Umbilical Doppler Indices Research Articles

Role of colour Doppler in predicting foetal outcome in maternal anaemia.

Anaemia is the most common nutritional deficiency in Indian pregnant females. It ensues foetal hypoxia resulting in different compensatory mechanisms in the foetus which may result in adverse perinatal outcomes. Colour Doppler can be used to measure these hemodynamic changes of the foetus ahead of the clinical manifestations, guiding the obstetrician for the appropriate management and circumventing any dire complication. The aim of this study is to detect foetal haemodynamic changes associated with maternal anaemia and assess the parameters which predict these changes accurately. Prospective cohort study. Two hundred and forty pregnant females in the third trimester, divided into four groups based on their haemoglobin levels in the non-anaemic, mild, moderate and severe anaemic groups, were included in the study. These patients were followed up for foetal outcome in terms of effective foetal weight, APGAR score and neonatal intensive care unit admission. Analysis of Variance Appearance, Pulse, Grimace, Activity and Respiration (ANOVA) test was used to compare the quantitative variables. SPSS software was used. The middle cerebral artery (MCA) Doppler indices and cerebroplacental ratio (CPR) values were increasing while umbilical Doppler indices were decreasing with the increasing severity of anaemia. CPR was found to be the most sensitive predictor for foetal outcome. Maternal anaemia results in foetal hypoxia which can be measured in terms of foetal Doppler indices. CPR was found to be more sensitive than the umbilical or MCA in predicting foetal hypoxia and in turn the perinatal outcome of foetuses of anaemic pregnant females. The foetuses with low CPR values will require urgent intervention to improve the outcomes.

Normal second and third trimester uterine and umbilical doppler indices among healthy singleton gestation Nigerian women

Background: Uterine and Umbilical artery Doppler ultrasound is an established and safe tool for quantitative analysis of the utero-placental and the feto-placental blood flow in pregnancy. Aim: To evaluate the Doppler indices in the uterine and umbilical arteries of healthy pregnant women. These will serve as baseline values in predicting impaired blood flow velocimetry in hypertensive disorders of pregnancy that leads to serious maternal and foetal health compromise. Methodology: This was a prospective longitudinal study in consenting singleton gestation women. The right and the left uterine arteries and the umbilical arteries were interrogated. Doppler parameters; Peak Systolic Velocity (PSV), End Diastolic Velocity (EDV), Resistive Index (RI), Pulsatility Index (PI) and the systolic to diastolic ratio(S/D) were obtained from each healthy pregnant indigenous Nigerian women. Pearson's correlation analysis of the relationship between these parameters and selected maternal demographic parameters was done. P < 0.05 was considered statistically significant. Results: The mean of the normal uterine and umbilical arteries values were different from most published reference values from other parts of the World. No correlation between these indices and maternal parameters were found in this study. Conclusion: Uterine and umbilical artery Doppler indices among normal indigenous pregnant African women are different from those from the developed World. Using other reference values may be inaccurate for pregnant women in our environment.

Doppler indices of the middle cerebral artery in fetuses with cardiac defects theoretically associated with impaired cerebral oxygen delivery in utero: is there a brain‐sparing effect?

To assess changes in the Doppler flow profiles of the middle cerebral artery in fetuses with cardiac defects theoretically associated with impaired cerebral oxygen delivery in utero. Z-scores were calculated for pulsatility and resistance indices (PI and RI, respectively) of the middle cerebral artery (MCA) and the cerebroplacental ratio (CPR) between 19 and 41 weeks' gestation, and for head circumference at birth (HC), in 113 fetuses with the following isolated cardiac defects: transposition of the great arteries (TGA; n = 18), hypoplastic left heart (HLH; n = 46), severe aortic stenosis (n = 17), pulmonary atresia (n = 18) and tetralogy of Fallot (TOF; n = 14). Pregnancies with uteroplacental dysfunction (indicated by increased uterine and/or umbilical Doppler indices), growth restriction, extracardiac malformations, chromosomal anomalies as well as multiple pregnancies were excluded to avoid any additional hypoxemic effect as strictly as possible. The results were compared with 1378 normal controls. Fetuses with pulmonary atresia, severe aortic stenosis and TOF had no significant alterations of Doppler parameters or HC at birth. In fetuses with TGA, mean Z-scores of HC at birth were significantly smaller compared with controls (mean +/- SD, -0.73 +/- 1.25; P < 0.05), but there was no significant difference in the Doppler parameters. Fetuses with HLH had significantly lower MCA-PI (-0.57 +/- 0.74; P < 0.05), MCA-RI (-0.73 +/- 0.85; P < 0.05), CPR (-1.44 +/- 1.05; P < 0.05) and HC (-0.50 +/- 1.24; P < 0.05) Z-scores compared with controls. Fetuses with cardiac defects theoretically associated with markedly impaired cerebral oxygen delivery in utero (TGA and HLH) have smaller HCs at birth. However, only fetuses with HLH have cerebrovascular alterations that are detectable by evaluation of the Doppler indices MCA-PI, MCA-RI and CPR.

Umbilical and middle cerebral artery Doppler indices in patients with preeclampsia

Objective: To compare changes in Doppler ultrasound studies of fetal circulation in normal pregnancies with those of a group of preeclamptic patients both with and without intrauterine growth retardation and to demonstrate the best index for predicting adverse perinatal outcome or IUGR. Study design: A cross-sectional study was performed on 125 normal pregnancies and 62 preeclamptic patients at 31–40 weeks of gestation. The umbilical artery systolic–diastolic ratio (UA S/D), UA pulsatility index (PI), the middle cerebral artery (MCA) PI, and the ratio of MCA PI to UA PI were measured. The mean values of the Doppler indices were compared. Different cut-off values (mean±2 S.D.) were used for the 31st–35th and the 36th–40th weeks. Results: Significant differences were found between normal pregnancies and preeclamptic patients without IUGR using the mean MCA PI and the MCA PI/UA PI ratio. In the preeclamptic patients with IUGR, all the mean Doppler indices were different from those of the normal pregnancies. In the preeclamptic patients with IUGR the values were different from the preeclamptic patients without IUGR, except for the MCA PI at 31–35 weeks. The UA S/D had the highest sensitivity (88%) and diagnostic accuracy (94%) in predicting the adverse perinatal outcome. The MCA PI/UA PI ratio showed the highest predictive value in determining IUGR by a sensitivity of 84% and a diagnostic accuracy of 87%. Conclusion: Both abnormal umbilical Doppler indices and cerebral–umbilical ratio are strong predictors of IUGR and of adverse perinatal outcome in preeclampsia. The MCA PI alone is not a reliable indicator. The combination of umbilical and fetal cerebral Doppler indices may increase the utility of Doppler ultrasound in preeclamptic subjects.

212 Effect of Sampling Site on Umbilical Doppler Indices in Intrauterine Growth Retardation (IUGR)

212 Effect of Sampling Site on Umbilical Doppler Indices in Intrauterine Growth Retardation (IUGR)

Colour image analysis of funicular vessels with normal and abnormal umbilical doppler index

Colour image analysis of funicular vessels with normal and abnormal umbilical doppler index

Influence of fetal breathing and movements on variability of umbilical Doppler indices using different numbers of waveforms.

Umbilical artery continuous-wave Doppler ultrasound waveforms were obtained from three groups of fetuses in late gestation: during quiescence, fetal breathing movements, and fetal body movements. The coefficients of variation, calculated from three values for each Doppler index, which were derived from one, two, four, six and eight waveforms, decreased as the number of waveforms increased. However, statistical analysis showed no significant improvement in variance when more than four waveforms were used during fetal quiescence and breathing and when more than six waveforms were used during fetal movement. A minimum of six waveforms ensured coefficients of variation less than or equal to 10% even during fetal breathing and fetal movements.