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Bendall A, Schreiber V, Crawford K, Kumar S. Predictive utility of the fetal cerebroplacental ratio for hypoxic ischaemic encephalopathy, severe neonatal morbidity and perinatal mortality in late-preterm and term infants. Aust N Z J Obstet Gynaecol 2023; 63:491-498. [PMID: 37029609 DOI: 10.1111/ajo.13668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/17/2023] [Indexed: 04/09/2023]
Abstract
AIMS The aim of this study was to evaluate the association of a low cerebroplacental ratio (CPR) with hypoxic ischaemic encephalopathy (HIE), severe neonatal morbidity (SNM) and perinatal mortality (PNM). METHODS This was a retrospective cohort study of late-preterm and term births at Mater Mothers' Hospital, Brisbane, between 2016 and 2020. Study outcomes were HIE, PNM and SNM (a composite of severe acidosis, Apgar score less than four at 5 min, severe respiratory distress or need for significant cardiopulmonary resuscitation at birth). Univariate and multivariable logistic regressions were used to determine if a low CPR was associated with HIE, SNM or PNM. RESULTS A total of 51 870 births met the inclusion criteria. Of these, 216 (0.42%) were complicated by HIE, 10 224 (19.7%) had SNM and 251 (0.48%) had PNM. Rates of low CPR (<10th and <5th centile) were significantly higher in the SNM cohort (20.1 and 13.2%, respectively) and PNM cohort (21.1 and 15.1%, respectively) compared to the overall cohort. A low CPR was associated with significantly increased adjusted odds for SNM but not for HIE or PNM. The area under the receiver operating characteristic curve for CPR <10th centile was greatest for SNM (0.768) and lowest for HIE (0.595). Predictive margins of a low CPR for HIE, SNM and PNM were significant only for SNM at late-preterm gestations. CONCLUSIONS A low CPR is associated with increased odds of SNM in infants born >34 weeks' gestation but not for HIE or PNM.
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Affiliation(s)
- Alexa Bendall
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Veronika Schreiber
- Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
| | - Kylie Crawford
- Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
| | - Sailesh Kumar
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
- NHMRC Centre for Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
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Graupner O, Kuschel B, Axt-Fliedner R, Enzensberger C. New Markers for Placental Dysfunction at Term - Potential for More. Geburtshilfe Frauenheilkd 2022; 82:719-726. [PMID: 35815096 PMCID: PMC9262629 DOI: 10.1055/a-1761-1337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/03/2022] [Indexed: 11/23/2022] Open
Abstract
The remaining placental reserve capacity at term plays a decisive role in the perinatal morbidity of mother and child. Considering advances made in the field of fetal monitoring, the
routine examination methods currently used at term or late term may be insufficient to detect subclinical placental dysfunction (PD). The aim of this study is to offer an up-to-date,
narrative review of the literature in the context of detecting PD at term using complementary ultrasound markers and biomarkers. Parameters of fetomaternal Doppler ultrasound and fetal
cardiac function, as well as (anti-)angiogenic factors in maternal serum are potential PD markers. These may help identify patients that may benefit from an elective, early induction of
labor at term, thereby potentially reducing morbidity and mortality. However, their value in terms of the optimal date of delivery must first be determined in randomized controlled trials on
a large number of cases.
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Affiliation(s)
- Oliver Graupner
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, RWTH Aachen, Aachen.,Frauenklinik und Poliklinik, Universitätsklinikum rechts der Isar, Technische Universität München, München
| | - Bettina Kuschel
- Frauenklinik und Poliklinik, Universitätsklinikum rechts der Isar, Technische Universität München, München
| | - Roland Axt-Fliedner
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum UKGM, Justus-Liebig-Universität Gießen, Gießen
| | - Christian Enzensberger
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, RWTH Aachen, Aachen
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Larson AC, Didier R, Daszewska-Smith G, Chang J, Sridharan A, Agarwal D, Carreon CK, Sanders SP, Toba S, Partridge E. The fetal lamb model of congenital diaphragmatic hernia shows altered cerebral perfusion using contrast enhanced ultrasound. J Pediatr Surg 2022; 57:991-998. [PMID: 35346482 DOI: 10.1016/j.jpedsurg.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Neurodevelopmental impairment is common in survivors of congenital diaphragmatic hernia (CDH). Altered cerebral perfusion in utero may contribute to abnormal brain development in CDH patients. METHODS 5 fetal lambs with surgical left-CDH and 5 controls underwent transuterine cranial Doppler and contrast enhanced ultrasound (CEUS). Global and regional perfusion metrics were obtained. Biometric and perfusion data were compared between groups via nonparametric Mann Whitney U test and Spearman's rank order correlation. RESULTS No significant differences in cerebral Doppler measurements were identified between groups. By CEUS, CDH animals demonstrated significantly decreased global brain perfusion and increased transit time. With focal regions-of-interest (ROIs), there was a tendency towards decreased perfusion in the central/thalamic region in CDH but not in the peripheral brain parenchyma. Transit time was significantly increased in both ROIs in CDH, whereas flux rate was decreased in the central/thalamic region but not the peripheral brain parenchyma. Biometric CDH severity was correlated to perfusion deficit. There was no difference in cardiomyocyte histology. CONCLUSION The fetal lamb model of CDH shows altered cerebral perfusion as measured by CEUS, correlating to disease severity. This suggests a physiological abnormality in fetal cerebrovascular perfusion that may contribute to abnormal brain development and neurodevelopmental impairment in survivors.
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Affiliation(s)
- Abby C Larson
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Ryne Didier
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Gabriela Daszewska-Smith
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Jonathan Chang
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Anush Sridharan
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Divyansh Agarwal
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Chrystalle Katte Carreon
- Cardiac Registry, Departments of Cardiology, Pathology, and Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA; Department of Pathology, Harvard Medical School, Boston, MA, USA
| | - Stephen P Sanders
- Cardiac Registry, Departments of Cardiology, Pathology, and Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Shuhei Toba
- Cardiac Registry, Departments of Cardiology, Pathology, and Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA; Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Emily Partridge
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA.
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Prediction of Fetal Growth Restriction for Fetal Umbilical Arterial/Venous Blood Flow Index Evaluated by Ultrasonic Doppler under Intelligent Algorithm. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7451185. [PMID: 35633923 PMCID: PMC9135523 DOI: 10.1155/2022/7451185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/17/2022] [Accepted: 04/23/2022] [Indexed: 11/20/2022]
Abstract
The empirical wavelet transform (EWT) algorithm was applied in ultrasound to explore the predictive value for fetal growth restriction (FGR) in fetal arteriovenous indexes. 142 pregnant women who received prenatal ultrasonic examination and delivered were selected. They were classified into control group and FGR group. There were 102 patients with normal pregnancy in the control group, and 40 patients with delayed fetal growth in the FGR group. The extended triple collocation (ETC) algorithm was employed to divide the Fourier spectrum of signals adaptively, and the constructed small filter banks were classified into corresponding intervals. The instantaneous frequency was analyzed, and the arterial blood flow indexes of the two groups were compared. The results showed that the time-frequency analysis method under EWT had lower normalization error and higher accuracy. The inner diameter and cross-sectional area of FGR were remarkably smaller than those of the control group, and the differences were statistically significant (P < 0.05). There were no significant differences in mean blood flow and mean blood velocity between the control group and FGR group (P > 0.05). The arterial blood flow parameters of the systolic flow velocity (VS) and the diastolic flow velocity (VD) in the FGR group were notably lower than those in the control group, and the differences were significant (P < 0.05). In conclusion, the frequency principal component extracted by EWT algorithm was less disturbed by noise, which could accurately and effectively evaluate fetal arteriovenous blood flow indexes and predict FGR.
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Lee-Tannock A, Hay K, Gooi A, Kumar S. Global longitudinal reference ranges for fetal myocardial deformation in the second half of pregnancy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:396-404. [PMID: 32191357 DOI: 10.1002/jcu.22826] [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: 10/04/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 06/10/2023]
Abstract
PURPOSE To construct longitudinal fetal reference ranges for global longitudinal myocardial deformation (strain and strain rate) of the left and right ventricles in the second half of pregnancy. METHODS A prospective, observational, longitudinal study of 120 women with uncomplicated singleton pregnancies. The participants underwent ultrasonographic scans every 4 weeks from enrolment (18-28 weeks) until delivery. Strain and strain rate were measured at each examination using velocity vector imaging. Changes in strain and strain rate as functions of gestational age (GA) were modeled using Bayesian mixed effects models. RESULTS A total of 406 assessments of global longitudinal strain and strain rate were performed for 120 women. Global longitudinal strain and strain rate decreased with increasing GA in the left ventricle. There was, however, no change in strain measurements of the right ventricle over the same gestational time frame. Posterior predictive distributions were used to derive reference centiles for each week of GA. CONCLUSION Assessment of myocardial deformation of the fetal heart is easily performed and may be useful for quantitative assessment of heart function, particularly in fetuses at risk of cardiac dysfunction.
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Affiliation(s)
- Alison Lee-Tannock
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
- Centre for Maternal and Fetal Medicine, Mater Health Services, South Brisbane, Queensland, Australia
| | - Karen Hay
- QMIR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Alex Gooi
- Centre for Maternal and Fetal Medicine, Mater Health Services, South Brisbane, Queensland, Australia
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
- Centre for Maternal and Fetal Medicine, Mater Health Services, South Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, Herston, Queensland, Australia
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Sleep in the Supine Position during Pregnancy Is Associated with Fetal Cerebral Redistribution. J Clin Med 2020; 9:jcm9061773. [PMID: 32517385 PMCID: PMC7356729 DOI: 10.3390/jcm9061773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/28/2020] [Accepted: 06/04/2020] [Indexed: 11/23/2022] Open
Abstract
The supine sleep position in late pregnancy is a major risk factor for stillbirth, with a population attributable risk of 5.8% and one in four pregnant women reportedly sleeping in a supine position. Although the mechanisms linking the supine sleep position and late stillbirth remain unclear, there is evidence that it exacerbates pre-existing maternal sleep disordered breathing, which is another known risk factor for adverse perinatal outcomes. Given that maternal sleep position is a potentially modifiable risk factor, the aim of this study was to characterize and correlate uteroplacental and fetal hemodynamics, including cardiac function, in a cohort of women with apparently uncomplicated pregnancies with their nocturnal sleep position. This was a prospective observational cohort study at an Australian tertiary obstetric hospital. Women were asked to complete a series of questions related to their sleep position in late pregnancy after 35 weeks of completed gestation. They also underwent an ultrasound assessment where Doppler indices of various fetoplacental vessels and fetal cardiac function were measured. Regional cerebral perfusion was also assessed. Pregnancy outcome data was extracted from the electronic hospital database for analysis. A total of 274 women were included in the final analysis. Of these, 78.1% (214/274) reported no supine sleep, and 21.9% (60/274) reported going to sleep in a supine position. The middle cerebral artery, anterior cerebral artery, and vertebral artery pulsatility indices were all significantly lower in the supine sleep cohort, as was the cerebroplacental ratio. There were no significant differences in the mode or indication for delivery or in serious neonatal outcomes, including 5-min Apgar score < 7, acidosis, and neonatal intensive care unit admission between cohorts. Women in the supine cohort were more likely to have an infant with a BW > 90th centile (p = 0.04). This data demonstrates fetal brain sparing in association with the maternal supine sleep position in a low-risk population. This data contributes to the growing body of literature attempting to elucidate the etiological pathways responsible for the association of late stillbirth with the maternal supine sleep position.
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Robertson N, Okano S, Kumar S. Feto-placental Dopplers are not altered in women with obstructive sleep apnoea symptoms. Aust N Z J Obstet Gynaecol 2020; 60:877-883. [PMID: 32367552 DOI: 10.1111/ajo.13166] [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: 10/09/2019] [Accepted: 03/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Snoring, gasping or choking during sleep are common symptoms of sleep-disordered breathing and are associated with multiple adverse maternal and obstetric outcomes. The mechanisms responsible remain unknown; however, placental dysfunction is suspected. AIMS The aim of this study was to investigate feto-placental and fetal cardiac function in women with pregnancies complicated by obstructive sleep apnoea symptoms. MATERIALS AND METHODS This was a prospective observational cohort study at a large tertiary obstetric hospital in Australia. Women were asked to complete a questionnaire relating to the presence and severity of obstructive sleep apnoea symptoms. They also underwent an ultrasound scan where Doppler indices of various feto-placental vessels and fetal cardiac function were measured. Regional cerebral perfusion was also assessed. RESULTS A total of 255 women were included in the final analysis. Of these, 36.1% (92/255) of women reported no obstructive sleep apnoea symptoms; 63.9% (163/255) reported they experienced some form of obstructive sleep apnoea symptoms that included any frequency of snoring or choking/gasping, while 42.0% (107/255) complained of severe obstructive sleep apnoea symptoms (snoring ≥ 3 times a week or choking/gasping). There were no significant differences in feto-placental Dopplers or fetal cardiac function parameters in women with obstructive sleep apnoea symptoms. There were also no differences in regional cerebral blood flow between groups, or any correlation with severity of symptoms. CONCLUSIONS Our data challenge the current perspective that adverse perinatal outcomes in women with obstructive sleep apnoea symptoms are related primarily to placental dysfunction and fetal compromise.
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Affiliation(s)
- Nicole Robertson
- Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.,Mater Mothers' Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Satomi Okano
- Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.,Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.,Mater Mothers' Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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