Ultrasound prediction of abnormal infant development in hypertensive pregnant women in the second and third trimester

Doppler Ultrasound of the Umbilical Artery: Clinical Application

OBJECTIVE

 To provide a survey of relevant literature on umbilical artery Doppler ultrasound use in clinical practice, technical considerations and limitations, and future perspectives.

METHODS

 Literature searches were conducted in PubMed and Medline, restricted to articles written in English. Additionally, the references of all analyzed studies were searched to obtain necessary information.

RESULTS

 The use of this technique as a routine surveillance method is only recommended for high-risk pregnancies with impaired placentation. Meta-analyses of randomized trials have established that obstetric management guided by umbilical artery Doppler findings can improve perinatal mortality and morbidity. The values of the indices of Umbilical artery Doppler decrease with advancing gestational age; however, a lack of consensus on reference ranges prevails.

CONCLUSION

 Important clinical decisions are based on the information obtained with umbilical artery Doppler ultrasound. Future efforts in research are imperative to overcome the current limitations of the technique.

The clinical value of blood flow parameters of the umbilical artery and middle cerebral artery for assessing fetal distress

OBJECTIVE

To explore the clinical value of blood flow parameters of the umbilical artery (UA) and middle cerebral artery (MCA) for gauging fetal distress.

METHODS

This study was conducted among 256 pregnant women who presented for routine prenatal checkups and successfully gave birth in our hospital from January 2018 to February 2020. These pregnant women were examined with the Color Doppler Ultrasound, and the color Doppler flow imaging (CDFI) showed the blood flow of the UA and MCA. In accordance with the diagnostic criteria of fetal distress, they were divided into a fetal distress group (n=67) and a control group (n=189). The receiver operator characteristic (ROC) curve analysis was performed on the diagnostic value of the flow in the UA and MCA. According to their pregnancy outcomes, they were divided into a good pregnancy outcome group (n=209) and an adverse pregnancy outcome group (n=47), and their blood flow parameters of the UA and MCA were compared.

RESULTS

The S/D, PI, and RI values of the UA in the fetal distress group exceeded those in the control group, and the S/D, PI, and RI values of the MCA were lower than those in the control group (P<0.05). The good pregnancy outcome group had lower S/D, PI, and RI values of the UA. The good pregnancy outcome group had higher S/D, PI, and RI values of the MCA (P<0.05). ROC curves revealed that the areas under curve of S/D, PI, and RI of the UA were 0.81, 0.76 and 0.74, respectively; the areas under curve of S/D, PI, and RI of the MCA were 0.82, 0.78 and 0.71, respectively.

CONCLUSION

The hemodynamic indexes of the UA and MCA can be used as a basis for evaluating fetal distress, which shows important clinical indications for gauging pregnancy outcome.

Nomogram-based prediction of pre-eclampsia in the first trimester of gestation

OBJECTIVES

Pre-eclampsia is a specific disease during gestation without a clear etiology. The lack of effective forecasting and prevention methods threatens the safety of maternal and infant lives.

STUDY DESIGN

We prospectively evaluated 356 pregnancies in their first trimester at the First Affiliated Hospital of Xi'an Jiaotong University and followed up the whole gestation.

MAIN OUTCOME MEASURES

Pre-eclampsia correlation parameters were subjected to dimensionality reduction analysis using the least absolute shrinkage and selection operator (LASSO) method.

RESULTS

Of the 356 pregnancies, 25 developed pre-eclampsia during late gestation. Sonographic parameters of the placenta, uterine artery, and umbilical artery were calculated using LASSO regression analysis. Five factors (vascularization and blood flow index of the placenta, peak systolic velocity and peak systolic to end-diastolic artery ratio of the left uterine artery, and pulse index of the umbilical artery) were applied in a final nomogram model. The fitting curve was closely correlated with the actual situation, with a C-index of 0.877.

CONCLUSIONS

The nomogram described here could be used to predict the risk of pre-eclampsia in pregnant women and provide strong support for early intervention.