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Objective: We aimed to assess the accuracy of the estimated fetal weight (EFW) to predict the birthweigth (BW) in pregnancies complicated by PPROM.Study Design: This study was a secondary analysis of a prospective cohort of pregnancies with PPROM. We included singleton pregnancies from 23 to 36 + 6 weeks, mothers from 13 to 46 years of age, and those with an EFW within two weeks of delivery. We excluded pregnancies with complex fetal anomalies and fetal demise. The accuracy of the EFW was determined by the absolute percent difference between BW and EFW ([BW-EFW]/BW*100%). T tests and linear regression were performed for statistical analysis.Results: The mean percent difference of BW vs. EFW was 8.72 ± 6.94%. The EFW was more accurate (8.24 ± 6.81 vs. 13.31 ± 6.88%, p = .027) and had more measurements with a absolute difference < 10% (70% vs. 30%; p = .034) when performed within seven days of delivery. The EFW accuracy decreased with anhydramnios (11.37 ± 7.06 vs. 7.69 ± 6.77%, p = .020), but the measurements with an absolute difference <10% was not significantly different (p = .27) with anhydramnios.Conclusion: In PPROM, the EFW within seven days to delivery by Hadlock accurately predicts the birthweight with a mean absolute difference of 8.2%.Brief Rationale: There are a limited number of studies evaluating the accuracy of the EFW in pregnancies with PPROM in the last four decades. [ABSTRACT FROM AUTHOR]

Introduction: Abnormal uterine artery Doppler studies have been associated with an increased risk of preeclampsia, fetal growth restriction (FGR), placental abruption, and fetal demise. These obstetrical complications can affect pregnancies with preterm prelabor rupture of membranes (PPROM). Therefore, our objective was to assess the prediction accuracy of the uterine artery pulsatility index (UtAPI) to detect these complications in pregnancies with PPROM.Materials and Methods: This was a prospective study of pregnancies complicated by PPROM from October 2015 to May 2018. We included mothers aged 13-46 years old with singleton pregnancies from 23 to 36 + 6 weeks with PPROM. Those without UtAPI measurements and complex fetal anomalies were excluded. Our primary outcome was a composite of obstetrical complications, defined as having one or more of the following: gestational hypertension or preeclampsia, placenta abruption, FGR, or fetal demise. The UtAPI was obtained at the time of enrollment. Logistic regression models with receiver operating curves were used to determine the predictive value of the UtAPI for obstetrical complications. A p value of <.05 was considered significant.Results: A total of 103 patients met inclusion criteria, of those 37 (36%) developed an obstetrical complication (FGR = 22 (21.5%); preeclampsia or gestational hypertension = 9 (9%); placental abruption = 8 (8%); fetal demise = 1 (1%)). Six mothers had more than one complication. The UtAPI was not a statistically significant predictor of a composite of obstetrical complications (AUC = 0.61; p = .07) or for any of the individual complications studied.Conclusions: The UtAPI appears to have limited clinical value for the prediction of obstetrical complications previously associated with abnormal uterine artery Doppler indices in pregnancies with PPROM. Larger and more diverse studies are needed to corroborate our findings.Brief Rationale: An accurate prediction for adverse outcomes in patients with PPROM may help identify those that may benefit from increased surveillance protocols. [ABSTRACT FROM AUTHOR]

Objective: To determine the prognostic accuracy of the fetal pulmonary artery acceleration time/ejection time (PATET) for the prediction of neonatal respiratory complications (NRCs) in pregnancies with preterm premature rupture of membranes (PPROM).Methods: This is a prospective cohort of singleton pregnancies complicated by PPROM managed in our institution from October 2015 to April 2018. Inclusion criteria included mothers from 13 to 46 years of age and singleton pregnancies with PATET measurements <7 days prior to delivery. PATET was obtained by placing the Doppler caliper in the main pulmonary artery proximal to the bifurcation of this vessel. NRC was defined as: need for ventilatory support, respiratory distress syndrome (RDS), or lung hypoplasia. Logistic regression models and area under the receiver operating characteristic curves (ROC) were utilized to determine the prognostic accuracy of PATET and gestational age for NRC and RDS.Results: Of 95 patients included, 46 had NRC (RDS = 33). PATET was a significant predictor of NRC (AUC 0.74; 95%CI: 0.61-0.83; p < .001) and RDS (AUC 0.69; 95%CI: 0.57-0.80; p = .021) in PPROM. Gestational age at delivery and gestational age at PPROM were also significantly associated with NRC and RDS. Their predictive accuracy for NRC was 0.87 and 0.84, and for RDS 0.85 and 0.86, respectively.Conclusions: PATET is a statistically significant predictor for NRC in pregnancies with PPROM; however, its clinical use may be limited as gestational age is a better predictor of these outcomes.Rationale: NRCs are common in pregnancies complicated by preterm prelabor rupture of membranes (PPROM). We aim to determine the prognostic accuracy of the fetal PATET for the prediction of neonatal NRC in these pregnancies. Our results indicate that PATET is a statistically significant predictor for NRC in pregnancies with PPROM; however, its clinical use may be limited, as gestational age is a better predictor of these outcomes. [ABSTRACT FROM AUTHOR]

Objectives: The American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy recommends assessing left ventricular function with echocardiogram or electrocardiogram (ECG) in women with severe hypertension of long duration. We aim to compare the rates of superimposed preeclampsia (SIP) and other obstetrical outcomes in pregnancies with chronic hypertension (CHTN) and left ventricular hypertrophy (LVH) by ECG criteria with mothers without LVH.Study design: After IRB approval, we performed a retrospective chart review from January 2015 to December 2016. Singleton pregnancies with CHTN who carried the pregnancy beyond 20 weeks and planned to deliver at our institution were included for analysis. Patients with insufficient data, multiple gestations, and those with systemic lupus erythematosus were excluded from this study. Rates of SIP and other obstetrical outcomes were compared among those with LVH and those without LVH. Univariate parametric and nonparametric statistical models were applied as appropriate. Associations were considered statistically significant at an alpha level of 0.05.Results: We included 218 pregnancies. Nineteen (8.7%) had LVH. The rate of SIP was higher in pregnancies with LVH than in those without it (68 versus 41%; OR = 3.01; 95% CI 1.1-8.5; p = .022). The birthweight was lower in the LVH group (2432 g [2120-2990] versus 2870 g [2430-3440]; p = .016). Other obstetrical outcomes were not significantly different between those patients with LVH and those without.Conclusions: LVH by ECG criteria may be associated with higher rates of SIP and with lower birthweight in pregnancies with CHTN. ECG may be a cost-effective tool to identify patients with CHTN at risk of adverse outcomes. Larger trials are necessary to corroborate our findings. [ABSTRACT FROM AUTHOR]

Background: The Doppler effect has allowed the characterization of several vessels in maternal-fetal circulation that have been used for practical purposes. Our review of the literature showed a paucity of information about fetal pulmonary artery pressure (FMPAP) and its behavior in regard to gestational age (GA). The objectives of the study were to evaluate a formula to calculate the main FMPAP and its correlation with GA. Methods: A total of 337 fetuses without obvious pathology were studied prospectively using Doppler evaluation of the FMPAP. Using the fetal main pulmonary artery Doppler acceleration time (FMPAT), we obtained the FMPAP using the following formula: FMPAP=90 – (0.62×FMPAT). Regression analyses, Pearson's bivariate correlation and paired sample t-test were used when appropriate. Results: FMPAT increases while FMPAP decreases with GA. Pearson's correlation coefficient for FMPAP and GA was −0.544 (P-value<0.001) and for FMPAT and GA was 0.556 (P-value<0.001). FMPAP and FMPAT were highly correlated (R=−0.972; P<0.001). Conclusion: Pulmonary artery pressure in the fetus decreases with GA. [ABSTRACT FROM AUTHOR]

Objectives: Abnormal placentation is an important factor in the pathogenesis of preeclampsia. As a result of diminished blood flow, the incidence of preeclampsia might be higher in patients with laterally located placentas compared to patients with centrally located placentas. The objective of this study was to evaluate the relationship between placental location and the development of hypertensive disorders of pregnancy. Methods: Patients with singleton pregnancies who were seen in our ultrasound unit and delivered at our institution from October 2014 to April 2015 were included. The incidence of hypertensive disorders was compared in those with a lateral placental location and those with centrally located placentas (placental locations other than lateral). Baseline characteristics and pregnancy outcomes were compared between groups. The χ2 test, Fisher exact test, Mann‐Whitney U test, and t test were used when appropriate. P < .05 was considered significant. Results: We included 464 patients; 411 (88.57%) had centrally located placentas, and 53 (11.42%) had laterally located placentas. The incidence of hypertensive disorders of pregnancy was similar between groups (21% versus 19%; P = .71). Gestational age at delivery (P = .73), and small for gestational age (P = .96) were also similar between our study groups. Conclusions: In our study, there was no difference in the rate of hypertensive disorders of pregnancy between patients with central and laterally located placentas. [ABSTRACT FROM AUTHOR]

The fetal sheep model has been widely used in fetal therapy research. However, there is a significant degree of variability among published normal values. Our study aimed to evaluate the literature available on normal values for hemodynamics, blood gases, and acid-base status in the sheep fetus and to determine the best possible estimation of such physiologic values. We conducted a systematic review with a comprehensive search of several databases. We included 189 articles in the database and over 2,800 sheep fetuses. Analysis revealed a mean umbilical blood flow of 202 mL/kg/min (95% CI: 182 to 223); mean arterial pCO2 of 49.8 mm Hg (95% CI: 49.2 to 50.3); mean arterial pO2 of 22.3 mm Hg (95% CI: 21.9 to 22.7); mean arterial pH of 7.35 (95% CI: 7.3487 to 7.3562); and mean arterial oxygen saturation of 59.8 (95% CI; 58 to 61.7). Our findings were punctuated by a high heterogeneity, for which we conducted several subanalyses. The results showed high heterogeneity and small study effect in the literature available and provided our best assessment of relevant variables on normal hemodynamics, blood gases, and acid-base status in the fetus after using strategies to mitigate the risk of bias present in the literature.

Objectives: Fetal growth restriction (FGR) is commonly associated with placental dysfunction, increasing perinatal morbidity and mortality. Visualizing placental vessels in utero would be advantageous for identifying functional FGR cause and determining proper management strategies. We aimed to utilize high-sensitivity ultrasound microvessel imaging (HUMI) for quantifying placental vessel density (VD) in pregnancies diagnosed with FGR., Methods: This pilot case-control study enrolled subjects in the third trimester with a diagnosis of FGR (n = 40) and gestational age-matched controls with normal fetal growth (n = 20) at a 2:1 ratio, respectively. The Verasonics Vantage ultrasound system was used to perform HUMI on each participant at one timepoint. Scanning involved randomized singular value decomposition-based clutter filtering to identify the villous tree, followed by step-by-step scanning to acquire 3-dimensional-like data. Mean VD was calculated from three ultrasound measurements per subject. Additional clinical and pathology data were also collected and compared., Results: Sixteen participants were utilized to establish the scanning protocol and 2 met exclusion criteria at delivery. Thus, VD was successfully measured on 42 pregnancies scanned at 35 weeks 5 days on average. In FGR (n = 24), placental VD was significantly reduced compared to controls (P < .01). VD measures were as good at predicting FGR as systolic/diastolic (S/D) ratios (area under the curve 0.86 versus 0.80). In a smaller cohort, VD in placentas with a diagnosis of inflammatory villitis (n = 10) by histology showed an increase in VD compared to those without inflammation (P = .01). Low VD was correlated with increased S/D ratios (P = .03)., Conclusions: HUMI is useful for identifying altered placental vascularization in utero for FGR. VD may be a valuable indicator for placental health and could lead to improved risk stratification methods considering underlying biology., (© 2024 American Institute of Ultrasound in Medicine.)