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Guo L, Wu T, Lu S, Wei Y, Cui L. Evaluation of fetal cerebral microvascular status and its relationship with fetal growth and development using microvascular imaging technique. Eur J Obstet Gynecol Reprod Biol 2024; 300:246-252. [PMID: 39043081 DOI: 10.1016/j.ejogrb.2024.06.041] [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: 02/19/2024] [Revised: 06/19/2024] [Accepted: 06/27/2024] [Indexed: 07/25/2024]
Abstract
The study conducted retrospective analysis design, aiming to explore the use of Microvascular Imaging Technique (MVFI) to assess fetal cerebral microcirculation and analyze the relationship between Microvascular Index (MVI) and fetal growth and development. 100 pregnant women who met the criteria for fetal growth restriction (FGR) provided in the Expert Consensus on Fetal Growth Restriction (2019 Edition) and underwent routine prenatal examinations at the Obstetrics and Gynecology Department of Peking University Third Hospital from January 2021 to June 2023 were selected as the study subjects. A normal fetus with a fetal weight less than 10 % can be classified as FGR, Pregnant women with fetal umbilical artery (UA) systolic and diastolic (S/D) values ≥3 were included in the observation group, while 200 pregnant women with normal fetuses were selected as the control group during the same period. The fetuses' change in both groups were measured using color Doppler ultrasound, including bi-parietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL). The cerebral microcirculation of the fetuses in both groups was evaluated using MVFI, and the MVI values were compared. The clinical characteristics of FGR fetuses with umbilical artery S/D ratio ≥ 3 were summarized, and the correlation between fetal cerebral microvascular status and fetal growth and development was analyzed using Pearson correlation analysis. The outcomes told that the BPD, HC, AC, and FL values of the fetuses in the control group were lower the other's value (P < 0.05), and the MVI and peak systolic velocity of the middle cerebral artery (MCA-PSV) values were also lower in the control group (P < 0.05). Pearson correlation analysis revealed a positive correlation between fetal growth and development and MVI and MCA-PSV values in FGR fetuses. In conclusion, MVFI can monitor and quantitatively analyze fetal intracranial microcirculation, visualize slow blood flow in microvascular structures, and this study provides preliminary evidence of the close relationship between fetal cerebral microcirculation and intrauterine growth and development.
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Affiliation(s)
- Lijuan Guo
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - Tianchen Wu
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - Shan Lu
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - Yuan Wei
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.
| | - Ligang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China.
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Abdelnaby EA, Emam IA, El-Sherbiny HR, Fadl AM. The effects of aging and gestational month on uteroplacental vascular perfusion, and umbilical artery hemodynamics in pregnant jennies. BMC Vet Res 2022; 18:404. [PMID: 36380376 PMCID: PMC9664605 DOI: 10.1186/s12917-022-03499-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to correlate the pulsed wave spectral indices of the middle uterine artery at both sides with placental development in jenny within mid-late pregnancies, and establish umbilical Doppler values for different ages and different gestational months. Twenty Equus Asinus pregnant jennies 260-450 kg (average, 320 ± 10 kg) were examined from 5 to 9 months of pregnancy with different ages (4-14 years). Monthly B-mode ultrasound examination was performed on both the combined thickness of the uterus and placenta (CTUP; mm) and umbilical artery cross-sectional diameter, and Doppler mode examination was performed on both the middle uterine (MUA at right [R] and left [L] sides) and umbilical arteries to measure both Doppler indices that expressed by resistance (RI) and pulsatility indices (PI), and blood flow rate. CTUP was elevated within pregnancy time at different ages (P < 0.05). L. PI was significantly declined throughout different ages (P < 0.05), but this declining trend was not observed in L. RI. The L. blood flow rate (R; bpm) was elevated among different ages and different months (P < 0.05). Both RI and PI were significantly decreased from 5 to 9 month of gestation period in jennies (P < 0.05).. The umbilical arteries cross-sectional diameter (Umb A; mm), was elevated among different ages and different months, while both Doppler indices were declined. A positive correlation was found (between both Doppler indices of both umbilical and uterine arteries P < 0.001). There was elevated vascular perfusion in uterine and umbilical arteries associated with reduced both Doppler indices along the course of pregnancy at different ages.
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Affiliation(s)
- Elshymaa A Abdelnaby
- Theriogenology Department, Faculty of Veterinary Medicine, Cairo University, Giza Square, Giza, 12211, Egypt.
| | - Ibrahim A Emam
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Hossam R El-Sherbiny
- Theriogenology Department, Faculty of Veterinary Medicine, Cairo University, Giza Square, Giza, 12211, Egypt
| | - Aya M Fadl
- Theriogenology Department, Faculty of Veterinary Medicine, Cairo University, Giza Square, Giza, 12211, Egypt
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3
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Ali S, Kawooya MG, Byamugisha J, Kakibogo IM, Biira EA, Kagimu AN, Grobbee DE, Zakus D, Papageorghiou AT, Klipstein-Grobusch K, Rijken MJ. Middle cerebral arterial flow redistribution is an indicator for intrauterine fetal compromise in late pregnancy in low-resource settings: A prospective cohort study. BJOG 2022; 129:1712-1720. [PMID: 35118790 PMCID: PMC9545180 DOI: 10.1111/1471-0528.17115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/13/2022] [Accepted: 02/01/2022] [Indexed: 11/27/2022]
Abstract
Objective We aimed to determine the prevalence of abnormal umbilical artery (UA), uterine artery (UtA), middle cerebral artery (MCA) and cerebroplacental ratio (CPR) Doppler, and their relationship with adverse perinatal outcomes in women undergoing routine antenatal care in the third trimester. Design Prospective cohort. Setting Kagadi Hospital, Uganda. Population Non‐anomalous singleton pregnancies. Methods Women underwent an early dating ultrasound and a third‐trimester Doppler scan between 32 and 40 weeks of gestation, from 2018 to 2020. We handled missing data using multiple imputation and analysed the data using descriptive methods and a binary logistic regression model. Main outcome measures Composite adverse perinatal outcome (CAPO), perinatal death and stillbirth. Results We included 995 women. The mean gestational age at Doppler scan was 36.9 weeks (SD 1.02 weeks) and 88.9% of the women gave birth in a health facility. About 4.4% and 5.6% of the UA pulsatility index (PI) and UtA PI were above the 95th percentile, whereas 16.4% and 10.4% of the MCA PI and CPR were below the fifth percentile, respectively. Low CPR was strongly associated with stillbirth (OR 4.82, 95% CI 1.09–21.30). CPR and MCA PI below the fifth percentile were independently associated with CAPO; the association with MCA PI was stronger in small‐for‐gestational‐age neonates (OR 3.75, 95% CI 1.18–11.88). Conclusion In late gestation, abnormal UA PI was rare. Fetuses with cerebral blood flow redistribution were at increased risk of stillbirth and perinatal complications. Further studies examining the predictive accuracy and effectiveness of antenatal Doppler ultrasound screening in reducing the risk of perinatal deaths in low‐ and middle‐income countries are warranted. Tweetable abstract Blood flow redistribution to the fetal brain is strongly associated with stillbirths in low‐resource settings. Blood flow redistribution to the fetal brain is strongly associated with stillbirths in low‐resource settings. This article includes Author Insights, a video abstract available at https://vimeo.com/bjogabstracts/authorinsights17115.
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Affiliation(s)
- Sam Ali
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Michael G Kawooya
- Ernest Cook Ultrasound Research and Education Institute (ECUREI), Mengo Hospital, Kampala, Uganda
| | - Josaphat Byamugisha
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Isaac M Kakibogo
- Antenatal and Maternity Unit, Kagadi Hospital, Kagadi District, Uganda
| | | | - Adia N Kagimu
- Ernest Cook Ultrasound Research and Education Institute (ECUREI), Mengo Hospital, Kampala, Uganda
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - David Zakus
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aris T Papageorghiou
- Nuffield Department of Women's and Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marcus J Rijken
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Moraitis AA, Bainton T, Sovio U, Brocklehurst P, Heazell AE, Thornton JG, Robson SC, Papageorghiou A, Smith GC. Fetal umbilical artery Doppler as a tool for universal third trimester screening: A systematic review and meta-analysis of diagnostic test accuracy. Placenta 2021; 108:47-54. [PMID: 33819861 DOI: 10.1016/j.placenta.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/11/2021] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
The objective of this study was to investigate the accuracy of universal third trimester umbilical artery (UA) Doppler to predict adverse pregnancy outcome at term. We searched Medline, EMBASE, the Cochrane library and ClinicalTrials.gov from inception to October 2020 and we also analyzed previously unpublished data from a prospective cohort study of nulliparous women, the Pregnancy Outcome Prediction (POP) study. We included studies that performed a third-trimester ultrasound scan in unselected, low or mixed risk populations, excluding studies which only included high risk pregnancies. Meta-analysis was performed using the hierarchal summary receiver operating characteristic curve (HSROC) analysis and bivariate logit-normal models. We identified 13 studies (including the POP study) involving 67,764 pregnancies which met our inclusion criteria. The overall quality was variable and only six studies (N = 5777 patients) blinded clinicians to the UA Doppler result. The summary sensitivity and positive likelihood ratio (LR) for small for gestational age (SGA; birthweight <10th centile) were 21.7% (95% CI 13.2-33.6%) and 2.65 (95% CI 1.89-3.72) respectively. The summary positive LR for NICU admission and metabolic acidosis were 1.35 (95% CI 0.93-1.97) and 1.34 (95% CI 0.86-2.08) respectively. The results were similar in the POP study: associations with SGA (positive LR 2.66 [95% CI 2.11-3.36]) and severe SGA (birthweight <3rd centile; positive LR 3.27 [95% CI 2.29-4.68]) but no statistically significant association with neonatal morbidity. We conclude that third trimester UA Doppler has moderate predictive accuracy for small for gestational age but not for indicators of neonatal morbidity in unselected and low risk pregnancies.
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Affiliation(s)
- Alexandros A Moraitis
- Department of Obstetrics and Gynaecology, University of Cambridge; NIHR Cambridge Comprehensive Biomedical Research Centre, CB2 2SW, United Kingdom
| | - Thomas Bainton
- Department of Obstetrics and Gynaecology, University of Cambridge; NIHR Cambridge Comprehensive Biomedical Research Centre, CB2 2SW, United Kingdom
| | - Ulla Sovio
- Department of Obstetrics and Gynaecology, University of Cambridge; NIHR Cambridge Comprehensive Biomedical Research Centre, CB2 2SW, United Kingdom
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Alexander Ep Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biological, Medical and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9WL, United Kingdom; St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, United Kingdom
| | - Jim G Thornton
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Stephen C Robson
- Reproductive and Vascular Biology Group, The Medical School, University of Newcastle, Newcastle, United Kingdom
| | - Aris Papageorghiou
- Nuffield Department of Obstetrics and Gynaecology, Oxford, United Kingdom
| | - Gordon Cs Smith
- Department of Obstetrics and Gynaecology, University of Cambridge; NIHR Cambridge Comprehensive Biomedical Research Centre, CB2 2SW, United Kingdom.
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Smith GC, Moraitis AA, Wastlund D, Thornton JG, Papageorghiou A, Sanders J, Heazell AE, Robson SC, Sovio U, Brocklehurst P, Wilson EC. Universal late pregnancy ultrasound screening to predict adverse outcomes in nulliparous women: a systematic review and cost-effectiveness analysis. Health Technol Assess 2021; 25:1-190. [PMID: 33656977 PMCID: PMC7958245 DOI: 10.3310/hta25150] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Currently, pregnant women are screened using ultrasound to perform gestational aging, typically at around 12 weeks' gestation, and around the middle of pregnancy. Ultrasound scans thereafter are performed for clinical indications only. OBJECTIVES We sought to assess the case for offering universal late pregnancy ultrasound to all nulliparous women in the UK. The main questions addressed were the diagnostic effectiveness of universal late pregnancy ultrasound to predict adverse outcomes and the cost-effectiveness of either implementing universal ultrasound or conducting further research in this area. DESIGN We performed diagnostic test accuracy reviews of five ultrasonic measurements in late pregnancy. We conducted cost-effectiveness and value-of-information analyses of screening for fetal presentation, screening for small for gestational age fetuses and screening for large for gestational age fetuses. Finally, we conducted a survey and a focus group to determine the willingness of women to participate in a future randomised controlled trial. DATA SOURCES We searched MEDLINE, EMBASE and the Cochrane Library from inception to June 2019. REVIEW METHODS The protocol for the review was designed a priori and registered. Eligible studies were identified using keywords, with no restrictions for language or location. The risk of bias in studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Health economic modelling employed a decision tree analysed via Monte Carlo simulation. Health outcomes were from the fetal perspective and presented as quality-adjusted life-years. Costs were from the perspective of the public sector, defined as NHS England, and the costs of special educational needs. All costs and quality-adjusted life-years were discounted by 3.5% per annum and the reference case time horizon was 20 years. RESULTS Umbilical artery Doppler flow velocimetry, cerebroplacental ratio, severe oligohydramnios and borderline oligohydramnios were all either non-predictive or weakly predictive of the risk of neonatal morbidity (summary positive likelihood ratios between 1 and 2) and were all weakly predictive of the risk of delivering a small for gestational age infant (summary positive likelihood ratios between 2 and 4). Suspicion of fetal macrosomia is strongly predictive of the risk of delivering a large infant, but it is only weakly, albeit statistically significantly, predictive of the risk of shoulder dystocia. Very few studies blinded the result of the ultrasound scan and most studies were rated as being at a high risk of bias as a result of treatment paradox, ascertainment bias or iatrogenic harm. Health economic analysis indicated that universal ultrasound for fetal presentation only may be both clinically and economically justified on the basis of existing evidence. Universal ultrasound including fetal biometry was of borderline cost-effectiveness and was sensitive to assumptions. Value-of-information analysis indicated that the parameter that had the largest impact on decision uncertainty was the net difference in cost between an induced delivery and expectant management. LIMITATIONS The primary literature on the diagnostic effectiveness of ultrasound in late pregnancy is weak. Value-of-information analysis may have underestimated the uncertainty in the literature as it was focused on the internal validity of parameters, which is quantified, whereas the greatest uncertainty may be in the external validity to the research question, which is unquantified. CONCLUSIONS Universal screening for presentation at term may be justified on the basis of current knowledge. The current literature does not support universal ultrasonic screening for fetal growth disorders. FUTURE WORK We describe proof-of-principle randomised controlled trials that could better inform the case for screening using ultrasound in late pregnancy. STUDY REGISTRATION This study is registered as PROSPERO CRD42017064093. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gordon Cs Smith
- Department of Obstetrics and Gynaecology, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Alexandros A Moraitis
- Department of Obstetrics and Gynaecology, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - David Wastlund
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jim G Thornton
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Aris Papageorghiou
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
| | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Alexander Ep Heazell
- Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Stephen C Robson
- Reproductive and Vascular Biology Group, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Ulla Sovio
- Department of Obstetrics and Gynaecology, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Edward Cf Wilson
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
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Al Hamayel NA, Baghlaf H, Blakemore K, Crino JP, Burd I. Significance of abnormal umbilical artery Doppler studies in normally grown fetuses. Matern Health Neonatol Perinatol 2020; 6:1. [PMID: 32110420 PMCID: PMC7033920 DOI: 10.1186/s40748-020-0115-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective To determine whether there is a relationship between abnormal umbilical artery Doppler studies (UADS) and small for gestational age (SGA) birth weight and other adverse perinatal outcomes in fetuses that appear normally grown by ultrasound. Methods This was a retrospective study of all women who had UADS performed at or after 26 weeks of gestation at our institution between January 2005 and December 2012. Women were excluded if they had a fetal demise, a fetus with growth restriction, a fetus with congenital anomaly, or a multiple gestation. Women with missing delivery outcomes were excluded. The primary outcome was birth weight below the 10th percentile. Results There were 2744 women included in the study. Of those, 98 (3.6%) had an abnormal UADS, and 379 (13.8%) had an SGA neonate. Of the 2646 women who had a normal UADS, 353 (13.3%) women had an SGA neonate. Twenty-six (26.5%) of the 98 women who had an abnormal UADS had an SGA neonate. After adjusting for potential confounders, the adjusted odds ratio for an SGA neonate with an abnormal UADS was 2.2 (95% CI, 1.38-3.58; p < 0.05). In examining other adverse perinatal outcomes, neonatal intensive care unit (NICU) admission and low 5-min Apgar scores were 12.4 and 2.3%, respectively. The adjusted odds ratio for NICU admission was 1.84 (95% CI, 1.06-3.21; p < 0.05). Abnormal UADS was not associated with low Apgar scores (aOR 1.39: 95% CI 0.47-4.07; p > 0.05). Conclusions Our data suggest that abnormal UADS in fetuses that appear normally grown by ultrasound are associated with SGA neonates and NICU admission.
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Affiliation(s)
- Nebras Abu Al Hamayel
- Department of Gynecology and Obstetrics, Johns Hopkins University, School of Medicine, 600 N Wolfe St, Phipps 228, Baltimore, MD 21287 USA
| | - Haitham Baghlaf
- Department of Gynecology and Obstetrics, Johns Hopkins University, School of Medicine, 600 N Wolfe St, Phipps 228, Baltimore, MD 21287 USA
| | - Karin Blakemore
- Department of Gynecology and Obstetrics, Johns Hopkins University, School of Medicine, 600 N Wolfe St, Phipps 228, Baltimore, MD 21287 USA
| | - Jude P Crino
- Department of Gynecology and Obstetrics, Johns Hopkins University, School of Medicine, 600 N Wolfe St, Phipps 228, Baltimore, MD 21287 USA
| | - Irina Burd
- Department of Gynecology and Obstetrics, Johns Hopkins University, School of Medicine, 600 N Wolfe St, Phipps 228, Baltimore, MD 21287 USA
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Chandra I, Sun L. Preterm and term preeclampsia: differences in biochemical parameter and pregnancy outcomes. Postgrad Med 2018; 130:703-707. [PMID: 30246594 DOI: 10.1080/00325481.2018.1527169] [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] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To analyze the similarities and differences in the clinical parameters, laboratory biomarkers, and pregnancy outcomes between preterm and term preeclampsia (PE). METHODS Data on 185 women diagnosed with PE were collected from a Jiangsu Province Hospital from January 2017 to December 2017 and analyzed. 74 (40%) patients were diagnosed with preterm PE, of which 70 (94.6%) patients with PE with severe features (PEs) and the rest with PE. 111 (60%) patients were diagnosed with term PE, of which 54 (48.6%) patients with PEs and the rest with PE. RESULTS Preterm PE group had significantly higher blood pressure than that of term PE, with mean delivery at gestational age of 34.3[Formula: see text]2.1 weeks for preterm PE and 39[Formula: see text]1.2 weeks for term PE. Preterm PE group was associated with previous cesarean section and PE history, fetal growth restriction (FGR), non-reassuring fetal status (NRFS), and fetal umbilical artery (UA) systolic velocity/diastolic velocity ratio (S/D R) abnormality, neonatal lower birth weight, lower APGAR score, and higher NICU transfer rate. 74.3% of pregnant women from preterm PE group had proteinuria of +2 to +4, whilst only 37.8% pregnant women from term PE group developed that condition. Liver and renal function, also serum Ca and K were significantly higher in preterm PE. CONCLUSION Our study found that preterm PE significantly correlated with higher incidence of PEs, neonatal morbidities, also higher liver and kidney function compared to term PE. These results may be helpful for obstetricians to make accurate quantification of risk regarding every result of antenatal check-up, and perform close follow up if any abnormalities were found on blood pressure, ultrasound, or blood tests.
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Affiliation(s)
- Ivana Chandra
- a Department of Obstetrics and Gynecology , The First Affiliated Hospital of Nanjing Medical University , Nanjing , Jiangsu , China
| | - Lizhou Sun
- a Department of Obstetrics and Gynecology , The First Affiliated Hospital of Nanjing Medical University , Nanjing , Jiangsu , China
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Leftwich HK, Stetson B, Sabol B, Leung K, Hibbard J, Wilkins I. Growth restriction: identifying fetuses at risk. J Matern Fetal Neonatal Med 2017; 31:1962-1966. [PMID: 28514879 DOI: 10.1080/14767058.2017.1332040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Examine risks of intrauterine growth restriction (IUGR) and composite perinatal outcomes with estimated fetal weights (EFW) 10-20th%, and compare outcomes using umbilical artery Doppler (UAD). MATERIALS AND METHODS Retrospective, cohort evaluating ultrasound (US) EFW 10-20th%, between 2002 and 2012. Cases were identified with EFW % 10-20. Controls, EFW >20th% were obtained for each case, matched by gestational age, and US date. Unadjusted and adjusted logistic regression was used for outcomes. RESULTS Seven hundred and sixty-seven cases met criteria with matched controls. Fetuses having EFW 10-20th% (GA 33.6 ± 3.7 weeks) had increased IUGR on follow up ultrasound (OR 26.5[10.2-68.7], p < .01), small for gestational age (SGA) (OR 9.2 [6.9-12.3], p < .01), neonatal intensive care unit (NICU) admissions (OR 2.4 [1.6-3.6], p < .01), and composite perinatal morbidity (OR 7.8 [6.0-10.1], p < .01) on adjusted analyses. Abnormal UAD in cases had greater rates of 5 min Apgar <7, NICU admission and composite morbidity (p < .05). CONCLUSIONS Pregnancies with EFW 10-20th% at the time of initial US are at increased risk for developing IUGR and being SGA at birth, with more NICU admissions and composite perinatal outcomes; abnormal UAD evaluation in cases conveyed further increase in outcomes.
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Affiliation(s)
- Heidi K Leftwich
- a Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology , University of Illinois at Chicago , Chicago , IL , USA.,b Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , University of Massachusetts , Worcester , MA , USA
| | - Bethany Stetson
- a Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology , University of Illinois at Chicago , Chicago , IL , USA.,c Department of Obstetrics and Gynecology , The Ohio State University , Worcester , MA , USA
| | - Bethany Sabol
- d Department of Obstetrics and Gynecology , Oregon Health and Science University , Portland , OR , USA
| | - Katherine Leung
- b Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , University of Massachusetts , Worcester , MA , USA
| | - Judith Hibbard
- a Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology , University of Illinois at Chicago , Chicago , IL , USA
| | - Isabelle Wilkins
- e Division of Maternal Fetal Medicine , Magee-Womens Hospital of University of Pittsburgh Medical Center , Pittsburgh , PA , USA
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Mufenda J, Gebhardt S, van Rooyen R, Theron G. Introducing a Mobile-Connected Umbilical Doppler Device (UmbiFlow™) into a Primary Care Maternity Setting: Does This Reduce Unnecessary Referrals to Specialised Care? Results of a Pilot Study in Kraaifontein, South Africa. PLoS One 2015; 10:e0142743. [PMID: 26600311 PMCID: PMC4658155 DOI: 10.1371/journal.pone.0142743] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 10/25/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES UmbiFlow™ is a mobile-connected Doppler device that utilises a continuous waveform to measure resistance in the umbilical artery. The main aim of this pilot study was to determine whether the use of UmbiFlow™ for umbilical artery Doppler in patients with a suspected decreased symphysis fundal (SF) growth could safely lead to a decreased number of patients requiring referral to a more specialised level of care. A secondary aim of the study was to evaluate the effectiveness of UmbiFlow™ Doppler as a screening tool for concealed placental insufficiency in late bookers by using a single screening cut-off value that will be abnormal for any gestation >28 weeks. METHODS The cohort comprised two groups of patients: The first group included all follow-up patients with suspected intra-uterine growth restriction (a decreased symphysis-fundus measurement based on serial assessment) who underwent on-site UmbiFlow™Doppler testing performed by the midwife directly after the clinical examination. The second group included late bookers, where gestation was uncertain; but estimated >28 weeks based on clinical grounds. This group was comprised of unselected patients who report to antenatal care late for the first time and received an UmbiFlow™Doppler test for concealed placental insufficiency. RESULTS UmbiFlow™Doppler could reduce the number of false referrals to hospital by 55%. A single UmbiFlow™Doppler test in late bookers appeared to identify a group of women at moderate risk of lower birth weight babies.
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Affiliation(s)
- Josef Mufenda
- Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Stefan Gebhardt
- Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
- * E-mail:
| | - Rita van Rooyen
- mHealth Inc., 12525 El Camino Real B, San Diego, California, 92130, United States of America
| | - Gerhard Theron
- Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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