW (P = 0.000) and HC/AC (P = 0.000) but no significant relationship with AFI (P = 0.593). The prevalence of abnormal umbilical arterial Doppler indices was high in apparently normal pregnancies mostly among women with low socio-economic status, with no demonstrable association with AFI.

Fetal thymus in growth-restricted fetuses due to placental insufficiency

The aim of this study was to assess fetal thymus size by ultrasound in growth-restricted fetuses due to placental insufficiency and compare to high-risk and low-risk pregnancy fetuses with normal placental function. This is a nested case-control study of pregnant women followed up at a university hospital (July 2012 to July 2013). In all, 30 pregnant women presenting small fetuses for gestational age (estimated fetal weight <p10) due to placental insufficiency (umbilical artery Doppler >p95) were compared to 30 high-risk and 30 low-risk pregnancies presenting normal Doppler indices. The thymus transverse diameter and perimeter were converted into zeta score according to the normal values for gestational age. Head circumference and femur length were used to calculate ratios. Fetal thymus were significantly lower in pregnancies with placental insufficiency when compared to high-risk and low-risk pregnancies presenting, respectively, transverse diameter zeta score (-0.69±0.83 vs. 0.49±1.13 vs. 0.83±0.85, p<0.001) and P zeta score (-0.73±0.68 vs. 0.45±0.96 vs. 0.26±0.89, p<0.001). There was also a significant difference (p<0.05) in the ratios among the groups: pregnancies with placental insufficiency (TD/HC=0.10, P/FL=1.32, and P/HC=0.26), high-risk pregnancies (TD/HC=0.11, P/FL=1.40, and P/HC=0.30), and control group (DT/HC=0.11, P/FL=1.45, and P/HC=0.31). Fetal thymus size is reduced in growth-restricted fetuses due to placental insufficiency, suggesting fetal response as a consequence of the adverse environment.

Evaluation of Serum Soluble Endoglin Levels in Pre-eclampsia: A Case-Control Study

Introduction: Soluble Endoglin (sEng) has an anti-angiogenic effect, by inhibiting of Transforming Growth Factor (TGF)-β1 bond at endoglin receptors and inhibiting vasodilatation. sEng levels increase in Pre-eclampsia (PE) due to hypoxic placenta and there have been possible role of it in the pathogenesis of PE and its therapeutic implications. Aim: To compare serum sEng levels in pre-eclamptic patients (cases) versus control. Materials and Methods: This case-control study was carried out November 2019 to October 2021, in the Department of Obstetrics and Gynecology, University College of Medical Sciences, Delhi. On 40 cases with a singleton pregnancy with diagnosis of PE enrolled as cases and 40 normal healthy pregnant women matched for age and gestational age as controls. sEng was estimated using commercially available Enzyme- Linked Immunosorbent Assay (ELISA) kit. Last uterine (Ut) and Umbilical Artery (UA) doppler findings were noted and sEng levels were compared with doppler studies. The analysis was done using student t-test and Chi-square test. Results: A total of 80 participants were included in the study, 40 in case group (mean age 26.53±4.93 years) and 40 in control group (mean age: 25.35±3.10 years). A total of 21 PE cases were Non Severe PE (NSPE) (52.5%) and 19 were Severe PE (SPE) (47.5%). Early-onset PE was observed in n=11 (28%) and the remaining n=29 (72%) had late-onset PE. sEng was significantly higher in pre-eclamptic women 55.08±21.42 ng/mL as compared to controls 44.15±12.02 ng/mL (p=0.006). Higher levels of sEng were seen in SPE 59.20±28.44 ng/mL vs NSPE 51.36±11.66 ng/mL (p 0.066). sEng levels between early onset PE (50.93±5.89 ng/mL) and late onset PE (56.66±24.84 ng/ ml) (p= 0.832). sEng levels were higher in cases with abnormal Resistance Index (RI) of Ut artery 54.23±6.68 ng/mL than in normal RI of Ut artery 54.23±6.68 ng/mL, though not significant. Abnormal Ut artery RI doppler was seen more in early-onset (n=2, 33%) than in late onset PE (n=1, 7%). Conclusion: PE cases had significantly higher levels of sEng compared to controls. Thus, it can be concluded that, there is a definitive role of sEng in pathogenesis of PE due to its antiangiogenic action.

Modified Myocardial Performance Index in Fetal Growth Disturbances as Diagnostic and Prognostic Adjunct.

Fetal growth disturbance can be associated with cardiac dysfunction. This study aimed to assess the modified myocardial performance index in growth-restricted and appropriate for gestational age fetuses and evaluate both its prognostic value in perinatal period and also its association with adverse perinatal outcomes. Totally 131 pregnant women were included in this prospective study. Of these, 56 cases were in study group with a diagnosis of small fetus and 75 cases were in control group with a diagnosis appropriately grown fetus. Fetal echocardiography was performed in all pregnant women to measure modified myocardial performance index. Umbilical, middle cerebral and uterine artery Doppler ultrasound parameters were measured in the study group. Small fetuses were categorized into 2 subgroups of late-onset fetal growth restriction and small for gestational age. Modified myocardial performance index was significantly higher in small fetuses compared to controls (0.45 vs. 0.37, P <.001). Newborn intensive care unit admission rates were significantly higher in small fetuses than in controls (chi-square test, P <.001). The highest mean modified myocardial performance index was recorded in the late-onset fetal growth restriction subgroup (0.45 vs. 0.41 vs. 0.37). The sensitivity and specificity of modified myocardial performance index in predicting adverse outcomes at a cut-off value of 0.41 were 63% and 75%, respectively. There was a significant negative correlation between modified myocardial performance index values and birth weights. We found higher left fetal heart modified myocardial performance index values in small fetuses indicating the presence of prenatal cardiac dysfunction. Fetal myocardial performance deteriorates in concordance with severity of growth restriction. Modified myocardial performance index can also be used to predict adverse perinatal outcomes among growth-restricted fetuses.

An atypical case of edema of the umbilical cord and histological chorioamnionitis in a fetus with normal growth and abnormal umbilical artery Doppler: a case report

An atypical case of edema of the umbilical cord and histological chorioamnionitis in a fetus with normal growth and abnormal umbilical artery Doppler: a case report

Disseminated intravascular coagulation in a pregnant woman with coronavirus disease 2019 infection: A case report

Introduction. Coronavirus infection may cause numerous complications in pregnant women, as well as an increased risk for the fetus. Disseminated intravascular coagulation and other coagulopathies can be caused by coronavirus disease 2019 infection. Case Report. A 22-year-old primigravida presented with a nineday history of dry cough, myalgia, nausea and fever. A nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 infection was positive. The patient?s condition rapidly deteriorated, resulting in severe liver damage and disseminated intravascular coagulation. Fetal cardiotocography showed a silent curve with late decelerations, while the umbilical artery Doppler showed end-diastolic block, indicating a fetal distress. Emergency cesarean section was performed at 28+5 weeks of gestation. After the cesarean section, the patient was treated with blood derivatives, thromboprophylaxis and supportive therapy and recovered quickly. Unfortunately, the premature infant died three hours after birth. Conclusion. It is very important to simultaneously monitor the parameters of the mother?s coagulation system, as well as the condition of the fetus, because there is a possibility of developing coagulopathies, including disseminated intravascular coagulation.

Prognostic value of the middle cerebral to umbilical artery Doppler ratio in the prediction of outcomes in post-term pregnancy

Objective. To evaluate the diagnostic value of the middle cerebral artery to umbilical artery Doppler ratio (MCA/UA ratio) in predicting poor perinatal outcomes in post-term pregnancies. Patients and methods. This study included patients diagnosed with post-term pregnancy who were admitted to the maternity hospitals in Ain Shams University and Al-Azhar University between January 2019 and December 2021. All patients underwent color Doppler velocimetry and were divided into two groups based on the MCA/UA ratio values: group A (n = 100) – MCA/UA ratio &lt;1, and group B (n = 100) – MCA/UA ratio ≥1. Outcome factors were admission to the neonatal intensive care unit, an Apgar score of less than 7 at 5 minutes, gestational age at delivery, birth weight, and intrauterine growth restriction. Results. The MCA/UA resistance index ratio (MCA-RI/UA-RI) with a cut-off value of 0.88 was found to be the most sensitive parameter in the prediction of adverse prenatal outcomes: sensitivity – 89%, specificity – 71%, positive predictive value (PPV) – 72%, negative predictive value (NPV) – 71%. All parameters combined showed a 93% sensitivity, 92% specificity, 92% PPV, and 89% NPV. Conclusion. To enhance obstetric outcomes and prevent unnecessary treatment and perinatal death, cerebroplacental ratio appears to be a helpful indication in predicting poor neonatal outcomes in post-term pregnancy. Key words: Doppler velocimetry, middle cerebral to umbilical artery ratio, post-term pregnancy

Middle Cerebral Artery and Umbilical Artery Doppler Indices in Pre-gestational diabetic Versus Normal Pregnancies and Their Values in Predicting Adverse Neonatal Outcome

Middle Cerebral Artery and Umbilical Artery Doppler Indices in Pre-gestational diabetic Versus Normal Pregnancies and Their Values in Predicting Adverse Neonatal Outcome

Factors associated with latency duration in growth-restricted fetuses with absent end diastolic flow

Gestational latency after findings of abnormal umbilical artery doppler indices, such as absent end diastolic flow (AEDF), in the setting of fetal growth restriction (FGR), is important yet difficult to predict. Our objective was to describe latency and factors associated with prolonged latency in growth-restricted fetuses with AEDF.

Umbilical artery doppler abnormalities in fetal growth restriction defined by isolated lagging abdominal circumference

Umbilical artery doppler abnormalities in fetal growth restriction defined by isolated lagging abdominal circumference

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.

The correlation of The Placental Thickness, Umbilical Artery Doppler and Fetal growth

The correlation of The Placental Thickness, Umbilical Artery Doppler and Fetal growth

Umbilical Artery Doppler Flow Velocimetry in Intrauterine Growth Restriction and its Relation to Perinatal Outcome

Umbilical Artery Doppler Flow Velocimetry in Intrauterine Growth Restriction and its Relation to Perinatal Outcome

Expression of Concern: Fetal middle cerebral and umbilical artery Doppler after 40 weeks gestational age

Expression of Concern: Fetal middle cerebral and umbilical artery Doppler after 40 weeks gestational age

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.

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.

Myocardial perfusion and function dichotomy in growth restricted preterm infants.

Compared to preterm appropriate for gestational age (AGA) fetuses, fetuses with fetal growth restriction (FGR) have earlier visualisation of coronary artery blood flow (CABF) but impaired cardiac function. This dichotomy remains uncharacterised during postnatal life. This study compared CABF and cardiac function in preterm FGR infants, against AGA infants during the postnatal period. FGR was defined as birthweight < 10th centile for gestation and sex with absent/reversed antenatal umbilical artery Doppler. Diastolic CABF was measured in the left anterior descending coronary artery. Twenty-eight FGR infants were compared with 26 AGA infants (gestation and birthweight, 29.7 ± 1.3 vs 29.9 ± 1 weeks, P = 0.6 and 918 ± 174 vs 1398 ± 263g, P < 0.001, respectively). Echocardiography was performed in the second week of life. FGR infants had higher CABF (velocity time integral, 2.4 ± 0.9 vs 1.6 ± 0.8 cm, P = 0.002). Diastolic function was impaired (↑ trans-mitral E/A ratio in FGR infants; 0.84 ± 0.05 vs 0.79 ± 0.03, P = 0.0002) while the systolic function was also affected (mean velocity of circumferential fibre shortening [mVCFc], 1.9 ± 0.3 vs 2.7 ± 0.5 circ/s, P < 0.001). Indexing CABF to cardiac function noted significant differences between the groups (CABF: E/A [FGR vs AGA], 2.9 ± 1.1 vs 2.1 ± 1, P = 0.01 and CABF: mVCFc [FGR vs AGA], 1.3 ± 0.5 vs 0.6 ± 0.3, P < 0.001). Diastolic blood pressure (BP) was significantly higher, and CABF to diastolic BP ratio trended higher in FGR infants (30 ± 2 vs 25 ± 3 mmHg, P < 0.001 and 0.08 ± 0.03 vs 0.06 ± 0.03, P = 0.059, respectively). Greater CABF in FGR infants did not translate into better cardiac function. This dichotomy may be a persistent response to fetal hypoxaemia (fetal programming) and/or reflection of altered cardiac architecture.

Maternal Serum Gasdermin D Concentrations in Pregnancies Complicated by Isolated Intrauterine Growth Restriction.

We aimed to investigate the relationship between the isolated intrauterine growth restriction (IUGR) and maternal serum gasdermin D (GSDMD) concentration. This cross-sectional study was conducted with 80 pregnant women who applied to the Umraniye Training and Research Hospital Gynecology and Obstetrics Clinic between January 2022 and May 2022. The IUGR group consisted of 40 pregnant women diagnosed with IUGR in the third trimester, and the control group consisted of 40 healthy pregnant women matched with the IUGR group in terms of age and BMI. Demographic characteristics, ultrasound findings, and neonatal outcomes were noted. The two groups were compared in terms of maternal serum GSDMD concentrations. Both groups were similar in terms of demographic characteristics. Fetal biometric measurements were found to be significantly lower in the IUGR group compared to the control group, and umbilical artery Doppler PI and SD were found to be higher. Gestational age, newborn birth weight, birth height, and Apgar scores were significantly lower and NICU admission rate was higher in the IUGR group. Gestational age at blood sampling for GSDMD was similar in both groups (p=0.805). While maternal serum GSDMD concentration was 11.14 ng/ml in the IUGR group, it was 6.66 ng/ml in the control group (p=0.000). ROC analysis was performed to determine the value of GSDMD concentration in terms of IUGR estimation. AUC analysis of GSDMD for IUGR estimation was 0.88 (p<.001, 95% CI=0.80-0.95). The optimal cutoff value for GSDMD concentration was determined as 8.84 ng/ml with 80% sensitivity and 75% specificity. Maternal serum GSDMD concentrations were found to be higher in pregnant women whose pregnancy was complicated by isolated IUGR. We think that high GSDMD concentrations may be a reflection of increased GSDMD-mediated pyroptosis in placental tissue in isolated IUGR cases.