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1. Fetal cerebral Doppler changes and outcome in late preterm fetal growth restriction : prospective cohort study

Author

Stampalija, T., Thornton, J., Marlow, N., Napolitano, R., Bhide, A., Pickles, T., Bilardo, C. M., Gordijn, S. J., Gyselaers, W., Valensise, H., Hecher, K., Sande, R. K., Lindgren, P., Bergman, E., Arabin, B., Breeze, A. C., Wee, L., Ganzevoort, W., Richter, J., Berger, A., Brodszki, J., Derks, J., Mecacci, F., Maruotti, G. M., Myklestad, K., Lobmaier, S. M., Prefumo, F., Klaritsch, P., Calda, P., Ebbing, C., Frusca, T., Raio, L., Visser, G. H. A., Krofta, L., Cetin, I., Ferrazzi, E., Cesari, E., Wolf, H., Lees, C. C., Brezinka, C., Casagrandi, D., Cerny, A., Dall'Asta, A., Devlieger, R., Duvekot, J., Eggebo, T. M., Fantasia, I., Ferrari, F., Fratelli, N., Ghi, T., Graupner, O., Greimel, P., Hofstaetter, C., Presti, D. Lo, Georg, M., Macsali, F., Marsal, K., Martinelli, P., Mylrea-Foley, B., Mullins, E., Ostermayer, E., Papageorghiou, A., Peasley, R., Ramoni, A., Sarno, L., Seikku, L., Simeone, S., Thilaganathan, B., Tiralongo, G., Valcamonico, A., van Holsbeke, C., Vietheer, A., APH - Quality of Care, ARD - Amsterdam Reproduction and Development, Obstetrics and Gynaecology, APH - Digital Health, Stampalija, T., Thornton, J., Marlow, N., Napolitano, R., Bhide, A., Pickles, T., Bilardo, C. M., Gordijn, S. J., Gyselaers, W., Valensise, H., Hecher, K., Sande, R. K., Lindgren, P., Bergman, E., Arabin, B., Breeze, A. C., Wee, L., Ganzevoort, W., Richter, J., Berger, A., Brodszki, J., Derks, J., Mecacci, F., Maruotti, G. M., Myklestad, K., Lobmaier, S. M., Prefumo, F., Klaritsch, P., Calda, P., Ebbing, C., Frusca, T., Raio, L., Visser, G. H. A., Krofta, L., Cetin, I., Ferrazzi, E., Cesari, E., Wolf, H., Lees, C. C., Brezinka, C., Casagrandi, D., Cerny, A., Dall'Asta, A., Devlieger, R., Duvekot, J., Eggebo, T. M., Fantasia, I., Ferrari, F., Fratelli, N., Ghi, T., Graupner, O., Greimel, P., Hofstaetter, C., Presti, D. L., Georg, M., Macsali, F., Marsal, K., Martinelli, P., Mylrea-Foley, B., Mullins, E., Ostermayer, E., Papageorghiou, A., Peasley, R., Ramoni, A., Sarno, L., Seikku, L., Simeone, S., Thilaganathan, B., Tiralongo, G., Valcamonico, A., Van Holsbeke, C., Vietheer, A., and HUS Gynecology and Obstetrics

Subjects
Technology, adverse outcome, umbilical-cerebral ratio, Umbilical Arteries, umbilical artery, TRUFFLE-2 Group, Fetal Development, 0302 clinical medicine, Obstetrics and gynaecology, Pregnancy, Reference Values, 3123 Gynaecology and paediatrics, Interquartile range, Birth Weight, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Fetal Growth Retardation, 030219 obstetrics & reproductive medicine, Radiological and Ultrasound Technology, Obstetrics, Radiology, Nuclear Medicine & Medical Imaging, Doppler, Obstetrics & Gynecology, Obstetrics and Gynecology, Gestational age, General Medicine, Stillbirth, 3. Good health, ddc, Europe, Fetal Weight, Pulsatile Flow, Infant, Small for Gestational Age, Female, Waist Circumference, Rheology, Life Sciences & Biomedicine, Live Birth, middle cerebral artery, neonatal, umbilicocerebral ratio, Radiology, Nuclear Medicine and Medical Imaging, Adult, medicine.medical_specialty, Birth weight, education, 610 Medicine & health, Gestational Age, Reproduktionsmedicin och gynekologi, DIAGNOSIS, Ultrasonography, Prenatal, 03 medical and health sciences, Fetus, Obstetrics, Gynecology and Reproductive Medicine, medicine, MANAGEMENT, Humans, Radiology, Nuclear Medicine and imaging, Risk factor, Obstetrics & Reproductive Medicine, Science & Technology, business.industry, CEREBROPLACENTAL RATIO, Infant, Newborn, Ultrasonography, Doppler, Acoustics, Reproductive Medicine, Relative risk, 1114 Paediatrics and Reproductive Medicine, Radiologi och bildbehandling, business
Abstract

OBJECTIVES: To explore the association between fetal umbilical and middle cerebral artery (MCA) Doppler abnormalities and outcome in late preterm pregnancies at risk of fetal growth restriction. METHODS: This was a prospective cohort study of singleton pregnancies at risk of fetal growth restriction at 32 + 0 to 36 + 6 weeks of gestation, enrolled in 33 European centers between 2017 and 2018, in which umbilical and fetal MCA Doppler velocimetry was performed. Pregnancies were considered at risk of fetal growth restriction if they had estimated fetal weight and/or abdominal circumference (AC)

Published
2020
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2. Influence of equipment and settings on myocardial performance index repeatability and definition of settings to achieve optimal reproducibility.

Author

Lobmaier, S. M., Cruz‐Lemini, M., Valenzuela‐Alcaraz, B., Ortiz, J. U., Martinez, J. M., Gratacos, E., and Crispi, F.

Subjects
*HEART rate monitoring, *DOPPLER echocardiography, *FETAL echocardiography, *HEART function tests, *FETAL pathophysiology
Abstract

ABSTRACT Objective To compare left myocardial performance index ( MPI) values and reproducibility using different settings and ultrasound equipment in order to standardize optimal machine settings. Methods Left MPI was prospectively evaluated by one observer performing conventional Doppler in 62 fetuses (28-36 weeks of gestational age) using different settings (changing sweep speed, gain and wall motion filter ( WMF)) and two different ultrasound devices (Siemens Antares, Siemens; Voluson 730 Expert, GE Medical Systems). Intraclass coefficients of agreement ( ICCs) were calculated using Bland-Altman analysis. Results Using baseline settings on the Siemens, mean ( SD) MPI was 0.44 (0.05) with an ICC of 0.81. Decreasing the sweep speed resulted in decreasing average MPI values (0.43) and decreasing ICC (0.61). Lowering gain also influenced average MPI values (0.46) and ICC (0.76). Raising gain resulted in similar MPI values (0.45) with better ICC (0.90) compared with baseline settings. Raising wall motion filter ( WMF) provided the best ICC (0.94) compared with the other settings. Changing the ultrasound equipment resulted in an ICC of 0.64. The optimal settings to achieve the highest reproducibility in measurement of MPI were sweep speed 8, gain 60 dB and WMF 281 Hz for Siemens Antares and sweep speed 5, gain −10 dB and WMF 210 Hz for Voluson 730 Expert. Conclusion Changing ultrasound settings or equipment may affect the calculation and repeatability of measurement of MPI values. Strict standardization of methods decreases the variability of this parameter for fetal cardiac function assessment. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Published
2014
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3. Angiogenic factors at diagnosis of late-onset small-for-gestational age and histological placental underperfusion.

Author

Triunfo, S., Lobmaier, S., Parra-Saavedra, M., Crovetto, F., Peguero, A., Nadal, A., Gratacos, E., and Figueras, F.

Abstract

Abstract: Objective: This study was designed to explore the association between angiogenic factors levels at diagnosis of small-for-gestational age (SGA) and placental underperfusion (PUP). Methods: In a cohort of SGA singleton pregnancies, each delivered at >34 weeks, uterine (UtA), umbilical (UA), and middle cerebral (MCA) arteries were evaluated by Doppler upon diagnosis of SGA status. In addition, maternal circulating concentrations of placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were assayed by ELISA, and each placenta was evaluated for histologic signs of PUP using a hierarchical and standardized classification system. Logistic regression was applied to analyze independent relationships (at diagnosis) between angiogenic factors and Doppler parameters. Results: A total of 122 suspected SGA pregnancies were studied, 70 (57.4%) of which ultimately met PUP criteria. In this group, 85 placental findings qualified as PUP. Both mean UtA pulsatility index z-values (1.26 vs. 0.84; p = 0.038) and PlGF multiples of normal median (0.21 vs. 0.55; p = 0.002) differed significantly in pregnancies with and without PUP, respectively. By logistic regression, PlGF alone was independently predictive of PUP (OR = 0.11 [95% CI 0.025–0.57]; p = 0.008). Discussion: Histologic placental abnormalities in term SGA neonates reflect latent insufficiency in uteroplacental blood supply. The heightened risk of adverse perinatal outcomes in this context underscores a need for new Doppler or biochemical prenatal markers of placental disease. Angiogenic factors may be pivotal identifying SGA neonates. Conclusions: Diminished circulating levels of placental growth factor, determined upon discovery of SGA status, are associated with histologic evidence of PUP. [Copyright &y& Elsevier]

Published
2014
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4. Angiogenic factors vs Doppler surveillance in the prediction of adverse outcome among late-pregnancy small-for- gestational-age fetuses.

Author

Lobmaier, S. M., Figueras, F., Mercade, I., Perello, M., Peguero, A., Crovetto, F., Ortiz, J. U., Crispi, F., and Gratacós, E.

Subjects
*VASCULAR endothelial growth factors, *DOPPLER effect, *PLACENTAL growth factor, *PROTEIN-tyrosine kinases, *FETUS
Abstract

ABSTRACT Objectives To compare the value of Doppler surveillance with maternal blood angiogenic factors at diagnosis for the prediction of adverse outcome in late-pregnancy small-for-gestational-age ( SGA) fetuses. Methods In a cohort of 198 SGA fetuses we evaluated the association of Doppler indices (mean uterine artery pulsatility index ( UtA-PI) and cerebroplacental ratio ( CPR)) and angiogenic factors (maternal serum levels of soluble fms-like tyrosine kinase-1 ( sFlt-1) and placental growth factor ( PlGF)) with the development of pre-eclampsia and adverse perinatal outcome (operative delivery for non-reassuring fetal status or neonatal metabolic acidosis). Results In SGA fetuses subsequently developing pre-eclampsia, mean UtA-PI ( P < 0.001), sFlt-1 MoM ( P < 0.001) and sFlt-1/ PlGF MoM ratio ( P < 0.001) were higher, while PlGF MoM was lower ( P = 0.004). In SGA fetuses with adverse perinatal outcome, CPR ( P < 0.002) and PlGF MoM ( P < 0.001) were lower, and sFlt-1/ PlGF MoM ratio was higher ( P = 0.001). For predicting pre-eclampsia, the areas under the receiver-operating characteristics ( ROC) curves for mean UtA-PI, sFlt-1 MoM and the combination of both were 0.852, 0.839 and 0.860, respectively. For adverse perinatal outcome, the areas under the ROC curves for CPR, PlGF MoM and the combination of both were 0.652, 0.656 and 0.684, respectively. The combination of Doppler indices and angiogenic factors did not significantly improve prediction of either pre-eclampsia ( P = 0.851) or adverse outcome ( P = 0.579). Conclusions In SGA fetuses, angiogenic factors at diagnosis and follow-up with Doppler ultrasound both predict adverse outcome with a similar performance. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Published
2014
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5. Is middle cerebral artery Doppler related to neonatal and 2-year infant outcome in early fetal growth restriction?

Author

Baskaran Thilaganathan, T. Diehl, A. G. van Wassenaer-Leemhuis, A. Aktas, A T Papageorghiou, Caterina M. Bilardo, Enrico Ferrazzi, R. Chaoui, G. H. A. Visser, Herbert Valensise, J. A. M. van der Post, Jan B. Derks, G. Oggè, J. van Eyck, Neil Marlow, I.K.M. Reiss, Wessel Ganzevoort, Ktm Schneider, M Oberto, A. Skabar, Raffaele Napolitano, U. Maurer-Fellbaum, H. Missfelder-Lobos, John Kingdom, G. Mansi, S. Borgione, Federico Prefumo, Anke Diemert, Tamara Stampalija, E. Lopriore, Gianpaolo Maso, Karel Marsal, Tiziana Frusca, L.S. Scheepers, F. Raimondi, Dietmar Schlembach, Adriana Valcamonico, N. Mensing van Charante, Christoph Lees, Silvia M. Lobmaier, Christoph Brezinka, L. Preston, S. Mulder-de Tollenaer, Pasquale Martinelli, Jim G Thornton, Marc E. A. Spaanderman, J.J. Duvekot, Nicola Fratelli, I.C. van Haastert, N. Weisglas-Kuperus, Dick Oepkes, Kurt Hecher, Hans Wolf, Tullia Todros, E. Ostermayer, Birgit Arabin, A. Zimmermann, Jérôme Cornette, P. Martelli, Other departments, ARD - Amsterdam Reproduction and Development, APH - Quality of Care, Obstetrics and Gynaecology, Other Research, Neonatology, APH - Digital Health, RS: GROW - R4 - Reproductive and Perinatal Medicine, Obstetrie & Gynaecologie, MUMC+: MA Medische Staf Obstetrie Gynaecologie (9), Stampalija, Tamara, Arabin, Birgit, Wolf, Han, Bilardo, Caterina M., Lees, Christoph, Brezinka, C., Derks, J. B., Diemert, A., Duvekot, J. J., Ferrazzi, E., Frusca, T., Ganzevoort, W., Hecher, K., Kingdom, J., Marlow, N., Marsal, K., Martinelli, P., Ostermayer, E., Papageorghiou, A. T., Schlembach, D., Schneider, K. T. M., Thilaganathan, B., Thornton, J., Todros, T., Valcamonico, A., Valensise, H., van Wassenaer-Leemhuis, A., Visser, G. H. A., Aktas, A., Borgione, S., Chaoui, R., Cornette, J. M. J., Diehl, T., van Eyck, J., Fratelli, N., van Haastert, I. C., Lobmaier, S., Lopriore, E., Missfelder-Lobos, H., Mansi, G., Martelli, P., Maso, G., Maurer-Fellbaum, U., Mensing van Charante, N., Mulder-de Tollenaer, S., Napolitano, R., Oberto, M., Oepkes, D., Ogge, G., van der Post, J. A. M., Prefumo, F., Preston, L., Raimondi, F., Reiss, I. K. M., Scheepers, L. S., Skabar, A., Spaanderman, M., Weisglas-Kuperus, N., Zimmermann, A., Bilardo, Caterina M, Raimondi, Francesco, Reproductive Origins of Adult Health and Disease (ROAHD), and Amsterdam Reproduction & Development (AR&D)

Subjects
Middle Cerebral Artery, PREDICTION, Intrauterine growth restriction, Umbilical Arteries, 0302 clinical medicine, Child Development, cerebroplacental ratio, Doppler velocimetry, intrauterine growth restriction, middle cerebral artery, neonatal, umbilicocerebral ratio, Pregnancy, RESISTANCE INDEX RATIO, Obstetrics and Gynaecology, FOR-GESTATIONAL-AGE, 1114 Paediatrics And Reproductive Medicine, Birth Weight, Prenatal, Cardiotocography, 030212 general & internal medicine, Prospective Studies, Child, Ultrasonography, RISK, 030219 obstetrics & reproductive medicine, Fetal Growth Retardation, medicine.diagnostic_test, Obstetrics, Doppler, Gestational age, Obstetrics and Gynecology, Settore MED/40, Child, Preschool, Pulsatile Flow, Middle cerebral artery, BLOOD-FLOW PARAMETERS, Female, Delivery, Ductus venosus, Human, medicine.medical_specialty, Delivery, Obstetric, Gestational Age, Humans, Ultrasonography, Doppler, Ultrasonography, Prenatal, Preschool, Obstetric, 03 medical and health sciences, PULSATILITY INDEX, FETUSES, medicine.artery, SURVEILLANCE, medicine, Journal Article, Obstetrics & Reproductive Medicine, business.industry, Umbilical artery, Odds ratio, medicine.disease, Confidence interval, Prospective Studie, Umbilical Arterie, WEIGHT, business
Abstract

BACKGROUND: Reduced fetal middle cerebral artery Doppler impedance is associated with hypoxemia in fetal growth restriction. It remains unclear as to whether this finding could be useful in timing delivery, especially in the third trimester. In this regard there is a paucity of evidence from prospective studies.OBJECTIVES: The aim of this study was to determine whether there is an association between middle cerebral artery Doppler impedance and its ratio with the umbilical artery in relation to neonatal and 2 year infant outcome in early fetal growth restriction (26(+0) -31(+6) weeks of gestation). Additionally we sought to explore which ratio is more informative for clinical use.STUDY DESIGN: This is a secondary analysis from the Trial of Randomized Umbilical and Fetal Flow in Europe, a prospective, multicenter, randomized management study on different antenatal monitoring strategies (ductus venosus Doppler changes and computerized cardiotocography short-term variation) in fetal growth restriction diagnosed between 26(+0) and 31(+6) weeks. We analyzed women with middle cerebral artery Doppler measurement at study entry and within 1 week before delivery and with complete postnatal follow-up (374 of 503). The primary outcome was survival without neurodevelopmental impairment at 2 years corrected for prematurity. Neonatal outcome was defined as survival until first discharge home without severe neonatal morbidity. Z-scores were calculated for middle cerebral artery pulsatility index and both umbilicocerebral and cerebroplacental ratios. Odds ratios of Doppler parameter Z-scores for neonatal and 2 year infant outcome were calculated by multivariable logistic regression analysis adjusted for gestational age and birthweight p50 ratio.RESULTS: Higher middle cerebral artery pulsatility index at inclusion but not within 1 week before delivery was associated with neonatal survival without severe morbidity (odds ratio, 1.24; 95% confidence interval, 1.02-1.52). Middle cerebral artery pulsatility index Z-score and umbilicocerebral ratio Z-score at inclusion were associated with 2 year survival with normal neurodevelopmental outcome (odds ratio, 1.33; 95% confidence interval, 1.03-1.72, and odds ratio, 0.88; 95% confidence interval, 0.78-0.99, respectively) as were gestation at delivery and birthweight p50 ratio (odds ratio, 1.41; 95% confidence interval, 1.20-1.66, and odds ratio, 1.86; 95% confidence interval, 1.33-2.60, respectively). When comparing cerebroplacental ratio against umbilicocerebral ratio, the incremental range of the cerebroplacental ratio tended toward zero, whereas the umbilicocerebral ratio tended toward infinity as the values became more abnormal.CONCLUSION: In a monitoring protocol based on ductus venosus and cardiotocography in early fetal growth restriction (26(+0) -31(+6) weeks of gestation), the impact of middle cerebral artery Doppler and its ratios on outcome is modest and less marked than birthweight and delivery gestation. It is unlikely that middle cerebral artery Doppler and its ratios are informative in optimizing the timing of delivery in fetal growth restriction before 32 weeks of gestation. The umbilicocerebral ratio allows for a better differentiation in the abnormal range than the cerebroplacental ratio.

Published
2017

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