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Kaya B, Atiş Aydin A. Umbilical Artery Doppler Indices at the Perivesical Segment in Growth-Restricted Fetuses. JOURNAL OF FETAL MEDICINE 2020. [DOI: 10.1007/s40556-020-00258-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Relevance of routine Doppler sampling at the two umbilical arteries in the follow-up of dichorionic twin pregnancies with intrauterine growth-restricted fetuses. J Gynecol Obstet Hum Reprod 2017; 46:285-289. [DOI: 10.1016/j.jogoh.2016.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 10/07/2016] [Accepted: 10/10/2016] [Indexed: 11/22/2022]
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Lecarpentier E, Cordier AG, Proulx F, Fouron JC, Gitz L, Grange G, Benachi A, Tsatsaris V. Hemodynamic impact of absent or reverse end-diastolic flow in the two umbilical arteries in growth-restricted fetuses. PLoS One 2013; 8:e81160. [PMID: 24312271 PMCID: PMC3842244 DOI: 10.1371/journal.pone.0081160] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 10/18/2013] [Indexed: 11/29/2022] Open
Abstract
Objective To determine if bilateral absent or reverse end-diastolic (ARED) flow in the two umbilical arteries (UAs) at the perivesical (PVC) segment represents a more severe degree of hemodynamic compromise than unilateral ARED flow at the PVC segment in singleton pregnancies complicated by intrauterine growth restriction (IUGR). Methods This was a prospective observational study. One hundred nine fetuses with IUGR underwent a total of 225 ultrasound (US) examinations. We measured the pulsatility index (PI) from the two UAs at the PVC segment, UA in the free floating cord (FFC), middle cerebral artery (MCA), ductus venosus (DV) and the aortic isthmus blood flow index (IFI). Three groups were classified according to bilateral positive end-diastolic (PED) flow, unilateral ARED flow or bilateral ARED flow in the UAs at the PVC segment. Results The proportions of US examinations with PED flow, unilateral ARED flow and bilateral ARED flow in the UAs were 54.7%, 20.4%, and 24.9%, respectively. At the last US examination, the IFI z-scores were significantly lower in the bilateral ARED group (-6.28±4.30) compared to the unilateral ARED group (-1.72±3.18, p<0.05) and the bilateral PED group (-0.83±2.36, p<0.05), the DV-PI z-scores were significantly higher in the bilateral ARED group (2.15±3.79) compared to the bilateral PED group (0.64±1.50, p<0.05). Before 32 weeks of gestation, the interval between US examination and delivery was significantly shorter in the bilateral ARED group (8.9 days ±8.2) than the unilateral ARED group (15.9 days ±13.4, p<0.05) and the bilateral PED group (30.3 days±25.7, p<0.05). Conclusion There are significant differences in fetal blood fluxes between left and right UA. Doppler examination at the PVC segment significantly improves the comparability of UA-PI between two successive US examinations and allows a longitudinal and independent hemodynamic investigation of each UA. Examination of a single UA in free floating cord may miss a large fraction of unilateral ARED flow. In singleton IUGR fetuses, a bilateral ARED flow in the UAs at the PVC segment indicates more severe hemodynamic compromise and worse fetal conditions than unilateral ARED flow.
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Affiliation(s)
- Edouard Lecarpentier
- Obstetrics and Gynecology Unit, Maternité Port-Royal, APHP, Paris Descartes University, Paris, France
| | - Anne Gaëlle Cordier
- Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, Assistance Publique des Hôpitaux de Paris, Université Paris Sud, Paris, France
| | - Francine Proulx
- Obstetrics and Gynecology Unit, Maternité Port-Royal, APHP, Paris Descartes University, Paris, France
- Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, Assistance Publique des Hôpitaux de Paris, Université Paris Sud, Paris, France
| | - Jean Claude Fouron
- Fetal Cardiology Unit, Pediatric Cardiology Service, Department of Pediatrics, Centre Hospitalier Universitaire (CHU) Saint-Justine, University of Montreal, Montreal, Canada
| | - Laurence Gitz
- Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, Assistance Publique des Hôpitaux de Paris, Université Paris Sud, Paris, France
| | - Gilles Grange
- Obstetrics and Gynecology Unit, Maternité Port-Royal, APHP, Paris Descartes University, Paris, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, Assistance Publique des Hôpitaux de Paris, Université Paris Sud, Paris, France
- Premup Foundation (Fondation pour la Prévention de la Prématurité et la Protection du Nouveau-né Prématuré), Paris, France
| | - Vassilis Tsatsaris
- Obstetrics and Gynecology Unit, Maternité Port-Royal, APHP, Paris Descartes University, Paris, France
- Premup Foundation (Fondation pour la Prévention de la Prématurité et la Protection du Nouveau-né Prématuré), Paris, France
- * E-mail:
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