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May RW, Maso Talou GD, Clark AR, Mynard JP, Smolich JJ, Blanco PJ, Müller LO, Gentles TL, Bloomfield FH, Safaei S. From fetus to neonate: A review of cardiovascular modeling in early life. WIREs Mech Dis 2023:e1608. [DOI: 10.1002/wsbm.1608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 01/31/2023] [Accepted: 03/03/2023] [Indexed: 04/03/2023]
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Diagnostic Tests in the Prediction of Neonatal Outcome in Early Placental Fetal Growth Restriction. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020406. [PMID: 36837607 PMCID: PMC9959018 DOI: 10.3390/medicina59020406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/12/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Abstract
Background and Objectives: Monitoring pregnancies with fetal growth restriction (FGR) presents a challenge, especially concerning the time of delivery in cases of early preterm pregnancies below 32 weeks. The aim of our study was to compare different diagnostic parameters in growth-restricted preterm neonates with and without morbidity/mortality and to determine sensitivity and specificity of diagnostic parameters for monitoring preterm pregnancies with early preterm fetal growth restriction below 32 weeks. Materials and Methods: Our clinical study evaluated 120 cases of early preterm deliveries, with gestational age ≤ 32 + 0 weeks, with prenatally diagnosed placental FGR. All the patients were divided into three groups of 40 cases each based on neonatal condition,: I-Neonates with morbidity/mortality (NMM); II-Neonates without morbidity with acidosis/asphyxia (NAA); III-Neonates without neonatal morbidity/acidosis/asphyxia (NWMAA). Results: Amniotic fluid index (AFI) was lower in NMM, while NWMAA had higher biophysical profile scores (BPS). UA PI was lower in NWMAA. NWMAA had higher MCA PI and CPR and fewer cases with CPR <5th percentile. NMM had higher DV PI, and more often had ductus venosus (DV) PI > 95th‱ or absent/reversed A wave, and pulsatile blood flow in umbilical vein (UV). The incidence of pathological fetal heart rate monitoring (FHRM) was higher in NMM and NAA, although the difference was not statistically significant. ROC calculated by defining a bad outcome as NMM and a good outcome as NAA and NWMAA showed the best sensitivity in DV PIi. ROC calculated by defined bad outcome in NMM and NAA and good outcome in NWMAA showed the best sensitivity in MCA PI. Conclusions: In early fetal growth restriction normal cerebral blood flow strongly predicts good outcomes, while pathological venous blood flow is associated with bad outcomes. In fetal growth restriction before 32 weeks, individualized expectant management remains the best option for the optimal timing of delivery.
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Emrani SE, Groene SG, Verweij EJ, Slaghekke F, Khalil A, Klink JMMV, Tiblad E, Lewi L, Lopriore E. Gestational Age at Birth and outcome in Monochorionic Twins with Different Types of Selective Fetal Growth Restriction: A Systematic Literature Review. Prenat Diagn 2022; 42:1094-1110. [PMID: 35808908 PMCID: PMC9543733 DOI: 10.1002/pd.6206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/15/2022] [Accepted: 07/03/2022] [Indexed: 11/09/2022]
Abstract
This systematic review aims to assess the gestational age at birth and perinatal outcome (intrauterine demise (IUD), neonatal mortality and severe cerebral injury) in monochorionic (MC) twins with selective fetal growth restriction (sFGR), according to Gratacós classification based on umbilical artery Doppler flow patterns in the smaller twin. Seventeen articles were included. Gestational age at birth varied from 33.0-36.0 weeks in type I, 27.6-32.4 weeks in type II, and 28.3-33.8 weeks in type III. IUD rate differed from 0-4% in type I to 0-40% in type II and 0-23% in type III. Neonatal mortality rate was between 0-10% in type I, 0-38% in type II, and 0-17% in type III. Cerebral injury was present in 0-2% of type I, 2-30% of type II and 0-33% of type III cases. The timing of delivery in sFGR varied substantially among studies, particularly in type II and III. The quality of evidence was moderate due to heterogenous study populations with varying definitions of sFGR and perinatal outcome parameters, as well as a lack of consensus on the use of the Gratacós classification, leading to substantial incomparability. Our review identifies the urgent need for uniform antenatal diagnostic criteria and definitions of outcome parameters. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Salma El Emrani
- Neonatology, Willem-Alexander Children's Hospital, Dept. of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sophie G Groene
- Neonatology, Willem-Alexander Children's Hospital, Dept. of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - E Joanne Verweij
- Fetal Medicine, Dept. of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Femke Slaghekke
- Fetal Medicine, Dept. of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Asma Khalil
- Fetal Medicine Unit, Dept. of Obstetrics, St George's Hospital, University of London, London, UK, Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of, UK; and Fetal Medicine Unit, Liverpool Women's Hospital, University of Liverpool, London, UK
| | - Jeanine M M van Klink
- Neonatology, Willem-Alexander Children's Hospital, Dept. of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Eleonor Tiblad
- Center for Fetal Medicine, Pregnancy Care and Delivery, Women´s Health, Karolinska University Hospital, and Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Liesbeth Lewi
- Fetal Medicine, Dept. of Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Enrico Lopriore
- Neonatology, Willem-Alexander Children's Hospital, Dept. of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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Prediction of Fetal Growth Restriction for Fetal Umbilical Arterial/Venous Blood Flow Index Evaluated by Ultrasonic Doppler under Intelligent Algorithm. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7451185. [PMID: 35633923 PMCID: PMC9135523 DOI: 10.1155/2022/7451185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/17/2022] [Accepted: 04/23/2022] [Indexed: 11/20/2022]
Abstract
The empirical wavelet transform (EWT) algorithm was applied in ultrasound to explore the predictive value for fetal growth restriction (FGR) in fetal arteriovenous indexes. 142 pregnant women who received prenatal ultrasonic examination and delivered were selected. They were classified into control group and FGR group. There were 102 patients with normal pregnancy in the control group, and 40 patients with delayed fetal growth in the FGR group. The extended triple collocation (ETC) algorithm was employed to divide the Fourier spectrum of signals adaptively, and the constructed small filter banks were classified into corresponding intervals. The instantaneous frequency was analyzed, and the arterial blood flow indexes of the two groups were compared. The results showed that the time-frequency analysis method under EWT had lower normalization error and higher accuracy. The inner diameter and cross-sectional area of FGR were remarkably smaller than those of the control group, and the differences were statistically significant (P < 0.05). There were no significant differences in mean blood flow and mean blood velocity between the control group and FGR group (P > 0.05). The arterial blood flow parameters of the systolic flow velocity (VS) and the diastolic flow velocity (VD) in the FGR group were notably lower than those in the control group, and the differences were significant (P < 0.05). In conclusion, the frequency principal component extracted by EWT algorithm was less disturbed by noise, which could accurately and effectively evaluate fetal arteriovenous blood flow indexes and predict FGR.
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Seravalli V, Masini G, Ponziani I, Di Tommaso M, Pasquini L. Ductus venosus Doppler assessment: do the results differ between the sagittal and the transverse approach? J Matern Fetal Neonatal Med 2022; 35:9661-9666. [PMID: 35282743 DOI: 10.1080/14767058.2022.2050364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare the ductus venosus (DV) pulsatility index for veins (PIV) obtained in a mid-sagittal plane with that obtained in an oblique transverse plane of the fetal abdomen. METHODS Prospective observational study in singleton uncomplicated pregnancies undergoing an ultrasound examination between 24 and 34 weeks of gestation. Pregnancies complicated by fetal anomalies, fetal growth restriction, or oligohydramnios were excluded. Two consecutive recordings of DV Doppler waveform were obtained in each woman: one in a mid-sagittal plane, and the other in an oblique transverse plane of the fetal abdomen. The peak velocity during ventricular systole (S-wave) and diastole (D-wave), the velocity during atrial contraction (a-wave), and the time-averaged maximum velocity (TAmax) were measured, and the PIV was calculated. The paired t-test was used to compare results obtained with the two approaches. A change of the DV-PIV of 0.10 or more was considered clinically relevant. RESULTS The DV waveform was successfully obtained in 53 women (mean gestational age 28.5 weeks). The mean DV-PIV was 0.57 (±0.16 SD) in the sagittal plane and 0.54 (±0.16 SD) in the transverse plane. The mean difference (0.03) was statistically significant (p = .04), but not clinically relevant. The sagittal S-, D-, and a-wave velocities and TAmax were significantly higher in the sagittal plane compared to the transverse plane, with an increase of 12, 8, 8, and 10%, respectively (p < .05). CONCLUSIONS The difference in the DV-PIV obtained in a mid-sagittal plane compared to a transverse plane of the fetal abdomen is small and not clinically significant. The higher DV flow velocities observed in the sagittal plane are likely the result of a better alignment with the vessel obtained using this plane. These findings have implications for clinical practice and for research.
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Affiliation(s)
- Viola Seravalli
- Division of Obstetrics and Gynecology, Department of Health Sciences, University of Florence, Florence, Italy.,Fetal Medicine Unit, Department of Obstetrics & Gynecology, Careggi University Hospital, Florence, Italy
| | - Giulia Masini
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, Careggi University Hospital, Florence, Italy
| | - Ilaria Ponziani
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, Careggi University Hospital, Florence, Italy
| | - Mariarosaria Di Tommaso
- Division of Obstetrics and Gynecology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Lucia Pasquini
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, Careggi University Hospital, Florence, Italy
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Abuhamad A, Martins JG, Biggio JR. Diagnosis and management of fetal growth restriction: the SMFM guideline and comparison with the ISUOG guideline. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:880-883. [PMID: 34077605 DOI: 10.1002/uog.23663] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Affiliation(s)
- A Abuhamad
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - J G Martins
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - J R Biggio
- Ochsner Health System, New Orleans, LA, USA
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Abramowicz JS. Obstetric ultrasound: where are we and where are we going? Ultrasonography 2020; 40:57-74. [PMID: 33105529 PMCID: PMC7758093 DOI: 10.14366/usg.20088] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/25/2020] [Indexed: 12/13/2022] Open
Abstract
Diagnostic ultrasound (DUS) is, arguably, the most common technique used in obstetrical practice. From A mode, first described by Ian Donald for gynecology in the late 1950s, to B mode in the 1970s, real-time and gray-scale in the early 1980s, Doppler a little later, sophisticated color Doppler in the 1990s and three dimensional/four-dimensional ultrasound in the 2000s, DUS has not ceased to be closely associated with the practice of obstetrics. The latest innovation is the use of artificial intelligence which will, undoubtedly, take an increasing role in all aspects of our lives, including medicine and, specifically, obstetric ultrasound. In addition, in the future, new visualization methods may be developed, training methods expanded, and workflow and ergonomics improved.
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Affiliation(s)
- Jacques S Abramowicz
- University of Chicago, Chicago, IL, USA.,World Federation for Ultrasound in Medicine and Biology, London, UK
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