1,008 results on '"Fetal heart"'
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2. Diagnostic quality of 3Tesla postmortem magnetic resonance imaging in fetuses with and without congenital heart disease
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Dana A. Muin, Anke Scharrer, Daniel Zimpfer, Vanessa Berger-Kulemann, Daniela Prayer, Barbara Ulm, Michael Weber, and G.O. Dovjak
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Heart Defects, Congenital ,Male ,medicine.medical_specialty ,Heart disease ,Perinatal Death ,Coarctation of the aorta ,Prenatal diagnosis ,Autopsy ,Sensitivity and Specificity ,Ultrasonography, Prenatal ,03 medical and health sciences ,0302 clinical medicine ,Fetal Heart ,Fetus ,medicine ,Medical imaging ,Humans ,030212 general & internal medicine ,Fetal Death ,Tetralogy of Fallot ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Magnetic resonance imaging ,medicine.disease ,Magnetic Resonance Imaging ,Female ,Radiology ,business ,Hypoplastic right heart syndrome - Abstract
Postmortem confirmation of prenatally diagnosed congenital heart disease after termination of pregnancy and evaluation of potential cardiac defects after spontaneous fetal or neonatal death are essential. Conventional autopsy rates are decreasing, and 1.5Tesla magnetic resonance imaging has demonstrated limited diagnostic accuracy for postmortem cardiovascular assessment.This study aimed to evaluate the feasibility and image quality of cardiac 3Tesla postmortem magnetic resonance imaging and to assess its diagnostic accuracy in detecting fetal heart defects compared with conventional autopsy. Secondarily, the study aimed to explore whether clinical factors affect the quality of 3Tesla postmortem magnetic resonance imaging.A total of 222 consecutive fetuses between 12 and 41 weeks' gestation, who underwent 3Tesla postmortem magnetic resonance imaging and conventional autopsy after spontaneous death or termination of pregnancy for fetal malformations, were included. First, 3Tesla postmortem magnetic resonance imaging of each fetus was rated as diagnostic or nondiagnostic for fetal cardiac assessment by 2 independent raters. The image quality of individual cardiac structures was then further evaluated by visual grading analysis. Finally, the presence or absence of a congenital heart defect was assessed by 2 radiologists and compared with autopsy results.Overall, 87.8% of 3Tesla postmortem magnetic resonance imaging examinations were rated as diagnostic for the fetal heart. Diagnostic imaging rates of individual cardiac structures at 3Tesla postmortem magnetic resonance imaging ranged from 85.1% (atrioventricular valves) to 94.6% (pericardium), with an interrater agreement of 0.82 (0.78-0.86). Diagnostic imaging of the fetal aortic arch and the systemic veins at 3Tesla postmortem magnetic resonance imaging was possible from 12+5 weeks' gestation onward in 90.1% and 92.3% of cases, respectively. A total of 55 fetuses (24.8%) had at least 1 cardiac anomaly according to autopsy, 164 (73.9%) had a normal heart, and in 3 fetuses (1.4%), autopsy was nondiagnostic for the heart. Considering all examinations rated as diagnostic, 3Tesla postmortem magnetic resonance imaging provided high diagnostic accuracy for the detection of fetal congenital heart defects with a sensitivity of 87.8%, a specificity of 97.9%, and concordance with autopsy of 95.3%. 3Tesla postmortem magnetic resonance imaging was less accurate in young fetuses (20 weeks compared with ≥20 weeks; P.001), in fetuses with low birthweight (≤100 g compared with100 g; P.001), in cases after spontaneous fetal death (compared with other modes of death; P=.012), in cases with increasing latency between death and 3Tesla postmortem magnetic resonance imaging (P.001), and in cases in which there was a high degree of maceration (maceration score of 3 compared with a score from 0 to 2; P=.004).Diagnostic 3Tesla postmortem magnetic resonance imaging assessment of the fetal heart is feasible in most fetuses from 12 weeks' gestation onward. In diagnostic images, sensitivity and, particularly, specificity in the detection of congenital heart disease are high compared with conventional autopsy. Owing to its high diagnostic accuracy, we suggest that 3Tesla postmortem magnetic resonance imaging may serve as a suitable imaging modality with which to direct a targeted conventional autopsy when pathology resources are limited or to provide a virtual autopsy when full autopsy is declined by the parents.
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- 2020
3. Special statement: Proposed quality metrics to assess accuracy of prenatal detection of congenital heart defects
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C. Andrew Combs, Afshan B. Hameed, Iffath A. Hoskins, and Alexander M. Friedman
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Heart Defects, Congenital ,medicine.medical_specialty ,Quality management ,media_common.quotation_subject ,Prenatal diagnosis ,Prenatal care ,Sensitivity and Specificity ,Ultrasonography, Prenatal ,03 medical and health sciences ,Prenatal ultrasound ,0302 clinical medicine ,Fetal Heart ,Pregnancy ,Medicine ,Humans ,Quality (business) ,False Positive Reactions ,030212 general & internal medicine ,Prospective Studies ,Intensive care medicine ,False Negative Reactions ,media_common ,Quality Indicators, Health Care ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Neonatal morbidity ,Female ,Metric (unit) ,business ,Pediatric cardiology - Abstract
Congenital heart defects are a leading cause of neonatal morbidity and mortality. Accurate prenatal diagnosis of congenital heart defects can reduce morbidity and mortality by improving prenatal care, facilitating predelivery pediatric cardiology consultation, and directing delivery to facilities with resources to manage the complex medical and surgical needs of newborns with congenital heart defects. Unfortunately, less than one half of congenital heart defect cases are detected prenatally, resulting in lost opportunities for counseling, shared decision-making, and delivery at an appropriate facility. Quality improvement initiatives to improve prenatal congenital heart defects detection depend on the ability to measure the rate of detection at the level of providers, facilities, or populations, but no standard metric exists for measuring the detection of congenital heart defects at any level. The need for such a metric was recognized at a Cooperative Workshop held at the 2016 Annual Meeting of the Society for Maternal-Fetal Medicine, which recommended the development of a quality metric to assess the rate of prenatal detection of clinically significant congenital heart defects. In this paper, we propose potential quality metrics to measure prenatal detection of critical congenital heart defects, defined as defects with a high rate of morbidity or mortality or that require surgery or tertiary follow-up. One metric is based on a retrospective approach, assessing whether postnatally diagnosed congenital heart defects had been identified prenatally. Other metrics are based on a prospective approach, assessing the sensitivity and specificity of prenatal diagnosis of congenital heart defects by comparing prenatal ultrasound findings with newborn findings. Potential applications, limitations, challenges, barriers, and value for both approaches are discussed. We conclude that future development of these metrics will depend on an expansion of the International Classification of Diseases system to include specific codes that distinguish fetal congenital heart defects from newborn congenital heart defects and on the development of record systems that facilitate the linkage of fetal records (in the maternal chart) with newborn records.
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- 2020
4. Paired maternal and fetal cardiac functional measurements in women with gestational diabetes mellitus at 35-36 weeks' gestation
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Jesica Aguilera, John M. Simpson, Kypros H. Nicolaides, Georgios Georgiopoulos, Janina Semmler, Marietta Charakida, and Carla Coronel
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Adult ,medicine.medical_specialty ,Offspring ,Systole ,Pregnancy Trimester, Third ,Disease ,Ultrasonography, Prenatal ,Ventricular Function, Left ,Obesity, Maternal ,03 medical and health sciences ,0302 clinical medicine ,Fetal Heart ,Diastole ,Pregnancy ,medicine ,Humans ,030212 general & internal medicine ,Subclinical infection ,Fetus ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,Functional measurement ,Heart ,medicine.disease ,Echocardiography, Doppler ,Gestational Weight Gain ,Gestational diabetes ,Diabetes, Gestational ,Echocardiography ,Case-Control Studies ,Gestation ,Female ,business ,Fetal echocardiography - Abstract
Background Gestational diabetes mellitus is associated with early-onset cardiovascular disease and increased incidence of adverse cardiovascular outcomes in mothers and their offspring. Few studies with a limited number of patients have reported subclinical cardiac changes in association with gestational diabetes mellitus; however, it remains unclear whether the mother and the fetus respond in a similar fashion to gestational diabetes mellitus; thus, by assessing the heart of one, we can estimate or predict changes in the other. Objective This study aimed to compare maternal and fetal cardiovascular functions in the third trimester between women with gestational diabetes mellitus and women with uncomplicated pregnancy and to explore whether gestational diabetes mellitus affects to the same extent the maternal and fetal heart. Study Design This was a cross-sectional study of maternal and fetal echocardiography for assessment of cardiovascular function in the third trimester in women with singleton pregnancies who received a diagnosis of gestational diabetes mellitus and the control group with uncomplicated pregnancies. Results In this study, we included 161 women with gestational diabetes mellitus and 483 women with uncomplicated pregnancies. Compared with women in the control group, women with gestational diabetes mellitus were older (34.5, standard deviation, 5.3 years] vs 32.5, standard deviation, 4.8 years]; P Conclusion In the third trimester, in pregnancies with gestational diabetes mellitus, there were subclinical cardiac changes in both the mother and the fetus, but there was no significant difference in any of the fetal cardiac parameters between women with and women without unfavorable cardiac profile. This suggests that the stimulus for cardiovascular responses in the mother and fetus may not be the same in pregnancies with gestational diabetes mellitus.
- Published
- 2020
5. Brainstem and cerebellar volumes at magnetic resonance imaging are smaller in fetuses with congenital heart disease.
- Author
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Dovjak GO, Hausmaninger G, Zalewski T, Schmidbauer V, Weber M, Worda C, Seidl-Mlczoch E, Berger-Kulemann V, Prayer D, Kasprian GJ, and Ulm B
- Subjects
- Brain pathology, Brain Stem diagnostic imaging, Case-Control Studies, Cerebellum diagnostic imaging, Female, Fetus pathology, Gestational Age, Humans, Magnetic Resonance Imaging methods, Pregnancy, Retrospective Studies, Heart Defects, Congenital complications, Tetralogy of Fallot complications, Tetralogy of Fallot pathology, Transposition of Great Vessels
- Abstract
Background: Congenital heart disease is associated with an increased risk of smaller brain volumes and structural brain damage, and impaired growth of supratentorial brain structures in utero has been linked to poor neurodevelopmental outcomes. However, little is known on brainstem and cerebellar volumes in fetuses with congenital heart disease. Moreover, it is not clear whether impaired infratentorial growth, if present, is associated with only certain types of fetal cardiac defects or with supratentorial brain growth, and whether altered biometry is already present before the third trimester., Objective: This study aimed to investigate brainstem and cerebellar volumes in fetuses with congenital heart disease and to compare them to infratentorial brain volumes in fetuses with normal hearts. Secondarily, the study aimed to identify associations between infratentorial brain biometry and the type of cardiac defects, supratentorial brain volumes, and gestational age., Study Design: In this retrospective case-control study, 141 magnetic resonance imaging studies of 135 fetuses with congenital heart disease and 141 magnetic resonance imaging studies of 125 controls with normal hearts at 20 to 37 gestational weeks (median, 25 weeks) were evaluated. All cases and controls had normal birthweight and no evidence of structural brain disease or genetic syndrome. Six types of congenital heart disease were included: tetralogy of Fallot (n=32); double-outlet right ventricle (n=22); transposition of the great arteries (n=27); aortic obstruction (n=24); hypoplastic left heart syndrome (n=22); and hypoplastic right heart syndrome (n=14). First, brainstem and cerebellar volumes of each fetus were segmented and compared between cases and controls. In addition, transverse cerebellar diameters, vermian areas, and supratentorial brain and cerebrospinal fluid volumes were quantified and differences assessed between cases and controls. Volumetric differences were further analyzed according to types of cardiac defects and supratentorial brain volumes. Finally, volume ratios were created for each brain structure ([volume in fetus with congenital heart disease/respective volume in control fetus] × 100) and correlated to gestational age., Results: Brainstem (cases, 2.1 cm
3 vs controls, 2.4 cm3 ; P<.001) and cerebellar (cases, 3.2 cm3 vs controls, 3.4 cm3 ; P<.001) volumes were smaller in fetuses with congenital heart disease than in controls, whereas transverse cerebellar diameters (P=.681) and vermian areas (P=.947) did not differ between groups. Brainstem and cerebellar volumes differed between types of cardiac defects. Overall, the volume ratio of cases to controls was 80.8% for the brainstem, 90.5% for the cerebellum, and 90.1% for the supratentorial brain. Fetuses with tetralogy of Fallot and transposition of the great arteries were most severely affected by total brain volume reduction. Gestational age had no effect on volume ratios., Conclusion: The volume of the infratentorial brain, which contains structures considered crucial to brain function, is significantly smaller in fetuses with congenital heart disease than in controls from midgestation onward. These findings suggest that impaired growth of both supra- and infratentorial brain structures in fetuses with congenital heart disease occurs in the second trimester. Further research is needed to elucidate associations between fetal brain volumes and neurodevelopmental outcomes in congenital heart disease., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)- Published
- 2022
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6. 953: Distribution of ductus venosus blood flow using computational fluid dynamics on fetal heart virtual models
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Lucille E. Anzia, Katrina L. Ruedinger, Barbara Trampe, Ryan Pewowaruk, Timothy Heiser, Alejandro Roldán-Alzate, and J. Igor Iruretagoyena
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medicine.medical_specialty ,business.industry ,Internal medicine ,Cardiology ,Obstetrics and Gynecology ,Medicine ,Distribution (pharmacology) ,Fetal heart ,Blood flow ,Computational fluid dynamics ,business ,Ductus venosus - Published
- 2020
7. Size and shape of the four-chamber view of the fetal heart in fetuses with an estimated fetal weight less than the tenth centile
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Greggory R. DeVore, Camille Driver, Annabelle Wilcox, Diane L. Gumina, Michael V. Zaretsky, and John C. Hobbins
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Male ,medicine.medical_specialty ,Middle Cerebral Artery ,Intrauterine growth restriction ,Fetal heart ,Ultrasonography, Prenatal ,Umbilical Arteries ,03 medical and health sciences ,0302 clinical medicine ,Fetal Heart ,Pregnancy ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Retrospective Studies ,Fetus ,030219 obstetrics & reproductive medicine ,Fetal Growth Retardation ,medicine.diagnostic_test ,business.industry ,Obstetrics and Gynecology ,Ultrasonography, Doppler ,Fetal weight ,medicine.disease ,Case-Control Studies ,Pulsatile Flow ,Cardiology ,Gestation ,Small for gestational age ,Female ,business ,Fetal echocardiography - Abstract
Background Fetuses with an estimated fetal weight (EFW) th centile have an increased risk for adverse perinatal and long-term outcomes as well as increased rates of cardiac dysfunction which often alters cardiac size and shape of the 4-chamber view and the individual ventricles. As a result, a simple method has emerged to screen for potential cardiac dysfunction in fetuses with EFWs th centile by measuring the size and shape of the 4-chamber view (4CV) and the size of the ventricles. Objective Determine the number of fetuses with an abnormal size and shape of the 4CV and size of the ventricles in fetuses with an EFW th centile. Study Design This was a retrospective study of 50 fetuses between 25 and 37 weeks of gestation with an EFW th centile. Data from their last examination were analyzed. From an end-diastolic image of the 4CV the largest basal-apical length and transverse width were measured from their corresponding epicardial borders. This allowed the 4CV area and global sphericity index (4CV length/4CV width) to be computed. In addition, tracing along the endocardial borders with speckle tracking software enabled measurements of the right and left ventricular chamber areas and the RV /LV area ratios to be computed. Doppler waveform pulsatility indices from the umbilical (UAPI) and middle cerebral arteries (MCAPI) were analyzed, and the cerebroplacental ratio (CPR) computed (MCAPI/UAPI). UAPIs > 90 th and CPRs th % were considered abnormal. Using data from the control fetuses, the centile for each of the cardiac measurements was categorized by whether it was th or >90 th centile, depending upon the measurement. Results Of the 50 fetuses with EFWs th centile, 50% (N=25) had a normal UAPI and CPR. These fetuses had significantly more (P 90 th centile, 32% had a 4CV global sphericity index th centile, 56% had a 4CV width >90 th centile, and 80% had one or more abnormalities of size and/or shape. The remaining 50% of fetuses (N=25) had abnormalities of one or both for the UAPI and/or CPR. These fetuses had significantly higher rates of abnormalities (P 90 th centile; 28% had a 4CV global sphericity index th centile; 68% had a 4CV width >90 th centile. Only those with an abnormal UAPI had significant changes in ventricular size; 56% had a LV area th centile; 28% had a RV area th centile; 36% had RV/LV area ratio >90 th centile. One or more of the above abnormal measurements were present in 92% of fetuses. Conclusions Higher rates of abnormalities of cardiac size and shape of the 4CV were found in fetuses with EFW th centile, regardless of their UAPI and CPR measurements. Those with a normal UAPI and abnormal CPR had larger and wider measurements of the 4CV. In addition, the shape of the 4CV was more globular or round than controls. These fetuses may have an increased risk for perinatal complications and childhood and/or adult cardiovascular disease. Screening tools derived from the 4CV, acting as surrogates for ventricular dysfunction, may identify fetuses who could benefit from further comprehensive testing and future preventive interventions.
- Published
- 2019
8. 139 Cessation of hyperoxygenation for category II fetal heart tracings: a quality improvement study
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Vincenzo Berghella, Daniel Duncan, Julia Burd, Johanna Quist-Nelson, Jason K. Baxter, and Kathryn Anderson
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medicine.medical_specialty ,Poster Session I ,Quality management ,Text mining ,Thursday, January 28, 2021 • 1:30 PM - 2:30 PM ,business.industry ,Internal medicine ,medicine ,Cardiology ,Obstetrics and Gynecology ,Fetal heart ,business - Published
- 2021
9. Maternal azithromycin therapy for Ureaplasma parvum intraamniotic infection improves fetal hemodynamics in a nonhuman primate model
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Ji Yeon Lee, Irina Burd, Meredith A. Kelleher, Victoria H. J. Roberts, Juha Rasanen, Terry K. Morgan, Christopher M. Novak, Ahmet A. Baschat, Miles J. Novy, Antonio E. Frias, Department of Obstetrics and Gynecology, HUS Gynecology and Obstetrics, Helsinki University Hospital Area, and University of Helsinki
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Middle Cerebral Artery ,030204 cardiovascular system & hematology ,Chorioamnionitis ,Ureaplasma ,Doppler ultrasound ,Umbilical Arteries ,0302 clinical medicine ,Pregnancy ,3123 Gynaecology and paediatrics ,Ductus arteriosus ,Cardiac Output ,Pregnancy Complications, Infectious ,Aorta ,RISK ,azithromycin ,030219 obstetrics & reproductive medicine ,TEI INDEX ,Obstetrics and Gynecology ,Echocardiography, Doppler ,chorioamnionitis ,Anti-Bacterial Agents ,3. Good health ,PRETERM PREMATURE RUPTURE ,Ureaplasma parvum ,medicine.anatomical_structure ,Pulsatile Flow ,cardiovascular system ,Cardiology ,Administration, Intravenous ,Female ,ANTIBIOTICS ,Blood Flow Velocity ,Ductus venosus ,CARDIAC DYSFUNCTION ,medicine.medical_specialty ,Pulmonary Artery ,Article ,Ultrasonography, Prenatal ,Injections ,03 medical and health sciences ,Fetal Heart ,INFLAMMATION ,Internal medicine ,medicine.artery ,medicine ,Animals ,Amnion ,LABOR ,Fetus ,Interleukin-6 ,business.industry ,Ureaplasma Infections ,Ureaplasma infection ,Hemodynamics ,INTRAUTERINE INFECTION ,preterm birth ,Ultrasonography, Doppler ,Umbilical artery ,Ductus Arteriosus ,Amniotic Fluid ,medicine.disease ,Macaca mulatta ,Disease Models, Animal ,CHRONIC LUNG-DISEASE ,FOLLOW-UP ,business ,Premature rupture of membranes - Abstract
BACKGROUND: Ureaplasma parvum infection is a prevalent cause of intrauterine infection associated with preterm birth, preterm premature rupture of membranes, fetal inflammatory response syndrome, and adverse postnatal sequelae. Elucidation of diagnostic and treatment strategies for infection-associated preterm labor may improve perinatal and long-term outcomes for these cases. OBJECTIVE: This study assessed the effect of intraamniotic Ureaplasma infection on fetal hemodynamic and cardiac function and the effect of maternal antibiotic treatment on these outcomes. STUDY DESIGN: Chronically catheterized pregnant rhesus monkeys were assigned to control (n=6), intraamniotic inoculation with Ureaplasma parvum (10(7) colony-forming units/mL, n=15), and intraamniotic infection plus azithromycin treatment (12.5 mg/kg twice a day intravenously, n=8) groups. At approximately 135 days’ gestation (term=165 days), pulsed and color Doppler ultrasonography was used to obtain measurements of fetal hemodynamics (pulsatility index of umbilical artery, ductus venosus, descending aorta, ductus arteriosus, aortic isthmus, right pulmonary artery, middle cerebral artery and cerebroplacental ratio, and left and right ventricular cardiac outputs) and cardiac function (ratio of peak early vs late transmitral flow velocity [marker of ventricular function], Tei index [myocardial performance index]). These indices were stratified by amniotic fluid proinflammatory mediator levels and cardiac histology. RESULTS: Umbilical and fetal pulmonary artery vascular impedances were significantly increased in animals from the intraamniotic inoculation with Ureaplasma parvum group (P1.1) than in those with normal blood flow (P1.6, P
- Published
- 2020
10. Fetal cardiac remodeling and dysfunction is associated with both preeclampsia and fetal growth restriction
- Author
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Olga Gómez, Kilian Vellvé, Grigorios Kalapotharakos, Eduard Gratacós, Francesca Crovetto, Álvaro Sepúlveda-Martínez, L. Youssef, Cristina Paules, Fatima Crispi, Laura García-Otero, and Jezid Miranda
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Adult ,Gestational hypertension ,medicine.medical_specialty ,Pregnancy Trimester, Third ,Intrauterine growth restriction ,Cardiomegaly ,Gestational Age ,Placental insufficiency ,Preeclampsia ,03 medical and health sciences ,Fetal Heart ,0302 clinical medicine ,Pre-Eclampsia ,Pregnancy ,Internal medicine ,Natriuretic Peptide, Brain ,Ventricular Dysfunction ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,reproductive and urinary physiology ,Fetus ,Fetal Growth Retardation ,030219 obstetrics & reproductive medicine ,Ventricular Remodeling ,medicine.diagnostic_test ,business.industry ,Troponin I ,Obstetrics and Gynecology ,Gestational age ,Fetal Blood ,medicine.disease ,Echocardiography ,Spain ,Cord blood ,embryonic structures ,Cardiology ,Female ,business ,Fetal echocardiography - Abstract
Preeclampsia and fetal growth restriction share some pathophysiologic features and are both associated with placental insufficiency. Fetal cardiac remodeling has been described extensively in fetal growth restriction, whereas little is known about preeclampsia with a normally grown fetus.To describe fetal cardiac structure and function in pregnancies complicated by preeclampsia and/or fetal growth restriction as compared with uncomplicated pregnancies.This was a prospective, observational study including pregnancies complicated by normotensive fetal growth restriction (n=36), preeclampsia with a normally grown fetus (n=35), preeclampsia with fetal growth restriction (preeclampsia with a normally grown fetus-fetal growth restriction, n=42), and 111 uncomplicated pregnancies matched by gestational age at ultrasound. Fetal echocardiography was performed at diagnosis for cases and recruitment for uncomplicated pregnancies. Cord blood concentrations of B-type natriuretic peptide and troponin I were measured at delivery. Univariate and multiple regression analysis were conducted.Pregnancies complicated by preeclampsia and/or fetal growth restriction showed similar patterns of fetal cardiac remodeling with larger hearts (cardiothoracic ratio, median [interquartile range]: uncomplicated pregnancies 0.27 [0.23-0.29], fetal growth restriction 0.31 [0.26-0.34], preeclampsia with a normally grown fetus 0.31 [0.29-0.33), and preeclampsia with fetal growth restriction 0.28 [0.26-0.33]; P.001) and more spherical right ventricles (right ventricular sphericity index: uncomplicated pregnancies 1.42 [1.25-1.72], fetal growth restriction 1.29 [1.22-1.72], preeclampsia with a normally grown fetus 1.30 [1.33-1.51], and preeclampsia with fetal growth restriction 1.35 [1.27-1.46]; P=.04) and hypertrophic ventricles (relative wall thickness: uncomplicated pregnancies 0.55 [0.48-0.61], fetal growth restriction 0.67 [0.58-0.8], preeclampsia with a normally grown fetus 0.68 [0.61-0.76], and preeclampsia with fetal growth restriction 0.66 [0.58-0.77]; P.001). Signs of myocardial dysfunction also were observed, with increased myocardial performance index (uncomplicated pregnancies 0.78 z scores [0.32-1.41], fetal growth restriction 1.48 [0.97-2.08], preeclampsia with a normally grown fetus 1.15 [0.75-2.17], and preeclampsia with fetal growth restriction 0.45 [0.54-1.94]; P.001) and greater cord blood B-type natriuretic peptide (uncomplicated pregnancies 14.2 [8.4-30.9] pg/mL, fetal growth restriction 20.8 [13.1-33.5] pg/mL, preeclampsia with a normally grown fetus 31.8 [16.4-45.8] pg/mL and preeclampsia with fetal growth restriction 37.9 [15.7-105.4] pg/mL; P.001) and troponin I as compared with uncomplicated pregnancies.Fetuses of preeclamptic mothers, independently of their growth patterns, presented cardiovascular remodeling and dysfunction in a similar fashion to what has been previously described for fetal growth restriction. Future research is warranted to better elucidate the mechanism(s) underlying fetal cardiac adaptation in these conditions.
- Published
- 2020
11. Maternal biomarkers for fetal heart failure in fetuses with congenital heart defects or arrhythmias
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Hiroshi Hosoda, Jun Yoshimatsu, Naoto Minamino, Kenji Kangawa, Kunihiro Nishimura, Takekazu Miyoshi, Mikiya Miyazato, Tomoaki Ikeda, and Michikazu Nakai
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Heart Defects, Congenital ,medicine.medical_specialty ,medicine.drug_class ,Pregnancy Trimester, Third ,Gestational Age ,Regurgitation (circulation) ,Umbilical cord ,Risk Assessment ,Ultrasonography, Prenatal ,03 medical and health sciences ,0302 clinical medicine ,Fetal Heart ,Pregnancy ,Internal medicine ,medicine ,Natriuretic peptide ,Humans ,030212 general & internal medicine ,Cardiovascular centre ,Elapid Venoms ,Heart Failure ,Fetus ,030219 obstetrics & reproductive medicine ,business.industry ,Incidence ,Pregnancy Outcome ,Obstetrics and Gynecology ,Natriuretic Peptide, C-Type ,medicine.disease ,Fetal Blood ,Fetal Arrhythmia ,Fetal Diseases ,medicine.anatomical_structure ,Cross-Sectional Studies ,ROC Curve ,Heart failure ,Pregnancy Trimester, Second ,Multivariate Analysis ,Cardiology ,Gestation ,Female ,business ,Biomarkers - Abstract
Diagnosis of fetal heart failure depends primarily on fetal ultrasonography assessment. Our recent study demonstrated that plasma natriuretic peptide levels in umbilical cord blood were correlated with the severity of heart failure in fetuses with congenital heart defects or arrhythmias. However, percutaneous umbilical blood sampling is an invasive procedure, and therefore, less or noninvasive biomarkers reflecting fetal heart failure are required.The aim of this study was to investigate the possibility of whether maternal serum biomarkers can diagnose fetal heart failure in fetuses with congenital heart defects or arrhythmias.This exploratory cross-sectional study was conducted at a tertiary pediatric cardiac center. A total of 50 singletons with fetal congenital heart defects or arrhythmias and 50 controls who were registered in the National Cerebral and Cardiovascular Center Biobank from 2013 to 2016 were included. Maternal serum samples obtained during the third trimester were analyzed for 2 hormones and 36 cytokines using the Bio-Plex Pro Human Cancer Biomarker panels 1 and 2. We comprehensively analyzed the association between maternal serum biomarkers and ultrasonography findings or fetal arrhythmia status. Fetal heart failure was defined as a cardiovascular profile score ≤7.Of 37 fetuses with congenital heart defects, heart failure was found in 1 case of tricuspid valve dysplasia with moderate tricuspid regurgitation. Of 13 fetuses with arrhythmias, 5 had heart failure at 28-33 weeks of gestation. Maternal serum cytokine and hormone concentrations were compared between patients with and without fetal heart failure at 28-33 weeks of gestation (n = 6 and n = 61, respectively). Sixty-one fetuses without heart failure consisted of 10 with congenital heart defect, 6 with arrhythmia, and 45 controls. Maternal serum concentrations of tumor necrosis factor-α, interleukin-6, soluble Fas ligand, transforming growth factor-α, and vascular endothelial growth factor-D were significantly higher when fetuses had heart failure than when they did not (P.05), whereas maternal serum concentrations of heparin-binding epidermal growth factor-like growth factor were significantly lower when fetuses had heart failure than when they did not (P.05). Multivariate analysis showed that maternal serum concentrations of tumor necrosis factor-α, vascular endothelial growth factor-D, and heparin-binding epidermal growth factor-like growth factor were independently associated with fetal heart failure. The cutoff values were as follows: tumor necrosis factor-α, 68 pg/mL (sensitivity of 50.0%, specificity of 93.4%, positive likelihood ratio of 7.6, negative likelihood ratio of 0.5); vascular endothelial growth factor-D, 1156 pg/mL (sensitivity of 50.0%, specificity of 93.4%, positive likelihood ratio of 7.6, negative likelihood ratio of 0.5); and heparin-binding epidermal growth factor-like growth factor, 90 pg/mL (sensitivity of 83.3%, specificity of 83.6%, positive likelihood ratio of 5.1, negative likelihood ratio of 0.2). The combination of these 3 cytokines showed sensitivity of 100%, specificity of 80.3%, positive likelihood ratio of 5.1, and negative likelihood ratio of 0. In the absence of fetal heart failure, concentrations of all maternal serum cytokines and hormones were similar in cases of fetal congenital heart defects and controls, while maternal serum soluble CD40 ligand concentrations were increased only in fetal arrhythmias.Maternal serum concentrations of tumor necrosis factor-α, vascular endothelial growth factor-D, and heparin-binding epidermal growth factor-like growth factor were associated with fetal heart failure.
- Published
- 2018
12. The importance of the learning process in ST analysis interpretation and its impact in improving clinical and neonatal outcomes
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Susanna Timonen and Kaisa Holmberg
- Subjects
Adult ,medicine.medical_specialty ,Cardiotocography ,Fetal heart rate monitoring ,Fetal Hypoxia ,Risk Assessment ,Sensitivity and Specificity ,Fetal Distress ,Electrocardiography ,03 medical and health sciences ,Fetal Heart ,0302 clinical medicine ,Pregnancy ,Fetal distress ,medicine ,Humans ,False Positive Reactions ,Prospective Studies ,030212 general & internal medicine ,Fetal Monitoring ,Asphyxia Neonatorum ,Blood Specimen Collection ,Fetus ,Scalp ,030219 obstetrics & reproductive medicine ,St analysis ,Cesarean Section ,business.industry ,Obstetrics and Gynecology ,Metabolic acidosis ,Heart Rate, Fetal ,Fetal Blood ,medicine.disease ,ta3123 ,Emergency medicine ,Population study ,Female ,Observational study ,Acidosis ,business ,Learning Curve ,Blood sampling - Abstract
Intrapartum fetal heart rate monitoring was introduced with the goal to reduce fetal hypoxia and deaths. However, continuous fetal heart rate monitoring has been shown to have a high sensitivity but also a high false-positive rate. To improve specificity, adjunctive technologies have been developed to identify fetuses at risk for intrapartum asphyxia. Intensive research on the value of ST-segment analysis of the fetal electrocardiogram as an adjunct to standard electronic fetal monitoring in lowering the rates of fetal metabolic acidosis and operative deliveries has been ongoing. The conflicting results in randomized and observational studies may partly be due to differences in study design.This study aims to determine the significance of the learning process for the introduction of ST analysis into clinical practice and its impact on initial and subsequent obstetric outcomes.This was a prospective observational study with the primary objective to evaluate the importance of the learning period on the rates of metabolic acidosis and operative deliveries after the implementation of ST analysis. The study was conducted at the Turku University Hospital, Turku, Finland, with 3400-4200 annual deliveries. The whole study population consisted of all 42,146 deliveries during the study period 2001 through 2011. The ST analysis usage rate was 18%. The data were collected prospectively from labors monitored with ST analysis as an adjunct to conventional intrapartum fetal heart rate monitoring. Primary endpoints were the rates of metabolic acidosis (cord artery pH7.05 and an extracellular fluid compartment base deficit12.0 mmol/L), fetal scalp blood sampling, and operative deliveries. Comparisons of these outcomes were made between the initiation period (the first 2 years) and the subsequent usage period (the next 9 years).In the whole study population the prevalence of cord pH7.05 decreased from 1.5-0.81% (relative risk, 0.54; 95% confidence interval, 0.43-0.67), the rate of cesarean deliveries from 17.2-14.1% (relative risk, 0.82; 95% confidence interval, 0.89-0.97), and the rate of fetal scalp blood sampling from 1.75-0.82% (relative risk, 0.47; 95% confidence interval, 0.38-0.58) when the 2 study periods were compared. In the ST analysis group, the frequency of cord metabolic acidosis rate was reduced from 1.0-0.25% (relative risk, 0.33; 95% confidence interval, 0.15-0.72).We provide evidence that the results improve over time and there is a learning curve in the introduction of the ST analysis method. This was demonstrated by the lower rates of metabolic acidosis and operative deliveries after the initial implementation period.
- Published
- 2018
13. Fetal and neonatal echocardiographic findings in twin-twin transfusion syndrome
- Author
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Fesslova, Vlasta, Villa, Laura, Nava, Simon, Mosca, Fabio, and Nicolini, Umberto
- Subjects
Echocardiography -- Research ,Twins -- Complications ,Fetal heart ,Health - Abstract
Serial Doppler echocardiography was conducted with 17 monochorionic twin pregnancies to determine kinds of cardiac involvement associated with twin-twin transfusion syndrome. Cardiovascular state of the donor twins was normal, while the recipient twins exhibited variable severity of biventricular hypertrophy and dilation with tricuspid regurgitation. Cardiac impairments were reversible after the fluid imbalances were corrected by decompressive amniocenteses or after birth.
- Published
- 1998
14. Diagnostic quality of 3Tesla postmortem magnetic resonance imaging in fetuses with and without congenital heart disease.
- Author
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Ulm B, Dovjak GO, Scharrer A, Muin DA, Zimpfer D, Prayer D, Weber M, and Berger-Kulemann V
- Subjects
- Female, Fetal Death, Fetal Heart physiology, Heart Defects, Congenital pathology, Humans, Infant, Newborn, Male, Perinatal Death, Retrospective Studies, Sensitivity and Specificity, Ultrasonography, Prenatal, Autopsy methods, Fetal Heart diagnostic imaging, Fetus diagnostic imaging, Heart Defects, Congenital diagnostic imaging, Magnetic Resonance Imaging methods
- Abstract
Background: Postmortem confirmation of prenatally diagnosed congenital heart disease after termination of pregnancy and evaluation of potential cardiac defects after spontaneous fetal or neonatal death are essential. Conventional autopsy rates are decreasing, and 1.5Tesla magnetic resonance imaging has demonstrated limited diagnostic accuracy for postmortem cardiovascular assessment., Objective: This study aimed to evaluate the feasibility and image quality of cardiac 3Tesla postmortem magnetic resonance imaging and to assess its diagnostic accuracy in detecting fetal heart defects compared with conventional autopsy. Secondarily, the study aimed to explore whether clinical factors affect the quality of 3Tesla postmortem magnetic resonance imaging., Study Design: A total of 222 consecutive fetuses between 12 and 41 weeks' gestation, who underwent 3Tesla postmortem magnetic resonance imaging and conventional autopsy after spontaneous death or termination of pregnancy for fetal malformations, were included. First, 3Tesla postmortem magnetic resonance imaging of each fetus was rated as diagnostic or nondiagnostic for fetal cardiac assessment by 2 independent raters. The image quality of individual cardiac structures was then further evaluated by visual grading analysis. Finally, the presence or absence of a congenital heart defect was assessed by 2 radiologists and compared with autopsy results., Results: Overall, 87.8% of 3Tesla postmortem magnetic resonance imaging examinations were rated as diagnostic for the fetal heart. Diagnostic imaging rates of individual cardiac structures at 3Tesla postmortem magnetic resonance imaging ranged from 85.1% (atrioventricular valves) to 94.6% (pericardium), with an interrater agreement of 0.82 (0.78-0.86). Diagnostic imaging of the fetal aortic arch and the systemic veins at 3Tesla postmortem magnetic resonance imaging was possible from 12+5 weeks' gestation onward in 90.1% and 92.3% of cases, respectively. A total of 55 fetuses (24.8%) had at least 1 cardiac anomaly according to autopsy, 164 (73.9%) had a normal heart, and in 3 fetuses (1.4%), autopsy was nondiagnostic for the heart. Considering all examinations rated as diagnostic, 3Tesla postmortem magnetic resonance imaging provided high diagnostic accuracy for the detection of fetal congenital heart defects with a sensitivity of 87.8%, a specificity of 97.9%, and concordance with autopsy of 95.3%. 3Tesla postmortem magnetic resonance imaging was less accurate in young fetuses (<20 weeks compared with ≥20 weeks; P<.001), in fetuses with low birthweight (≤100 g compared with >100 g; P<.001), in cases after spontaneous fetal death (compared with other modes of death; P=.012), in cases with increasing latency between death and 3Tesla postmortem magnetic resonance imaging (P<.001), and in cases in which there was a high degree of maceration (maceration score of 3 compared with a score from 0 to 2; P=.004)., Conclusion: Diagnostic 3Tesla postmortem magnetic resonance imaging assessment of the fetal heart is feasible in most fetuses from 12 weeks' gestation onward. In diagnostic images, sensitivity and, particularly, specificity in the detection of congenital heart disease are high compared with conventional autopsy. Owing to its high diagnostic accuracy, we suggest that 3Tesla postmortem magnetic resonance imaging may serve as a suitable imaging modality with which to direct a targeted conventional autopsy when pathology resources are limited or to provide a virtual autopsy when full autopsy is declined by the parents., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
15. Prospective evaluation of the antenatal incidence and postnatal significance of the fetal echogenic cardiac focus: a case-control study
- Author
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Dildy, Gary A., Judd, Victoria E., and Clark, Steven L.
- Subjects
Fetal heart ,Prenatal diagnosis -- Methods ,Congenital heart disease -- Diagnosis ,Health - Abstract
Finding echogenic cardiac foci during second trimester ultrasound imaging does not always indicate heart complications. Cardiac echogenic foci could indicate a tumor or dysfunction of the heart muscle. Of 506 fetuses routinely evaluated by ultrasound imaging in the middle trimester, 5% had echogenic foci. All had ultrasonographic evaluation within 20 weeks after birth. One newborn had a minor heart malformation unrelated to the ultrasound imaging finding. Therefore, following up the finding of echogenic cardiac foci with heart evaluation studies after birth does not appear warranted.
- Published
- 1996
16. A new method for on-screen ultrasonographic determination of fetal cardiac axis
- Author
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Bork, Michael D., Egan, James F.X., Diana, Daniel J., Scorza, William E., Fabbri, Elizabeth L., Feeney, Lori D., and Campbell Winston A.
- Subjects
Fetus -- Ultrasonic imaging ,Fetal heart ,Health - Abstract
The use of several electronic calipers for on-screen ultrasonic measurement of the axis of the fetal heart may enable doctors to detect fetal heart defects. Abnormal heart axis has been associated with congenital heart defects. Researchers performed ultrasound examinations of two hundred low-risk fetuses using several electronic calipers to measure the placement of the heart axis. This measurement was compared to that obtained by a manual method using a protractor. Both methods yielded similar results. All 200 infants were found to have heart axes in a normal position of 43 degrees, which was confirmed by examining infants after birth. The use of electronic calipers may be more convenient for ultrasonic measurement of fetal heart axis. Three to five sets of calipers should be used.
- Published
- 1995
17. Effect of advancing gestational age on the frequency of fetal ductal constriction in association with maternal indomethacin use
- Author
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Moise, Kenneth J., Jr.
- Subjects
Indomethacin -- Adverse and side effects ,Pregnant women -- Drug use ,Fetal heart ,Gestational age -- Physiological aspects ,Health - Abstract
Treatment with indomethacin after the eighth month of pregnancy may increase the risk of fetal ductal constriction. Indomethacin is a drug used to treat premature labor, an excess of amniotic fluid (hydramnios), and benign uterine tumors. Fetal ductal constriction is narrowing of the ductus arteriosus, a fetal blood vessel that directly connects the pulmonary artery to the descending aorta. A study examined the incidence of fetal ductal constriction in 44 pregnant women who were treated with indomethacin for premature labor or hydramnios. Fourteen of the women were pregnant with twins or triplets, and 30 were pregnant with a single fetus. Constriction of the ductus arteriosus occurred in 17 fetuses, and the frequency was the same in the multiple and the singleton (single fetus) pregnancies. The incidence of fetal ductal constriction increased significantly after the eighth month of pregnancy.
- Published
- 1993
18. 292: Does intrapartum maternal oxygen supplementation improve category II fetal heart tracings?
- Author
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George A. Macones, Julia D. López, Alison G. Cahill, Methodius G. Tuuli, and Nandini Raghuraman
- Subjects
medicine.medical_specialty ,Oxygen supplementation ,Obstetrics ,business.industry ,medicine ,Obstetrics and Gynecology ,Fetal heart ,business - Published
- 2018
19. 288: Fetal scalp lactate and digital scalp stimulation among those with non-reassuring fetal heart tracings: A decision analytic model
- Author
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Alison G. Cahill, Scott W. Hoffmann, Brian L Shaffer, Aaron B. Caughey, and Blake Zwerling
- Subjects
medicine.medical_specialty ,Fetus ,medicine.anatomical_structure ,business.industry ,Internal medicine ,Scalp ,Analytic model ,medicine ,Cardiology ,Obstetrics and Gynecology ,Stimulation ,Fetal heart ,business - Published
- 2018
20. 757: Admission fetal heart tracing category and risk of cesarean delivery
- Author
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Anisha Farishta, Steven L. Clark, Mary Catherine Tolcher, and Catherine Eppes
- Subjects
medicine.medical_specialty ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,Medicine ,Fetal heart ,Cesarean delivery ,Tracing ,business - Published
- 2019
21. 677: Risk factors for non-reassuring fetal heart tracing among growth restricted fetuses undergoing labor induction
- Author
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Anthony Odibo, Linda Odibo, Rachel G. Sinkey, Chinedu Nwabuobi, Leah Bagiardi, and Nicole Wood
- Subjects
Fetus ,medicine.medical_specialty ,business.industry ,Obstetrics ,Labor induction ,medicine.medical_treatment ,Obstetrics and Gynecology ,Medicine ,Fetal heart ,business - Published
- 2019
22. Longitudinal fetal heart rate changes are not generally disregarded but should be supplemented by meaningful categorization of decelerations
- Author
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Shashikant L. Sholapurkar
- Subjects
medicine.medical_specialty ,Deceleration ,Fetal heart ,Fetal monitoring ,03 medical and health sciences ,0302 clinical medicine ,Fetal Heart ,Fetus ,Heart Rate ,Pregnancy ,Internal medicine ,Heart rate ,Medicine ,Humans ,030212 general & internal medicine ,Fetal Monitoring ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,Prenatal Care ,Heart Rate, Fetal ,Fetal heart rate ,Categorization ,Anesthesia ,Cardiology ,Female ,business - Published
- 2016
23. 441: Applicability of standardized fetal heart examination in obese population at first trimester
- Author
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Ozhan Turan, Sifa Turan, Christopher R. Harman, Ruofan Yao, Lindsey Seger, and Mehmet Resit Asoglu
- Subjects
education.field_of_study ,medicine.medical_specialty ,First trimester ,Obstetrics ,business.industry ,Population ,medicine ,Obstetrics and Gynecology ,Fetal heart ,education ,business - Published
- 2018
24. Assessment of ventricular contractility in fetuses with an estimated fetal weight less than the tenth centile.
- Author
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DeVore GR, Gumina DL, and Hobbins JC
- Subjects
- Case-Control Studies, Female, Heart Ventricles physiopathology, Humans, Middle Cerebral Artery diagnostic imaging, Middle Cerebral Artery physiology, Pregnancy, Pulsatile Flow physiology, Retrospective Studies, Ultrasonography, Doppler, Ultrasonography, Prenatal, Umbilical Arteries diagnostic imaging, Umbilical Arteries physiology, Fetal Growth Retardation physiopathology, Heart Ventricles diagnostic imaging, Myocardial Contraction physiology
- Abstract
Objective: To determine whether abnormal global, transverse, and longitudinal ventricular contractility of the heart in fetuses with an estimated fetal weight <10th centile is present, irrespective of Doppler studies of the umbilical artery and cerebroplacental ratio., Study Design: This was a retrospective study of 50 fetuses with an estimated fetal weight <10th centile that were classified based on Doppler results from the pulsatility indices of the umbilical artery and middle cerebral artery, and the calculated cerebroplacental ratio (pulsatility indices of the umbilical artery/middle cerebral artery). Right and left ventricular measurements were categorized into 3 groups: (1) global ventricular contractility (fractional area change), (2) transverse ventricular contractility (24-segment transverse fractional shortening), and (3) basal-apical longitudinal contractility (longitudinal strain, longitudinal displacement fractional shortening, and basal lateral and septal wall annular plane systolic excursion). Z scores for the above measurements were computed for fetuses with an estimated fetal weight <10th centile using the mean and standard deviation derived from normal controls. Ventricular contractility measurements were considered abnormal if their Z score values were <5th centile (z score <-1.65) or >95th centile (Z score >1.65), depending on the specific ventricular measurement., Results: The average gestational age at the time of the examination was 32 weeks 4 days (standard deviation 3 weeks 4 days). None of the 50 study fetuses demonstrated absent or reverse flow of the umbilical artery Doppler waveform. Eighty-eight percent (44/50) of fetuses had one or more abnormal measurements of cardiac contractility of 1 or both ventricles. Analysis of right ventricular contractility demonstrated 78% (39/50) to have 1 or more abnormal measurements, which were grouped as follows: global contractility 38% (19/50), transverse contractility 66% (33/50); and longitudinal contractility 48% (24/50). Analysis of left ventricular contractility demonstrated 1 or more abnormal measurements in 58% (29/50) that were grouped as follows: global contractility 38% (19/50); transverse contractility 40% (20/50); and longitudinal contractility 40% (20/50). Of the 50 study fetuses, 25 had normal pulsatility index of the umbilical artery and cerebroplacental ratios, 80% of whom had 1 or more abnormalities of right ventricular contractility and 56% of whom had 1 or more abnormalities of left ventricular contractility. Abnormal ventricular contractility for these fetuses was present in all 3 groups of measurements; global, transverse, and longitudinal. Those with an isolated abnormal pulsatility index of the umbilical artery (n=11) had abnormalities of transverse contractility of the right ventricular and global contractility in the left ventricle. When an isolated cerebroplacental ratio abnormality was present, the right ventricle demonstrated abnormal global, transverse, and longitudinal contractility, with the left ventricle only demonstrating abnormalities in transverse contractility. When both the pulsatility index of the umbilical artery and cerebroplacental ratio were abnormal (3/50), transverse and longitudinal contractility measurements were abnormal for both ventricles, as well as abnormal global contractility of the left ventricle., Conclusions: High rates of abnormal ventricular contractility were present in fetuses with an estimated fetal weight <10th centile, irrespective of the Doppler findings of the pulsatility index of the umbilical artery, and/or cerebroplacental ratio. Abnormalities of ventricular contractility were more prevalent in transverse measurements than global or longitudinal measurements. Abnormal transverse contractility was more common in the right than the left ventricle. Fetuses with estimated fetal weight less than the 10th centile may be considered to undergo assessment of ventricular contractility, even when Doppler measurements of the pulsatility index of the umbilical artery, and cerebroplacental ratio are normal., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
25. Fetal pulmonary artery diameter measurements as a predictor of morbidity in antenatally diagnosed congenital diaphragmatic hernia: A prospective study
- Author
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Dorota A. Doherty, Naoki Shimizu, Jenni Sokol, Lisa K. Hornberger, Desmond Bohn, and Greg Ryan
- Subjects
medicine.medical_specialty ,Diaphragmatic breathing ,Gestational Age ,Pulmonary Artery ,Fetal Heart ,Internal medicine ,medicine.artery ,medicine ,Humans ,Diaphragmatic hernia ,Hernia ,Prospective Studies ,Ultrasonography ,Hernia, Diaphragmatic ,Fetus ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Gestational age ,Congenital diaphragmatic hernia ,Length of Stay ,medicine.disease ,Respiration, Artificial ,Pulmonary artery hypoplasia ,Surgery ,ROC Curve ,Pulmonary artery ,Cardiology ,Morbidity ,Hernias, Diaphragmatic, Congenital ,business - Abstract
Objective The objective of the study was to examine the size and growth of fetal pulmonary artery diameters in congenital diaphragmatic hernia and assess their correlation with postnatal survival and morbidity outcomes. Study design Prospective antenatal echocardiographic examination of fetal branch pulmonary arteries were correlated with postnatal survival and respiratory morbidity in cases of congenital diaphragmatic hernia. Receiver operator curves were developed to assess their utilization as predictors of respiratory morbidity and survival. Results Twenty-one cases were diagnosed antenatally over 3 years. Fifteen subjects survived postnatally. The ipsilateral fetal branch pulmonary artery diameter was smaller throughout gestation in left-sided congenital diaphragmatic hernia ( P = .008). The small left pulmonary diameter did not correlate with survival but correlated strongly with morbidity outcomes. Progressive ipsilateral fetal pulmonary artery hypoplasia was demonstrated throughout gestation in subjects who died or had severe morbidity. Conclusion Fetal pulmonary artery diameter measurements correlate with respiratory morbidity in postnatal congenital diaphragmatic hernia and may assist with prediction of outcome. Survival has improved, possibly because of improved postnatal management of congenital diaphragmatic hernia, limiting this measurement in assessing survival.
- Published
- 2006
26. An isolated intracardiac echogenic focus as a marker for aneuploidy
- Author
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William Herbert, Thomas S. Santulli, Kathleen E. Bradley, Kimberly D. Gregory, Lawrence D. Platt, and Dru E. Carlson
- Subjects
Adult ,Heart Defects, Congenital ,medicine.medical_specialty ,Heart Ventricles ,Population ,Aneuploidy ,Prenatal diagnosis ,California ,Medical Records ,Ultrasonography, Prenatal ,Intracardiac injection ,Fetal Heart ,Pregnancy ,Risk Factors ,Prevalence ,medicine ,Humans ,education ,Retrospective Studies ,education.field_of_study ,medicine.diagnostic_test ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,medicine.disease ,Pregnancy Trimester, Second ,Relative risk ,Amniocentesis ,Female ,business ,Maternal Age ,Echogenic intracardiac focus - Abstract
Objective This study was undertaken to evaluate the relationship of an isolated fetal intracardiac echogenic focus in a population of patients with a mixed risk for aneuploidy when presenting for prenatal diagnosis. Study design All women referred to our institution for screening ultrasound were prospectively evaluated for the presence of an intracardiac echogenic focus in the fetal heart. Each patient was evaluated for the presence of clinical risk factors including ultrasound findings, biochemical screening, and maternal age. The population of patients was then described and neonatal outcomes were obtained. Results A total of 10,875 patients were referred and 176 cases of fetal intracardiac echogenic foci were evaluated. There was an overall prevalence of 1.6% in our population. The patients with other ultrasound findings and/or maternal age older than 35 years who underwent amniocentesis had 3 abnormal karyotypes identified and had identifiable risk factors. In the group less than 35 years, the relative risk was 2.55 of having an amniocentesis for an isolated echogenic focus (with no cases of fetal aneuploidy found) in comparison with our referred group of nonadvanced maternal age patients without any ultrasound markers or findings. Conclusion This isolated echogenic finding appears to be a benign variant and not an increased risk for fetal aneuploidy. The chromosomal abnormalities were seen in the group with risk factors including maternal age and/or other ultrasound findings. Evaluation of maternal age, biochemical markers, and ultrasound markers should be used together to help determine the risk of patients with an isolated echogenic focus.
- Published
- 2005
27. Meconium-stained liquor during labor is associated with raised neonatal cord blood 8-iso-prostaglandin F2α concentration
- Author
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Bao Yi, Liu, Chi Chiu, Wang, Tze Kin, Lau, Ching Yan, Chu, M, Phil, Chi Pui, Pang, Michael Scott, Rogers, and Tse Ngong, Leung
- Subjects
Adult ,Meconium ,Fetal heart ,Dinoprost ,Umbilical cord ,Fetal Distress ,Andrology ,fluids and secretions ,Pregnancy ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,reproductive and urinary physiology ,8 iso prostaglandin f2α ,business.industry ,food and beverages ,Obstetrics and Gynecology ,Amniotic Fluid ,Fetal Blood ,equipment and supplies ,medicine.disease ,Oxidative Stress ,medicine.anatomical_structure ,Case-Control Studies ,Anesthesia ,Cord blood ,embryonic structures ,Arterial blood ,Female ,business ,Biomarkers - Abstract
Objective The purpose of this study was to compare the umbilical arterial 8-iso-prostaglandin F 2α, concentrations between pregnancies that were complicated by moderate or thick meconium-stained liquor and those with clear liquor. Study design Umbilical cord arterial blood samples were collected from 247 singleton pregnancies with either moderate or thick meconium-stained liquor at any stage of labor or clear liquor at all stages of labor for the determination of the total 8-iso-prostaglandins F 2α concentration. Results The median total 8-iso-prostaglandins F 2α concentration of the meconium-stained liquor group was significantly higher than that of the control group (719.2 vs 115.8 pg/mL). Among the meconium-stained liquor group, those who had a change from "clear liquor" at early labor to "moderate/ thick meconium-stained liquor" at late first stage or at delivery (late meconium-stained liquor group) had higher 8-iso-prostaglandins F 2α concentration, compared with those who had moderate/ thick meconium-stained liquor since early labor (early meconium-stained liquor group; 959.8 vs 499.9 pg/mL). With the use of multiple regression analysis, meconium-stained liquor, duration of second stage of labor, and abnormal fetal heart tracings were independent determinants of cord blood 8-iso-prostaglandins F 2α concentration. Conclusion Moderate or thick meconium-stained liquor is an independent factor for increased oxidative stress in pregnancy.
- Published
- 2005
28. Does advanced ultrasound equipment improve the adequacy of ultrasound visualization of fetal cardiac structures in the obese gravid woman?
- Author
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Robert J. Sokol, Emmanuel Bujold, Yoram Sorokin, Marjorie C. Treadwell, Israel Hendler, and Sean C. Blackwell
- Subjects
Adult ,medicine.medical_specialty ,Adolescent ,Population ,Gestational Age ,Risk Assessment ,Sensitivity and Specificity ,Ultrasonography, Prenatal ,Body Mass Index ,Embryonic and Fetal Development ,Fetal Heart ,Pregnancy ,Reference Values ,Humans ,Medicine ,Obesity ,education ,Probability ,Retrospective Studies ,Fetus ,education.field_of_study ,business.industry ,Obstetrics ,Ultrasound ,Obstetrics and Gynecology ,Gestational age ,Fetal Presentation ,medicine.disease ,Logistic Models ,Case-Control Studies ,Gestation ,Female ,business ,Body mass index - Abstract
Objective This study was undertaken to determine the effect of advanced ultrasound equipment on the ability to visualize fetal cardiac structures in obese gravid women. Study design Singleton pregnancies undergoing initial ultrasound examination between 14 weeks and 23 weeks 6 days were included. Patients were classified by body mass index (BMI) (nonobese [BMI 2 ] and obese [BMI ≥30 kg/m 2 ]). The rate of suboptimal ultrasound visualization (SUV) of the fetal heart (cardiac axis, cardiac position, 4-chamber, and outflow tracts views) was compared between patients examined by standard (HDI 3000) or advanced ultrasound equipment (HDI 5000) (ATL, Philips Medical Systems, Bothell, Wash). Results Over a 5-year period, 7029 singleton gestations met inclusion criteria; 2498 (35.5%) were clinically obese. There was no difference in gestational age, rate of low amniotic fluid volume, anterior placenta, or vertex fetal presentation between the groups. When the advanced ultrasound equipment was used, SUV of the fetal heart was lower in the nonobese population (20.8% vs 16.4%; P P =.27). However, obese patients who were examined by advanced ultrasound equipment after 18 weeks had less SUV of the outflow tracts (28.5% vs 23.1%, P =.04) but not of the 4-chamber view. Conclusion Despite advanced ultrasound equipment, maternal obesity significantly limits visualization of the fetal heart. However, the advanced ultrasound equipment may somewhat benefit obese gravid women examined after 18 weeks' gestation
- Published
- 2004
29. Defining the limits of electronic fetal heart rate
- Author
-
Brian J. Koos and Barry S. Schifrin
- Subjects
medicine.medical_specialty ,MEDLINE ,Fetal heart ,Fetal monitoring ,03 medical and health sciences ,Fetal Heart ,0302 clinical medicine ,Heart Rate ,Pregnancy ,Internal medicine ,Heart rate ,medicine ,Humans ,030212 general & internal medicine ,Fetal Monitoring ,Fetus ,Labor, Obstetric ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,Heart Rate, Fetal ,medicine.disease ,Fetal heart rate ,Cardiology ,Female ,business - Published
- 2017
30. The impact of the use of the isolated echogenic intracardiac focus as a screen for Down syndrome in women under the age of 35 years
- Author
-
Deirdre J. Lyell, Aaron B Caughey, Roy A. Filly, Mary E. Norton, and A. Eugene Washington
- Subjects
Adult ,medicine.medical_specialty ,Down syndrome ,Aneuploidy ,Abortion ,Sensitivity and Specificity ,Ultrasonography, Prenatal ,Decision Support Techniques ,Fetal Heart ,Pregnancy ,Risk Factors ,medicine ,Humans ,Mass Screening ,Gynecology ,medicine.diagnostic_test ,business.industry ,Obstetrics ,Incidence ,Incidence (epidemiology) ,Ultrasound ,Obstetrics and Gynecology ,medicine.disease ,Abortion, Spontaneous ,Amniocentesis ,Female ,Down Syndrome ,business ,Echogenic intracardiac focus - Abstract
The purpose of this study was to determine the public health impact of the routine offering of amniocentesis to women under the age of 35 years who have an isolated fetal echogenic intracardiac focus on second trimester ultrasound scan.A decision analytic model was designed that compared the accepted standard of second trimester triple marker screen for Down syndrome to a policy in which amniocentesis with an isolated echogenic intracardiac focus on ultrasound in addition to the triple marker screen is offered to all women in the United States who are35 years of age. A sensitivity of 20%, an echogenic intracardiac focus screen positive rate of 5%, and a risk of Down syndrome of 1:1000 were assumed. A sensitivity analysis was performed that varied the screen positive rate, the sensitivity of echogenic intracardiac focus for Down syndrome, and the prescreen risk for Down syndrome in the population.With the baseline sensitivities, rates, and risks, the use of isolated echogenic intracardiac focus as a screen would result in an additional 118,146 amniocenteses performed annually to diagnose 244 fetuses with Down syndrome. These amniocenteses would result in 582 additional miscarriages. It would be necessary to perform 485 amniocenteses that would result in 2.4 procedure-related losses for each additional Down syndrome fetus that was identified.Although the echogenic intracardiac focus appears to be associated with a small increased risk of Down syndrome, its use as a screening tool in low-risk populations would lead to a large number of amniocenteses and miscarriages to identify a small number of Down syndrome fetuses.
- Published
- 2001
31. Association of the C677T methylenetetrahydrofolate reductase mutation and elevated homocysteine levels with congenital cardiac malformations
- Author
-
Katharine D. Wenstrom, Gary L. Johanning, Kelley E. Johnston, and Mary B. DuBard
- Subjects
Heart Defects, Congenital ,medicine.medical_specialty ,Amniotic fluid ,Homocysteine ,Heart disease ,Polymerase Chain Reaction ,Pathogenesis ,chemistry.chemical_compound ,Fetal Heart ,Pregnancy ,Internal medicine ,medicine ,Humans ,Point Mutation ,Chromatography, High Pressure Liquid ,Methylenetetrahydrofolate Reductase (NADPH2) ,Electrophoresis, Agar Gel ,Oxidoreductases Acting on CH-NH Group Donors ,Fetus ,biology ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Amniotic Fluid ,medicine.disease ,Endocrinology ,chemistry ,Methylenetetrahydrofolate reductase ,biology.protein ,Gestation ,Female ,business - Abstract
Objective: The aim of this study was determine whether the cytosine-to-thymine mutation at base 677 of the gene for methylenetetrahydrofolate reductase (C677T MTHFR ), which has been associated with neural tube defects, is also associated with congenital cardiac malformations. Study Design: Amniotic fluid homocysteine levels were measured and the presence or absence of the C677T MTHFR mutation in amniocytes was determined in stored amniotic fluid obtained from 26 pregnancies complicated by isolated (presumed multifactorial) fetal cardiac defects and from 116 normal pregnancies. Results: The pregnancies affected by fetal cardiac defects had higher amniotic fluid homocysteine levels (1.7 ± 1.7 vs 1.0 ± 0.7 μmol/L; P =.07) and included more samples with homocysteine levels >90th percentile (27% vs 9%; P =.02) and more cases with the C677T MTHFR mutation (35% vs 13%; P =.01). Fifty percent of cases had either a high homocysteine level or the C677T MTHFR mutation (50% vs 20%; P =.003) and 12% had both (12% vs 0%; P =.0006). Conclusion: Fifty percent of these isolated congenital cardiac defects were associated with either the C677T MTHFR mutation or elevated amniotic fluid homocysteine levels, or both. This finding adds to what is already known about the multiple and complex biochemical and developmental functions of the homocysteine pathway. (Am J Obstet Gynecol 2001;184:806-17.)
- Published
- 2001
32. Comparison of visual and computerized interpretation of nonstress test results in a randomized controlled trial
- Author
-
Sylvia Morgan, Daniel W. Byrne, and Luis A. Bracero
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Neonatal intensive care unit ,Logistic regression ,Ultrasonography, Prenatal ,Nonstress test ,law.invention ,Random Allocation ,Fetal Heart ,Fetus ,Randomized controlled trial ,Pregnancy ,Risk Factors ,law ,Intensive care ,medicine ,Humans ,Fetal Monitoring ,Fetal Death ,medicine.diagnostic_test ,Cesarean Section ,business.industry ,Infant, Newborn ,Pregnancy Outcome ,Obstetrics and Gynecology ,Signal Processing, Computer-Assisted ,Odds ratio ,Confidence interval ,Diabetes, Gestational ,Logistic Models ,Sample size determination ,Exercise Test ,Female ,business - Abstract
Objective: This study tested the null hypothesis that the number of fetal surveillance tests and perinatal outcomes would not differ statistically between pregnancies randomized to visual or computerized interpretation of antepartum nonstress test results. Study Design: A prospective, randomized controlled trial was conducted, which required a sample size of 404 patients. By using a random-number table with assignment codes concealed in opaque envelopes, half of the patients were randomized to computerized interpretation of nonstress test results and half to standard visual interpretation of nonstress test results. The amount of antepartum testing and the perinatal outcome were measured and compared between the groups. Logistic regression analysis was used to control for maternal risk factors while morbidity differences between the 2 groups were assessed. Results: The 2 randomized groups were similar at baseline, but the computerized interpretation group had significantly fewer biophysical profiles compared with the visual interpretation group (1.3 ± 1.8 vs 1.9 ± 2.1; P = .002). The patients in the computerized interpretation group spent less time per test than patients in the visual interpretation group (12 vs 20 minutes; P = .038). After the 5 pregnancies with congenital anomalies were excluded, the overall perinatal outcome was similar in the 2 groups. The computerized interpretation group, however, had a slightly lower proportion of infants who required ≥2 days of neonatal intensive care (7.4% vs 12.4%; P = .086; odds ratio, 0.56; 95% confidence interval, 0.29-1.09). The average number of neonatal intensive care days was also slightly lower in the computerized interpretation group (0.4 vs 0.9; P = .105). Neither of these variables was statistically significant. Conclusions: Computerized interpretation of nonstress test results is associated with fewer additional fetal surveillance examinations, less time spent in testing, and a similar length of stay in the neonatal intensive care unit compared with standard visual interpretation. (Am J Obstet Gynecol 1999;181:1254-8.)
- Published
- 1999
33. Relationship between flow through the fetal aortic isthmus and cerebral oxygenation during acute placental circulatory insufficiency in ovine fetuses
- Author
-
Sven-Erik Sonesson, Jean-Claude Fouron, Manon Lessard, Mirjam Pfizenmaier, Amanda Skoll, and Edgar Jaeggi
- Subjects
Umbilical Veins ,medicine.medical_specialty ,Hemodynamics ,Blood Pressure ,Placental insufficiency ,Umbilical Arteries ,Fetal Heart ,Fetus ,Pregnancy ,medicine.artery ,Internal medicine ,medicine ,Animals ,Aorta ,Sheep ,business.industry ,Brain ,Obstetrics and Gynecology ,Cerebral hypoxia ,Umbilical artery ,Blood flow ,Anatomy ,Carbon Dioxide ,Fetal Blood ,Placental Insufficiency ,medicine.disease ,Echocardiography, Doppler ,Oxygen ,Carotid Arteries ,medicine.anatomical_structure ,Regional Blood Flow ,Cerebrovascular Circulation ,Acute Disease ,Circulatory system ,Vascular resistance ,Cardiology ,Female ,Acidosis ,business - Abstract
Objective: We sought to investigate whether the reversal of blood flow through the aortic isthmus, as observed during an increase in placental vascular resistance, could be responsible for a significant fall in oxygen delivered to the fetal brain. Study Design: With the appearance of reverse flow in the aortic isthmus, preplacental blood with low oxygen saturation could contaminate the ascending aorta blood destined for the brain. Stepwise compression of the umbilical veins of 8 exteriorized fetal lambs was realized at approximately 140 days of gestation. Four other animals were used as controls. Flows through the aortic isthmus and both carotid and umbilical arteries were measured by Doppler echocardiography in the basal state (hemodynamic class 1) and during moderate (class 2), severe (class 3), and extreme (class 4) increases in resistance to placental flow. Oxygen delivered to the brain was calculated from carotid blood flow and oxygen content. Results: In the control group no change was noted in umbilical and carotid arteries or in the aortic isthmus blood flow. Oxygen delivered to the brain remained stable. In the study group the increase in resistance to placental flow caused a significant fall in umbilical flow and carotid oxygen content, while blood flow in the carotid arteries increased slightly. The values for aortic isthmus flow and oxygen delivered to the brain during the 4 hemodynamic classes were, on average, as follows: class 1, 98.2 and 2.9 mL/(min · kg); class 2, 52.8 and 3.1 mL/(min · kg); class 3, 3.7 and 2.6 mL/(min · kg); and class 4, –29.8 and 0.7 mL/(min · kg), respectively. Conclusion: During an acute increase in placental vascular resistance, delivery of oxygen to the brain is preserved despite a significant drop in arterial oxygen content as long as net flow through the isthmus is anterograde. (Am J Obstet Gynecol 1999;181:1102-7.)
- Published
- 1999
34. Fetal and neonatal echocardiographic findings in twin-twin transfusion syndrome
- Author
-
Vlasta Fesslova, Laura Villa, Simon Nava, Umberto Nicolini, and Fabio Mosca
- Subjects
medicine.medical_specialty ,Heart disease ,Gestational Age ,Fetal Heart ,Pregnancy ,Diseases in Twins ,medicine ,Humans ,Twin Pregnancy ,Fetus ,Hypertrophy, Right Ventricular ,medicine.diagnostic_test ,Obstetrics ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Gestational age ,Fetofetal Transfusion ,medicine.disease ,Surgery ,Echocardiography ,In utero ,Female ,Hypertrophy, Left Ventricular ,Complication ,business ,Fetal echocardiography - Abstract
Objective: The study’s aim was to analyze the type of cardiac involvement in fetuses or infants with twin-twin transfusion syndrome. Study Design: Seventeen pairs of monochorionic diamniotic twin fetuses with twin-twin transfusion syndrome underwent serial Doppler echocardiographic studies. Repeated decompressive amniocenteses were performed in all pregnancies. Results: No specific cardiac involvement was seen in donor twins in utero or after birth. All recipient twin fetuses showed variable degrees of biventricular hypertrophy and dilation with tricuspid regurgitation. These features were also evident in 45% of the recipient twin neonates. The fluid unbalance resolved with serial amniocenteses in 9 cases and in a further 2 after the death of the donor twin; in all 11 of these recipient twin fetuses there was some degree of improvement of the cardiac involvement, which became normal in all surviving recipient twin infants within 40 days to 6 months after birth. Conclusion: Features of cardiac hypertrophy with signs of a prehydropic or hydropic state develop during fetal life in recipient twins in twin-twin transfusion syndrome; this impairment is reversible with the resolution of the fluid imbalance or after delivery. (Am J Obstet Gynecol 1998;179:1056-62.)
- Published
- 1998
35. Echogenic intracardiac foci: disclosure and the rate of amniocentesis in low-risk patients
- Author
-
Armin S. Razavi and Stephen T. Chasen
- Subjects
Adult ,Down syndrome ,medicine.medical_specialty ,Disclosure ,Risk Assessment ,Intracardiac injection ,Ultrasonography, Prenatal ,Risk category ,symbols.namesake ,Fetal Heart ,Pregnancy ,medicine ,Humans ,Pregnancy-Associated Plasma Protein-A ,Chorionic Gonadotropin, beta Subunit, Human ,Inhibins ,Fisher's exact test ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Obstetrics ,Estriol ,Obstetrics and Gynecology ,Echogenicity ,Retrospective cohort study ,Patient Preference ,medicine.disease ,symbols ,Amniocentesis ,Female ,alpha-Fetoproteins ,Down Syndrome ,business ,Nuchal Translucency Measurement ,Echogenic intracardiac focus - Abstract
Our objective was to determine the impact of disclosure of echogenic intracardiac focus (EIF) on the rate of amniocentesis in women who have undergone sequential testing.This was a retrospective study of women who had sequential testing for Down syndrome from 2009 through 2011. The Down syndrome risk was doubled in pregnancies with EIF, consistent with counseling provided to patients. In the control group Down syndrome risk was based on sequential testing. Within risk categories (1 in250, 251-1000, 1001-5000,5000) rates of amniocentesis with and without documented EIF were compared using Fisher exact test.In all, 4429 women at a median maternal age were included, including 229 with EIF (5.2%). In those at highest Down syndrome risk (1 in250), rates of amniocentesis were similar between the 2 groups. In those at lower levels of risk, the rate of amniocentesis was significantly higher following disclosure of EIF compared to pregnancies without EIF at similar levels of risk.Except for those at highest risk, rates of invasive testing were significantly higher in pregnancies with isolated EIF vs those at comparable risk.
- Published
- 2013
36. Prospective evaluation of the antenatal incidence and postnatal significance of the fetal echogenic cardiac focus: A case-control study
- Author
-
Gary A. Dildy, Victoria E. Judd, and Steven L. Clark
- Subjects
medicine.medical_specialty ,Birth weight ,Ultrasonography, Prenatal ,Fetal Heart ,Pregnancy ,medicine ,Humans ,Prospective Studies ,Fetus ,medicine.diagnostic_test ,business.industry ,Obstetrics ,Infant, Newborn ,Obstetrics and Gynecology ,Gestational age ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Echocardiography ,Ventricle ,Case-Control Studies ,Pregnancy Trimester, Second ,Gestation ,Female ,business ,Fetal echocardiography ,Follow-Up Studies ,Echogenic intracardiac focus - Abstract
OBJECTIVE: We evaluated the antenatal incidence and postnatal significance of echogenic cardiac foci observed during antenatal ultrasonography. STUDY DESIGN: During a 4-month period, all women undergoing dating ultrasonography between 16.0 and 24.9 weeks' gestation at one referral center were prospectively evaluated for an echogenic cardiac focus during an apical four-chamber view of the heart. Referrals for maternal or fetal complications were excluded. Postnatal echocardiography was performed for those identified with positive findings. Controls were selected from among normal subjects in the general group for comparison with the study group. RESULTS: Five hundred six consecutive fetuses were evaluated at a mean ± SD gestational age of 20.6 ± 1.6 weeks. There were 25 (4.9%) fetuses found to have echogenic cardiac focus (left ventricle=19, right ventricle=6). Echocardiography was performed between 0.3 and 20.1 weeks postdelivery. After birth, 12 echogenic left ventricle papillary muscles and three echogenic left ventricle chordae were identified; there were no postnatal right ventricle findings. There were no cases of intracardiac tumor or myocardial dysfunction; one neonate had minor structural malformations. There were no significant differences in maternal age, gravidity, parity, gestational age at ultrasonography, gestational age at delivery, or 5-minute Apgar scores. A significant difference was observed in birth weight between the control ( n = 50) and study ( n = 25) groups (3465 ± 501 gm vs 3124 ± 589 gm; p = 0.002). This difference persisted after correcting for gestational age, although all infants in both groups born after 37.0 weeks weighed >2500 gm. CONCLUSIONS: The incidence of echogenic cardiac foci during routine midtrimester ultrasonography is 4.9%. As an isolated finding, the echogenic cardiac focus may be associated with a statistically significant but clinically insignificant decrease in birth weight. Because of these findings, we consider an isolated echogenic cardiac focus in a patient at low risk for cardiac abnormalities a variant of normal, which does not warrant follow-up clinical evaluation. (Am J Obstet Gynecol 1996;175:1008-12.)
- Published
- 1996
37. Cardiac oxygenation by extracorporeal membrane oxygenation in exteriorized fetal lambs
- Author
-
Yuji Murata, Satoshi Ibara, Keiya Fujimori, Naoki Nagata, Takahiro Hirano, Edward J. Quilligan, and Toshiya Kamimura
- Subjects
Umbilical Veins ,medicine.medical_specialty ,Heart Ventricles ,medicine.medical_treatment ,Umbilical vein ,Extracorporeal Membrane Oxygenation ,Fetal Heart ,Fetus ,Pregnancy ,Internal medicine ,Ductus arteriosus ,Extracorporeal membrane oxygenation ,Animals ,Medicine ,Heart Atria ,cardiovascular diseases ,Sheep ,business.industry ,Obstetrics and Gynecology ,Blood flow ,Oxygenation ,Carbon Dioxide ,Hydrogen-Ion Concentration ,Fetal Blood ,Microspheres ,Oxygen ,Carotid Arteries ,medicine.anatomical_structure ,Fetal circulation ,Ventricle ,Anesthesia ,cardiovascular system ,Cardiology ,Regression Analysis ,Female ,business - Abstract
OBJECTIVE: The purpose of this study was to determine the degree of cardiac oxygenation produced by different routes of extracorporeal membrane oxygenation in fetal lambs submerged in warm saline solution. STUDY DESIGN: Seven fetal lambs ranging in age from 113 to 133 days of gestation were delivered by cesarean section and oxygenated with extracorporeal membrane oxygenation. To maintain the patency of the ductus arteriosus, prostaglandin E 1 was continuously infused intravenously to the fetus. Initially the extracorporeal membrane oxygenation route was from the right atrium to the carotid artery. Then the extracorporeal membrane oxygenation route was changed to flow from the right atrium to the umbilical vein. The fetus was kept in a warm saline solution bath, and the fetal circulation was maintained. Extracorporeal membrane oxygenation flow ranged between 100 and 200 ml/min throughout the experiment. Simultaneous blood samples were taken during both types of extracorporeal membrane oxygenation from the following points in the fetal circulation: premembrane (least oxygenated blood leaving the fetus from the right atrium), postmembrane (oxygenated blood returning to the fetus), the carotid artery, and the left ventricle. The respiratory gases and pH of each sample were measured. Six fetuses received nonradioactive colored microspheres injected into the oxygenated blood returning to the fetus flow before returning to the fetuses during both types of extracorporeal membrane oxygenation. After the animals were killed, microspheres were counted in the myocardium separately taken from the right and left atria and the right and left ventricles to determine cardiac blood flow. RESULTS: During right atrium to carotid artery extracorporeal membrane oxygenation, left ventricle PO 2 remained low as postmembrane PO 2 increased; these values were not significantly correlated ( r = 0.234, p = 0.61). During right atrium to umbilical vein extracorporeal membrane oxygenation, left ventricle and postmembrane PO 2 exhibited a significant positive correlation ( r = 0.855, p = 0.014). When the extracorporeal membrane oxygenation route was switched from the right atrium to carotid artery to the right atrium to umbilical vein, there was a significant increase in left ventricle PO 2 and a decrease in left ventricle PCO 2 , whereas the respiratory gases and pH remained unchanged at other sites in the circulation. Microsphere counts were consistently higher during right atrium to umbilical vein extracorporeal membrane oxygenation than during right atrium to carotid artery extracorporeal membrane oxygenation in all four samples from different parts of myocardium ( p t test). CONCLUSION: More effective cardiac oxygenation is provided by right atrium to umbilical vein extracorporeal membrane oxygenation than by right atrium to carotid artery extracorporeal membrane oxygenation. (AM J OBSTET GYNECOL 1996;174:864-70.)
- Published
- 1996
38. Myocardial and cerebral oxygen delivery are not adversely affected by cocaine administration to early-gestation fetal sheep
- Author
-
David J. Burchfield, Antonio E. Peña, and Robert M. Abrams
- Subjects
Hemodynamics ,Blood Pressure ,Hypoxemia ,Fetal Heart ,Fetus ,Cocaine ,Pregnancy ,Heart rate ,medicine ,Animals ,Infusions, Intravenous ,Sheep ,business.industry ,Brain ,Obstetrics and Gynecology ,Blood flow ,Heart Rate, Fetal ,Oxygen ,Blood pressure ,Cerebral blood flow ,Cerebrovascular Circulation ,Anesthesia ,Gestation ,Female ,medicine.symptom ,business - Abstract
OBJECTIVES: Cocaine administration to near-term pregnant sheep causes fetal hypoxemia, but oxygen delivery to the heart and brain are preserved because of increased blood flow. We hypothesized that cocaine administration during earlier fetal gestation impairs oxygen delivery to the heart and brain. STUDY DESIGN: Ten pregnant ewes and fetuses at 0.7 term gestation underwent surgical instrumentation. After 48 hours of recovery fetal blood pressure, heart rate, cerebral and myocardial blood flow, and arterial oxygen content were determined before and during cocaine administration to the ewe. RESULTS: Fetal hypoxemia was not noted in these animals. Fetal myocardial blood flow increased from 220 ± 100 ml per 100 gm per minute to 349 ± 183 ml per 100 gm per minute ( p = 0.03), and oxygen delivery increased from 16 ± 5 ml of oxygen per 100 gm per minute to 22 ± 7 ml of oxygen per 100 gm per minute ( p = 0.02). Fetal cerebral blood flow and oxygen delivery remained unchanged. CONCLUSION: Cerebral and myocardial oxygen delivery are unimpeded by maternal cocaine administration in 0.7 term gestation ovine fetuses. (AM J OBSTET GYNECOL 1996;174:1028-32.)
- Published
- 1996
39. Percutaneous ultrasonographically guided ablation of an acardiac twin
- Author
-
Richard P. Porreco
- Subjects
Adult ,Polyhydramnios ,medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Diastole ,Twin reversed arterial perfusion ,Ultrasonography, Prenatal ,Umbilical Arteries ,Fetal Heart ,Fetus ,Pregnancy ,Internal medicine ,Diseases in Twins ,medicine ,Humans ,Ethanol ,business.industry ,Obstetrics and Gynecology ,Heart ,Fetofetal Transfusion ,Twins, Monozygotic ,Blood flow ,medicine.disease ,Ablation ,Pregnancy Reduction, Multifetal ,Surgery ,Injections, Intra-Arterial ,Surgery, Computer-Assisted ,Acardiac twin ,Cardiology ,Term Birth ,Female ,business - Abstract
Acardiac twinning is caused by twin reversed arterial perfusion (TRAP). Normal “pump” twins may face early delivery and cardiac decompensation and have a high perinatal mortality. A primagravid patient had serial evaluation of a TRAP pregnancy beginning early in the second trimester. Rapid growth of the acardiac sibling, high diastolic velocity Doppler waveforms in the perfusing vessel, and early hydramnios prompted ablation of blood flow by a percutaneous ultrasonographically guided infusion of absolute alcohol. A term birth of a normal pump twin was the outcome. Ablation of blood flow into an acardiac sibling of a TRAP pregnancy may be indicated in cases with a poor prognosis by use of an effective percutaneous ultrasonographically guided technique.
- Published
- 2004
40. A new method for on-screen ultrasonographic determination of fetal cardiac axis
- Author
-
Michael D. Bork, Winston A. Campbell, Elizabeth L. Fabbri, William E. Scorza, James F.X. Egan, Daniel J. Diana, and Lori D. Feeney
- Subjects
Fetus ,Measurement method ,business.industry ,Obstetrics and Gynecology ,Fetal heart ,Anatomy ,Cardiac axis ,Antenatal ultrasonography ,Ultrasonography, Prenatal ,Normal results ,Fetal Heart ,Echocardiography ,Pregnancy ,cardiovascular system ,Humans ,Calipers ,Medicine ,Female ,Prospective Studies ,business ,Nuclear medicine ,Protractor - Abstract
OBJECTIVE: Our purpose was to develop an ultrasonographic method of using multiple electronic calipers for on-screen measurement of fetal cardiac axis. STUDY DESIGN: Two hundred low-risk patients who were seen for antenatal ultrasonography were studied. Standard biometry, anatomic survey, and echocardiography were performed on all fetuses. By use of a four-chamber view fetal cardiac axis was measured with electronic calipers. A table, derived from a trigonometric formula, was created to convert the caliper measurements to cardiac axis in degrees. The results were compared with a protractor-determined fetal cardiac axis. RESULTS: All echocardiograms had normal results. Fetal cardiac axis (±2 SD) by the ultrasonographic method was 43 degrees (±16 degrees) versus 43 degrees (±14 degrees) by the protractor method. This difference was not significant. CONCLUSION: An on-screen method to determine fetal cardiac axis by use of multiple calipers is described. It is comparable to a protractor-measured fetal cardiac axis.
- Published
- 1995
41. Fetal cardiac function and ductus arteriosus during indomethacin and sulindac therapy for threatened preterm labor: A randomized study
- Author
-
Juha Rasanen and Pentti Jouppila
- Subjects
Cardiac function curve ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Indomethacin ,Fetal Heart ,Obstetric Labor, Premature ,Sulindac ,Pregnancy ,Internal medicine ,Ductus arteriosus ,medicine.artery ,Ascending aorta ,medicine ,Humans ,cardiovascular diseases ,Pulse ,Fetus ,business.industry ,Obstetrics and Gynecology ,Ductus Arteriosus ,medicine.disease ,medicine.anatomical_structure ,Echocardiography ,Ventricle ,Anesthesia ,embryonic structures ,cardiovascular system ,Cardiology ,Female ,Tricuspid Valve Regurgitation ,business ,medicine.drug - Abstract
OBJECTIVE: The purpose of this randomized study was to evaluate the effects of indomethacin (10 patients) and sulindac (10 patients) given for 4-days on the fetal cardiac function and ductus arteriosus in pregnancies complicated by threatened premature labor between 28 and 32 gestational weeks. STUDY DESIGN: By use of pulsed color Doppler techniques the pulsatility index in fetal ductus arteriosus was calculated. Peak systolic valocities in the fetal ascending aorta and pulmonary trunk were also measured. By M-mode echocardiography both ventricular inner end-diastolic and end-systolic diameters were measured and ventricular fractional shortenings were calculated. Tricuspid valve regurgitation was evaluated by pulsed and color Doppler techniques. The ultrasonic examinations were made before and 4, 24, 48, and 72 hours after the start and 24 hours after the end of medication. RESULTS: Indomethacin significantly decreased the mean pulsatility index in fetal ductus arteriosus 4 hours after the beginning of medication. This decrease became greater later during medication, and it was associated with a significant increase in both ventricular inner end-diastolic diameters and with a significant decrease in right ventricular fractional shortening. The mean pulsatility index in the fetal ductus arteriosus increased to control values at 24 hours after the end of medication. Sulindac significantly decreased the mean pulsatility index in fetal ductus arteriosus only 24 hours after the beginning of medication. All other mean pulsatility index values did not differ from control values. Other cardiac parameters remained unchanged during sulindac treatment. CONCLUSION: Indomethacin has a significant reversible constrictive effect on the fetal ductus arteriosus that is associated with secondary changes, especially in the right ventricle. Sulindac seems to have only a mild and transient constrictive effect on the fetal ductus arteriosus.
- Published
- 1995
42. Alterations in fetal and placental deoxyribonucleic acid synthesis rates after chronic fetal placental embolization
- Author
-
Robert Gagnon, Howard D. Rundle, Victor K. M. Han, and Laura Johnston
- Subjects
Blood Glucose ,medicine.medical_specialty ,Placenta ,Placental insufficiency ,Fetal Hypoxia ,Catheterization ,Embryonic and Fetal Development ,Fetal Heart ,Fetus ,Pregnancy ,Internal medicine ,medicine ,Animals ,Muscle, Skeletal ,Analysis of Variance ,Sheep ,DNA synthesis ,business.industry ,Obstetrics and Gynecology ,DNA ,Organ Size ,Hypoxia (medical) ,Fetal Blood ,medicine.disease ,Oxygen ,medicine.anatomical_structure ,Endocrinology ,embryonic structures ,Lactates ,Vascular resistance ,Gestation ,Female ,Blood Gas Analysis ,medicine.symptom ,business ,Cotyledon ,Perfusion - Abstract
Fetal growth and development are closely related to normal placental growth and function. We performed a study to determine the effect of a 10-day period of fetal hypoxemia induced by umbilical-placental hypoperfusion on tissue deoxyribonucleic acid synthesis rates in the 0.84 to 0.91 of gestation ovine fetus and placenta.Daily fetal placental embolization was performed in four chronically catheterized sheep fetuses until fetal arterial oxygen content decreased by approximately 30% compared with preembolization values. Five control fetuses received vehicle only. On experimental day 10, the deoxyribonucleic acid synthesis rate was determined by injecting tritiated thymidine (1 mCi/kg) intravenously approximately 8 hours before the end of the study.Fetal arterial oxygen decreased from 3.2 +/- 0.1 (SEM) mmol/L preembolization to 2.2 +/- 0.2 mmol/L on day 10 (p0.001) and remained unchanged in controls. On day 10 deoxyribonucleic acid synthesis rates were significantly reduced in embolized fetuses compared with controls, by 38% in cotyledons (83.0 +/- 15.1 vs 133.7 +/- 9.9 disintegrations/min/micrograms deoxyribonucleic acid, p0.05), 28% in the left ventricular wall (36.8 +/- 3.7 vs 51.0 +/- 4.7 disintegrations/min/micrograms deoxyribonucleic acid, p0.05), and 45% in the quadriceps muscle (15.4 +/- 4.0 vs 28.1 +/- 3.0 disintegrations/min/micrograms deoxyribonucleic acid, p0.05). Tritiated thymidine autoradiography demonstrated that cotyledonary deoxyribonucleic acid synthesis occurred exclusively in the fetal trophoblasts cells.We concluded that a reduction in cotyledonary, quadriceps muscle, and left ventricular myocardium deoxyribonucleic acid synthesis rates are the earliest adaptive mechanisms of fetal growth associated with development of umbilical-placental insufficiency. We speculate that alteration in the myocardial deoxyribonucleic acid synthesis rate could be a major contributing factor in the deterioration of fetal myocardial function associated with increased placental vascular resistance.
- Published
- 1995
43. Doppler assessment of the fetus with intrauterine growth restriction
- Author
-
Suneet P. Chauhan, Eliza Berkley, and Alfred Abuhamad
- Subjects
congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Middle Cerebral Artery ,Intrauterine growth restriction ,Cochrane Library ,Ultrasonography, Prenatal ,Umbilical Arteries ,Fetal Heart ,Pregnancy ,medicine.artery ,medicine ,Humans ,Uterine artery ,reproductive and urinary physiology ,Randomized Controlled Trials as Topic ,Fetus ,Fetal Growth Retardation ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,Umbilical artery ,Ultrasonography, Doppler ,medicine.disease ,female genital diseases and pregnancy complications ,embryonic structures ,Middle cerebral artery ,Female ,business ,Ductus venosus ,Blood Flow Velocity - Abstract
Objective We sought to provide evidence-based guidelines for utilization of Doppler studies for fetuses with intrauterine growth restriction (IUGR). Methods Relevant documents were identified using PubMed (US National Library of Medicine, 1983 through 2011) publications, written in English, which describe the peripartum outcomes of IUGR according to Doppler assessment of umbilical arterial, middle cerebral artery, and ductus venosus. Additionally, the Cochrane Library, organizational guidelines, and studies identified through review of the above were utilized to identify relevant articles. Consistent with US Preventive Task Force suggestions, references were evaluated for quality based on the highest level of evidence, and recommendations were graded. Results and Recommendations Summary of randomized and quasirandomized studies indicates that, among high-risk pregnancies with suspected IUGR, the use of umbilical arterial Doppler assessment significantly decreases the likelihood of labor induction, cesarean delivery, and perinatal deaths (1.2% vs 1.7%; relative risk, 0.71; 95% confidence interval, 0.52–0.98). Antepartum surveillance with Doppler of the umbilical artery should be started when the fetus is viable and IUGR is suspected. Although Doppler studies of the ductus venous, middle cerebral artery, and other vessels have some prognostic value for IUGR fetuses, currently there is a lack of randomized trials showing benefit. Thus, Doppler studies of vessels other than the umbilical artery, as part of assessment of fetal well-being in pregnancies complicated by IUGR, should be reserved for research protocols.
- Published
- 2012
44. Spatiotemporal properties of the fetal magnetocardiogram
- Author
-
Minghong Wang, Ronald T. Wakai, and Chester B. Martin
- Subjects
Fetus ,Time Factors ,Cardiac cycle ,medicine.diagnostic_test ,business.industry ,Obstetrics and Gynecology ,Fetal heart ,Anatomy ,Heart Rate, Fetal ,Fetal monitoring ,Electrocardiography ,Magnetics ,QRS complex ,Nuclear magnetic resonance ,Pregnancy ,Heart Function Tests ,Humans ,Medicine ,Female ,Fetal Monitoring ,business ,Magnetocardiography ,Ventricular depolarization - Abstract
OBJECTIVE: Our purpose was to investigate the spatiotemporal properties of the fetal magnetocardiogram. STUDY DESIGN: Fetal magnetocardiogram maps were measured for the first time in 20 subjects from 22 to 39 weeks' gestation. Waveform and topographic maps were used to display the data. RESULTS: The maps showed spatiotemporal properties consistent with simple volume conductor theory: topography was closely related to the presentation of the fetus, Q-wave sources were dipolar and localized, the magnetic heart vector rotated extensively during the QRS complex, and close correspondence was observed between fetal and neonatal maps. Ventricular depolarization and events in the cardiac cycle could be visualized in considerable detail by means of a time series of topographic maps. CONCLUSION: Fetal magnetocardiogram shows excellent spatiotemporal properties and is well suited for in utero studies of fetal heart activity. (AM J OBSTET GYNECOL 1994;170:770-6.)
- Published
- 1994
45. Relationship between the fetal biophysical profile score, umbilical artery Doppler velocimetry, and fetal blood acid-base status determined by cordocentesis
- Author
-
S. Kim, Bo Hyun Yoon, Roberto Romero, Hee Chul Syn, Seung Hyup Kim, David B. Cotton, Joel W. Ager, and Cheng Rae Roh
- Subjects
Biophysical profile ,medicine.medical_specialty ,Ultrasonography, Prenatal ,Umbilical Arteries ,Umbilical vein ,Hypoxemia ,Fetal Heart ,Fetus ,Pregnancy ,medicine.artery ,Internal medicine ,medicine ,Humans ,Hypoxia ,Acidosis ,Acid-Base Equilibrium ,business.industry ,Obstetrics and Gynecology ,Gestational age ,Umbilical artery ,Carbon Dioxide ,Velocimetry ,Fetal Blood ,Surgery ,Oxygen ,Fetal Diseases ,Logistic Models ,Pulsatile Flow ,Cardiology ,Female ,medicine.symptom ,Cordocentesis ,business ,Blood Flow Velocity - Abstract
Fetal hypoxia-acidosis is part of the terminal pathway leading to intrauterine fetal death. A central premise of antepartum surveillance is that identification and timely delivery of the hypoxic or acidotic fetus will prevent intrauterine death and decrease long-term neurologic damage. The optimal method to identify fetal hypoxia-acidosis has not been determined. We attempted to compare the performance of the biophysical profile score and umbilical artery Doppler velocimetry in the identification of fetal acidemia, hypoxemia, and hypercarbia as determined by pH and gas analysis of fetal blood obtained by cordocentesis.Fetal biophysical profile and umbilical artery Doppler velocimetry studies were performed before cordocentesis in 24 patients (26 to 40 weeks). Umbilical vein pH and blood gas values were determined in all cases. The pulsatility index of the umbilical artery was obtained with pulsed Doppler equipment. Receiver-operator characteristic curve analysis and stepwise multiple logistic regression were performed to examine the relationship between biophysical profile score, umbilical artery Doppler velocimetry, and acid-base status.The prevalence of fetal acidemia (pH 2 SD below the mean for gestational age) was 41.7% (10/24). There was a significant relationship between the change in umbilical artery pulsatility index and fetal acidemia (chi 2 = 26.6, p0.001) and hypercarbia (chi 2 = 22.9, p0.001), but not hypoxemia (chi 2 = 1.0, p0.1), and between the biophysical profile score and fetal acidemia (chi 2 = 11.1, p0.001) and hypercarbia (chi 2 = 9.0, p0.005), but not hypoxemia (chi 2 = 2.3, p0.1). Stepwise multiple logistic regression demonstrated that umbilical artery Doppler velocimetry was a better explanatory variable for acidemia and hypercarbia than the biophysical profile score.A strong relationship between the degree of fetal acidemia and hypercarbia and the results of umbilical artery Doppler velocimetry and biophysical profile was found. However, umbilical artery Doppler velocimetry was a better explanatory variable for these outcome than the biophysical profile score.
- Published
- 1993
46. Plymouth randomized trial of cardiotocogram only versus ST waveform plus cardiotocogram for intrapartum monitoring in 2400 cases
- Author
-
Keith R. Greene, John S.H. Curnow, Jennifer A. Westgate, and Maureen I Harris
- Subjects
medicine.medical_specialty ,Cardiotocography ,Quality Assurance, Health Care ,law.invention ,Electrocardiography ,Fetal Heart ,Randomized controlled trial ,Heart Rate ,Pregnancy ,law ,medicine ,Humans ,ST segment ,Prospective Studies ,Fetal Monitoring ,Prospective cohort study ,Labor, Obstetric ,medicine.diagnostic_test ,Cesarean Section ,Obstetrics ,business.industry ,Pregnancy Outcome ,Obstetrics and Gynecology ,ST Waveform Analysis ,Odds ratio ,Fetal Blood ,Clinical trial ,Anesthesia ,Female ,Blood Gas Analysis ,business - Abstract
The physiology of changes in the ST waveform of the fetal electrocardiogram has been elucidated in extensive animal and human observational studies. A combination of heart rate and ST waveform analysis might improve the predictive value of intrapartum monitoring. Our purpose was to compare operative intervention and neonatal outcome in labors monitored by the conventional cardiotocogram with those monitored by ST waveform plus the cardiotocogram.A prospective, randomized clinical trial was performed on 2434 high-risk labors in a district general hospital in Plymouth, England. Statistical analysis was performed by Student t test and chi 2 analysis.There was a 46% reduction (p0.001, odds ratio 1.85 [1.35-2.66]) in operative deliveries for "fetal distress" and a trend to less metabolic acidosis (p = 0.09, odds ratio 0.38 [0.13-1.07]) and fewer low 5-minute Apgar scores (p = 0.12, odds ratio 0.62 [0.35-1.08]) in the ST waveform plus cardiotocogram arm.ST waveform analysis discriminates cardiotocogram changes in labor, and the protocol for interpretation is safe. Further randomized studies are warranted.
- Published
- 1993
47. Effects of long-term, high-altitude hypoxemia on ovine fetal cardiac output and blood flow distribution
- Author
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Justo Alonso, Lawrence D. Longo, Raymond D. Gilbert, Takashi Okai, and Masato Kamitomo
- Subjects
Cardiac output ,Time Factors ,Blood Pressure ,Kidney ,Hypoxemia ,Hemoglobins ,Fetal Heart ,Fetus ,Pregnancy ,Coronary Circulation ,Adrenal Glands ,medicine ,Animals ,Cardiac Output ,Hypoxia ,Sheep ,business.industry ,Altitude ,Brain ,Obstetrics and Gynecology ,Organ Size ,Blood flow ,Carbon Dioxide ,Hypoxia (medical) ,Effects of high altitude on humans ,Fetal Blood ,Oxygen ,Cerebral blood flow ,Regional Blood Flow ,Anesthesia ,Gestation ,Female ,medicine.symptom ,business ,Digestive System - Abstract
Objective: We sought to determine the effects of long-term hypoxemia on fetal cardiac output and flow distribution. Study Design: We exposed six pregnant sheep to high altitude (3820 m) hypoxia from 30 to 135 days' gestation (term 146 days). Ten to 14 days after surgery we determined fetal cardiac output and organ blood flows by means of the radiolabeled microsphere technique during a baseline period and also during an additional 30-minute period of more severe added acute hypoxemia. Results: Baseline maternal arterial Po 2 was 60.7 ± 1.7 torr and fell to 35.1 ± 3.0 torr during the added acute hypoxemia. Fetal arterial Po 2 decreased from 18.5 ± 1.1 to 11.4 ± 1.5 torr during added acute hypoxemia. Baseline fetal cardiac output was 351 ± 55 ml/min/kg, which was significantly lower than previously reported values in low-altitude fetuses. Blood flow to critical organs such as the heart and brain was maintained at levels found in low-altitude fetuses, but flow to the carcass was significantly lower (−49%) than the mean value reported in the literature for low-altitude fetuses. Oxygen delivery was also maintained at normal levels to the brain and heart but was reduced in the kidneys (−31%), gastrointestinal tract (51%), and carcass (−58%). During added acute hypoxemia cardiac output did not change significantly; however, blood flow to the brain, heart, and adrenal glands increased 112%, 135%, and 156% ( p Conclusion: We conclude that during long-term hypoxemia redistribution of fetal cardiac output is maintained favoring the brain and heart.
- Published
- 1993
48. Fetal heart circumference as a predictor of menstrual in fetuses affected by disturbances in growth
- Author
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Lyndon M. Hill, Dawn DiNofrio, Carol Peterson, Judy Maloney, David S. Guzick, and Pamela Nedzeksy
- Subjects
Pediatrics ,medicine.medical_specialty ,Gestational Age ,Fetal heart ,Ultrasonography, Prenatal ,Fetal Macrosomia ,Fetal Heart ,Pregnancy ,Reference Values ,Fetal growth ,Independent parameter ,Animals ,Humans ,Medicine ,Fetus ,Fetal Growth Retardation ,Anthropometry ,Growth retardation ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,Gestational age ,Circumference ,Gestation ,Female ,business - Abstract
Objective: The purpose of this study was twofold: (1) to evaluate the relationship between fetal heart circumference and gestational age and (2) to determine the effect, if any, of disturbances in fetal growth on heart circumference. Study design: Heart circumference was measured in 262 women with normal gestations (control group) and in two study groups consisting of 52 large-for-gestational age 32 small-for-gestational age fetuses. Standardized, gestational age-adjusted values in the two study groups were compared with normative data provided by the control group. Results: There was a close correlation ( R 2 = 0.94) between heart circumference and gestational age in normally growing fetuses. Disturbances of fetal growth (i.e., macrosomia and growth retardation) were found to have an inconsistent effect on heart circumference. Conclusion: Heart circumference cannot be used as an independent parameter for gestational age evaluation in fetuses with disturbances of growth.
- Published
- 1993
49. Accuracy of right ventricular output estimated by Doppler echocardiography in the sheep fetus
- Author
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Norman H. Silverman, Hirohiko Shiraishi, and Abraham M. Rudolph
- Subjects
Cardiac output ,medicine.medical_specialty ,Sheep fetus ,Doppler echocardiography ,Ultrasonography, Prenatal ,Flow measurement ,Microsphere ,symbols.namesake ,Fetal Heart ,Pregnancy ,Ultrasonic flow meter ,Internal medicine ,Animals ,Ventricular Function ,Medicine ,Cardiac Output ,Sheep ,medicine.diagnostic_test ,business.industry ,Obstetrics and Gynecology ,Stroke Volume ,Anatomy ,Heart Rate, Fetal ,Echocardiography, Doppler ,Microspheres ,Circulatory system ,cardiovascular system ,symbols ,Cardiology ,Female ,business ,Doppler effect - Abstract
OBJECTIVE: Our goal was to determine whether Doppler ultrasonographic estimation of fetal right ventricular output was accurate enough to evaluate fetal cardiac performance before the technique can be applied with confidence to the human fetus. The accuracy of this method has not been validated experimentally. STUDY DESIGN: We compared the right ventricular output measured by Doppler echocardiography with that determined from a transit-time ultrasonic flowmeter placed around the fetal pulmonary trunk and to that determined by microsphere technique. We obtained 72 Doppler flow measurements and 16 microsphere flow measurements in six fetuses. RESULTS: There was a fair correlation between cardiac output estimated by Doppler echocardiography performed transabdominally and that determined by a transit-time flowmeter ( r = 0.76). The correlation was excellent when Doppler echocardiography was performed by the transuterine approach ( r = 0.94). There was also an excellent correlation between right ventricular output determined by a transit-time flowmeter and that by microsphere technique ( r = 0.94). CONCLUSION: Doppler echocardiographic estimation of fetal right ventricular cardiac output is thus feasible and accurate.
- Published
- 1993
50. Partial contributions of developmental hypoxia and undernutrition to prenatal alterations in somatic growth and cardiovascular structure and function
- Author
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Andrew D. Kane, Emily J. Camm, Nicholas W. Morrell, Dino A. Giussani, Jeremy A. Hansell, Cara Lewis, Samuel Wong, and Emilio A. Herrera
- Subjects
medicine.medical_specialty ,Placental insufficiency ,Preeclampsia ,Fetal Development ,Fetal Heart ,Pregnancy ,medicine.artery ,Internal medicine ,medicine ,Animals ,Rats, Wistar ,Hypoxia ,Prenatal Nutritional Physiological Phenomena ,Aorta ,Fetus ,Electrical impedance myography ,business.industry ,Malnutrition ,Myography ,Obstetrics and Gynecology ,Hypoxia (medical) ,medicine.disease ,Placental Insufficiency ,Rats ,Endocrinology ,embryonic structures ,Gestation ,Female ,medicine.symptom ,business - Abstract
Objective The objective of the study was to compare and contrast the effects of developmental hypoxia vs undernutrition on fetal growth, cardiovascular morphology, and function. Study Design On day 15 of gestation, Wistar dams were divided into control, hypoxic (10% O 2 ), or undernourished (35% reduction in food intake) pregnancy. On day 20, fetal thoraces were fixed, and the fetal heart and aorta underwent quantitative histological analysis. In a separate group, fetal aortic vascular reactivity was determined via wire myography. Results Both hypoxic and undernourished pregnancy was associated with asymmetric fetal growth restriction. Pregnancy complicated by hypoxia promoted fetal aortic thickening without changes in cardiac volumes when expressed as a percentage of total heart volume. In contrast, maternal undernutrition affected fetal cardiac morphology without changes in aortic structure. Fetal aortic vascular reactivity was also differentially affected by hypoxia or undernutrition. Conclusion Developmental hypoxia or undernutrition in late gestation has differential effects on fetal cardiovascular morphology and function.
- Published
- 2010
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