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Martins JG, Kawakita T, Barake C, Gould L, Baraki D, Connell P, Sinkovskaya E, Abuhamad A. Rate of deterioration of umbilical artery Doppler indices in fetuses with severe early-onset fetal growth restriction. Am J Obstet Gynecol MFM 2024; 6:101283. [PMID: 38219949 DOI: 10.1016/j.ajogmf.2024.101283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/10/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Incorporation of umbilical artery Doppler in the surveillance of fetal growth restriction has been shown to reduce the risk of perinatal deaths. Systole/Diastole ratio, Pulsatility Index and Resistance Index are obtained upon Doppler interrogation of the umbilical artery however it is unknown which index predicts more advanced stages of placental deterioration. OBJECTIVE This study aimed to examine risk factors for the development of absent or reversed end-diastolic velocity and the time intervals of deterioration from normal umbilical artery end-diastolic velocity (indicated by systole/diastole ratio, pulsatility index, or resistance index) to decreased and absent or reversed end-diastolic velocity in fetuses with early-onset severe fetal growth restriction. STUDY DESIGN This was a retrospective cohort study performed from 2005 to 2020. All singleton pregnancies with severe (estimated fetal weight or abdominal circumference below the third percentile) and early-onset (diagnosed between 20 0/7 and 31 6/7 weeks of gestation) fetal growth restriction were included. Patients with fetal genetic or structural anomalies, suspected congenital infections, absent or reversed end-diastolic velocity at diagnosis, poor pregnancy dating, and absence of follow-up ultrasounds were excluded. Estimated fetal weight, abdominal circumference, and Doppler indices were reviewed longitudinally from diagnosis to delivery. To examine risk factors for absent or reversed end-diastolic velocity, we performed backward stepwise logistic regression and calculated odds ratios with 95% confidence intervals. Kaplan-Meier curves were compared using log-rank tests. RESULTS A total of 985 patients met the inclusion criteria, and 79 (8%) progressed to absent or reversed end-diastolic velocity. Factors associated with development of absent or reversed end-diastolic velocity included gestational age at diagnosis (adjusted odds ratio, 4.88 [95% confidence interval, 2.55-9.37] at 20 0/7 to 23 6/7 weeks; adjusted odds ratio, 1.56 [95% confidence interval, 0.86-2.82] at 24 0/7 to 27 6/7 weeks compared with 28 0/7 to 31 6/7 weeks) and presence of chronic hypertension (adjusted odds ratio, 2.37 [95% confidence interval, 1.33-4.23]). Rates of progression from diagnosis of fetal growth restriction with normal umbilical artery Doppler to absent or reversed end-diastolic velocity were significant after 4 weeks from diagnosis (5.84% [95% confidence interval, 4.50-7.57]). Regarding the Doppler indices, the progression from normal values to abnormal indices was similar at 1 and 2 weeks. However, the rate of progression from normal to abnormal systole/diastole ratio compared with the rates of progression from normal to abnormal pulsatility index or resistance index was higher at 4 and 6 weeks. Deterioration from abnormal indices to absent or reversed end-diastolic velocity was shorter with abnormal resistance index and pulsatility index when compared with the systole/diastole ratio at 2, 4, and 6 weeks after diagnosis and at 6 weeks, respectively. CONCLUSION Earlier gestational age at diagnosis and chronic hypertension are considered as risk factors for Doppler deterioration and development of absent or reversed end-diastolic velocity in the umbilical artery. With normal Doppler indices, significant deterioration and progression to absent or reversed end-diastolic velocity is unlikely until 4 weeks after diagnosis. Abnormal systole/diastole ratio seems to appear first. However, abnormal pulsatility index or resistance index was associated with absent or reversed end-diastolic velocity.
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Affiliation(s)
- Juliana Gevaerd Martins
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Gevaerd Martins, Kawakita, Gould, Sinkovskaya, and Abuhamad).
| | - Tetsuya Kawakita
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Gevaerd Martins, Kawakita, Gould, Sinkovskaya, and Abuhamad)
| | - Carole Barake
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX (Dr Barake)
| | - Lindsay Gould
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Gevaerd Martins, Kawakita, Gould, Sinkovskaya, and Abuhamad)
| | - Dana Baraki
- Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, OH (Dr Baraki)
| | - Phillip Connell
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Dr Connell)
| | - Elena Sinkovskaya
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Gevaerd Martins, Kawakita, Gould, Sinkovskaya, and Abuhamad)
| | - Alfred Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Gevaerd Martins, Kawakita, Gould, Sinkovskaya, and Abuhamad)
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Necrotizing Enterocolitis: The Role of Hypoxia, Gut Microbiome, and Microbial Metabolites. Int J Mol Sci 2023; 24:ijms24032471. [PMID: 36768793 PMCID: PMC9917134 DOI: 10.3390/ijms24032471] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 02/01/2023] Open
Abstract
Necrotizing enterocolitis (NEC) is a life-threatening disease that predominantly affects very low birth weight preterm infants. Development of NEC in preterm infants is accompanied by high mortality. Surgical treatment of NEC can be complicated by short bowel syndrome, intestinal failure, parenteral nutrition-associated liver disease, and neurodevelopmental delay. Issues surrounding pathogenesis, prevention, and treatment of NEC remain unclear. This review summarizes data on prenatal risk factors for NEC, the role of pre-eclampsia, and intrauterine growth retardation in the pathogenesis of NEC. The role of hypoxia in NEC is discussed. Recent data on the role of the intestinal microbiome in the development of NEC, and features of the metabolome that can serve as potential biomarkers, are presented. The Pseudomonadota phylum is known to be associated with NEC in preterm neonates, and the role of other bacteria and their metabolites in NEC pathogenesis is also discussed. The most promising approaches for preventing and treating NEC are summarized.
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Wołejszo S, Genowska A, Motkowski R, Strukcinskiene B, Klukowski M, Konstantynowicz J. Insights into Prevention of Health Complications in Small for Gestational Age (SGA) Births in Relation to Maternal Characteristics: A Narrative Review. J Clin Med 2023; 12:jcm12020531. [PMID: 36675464 PMCID: PMC9862121 DOI: 10.3390/jcm12020531] [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: 11/22/2022] [Revised: 12/29/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Small for gestational age (SGA) births are a significant clinical and public health issue. The objective of this review was to summarize maternal biological and socio-demographic factors and preventive strategies used to reduce the risk of SGA births. A literature search encompassing data from the last 15 years was conducted using electronic databases MEDLINE/PubMed, Google Scholar and Scopus to review risk factors and preventive strategies for SGA. Current evidence shows that primiparity, previous stillbirths, maternal age ≤24 and ≥35 years, single motherhood, low socio-economic status, smoking and cannabis use during pregnancy confer a significant risk of SGA births. Studies on alcohol consumption during pregnancy and SGA birth weight are inconclusive. Beneficial and preventive factors include the "Mediterranean diet" and dietary intake of vegetables. Periconceptional folic acid supplementation, maternal 25-hydroxyvitamin D, zinc and iron levels are partly associated with birth weight. No significant associations between COVID-19 vaccinations and birthweight are reported. A midwifery-led model based on early and extensive prenatal care reduces the risk of SGA births in women with low socio-economic status. Major preventive measures relate to the awareness of modifiable and non-modifiable risk factors of SGA, leading to changes in parents' lifestyles. These data support that education, monitoring during pregnancy, and implementing preventive strategies are as important as biological determinants in risk reduction of SGA births.
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Affiliation(s)
- Sebastian Wołejszo
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children′s Hospital, 15-274 Bialystok, Poland
- Correspondence: (S.W.); (A.G.)
| | - Agnieszka Genowska
- Department of Public Health, Medical University of Bialystok, 15-295 Bialystok, Poland
- Correspondence: (S.W.); (A.G.)
| | - Radosław Motkowski
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children′s Hospital, 15-274 Bialystok, Poland
| | | | - Mark Klukowski
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children′s Hospital, 15-274 Bialystok, Poland
| | - Jerzy Konstantynowicz
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children′s Hospital, 15-274 Bialystok, Poland
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Idowu B, Adedo A, Arogundade R, Okunowo A, Oduola-Owoo L. Comparative study of the umbilical artery Doppler indices of healthy and growth-restricted foetuses in Lagos. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:63-69. [PMID: 36213799 PMCID: PMC9536402 DOI: 10.4103/jwas.jwas_63_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/07/2022] [Indexed: 11/27/2022]
Abstract
Aim of the Study: This study compared the umbilical artery Doppler indices (UADI) in normal and foetal growth-restricted (FGR) foetuses to determine the relationship between the UADI and pregnancy outcomes. Materials and Methods: This was a case-control study that recruited one hundred and eighty pregnant women comprising 90 with FGR pregnancies and 90 with normal pregnancies. Foetal biometric parameters and UADI were measured in all the participants. The UADI and clinical outcomes (preterm delivery, birth weight, perinatal death, etc.) of the normal and FGR foetuses were compared. Results: The mean estimated foetal weights of the FGR pregnancies (subjects) and normal pregnancies (controls) were 2.76 ± 0.66 kg and 3.62 ± 0.37 kg, respectively (P < 0.0001). The mean APGAR score at 5 min was 6.93 ± 1.72 for subjects and 8.03 ± 0.94 for controls (P < 0.0001). Abnormal umbilical artery Doppler waveforms were detected: decreased end-diastolic flow in 25 (27.8%), absent end-diastolic in 7 (7.8%) and reversed end-diastolic flow in 4 (4.4%) of the FGR pregnancies. There were 74 (82.2%) preterm deliveries among the subjects, while only 7 (7.8%) of the controls had preterm deliveries. Six deaths (two perinatal and four neonatal deaths) were recorded among the subjects, while no death occurred among the controls. Conclusion: Foetuses with FGR showed significantly higher quantitative Doppler indices (increased RI, PI, SD ratio), and a higher prevalence of abnormal umbilical artery waveform pattern (qualitative) than the healthy foetuses (controls).
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Ouidir M, Tekola-Ayele F, Canty T, Grantz KL, Sciscione A, Tong D, Jones RR, Sundaram R, Williams A, Stevens D, Mendola P. Acute ambient air pollution exposure and placental Doppler results in the NICHD fetal growth studies - Singleton cohort. ENVIRONMENTAL RESEARCH 2021; 202:111728. [PMID: 34297937 PMCID: PMC8578287 DOI: 10.1016/j.envres.2021.111728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/21/2021] [Accepted: 07/16/2021] [Indexed: 05/29/2023]
Abstract
BACKGROUND Increased placental vascular resistance is a proposed mechanism by which air pollution exposure during pregnancy lowers birth weight and increases pregnancy-induced hypertensive disorders. OBJECTIVE To examine the impact of acute air pollution exposure during pregnancy on uterine and umbilical artery Doppler indicators of placental vascular resistance. METHODS After a first ultrasound to confirm gestational age, 2562 pregnant women recruited in 12 clinics throughout the United States underwent up to five standardized ultrasounds with Doppler measurements. Exposures to 11 air pollutants were estimated for the hour of ultrasound and each of the 2 h prior to ultrasound at the clinics using the National Air Quality Forecast Capability reanalysis products. We used mixed logistic regression to study the longitudinal odds ratio (OR) of any, uni- or bi-lateral systolic and diastolic uterine artery notching compared to no notching and the longitudinal OR of abnormal end diastolic flow of the umbilical artery compared to forward flow. Uterine and umbilical artery resistance indexes were studied using linear mixed models. RESULTS Each inter-quartile range (IQR) increase of particulate matter < 2.5 μm, nitrate, ammonium, primary organic matter (POM) and nitrogen dioxide during the hour of ultrasound was associated with a decreased risk of unilateral systolic notch and with increased resistance index of the left uterine artery. For the umbilical artery, each IQR increase in ozone was associated with decreased resistance index (b: -0.26, 95 % CI: -0.52, -0.01) and with a decreased risk of abnormal end diastolic flow (OR: 0.36, 95 % CI: 0.14, 0.94); while each IQR increase of elemental carbon and POM was associated with increased risk of abnormal end diastolic flow (OR: 1.47, 95 % CI: 1.02, 2.13 and OR: 1.67, 95 % CI: 1.17, 2.39, respectively). DISCUSSION Our results suggest acute air pollution exposure may influence placental vascular resistance.
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Affiliation(s)
- Marion Ouidir
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Fasil Tekola-Ayele
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Timothy Canty
- Department of Atmospheric and Oceanic Science, University of Maryland, College Park, MD, USA
| | - Katherine L Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Anthony Sciscione
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE, USA
| | - Daniel Tong
- Center for Spatial Science and Systems, George Mason University, Fairfax, VA, USA
| | - Rena R Jones
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Rajeshwari Sundaram
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Andrew Williams
- University of North Dakota, School of Medicine & Health Sciences, Grand Forks, ND, USA
| | - Danielle Stevens
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Pauline Mendola
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA; Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
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6
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Rodrigues Bento J, Feben C, Kempers M, van Rij M, Woiski M, Devriendt K, De Catte L, Baldewijns M, Alaerts M, Meester J, Verstraeten A, Hendson W, Loeys B. Two novel presentations of KCNMA1-related pathology--Expanding the clinical phenotype of a rare channelopathy. Mol Genet Genomic Med 2021; 9:e1797. [PMID: 34499417 PMCID: PMC8580096 DOI: 10.1002/mgg3.1797] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 05/19/2021] [Accepted: 08/13/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND KCNMA1 mutations have recently been associated with a wide range of dysmorphological, gastro-intestinal, cardiovascular, and neurological manifestations. METHODS Whole exome sequencing was performed in order to identify the underlying pathogenic mutation in two cases presenting with diverse phenotypical manifestations that did not fit into well-known clinical entities. RESULTS In an 8-year-old boy presenting with severe aortic dilatation, facial dysmorphism, and overgrowth at birth a de novo p.Gly375Arg KCNMA1 mutation was identified which has been reported previously in association with gingival hypertrophy, aortic dilatation, and developmental delay. Additionally, in a 30-week-old fetus with severe growth retardation and duodenal atresia a de novo p.Pro805Leu KCNMA1 mutation was identified. The latter has also been reported before in a boy with severe neurological manifestations, including speech delay, developmental delay, and cerebellar dysfunction. CONCLUSION The current report presents the first antenatal presentation of a pathogenic KCNMA1 mutation and confirms the specific association of the p.Gly375Arg variant with early onset aortic root dilatation, gingival hypertrophy, and neonatal overgrowth.
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Affiliation(s)
- Jotte Rodrigues Bento
- Centre of Medical Genetics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Candice Feben
- Division of Human Genetics, National Health Laboratory Service & The School of Pathology, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Marlies Kempers
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maartje van Rij
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Gynaecology and Obstetrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mallory Woiski
- Department of Gynaecology and Obstetrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Koenraad Devriendt
- Department of Human Genetics, Catholic University of Leuven, Leuven, Belgium
| | - Luc De Catte
- Department of Gynaecology and Obstetrics, Catholic University of Leuven, Leuven, Belgium
| | - Marcella Baldewijns
- Department of Gynaecology and Obstetrics, Catholic University of Leuven, Leuven, Belgium
| | - Maaike Alaerts
- Centre of Medical Genetics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Josephina Meester
- Centre of Medical Genetics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Aline Verstraeten
- Centre of Medical Genetics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Willy Hendson
- Department of Paediatrics, Rahima Moosa Mother and Child Hospital & The University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Bart Loeys
- Centre of Medical Genetics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.,Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
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Srinivasan V, Melbourne A, Oyston C, James JL, Clark AR. Multiscale and multimodal imaging of utero-placental anatomy and function in pregnancy. Placenta 2021; 112:111-122. [PMID: 34329969 DOI: 10.1016/j.placenta.2021.07.290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 06/09/2021] [Accepted: 07/19/2021] [Indexed: 12/12/2022]
Abstract
Placental structures at the nano-, micro-, and macro scale each play important roles in contributing to its function. As such, quantifying the dynamic way in which placental structure evolves during pregnancy is critical to both clinical diagnosis of pregnancy disorders, and mechanistic understanding of their pathophysiology. Imaging the placenta, both exvivo and invivo, can provide a wealth of structural and/or functional information. This review outlines how imaging across modalities and spatial scales can ultimately come together to improve our understanding of normal and pathological pregnancies. We discuss how imaging technologies are evolving to provide new insights into placental physiology across disciplines, and how advanced computational algorithms can be used alongside state-of-the-art imaging to obtain a holistic view of placental structure and its associated functions to improve our understanding of placental function in health and disease.
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Affiliation(s)
| | - Andrew Melbourne
- School of Biomedical Engineering & Imaging Sciences, Kings College London, UK
| | - Charlotte Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Alys R Clark
- Auckland Bioengineering Institute, University of Auckland, New Zealand
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8
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Mylrea-Foley B, Lees C. Clinical monitoring of late fetal growth restriction. Minerva Obstet Gynecol 2021; 73:462-470. [PMID: 34319059 DOI: 10.23736/s2724-606x.21.04845-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Late fetal growth restriction (FGR) poses its own challenges in respect of diagnosis, surveillance and delivery timing. Perinatal morbidity is relatively rare, and mortality extremely unusual, but given that late FGR is much more frequent than early FGR, the burden on neonatal services must not be underestimated. Doppler findings are more subtle than in early FGR, and growth rate rather than absolute fetal size may be important in defining the condition. Though umbilical artery Doppler changes form the basis for triggering delivery: reversed end diastolic flow at 32 weeks, absent at 34 weeks and raised PI at 36 weeks, other modalities of monitoring - for example cardiotocography and cerebral Doppler - are important in surveillance and timing follow up of the condition.
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Affiliation(s)
| | - Christoph Lees
- Imperial College London, London, UK - .,Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, London, UK
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9
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Baser E, Celik IH, Bilge M, Kasapoglu T, Isik DU, Yalvac ES, Tapisiz OL, Ozdemirci S. Abnormal Umblical Artery Doppler is Utilized for Fetuses with Intrauterine Growth Restriction Birth at 28 0/7-33 6/7 Gestational Weeks. Fetal Pediatr Pathol 2020; 39:467-475. [PMID: 31997690 DOI: 10.1080/15513815.2020.1716900] [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] [Indexed: 10/25/2022]
Abstract
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 (280/7-336/7 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.
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Affiliation(s)
- Emre Baser
- Department of Obstetrics and Gynecology, Yozgat Bozok University, Faculty of Medicine, Yozgat, Turkey
| | - Istemi Han Celik
- Department of Neonatology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Melek Bilge
- Department of Obstetrics, Clinic Ministry of Health Dr. Ali Kemal Belviranli Hospital for Obstetrics and Pediatrics, Konya, Turkey
| | - Taner Kasapoglu
- Department of Obstetrics and Gynecology, Perinatology & High-Risk Pregnancy Clinic, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Dilek Ulubas Isik
- Department of Neonatology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Ethem Serdar Yalvac
- Department of Obstetrics and Gynecology, Yozgat Bozok University, Faculty of Medicine, Yozgat, Turkey
| | - Omer Lutfi Tapisiz
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Safak Ozdemirci
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Health Science University, Ankara, Turkey
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10
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Hidaka N, Sato Y, Kido S, Fujita Y, Kato K. Ductus venosus Doppler and the postnatal outcomes of growth restricted fetuses with absent end-diastolic blood flow in the umbilical arteries. Taiwan J Obstet Gynecol 2017; 56:642-647. [DOI: 10.1016/j.tjog.2017.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2017] [Indexed: 11/24/2022] Open
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11
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Oliveira B, Flôr-DE-Lima F, Rocha G, Rodrigues M, Ladeiras R, Guimarães H. The impact of intrauterine growth restriction on respiratory outcomes. Minerva Pediatr (Torino) 2017; 73:426-434. [PMID: 28565900 DOI: 10.23736/s2724-5276.17.04965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Intrauterine growth restriction (IUGR) is caused by fetal growth below what is normal for its genetic potential. Recent studies have shown a distinct association between changes in umbilical artery flow in IUGR subjects and an increased risk of respiratory morbidity and consequently, higher mortality. The aim of this study was to find the impact of IUGR on the respiratory outcomes of premature neonates born with less than 32 weeks gestational age. METHODS This retrospective cohort study targeted infants born with less than 32 weeks of gestation, admitted at NCIU, between January 2010 and December 2016. Each selected IUGR case was matched according to gestational age and sex with an appropriate birthweight newborn at a 1:2 ratio, within a 12-month period. RESULTS The study involved 126 neonates, 42 with IUGR, and 84 control subjects. IUGR was not identified as a predictor of Bronchopulmonary Dysplasia (BDP) (OR 4.80, 95% CI: 1.14-20.21, P=0.033). Abnormal umbilical artery flow (OR 4.80, 95% CI: 1.14-20.21, P=0.033) and late onset sepsis (OR 3.31, 95% CI: 1.04-10.56, P=0.044) were significantly associated with BDP. CONCLUSIONS It is essential to recognize changes in the umbilical artery flow, especially in high-risk pregnancies such as IUGR, since these represent an a priori risk marker for the development of BDP. The individual and combined effect of IUGR, alterations on umbilical artery flow and extreme prematurity has not yet been completely clarified on the impact on lung morbidity, requiring a larger number of studies.
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Affiliation(s)
| | - Filipa Flôr-DE-Lima
- Faculty of Medicine, University of Porto, Porto, Portugal.,Neonatal Intensive Care Unit, Pediatric Hospital, Hospital of São João, Porto, Portugal
| | - Gustavo Rocha
- Faculty of Medicine, University of Porto, Porto, Portugal.,Neonatal Intensive Care Unit, Pediatric Hospital, Hospital of São João, Porto, Portugal
| | - Manuela Rodrigues
- Neonatal Intensive Care Unit, Pediatric Hospital, Hospital of São João, Porto, Portugal
| | - Rita Ladeiras
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Hercília Guimarães
- Faculty of Medicine, University of Porto, Porto, Portugal.,Neonatal Intensive Care Unit, Pediatric Hospital, Hospital of São João, Porto, Portugal
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Haram K, Mortensen JH, Magann EF, Morrison JC. Antenatal corticosteroid treatment: factors other than lung maturation. J Matern Fetal Neonatal Med 2016; 30:1437-1441. [DOI: 10.1080/14767058.2016.1219716] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Brütsch S, Burkhardt T, Kurmanavicius J, Bassler D, Zimmermann R, Natalucci G, Ochsenbein-Kölble N. Neurodevelopmental outcome in very low birthweight infants with pathological umbilical artery flow. Arch Dis Child Fetal Neonatal Ed 2016; 101:F212-6. [PMID: 26304460 DOI: 10.1136/archdischild-2014-307820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 08/04/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess neurodevelopmental outcome during toddlerhood in very low birthweight (VLBW) infants with absent or reverse end-diastolic flow (AREDF) in the umbilical artery (UA) during pregnancy. DESIGN Retrospective cohort study with matched control group. SETTING Tertiary perinatal centre. PATIENTS AND OUTCOME MEASURES We compared longitudinally collected data on neonatal and neurodevelopmental outcomes among 41 infants born in our institution from 1997 to 2010 with birth weight <1500 g and UA AREDF and 41 infants with prenatally normal UA Doppler parameters matched for gestational age, birth weight, sex and year of birth. We evaluated neurodevelopmental outcome at a median (range) corrected age of 23.3 (10.1-29.6) months using the Bayley scales of infant development, 2nd edition (BSID-II), and neurological examination. RESULTS The mental development index in UA AREDF children (median (range) 84 (49-116)) was significantly lower than in controls (median (range) 91 (62-140)), including after adjustment for confounders. Intergroup differences in psychomotor development index (PDI; BSID-II) and the rate of cerebral palsy or minor neuromotor dysfunction were non-significant. CONCLUSIONS VLBW infants with UA AREDF have a higher risk of poorer mental development during toddlerhood than controls matched for gestational age, birth weight, sex and year of birth. UA AREDF may be considered a prenatal predictor of poorer mental development in this population. Long-term follow-up studies with larger cohorts are needed to better evaluate the impact of this prenatal factor on later neurodevelopment.
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Affiliation(s)
- Simonne Brütsch
- Obstetric Research Unit, Clinic of Obstetrics, Zurich University Hospital, Zurich, Switzerland
| | - Tilo Burkhardt
- Obstetric Research Unit, Clinic of Obstetrics, Zurich University Hospital, Zurich, Switzerland
| | - Juozas Kurmanavicius
- Obstetric Research Unit, Clinic of Obstetrics, Zurich University Hospital, Zurich, Switzerland
| | - Dirk Bassler
- Division of Neonatology, Zurich University Hospital, Zurich, Switzerland
| | - Roland Zimmermann
- Obstetric Research Unit, Clinic of Obstetrics, Zurich University Hospital, Zurich, Switzerland
| | - Giancarlo Natalucci
- Division of Neonatology, Zurich University Hospital, Zurich, Switzerland Child Development Centre, Children's University Hospital Zurich, Zurich, Switzerland
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Lee VR, Pilliod RA, Frias AE, Rasanen JP, Shaffer BL, Caughey AB. When is the optimal time to deliver late preterm IUGR fetuses with abnormal umbilical artery Dopplers? J Matern Fetal Neonatal Med 2015; 29:690-5. [DOI: 10.3109/14767058.2015.1018170] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abheiden C, Van Hoorn ME, Hague WM, Kostense PJ, van Pampus MG, de Vries J. Does low-molecular-weight heparin influence fetal growth or uterine and umbilical arterial Doppler in women with a history of early-onset uteroplacental insufficiency and an inheritable thrombophilia? Secondary randomised controlled trial results. BJOG 2015; 123:797-805. [PMID: 26036190 DOI: 10.1111/1471-0528.13421] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Does low-molecular-weight heparin (LMWH) added to low-dose aspirin influence fetal growth and flow velocity in uterine and umbilical arteries in women with an inheritable thrombophilia and previous early-onset uteroplacental insufficiency? DESIGN Secondary outcomes of the FRUIT-RCT. SETTING Multicentre, international. POPULATION The FRUIT-RCT included 139 women with inheritable thrombophilia before 12 weeks of gestation. Inclusion criteria were previous delivery before 34 weeks of gestation with a hypertensive disorder of pregnancy and/or small-for-gestational-age infant and an inheritable thrombophilia. METHODS After randomisation to either daily LMWH with aspirin, or aspirin only, ultrasound measurements were performed at 22-24, 28-30 and 34-36 weeks of gestation. Development during gestation of growth, birthweight and flow velocity of the umbilical artery was examined using the linear mixed model. Uterine artery flow velocity at a single time-point (22-24 weeks) was examined using a chi-square test. MAIN OUTCOME MEASURES Fetal growth over time including birthweight, using Scandinavian, Dutch and customised growth curves; and flow velocity within the uterine and umbilical arteries. RESULTS No difference of fetal growth over time could be demonstrated between the study arms, regardless of which reference criteria were used. The flow velocity within the uterine artery and umbilical artery did not differ between study arms. CONCLUSION The addition of LMWH to aspirin did not influence fetal growth or umbilical artery flow velocity over time; nor did it influence uterine artery flow velocity. TWEETABLE ABSTRACT LMWH does not influence fetal growth or uterine or umbilical flow velocities.
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Affiliation(s)
- Cnh Abheiden
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands
| | - M E Van Hoorn
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands
| | - W M Hague
- Robinson Research Institute, University of Adelaide, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - P J Kostense
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands
| | - M G van Pampus
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Jip de Vries
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands
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Cordioli RL, Cordioli E, Negrini R, Silva E. Sepsis and pregnancy: do we know how to treat this situation? Rev Bras Ter Intensiva 2015; 25:334-44. [PMID: 24553516 PMCID: PMC4031877 DOI: 10.5935/0103-507x.20130056] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 11/21/2013] [Indexed: 12/18/2022] Open
Abstract
Sepsis is defined as an acute inflammatory response syndrome secondary to an
infectious focus. It has a high incidence, morbidity and mortality, causing
substantial financial costs, especially due to complications such as septic shock and
multiple organ dysfunction. The pathogen toxins associated with individual
susceptibility culminate with cytokine release, which promotes a systemic
inflammatory response that can progress to multiple organ dysfunction and eventual
patient death. Specifically, sepsis incidence, morbidity and mortality are lower in pregnant women,
as this group is typically younger with fewer comorbidities having a polymicrobial
etiology resulting in sepsis. Pregnant women exhibit physiological characteristics that may confer specific
clinical presentation and laboratory patterns during the sepsis course. Thus, a
better understanding of these changes is critical for better identification and
management of these patients. The presence of a fetus also requires unique approaches
in a pregnant woman with sepsis. Sepsis treatment is based on certain guidelines that were established after major
clinical trials, which, unfortunately, all classified pregnancy as a exclusion
criteria. Thus, the treatment of sepsis in the general population has been extrapolated to the
pregnant population, with the following main goals: maintenance of tissue perfusion
with fluid replacement and vasoactive drugs (initial resuscitation), adequate
oxygenation, control of the infection source and an early start of antibiotic
therapy, corticosteroid infusion and blood transfusion when properly indicated,
prophylaxis, and specifically monitoring and maintenance of fetal heath.
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Affiliation(s)
- Ricardo Luiz Cordioli
- Corresponding author: Ricardo Luiz Cordioli, Unidade de Terapia
Intensiva do Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701,
5º Andar - Morumbi, Zip code: 05652-900 - São Paulo (SP), Brazil.
E-mail:
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Maternal preeclampsia is associated with increased risk of necrotizing enterocolitis in preterm infants. Early Hum Dev 2012; 88:893-8. [PMID: 22831636 DOI: 10.1016/j.earlhumdev.2012.07.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 07/03/2012] [Accepted: 07/05/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) is an important cause of mortality and morbidity in preterm infants. AIMS To evaluate the effect of maternal preeclampsia on the development and severity of NEC in premature infants. STUDY DESIGN Prospective observational study in a tertiary neonatal intensive care unit. SUBJECTS The preterm infants of ≤ 37 gestational age who were consecutively hospitalized were enrolled. The study group contained preterm infants born to a preeclamptic mother and the comparison group contained preterm infants born to a normotensive mother. OUTCOME MEASURES The primary outcome was to determine the association between preeclampsia and NEC. RESULTS A total of 88 infants had NEC diagnosis. The incidence of NEC in infants born to preeclamptic mothers (22.9%) was significantly higher compared with those born to normotensive mothers (14.6%). According to NEC stages, NEC was more advanced in preeclamptic mother infants. NEC developed significantly earlier in infants with NEC in the study group. The duration of NEC was also significantly longer in infants born to preeclamptic mothers. In multiple logistic regression model, preeclampsia was found to be predictive of NEC with an odds ratio of 1.74 (95% confidence interval 0.64-0.92). CONCLUSIONS Maternal preeclampsia may be an important risk factor for the development of NEC in premature infants as NEC incidence and severity of NEC were found to be significantly higher in premature infants born to preeclamptic mothers. The onset of NEC was significantly earlier and duration of NEC was longer in these infants.
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Gruslin A, Lemyre B. Pre-eclampsia: Fetal assessment and neonatal outcomes. Best Pract Res Clin Obstet Gynaecol 2011; 25:491-507. [DOI: 10.1016/j.bpobgyn.2011.02.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 02/10/2011] [Indexed: 10/18/2022]
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Pan M, Chen M, Leung TY, Sahota DS, Ting YH, Lau TK. Outcome of monochorionic twin pregnancies with abnormal umbilical artery Doppler between 16 and 20 weeks of gestation. J Matern Fetal Neonatal Med 2011; 25:277-80. [DOI: 10.3109/14767058.2011.573830] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yoo C, Jang DG, Jo YS, Yoo J, Lee G. Pathologic Differences between Placentas from Intrauterine Growth Restriction Pregnancies with and without Absent or Reversed End Diastolic Velocity of Umbilical Arteries. KOREAN JOURNAL OF PATHOLOGY 2011. [DOI: 10.4132/koreanjpathol.2011.45.1.36] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Changyoung Yoo
- Department of Pathology, St. Vincent Hospital, The Catholic University of Korea School of Medicine, Suwon, Korea
| | - Dong Gyu Jang
- Department of Obstetrics and Gynecology, St. Vincent Hospital, The Catholic University of Korea School of Medicine, Suwon, Korea
| | - Yun Sung Jo
- Department of Obstetrics and Gynecology, St. Vincent Hospital, The Catholic University of Korea School of Medicine, Suwon, Korea
| | - Jinyoung Yoo
- Department of Pathology, St. Vincent Hospital, The Catholic University of Korea School of Medicine, Suwon, Korea
| | - Guisera Lee
- Department of Obstetrics and Gynecology, St. Vincent Hospital, The Catholic University of Korea School of Medicine, Suwon, Korea
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