Venous Duct Research Articles

Short-term effects of antenatal betamethasone on fetal cardiovascular and circulation status: A quasi-experimental observational (before-after) study.

The administration of antenatal corticosteroid is a standard treatment to reduce the rate of perinatal mortality and morbidity; however, there is limited evidence regarding the potential effects of betamethasone on the constriction of the ductus arteriosus (DA). This study aimed to investigate the short-term effects of antenatal betamethasone on fetal cardiovascular and circulation status. This quasi-experimental observational (before-after) study was conducted on 32 singleton fetuses. The participants were healthy pregnant women with a diagnosis of placenta accreta spectrum who were eligible for 2 doses of betamethasone and referred to prenatal care clinic, Vali-E-Asr hospital, Tehran, Iran from January 2021-May 2022. The results of fetal echocardiography and Doppler sonography were compared before and after the administration of antenatal corticosteroid therapy. Following betamethasone injection, significant increases were observed in peak systolic and diastolic velocity of the DA without constriction of the DA (p 0.001, p = 0.002 respectively). However, no significant changes were observed in right ventricular function, tricuspid valve function, Doppler of ductus venous, and peak systolic velocity of the aortic isthmus (p 0.05). Doppler examination of the uterine, umbilical, and middle cerebral arteries also showed no significant changes (p 0.05). Considering the benefits of antenatal corticosteroid therapy, its administration seems reasonable in preterm births. The transient changes in ductal blood flow are not prohibitive.

Navigating Uncertain Waters: First-Trimester Screening's Role in Identifying Neonatal Complications.

Background: Contemporary diagnostic methods aimed at assessing neonatal outcomes predominantly rely on the medical history of pregnant women. Ideally, universal biomarkers indicating an increased risk of delivering infants in poor clinical condition, with a heightened likelihood of requiring hospitalization in a Neonatal Intensive Care Unit (NICU), would be beneficial for appropriately stratifying pregnant women into a high-risk category. Our study evaluated whether biochemical and ultrasonographical markers universally used in first-trimester screenings for non-heritable chromosomal aberrations could serve this purpose. Methods: This study encompassed 1164 patients who underwent first-trimester screening, including patient history, ultrasound examinations, and biochemical tests for pregnancy-associated plasma protein-A (PAPP-A) and the free beta-HCG subunit (fbHCG), from January 2019 to December 2021. The research concentrated on the correlation between these prenatal test results and neonatal outcomes, particularly Apgar scores, umbilical blood pH levels, and the necessity for NICU admission. Results: In our cohort, neonates scoring lower than 8 on the Apgar scale at birth exhibited lower concentrations of PAPP-A in the first trimester, both in raw and normalized values (PAPP-A MoM 0.93 vs. 1.027, p = 0.032). We also observed a higher pulsatility index in the venous duct in the first trimester in full-term neonates born with <8 points on the Apgar scale. Additionally, newborns born with an umbilical blood pH < 7.2 had lower normalized first-trimester PAPP-A concentrations (0.69 vs. 1.01 MoM, p = 0.04). We also noted that neonates requiring NICU hospitalization post-delivery had lower first-trimester bHCG concentrations (0.93 MoM vs. 1.11 MoM, p = 0.03). However, none of the correlations in our study translated into a robust prognostic ability for predicting dichotomous outcomes. All areas under the curve achieved a value < 0.7. Conclusions: Low concentrations of PAPP-A and free bHCG subunit in the first trimester may be associated with poorer clinical and biochemical conditions in neonates post-delivery. However, the relationship is weak and has limited predictive capability. Further research evaluating these relationships is necessary for the appropriate stratification of pregnant women into high-risk categories for neonatological complications.

CLINICAL, ULTRASOUND AND CYTOGENETIC CHARACTERISTICS OF FETUSES WITH INCREASED NUCHAL TRANSLUCENCY THICKNESS IN THE FIRST TRIMESTER OF PREGNANCY

Background: Improving programs for early prenatal detection of congenital malformations remains a relevant scientific and practical problem. The prevalence of congenital anomalies in Ukraine is 23.7:1000 among live-born babies, and there is no significant decrease in it. The aim of this study was to compare clinical, ultrasound and cytogenetic data in swollen fetuses with increased nuchal translucency (NT) thicknesses from the group of pregnant women in the first trimester at high genetic risk to optimize the algorithm of prenatal diagnostics.&#x0D; Materials and Methods: Clinical examinations, ultrasound diagnostics, invasive methods of prenatal diagnostics (chorion biopsy, amniocentesis), genetic testing techniques, such as karyotyping and FISH, genetic counseling and statistical analysis were carried out. The results of complex examinations of 127 fetuses with an increased NT thickness from the group of pregnant women were analyzed. Fetuses were divided into two groups with an NT thickness of 2.5–3.5 mm (group 1) (38 cases) and with an NT above 3.5 mm (group 2)(89 cases).&#x0D; Results: Among pregnancies with fetuses with an increased NT thickness, there were 65.4% cases of adverse outcomes with chromosomal pathology (69.9%), congenital malformations of non-chromosomal etiology (25.3%) and pregnancy loss (4.8%). The frequency of chromosomal abnormalities in fetuses of group 1 was 55.3% and 41.6% in group 2. Congenital malformations of various systems and organs in fetuses, the most frequent of which were cardiac defects, were diagnosed. The ratio of congenital heart defects in the fetuses of groups 1 and 2 was 23.7% and 43.8%, respectively (p=0.03; OR=0.40).&#x0D; Conclusion: There is no significant difference between the frequency of chromosomal abnormalities in the fetuses of group 1 compared to group 2, which indicates a high informative value of an increased NT thickness, including the thickness of 2.5–3.5 mm in fetuses in the first trimester as a marker of chromosomal pathology. A significantly higher incidence of congenital malformations of non-chromosomal etiology was found in fetuses with venous duct pathology and NT thickness over 3.5 mm compared to fetuses with the same pathology and NT thickness of 2.5–3.5 mm. Proposed changes to the management algorithm for pregnant women with swollen fetuses include mandatory congenital heart defects screening in the first trimester.

Importance of prenatally diagnosed portosystemic vascular shunts in clinical outcomes

To report two cases of prenatal diagnosis of portosystemic vascular shunts and review the importance of this rare pathology in its neonatal and pediatric evolution. Case 1: pregnancy with fetal growth restriction, 2nd percentile, polyhydramnios, without fetal malformations and abnormal patterns on fetal Doppler. Abnormal blood flow through the ductus venous and abnormal venous communication in the liver were identified. Normal genetic study. Male newborn (NB) delivered at 36 weeks, because of severe fetal growth restriction, by emergency cesarean section. He evolved asymptomatic, with normal liver function, and did not continue follow-up. Case 2: pregnancy with fetal growth restriction < percentile 1. Agenesis of the ductus venous and abnormal communication between the portal vein and the left suprahepatic vein were identified with no other malformations or signs of heart failure. Severe SGA newborn was delivered by induction of labor at 35 weeks. He evolved asymptomatic. Normal complementary study. A home check-up at 2 months showed persistent vascular anomaly without systemic involvement. Even though in the cases presented there were no neonatal complications, this kind of malformations require a high index of suspicion in cases with fetal growth restriction, as well as a long-term multidisciplinary follow-up.

THE RISK OF PERINATAL LOSSES DUE TO PARVOVIRUS INFECTION DURING PREGNANCY AND WAYS TO PREVENT THEM

THE RISK OF PERINATAL LOSSES DUE TO PARVOVIRUS INFECTION DURING PREGNANCY AND WAYS TO PREVENT THEM

Diagnosis of the venous duct in fetuses of the early period of human ontogeny

To carry out an analysis of data from the world literature regarding the role of Doppler assessment of blood flow in the venous duct of the fetus in chromosomal abnormalities in the first trimester of pregnancy, as a marker – the spectral form of wave blood flow and its pulsation, which is generated by changes in the pressure and volume of blood to the heart of the fetus. Prenatal diagnosis of venous blood flow makes it possible to assess the state of the fetal cardiovascular system. Blood flow in the ductus venosus is an integrative indicator that reflects the formation of blood circulation of both the uteroplacental and placental-fetal components of gestational hemodynamics during physiological and complicated pregnancy. The performance of this test is 63%, and in combination with the assessment of the thickness of the clavicle – 89.1%. When reverse values of blood flow in the ductus venosus are detected in the phase of contraction of the atrium and dilated cervical space, it is necessary to carry out karyotyping to rule out chromosomal abnormalities. Dopplerography allows us to objectively assess the functioning state of the fetus during physiological and complicated pregnancy based on the study of the state of blood flow in the vessels of the placenta, in the middle cerebral artery, thoracic aorta, renal arteries, inferior vena cava and venous duct. The spectrum of venous blood flow reflects changes in volume and pressure in the atria during the cardiac cycle. With normal fetal development, blood flow in the venous duct has a pulsating character in the form of a unidirectional three-phase curve that corresponds to different periods of the cardiac cycle. The spectrum of normal blood flow in the venous duct in a healthy newborn has a biphasic curve, with the direction from the portal sinus to the inferior vena cava. During three weeks of regular examinations in most babies, obliteration of the venous duct occurs, and the ductus turns into a venous connection. Two-dimensional echocardiogram, color and pulsed dopplerography allow recording the waveforms of blood flow in several structures of the heart. Doppler analysis of blood flow in the venous duct is important to perform in fetuses of the first trimester, as it increases the sensitivity of the combined test in assessing the risk of chromosomal disorders. Assessment of blood flow in the ductus venosus provides an understanding of physiological and pathological processes in the fetal body and identifies fetuses that are prone to or at risk of disease.

Food intolerance in premature babies: possibilities of additional diagnostics

Due to the immaturity of the digestive system and gastrointestinal motility the preterm infants have a critical challenge in establishing adequate enteral nutrition, which is a frequent cause of gastrointestinal complications such as food intolerance and necrotizing enterocolitis. Modern clinical methods of assessing the maturity of the intestines and the child's readiness for enteral nutrition are subjective, this slows down the expansion of enteral nutrition, increases the duration of parenteral nutrition, and accordingly , period of a child`s hospitalizing. Objective methods of diagnosis are needed, which would contribute to the effective diagnosis and monitoring of food intolerance in preterm infants. Therefore, the purpose of our review was to search and summarize literature data on objective methods of diagnosing impaired food tolerance in premature baby, which could to provide daily monitoring, would be safe, cost-effective and easily accessible. Results and their discussion. Accordingly, three leading and most promising methods of examining the newborns gastrointestinal tract were analyzed. The were ultrasound examination (absence or reverse diastolic blood flow in the umbilical artery, high pulsation index in the fetal venous duct, indicators of blood flow in the upper mesenteric artery of the newborn), near-infrared spectroscopy (estimation of oxygen saturation of splanchnic tissue), and auscultation of intestinal sounds (phonoenterogram). Each of these methods has advantages and disadvantages, but to solve these existing problems, there has been recently an increasing amount of research on the bowel sounds using (namely their computerized assessment) as a new diagnostic tool. New research and further study of intestinal murmurs in premature newborns of different gestational ages with the development of clear criteria for data interpretation are needed to assess the maturity of the gastrointestinal tract, to create a diagnosis plan of food intolerance, and to develop an algorithm for early intervention.

Aortic Isthmus Retrograde Blood Flow in Intrauterine Child as a Sign of the Terminal Stage of Placental Dysfunction: Clinical Observation

Background. Aortic isthmus retrograde blood flow in intrauterine children with growth delay and centralization of blood circulation in the late stages of placental dysfunction is associated with a high risk of perinatal death. Timely diagnosis of such condition is crucial to select further obstetric tactics and delivery time. Clinical case description. Growth delay and absent end-diastolic flow in umbilical artery and no A-wave in the venous duct were diagnosed in intrauterine child (gestational age — 36 weeks) at ultrasound study. Peripheral resistance indices in middle cerebral artery in the intrauterine child were lower than peripheral resistance indices in umbilical artery. Color Doppler imaging has revealed aortic isthmus retrograde blood flow. The woman was recommended delivery due to critical circulatory disorder in the intrauterine child. Female child was delivered via Caesarean section, child’s weight — 890 g, APGAR score — 3/4. The newborn girl died due to multi-organ failure within the first day.Conclusion. Revealing the retrograde blood flow in intrauterine child in the aortic isthmus throughout the entire ventricular diastole is an unfavorable prognostic sign of the terminal stage of cerebral blood flow disturbance associated with placental dysfunction.

Ультразвукові критерії затримки росту плода при передчасних пологах

Purpose - to increase the effectiveness of forecasting and early diagnosis of fetal growth retardation (FGR) in premature pregnancy on the basis of ultrasound examination. Materials and methods. 165 pregnant women were examined: 30 patients with an uncomplicated pregnancy that ended in physiological timely delivery - the control group (CG); 45 patients with premature birth (PB) (the Group I); 45 women with full-term pregnancy and FGR (the Group II) and 45 patients with PB and FGR (the Group III). Ultrasound examination included serial dynamic fetometry and placentography, dopplerography of vessels of the umbilical cord, ductus venosus, middle cerebral artery and fetal aorta with determination of systolic blood flow velocity and systolic peak velocity of blood flow, systolic-diastolic ratio, index resistance and pulsation index. Statistical processing of research results was carried out using standard programs «Microsoft Excel 5.0» and «Statistica 8.0». Results. А significant decrease in the parameters of the biparietal size of the fetal head in pregnant women of the Group III was detected at 24-25 weeks of pregnancy: in the CG - 66.4±0.65 mm, in the Group III - 65.02±0.31 mm (p&lt;0.05), in the Group II - 66.2±0.46 mm. A more pronounced slowdown in the rate of growth of the biparietal size of the fetal head was found in pregnant women at 28-29 weeks of gestation, when a significant decrease (p&lt;0.05) in its growth rate was observed in pregnant women of the Groups II and III. The peculiarities of the formation and functioning of the fetoplacental complex in this Groups were characterised by impaired fetal haemodynamics: increase in blood circulation velocity in the venous duct - 74.43±2.24 cm/s vs. 46.54±1.62 cm/s, respectively; p&lt;0.05; increase in pulsatile index in the uterine artery - 1.611±0.04 vs. 1.424±0.07; p&lt;0.05, and in the middle cerebral artery - 1.527±0.02 vs. 1.251±0.03; p&lt;0.005, indicating the tension of subcompensatory reactions. Conclusions. Ultrasound feto- and placentametry in pregnant women with premature births against the backdrop of FGR showed that in patients with premature births, statistically significant deviations in the size of the fetus and placenta are observed from 24-25 weeks of gestation. Disruption of fetal hemodynamics is indicated by a significant increase in the speed of blood circulation in the ductus venosus in the Groups II and III (74.43±2.24 cm/s vs. 46.54±1.62 cm/s; p&lt;0.05). The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Major Pulmonary Arterial Hypertension Secondary to Congenital Portosystemic Intra Hepatic Shunt: A Case Report

Congenital portosystemic shunt, also known as Abernethy malformation, is a rare vascular malformation in which the portal blood drains towards the systemic circulation eluding the liver. These shunts arise through disturbances that intervene in the embryonic development of the splanchnic circulation, or when elements that are specific to the fetal circulation (especially those regarding the ductus venous) persist beyond the intrauterine life. We present the case of an 23 men years old, followed for ventricular septal defect (VSD) and pulmonary hypertension (PHA), who was addressed to our department to realize a Computed tomography pulmonary angiography (CTPA) for suspicion an acute pulmonary embolism (APE) due to a high d-dimer level. This examination does not show direct or indirect signs of pulmonary embolism but on the other hand objective a major pulmonary arterial hypertension associated with cardiomegaly secondary to a portosystemic intrahepatic shunt. An abdominal CT scan was requested in order to detail this vascular malformation and to objectify the presence of the portal trunk by the confluence of the spleno-mesaraic trunk and the inferior mesenteric vein with the demonstration of the communication of the right portal branch with inferior vena cava. Angio-CT should be the performed whenever a vascular malformation is suspected in order to establish a correct diagnosis, because portosystemic shunts carry a high risk of severe complications.

Maternal Steroids on Fetal Doppler Indices, in Growth-Restricted Fetuses with Abnormal Umbilical Flow from Pregnancies Complicated with Early-Onset Severe Preeclampsia.

Corticoids are largely used for fetal interest in expected preterm deliveries. This study went further, evaluating the effect of maternal administration of dexamethasone (Dex) on the umbilical artery (UA), middle cerebral artery (MCA), and ductus venous (DV) spectrum, in growth-restricted fetuses, with the absent end-diastolic flow (AEDF) in UA, from singleton early-onset severe preeclamptic pregnancies. Supplementary, the impact on both uterine arteries (UTAs) flow was also evaluated. In 68.7% of cases, the EDF was transiently restored (trAEDF group), in the rest of 31.2% remained persistent absent (prAEDF group). UA-PI significantly decreased in the first day after Dex (day 1/0; p < 0.05), reaching its minimum during day 2 (day 2/1; p > 0.05), revealing a significant recovery to day 4 (day 4/2; p < 0.05), in both groups. The MCA-PI decreased from day 1 until day 3 in both groups, but significantly only in the trAEDF group (p = 0.030 vs. p = 0.227. The DV-PI's decrease (during day 1) and the CPR's increase (between days 0 and 2) were not significant in both groups. UTAs-PIs did not vary. The prAEDF group had a significantly increased rate of antenatal worsening Doppler and a poorer perinatal outcome compared with the trAEDF group. In conclusion, Dex transiently restored the AEDF in UA in the majority of cases, a "positive" effect being a useful marker for better perinatal prognosis. UA-PI significantly decreased in all cases. The improvement in umbilical circulation probably was responsible for the short but not significant DV-PI reduction. MCA-PI decreased only in sensitive cases, probably due to an already cerebral "full" vasodilation in the prAEDF group. Furthermore, the CPR's nonsignificant improvement was the result of a stronger effect of Dex on UA-PI than on MCA-PI. Finally, despite the same etiology, it was only a weak correlation between the severity of the umbilical and uterine abnormal spectrum.

Possibilities of early prediction of placental complications according to changes in the fetal venous duct blood flow in the first half of pregnancy

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Разработка прогностических маркеров плацентозависимых осложнений путем изучения кровотока в венозном протоке плода в первой половине беременности. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В основную группу вошли 93 беременные с плацентозависимыми осложнениями, родившие недоношенных или незрелых новорожденных с задержкой роста во внутриутробном периоде. Группу сравнения составили 54 беременные, родившие живых доношенных новорожденных без внутриутробной задержки роста. Обследование пациенток проводилось согласно приказу МЗ РФ «Порядок оказания медицинской помощи по профилю акушерство и гинекология за исключением вспомогательных репродуктивных технологий» №1130н от 20.10.20 в сроки беременности 11—13,6 и 18—21 нед с определением уголнезависимого индекса резистентности вен в венозном протоке плода. <h3>РЕЗУЛЬТАТЫ</h3> При физиологическом течении беременности к сроку 11—13,6 нед отмечена активизация гемодинамических процессов в венозном звене плацентарно-плодового кровотока (венозный проток) как следствие завершения 1-го этапа гестационной трансформации эндометриального участка спиральных артерий. На протяжении 2-го этапа гестационных преобразований спиральных артерий, обусловливающего быстрый рост плаценты и увеличение объема межворсинчатого пространства (18—21 нед), отмечена дополнительная активизация гемодинамики венозного протока плода, проявляющаяся увеличением скорости волны A на 25% и более и снижением индекса резистентности вен на 25% и более. У беременных на фоне формирования первичной плацентарной недостаточности в сроке беременности 18—21 нед установлены увеличение скорости кровотока волны A менее чем на 22% и снижение индекса резистентности вен менее чем на 17%, что позволяет прогнозировать развитие плацентарной недостаточности и ассоциированных с ней осложнений. <h3>ЗАКЛЮЧЕНИЕ</h3> Патологические изменения кровотока в венозном протоке плода могут рассматриваться как прогностические маркеры осложнений, ассоциированных с нарушением плацентации.

Особенности фетоплацентарного комплекса и перинатальные исходы у беременных, перенесших СOVID-19

Aim: Analysis of the features of a comprehensive laboratory and instrumental assessment of the state of the fetoplacental complex and perinatal outcomes in the be-radiation, which have undergone a new coronavirus infection caused by SARS-COV-2, at different stage of gestation. Design. The one-central prospective cohort comparative study for the period from April 2020 to March 2023 conducted a survey of 625 pregnant women who underwent COVID-19 of varying severity at different gestation periods observed in the Moscow Hospital named after S.S. Yudin. Materials and methods. The study included 700 pregnant women: 625 women who have undergone COVID-19 of varying severity at different gestation periods (main group) and 75 with a normal pregnancy without COVID-19 (comparison group). Pregnant women who have undergone a new coronavirus infection were divided into groups depending on the gestation period: I trimester — 32 (5.1%), II trimester — 168 women (26.9%), III trimester — 425 (68.0%). All patients conducted an ultrasound examination, including echography with biometria in accordance with the adopted protocols for the gestation, 1 and 2 screening studies under the Astraia program and on protocols adopted in Moscow; Dopplerometry in the uterine arteries, the arteries of the fetal-placental, the middle cerebral artery, the venous duct of the fetus; assessment of localization, thickness and structurality of the placenta; the amount and quality of amniotic fluid; cardiotocography. Based on the results of the primary ultrasound examination according to the indications, non -invasive prenatal testing, therapeutic amniocentesis and amniodrainage were carried out. Results. The frequency of almost all parameters of violation of the state of the fetoplacental complex was statistically distinguished, the differences in the frequency of violations of the uterine-placental blood flow, especially among women who transferred COVID-19 to the first half of gestation, were most significant in comparison with the control group (among the gestational-hay diabetes (among all groups of women with NCI), anemia of varying severity. The frequency of low water also turned out to be significant, and in 19 observations of 118 (16.1%) — this was a pronounced inexumpit and anhydramnion in the III trimester of gestation. The large frequency of thrombotic complications in women who have been the COVID-19 in terms of 22–38 weeks of pregnancy is noteworthy, which requires the expansion of indications for the prevention of a given type of pathology in women, including with the use of NMGs who have suffered even easy and moderate forms of the disease. 3 women with multi-guide (3/56 (5.4%)) required amnio-adiralization. Conclusion. Based on the data we have received and the analysis of the literature, we can conclude that short-term and long-term consequences for the development of children from mothers who have arisen during pregnancy COVID-19 are alarming, requiring an additional diagnostic search and dynamic postnatal observation. Keywords: new coronavirus infection, COVID-19, echography, dopplerometry during pregnancy, cardiotocography, mother–placenta–fetus system.

Ultrasound Multiparametric Assessment of the Impact of Hypertensive Disorders of Pregnancy on Fetal Cardiac Function and Growth and Development.

ObjectiveTo evaluate the ultrasound multiparametric assessment of the impact of hypertensive disorders of pregnancy (HDP) on fetal cardiac function and growth and development. Methods In this prospective study, 98 cases of HDP treated in our institution were recruited into a study group, and 100 pregnant women with healthy singleton pregnancies were included in a control group. All eligible patients were also assigned to either study group A (HDP fetuses with growth restriction) or study group B (HDP fetuses with normal growth). Fetal echocardiography was performed on all eligible participants to obtain hemodynamic and cardiac function parameters for the evaluation of fetal growth and development, and the impact of HDP on fetal heart function and growth and development was analyzed. Results HDP fetuses were associated with smaller head circumference, biparietal diameter, femoral length, and abdominal circumference versus healthy fetuses. The study group had a higher resistance index (RI) and pulsatility index (PI) of umbilical artery (UA), ductus venous (DV), pulmonary vein (PV), and lower RI and PI of aortic isthmus (AoI) than the control group. The study group showed higher left and right ventricular isovolumic contraction time (IVCT), isovolumic relaxation time (IVRT), and myocardial performance index (MPI) values and lower mitral and tricuspid E wave and E/A values than the control group. The systolic blood pressure was positively correlated with PI, RI of UA, DV, and PV, and left and right ventricular IVCT, IVRT, and MPI and negatively correlated with PI and RI of AoI and mitral and tricuspid E wave and E/A values of HDP fetuses. The peak systolic/diastolic flow rate (S/D), PI, and RI of umbilical blood flow in study group A were higher than those in study group B. Umbilical blood flow S/D showed the highest AUC and specificity for predicting fetal growth restriction, and PI had the highest sensitivity for predicting fetal growth restriction. Conclusion HDP compromises fetal cardiac function and growth, and ultrasound multiparametric assessment provides accurate detection of fetal cardiac function and hemodynamics changes. The patient's condition can be monitored through the assessment of ultrasound parameters of fetal growth and development.

Methods for studying the ductus venosus in animals

The ductus venosus is a physiological vascular shunt to the umbilical and caudal vena cava in the fetus. The umbilical vein (vena umbilicalis) leaves the placenta, enters the fetus through the foramen umbilical, and goes to the liver hilum. It carries oxygenated and nutrient‐rich blood from the placenta to the fetus. Part of the blood enters the liver through the umbilical vein, through the shunt ‐ the ductus vein enters the central venous line ‐ the caudal vena cava. This mechanism of blood redistribution is necessary for feeding the fetal brain with blood that is more saturated with oxygen. Given the scarce data on the topography, shape, and morphometric parameters of the venous duct in animals, we set the goal of revealing the methods used for its postmortem study. For a complete and comprehensive study of the topography of the venous duct, it is necessary to use a set of anatomical methods: thin anatomical preparation, vasoradiography, production of corrosive preparations, and morphometry. When conducting vasoradiography, a mass for injection prepared according to the recipe was used as a radio‐opaque mass: 45% ‐ lead white, 45% ‐ gum turpentine, 10% ‐ medical gypsum powder (M.V. Shchipakina, A.V. Prusakova, D.S. Bylinskaya, S.A. Kuga, 2013). In the manufacture of corrosive preparations, self‐hardening dental plastic was used. It belongs to the acrylic group of cold curing plastics and consists of powder and solvent components. In both cases, the injection of these substances was carried out through the umbilical vein, without opening the abdominal cavity, by accessing through the umbilical cord. After introducing the X‐ray contrast mass, the objects of study were placed in a fixing solution (10% formalin solution) and left in it for up to 5 days. Subsequently, thin anatomical preparation and photography, as well as radiography, were performed. After introducing a plastic solution, the objects were placed in chambers with a temperature of +4°C for two days. Subsequently, corrosion treatment was carried out in an aqueous potassium hydroxide solution for 4 ‐ 5 days. The morphometry of the venous duct in the study of vaso‐radiographs was carried out in the RadiAnt computer program, in the study of a corrosive preparation ‐ using an electronic caliper (Stainless hardened). On vaso‐radiographs, the ductus venous is identified as a sizeable cone‐shaped vessel located in the area of the liver hilum. The ductus venosus is identified as a craniodorsal blood vessel that flows into the caudal vena cava on the casts of the vascular bed. The proposed methods for studying the ductus venosus make it possible to accurately anatomically describe the position, shape, and size of the ductus venosus in fetuses.

Non-immune fetal hydrops in late pregnancу: antenatal ultrasound monitoring and pregnancy outcomes in a series of 14 cases

Background. Fetal hydrops is the accumulation of extracellular fluid in two or more fetal cavities, often in combination with subcutaneous edema. An isolated accumulation of fluid only in the abdominal, pleural, or pericardial cavities is described as ascites, pleural effusion (hydrothorax), pericardial effusion (hydropericardium). Features of the pathogenesis of non-immune hydrops fetalis (NIHF) are the follow: high hydrophilicity of fetal tissues, obstruction of the lymphatic vessels, impaired lymph return, congestive heart failure, obstruction of venous return, changes in fetal venous pressure. All these factors lead to the release of fluid from cells and tissues into the «third» spaces – the abdominal, thoracic, pericardial cavities, as well as the subcutaneous space. The oncotic pressure of fetal plasma proteins is not of great importance in the formation of the fetal circulating blood volume. Currently, all the links in the pathogenesis of hydrops fetalis syndrome with various etiological factors are not fully known. The prevalence of NIHF is unknown because it is difficult to collect relevant data; many cases of the disease are not diagnosed until intrauterine fetal death or may spontaneously resolve during the prenatal period. Currently, up to 90% of all cases of fetal dropsy are attributed to NIHF. Purpose – acquaintance of the medical community with the diagnosis and treatment of non-immune hydrops as well as the analysis of clinical features, ultrasound monitoring and perinatal outcomes of 14 cases of non-immune fetal hydrops onset in a second half of pregnancy. Materials and methods. The material for the study were publications and results of clinical trials found in the databases Scopus, Web of Science Core Collection and PubMed for the period 2009–2020 and the analytic report of the own series of 14 cases of non-immune hydrops fetalis (NIHF) of various origins. During the period of 2005–2020 under the supervision in the Ultrasound Department of Kharkiv regional hospital with regional perinatal center there were 14 pregnant women with NIHF diagnosed in a second half of pregnancy. Clinical features are described, ultrasound images and Doppler monitoring are given, perinatal / postnatal results are studied. Results and discussion. The analysis of clinical features, ultrasound monitoring and pregnancy outcomes of 14 cases of non-immune fetal hydrops developed in the second half of pregnancy in presented series was carried out. 6/14 fetuses had structural anatomical defects (lung sequestration, СDH, myasthenia gravis, megacystis and hydronephrosis, epidermolysis bullosa, meconium peritonitis, intestinal atresia). Mortality rate (including perinatal and infant losses) was as high as 9/14 cases (64.2%): 3 of antenatal, 4 of neonatal, 2 of infant death). Surgical treatment was performed on 2 newborns. 5 newborns had apparently a favorable clinical postnatal outcome. In 2 cases, spontaneous resolution with complete regression of hydrops was observed (parvovirus-B19 and idiopathic NIHF). Complete recovery of fetus (spontaneous regression of hydrops without any deterioration and pathological consequences) was observed in 1 case. Conclusions. Antenatal ultrasound monitoring of fetus with NIHF is based on the assessment of PSV CMA, ductus venous, umbilical vein, atrioventricular flow. According to the results of the study, it was revealed that the cardiovascular profile of the fetus with NIHF is disturbed earlier, and the placental profile and arterial Doppler-later. Normal umbilical artery Doppler do not exclude the possibility of an adverse outcome, including intrauterine fetal demise. Extended Doppler monitoring is essential at NIHF. All neonates with NIHF in an antenatal anamnesis require postnatal follow-up.

TOPOGRAPHY FORMATION OF THE UMBILICAL VEIN IN PREFETUS

Venous blood fl ow in the liver is unique because it is provided by two embryonic and functionally diff erent systems: the umbilical and portal hepatic or yolk systems.The largest tributary vessel of the liver in pre-fetuses is the umbilical vein (UV), which passes through the gap of the round ligament of the liver and gives from 2 to 5 branches to the left side of the liver and the same number to the square. At the level of the left edge of the transverse sulcus, the UV is divided into three termin branches: the posterior branch to the left lobe, the venous (Arantian) duct, and the anastomotic branch, through which the UV connects to the portal hepatic vein (PHV).To study the patterns and identify the features of the intrahepatic topography of venous structures, in particular the umbilical vein in the prefetal period of human ontogenesis.For the study, 50 objects of pre-fetuses were used. To achieve this goal, a complex of morphological research methods was used, including the method of morphometry, the production and study of a series of histological sections, macro- and microscopy, conventional and fi ne preparation under the control of an MBS-10 microscope, injection of vessels with the following radiography.At the beginning of the prefetal period of development (VII week), the liver occupies the cranioventral and middle sections of the abdominal cavity. Its transverse dimension is 4.8 mm (pre-fetus 19.8 mm of parietalcoccygeal length (PCL)) and 5.1 mm (pre-fetus 20.0 mm PCL).UV of pre-fetuses of the 7th week of development (14.0-20.0 mm PCL) was studied on 16 series of histological sections. It enters the liver in the area of the anterior edge of the left sagittal groove and is covered from below by the liver tissue. Along the way, it gives off 2-3 left side branches with a diameter of 40-50 microns, branching in the left lobe of the organ, and 1-2 right ones, entering the square lobe. The UV enters the liver parenchyma in the area of the anterior edge of the left sagittal sulcus and passes in the anterior- posterior direction within its anterior part. From below, the vein is covered with liver tissue.The outer diameter of the UV at the edge of the liver is 370 μm (pre-fetus 30.0 mm PCL), its length reaches 940 μm.In the course of the UV, it gives off 2-3 left lateral branches with a diameter of 98-102 microns, branching in the left lobe of the liver, within the future II, III and partially I and IV segments, and 1-2 right ones, entering the square lobe, ending in the future IV segment.Consequently, at the end of the prefetal period of development, the intrahepatic topography of the aff erent venous vessels (umbilical and portal veins) and their branches of 1-2 orders acquires certain features of the defi nitive one.

Second-trimester abdominal circumference discordance and adverse perinatal outcomes in monochorionic twins

Objective The perinatal outcomes in second-trimester abdominal circumference (AC) discordant twins are yet to be established. The aim of this study was to ascertain perinatal risks associated with second-trimester AC discordance in monochorionic (MC) twins. Method We conducted a retrospective study of all MC twin pregnancies over a 7-year period. Intertwin AC discordance at 14–26 gestational weeks was analyzed in relation to Doppler abnormalities, obstetric complications, and perinatal adverse outcomes. Results A total of 246 MC twin pregnancies were included in the analysis. The smaller twins of second-trimester AC discordant pairs were at increased prevalence of abnormal umbilical artery flow (50% versus 24%, p < .001) and low positive A wave of ductus venous flow (24% versus 9%, p = .002). The second-trimester AC discordant twins were at increased risk of oligohydramnios in smaller twin (OR = 2.44, 95% CI = 1.37–4.32, p < .01), cardiomegaly in larger twin (OR = 2.95, 95% CI = 1.01–8.60, p < .05), birth weight of either twin below the 10th percentile for gestational age (OR = 5.56, 95% CI = 2.67–11.59, p < .001), birth weight discordance > 25% (OR = 9.41, 95% CI = 4.46–19.87, p < .001), IUFD (OR = 3.26, 95% CI = 1.76–6.05, p < .001), and severe neonatal morbidity (OR = 1.83, 95% CI = 1.03–3.26, p < .05). The intact survival rate in discordant and concordant twin pairs was 70% and 89%, respectively (p < .001). Conclusions Early and increase fetal surveillance of the second-trimester AC discordant twins should be utilized to establish perinatal risks, thus allowing prenatal care to improve.

FETAL INFECTIONS OPTIMIZATION OF PREGNANCY AND DELIVERY INTRODUCTION

The aim: Improving perinatal outcomes in pregnant women at high risk of intrauterine infection by developing diagnostic criteria and algorithms for managing pregnancy and childbirth. Materials and methods: The study of pregnancy and childbirth was conducted in 72 patients at high risk of IUI, which formed the main group. The control group consisted of 64 patients with a low infectious risk of IUI. Culture, bacterioscopic and biochemical methods were used to identify microorganisms. Peculiarities of infection in the examined women were investigated by determining the concentration of Ig M and IgG in the blood serum and performed polymerase chain reaction for measles virus, cytomegalovirus, parvovirus B19. Serum for the presence of specific immune globulins to these pathogens was examined by ELISA. Comprehensive ultrasound examination in B-mode was performed to determine the feto metry of the fetus and assess its development with the determination of the estimated mass, location, size and structure of the placenta, the amount of amniotic fluid. To determine the condition of the fetus, a Doppler study of blood flow in the uterine arteries, umbilical artery, middle cerebral artery of the fetus and venous duct. Results: Analyzing the course of this pregnancy in women of the studied groups threatened miscarriage and the threat of premature birth occurred in 24 (33.3%) cases, with signs of isthmic-cervical insufficiency were diagnosed in 13 (18.1%) patients. In the control group of patients, the threat of abortion was diagnosed in 15 (23.4%) patients. According to ultrasound examination, patients in the main group in 12 (16.7%) cases were diagnosed with fetal growth retardation, in 25 (34.7%) patients at high risk of IUI there were changes in the placenta, namely, hyper echogenic inclusions in the placenta occurred in 7 (9.7%) cases, dilation of the intervillous space in 8 (11.1%) cases, placental hyperplasia in 7 (9.7%) cases, polyhydramnios was diagnosed in only 5 (6), 9%) cases, with 1 (1.4%) acute polyhydramnios in patients with signs of acute respiratory viral infection during pregnancy. Conclusions: Women at high risk for IUI require close monitoring of the fetus due to the increased frequency of hemodynamic changes in uteroplacental-fetal circulation, including fetal-placental - 22.2% and the occurrence of intrauterine growth retardation. Women with suspected cytomegalovirus infection require determination of seroconversion; in case of immunologically confirmed infection, it is desirable to recognize PCR for cytomegalovirus in the amniotic fluid in order to determine further management and monitoring of this pregnancy.

Prenatal diagnosis of abnormality of the umbilical portal DV complex: difficulty in universal classification due to various alternative routes in hepatic circulation for placental drainage

Objective To review our experience with fetal abnormality of the umbilical-portal-DV complex and to discuss the new classification system for umbilical portal systemic venous shunts (UPSVS) according to our cases. Methods This study was a retrospective analysis of fetuses with a prenatal diagnosis of abnormality of the umbilical-portal-DV complex. The integrity of the fetal umbilical-portal ductus venosus complex and the hepatic venous system were evaluated using two-dimensional color Doppler sonography. The origin of the shunt, the location of the drainage, and the presence or absence of intrahepatic portal venous system and DV were noted. Results 35 cases of abnormality of the umbilical-portal-DV complex were identified. Agenesis of ductus venous was detected in 33 of them. Based on the abnormality of the umbilical-portal-DV complex, we divided the cases into five groups. Group 1, ductus venosus agenesis with normal hepatic venous anatomy (n = 11); Group 2 downward displacement of the umbilical-portal-DV complex (n = 13); Group 3, umbilical-systemic shunt (n = 5); Group 4, intrahepatic portosystemic shunt (n = 4), Group 5, hepatic arteriovenous malformation (n = 2). Three different intrahepatic portosystemic shunt and one different downward displacement of the umbilical-portal-DV complex cases were detected. Conclusions Disruption of the normal anatomy of the umbilical-portal-DV complex causes various alternative pathway of the placental drainage. This illustrates highlights the challenge of creating a universal classification.