Ductus venosus Doppler and the postnatal outcomes of growth restricted fetuses with absent end-diastolic blood flow in the umbilical arteries

The pre-eclampsia, growth restriction, and ductus venosus doppler (GRADED) study: An observational study of early-onset fetal growth restriction and pre-eclampsia

OBJECTIVE

To assess the feasibility of using ductus venosus Doppler (DVD) to time delivery in early-onset fetal growth restriction (FGR) and pre-eclampsia in a resource-constrained setting.

METHODS

This was a prospective, observational study of pregnancies affected by early-onset FGR and pre-eclampsia. Patient characteristics, risk factors, ultrasound findings, and pregnancy outcomes were entered into a data collection tool. The association of these variables with perinatal and maternal outcomes were determined using binary logistic regression analysis.

RESULTS

The study had 61 participants. Most patients were delivered at 29-31⁺⁶ weeks of pregnancy (67%). Neonates with an estimated fetal weight on ultrasound of less than 800 g had the highest incidence of perinatal mortality (63%). There was a near six-fold increase in risk of major neonatal morbidity in patients with abnormal DVD (odds ratio 5.9, 95% confidence interval [CI] 1.8-19.0). Absent flow in the DVD a-wave carried a higher risk of perinatal mortality (OR 23.8, 95% CI 1.7-334.8); 22% of patients with an abnormal DVD a-wave experienced placental abruption.

CONCLUSION

Having an abnormal DVD in the background of pre-eclampsia was related to increased perinatal morbidity and mortality, with increased risk of placental abruption.

Abnormal Umblical Artery Doppler is Utilized for Fetuses with Intrauterine Growth Restriction Birth at 280/7-336/7 Gestational Weeks

Purpose: To compare short-term perinatal outcomes in preterm infants with intrauterine growth restriction (IUGR) in those with absent or reversed end-diastolic umbilical artery blood flow (AREDF) to those with normal end-diastolic umbilical artery blood flow (NEDF). Methods: This study included preterm births (28^0/7-33^6/7 gestational weeks) with IUGR with AREDF (n = 86) or NEDF (n = 27). Results: There were lower mean gestational weeks, birth weights, and a higher ratio of corticosteroid application in the AREDF group (p < 0.05). The mean length of neonatal intensive care unit stay of the AREDF group was significantly longer (p < 0.001). Sepsis and feeding intolerance ratios in the AREDF group were also significantly higher (p = 0.041 and p < 0.001 respectively). Conclusions: Patients with IUGR and umbilical Doppler abnormalities have longer neonatal intensive care unit stays.

Trouble With the Curve: Pearls and Pitfalls in the Evaluation of Fetal Growth

OBJECTIVES

Poor fetal growth is one of the most important findings on an obstetric ultrasound (US) examination. First-trimester US is the most accurate means for dating pregnancies; however, dating based on last menstrual period remains the standard for determining gestational age. Discrepancies between menstrual and US dating can lead to the overdiagnosis of in utero growth restriction (IUGR). This article will demonstrate that as long as the fetal growth falls along a curve that parallels normal growth curves, appropriate growth has occurred regardless of the gestational age and weight percentile that has been assigned to the fetus.

METHODS

Following Institutional Review Board approval (HSD-00002969), 860 third-trimester fetal US examinations were retrospectively evaluated from January 1 through July 1, 2017, to determine whether they had normal growth curves. Outcome data on all cases were obtained from review of the medical records.

RESULTS

Of 216 fetuses (25%) suspected of IUGR based on a weight below the 10th percentile, 6 developed true IUGR: 5 that led to emergent delivery of fetuses weighing less than a 1000 g and 1 in utero fetal demise. The remaining 210 fetuses all had normal outcomes.

CONCLUSIONS

As long as the fetal growth falls along a curve that parallels normal growth curves, appropriate growth has occurred regardless of the gestational age and weight percentile that has been assigned to the fetus.

Assessment of fetal modified myocardial performance index in early-onset and late-onset fetal growth restriction

Aim

To investigate the changes of modified myocardial performance index (Mod‐MPI) in early‐onset and late‐onset fetal growth restriction (FGR) cases, and its association with adverse perinatal outcome.

Methods

This was a prospective study on 77 early‐onset and 100 late‐onset FGR cases. Hundred normal fetuses were matched as control groups for early‐onset and late‐onset FGR groups, respectively. Mod‐MPI and vessel Doppler parameters including umbilical artery (UA), ductus venosus (DV), and middle cerebral artery (MCA) were measured. Perinatal outcomes were followed up. Mod‐MPI of FGR cases were compared in normal Doppler, abnormal Doppler, and control groups. The association of Mod‐MPI and perinatal outcome was investigated, and further efficacy of Mod‐MPI predicting adverse outcome was studied.

Results

Compared with control groups, both abnormal and normal Doppler groups showed increased Mod‐MPI in early‐onset and late‐onset FGR, respectively. Mod‐MPI had no significant difference between abnormal and normal Doppler groups. Mod‐MPI was associated with adverse outcome in early‐onset FGR (OR = 3.307) and late‐onset FGR (OR = 3.412). The sensitivity and specificity of Mod‐MPI predicting adverse outcome were 60% and 80% when cutoff value was 0.47 in early‐onset FGR. And they were 65% and 70% when cutoff value was 0.50 in late‐onset FGR.

Conclusion

Fetal growth restriction fetuses had increased Mod‐MPI. Mod‐MPI could be used to predict adverse perinatal outcome of FGR fetuses. Mod‐MPI was an effective parameter to supplement vessels’ Doppler parameters in monitoring FGR.

Modern Ultrasonography of the Umbilical Cord: Prenatal Diagnosis of Umbilical Cord Abnormalities and Assessement of Fetal Wellbeing

The umbilical cord is the only connection between the mother and the fetus, through which it is possible to transport respiratory gases, nutrients, and metabolites. Thanks to the umbilical cord, the fetus has also the ability to move, which is necessary for its proper psychomotor development. The correct structure and function of umbilical vessels and the entire umbilical cord determine the possibility of proper development and survival of the fetus. Umbilical cord anatomy should be assessed in the ultrasound examination in the first trimester. It is of vital importance to confirm the correct number of umbilical vessels and their intra-abdominal course, as well as carefully assessing the abdominal and placental insertion sites. In the latter half of pregnancy, the use of the Doppler imaging enables assessment of the function of the fetal-placental vessels, thus providing valuable information about the condition of the fetus.