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Yu S, Nair AG, Huang T, Melamed N, Mei Dan E, Aviram A. Bridging the notch: quantification of the end diastolic notch to better predict fetal growth restriction. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024. [PMID: 38295834 DOI: 10.1055/a-2257-8557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
PURPOSE We aimed to evaluate several quantitative methods to describe the diastolic notch (DN) and compare their performance in the prediction of fetal growth restriction. MATERIALS AND METHODS Patients who underwent a placental scan at 16-26 weeks of gestation and delivered between Jan 2016 and Dec 2020 were included. The uterine artery pulsatility index was measured for all of the patients. In patients with a DN, it was quantified using the notch index and notch depth index. Odds ratios for small for gestational age neonates (defined as birth weight <10th and <5th percentile) were calculated. Predictive values of uterine artery pulsatility, notch, and notch depth index for fetal growth restriction were calculated. RESULTS Overall, 514 patients were included, with 69 (13.4%) of them delivering a small for gestational age neonate (birth weight<10th percentile). Of these, 20 (20.9%) had a mean uterine artery pulsatility index >95th percentile, 13 (18.8%) had a unilateral notch, and 11 (15.9%) had a bilateral notch. 16 patients (23.2%) had both a high uterine artery pulsatility index (>95th percentile) and a diastolic notch. Comparison of the performance between uterine artery pulsatility, notch, and notch depth index using receiver operating characteristic curves to predict fetal growth restriction <10th percentile found area under the curve values of 0.659, 0.679, and 0.704, respectively, with overlapping confidence intervals. CONCLUSION Quantifying the diastolic notch at 16-26 weeks of gestation did not provide any added benefit in terms of prediction of neonatal birth weight below the 10th or 5th percentile for gestational age, compared with uterine artery pulsatility index.
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Affiliation(s)
- Sheila Yu
- DAN Women and Babies Program, Sunnybrook Health Sciences Centre, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Ananya Gopika Nair
- DAN Women and Babies Program, Sunnybrook Health Sciences Centre, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Tianhua Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of genetics, North York General Hospital, Toronto, Canada
| | - Nir Melamed
- DAN Women and Babies Program, Sunnybrook Health Sciences Centre, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Elad Mei Dan
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Obstetrics and Gynecology, North York General Hospital, Toronto, Canada
| | - Amir Aviram
- DAN Women and Babies Program, Sunnybrook Health Sciences Centre, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Schiermeier S, von Kaisenberg CS, Kehl S, Reister F, Mosimann B, Reif P, Harlfinger W, König K, Schwarz C, Matern E, Kühnert M, Schmitz R, Hoopmann M, Ramsell A, Kalberer BS, Heule PG, Heinzl S, Kayer B, Gruber P, Steiner H, Schäffer L. Fetal Assessment in Pregnancy (Indication and Methodology for Fetal Monitoring in a low-risk Population). Guideline of the DGGG, DEGUM, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/089, February 2023). ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:147-167. [PMID: 37582399 DOI: 10.1055/a-2113-7638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
PURPOSE The aim of this guideline was to find evidence on whether carrying out Doppler examinations and CTGs in low-risk cohorts of pregnant women improves outcomes. METHODS First, a systematic search for guidelines was carried out. Identified guidelines were evaluated using the DELPHI instrument of the AWMF. Three guidelines were found to be suitable to evaluate CTG. Two DEGUM best practice guidelines were judged suitable to describe the methods. All studies on this issue were additionally analyzed using 8 PICO questions. A structured consensus of the participating professional societies was achieved using a nominal group process and a structured consensus conference moderated by an independent moderator. RECOMMENDATIONS No antepartum Doppler sonography examinations should be carried out in low-risk cohorts in the context of antenatal care. No antepartum CTG should be carried out in low-risk cohorts. NOTE: The guideline will be published simultaneously in the official journals of both professional societies (i. e., Geburtshilfe und Frauenheilkunde for the DGGG and Ultraschall in der Medizin/European Journal of Ultrasound for the DEGUM).
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Affiliation(s)
- Sven Schiermeier
- Lehrstuhl für Frauenheilkunde und Geburtshilfe der Universität Witten/Herdecke, Marien-Hospital Witten, Witten, Germany
| | | | - Sven Kehl
- Gynecology and Obstetrics, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Frank Reister
- Sektion Geburtshilfe, Univ.-Frauenklinik, Univ.-Klinikum Ulm, Ulm, Germany
| | - Beatrice Mosimann
- University Women's Hospital, Department of Obstetrics, Inselspital, Bern, Switzerland
| | - Philipp Reif
- Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | | | - Klaus König
- Berufsverband der Frauenärzte, Eschborn, Germany
| | - Christiane Schwarz
- Institute of Health Sciences, Department of Midwifery Science, Universität zu Lübeck, Lübeck, Germany
| | - Elke Matern
- Medical Department, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Maritta Kühnert
- Geburtshilfe, Philipps-Universität Marburg, Marburg, Germany
| | - Ralf Schmitz
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Markus Hoopmann
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | | | | | | | | | - Beate Kayer
- Österreichisches Hebammengremium, Wien, Austria
| | | | - Horst Steiner
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Landeskrankenhaus Salzburg, Paracelsus, Salzburg, Austria
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Enakpene CA, Canci ME, Ventolini G. Obstetric vascular Doppler velocimetry: clinical applications and overuses. Minerva Obstet Gynecol 2023; 75:482-490. [PMID: 37140586 DOI: 10.23736/s2724-606x.23.05164-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
A safe and non-intrusive assessment of fetal health is not only crucial in low-risk gestations, but it is also the standard of care in high-risk pregnancies. Therefore, measuring blood flow across different vessels with non-invasive ultrasound methods has been accurately and painstakingly studied and published. Amongst these state-of-the-art techniques, umbilical artery (blood flow) Doppler velocimetry (UADV) has allowed for fetal well-being follow-ups and assess uteroplacental function, which obtains a more complete and clearer picture; particularly in regard to complicated pregnancies. Additionally, there are other modalities with diverse clinical applications that have emerged, including their clinical and research utilization in conditions such as fetal growth restriction (FGR), preeclampsia, fetal anemia, monochorionic twins vascular blood flow mismatch such as is in twin-to-twin transfusion syndrome, twin anemia polycythemia sequence, and twin reverse arterial perfusion sequence. Nevertheless, their applications regarding various other maternal-fetal diagnoses in the same way as premature births and/or multiple gestation surveillance have not been reported to hold strong clinical evidence. With that in regard, the purpose of this unique study was to give update of the multiple clinical applications of this very important obstetrical tool. Additionally, to review the pathophysiology as well as revisit their reported significant valid uses and occasional overuses. We also delved into quality control measures as related to the application of Doppler in obstetrics. Lastly, it is essential to look through and reflect on the future developments of this valuable, non-invasive, high-risk marvelous modern device.
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Affiliation(s)
- Christopher A Enakpene
- Maternal-Fetal Medicine, School of Medicine, Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Permian Basin, TX, USA
| | - Maria E Canci
- Department of Family Medicine, Texas Tech University Health Sciences Center, Permian Basin, TX, USA
| | - Gary Ventolini
- Maternal-Fetal Medicine, School of Medicine, Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Permian Basin, TX, USA -
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Schiermeier S, von Kaisenberg CS, Kehl S, Reister F, Mosimann B, Reif P, Harlfinger W, König K, Schwarz C, Matern E, Kühnert M, Schmitz R, Hoopmann M, Ramsell A, Kalberer BS, Heule PG, Heinzl S, Kayer B, Gruber P, Steiner H, Schaeffer L. Fetal Assessment in Pregnancy (Indication and Methodology for Fetal Monitoring in a Low-risk Population). Guideline of the DGGG, DEGUM, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/089, February 2023). Geburtshilfe Frauenheilkd 2023; 83:996-1016. [PMID: 37588256 PMCID: PMC10427199 DOI: 10.1055/a-2096-1182] [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: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 08/18/2023] Open
Abstract
Purpose The aim of this guideline was to find evidence on whether carrying out Doppler examinations and CTGs in low-risk cohorts of pregnant women improves outcomes. Methods First, a systematic search for guidelines was carried out. Identified guidelines were evaluated using the DELPHI instrument of the AWMF. Three guidelines were found to be suitable to evaluate CTG. Two DEGUM best practice guidelines were judged suitable to describe the methods. All studies on this issue were additionally analyzed using 8 PICO questions. A structured consensus of the participating professional societies was achieved using a nominal group process and a structured consensus conference moderated by an independent moderator. Recommendations No antepartum Doppler sonography examinations should be carried out in low-risk cohorts in the context of antenatal care. No antepartum CTG should be carried out in low-risk cohorts. Note The guideline will be published simultaneously in the official journals of both professional societies (i.e., Geburtshilfe und Frauenheilkunde for the DGGG and Ultraschall in der Medizin/European Journal of Ultrasound for the DEGUM).
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Affiliation(s)
- Sven Schiermeier
- Lehrstuhl für Frauenheilkunde und Geburtshilfe der Universität Witten/Herdecke, Marien-Hospital Witten, Witten, Germany
| | | | - Sven Kehl
- Gynecology & Obstetrics, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Frank Reister
- Sektion Geburtshilfe, Univ.-Frauenklinik, Univ.-Klinikum Ulm, Ulm, Germany
| | - Beatrice Mosimann
- University Womenʼs Hospital, Department of Obstetrics, Inselspital, Bern, Switzerland
| | - Philipp Reif
- Obstetrics & Gynecology, Medical University of Graz, Graz, Austria
| | | | - Klaus König
- Berufsverband der Frauenärzte, Eschborn, Germany
| | - Christiane Schwarz
- Institute of Health Sciences, Department of Midwifery Science, Universität zu Lübeck, Lübeck, Germany
| | - Elke Matern
- Medical Department, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Maritta Kühnert
- Geburtshilfe, Philipps-Universität Marburg, Marburg, Germany
| | - Ralf Schmitz
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Markus Hoopmann
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | | | | | | | | | - Beate Kayer
- Österreichisches Hebammengremium, Wien, Austria
| | | | - Horst Steiner
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Landeskrankenhaus Salzburg, Paracelsus, Salzburg, Austria
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Pecks U, Agel L, Doubek KJ, Hagenbeck C, Jennewein L, von Kaisenberg C, Kranke P, Leitner S, Mand N, Rüdiger M, Zöllkau J, Mingers N, Sitter M, Louwen F. SARS-CoV-2 in Pregnancy, Birth and Puerperium. Guideline of the DGGG und DGPM (S2k-Level, AWMF Registry Number 015/092, March 2022). Geburtshilfe Frauenheilkd 2023. [DOI: 10.1055/a-2003-5983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Abstract
Objective This S2k guideline of the German Society for Gynecology and Obstetrics (DGGG) and the German Society of Perinatal Medicine (DGPM) contains consensus-based recommendations for the care and treatment of pregnant women, parturient women, women who have recently given birth, and breastfeeding women with SARS-CoV-2 infection and their newborn infants. The aim of the guideline is to provide recommendations for action in the time of the COVID-19 pandemic for professionals caring for the above-listed groups of people.
Methods The PICO format was used to develop specific questions. A systematic targeted search of the literature was carried out using PubMed, and previously formulated statements and recommendations issued by the DGGG and the DGPM were used to summarize the evidence. This guideline also drew on research data from the CRONOS registry. As the data basis was insufficient for a purely evidence-based guideline, the guideline was compiled using an S2k-level consensus-based process. After summarizing and presenting the available data, the guideline authors drafted recommendations in response to the formulated PICO questions, which were then discussed and voted on.
Recommendations Recommendations on hygiene measures, prevention measures and care during pregnancy, delivery, the puerperium and while breastfeeding were prepared. They also included aspects relating to the monitoring of mother and child during and after infection with COVID-19, indications for thrombosis prophylaxis, caring for women with COVID-19 while they are giving birth, the presence of birth companions, postnatal care, and testing and monitoring the neonate during rooming-in or on the pediatric ward.
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Affiliation(s)
- Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Lena Agel
- Technische Hochschule Aschaffenburg, Hebammenkunde, Aschaffenburg, Germany
| | | | - Carsten Hagenbeck
- Geburtshilfe und Perinatalmedizin, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Lukas Jennewein
- Geburtshilfe und Pränatalmedizin, Universitätsklinikum Frankfurt Goethe-Universität, Frankfurt am Main, Germany
| | - Constantin von Kaisenberg
- Pränatalmedizin und Geburtshilfe im Perinatalzentrum, Universitätsklinik der Medizinischen Hochschule Hannover, Hannover, Germany
| | - Peter Kranke
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Sabine Leitner
- Bundesverband „Das frühgeborene Kind“ e. V., Frankfurt, Germany
| | - Nadine Mand
- Philipps-Universität Marburg, Zentrum für Kinder- und Jugendmedizin, Marburg, Germany
| | - Mario Rüdiger
- Klinik für Kinder- und Jugendmedizin, Fachbereich Neonatologie und pädiatrische Intensivmedizin, Medizinische Fakultät der TU Dresden, Dresden, Germany
| | - Janine Zöllkau
- Klinik für Geburtsmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Nina Mingers
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Magdalena Sitter
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Frank Louwen
- Geburtshilfe und Pränatalmedizin, Universitätsklinikum Frankfurt Goethe-Universität, Frankfurt am Main, Germany
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