51
|
Anand S, Mehrotra S, Singh U, Solanki V, Agarwal S. Study of Association of Fetal Cerebroplacental Ratio with Adverse Perinatal Outcome in Uncomplicated Term AGA Pregnancies. J Obstet Gynaecol India 2020; 70:485-489. [PMID: 33417639 DOI: 10.1007/s13224-020-01357-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 07/06/2019] [Indexed: 10/23/2022] Open
Abstract
Background The cerebroplacental ratio (CPR) is emerging as a predictor for adverse perinatal outcome in term pregnancies. Earlier, it has shown a role in small for gestational age (SGA) pregnancies, but a proportion of appropriate for gestational age foetuses (AGA) despite of good size have impaired growth velocity and are thereby at risk of adverse outcome. CPR has implication for assessment of well being of SGA and AGA foetuses close to term. Objective To investigate the association between foetal CPR and adverse perinatal outcome in uncomplicated term AGA pregnancies. Methods This was a prospective observational study done in Department of Obstetric and Gynaecology, King George Medical University, Lucknow, over a period of one year. Women > 37 week singleton pregnancy with no known risk factor who had Doppler USG done within a week of delivery were included. CPR was calculated by dividing the Doppler indices of middle cerebral artery (MCA) by umbilical artery (MCA PI/UA PI). CPR < 1 was taken as abnormal. These patients were followed up till delivery to look for various perinatal outcomes. Results Out of 127 low-risk AGA pregnancies who went for USG colour Doppler scan, 117 patients who met our inclusion criteria were analysed; out of 117 patients 23(i.e. 19.65 %) were having CPR < 1 and 94 patients (i.e. 80.34%) were having CPR>1. Among 23 patients with CPR < 1, 22 (91.30%) had adverse outcome as compared to only 20.21% patients with CPR > 1, and this is found to be statistically significant (p < 0.001). Conclusion Our study found CPR measure to be a very promising tool for optimising the identification of at risk foetus in low-risk AGA pregnancies.
Collapse
Affiliation(s)
- Shikha Anand
- Department of Obst and Gynae, King George Medical University, Lucknow, Uttar Pradesh India
| | - Seema Mehrotra
- Department of Obst and Gynae, King George Medical University, Lucknow, Uttar Pradesh India
| | - Urmila Singh
- Department of Obst and Gynae, King George Medical University, Lucknow, Uttar Pradesh India
| | - Vandana Solanki
- Department of Obst and Gynae, King George Medical University, Lucknow, Uttar Pradesh India
| | - Shuchi Agarwal
- Department of Obst and Gynae, King George Medical University, Lucknow, Uttar Pradesh India
| |
Collapse
|
52
|
Tolu LB, Ararso R, Abdulkadir A, Feyissa GT, Worku Y. Perinatal outcome of growth restricted fetuses with abnormal umbilical artery Doppler waveforms compared to growth restricted fetuses with normal umbilical artery Doppler waveforms at a tertiary referral hospital in urban Ethiopia. PLoS One 2020; 15:e0234810. [PMID: 32555633 PMCID: PMC7302535 DOI: 10.1371/journal.pone.0234810] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/02/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intrauterine growth restriction is defined as a fetal weight below the 10th percentile for a given gestational age and can be identified using umbilical artery Doppler velocimetry which is a non-invasive technique. The objective of this study was to determine the perinatal outcome of growth-restricted fetuses with abnormal umbilical artery Doppler study compared to those with normal umbilical artery Doppler waveforms at a tertiary referral hospital in Ethiopia. METHODS A prospective cohort study was conducted among pregnant mothers with fetal growth restriction admitted for labour and delivery from September 2018-February 2019. The data were entered and analyzed using SPSS version 23. After conducting descriptive analysis, exploring the entire data, and checking for, statistical associations between abnormal umbilical artery Doppler and outcome variables, multiple logistic regression was conducted to control for confounders. RESULTS A total of 170 pregnant mothers complicated with growth-restricted fetuses were included in the study, among which 133 were with normal umbilical artery Doppler studies and 37 were with abnormal umbilical artery Doppler studies. Four (3%) of normal and 9(24.3%) of abnormal umbilical artery Doppler studies ended in perinatal death-value = 0.001. Twenty (15%) of normal and 24(64.9%) of abnormal umbilical artery Doppler study neonates required neonatal intensive care admission-value = 0.002. Growth restricted fetuses complicated with abnormal Doppler were two times more likely to require neonatal intensive care unit admissions compared to growth-restricted fetuses with normal umbilical artery Doppler flow, P-value 0.002, (OR = 2.059,95%CI 1.449-2.926). Growth restricted fetuses complicated with abnormal Doppler were four times more likely to end in early neonatal death compared to growth-restricted fetuses with normal umbilical artery Doppler flow, P-value 0.001, (OR = 4.136, 95%CI 3.423-4.998). However, the study is unmatched and there is a possibility of gestational age confounding the result and should be seen with the context of preterm morbidity and mortality. CONCLUSION The abnormal umbilical artery Doppler waveform is associated with cesarean section delivery, neonatal intensive care unit admission, respiratory distress syndrome, neonatal sepsis, neonatal hyperbilirubinemia, and early neonatal death compared to normal umbilical artery Doppler flow.
Collapse
Affiliation(s)
- Lemi Belay Tolu
- Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Roba Ararso
- Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | - Yoseph Worku
- Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| |
Collapse
|
53
|
Nwabuobi C, Gowda N, Schmitz J, Wood N, Pargas A, Bagiardi L, Odibo L, Camisasca-Lopina H, Kuznicki M, Sinkey R, Odibo A. Risk factors for Cesarean delivery in pregnancy with small-for-gestational-age fetus undergoing induction of labor. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:799-805. [PMID: 31441151 DOI: 10.1002/uog.20850] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To identify risk factors for Cesarean delivery and non-reassuring fetal heart tracing (NRFHT) in pregnancies with a small-for-gestational-age (SGA) fetus undergoing induction of labor and to design and validate a prediction model, combining antenatal and intrapartum variables known at the time of labor induction, to identify pregnancies at increased risk of Cesarean delivery. METHODS This was a retrospective cohort study of non-anomalous, singleton gestations with a SGA fetus that underwent induction of labor, delivered in a single tertiary referral center between January 2011 and December 2016. SGA was defined as estimated fetal weight (EFW) < 10th percentile. The primary outcome was to identify risk factors associated with Cesarean delivery. The secondary outcome was to identify risk factors associated with NRFHT. Univariate and multivariate analyses were used to determine which clinical characteristics, available at the time of admission, had the strongest association with Cesarean delivery and NRFHT during labor induction. The predictive value of the final models was assessed by the area under the receiver-operating-characteristics curve (AUC). Sensitivity and specificity of the models were also assessed. Internal validation of the models was performed using 10 000 bootstrap replicates of the original cohort. The adequacy of the models was evaluated using the Hosmer-Lemeshow goodness-of-fit test. RESULTS A total of 594 pregnancies were included. Cesarean delivery was performed in 243 (40.9%) pregnancies. Significant risk factors associated with Cesarean delivery, and included in the final model, were maternal age, gestational age at delivery and initial method of labor induction. The bootstrap estimate of the AUC of the final prediction model for Cesarean delivery was 0.82 (95% CI, 0.78-0.86). The model had sensitivity of 64.2%, specificity of 86.9%, positive likelihood ratio (LR) of 4.9 and negative LR of 0.41. The model had good fit (P = 0.617). NRFHT complicated 117 (19.7%) pregnancies. Significant risk factors for NRFHT included EFW < 5th percentile, abnormal umbilical artery Doppler studies (pulsatility index > 95th percentile or absent/reversed end-diastolic flow) and gestational age at delivery. The final prediction model for NRFHT had an AUC of 0.69 (95% CI, 0.63-0.75) and specificity of 97.0%. CONCLUSION We identified several significant risk factors for Cesarean delivery and NRFHT among SGA pregnancies undergoing induction of labor. Clinicians may use these risk factors to guide patient counseling and to help anticipate the potential need for operative delivery. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- C Nwabuobi
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - N Gowda
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - J Schmitz
- Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - N Wood
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - A Pargas
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - L Bagiardi
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - L Odibo
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - H Camisasca-Lopina
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - M Kuznicki
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - R Sinkey
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - A Odibo
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| |
Collapse
|
54
|
Aski SK, Akbari R, Hantoushzadeh S, Ghotbizadeh F. A bibliometric analysis of Intrauterine Growth Restriction research. Placenta 2020; 95:106-120. [PMID: 32452397 DOI: 10.1016/j.placenta.2020.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/24/2020] [Indexed: 12/15/2022]
Abstract
Intrauterine growth restriction (IUGR) is not a new subject in pregnancy. Nevertheless, this concept has newly begun to be integrated into pregnancy studies. We recognized articles that were published in English from 1977 to 2019 through electronic searches of the Web of Science™ database. The WoS database was searched for all published articles that compared preeclampsia from 1977 to January 2020. About 1469 documents in obstetrics and gynecology areas were analyzed in WoS database. VOSviewer software was employed to visualize the networks. The survey resulted in a 1469 published documents from 1977 to 2020. 'Gratacos' from Spain and 'Cetin' from Italy contributed the most publications. The greatest contribution came from the 'USA' (n = 498), 'Italy' (n = 155), and 'England' (n = 147). Furthermore, our results found that among these journals, the 'AJOG' (n = 318) and the 'Reproductive Sciences' (n = 209) published the largest number of papers. The top 100 most cited papers showed that 30% were reported in the 'AJOG'. About half the articles were published in the last decade and the most common studies were research paper (77%). The co-occurrence and co-citation analysis showed that the study formed four clusters. Finally, the strategic map was designed. We found that there existed an increasing trend in the large amount of publication on IUGR from 1977 to 2020. The number of studies in IUGR has substantially improved in the last decade. Authors from the 'USA' appeared the most proactive in addressing the IUGR area. By studying these articles, we propose important to support not only for grinding the IUGR challenges field but also for designing a new trend in this area.
Collapse
Affiliation(s)
- Soudabeh Kazemi Aski
- Reproductive Health Research Center, Department of Obstetrics & Gynecology, Rasht, Iran.
| | - Razieh Akbari
- Department of Obstetrics and Gynecology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sedigheh Hantoushzadeh
- Department of Obstetrics and Gynecology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Fahimeh Ghotbizadeh
- Department of Obstetrics and Gynecology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
55
|
Kennedy AM, Woodward PJ. A Radiologist's Guide to the Performance and Interpretation of Obstetric Doppler US. Radiographics 2020; 39:893-910. [PMID: 31059392 DOI: 10.1148/rg.2019180152] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Doppler US provides a unique window to the fetoplacental circulation, allowing assessment of fetal well-being. Doppler US of the umbilical artery is an integral component of managing the fetus with growth restriction; and Doppler US of the middle cerebral artery, as a noninvasive means of detecting fetal anemia, has revolutionized the management of pregnancies complicated by alloimmunization. Serial use of amniocentesis, with its attendant risks, has been replaced by serial Doppler US examinations. Invasive procedures are now reserved for the treatment of anemia with intrauterine transfusion. Technique is critical to obtain the best waveforms for ease of shape assessment, velocity measurement, and calculation of various ratios. In this article, the safety of Doppler US is reviewed, the fetal circulation is described, and the role of Doppler US is demonstrated in first-trimester screening and in the evaluation of growth restriction, anemia, and other causes of fetal compromise in the second and third trimesters. Sampling technique is explained, and normal and abnormal waveforms are illustrated for the ductus venosus, umbilical artery, umbilical vein, middle cerebral artery, and uterine artery. Some examples of clinical cases are provided to illustrate how the results are used in clinical practice. Clinical examples of velamentous insertion and vasa previa are also provided to aid the practicing radiologist with recognition of these entities. In particular, vasa previa is considered a critical finding; it alters pregnancy management, requiring hospital admission, administration of steroid therapy, and planned early cesarean delivery. ©RSNA, 2019.
Collapse
Affiliation(s)
- Anne M Kennedy
- From the Department of Radiology and Imaging Sciences, University of Utah Health, 30N 1099E, Room 1A71, Salt Lake City, UT 84132
| | - Paula J Woodward
- From the Department of Radiology and Imaging Sciences, University of Utah Health, 30N 1099E, Room 1A71, Salt Lake City, UT 84132
| |
Collapse
|
56
|
Bahado-Singh RO, Turkoglu O, Yilmaz A, Kumar P, Zeb A, Konda S, Sherman E, Kirma J, Allos M, Odibo A, Maulik D, Graham SF. Metabolomic identification of placental alterations in fetal growth restriction. J Matern Fetal Neonatal Med 2020; 35:447-456. [PMID: 32041426 DOI: 10.1080/14767058.2020.1722632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Fetal growth restriction (FGR), viz., birth weight <10th percentile is a common pregnancy complication which increases the risk of adverse fetal and newborn outcomes. The placenta is the key organ for fetal growth as it controls oxygen and nutrient availability. This study aims to elucidate the mechanisms of and identify putative placental biomarkers for FGR using high-resolution metabolomics.Methods: Placenta samples from 19 FGR cases and 30 controls were analyzed using proton magnetic resonance (1H NMR) spectroscopy and direct flow injection mass spectrometry with reverse-phase liquid-chromatography mass spectrometry (DI-LC-MS/MS). Significant concentration differences (p-value <.05) in 179 of the 220 metabolites were measured.Results: Of the 179 metabolites, 176 (98.3%) had reduced placental levels in FGR cases. The best performing metabolite model: 3-hydroxybutyrate, glycine and PCaaC42:0 achieved an AUC (95% CI) = 0.912 (0.814-1.000) with a sensitivity of 86.7% and specificity of 84.2% for FGR detection. Metabolite set enrichment analysis (MSEA) revealed significant (p < .05) perturbation of multiple placental metabolite pathways including urea metabolism, ammonia recycling, porphyrin metabolism, bile acid biosynthesis, galactose metabolism and perturbed protein biosynthesis.Conclusion: The placental metabolic pathway analysis revealed abnormalities that are consistent with fetal hepatic dysfunction in FGR. Near global reduction of metabolite concentrations was found in the placenta from FGR cases and metabolites demonstrated excellent diagnostic accuracy for FGR detection.
Collapse
Affiliation(s)
- Ray O Bahado-Singh
- Department of Obstetrics and Gynecology, Beaumont Health, Royal Oak, Michigan, USA
| | - Onur Turkoglu
- Department of Obstetrics and Gynecology, Beaumont Health, Royal Oak, Michigan, USA
| | - Ali Yilmaz
- Department of Obstetrics and Gynecology, Beaumont Health, Royal Oak, Michigan, USA
| | - Praveen Kumar
- Department of Obstetrics and Gynecology, Beaumont Health, Royal Oak, Michigan, USA
| | - Amna Zeb
- Department of Obstetrics and Gynecology, Beaumont Health, Royal Oak, Michigan, USA
| | - Shruti Konda
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA
| | - Eric Sherman
- University of Michigan, Ann Arbor, Michigan, USA
| | - Joseph Kirma
- Oakland University, William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Mathew Allos
- Oakland University, William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Anthony Odibo
- Morsani College of Medicine, USF Health, Tampa, Florida, USA
| | - Dev Maulik
- Department of Obstetrics and Gynecology, Kansas City School of Medicine, University of Missouri, Kansas City, Missouri, USA
| | - Stewart F Graham
- Department of Obstetrics and Gynecology, Beaumont Health, Royal Oak, Michigan, USA
| |
Collapse
|
57
|
Purnell ME, Chon AH, Korst LM, Llanes A, Grubbs BH, Chmait RH. Percent Absent End-Diastolic Velocity in the Umbilical Artery and Donor Twin Demise after Laser Surgery for Twin-Twin Transfusion Syndrome. Fetal Diagn Ther 2020; 47:572-579. [PMID: 32023611 DOI: 10.1159/000505780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 01/07/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To examine the association of preoperative absent end-diastolic velocity (AEDV) and percent AEDV (%AEDV) in the umbilical artery (UA) with donor twin intrauterine fetal demise (IUFD) after laser surgery for twin-twin transfusion syndrome (TTTS). METHODS We performed a retrospective study of stage III/IV TTTS patients who underwent laser surgery from 2006 to 2016. Donors were classified as having preoperative persistent AEDV (yes/no). %AEDV was calculated for those with AEDV as 100× the proportion of the total cardiac cycle in AEDV. Using multiple logistic regression, we tested for an association between the outcome donor IUFD and AEDV risk factors (part 1) and %AEDV (part 2). We stratified these analyses by estimated fetal weight (EFW) discordance ≥20 versus <20%. RESULTS Of 344 cases, 153 (44.5%) donors had AEDV. Part 1 did not confirm an independent association between AEDV and donor IUFD. In the part 2 analysis of the 153 patients with AEDV, %AEDV was a positive risk factor for donor IUFD only in those with discordance (n = 129) (OR 1.04, 95% CI 1.01-1.08, p = 0.0278) when adjusting for %EFW discordance, presence of arterioarterial anastomoses, and multiparity. DISCUSSION Among stage III/IV TTTS patients with AEDV, %AEDV was a risk factor for donor IUFD only in the presence of EFW discordance.
Collapse
Affiliation(s)
- Margaret E Purnell
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Andrew H Chon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Lisa M Korst
- Childbirth Research Associates, LLC, Los Angeles, California, USA
| | - Arlyn Llanes
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Brendan H Grubbs
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ramen H Chmait
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA,
| |
Collapse
|
58
|
Anatomical-clinical and ultrasound correlations in pregnancy-induced hypertension. GINECOLOGIA.RO 2020. [DOI: 10.26416/gine.30.4.2020.3941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
59
|
Babic I, Mejia A, Wrobleski JA, Shen M, Wen SW, Moretti F. Intraplacental Villous Artery Doppler as an Independent Predictor for Placenta-Mediated Disease and Its Comparison with Uterine Artery Doppler and/or Placental Biochemical Markers in Predictive Models: A Prospective Cohort Study. Fetal Diagn Ther 2019; 47:292-300. [PMID: 31726454 DOI: 10.1159/000503963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 09/26/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To validate intraplacental villous artery (IPVA) Doppler as a predictor for placenta-mediated diseases (PMDs), to compare its predictive value with uterine artery (UtA) Doppler and placental biochemical markers, and to assess its value in predictive PMD models. METHODS IPVA and UtA indices (pulsatility index [PI] and resistance index [RI]) were recorded at 18-24 weeks of gestation in a cohort of 117 women. The predictive values of IPVA, UtA, and placental biochemical markers were analyzed and compared between the PMD group (the women who developed preeclampsia or intrauterine growth restriction) and the non-PMD group (the women who remained healthy throughout pregnancy and 3 months postpartum) using the receiver-operating characteristic curves. Logistic regression was used to compare predictive models for PMDs based on IPVA, UtA, and/or biochemical markers. RESULTS 31 (26.5%) women developed PMD (17 preeclampsia and 14 intrauterine growth restriction). IPVA PI was significantly higher in the PMD group than in the non-PMD group (p = 0.001). UtA PI and RI values remained nonsignificant between both groups (p = 0.066 and 0.104, respectively). IPVA PI from the 3 main branches of the placenta, and specifically the central main stem villi, showed a strong association with PMDs in comparison to UtA (p = 0.03 and 0.001 vs. 0.29). Model prediction including IPVA and UtA PI with or without placental biomarkers did not add any further significance to IPVA PI alone (p = 0.03, 0.41, and 0.36). CONCLUSIONS IPVA PI appears superior to UtA PI or RI and placental biomarkers in PMD prediction. Model prediction for PMDs including IPVA, UtA Doppler, and biochemical markers did not enhance prediction values compared to IPVA Doppler alone.
Collapse
Affiliation(s)
- Inas Babic
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia, .,Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada,
| | - Alberto Mejia
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Julie-Anne Wrobleski
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Minxue Shen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Shi Wu Wen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Felipe Moretti
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
60
|
DeVore GR, Gumina DL, Hobbins JC. Assessment of ventricular contractility in fetuses with an estimated fetal weight less than the tenth centile. Am J Obstet Gynecol 2019; 221:498.e1-498.e22. [PMID: 31153929 DOI: 10.1016/j.ajog.2019.05.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine whether abnormal global, transverse, and longitudinal ventricular contractility of the heart in fetuses with an estimated fetal weight <10th centile is present, irrespective of Doppler studies of the umbilical artery and cerebroplacental ratio. STUDY DESIGN This was a retrospective study of 50 fetuses with an estimated fetal weight <10th centile that were classified based on Doppler results from the pulsatility indices of the umbilical artery and middle cerebral artery, and the calculated cerebroplacental ratio (pulsatility indices of the umbilical artery/middle cerebral artery). Right and left ventricular measurements were categorized into 3 groups: (1) global ventricular contractility (fractional area change), (2) transverse ventricular contractility (24-segment transverse fractional shortening), and (3) basal-apical longitudinal contractility (longitudinal strain, longitudinal displacement fractional shortening, and basal lateral and septal wall annular plane systolic excursion). Z scores for the above measurements were computed for fetuses with an estimated fetal weight <10th centile using the mean and standard deviation derived from normal controls. Ventricular contractility measurements were considered abnormal if their Z score values were <5th centile (z score <-1.65) or >95th centile (Z score >1.65), depending on the specific ventricular measurement. RESULTS The average gestational age at the time of the examination was 32 weeks 4 days (standard deviation 3 weeks 4 days). None of the 50 study fetuses demonstrated absent or reverse flow of the umbilical artery Doppler waveform. Eighty-eight percent (44/50) of fetuses had one or more abnormal measurements of cardiac contractility of 1 or both ventricles. Analysis of right ventricular contractility demonstrated 78% (39/50) to have 1 or more abnormal measurements, which were grouped as follows: global contractility 38% (19/50), transverse contractility 66% (33/50); and longitudinal contractility 48% (24/50). Analysis of left ventricular contractility demonstrated 1 or more abnormal measurements in 58% (29/50) that were grouped as follows: global contractility 38% (19/50); transverse contractility 40% (20/50); and longitudinal contractility 40% (20/50). Of the 50 study fetuses, 25 had normal pulsatility index of the umbilical artery and cerebroplacental ratios, 80% of whom had 1 or more abnormalities of right ventricular contractility and 56% of whom had 1 or more abnormalities of left ventricular contractility. Abnormal ventricular contractility for these fetuses was present in all 3 groups of measurements; global, transverse, and longitudinal. Those with an isolated abnormal pulsatility index of the umbilical artery (n=11) had abnormalities of transverse contractility of the right ventricular and global contractility in the left ventricle. When an isolated cerebroplacental ratio abnormality was present, the right ventricle demonstrated abnormal global, transverse, and longitudinal contractility, with the left ventricle only demonstrating abnormalities in transverse contractility. When both the pulsatility index of the umbilical artery and cerebroplacental ratio were abnormal (3/50), transverse and longitudinal contractility measurements were abnormal for both ventricles, as well as abnormal global contractility of the left ventricle. CONCLUSIONS High rates of abnormal ventricular contractility were present in fetuses with an estimated fetal weight <10th centile, irrespective of the Doppler findings of the pulsatility index of the umbilical artery, and/or cerebroplacental ratio. Abnormalities of ventricular contractility were more prevalent in transverse measurements than global or longitudinal measurements. Abnormal transverse contractility was more common in the right than the left ventricle. Fetuses with estimated fetal weight less than the 10th centile may be considered to undergo assessment of ventricular contractility, even when Doppler measurements of the pulsatility index of the umbilical artery, and cerebroplacental ratio are normal.
Collapse
Affiliation(s)
- Greggory R DeVore
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Fetal Diagnostic Centers, Pasadena, Tarzana, and Lancaster, CA.
| | - Diane L Gumina
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, CO
| | - John C Hobbins
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, CO
| |
Collapse
|
61
|
Ravikumar G, Crasta J. Do Doppler Changes Reflect Pathology of Placental Vascular Lesions in IUGR Pregnancies? Pediatr Dev Pathol 2019; 22:410-419. [PMID: 30894076 DOI: 10.1177/1093526619837790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Doppler assessment of uteroplacental (UP) and fetoplacental (FP) circulation detects abnormal waveforms in intrauterine growth-restricted (IUGR) pregnancies. Similarly, histopathology also reveals lesions of vascular compromise in IUGR placenta. We evaluated an association between Doppler and histopathological (HP) assessment of the maternal and fetal circulation in IUGR. METHODS IUGR cases with both Doppler and histopathology assessment were selected from our database. Doppler patterns recorded UP and FP insufficiency. The HP vascular lesions were classified as maternal vascular underperfusion and fetal thrombotic vasculopathy (FTV). IUGRs were grouped based on (i) presence of preeclampsia (PE), (ii) clinical onset (early vs late) of IUGR (early onset [EO]/late onset), and (iii) gestational age (term, T/preterm, PT). RESULTS Abnormal Doppler waveforms were present in 69 of the total 88 IUGR cases (78.4%). The most frequent pattern was fetoplacental insufficiency (FPI) (66%) which was combined with uteroplacental insufficiency (UPI) in 49%. HP showed vascular lesions in 52.3% and most frequent was FTV (38%). PE-associated IUGR (n = 49) had higher UPI pattern (75.5% vs 43.6%, P = .004), while normotensive IUGR had higher FPI pattern (28.2% vs 8.2%, P = .01). EO-IUGR (n = 55) and PT-IUGR (n = 52) had significant abnormal Doppler waveforms (P < .05) with higher combined patterns and brain sparing. Doppler was more sensitive for fetal vascular lesions than maternal (75.8% vs 66.7%). However, 42% of cases with normal Doppler findings showed HP vascular lesions. CONCLUSION IUGR pregnancies harbor significant vascular compromise. Fetal circulatory lesions were more common in IUGR pregnancies. In a significant number of cases with normal Doppler report, vascular lesions were identified on histopathology, emphasizing placental examination in all cases of IUGR.
Collapse
Affiliation(s)
- Gayatri Ravikumar
- Department of Pathology, St. John's Medical College, Bangalore, Karnataka, India
| | - Julian Crasta
- Department of Pathology, St. John's Medical College, Bangalore, Karnataka, India
| |
Collapse
|
62
|
Stenhouse C, Tennant P, Duncan WC, Ashworth CJ. Doppler ultrasound can be used to monitor umbilical arterial blood flow in lightly sedated pigs at multiple gestational ages. Reprod Fertil Dev 2019; 30:1402-1411. [PMID: 29723486 DOI: 10.1071/rd17298] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 03/28/2018] [Indexed: 12/14/2022] Open
Abstract
Doppler ultrasound was performed under moderate sedation (ketamine and azaperone) for 30min to monitor umbilical arterial (UA) blood flow in one uterine horn of Large White×Landrace gilts (n=23) at Gestational Days (GD) 30, 45, 60 and 90. Gilts were scanned before they were killed to examine relationships between litter size, sex ratio and five UA parameters (peak systolic velocity (PSV), end diastolic velocity (EDV), A/B (PSV to EDV) ratio, fetal heart rate (FHR) and resistance index (RI)). In gilts in which scans were obtained from all fetuses in the scanned horn, relationships between UA parameters, and fetal weight and sex were examined. A subset of gilts were sedated, scanned and recovered (SSR) earlier in gestation (GD30 or GD45) to assess the effects of sedation on later fetal development by comparison with control litters (no previous sedation). Temporal changes were observed in all UA parameters (P≤0.001). At GD60 and GD90, FHR decreased with increasing duration of sedation (P≤0.001). Sex ratio and fetal weight affected UA blood flow, whereas litter size and fetal sex did not. SSR at GD30 and GD45 was associated with decreased fetal weight at GD60 (P≤0.001) and GD90 (P=0.06) respectively, compared with controls. These results suggest maternal sedation during gestation affects fetal development, which should be investigated further. Measuring UA blood flow in growth-restricted porcine fetuses throughout gestation may be feasible.
Collapse
Affiliation(s)
- Claire Stenhouse
- Developmental Biology Division, The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Edinburgh, EH25 9RG, UK
| | - Peter Tennant
- Developmental Biology Division, The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Edinburgh, EH25 9RG, UK
| | - W Colin Duncan
- Centre for Reproductive Health, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Cheryl J Ashworth
- Developmental Biology Division, The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Edinburgh, EH25 9RG, UK
| |
Collapse
|
63
|
Serial Third-Trimester Ultrasonography Compared With Routine Care in Uncomplicated Pregnancies: A Randomized Controlled Trial. Obstet Gynecol 2019; 132:1358-1367. [PMID: 30399092 DOI: 10.1097/aog.0000000000002970] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Among uncomplicated pregnancies, serial third-trimester ultrasound examinations identified significantly more cases with a composite of fetal growth or amniotic fluid abnormalities (27%) than did routine fundal height measurements (8%). METHODS Women without complications between 24 0/7 and 30 6/7 weeks of gestation were randomized (NCT0270299) to either routine care (control arm) or ultrasound examination every 4 weeks (intervention arm). The primary outcome was a composite of abnormalities of fluid volume and growth: oligohydramnios or polyhydramnios; fetal growth restriction; or large for gestational age. The secondary outcome was the presence of composite maternal or neonatal morbidity among the two groups. A total of 206 participants was needed to have 80% power to detect an increase in the primary composite outcome from 10% in control to 25% in the intervention group (baseline rate 10%; two-tailed; α=0.05; loss to follow-up 5%). All women were included in the intent-to-treat analysis. Fisher exact, χ tests, or two-sample t tests were used to assess group differences. RESULTS From July 11, 2016, to May 24, 2017, 852 women were screened for eligibility and 206 were randomized as follows: 102 in routine care and 104 in serial ultrasound examinations. The two groups were comparable in baseline characteristics. The primary composite outcome was significantly higher among women who were in the ultrasound examination group than the routine care group (27% vs 8%; relative risk 3.43, 95% CI 1.64-7.17); five women (95% CI 3-11) were needed to identify at least one of the composite ultrasound abnormalities. Although we were underpowered to detect a significant difference, the following secondary endpoints occurred with similar frequency in the ultrasound examination group than the routine care group: induction resulting from abnormal ultrasound examination findings (14% vs 6%), cesarean delivery in labor (5% vs 6%), and prespecified composite maternal morbidity (9% in both groups) and composite neonatal morbidity (1% vs 4%). CONCLUSION Among uncomplicated pregnancies between 24 0/7 and 30 6/7 weeks of gestation, serial third-trimester ultrasound examinations were significantly more likely to identify abnormalities of fetal growth or amniotic fluid than measurements of fundal height and indicated ultrasound examination. No differences in maternal and neonatal outcomes were noted, although we were underpowered for these endpoints. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02702999.
Collapse
|
64
|
Tun WM, Yap CH, Saw SN, James JL, Clark AR. Differences in placental capillary shear stress in fetal growth restriction may affect endothelial cell function and vascular network formation. Sci Rep 2019; 9:9876. [PMID: 31285454 PMCID: PMC6614400 DOI: 10.1038/s41598-019-46151-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 06/19/2019] [Indexed: 11/09/2022] Open
Abstract
Fetal growth restriction (FGR) affects 5-10% of pregnancies, leading to clinically significant fetal morbidity and mortality. FGR placentae frequently exhibit poor vascular branching, but the mechanisms driving this are poorly understood. We hypothesize that vascular structural malformation at the organ level alters microvascular shear stress, impairing angiogenesis. A computational model of placental vasculature predicted elevated placental micro-vascular shear stress in FGR placentae (0.2 Pa in severe FGR vs 0.05 Pa in normal placentae). Endothelial cells cultured under predicted FGR shear stresses migrated significantly slower and with greater persistence than in shear stresses predicted in normal placentae. These cell behaviors suggest a dominance of vessel elongation over branching. Taken together, these results suggest (1) poor vascular development increases vessel shear stress, (2) increased shear stress induces cell behaviors that impair capillary branching angiogenesis, and (3) impaired branching angiogenesis continues to drive elevated shear stress, jeopardizing further vascular formation. Inadequate vascular branching early in gestation could kick off this cyclic loop and continue to negatively impact placental angiogenesis throughout gestation.
Collapse
Affiliation(s)
- Win M Tun
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Choon Hwai Yap
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Shier Nee Saw
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Alys R Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
| |
Collapse
|
65
|
Hromadnikova I, Dvorakova L, Kotlabova K, Krofta L. The Prediction of Gestational Hypertension, Preeclampsia and Fetal Growth Restriction via the First Trimester Screening of Plasma Exosomal C19MC microRNAs. Int J Mol Sci 2019; 20:ijms20122972. [PMID: 31216670 PMCID: PMC6627682 DOI: 10.3390/ijms20122972] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/11/2019] [Accepted: 06/15/2019] [Indexed: 12/21/2022] Open
Abstract
The aim of the study was to verify if quantification of placental specific C19MC microRNAs in plasma exosomes would be able to differentiate during the early stages of gestation between patients subsequently developing pregnancy-related complications and women with the normal course of gestation and if this differentiation would lead to the improvement of the diagnostical potential. The retrospective study on singleton Caucasian pregnancies was performed within 6/2011-2/2019. The case control study, nested in a cohort, involved women that later developed GH (n = 57), PE (n = 43), FGR (n = 63), and 102 controls. Maternal plasma exosome profiling was performed with the selection of C19MC microRNAs with diagnostical potential only (miR-516b-5p, miR-517-5p, miR-518b, miR-520a-5p, miR-520h, and miR-525-5p) using real-time RT-PCR. The down-regulation of miR-517-5p, miR-520a-5p, and miR-525-5p was observed in patients with later occurrence of GH and PE. Maternal plasma exosomal profiling of selected C19MC microRNAs also revealed a novel down-regulated biomarker during the first trimester of gestation (miR-520a-5p) for women destinated to develop FGR. First trimester circulating plasma exosomes possess the identical C19MC microRNA expression profile as placental tissues derived from patients with GH, PE and FGR after labor. The predictive accuracy of first trimester C19MC microRNA screening (miR-517-5p, miR-520a-5p, and miR-525-5p) for the diagnosis of GH and PE was significantly higher in the case of expression profiling of maternal plasma exosomes compared to expression profiling of the whole maternal plasma samples.
Collapse
Affiliation(s)
- Ilona Hromadnikova
- Department of Molecular Biology and Cell Pathology, Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic.
| | - Lenka Dvorakova
- Department of Molecular Biology and Cell Pathology, Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic.
| | - Katerina Kotlabova
- Department of Molecular Biology and Cell Pathology, Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic.
| | - Ladislav Krofta
- Institute for the Care of the Mother and Child, Third Faculty of Medicine, Charles University, 14700 Prague, Czech Republic.
| |
Collapse
|
66
|
Surico D, Bordino V, Cantaluppi V, Mary D, Gentilli S, Oldani A, Farruggio S, Melluzza C, Raina G, Grossini E. Preeclampsia and intrauterine growth restriction: Role of human umbilical cord mesenchymal stem cells-trophoblast cross-talk. PLoS One 2019; 14:e0218437. [PMID: 31206561 PMCID: PMC6576763 DOI: 10.1371/journal.pone.0218437] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/02/2019] [Indexed: 12/27/2022] Open
Abstract
Background Oxidative stress is involved in the pathogenesis and maintenance of pregnancy-related disorders, such as intrauterine growth restriction (IUGR) and preeclampsia (PE). Human umbilical cord mesenchymal stem cells (hUMSCs) have been suggested as a possible therapeutic tool for the treatment of pregnancy-related disorders in view of their paracrine actions on trophoblast cells. Objectives To quantify the plasma markers of peroxidation in patients affected by PE and IUGR and to examine the role of oxidative stress in the pathophysiology of PE and IUGR in vitro by using hUMSCs from physiological and pathological pregnancies and a trophoblast cell line (HTR-8/SVneo). Study design In pathological and physiological pregnancies the plasma markers of oxidative stress, arterial blood pressure, serum uric acid, 24h proteinuria, weight gain and body mass index (BMI) were examined. Furthermore, the pulsatility index (PI) of uterine and umbilical arteries, and of fetal middle cerebral artery was measured. In vitro, the different responses of hUMSCs, taken from physiological and pathological pregnancies, and of HTR-8/SVneo to pregnancy-related hormones in terms of viability and nitric oxide (NO) release were investigated. In some experiments, the above measurements were performed on co-cultures between HTR-8/SVneo and hUMSCs. Results The results obtained have shown that in pathological pregnancies, body mass index, serum acid uric, pulsatility index in uterine and umbilical arteries and markers of oxidative stress were higher than those found in physiological ones. Moreover, in PE and IUGR, a relation was observed between laboratory and clinical findings and the increased levels of oxidative stress. HTR-8/SVneo and hUMSCs showed reduced viability and increased NO production when stressed with H2O2. Finally, HTR-8/SVneo cultured in cross-talk with hUMSCs from pathological pregnancies showed a deterioration of cell viability and NO release when treated with pregnancy-related hormones. Conclusion Our findings support that hUMSCs taken from patients affected by PE and IUGR have significant features in comparison with those from physiologic pregnancies. Moreover, the cross-talk between hUMSCs and trophoblast cells might be involved in the etiopathology of IUGR and PE secondary to oxidative stress.
Collapse
Affiliation(s)
- Daniela Surico
- Department of Translational Medicine, Gynecologic Unit, University East Piedmont, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara, Italy
- Department of Translational Medicine, AGING PROJECT, University East Piedmont, Novara, Italy
| | - Valerio Bordino
- Department of Translational Medicine, Gynecologic Unit, University East Piedmont, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara, Italy
| | - Vincenzo Cantaluppi
- Department of Translational Medicine, AGING PROJECT, University East Piedmont, Novara, Italy
- Department of Translational Medicine, Nephrology-Kidney Transplantation Unit and Center for Autoimmune and Allergic Diseases (CAAD), University East Piedmont, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara, Italy
| | - David Mary
- Department of Translational Medicine, Laboratory of Physiology/Experimental Surgery, University East Piedmont, Novara, Italy
| | - Sergio Gentilli
- Department of Translational Medicine, Laboratory of Physiology/Experimental Surgery, University East Piedmont, Novara, Italy
| | - Alberto Oldani
- Department of Translational Medicine, Laboratory of Physiology/Experimental Surgery, University East Piedmont, Novara, Italy
| | - Serena Farruggio
- Department of Translational Medicine, AGING PROJECT, University East Piedmont, Novara, Italy
- Department of Translational Medicine, Laboratory of Physiology/Experimental Surgery, University East Piedmont, Novara, Italy
| | - Carmela Melluzza
- Department of Translational Medicine, Gynecologic Unit, University East Piedmont, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara, Italy
| | - Giulia Raina
- Department of Translational Medicine, AGING PROJECT, University East Piedmont, Novara, Italy
- Department of Translational Medicine, Laboratory of Physiology/Experimental Surgery, University East Piedmont, Novara, Italy
| | - Elena Grossini
- Department of Translational Medicine, AGING PROJECT, University East Piedmont, Novara, Italy
- Department of Translational Medicine, Laboratory of Physiology/Experimental Surgery, University East Piedmont, Novara, Italy
- * E-mail:
| |
Collapse
|
67
|
Yakıştıran B, Katlan DC, Yüce T, Koç A. Neural and cardiac injury markers in fetal growth restriction and their relation to perinatal outcomes. Turk J Obstet Gynecol 2019; 16:50-54. [PMID: 31019840 PMCID: PMC6463424 DOI: 10.4274/tjod.galenos.2019.84665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 02/07/2019] [Indexed: 12/01/2022] Open
Abstract
Objective: To compare the levels of umbilical cord blood Neuron-Specific Enolase (NSE) and troponin T and venous blood gas samples between healthy newborns and growth-retarded fetuses with impaired Doppler velocity or low APGAR scores. Materials and Methods: This study was a prospective cohort study. The study group comprised 26 patients with intrauterine growth restriction and pathologic Doppler symptoms, and the control group included 24 healthy fetuses. Umbilical cord blood and blood gas samples were taken from all patients. The blood samples were centrifuged and sent to a laboratory to study NSE and troponin T Perinatal outcomes were evaluated from the medical records of the newborns. Results: Both groups were similar in terms of demographic characteristics. Fetuses with fetal growth restriction (FGR) were born earlier and had lower APGAR scores than the study group. Chronic hypoxemic fetuses in the study group had lower cord pH and HCO3 levels. Further, troponin T levels were higher in the study group than in the control group. There were no major differences in Doppler velocity measurements. Conclusion: It has been understood that cardiac and neuronal injury detection on fetuses with FGR, troponin T, and NSE are indicators that can be used. In the literature there are studies with heterogeneous paradigms using different indicators to find neuronal injury. As a result of this study, it is clear that to assess neonatal prognosis, wider-scoped and comparative studies will provide more information about the subject.
Collapse
Affiliation(s)
- Betül Yakıştıran
- University of Health Sciences, Ankara Zekai Tahir Burak Woman's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Doruk Cevdi Katlan
- İstanbul Süleymaniye Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Tuncay Yüce
- University of Health Sciences, Ankara Zekai Tahir Burak Woman's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Acar Koç
- Ankara University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
| |
Collapse
|
68
|
Placenta Transcriptome Profiling in Intrauterine Growth Restriction (IUGR). Int J Mol Sci 2019; 20:ijms20061510. [PMID: 30917529 PMCID: PMC6471577 DOI: 10.3390/ijms20061510] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 03/22/2019] [Accepted: 03/24/2019] [Indexed: 12/14/2022] Open
Abstract
Intrauterine growth restriction (IUGR) is a serious pathological complication associated with compromised fetal development during pregnancy. The aim of the study was to broaden knowledge about the transcriptomic complexity of the human placenta by identifying genes potentially involved in IUGR pathophysiology. RNA-Seq data were used to profile protein-coding genes, detect alternative splicing events (AS), single nucleotide variant (SNV) calling, and RNA editing sites prediction in IUGR-affected placental transcriptome. The applied methodology enabled detection of 37,501 transcriptionally active regions and the selection of 28 differentially-expressed genes (DEGs), among them 10 were upregulated and 18 downregulated in IUGR-affected placentas. Functional enrichment annotation indicated that most of the DEGs were implicated in the processes of inflammation and immune disorders related to IUGR and preeclampsia. Additionally, we revealed that some genes (S100A13, GPR126, CTRP1, and TFPI) involved in the alternation of splicing events were mainly implicated in angiogenic-related processes. Significant SNVs were overlapped with 6533 transcripts and assigned to 2386 coding sequence (CDS), 1528 introns, 345 5’ untranslated region (UTR), 1260 3’UTR, 918 non-coding RNA (ncRNA), and 10 intergenic regions. Within CDS regions, 543 missense substitutions with functional effects were recognized. Two known mutations (rs4575, synonymous; rs3817, on the downstream region) were detected within the range of AS and DEG candidates: PA28β and PINLYP, respectively. Novel genes that are dysregulated in IUGR were detected in the current research. Investigating genes underlying the IUGR is crucial for identification of mechanisms regulating placental development during a complicated pregnancy.
Collapse
|
69
|
Lewkowitz AK, Tuuli MG, Cahill AG, Macones GA, Dicke JM. Perinatal outcomes after intrauterine growth restriction and intermittently elevated umbilical artery Doppler. Am J Obstet Gynecol MFM 2019; 1:64-73. [PMID: 33319758 DOI: 10.1016/j.ajogmf.2019.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/23/2019] [Accepted: 02/25/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intermittently elevated umbilical artery pulsatility index has been identified among pregnancies with intrauterine growth restriction but has unclear clinical significance. OBJECTIVE The purpose of this study was to analyze perinatal morbidity and stillbirth after intrauterine growth restriction with an intermittently elevated umbilical artery pulsatility index. STUDY DESIGN This retrospective cohort study included nonanomalous singleton, intrauterine growth-restricted pregnancies that received umbilical artery pulsatility index testing at a tertiary-care prenatal diagnostic center from 2010-2016. Women with persistently elevated umbilical artery pulsatility index, absent or reversed end-diastolic blood flow on umbilical artery pulsatility index, or only 1 umbilical artery pulsatility index result were excluded. Intermittently elevated umbilical artery pulsatility index was defined as ≥1 elevated umbilical artery pulsatility index (>95%) and ≥1 normal umbilical artery pulsatility index (≤95%). Women with an intermittently elevated umbilical artery pulsatility index were matched 1:3 by gestational age at intrauterine growth restriction diagnosis to those with a normal umbilical artery pulsatility index. The primary outcome was composite neonatal morbidity and deaths (stillbirth, mechanical ventilation, sepsis, intraventricular hemorrhage, and necrotizing enterocolitis). Secondary outcomes included 5-minute Apgar score, umbilical artery pH, delivery type, and interval from intrauterine growth restriction diagnosis to delivery. We compared outcomes after intermittently elevated umbilical artery pulsatility index with those after normal umbilical artery pulsatility index with multivariable logistic regression, adjusting for gestational age at delivery, betamethasone use, and maternal factors. RESULTS Of 1893 women, 143 (7.6%) had an intermittently elevated umbilical artery pulsatility index and were matched to 429 control subjects. Among the 143 women with an intermittently elevated umbilical artery pulsatility index, 78 (54.5%), 52 (36.4%), and 13 (0.9%) women had elevated umbilical artery pulsatility index for 1-24%, 25-49%, and 50-74% of recorded Doppler measurements, respectively. None of the women had an elevated umbilical artery pulsatility index for 75-99% of recorded umbilical artery pulsatility index measurements. The last recorded umbilical artery pulsatility index was elevated for 37 women with an intermittently elevated umbilical artery pulsatility index (25.9%). Overall, the odds of composite neonatal morbidity was similar among intrauterine growth-restricted pregnancies with an intermittently elevated vs a normal umbilical artery pulsatility index (adjusted odds ratio, 1.05; 95% confidence interval, 0.59-1.87); there were no stillbirths. There was no difference in 5-minute Apgar scores, umbilical artery pH, rate of cesarean delivery for fetal distress, or interval from intrauterine growth restriction diagnosis to delivery between the 2 groups. Similarly, sensitivity analyses that stratified the population of intermittently elevated umbilical artery pulsatility index by the proportion of elevated umbilical artery pulsatility index to overall umbilical artery pulsatility index measurements and by whether the last umbilical artery pulsatility index recorded was normal or elevated showed no difference in neonatal morbidity or obstetric outcomes between the comparator groups. CONCLUSION Among intrauterine growth-restricted pregnancies, an intermittently elevated umbilical artery pulsatility index is neither uncommon nor associated with an increased risk of neonatal morbidity, stillbirth, or cesarean delivery. These findings suggest intrauterine growth-restricted pregnancies with intermittently elevated umbilical artery pulsatility index could be managed clinically as are those with normal umbilical artery pulsatility index.
Collapse
Affiliation(s)
- Adam K Lewkowitz
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO.
| | - Methodius G Tuuli
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | - Alison G Cahill
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO
| | - George A Macones
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO
| | - Jeffrey M Dicke
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO
| |
Collapse
|
70
|
Maged AM, Waly M, AbdelHak A, Eissa TS, Osman NK. Correlation of Doppler Velocimetry of Uterine and Umbilical Arteries with Placental Pathology in Pregnancy Associated with Intrauterine Growth Restriction. JOURNAL OF FETAL MEDICINE 2019. [DOI: 10.1007/s40556-019-00191-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
71
|
Bornstein E, Chervenak FA. Ultrasound Doppler waveform assessment: the story continues. J Perinat Med 2019; 47:139-141. [PMID: 30689548 DOI: 10.1515/jpm-2018-0387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Eran Bornstein
- Lenox Hill Hospital, Northwell Health, New York, NY 10075, USA
- Zucker School of Medicine at HOFSTRA/Northwell, New York, NY 11549, USA
| | - Frank A Chervenak
- Lenox Hill Hospital, Northwell Health, New York, NY, USA
- Zucker School of Medicine at HOFSTRA/Northwell, New York, NY, USA
| |
Collapse
|
72
|
|
73
|
Ross JW, Betz A, Paglia MJ, Feng W, Neubert AG, Mackeen AD. Short- and Long-Term Growth as a Function of Abnormal Doppler Flow in Growth-Restricted Fetuses. PRENATAL CARDIOLOGY 2018. [DOI: 10.1515/pcard-2018-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
OBJECTIVES: To evaluate short- and long-term growth in fetuses with growth restriction (FGR) and elevated umbilical artery Doppler (UAD) systolic/diastolic (S/D) ratios.
METHODS: In this prospective observational study, two UAD waveforms were obtained from each umbilical artery weekly and were classified as normal or abnormal. Fetal growth was assessed every 3 weeks. Short-term growth was calculated from the first visit with elevated ratios until next growth assessment. Results were grouped by number of initial elevated S/D ratios (maximum, 4). Long-term growth was evaluated by change in estimated fetal weight from diagnosis of FGR to birth weight. Fetuses were grouped by average number of elevated S/D ratios and compared to a reference population of growth restricted fetuses with normal testing.
RESULTS: Of 241 fetuses evaluated, 105 demonstrated elevated S/D ratios. Short-term growth was impaired when fetuses had elevated S/D ratios. Long-term growth was affected when the average number of elevated S/D ratios was ≥1 per visit. Progressive 3 or 4 growth delay was noted as the average number of abnormal S/D ratios increased.
CONCLUSIONS: Short- and long-term fetal growth are affected by elevated UAD S/D ratios. Fetuses with more abnormal values initially and those with a higher average of elevated values over pregnancy demonstrate decreased growth.
Collapse
Affiliation(s)
- John W. Ross
- Geisinger, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine (1), and Biostatistics Core (2), 100 N. Academy Ave, Danville , Pennsylvania, 17821 USA
| | - Alexandria Betz
- Geisinger, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine (1), and Biostatistics Core (2), 100 N. Academy Ave, Danville , Pennsylvania, 17821 USA
| | - Michael J. Paglia
- Geisinger, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine (1), and Biostatistics Core (2), 100 N. Academy Ave, Danville , Pennsylvania, 17821 USA
| | - Wen Feng
- Department of Obstetrics and Gynecology , Reading Hospital , Sixth Avenue and Spruce Street West Reading, Pennsylvania 19611 USA
| | - A. George Neubert
- Geisinger, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine (1), and Biostatistics Core (2), 100 N. Academy Ave, Danville , Pennsylvania, 17821 USA
| | - A. Dhanya Mackeen
- Geisinger, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine (1), and Biostatistics Core (2), 100 N. Academy Ave, Danville , Pennsylvania, 17821 USA
| |
Collapse
|
74
|
Ranzil S, Walker DW, Borg AJ, Wallace EM, Ebeling PR, Murthi P. The relationship between the placental serotonin pathway and fetal growth restriction. Biochimie 2018; 161:80-87. [PMID: 30605696 DOI: 10.1016/j.biochi.2018.12.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 12/26/2018] [Indexed: 01/18/2023]
Abstract
Fetal growth restriction (FGR) is a complex disorder of human pregnancy that leads to poor health outcomes in offspring. These range from immediate risks such as perinatal morbidity and stillbirths, to long-term complications including severe neurodevelopmental problems. Despite its relatively high global prevalence, the aetiology of FGR and its complications is not currently well understood. We now know that serotonin (5-HT) is synthesised in the placenta and is crucial for early fetal forebrain development in mice. However, the contribution of a disrupted placental 5-HT synthetic pathway to the pathophysiology of placental insufficiency in FGR and its significant fetal neurodevelopmental complications are unclear.
Collapse
Affiliation(s)
- Suveena Ranzil
- Department of Obstetrics and Gynaecology, Monash University, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | | | - Anthony J Borg
- Department of Maternal-Fetal Medicine, Pregnancy Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Clayton, Victoria, Australia
| | - Padma Murthi
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia; Department of Maternal-Fetal Medicine, Pregnancy Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia; Department of Medicine, School of Clinical Sciences, Clayton, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Parkville, Victoria, Australia.
| |
Collapse
|
75
|
Interartery discordance in fetuses with growth restriction. PRENATAL CARDIOLOGY 2018. [DOI: 10.1515/pcard-2018-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
OBJECTIVES: Our objectives were two-fold: 1) to determine the frequency of discordant umbilical artery Doppler systolic to diastolic (S/D) ratios in the individual umbilical arteries of growth-restricted fetuses and 2) to examine the impact of the frequency of discordance on clinical outcomes. METHODS: This was a prospective, observational study of growth-restricted fetuses. Doppler velocimetry was performed weekly and two S/D ratios were obtained for each fetal umbilical artery. Inter-artery discordance was defined as a difference in measurement categories (i.e., normal, elevated, absent, reversed) between the arteries. The number of abnormal measurements per visit was summed to 0-4 out of 4 values. A composite average number of abnormal Doppler measurements was calculated and fetuses were stratified based on degree of average number of abnormalities in increments of 25%: 0-<25%, 25-<50%, 50-<75%, and 75-100% abnormality. RESULTS: Of a total 241 fetuses (1762 visits), 110 (45.6%) had abnormal UAD flow and 189 (66%) demonstrated discordance. Abnormal values were noted in only one artery in 53% (n=151) of visits. Fetuses with any abnormal Doppler testing had smaller birthweights compared to fetuses with consistently normal testing (2485g vs 2623g, p <0.01); birthweight decreased as composite average of abnormal measurements increased (p = 0.03). CONCLUSION: The majority (66%) of fetuses with abnormal testing demonstrated UAD discordance. Up to 53% of fetuses could have been misdiagnosed if only one artery was tested. Fetuses with a higher frequency of Doppler abnormalities had lower birthweights. We propose obtaining two measurements from each umbilical artery in growth-restricted fetuses.
Collapse
|
76
|
Umekawa T, Maki S, Kubo M, Tanaka H, Nii M, Tanaka K, Osato K, Kamimoto Y, Tamaru S, Ogura T, Nishimura Y, Kodera M, Minamide C, Nishikawa M, Endoh M, Kimura T, Kotani T, Nakamura M, Sekizawa A, Ikeda T. TADAFER II: Tadalafil treatment for fetal growth restriction - a study protocol for a multicenter randomised controlled phase II trial. BMJ Open 2018; 8:e020948. [PMID: 30381311 PMCID: PMC6224767 DOI: 10.1136/bmjopen-2017-020948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION There is no proven therapy to reverse or ameliorate fetal growth restriction (FGR). Sildenafil, a selective phosphodiesterase 5 (PDE5) inhibitor, has been reported to potentially play a therapeutic role in FGR, but this has not been established. Tadalafil is also a selective PDE5 inhibitor. We have demonstrated the efficacy of tadalafil against FGR along with short-term outcomes and the feasibility of tadalafil treatment. Based on the hypothesis that tadalafil will safely increase the likelihood of increased fetal growth in FGR, we designed this phase II study to prospectively evaluate the efficacy and safety of tadalafil against FGR. METHODS AND ANALYSIS This study is a multicentre, randomised controlled phase II trial. A total of 140 fetuses with FGR will be enrolled from medical centres in Japan. Fetuses will be randomised to receive either the conventional management for FGR or a once-daily treatment with 20 mg of tadalafil along with the conventional management until delivery. The primary endpoint is fetal growth velocity from the first day of the protocol-defined treatment to birth (g/day). To minimise bias in terms of fetal baseline conditions and timing of delivery, a fetal indication for delivery was established in this study. The investigator will evaluate fetal baseline conditions at enrolment and will decide the timing of delivery based on this fetal indication. Infants will be followed up for development until 1.5 years of age. ETHICS AND DISSEMINATION This study was approved by the Institutional Review Board of Mie University Hospital and each participating institution. Our findings will be widely disseminated through peer-reviewed publications. TRIAL REGISTRATION NUMBER UMIN000023778.
Collapse
Affiliation(s)
- Takashi Umekawa
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Shintaro Maki
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Michiko Kubo
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kayo Tanaka
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kazuhiro Osato
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yuki Kamimoto
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Satoshi Tamaru
- Clinical Research Support Center, Mie University Hospital, Tsu, Japan
| | - Toru Ogura
- Clinical Research Support Center, Mie University Hospital, Tsu, Japan
| | - Yuki Nishimura
- Clinical Research Support Center, Mie University Hospital, Tsu, Japan
| | - Mayumi Kodera
- Clinical Research Support Center, Mie University Hospital, Tsu, Japan
| | - Chisato Minamide
- Clinical Research Support Center, Mie University Hospital, Tsu, Japan
| | | | - Masayuki Endoh
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masamitsu Nakamura
- Department of Obstetrics and Gynecology, Showa University Graduate School of Medicine, Tokyo, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University Graduate School of Medicine, Tokyo, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Japan
| |
Collapse
|
77
|
Barbieri MM, Bennini JR, Nomura ML, Morais SS, Surita FG. Fetal growth standards in gastroschisis: Reference values for ultrasound measurements. Prenat Diagn 2018; 37:1327-1334. [PMID: 29110317 DOI: 10.1002/pd.5179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/26/2017] [Accepted: 10/29/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The objectives of this study were to create growth curves based on ultrasonography biometric parameters of fetuses with gastroschisis, comparing them with normal growth standards, and to analyze umbilical artery (UA) Doppler velocimetry patterns. METHODS A cohort study of 72 fetuses with gastroschisis, at gestational ages between 14 and 39 weeks was designed. Mean and standard deviation were calculated, with the 5th, 10th, 50th, 90th, and 95th centiles being established for biometric parameters according to gestational age. Curves were obtained, comparing with normal reference via the Mann-Whitney test. UA Doppler velocimetry patterns were obtained. RESULTS A total of 434 examinations were performed, and centiles were established for biparietal diameter, head circumference, abdominal circumference, femur length, and estimated fetal weight. A significant difference was observed between the gastroschisis measurements when compared to control, with all curves shifted downwards. Abdominal circumference was the parameter presenting the largest difference. Estimated fetal weight was also lower, with mean difference of 256.3 ± 166.8 g for the 50th centile (P < .0001). UA Doppler velocimetry was normal in 97.5%. CONCLUSIONS Fetuses with gastroschisis show symmetrical growth deficits in the second and third trimesters, with normal UA Doppler velocimetry. These results reinforce the hypothesis that they are constitutionally smaller, yet not restricted because of placental insufficiency.
Collapse
Affiliation(s)
- Mariane Massaini Barbieri
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil
| | - João Renato Bennini
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil
| | - Marcelo Luís Nomura
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil
| | - Sirlei Siani Morais
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil
| | - Fernanda Garanhani Surita
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil
| |
Collapse
|
78
|
Seravalli V, Di Tommaso M, Petraglia F. Managing fetal growth restriction: surveillance tests and their interpretation. ACTA ACUST UNITED AC 2018; 71:81-90. [PMID: 30318874 DOI: 10.23736/s0026-4784.18.04323-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The main challenges in pregnancies affected by fetal growth restriction consist in identifying signs of disease progression and determining the appropriate timing of delivery. The risk of continuing the pregnancy must be balanced with the risk of prematurity, which depends on gestational age. To allow appropriate monitoring of the growth-restricted fetus, several surveillance tests are available. These include ultrasound Doppler velocimetry of feto-placental vessels, cardiotocography, and amniotic fluid evaluation. It is well known that the combination of tests performs better than each test alone to predict fetal deterioration. The interpretation of test results depends on the gestational age and on the nature of the growth disorder (early- vs. late-onset disease). Appropriate knowledge on the surveillance tests interpretation and the frequency at which they need to be performed is crucial in managing fetal growth restriction, in order to produce better outcome and prevent stillbirth, and at the same time to avoid unnecessary interventions.
Collapse
Affiliation(s)
- Viola Seravalli
- Department of Health Sciences, University of Florence, Florence, Italy -
| | | | - Felice Petraglia
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| |
Collapse
|
79
|
Conde-Agudelo A, Villar J, Kennedy SH, Papageorghiou AT. Predictive accuracy of cerebroplacental ratio for adverse perinatal and neurodevelopmental outcomes in suspected fetal growth restriction: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:430-441. [PMID: 29920817 DOI: 10.1002/uog.19117] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/21/2018] [Accepted: 05/23/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The cerebroplacental ratio (CPR) has been proposed for the routine surveillance of pregnancies with suspected fetal growth restriction (FGR), but the predictive performance of this test is unclear. The aim of this study was to determine the accuracy of CPR for predicting adverse perinatal and neurodevelopmental outcomes in suspected FGR. METHODS PubMed, EMBASE, CINAHL and Lilacs were searched from inception to 31 July 2017 for cohort or cross-sectional studies reporting on the accuracy of CPR for predicting adverse perinatal and/or neurodevelopmental outcomes in singleton pregnancies with FGR suspected antenatally based on sonographic parameters. Summary receiver-operating characteristics (ROC) curves, pooled sensitivities and specificities, and summary likelihood ratios (LRs) were generated. RESULTS Twenty-two studies (including 4301 women) met the inclusion criteria. Summary ROC curves showed that the best predictive accuracy of CPR was for perinatal death and the worst was for neonatal acidosis, with areas under the summary ROC curves of 0.83 and 0.57, respectively. The predictive accuracy of CPR was moderate to high for perinatal death (pooled sensitivity and specificity of 93% and 76%, respectively, and summary positive and negative LRs of 3.9 and 0.09, respectively) and low for composite of adverse perinatal outcomes, Cesarean section for non-reassuring fetal status, 5-min Apgar score < 7, admission to the neonatal intensive care unit, neonatal acidosis and neonatal morbidity, with summary positive and negative LRs ranging from 1.1 to 2.5 and 0.3 to 0.9, respectively. An abnormal CPR result had moderate accuracy for predicting small-for-gestational age at birth (summary positive LR of 7.4). CPR had a higher predictive accuracy in pregnancies with suspected early-onset FGR. No study provided data for assessing the predictive accuracy of CPR for adverse neurodevelopmental outcome. CONCLUSION CPR appears to be useful in predicting perinatal death in pregnancies with suspected FGR. Nevertheless, before incorporating CPR into the routine clinical management of suspected FGR, randomized controlled trials should assess whether the use of CPR reduces perinatal death or other adverse perinatal outcomes. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- A Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
| | - J Villar
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| | - S H Kennedy
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| | - A T Papageorghiou
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| |
Collapse
|
80
|
Alanwar A, El Nour AA, El Mandooh M, Abdelazim IA, Abbas L, Abbas AM, Abdallah A, Nossair WS, Svetlana S. Prognostic accuracy of cerebroplacental ratio for adverse perinatal outcomes in pregnancies complicated with severe pre-eclampsia; a prospective cohort study. Pregnancy Hypertens 2018; 14:86-89. [PMID: 30527124 DOI: 10.1016/j.preghy.2018.08.446] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/11/2018] [Accepted: 08/15/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The current study aims to assess the efficacy of fetal middle cerebral artery/umbilical artery pulsatility index ratio (cerebroplacental ratio CPR) in predicting the occurrence of adverse perinatal outcomes in pregnancies complicated with severe pre-eclampsia. MATERIALS AND METHODS This cohort study included 100 pregnant women between 34 and 40 weeks of gestation attended the labor ward and diagnosed with severe pre-eclampsia. Doppler evaluation was carried out to measure the CPR. Apgar score and fetal umbilical artery pH were assessed within 5 min of delivery. The rate of neonatal intensive care unit (NICU) admission was obtained. RESULTS Apgar score at 5 min >7 was in 82 cases (82%) and 12 cases (12%) scored < 7. Fetal blood PH was >7.2 in 67% of cases while 33% of cases had PH <7.2. As regard the NICU admission; 66% of neonates did not need admission while 34% of neonates were admitted to the NICU. There was a significant association between CPR and low Apgar score at 5 min (P < 0.001). The sensitivity of CPR in detection of Apgar score <7 was 50%, and specificity 88.1%. CPR had a poor predictive value of the low umbilical artery PH <7.2 (P = 0.318) with 43.75% sensitivity and 69.05% specificity. There was a significant association between CPR and NICU admission (P = 0.009). CONCLUSIONS Adding CPR ratio to routine antepartum fetal surveillance from 34 weeks gestation may help with patient counseling regarding adverse neonatal outcomes for women with severe pre-eclampsia as there is a strong correlation between it and adverse neonatal outcomes.
Collapse
Affiliation(s)
- Ahmed Alanwar
- Department of Obstetrics and Gynecology, Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Ayman Abou El Nour
- Department of Obstetrics and Gynecology, Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed El Mandooh
- Department of Obstetrics and Gynecology, Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ibrahim A Abdelazim
- Department of Obstetrics and Gynecology, Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Luma Abbas
- Department of Obstetrics and Gynecology, Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed M Abbas
- Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ameer Abdallah
- Department of Obstetrics and Gynecology, Minia University, Minia, Egypt
| | - Wael S Nossair
- Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Shikanova Svetlana
- Department of Obstetrics and Gynecology, Marat Ospanov, West Kazakhstan State Medical University, Aktobe, Kazakhstan
| |
Collapse
|
81
|
Easter SR, Eckert LO, Boghossian N, Spencer R, Oteng-Ntim E, Ioannou C, Patwardhan M, Harrison MS, Khalil A, Gravett M, Goldenberg R, McKelvey A, Gupta M, Pool V, Robson SC, Joshi J, Kochhar S, McElrath T. Fetal growth restriction: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2018; 35:6546-6554. [PMID: 29150060 PMCID: PMC5710982 DOI: 10.1016/j.vaccine.2017.01.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 01/13/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Sarah Rae Easter
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Linda O Eckert
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Nansi Boghossian
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Rebecca Spencer
- Consultant in Obstetrics, Institute for Women's Health, University College London, UK
| | | | - Christos Ioannou
- Consultant in Obstetrics and Fetal Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Manasi Patwardhan
- Division of Maternal-Fetal Medicine, Wayne State University, Detroit, MI, USA
| | - Margo S Harrison
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Asma Khalil
- Consultant in Obstetrics and Subspecialist in Fetal Medicine, St George's University of London, London, UK
| | - Michael Gravett
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Robert Goldenberg
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Alastair McKelvey
- Consultant in Obstetrics and Fetal Medicine, Norfolk and Norwich University Hospital, Norwich, UK
| | - Manish Gupta
- Consultant Obstetrician, Subspecialist in Maternal and Fetal Medicine, Barts Health NHS Trust, London, UK
| | - Vitali Pool
- Director of Scientific and Medical Affairs, Sanofi Pasteur, Swiftwater, PA, USA
| | - Stephen C Robson
- Professor of Fetal Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Jyoti Joshi
- Deputy Director of Immunization Technical Support Unit, Public Health Fund of India, New Delhi, India
| | - Sonali Kochhar
- Global Healthcare Consulting, New Delhi, India; Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tom McElrath
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
82
|
Iwagaki S, Takahashi Y, Chiaki R, Asai K, Matsui M, Mori T, Kawabata I. Hypercoiled cord can cause a reversible abnormal Doppler in ductus venosus in cases of fetal growth restriction. J Obstet Gynaecol Res 2018; 44:1922-1928. [PMID: 29974562 DOI: 10.1111/jog.13722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 06/02/2018] [Indexed: 11/29/2022]
Abstract
AIM Although an absent or reversed a-wave in ductus venosus (DV-RAV) is reported to be the terminal finding of fetal growth restriction (FGR), we have seen DV-RAV that disappears within a short span of time in some FGR cases with a hypercoiled cord. The purpose of this study was to investigate the relationship between hypercoiled cord and reversible DV-RAV in FGR. METHODS This was a retrospective study of 499 FGR cases, including 14 with DV-RAV. Transabdominal amnioinfusion (AI) was performed when oligohydramnios was severe (maximum vertical pocket <2 cm) and/or variable deceleration was detected. DV-RAV that disappeared quickly was defined as 'temporary DV-RAV'. DV-RAV that continued until delivery or fetal death (FD) was defined as 'persistent DV-RAV'. A hypercoiled cord was defined as one with an umbilical coiling index >0.6 antenatally or >0.3 postnatally. Clinical characteristics and clinical courses of the two types of DV-RAV were compared. RESULTS DV-RAV disappeared after AI in all five cases in which temporary DV-RAV was identified. The incidence of a hypercoiled cord was significantly higher among temporary DV-RAV cases (100%) than among persistent DV-RAV cases (14.3%; P = 0.015). The time from detection of DV-RAV to delivery or FD was significantly longer among temporary DV-RAV cases (4.5 weeks) than among persistent DV-RAV cases (0.7 weeks; P = 0.027). CONCLUSION Temporary DV-RAV is suspected to be related to the combination of a hypercoiled cord and oligohydramnios. DV-RAV may not be always be a terminal finding in FGR with a hypercoiled cord.
Collapse
Affiliation(s)
- Shigenori Iwagaki
- Department of Fetal Maternal Medicine, National Nagara Medical Center, Gifu City, Gifu, Japan
| | - Yuichiro Takahashi
- Department of Fetal Maternal Medicine, National Nagara Medical Center, Gifu City, Gifu, Japan
| | - Rika Chiaki
- Department of Fetal Maternal Medicine, National Nagara Medical Center, Gifu City, Gifu, Japan
| | - Kazuhiko Asai
- Department of Fetal Maternal Medicine, National Nagara Medical Center, Gifu City, Gifu, Japan
| | - Masako Matsui
- Department of Fetal Maternal Medicine, National Nagara Medical Center, Gifu City, Gifu, Japan
| | - Takahiro Mori
- Department of Fetal Maternal Medicine, National Nagara Medical Center, Gifu City, Gifu, Japan
| | - Ichiro Kawabata
- Department of Fetal Maternal Medicine, National Nagara Medical Center, Gifu City, Gifu, Japan
| |
Collapse
|
83
|
Raghuraman N, Porcelli B, Temming LA, Macones GA, Cahill AG, Tuuli MG, Dicke JM. Clinical implications of umbilical artery Doppler changes after betamethasone administration †. J Matern Fetal Neonatal Med 2018; 33:42-48. [PMID: 29863424 DOI: 10.1080/14767058.2018.1484095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Background: Betamethasone (BMZ) is commonly administered to patients with fetal growth restriction (FGR) and abnormal umbilical artery Doppler (UAD) velocimetry due to the increased risk of preterm delivery; however, the clinical impact of UAD changes after BMZ exposure is unknown.Objective: To test the hypothesis that lack of UAD improvement after BMZ administration is associated with shorter latency and greater neonatal morbidity in patients with FGR.Study design: This was a retrospective cohort study of pregnancies complicated by FGR and abnormal UAD between 240 and 336 weeks gestation. Abnormal UAD included the following categories of increasing severity: elevated (pulsatility index >95%), absent end diastolic flow (EDF), or reversed EDF improvement was defined as any improvement in category of UAD within two weeks of BMZ. Sustained improvement was defined as improvement until the last ultrasound before delivery, whereas transient improvement was considered as unsustained. The primary outcome was latency, defined as interval from betamethasone administration to delivery. Secondary outcomes were gestational age at delivery, umbilical artery pH, and a composite of neonatal morbidity (intubation, necrotizing enterocolitis, ionotropic support, intraventricular hemorrhage, total parenteral nutrition, neonatal death). Outcomes were compared between (a) patients with and without UAD improvement and (b) patients with sustained and unsustained improvement, using univariable, multivariable and time-to-event analyses.Results: Of the 222 FGR pregnancies with abnormal UAD, 94 received BMZ and had follow-up ultrasounds. UAD improved in 48 (51.1%), with 27 (56.3%) having sustained improvement. Patients with hypertension and drug use were less likely to have UAD improvement. Patients without UAD improvement had shorter latency (21.5 days [interquartile range (IQR) 8,45] versus 35 [IQR 22,61], p = .02) and delivered at an earlier gestational age (34 weeks [IQR 31,36] versus 37 [IQR 33,37], p < .01) than those with improvement. There were no differences in umbilical artery pH between groups. Composite neonatal morbidity was higher in patients without UAD improvement, but this was not statistically significant after adjusting for confounders (aOR 2.0; 95% CI 0.08-5.1). There were no differences in outcomes between patients with sustained versus unsustained improvement.Conclusions: UAD improved in half of patients following BMZ. Lack of UAD improvement was associated with shorter latency and earlier gestational age at delivery, but no difference in composite neonatal morbidity. UAD response to BMZ may be useful to further risk stratify FGR pregnancies.
Collapse
Affiliation(s)
- Nandini Raghuraman
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Bree Porcelli
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Lorene A Temming
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - George A Macones
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Alison G Cahill
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Methodius G Tuuli
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey M Dicke
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
84
|
The relationship between intrapartum cerebroplacental ratio and adverse perinatal outcomes in term fetuses. Eur J Obstet Gynecol Reprod Biol 2018; 228:82-86. [PMID: 29909268 DOI: 10.1016/j.ejogrb.2018.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/05/2018] [Accepted: 06/10/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The cerebroplacental ratio (CPR) Doppler has been proposed as an instrument for predicting adverse perinatal outcomes particularly during antepartum period. Abnormal CPR is associated with non-reassuring fetal status requiring operative delivery, low Apgar score and neonatal complications. The aim of this study was to assess the role of CPR Doppler in the labor triage suite, so as to identify fetuses at risk for non-reassuring status as well as other adverse perinatal outcomes. METHODS This was a prospective cohort study of term pregnancies who attended the labor room during the latent phase of labor. Both fetal Middle Cerebral Artery Pulsatility Index (MCA-PI) and Umbilical Artery Pulsatility Index (UA-PI) were measured and these values were converted to CPR values. Non-reassuring fetal status requiring operative delivery and other adverse perinatal outcomes were compared between women with normal and abnormal CPR values. Accuracy of CPR for predicting non-reassuring fetal status and abnormal fetal heart rate patterns were calculated. RESULTS A total of 384 women were recruited. Lower CPR values were observed in women who underwent operative delivery for non-reassuring fetal status. However, when dividing women into normal and abnormal CPR groups, using 3 different cut-off values, the rate of non-reassuring fetal status was not significantly different between the groups. There was a significantly higher rate of abnormal fetal heart rate monitoring in fetuses with CPR < 5th percentile and CPR < 1. CPR appeared to have a low positive predictive value (PPV) for predicting non-reassuring fetal heart rate patterns, however, the negative predictive value (NPV) was high. CONCLUSIONS In term fetuses, lower CPR is associated with non-reassuring fetal status. CPR measurement during the intrapartum period with currently available CPR cut-off values is not a good predictor for adverse perinatal outcomes, with the exception of abnormal fetal heart rate patterns. However, the high NPV may be used to stratify pregnant women who may benefit from continuous fetal heart rate monitoring.
Collapse
|
85
|
Alsaied T, Tseng S, King E, Hahn E, Divanovic A, Habli M, Cnota J. Hemodynamic adaptation to suboptimal fetal growth in patients with single ventricle physiology. Echocardiography 2018; 35:1378-1384. [PMID: 29886568 DOI: 10.1111/echo.14047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In fetuses with structurally normal heart and suboptimal fetal growth (SFG), umbilical artery vascular resistance increases as measured by umbilical artery pulsatility index (UA-PI). The objective of this study is to compare hemodynamic responses to SFG in fetuses with single ventricle (SV) and controls with structurally normal heart. METHODS Fetal echocardiograms around 30 weeks of gestation were reviewed. UA-PI and middle cerebral artery pulsatility index (MCA-PI) were calculated. SFG was defined as a birth weight below 25th percentile for gestational age. RESULTS Studies from 92 fetuses were reviewed-SV (n = 50) and controls (n = 42). The prevalence of SFG was higher in SV compared to controls (46% vs 21%, P = .02). In patients with normal heart and SFG, UAPI was significantly higher than normal controls (P = .003) suggesting increased placental vascular resistance. In SV with SFG there was no difference in UAPI compared to SV without SFG. There was no difference in MCA-PI between the groups. CONCLUSIONS The hemodynamic response to SFG in SV varies from fetuses with structurally normal heart. The mechanism of SFG and the placental pathology may be distinct in SV.
Collapse
Affiliation(s)
- Tarek Alsaied
- Boston Children's Hospital, Boston Children's Heart Center, Boston, MA, USA.,Cincinnati Children's Hospital Medical Center, Children's Heart Institute, Cincinnati, OH, USA
| | - Stephanie Tseng
- Cincinnati Children's Hospital Medical Center, Children's Heart Institute, Cincinnati, OH, USA
| | - Eileen King
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eunice Hahn
- Cincinnati Children's Hospital Medical Center, Children's Heart Institute, Cincinnati, OH, USA
| | - Allison Divanovic
- Cincinnati Children's Hospital Medical Center, Children's Heart Institute, Cincinnati, OH, USA
| | - Mounira Habli
- Division of Maternal Fetal Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James Cnota
- Cincinnati Children's Hospital Medical Center, Children's Heart Institute, Cincinnati, OH, USA
| |
Collapse
|
86
|
Walton RB, Reed LC, Estrada SM, Schmiedecke SS, Villazana-Kretzer DL, Napolitano PG, Ieronimakis N. Evaluation of Sildenafil and Tadalafil for Reversing Constriction of Fetal Arteries in a Human Placenta Perfusion Model. Hypertension 2018; 72:167-176. [PMID: 29735634 DOI: 10.1161/hypertensionaha.117.10738] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 12/28/2017] [Accepted: 04/11/2018] [Indexed: 11/16/2022]
Abstract
Fetal growth restriction resulting from reduced placental blood perfusion is a major cause of neonatal morbidity and mortality. Aside from intense surveillance and early delivery, there is no treatment for fetal growth restriction. A potential treatment associated with placental vasoconstriction is the class of PDE5 (phosphodiesterase type 5) inhibitors such as sildenafil, which is known to cross the placenta. In contrast, tadalafil, a more potent and selective PDE5 inhibitor has not been studied in pregnancy or experimental models of fetal growth restriction. Therefore, we compared the efficacy of these 2 PDE5 inhibitors for reversing vasoconstriction in an ex vivo human placental model and evaluating molecular and physiological responses. Sildenafil and tadalafil were infused into the intervillous space in a preconstricted human placental dual cotyledon, dual perfusion assay for the comparison of arteriole pressures and molecular indicators of drug inhibition. Results indicate a decrease arterial pressure with sildenafil citrate compared with controls, whereas tadalafil showed no difference. PDE5 and endothelial nitric oxide synthase activity were altered with sildenafil but not tadalafil. Sildenafil citrate improved preconstricted placental arterial perfusion in a human placental model, whereas tadalafil showed no response. It is possible that tadalafil did not cross the human placental barrier or was degraded by trophoblasts. This study supports human clinical trials exploring sildenafil as a potential treatment for improving fetal blood flow in fetal growth restriction associated with vasoconstriction.
Collapse
Affiliation(s)
- Robert B Walton
- From the Department of Obstetrics and Gynecology (R.B.W., L.C.R., S.M.E., S.S.S., D.L.V.-K., P.G.N.)
| | - Luckey C Reed
- From the Department of Obstetrics and Gynecology (R.B.W., L.C.R., S.M.E., S.S.S., D.L.V.-K., P.G.N.)
| | - Sarah M Estrada
- From the Department of Obstetrics and Gynecology (R.B.W., L.C.R., S.M.E., S.S.S., D.L.V.-K., P.G.N.)
| | - Stacey S Schmiedecke
- From the Department of Obstetrics and Gynecology (R.B.W., L.C.R., S.M.E., S.S.S., D.L.V.-K., P.G.N.)
| | - Diana L Villazana-Kretzer
- From the Department of Obstetrics and Gynecology (R.B.W., L.C.R., S.M.E., S.S.S., D.L.V.-K., P.G.N.)
| | - Peter G Napolitano
- From the Department of Obstetrics and Gynecology (R.B.W., L.C.R., S.M.E., S.S.S., D.L.V.-K., P.G.N.)
| | - Nicholas Ieronimakis
- Department of Clinical Investigation (N.I.), Madigan Army Medical Center, Joint Base Lewis-McCord, Tacoma, WA.
| |
Collapse
|
87
|
Karabiyik Y, Ekroll IK, Eik-Nes SH, Lovstakken L. Quantitative Doppler Analysis Using Conventional Color Flow Imaging Acquisitions. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2018; 65:697-708. [PMID: 29733274 DOI: 10.1109/tuffc.2018.2808226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Interleaved acquisitions used in conventional triplex mode result in a tradeoff between the frame rate and the quality of velocity estimates. On the other hand, workflow becomes inefficient when the user has to switch between different modes, and measurement variability is increased. This paper investigates the use of power spectral Capon estimator in quantitative Doppler analysis using data acquired with conventional color flow imaging (CFI) schemes. To preserve the number of samples used for velocity estimation, only spatial averaging was utilized, and clutter rejection was performed after spectral estimation. The resulting velocity spectra were evaluated in terms of spectral width using a recently proposed spectral envelope estimator. The spectral envelopes were also used for Doppler index calculations using in vivo and string phantom acquisitions. In vivo results demonstrated that the Capon estimator can provide spectral estimates with sufficient quality for quantitative analysis using packet-based CFI acquisitions. The calculated Doppler indices were similar to the values calculated using spectrograms estimated on a commercial ultrasound scanner.
Collapse
|
88
|
Yamamoto R, Ishii K, Nakajima E, Sasahara J, Mitsuda N. Ultrasonographic prediction of antepartum deterioration of growth-restricted fetuses after late preterm. J Obstet Gynaecol Res 2018; 44:1057-1062. [PMID: 29607579 DOI: 10.1111/jog.13626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/08/2018] [Indexed: 11/28/2022]
Abstract
AIM To examine the predictive value of ultrasound parameters for antepartum non-reassuring fetal status (NRFS) in fetal growth restriction (FGR) cases after late preterm. METHODS Retrospective review of singleton FGR cases before 37 weeks gestation who delivered after 34 weeks gestation was performed. The association between ultrasound parameters that was assessed from 34 to 36 weeks gestation and the development of antepartum NRFS that was diagnosed by nonstress test and biophysical profile was analyzed by using multivariate Cox proportional hazards analyses. RESULTS A total of 214 patients were included in final data analyses. Antepartum NRFS occurred in 23 cases (10.7%) including five cases of placental abruption. Lower standard deviation (SD) of estimated fetal weight (EFW), lower cerebroplacental ratio (CPR) and the presence of oligohydramnios were independently associated with antepartum NRFS. The prevalence of antepartum NRFS was highest (50.4%) in the group of EFW ≤-2.5 SD with CPR ≤1.45. CONCLUSION Ultrasound parameters of lower SD of EFW, lower CPR and oligohydramnios were predictive for antepartum NRFS in FGR after late preterm.
Collapse
Affiliation(s)
- Ryo Yamamoto
- Department of Maternal Fetal Medicine, Osaka Medical Center Research Institute for Maternal and Child Health, Osaka, Japan
| | - Keisuke Ishii
- Department of Maternal Fetal Medicine, Osaka Medical Center Research Institute for Maternal and Child Health, Osaka, Japan
| | - Erika Nakajima
- Department of Maternal Fetal Medicine, Osaka Medical Center Research Institute for Maternal and Child Health, Osaka, Japan
| | - Jun Sasahara
- Department of Maternal Fetal Medicine, Osaka Medical Center Research Institute for Maternal and Child Health, Osaka, Japan
| | - Nobuaki Mitsuda
- Department of Maternal Fetal Medicine, Osaka Medical Center Research Institute for Maternal and Child Health, Osaka, Japan
| |
Collapse
|
89
|
Wibbeke D, Hammer K, Möllers M, Braun J, Köster HA, Falkenberg MK, Oelmeier de Murcia K, Borowski M, Klockenbusch W, Schmitz R. Assessment of the Fetal Cerebral Artery: Importance of Doppler Preset Settings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:621-628. [PMID: 28877357 DOI: 10.1002/jum.14378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 06/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The Doppler assessment of the middle cerebral artery (MCA) has a central role in the monitoring of high-risk pregnancies. The objective of this study was to investigate the importance of Doppler preset settings for measurement of the peak systolic velocity (PSV) and pulsatility index (PI) of the MCA. METHODS The PI and PSV of the MCA were determined prospectively in 350 healthy fetuses between 19 and 42 weeks of pregnancy. The first measurement of the MCA (MCA.S) was performed with the conventional settings and the second (MCA.O) with an optimized setting of the maximum achievable frame rate. For the MCA.O measurement, the width of the B-mode image and the color Doppler window were adjusted as narrowly as possible. In addition, the MCA was shown in optimized high-definition zoom. Resulting values were compared with commonly used reference values. RESULTS The PSV and PI values and frame rates of the MCA.O setting were noticeably greater than those of the MCA.S setting (P < .001 for all). For both settings, the PSV and PI values were increased compared to common reference values. CONCLUSIONS The assessment of the MCA with the optimized Doppler default setting yielded increased PSV and PI values compared to the commonly used measurement technique. Moreover, the resulting median curves differed from the established median reference curves. Therefore, an updated standardization for measuring the MCA should be set out, and current reference values should be adjusted.
Collapse
Affiliation(s)
- Denis Wibbeke
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Kerstin Hammer
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Mareike Möllers
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Janina Braun
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Helen Ann Köster
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | | | | | - Matthias Borowski
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Walter Klockenbusch
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Ralf Schmitz
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| |
Collapse
|
90
|
McCowan LM, Figueras F, Anderson NH. Evidence-based national guidelines for the management of suspected fetal growth restriction: comparison, consensus, and controversy. Am J Obstet Gynecol 2018; 218:S855-S868. [PMID: 29422214 DOI: 10.1016/j.ajog.2017.12.004] [Citation(s) in RCA: 260] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/20/2017] [Accepted: 12/01/2017] [Indexed: 11/25/2022]
Abstract
Small for gestational age is usually defined as an infant with a birthweight <10th centile for a population or customized standard. Fetal growth restriction refers to a fetus that has failed to reach its biological growth potential because of placental dysfunction. Small-for-gestational-age babies make up 28-45% of nonanomalous stillbirths, and have a higher chance of neurodevelopmental delay, childhood and adult obesity, and metabolic disease. The majority of small-for-gestational-age babies are not recognized before birth. Improved identification, accompanied by surveillance and timely delivery, is associated with reduction in small-for-gestational-age stillbirths. Internationally and regionally, detection of small for gestational age and management of fetal growth problems vary considerably. The aim of this review is to: summarize areas of consensus and controversy between recently published national guidelines on small for gestational age or fetal growth restriction; highlight any recent evidence that should be incorporated into existing guidelines; and identify future research priorities in this field. A search of MEDLINE, Google, and the International Guideline Library identified 6 national guidelines on management of pregnancies complicated by fetal growth restriction/small for gestational age published from 2010 onwards. There is general consensus between guidelines (at least 4 of 6 guidelines in agreement) in early pregnancy risk selection, and use of low-dose aspirin for women with major risk factors for placental insufficiency. All highlight the importance of smoking cessation to prevent small for gestational age. While there is consensus in recommending fundal height measurement in the third trimester, 3 specify the use of a customized growth chart, while 2 recommend McDonald rule. Routine third-trimester scanning is not recommended for small-for-gestational-age screening, while women with major risk factors should have serial scanning in the third trimester. Umbilical artery Doppler studies in suspected small-for-gestational-age pregnancies are universally advised, however there is inconsistency in the recommended frequency for growth scans after diagnosis of small for gestational age/fetal growth restriction (2-4 weekly). In late-onset fetal growth restriction (≥32 weeks) general consensus is to use cerebral Doppler studies to influence surveillance and/or delivery timing. Fetal surveillance methods (most recommend cardiotocography) and recommended timing of delivery vary. There is universal agreement on the use of corticosteroids before birth at <34 weeks, and general consensus on the use of magnesium sulfate for neuroprotection in early-onset fetal growth restriction (<32 weeks). Most guidelines advise using cardiotocography surveillance to plan delivery in fetal growth restriction <32 weeks. The recommended gestation at delivery for fetal growth restriction with absent and reversed end-diastolic velocity varies from 32 to ≥34 weeks and 30 to ≥34 weeks, respectively. Overall, where there is high-quality evidence from randomized controlled trials and meta-analyses, eg, use of umbilical artery Doppler and corticosteroids for delivery <34 weeks, there is a high degree of consistency between national small-for-gestational-age guidelines. This review discusses areas where there is potential for convergence between small-for-gestational-age guidelines based on existing randomized controlled trials of management of small-for-gestational-age pregnancies, and areas of controversy. Research priorities include assessing the utility of late third-trimester scanning to prevent major morbidity and mortality and to investigate the optimum timing of delivery in fetuses with late-onset fetal growth restriction and abnormal Doppler parameters. Prospective studies are needed to compare new international population ultrasound standards with those in current use.
Collapse
|
91
|
Bellido-González M, Díaz-López MÁ, López-Criado S, Maldonado-Lozano J. Cognitive Functioning and Academic Achievement in Children Aged 6-8 Years, Born at Term After Intrauterine Growth Restriction and Fetal Cerebral Redistribution. J Pediatr Psychol 2017; 42:345-354. [PMID: 27342302 DOI: 10.1093/jpepsy/jsw060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 06/03/2016] [Indexed: 11/14/2022] Open
Abstract
Objective To determine whether cerebroplacental ratio, an indicator of fetal cerebral redistribution (FCR), predicts adverse results for neurodevelopment in intrauterine growth restriction (IUGR) infants. Methods In a cohort of 5,702 infants, 64 were IUGR born at term with FCR. Five were excluded. Of the remainder, 32 presented an abnormal cerebroplacental ratio (IUGR-A) and 27 a normal one (IUGR-B). The controls were 61 appropriate-for-gestational-age children. Cognitive and academic outcomes and the odds ratio of lower academic scores were assessed by multivariate analysis of covariance and logistic regression. Results IUGR-A children presented deficits in cognitive functioning and academic achievement in all domains. IUGR-B children presented slight deficits. Suboptimal cognitive functioning in IUGR-A was more marked in working memory. Abnormal cerebroplacental ratio predicted low academic scores in IUGR-A. Conclusions FCR is a risk factor for IUGR infants, and cerebroplacental ratio identifies those most severely affected. Intervention programs may produce benefits in early-middle childhood.
Collapse
|
92
|
Kehl S, Dötsch J, Hecher K, Schlembach D, Schmitz D, Stepan H, Gembruch U. Intrauterine Growth Restriction. Guideline of the German Society of Gynecology and Obstetrics (S2k-Level, AWMF Registry No. 015/080, October 2016). Geburtshilfe Frauenheilkd 2017; 77:1157-1173. [PMID: 29375144 PMCID: PMC5784232 DOI: 10.1055/s-0043-118908] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 08/19/2017] [Accepted: 08/25/2017] [Indexed: 12/12/2022] Open
Abstract
AIMS The aim of this official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG) was to provide consensus-based recommendations obtained by evaluating the relevant literature for the diagnostic treatment and management of women with fetal growth restriction. METHODS This S2k guideline represents the structured consensus of a representative panel of experts with a range of different professional backgrounds commissioned by the Guideline Committee of the DGGG. RECOMMENDATIONS Recommendations for diagnostic treatment, management, counselling, prophylaxis and screening are presented.
Collapse
Affiliation(s)
- Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jörg Dötsch
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Köln, Köln, Germany
| | - Kurt Hecher
- Klinik für Geburtshilfe und Pränatalmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Dagmar Schmitz
- Institut für Geschichte, Theorie und Ethik der Medizin, Uniklinik RWTH Aachen, Aachen, Germany
| | - Holger Stepan
- Abteilung für Geburtsmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Ulrich Gembruch
- Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn, Bonn, Germany
| |
Collapse
|
93
|
Uquillas KR, Grubbs BH, Prosper AE, Chmait RH, Grant EG, Walker DK. Doppler US in the Evaluation of Fetal Growth and Perinatal Health. Radiographics 2017; 37:1831-1838. [DOI: 10.1148/rg.2017170020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Kristen R. Uquillas
- From the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine (K.R.U., B.H.G., R.H.C.), and Department of Radiology (A.E.P., E.G.G., D.K.W.), Keck School of Medicine, University of Southern California, 2020 Zonal Ave, IRD 203, Los Angeles, CA 90033
| | - Brendan H. Grubbs
- From the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine (K.R.U., B.H.G., R.H.C.), and Department of Radiology (A.E.P., E.G.G., D.K.W.), Keck School of Medicine, University of Southern California, 2020 Zonal Ave, IRD 203, Los Angeles, CA 90033
| | - Ashley E. Prosper
- From the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine (K.R.U., B.H.G., R.H.C.), and Department of Radiology (A.E.P., E.G.G., D.K.W.), Keck School of Medicine, University of Southern California, 2020 Zonal Ave, IRD 203, Los Angeles, CA 90033
| | - Ramen H. Chmait
- From the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine (K.R.U., B.H.G., R.H.C.), and Department of Radiology (A.E.P., E.G.G., D.K.W.), Keck School of Medicine, University of Southern California, 2020 Zonal Ave, IRD 203, Los Angeles, CA 90033
| | - Edward G. Grant
- From the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine (K.R.U., B.H.G., R.H.C.), and Department of Radiology (A.E.P., E.G.G., D.K.W.), Keck School of Medicine, University of Southern California, 2020 Zonal Ave, IRD 203, Los Angeles, CA 90033
| | - Daphne K. Walker
- From the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine (K.R.U., B.H.G., R.H.C.), and Department of Radiology (A.E.P., E.G.G., D.K.W.), Keck School of Medicine, University of Southern California, 2020 Zonal Ave, IRD 203, Los Angeles, CA 90033
| |
Collapse
|
94
|
Quality measures in high-risk pregnancies: Executive Summary of a Cooperative Workshop of the Society for Maternal-Fetal Medicine, National Institute of Child Health and Human Development, and the American College of Obstetricians and Gynecologists. Am J Obstet Gynecol 2017; 217:B2-B25. [PMID: 28735702 DOI: 10.1016/j.ajog.2017.07.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/14/2017] [Indexed: 01/07/2023]
Abstract
Providers perceive current obstetric quality measures as imperfect and insufficient. Our organizations convened a "Quality Measures in High-Risk Pregnancies Workshop." The goals were to (1) review the current landscape regarding quality measures in obstetric conditions with increased risk for adverse maternal or fetal outcomes, (2) evaluate the available evidence for management of common obstetric conditions to identify those that may drive the highest impact on outcomes, quality, and value, (3) propose measures for high-risk obstetric conditions that reflect enhanced quality and efficiency, and (4) identify current research gaps, improve methods of data collection, and recommend means of change.
Collapse
|
95
|
Hernandez-Andrade E, Maymon E, Erez O, Saker H, Luewan S, Garcia M, Ahn H, Tarca AL, Done B, Korzeniewski SJ, Hassan SS, Romero R. A Low Cerebroplacental Ratio at 20-24 Weeks of Gestation Can Predict Reduced Fetal Size Later in Pregnancy or at Birth. Fetal Diagn Ther 2017; 44:112-123. [PMID: 28926826 DOI: 10.1159/000479684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 07/19/2017] [Indexed: 02/04/2023]
Abstract
AIM To determine whether Doppler evaluation at 20-24 weeks of gestation can predict reduced fetal size later in pregnancy or at birth. METHODS Fetal biometry and Doppler velocimetry were performed in 2,986 women with a singleton pregnancy at 20-24 weeks of gestation. Predictive performances of the umbilical artery pulsatility index (UA-PI) or the mean uterine artery pulsatility index (UtA-PI) >95th percentile, middle cerebral artery pulsatility index, or cerebroplacental ratio (CPR) <5th percentile for early small for gestational age (SGA; <34 weeks of gestation), late SGA (≥34 weeks of gestation), or SGA at birth (birthweight <10th percentile) were analyzed. RESULTS The prevalence of early SGA, late SGA, and SGA at birth was 1.1, 9.6, and 14.7%, respectively. A CPR <5th percentile had a positive likelihood ratio (LR+) of 8.2 (95% confidence interval [CI] 5.7-12.0) for early SGA, a LR+ of 1.6 (95% CI 1.1-1.2) for late SGA, and a LR+ of 1.9 (95% CI 1.4-2.6) for SGA at birth. A UtA-PI >95th percentile was associated with late SGA and SGA at birth, while an UA-PI >95th percentile was associated with early SGA. Associations were higher in fetuses with an estimated fetal weight <10th percentile. CONCLUSION Fetal biometry and Doppler evaluation at 20-24 weeks of gestation can predict early and late SGA as well as SGA at birth.
Collapse
|
96
|
Aditya I, Tat V, Sawana A, Mohamed A, Tuffner R, Mondal T. Use of Doppler velocimetry in diagnosis and prognosis of intrauterine growth restriction (IUGR): A Review. J Neonatal Perinatal Med 2017; 9:117-26. [PMID: 27197939 DOI: 10.3233/npm-16915132] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intrauterine growth restriction (IUGR) is a condition which has been difficult to assess at an early stage, resulting in the delivery of children who have poor genetic growth potential. Currently, IUGR classification is based upon the system of ultrasound biometry. Doppler velocimetry allows the measurement of hemodynamic flow of major fetal vessels, comparing the flow indices and patterns of normal and IUGR cases. In this review, the effectiveness of Doppler velocimetry in assessing blood flow in major vessels including the umbilical artery, ductus venosus, and middle cerebral artery was studied for both diagnostic and prognostic screening of IUGR. The umbilical artery is the most frequently studied vessel in Doppler velocimetry due to its accessibility and the strength of its associations with fetal outcomes. Abnormalities in the ductus venosus waveform can be indicative of increased resistance in the right atrium due to placental abnormalities. The middle cerebral artery is the most studied fetal cerebral artery and can detect cerebral blood flow and direction, which is why these three vessels were selected to be examined in this context. A potential mathematical model could be developed to incorporate these Doppler measurements which are indicative of IUGR, in order to reduce perinatal mortality. The purpose of the proposed algorithm is to integrate Doppler velocimetry with biophysical profiling in order to determine the optimal timing of delivery, thus reducing the risks of adverse perinatal outcomes.
Collapse
|
97
|
Miranda J, Triunfo S, Rodriguez-Lopez M, Sairanen M, Kouru H, Parra-Saavedra M, Crovetto F, Figueras F, Crispi F, Gratacós E. Performance of third-trimester combined screening model for prediction of adverse perinatal outcome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:353-360. [PMID: 27706856 DOI: 10.1002/uog.17317] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/07/2016] [Accepted: 09/21/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To explore the potential value of third-trimester combined screening for the prediction of adverse perinatal outcome (APO) in the general population and among small-for-gestational-age (SGA) fetuses. METHODS This was a nested case-control study within a prospective cohort of 1590 singleton gestations undergoing third-trimester evaluation (32 + 0 to 36 + 6 weeks' gestation). Maternal baseline characteristics, mean arterial blood pressure, fetoplacental ultrasound and circulating biochemical markers (placental growth factor (PlGF), lipocalin-2, unconjugated estriol and inhibin A) were assessed in all women who subsequently had an APO (n = 148) and in a control group without perinatal complications (n = 902). APO was defined as the occurrence of stillbirth, umbilical artery cord blood pH < 7.15, 5-min Apgar score < 7 or emergency operative delivery for fetal distress. Logistic regression models were developed for the prediction of APO in the general population and among SGA cases (defined as customized birth weight < 10th centile). RESULTS The prevalence of APO was 9.3% in the general population and 27.4% among SGA cases. In the general population, a combined screening model including a-priori risk (maternal characteristics), estimated fetal weight (EFW) centile, umbilical artery pulsatility index (UA-PI), estriol and PlGF achieved a detection rate for APO of 26% (area under receiver-operating characteristics curve (AUC), 0.59 (95% CI, 0.54-0.65)), at a 10% false-positive rate (FPR). Among SGA cases, a model including a-priori risk, EFW centile, UA-PI, cerebroplacental ratio, estriol and PlGF predicted 62% of APO (AUC, 0.86 (95% CI, 0.80-0.92)) at a FPR of 10%. CONCLUSIONS The use of fetal ultrasound and maternal biochemical markers at 32-36 weeks provides a poor prediction of APO in the general population. Although it remains limited, the performance of the screening model is improved when applied to fetuses with suboptimal fetal growth. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- J Miranda
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - S Triunfo
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - M Rodriguez-Lopez
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | | | - H Kouru
- PerkinElmer, Inc., Turku, Finland
| | - M Parra-Saavedra
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
- Maternal-Fetal Unit, CEDIFETAL, Centro de Diagnostico de Ultrasonido e Imágenes, CEDIUL, Barranquilla, Colombia
| | - F Crovetto
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Figueras
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Crispi
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - E Gratacós
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, IDIBAPS, University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| |
Collapse
|
98
|
Chauhan SP, Rice MM, Grobman WA, Bailit J, Reddy UM, Wapner RJ, Varner MW, Thorp JM, Leveno KJ, Caritis SN, Prasad M, Tita ATN, Saade G, Sorokin Y, Rouse DJ, Tolosa JE. Neonatal Morbidity of Small- and Large-for-Gestational-Age Neonates Born at Term in Uncomplicated Pregnancies. Obstet Gynecol 2017; 130:511-519. [PMID: 28796674 PMCID: PMC5578445 DOI: 10.1097/aog.0000000000002199] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare morbidity among small-for-gestational-age (SGA; birth weight less than the 10th percentile for gestational age), appropriate-for-gestational-age (AGA; birth weight 10th to 90th percentile; reference group), and large-for-gestational-age (LGA; birth weight greater than the 90th percentile) neonates in apparently uncomplicated pregnancies at term (37 weeks of gestation or greater). METHODS This secondary analysis, derived from an observational obstetric cohort of 115,502 deliveries, included women with apparently uncomplicated pregnancies of nonanomalous singletons who had confirmatory ultrasound dating no later than the second trimester and who delivered between 37 0/7 and 42 6/7 weeks of gestation. We used two different composite neonatal morbidity outcomes: hypoxic composite neonatal morbidity for SGA and traumatic composite neonatal morbidity for LGA neonates. Log Poisson relative risks (RRs) with 95% CIs adjusted for potential confounding factors (nulliparity, body mass index, insurance status, and neonatal sex) were calculated. RESULTS Among the 63,436 women who met our inclusion criteria, SGA occurred in 7.9% (n=4,983) and LGA in 8.3% (n=5,253). Hypoxic composite neonatal morbidity was significantly higher in SGA (1.1%) compared with AGA (0.7%; adjusted RR 1.44, 95% CI 1.07-1.93) but similar between LGA (0.6%) and AGA (adjusted RR 0.84, 95% CI 0.58-1.22). Traumatic composite neonatal morbidity was significantly higher in LGA (1.9%) than AGA (1.0%; adjusted RR 1.88, 95% CI 1.51-2.34) but similar in SGA (1.3%) compared with AGA (adjusted RR 1.28, 95% CI 0.98-1.67). CONCLUSION Among women with uncomplicated pregnancies, hypoxic composite neonatal morbidity is more common with SGA neonates and traumatic-composite neonatal morbidity is more common with LGA neonates.
Collapse
Affiliation(s)
- Suneet P Chauhan
- Departments of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, McGovern Medical School-Children's Memorial Hermann Hospital, Houston, Texas, Northwestern University, Chicago, Illinois, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio, Columbia University, New York, New York, the University of Utah Health Sciences Center, Salt Lake City, Utah, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, the University of Texas Southwestern Medical Center, Dallas, Texas, the University of Pittsburgh, Pittsburgh, Pennsylvania, The Ohio State University, Columbus, Ohio, the University of Alabama at Birmingham, Birmingham, Alabama, the University of Texas Medical Branch, Galveston, Texas, Wayne State University, Detroit, Michigan, Brown University, Providence, Rhode Island, and Oregon Health & Science University, Portland, Oregon; the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
99
|
Yamasato K, Zalud I. Three dimensional power Doppler of the placenta and its clinical applications. J Perinat Med 2017; 45:693-700. [PMID: 28306539 DOI: 10.1515/jpm-2016-0366] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 02/09/2017] [Indexed: 11/15/2022]
Abstract
The aim of this review is to discuss three dimensional (3D) power Doppler of the placenta and its clinical applications. There is a strong clinical need to develop noninvasive, simple and widely available methods of evaluating in vivo placental function to assess fetal wellbeing. While conventional ultrasound is a proven tool in the evaluation of fetal structural anomalies and health, its ability to assess placental function, especially prior to the onset of fetal compromise, is the subject of ongoing investigation. Three dimensional power Doppler has the ability to detect vascularity and blood flow with greater detail than conventional ultrasound, which has led to its investigation in preeclampsia, fetal growth restriction, and other placental vascular abnormalities. While more data are needed on the optimal imaging protocol and its predictive ability for clinical outcomes, 3D power Doppler is emerging as a promising new technology that will improve the evaluation of placental function.
Collapse
|
100
|
The clinical significance of an estimated fetal weight below the 10th percentile: a comparison of outcomes of <5th vs 5th-9th percentile. Am J Obstet Gynecol 2017; 217:198.e1-198.e11. [PMID: 28433732 DOI: 10.1016/j.ajog.2017.04.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 04/08/2017] [Accepted: 04/11/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND The association between small-for-gestational-age (birthweight <10th percentile for gestational age) and neonatal morbidity is well established. Yet, there is a paucity of data on the relationship between suspected small for gestational age (sonographic-estimated fetal weight <10th percentile) at 2 thresholds and subsequent neonatal morbidity. OBJECTIVE The objective of this study was to determine the relationship between sonographic-estimated fetal weight <5th percentile vs 5-9th percentile and neonatal morbidity. STUDY DESIGN This retrospective study involved 5 centers and included nonanomalous, singletons with sonographic-estimated fetal weight <10th percentile for gestational age who delivered from 2009-2012. Composite neonatal morbidity included respiratory distress syndrome, proven sepsis, intraventricular hemorrhage grade III or IV, necrotizing enterocolitis, thrombocytopenia, seizures, or death. Odd ratios were adjusted for center, maternal age, race, body mass index at first visit, smoking status, use of alcohol, use of drugs, and neonatal gender. RESULTS Of 834 women with suspected small-for-gestational-age fetuses, 513 (62%) had sonographic-estimated fetal weight <5th percentile, and 321 (38%) had sonographic-estimated fetal weight of 5-9th percentile for gestational age. At delivery, 81% of women with a suspected small-for-gestational-age fetus had a confirmed small-for-gestational-age fetus. In the group with a sonographic-estimated fetal weight <5th percentile, 59% of neonates had birthweight <5th percentile; in the group with a sonographic-estimated fetal weight 5-9th percentile, 41% had birthweight <5th percentile, and 36% had birthweight at 5-9th percentile. Neonatal intensive care unit admission differed significantly for those fetuses at <5th percentile (29%) compared with those fetuses at 5-9th percentile (15%; P<.001). The composite neonatal morbidity among the sonographic-estimated fetal weight <5th percentile group was higher than the sonographic-estimated fetal weight of 5-9th percentile group (31% vs 13%; adjusted odds ratio, 2.41; 95% confidence interval, 1.53-3.80). Similar findings were noted when the analysis was limited to sonographic-estimated fetal weight within 28 days of delivery (adjusted odds ratio, 2.22; 95% confidence interval, 1.34-3.67). CONCLUSION Eight of 10 suspected small-for-gestational-age fetuses had birthweight <10th percentile for gestational age; the prediction of actual birthweight was more accurate in the <5th percentile group. Neonates with sonographic-estimated fetal weight of <5th percentile were more likely to be admitted to the neonatal intensive care unit and have complications than were those neonates with sonographic-estimated fetal weight of 5-9th percentile.
Collapse
|