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Kanagawa T, Ishii K, Yamamoto R, Sasahara J, Mitsuda N. Fetal Outcomes Associated with the Sequence of Doppler Deterioration in Severely Growth-Restricted Fetuses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2307-2315. [PMID: 33438784 DOI: 10.1002/jum.15614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/01/2020] [Accepted: 12/19/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Various patterns of Doppler deterioration exist in fetal growth restriction (FGR). However, the factors that differentiate these patterns are still unknown. The purpose of this study was to clarify the perinatal outcomes and factors to determine the pattern of Doppler deterioration in severe FGR. MATERIALS AND METHODS We conducted a retrospective cohort study of preterm severe FGR with Doppler abnormality, wherein the clinical features, including maternal characteristics, medical history, and sonographic findings, were compared between the patterns of Doppler deterioration. We used the multivariable logistic regression analyses to identify the factors associated with the pattern of Doppler deterioration. RESULTS Of 322 eligible fetuses, 143 had Doppler abnormalities. Fetuses with Doppler deterioration from ductus venosus uniquely featured fetal and placental-umbilical abnormalities detected after birth. Gestational age (GA) at diagnosis of FGR and at the first diagnosis of Doppler abnormality in fetuses with Doppler deterioration from middle cerebral artery (MCA) were later than those from umbilical artery. In addition, the factor associated with Doppler deterioration from MCA was 31-week GA at the first diagnosis of Doppler abnormality (adjusted odds ratio [aOR]: 26.7; 95% CI: 8.35-103), not GA at diagnosis of FGR (aOR: 1.82; 95% CI: 0.50-5.96). CONCLUSIONS Characteristics of each Doppler deterioration pattern might reflect FGR etiology. Undetectable anomalies and umbilical-placental abnormalities were found in fetuses with Doppler deterioration from the ductus venosus. Doppler deterioration from the MCA was observed after 31 weeks of gestation not only in the late-onset FGR but also in the early-onset FGR with normal umbilical artery Doppler findings.
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Affiliation(s)
- Takeshi Kanagawa
- Osaka Women's and Children's Hospital, Department of Maternal-Fetal Medicine, Osaka, Japan
| | - Keisuke Ishii
- Osaka Women's and Children's Hospital, Department of Maternal-Fetal Medicine, Osaka, Japan
| | - Ryo Yamamoto
- Osaka Women's and Children's Hospital, Department of Maternal-Fetal Medicine, Osaka, Japan
| | - Jun Sasahara
- Osaka Women's and Children's Hospital, Department of Maternal-Fetal Medicine, Osaka, Japan
| | - Nobuaki Mitsuda
- Osaka Women's and Children's Hospital, Department of Maternal-Fetal Medicine, Osaka, Japan
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Weichert J, Weichert A. A 'holistic' sonographic view on congenital heart disease - How automatic reconstruction using fetal intelligent navigation echocardiography (FINE) eases the unveiling of abnormal cardiac anatomy part I: Right heart anomalies. Echocardiography 2021; 38:1430-1445. [PMID: 34232534 DOI: 10.1111/echo.15134] [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: 09/18/2020] [Revised: 04/18/2021] [Accepted: 06/01/2021] [Indexed: 11/28/2022] Open
Abstract
Attempting a comprehensive examination of the fetal heart remains challenging for unexperienced operators as it emphasizes the acquisition and documentation of sequential cross-sectional and sagittal views and inevitably results in diminished detection rates of fetuses affected by congenital heart disease. The introduction of four-dimensional spatio-temporal image correlation (4D STIC) technology facilitated a volumetric approach for thorough cardiac anatomic evaluation by the acquisition of cardiac 4D datasets. By analyzing and re-arranging of numerous frames according to their temporal event within the heart cycle, STIC allows visualization of cardiac structures as an endless cine loop sequence of a complete single cardiac cycle in motion. However, post-analysis with manipulation and repeated slicing of the volume usually requires experience and in-depth anatomic knowledge, which limits the widespread application of this advanced technique in clinical care and unfortunately leads to the underestimation of its diagnostic value to date. Fetal intelligent navigation echocardiography (FINE), a novel method that automatically generates and displays nine standard fetal echocardiographic views in normal hearts, has shown to be able to overcome these limitations. Very recent data on the detection of congenital heart defects (CHDs) using the FINE method revealed a high sensitivity and specificity of 98% and 93%, respectively. In this two-part manuscript, we focused on the performance of FINE in delineating abnormal anatomy of typical right and left heart lesions and thereby emphasized the educational potential of this technology for more than just teaching purposes. We further discussed recent findings in a pathophysiological and/or functional context.
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Affiliation(s)
- Jan Weichert
- Department of Gynecology & Obstetrics, Division of Prenatal Medicine, Campus Luebeck, University Hospital of Schleswig-Holstein, Luebeck, Schleswig-Holstein, Germany
| | - Alexander Weichert
- Elbe Center of Prenatal Medicine and Human Genetics, Hamburg, Germany.,Department of Obstetrics, Charité-Universitätsmedizin Berlin - CCM, Berlin, Germany.,Prenatal Medicine Bergmannstrasse, Berlin, Germany
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Wang S, Freud LR, Detterich J, Moon-Grady AJ, Donofrio MT, Jaeggi ET, Szwast AL, Morris SA, Kavanaugh-Mchugh A, Howley LW, van der Velde ME, Cuneo BF, Phoon CK, Tworetzky W, Pruetz JD. Extracardiac Doppler indices predict perinatal mortality in fetuses with Ebstein anomaly and tricuspid valve dysplasia. Prenat Diagn 2021; 41:332-340. [PMID: 33242215 DOI: 10.1002/pd.5873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Ebstein anomaly and tricuspid valve dysplasia (EA/TVD) carry high perinatal mortality. Past studies have focused on cardiac predictors of mortality; we sought to describe the fetal echo (FE) extracardiac Dopplers in this cohort and determine their association with perinatal mortality. METHOD Fetuses with EA/TVD at 23 centers from 2005-2011 were included for retrospective study. Doppler pattern and velocity of the umbilical artery (UA), umbilical vein (UV), ductus venosus (DV), and middle cerebral artery (MCA) were collected. Bivariate and multivariate analyzes were performed. The primary outcome measure was perinatal mortality, defined as fetal demise or neonatal death. RESULTS Of 190 cases that met eligibility criteria, alterations were seen in 50% of UA, 16% of UV, 48% of DV, and 8% of MCA Doppler indices on the last FE (median 27.4 weeks). Independent predictors of perinatal mortality included abnormal UA Doppler pattern of absence or reversed end diastolic flow (OR 9.7) and UV velocity z score <1 (OR 2.5), in addition to diagnosis <32 weeks (OR 4.2) and tricuspid valve (TV) annulus z score ≥6 (OR 5.3). CONCLUSION Abnormal UA Doppler pattern and decreased UV velocity are independent predictors of perinatal mortality in EA/TVD fetuses and should be used to refine mortality risk and guide perinatal management.
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Affiliation(s)
- Shuo Wang
- Department of Pediatrics, Division of Cardiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Lindsay R Freud
- Department of Pediatrics, Division of Cardiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jon Detterich
- Department of Pediatrics, Division of Cardiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Anita J Moon-Grady
- Department of Pediatrics, Division of Cardiology, Benioff Children's Hospital, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Mary T Donofrio
- Department of Pediatrics, Division of Cardiology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Edgar T Jaeggi
- Department of Pediatrics, Division of Cardiology, Hospital for Sick Children, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Anita L Szwast
- Department of Pediatrics, Division of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Shaine A Morris
- Department of Pediatrics, Division of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Ann Kavanaugh-Mchugh
- Department of Pediatrics, Division of Cardiology, Monroe Carell Jr. Children's Hospital, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Lisa W Howley
- Department of Pediatrics, Division of Cardiology, The Children's Heart Clinic and Children's Minnesota, Minnesota, USA
| | - Mary E van der Velde
- Department of Pediatrics, Division of Cardiology, C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Bettina F Cuneo
- Department of Pediatrics, Division of Cardiology, The Children's Heart Clinic and Children's Minnesota, Minnesota, USA
| | - Colin K Phoon
- Department of Pediatrics, Division of Cardiology, Hassenfeld Children's Hospital at NYU Langone, New York University School of Medicine, New York, New York, USA
| | - Wayne Tworetzky
- Department of Pediatrics, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jay D Pruetz
- Department of Pediatrics, Division of Cardiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
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Eraslan Sahin M, Sahin E, Col Madendag I, Madendag Y, Acmaz G, Ozdemir F, Kırlangıç MM, Muderris II. Evaluation of midtrimester ductus venosus diameter and peak systolic velocity to predict late onset small for gestational age fetuses. J Matern Fetal Neonatal Med 2020; 35:3984-3990. [PMID: 33190543 DOI: 10.1080/14767058.2020.1846175] [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: 10/23/2022]
Abstract
OBJECTIVE The ductus venosus, a small blood vessel in the fetal venous system, has extraordinary physiologic significance because it connects the umbilical vein to the inferior vena cava in the fetus circulation system and transports highly oxygenated blood from the placenta to the fetus' heart. Hence, assessment of ductus venosus flows is helpful in evaluating fetal hemodynamics. Considering the critical function of the ductus venosus, we hypothesized that the diameter of the midtrimester ductus venosus and its peak velocity index can be related to adequate fetal growth; therefore, the aim of this study was to evaluate the role of the midtrimester umbilical venous blood flow, ductus venosus diameter, and ductus venosus peak systolic velocity to help predict uncomplicated deliveries of late onset small for gestational age (SGA) fetuses. METHODS In this prospective study we analyzed the pregnancies and deliveries of 398 pregnant women who met the inclusion criteria and divided them into three groups according to fetal birth weight as follows: birth weight <3 percentile SGA group (n = 16), birth weight 3-10 percentile SGA group (n = 42), and appropriate for the gestational age (AGA) group (n = 340). The midtrimester ductus venosus diameter and peak sistolic velocity, umbilical venous blood flow, and umbilical artery pulsatility index (PI) were recorded. In the absence of congenital anomalies, the diagnosis of fetal growth restriction (FGR) is made according to Delphi consensus criteria. In the absence of abnormal Doppler findings, late FGR was defined as occurring ≥32 weeks. RESULTS Maternal age, nulliparity, mean gestational age at ultrasound evaluation, ethnicity, body mass index, and previous cesarean delivery rates were similar among the groups. In addition, mid-trimester fetal biometric measurements and amniotic fluid volume were similar among the groups. The gestational age at delivery, prematurity, fetal birth weight, vaginal delivery rates, and rate of admission to the neonatal intensive care unit were significantly different among the groups. The mean mid-trimester umbilical vein blood flow to abdominal circumference ratio (UVBF/AC) was similar among the groups (p=.740). In the <3 group, the mean peak systolic velocity of the ductus venosus was significantly lower and the mean diameter of the ductus venosus significantly higher than those in the 3-10 and AGA groups (both p<.001). Although the values are below the 95th percentile mid-trimester umbilical artery PI was significantly higher in the <3 percentile SGA group than in the 3-10 percentile SGA and AGA groups. CONCLUSION Our results suggest that the diameter and peak systolic velocity of the mid-trimester ductus venosus are useful noninvasive measurements that provide prediction of late onset SGA fetuses.
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Affiliation(s)
| | - Erdem Sahin
- Department of Obstetrics and Gynecology, Erciyes University Medicine Faculty, Kayseri, Turkey
| | - Ilknur Col Madendag
- Department of Obstetrics and Gynecology, Kayseri City Hospital, Kayseri, Turkey
| | - Yusuf Madendag
- Department of Obstetrics and Gynecology, Erciyes University Medicine Faculty, Kayseri, Turkey
| | - Gokhan Acmaz
- Department of Obstetrics and Gynecology, Erciyes University Medicine Faculty, Kayseri, Turkey
| | - Fatma Ozdemir
- Department of Obstetrics and Gynecology, Erciyes University Medicine Faculty, Kayseri, Turkey
| | - Mehmet Mete Kırlangıç
- Department of Obstetrics and Gynecology, Tuzla Government Hospital, İstanbul, Turkey
| | - Iptisam Ipek Muderris
- Department of Obstetrics and Gynecology, Erciyes University Medicine Faculty, Kayseri, Turkey
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Suksai M, Suwanrath C, Kor-Anantakul O, Geater A. Time Interval Measurements of the Ductus Venosus During the Early Second Trimester of Pregnancy: Reference Ranges and Clinical Application. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:745-753. [PMID: 28948639 DOI: 10.1002/jum.14409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The aims of this study were to construct reference ranges for the time interval parameters of the ductus venosus during the early second trimester of pregnancy and to demonstrate the clinical utility in various fetal disorders. METHODS The ductus venosus Doppler measurements of 331 healthy fetuses between 15 and 22 weeks' gestation were analyzed. The systolic time and diastolic time were subdivided into the systolic acceleration time, systolic deceleration time, diastolic acceleration time, and diastolic deceleration time. The median, 5th, and 95th regression lines for each variable were determined according to gestational age. The ductus venosus time interval parameters in cases of fetoplacental abnormalities were calculated and plotted against the reference ranges. RESULTS With advancing gestation, the systolic acceleration time and total systolic time increased significantly (P < .001). In contrast to the systolic phase, the diastolic deceleration time decreased significantly during the early second trimester of pregnancy (P = .023). The systolic deceleration time, diastolic acceleration time, and diastolic time were relatively constant. Fetuses with tricuspid insufficiency, twin-twin transfusion syndrome, intrauterine fetal growth restriction, and anemia had abnormal ductus venosus times with different patterns. CONCLUSIONS Predicted normal reference ranges for time interval variables in relation to gestational age were established. These could be helpful for assessing fetal cardiovascular function during the early second trimester of pregnancy.
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Affiliation(s)
- Manaphat Suksai
- Maternal and Fetal Medicine Unit, Department of Obstetrics and Gynecology
| | | | | | - Alan Geater
- Epidemiology Unit , Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Seravalli V, Miller JL, Block-Abraham D, Baschat AA. Ductus venosus Doppler in the assessment of fetal cardiovascular health: an updated practical approach. Acta Obstet Gynecol Scand 2016; 95:635-44. [PMID: 26946331 DOI: 10.1111/aogs.12893] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/01/2016] [Indexed: 12/14/2022]
Abstract
The ductus venosus has a central role in the distribution of highly oxygenated umbilical venous blood to the heart. Its waveform is related to the pressure-volume changes in the cardiac atria and it is therefore important in the monitoring of any fetal condition that may affect forward cardiac function. The cardiovascular parameters that can influence forward cardiac function include afterload, myocardial performance and preload. Decreased forward flow during atrial systole (a-wave) is the most sensitive and ubiquitous finding when any of these parameters is affected. In contrast, decreased forward velocities during end-systolic relaxation (v-wave) are more specifically related to myocardial performance. The ductus venosus pulsatility index alone does not accurately reflect cardiac function, and in cases of suspected fetal cardiac dysfunction, echocardiography is required to identify the underlying mechanism. The role of ductus venosus Doppler in the assessment of fetal growth restriction, supraventricular tachycardia, fetal hydrops, complicated monochorionic twins and congenital heart disease is discussed with these considerations in mind.
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Affiliation(s)
- Viola Seravalli
- The Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jena L Miller
- The Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Dana Block-Abraham
- The Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Ahmet A Baschat
- The Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, MD, USA
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