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Background and Objectives Evaluation of amniotic fluid is one of the main variables of examining fetal health in the second and third trimesters of pregnancy. An increase in amniotic fluid can affect the health of the fetus. The aim of this study is to compare the severity of blood flow disorder in the umbilical artery and MCA of the fetus in idiopathic polyhydramnios (IP) and diabetic polyhydramnios (DP). Subjects and MethodsIn this study, singleton pregnancies with a calendar age of 31 to 40 weeks along with DP and IP were included in the study from June 2019 to June 2019, following the inclusion and exclusion criteria. First, the patients were divided into two groups, diabetic and non-diabetic, and then each group was divided into three groups with mild, moderate, and severe polyhydramnios. In all cases, the amniotic fluid index and after fetal Doppler cytometry, pulsation index, systolic to diastolic ratio of the umbilical artery, and pulsation index, maximum systolic velocity, systolic to diastolic ratio of the middle cerebral artery were measured. Results In this study, 138 pregnant mothers with polyhydramnios in the third trimester (70 in the IP group and 68 in the DP group) were studied. Compared to the standard values, 14 (20%) of the patients in the IP group and 10 (14.7%) in the DP group had abnormal fetal Doppler indices. In the idiopathic group, Doppler indices of the umbilical artery differed significantly only in the severe subgroup compared to the other two subgroups. Doppler indices of the middle cerebral artery, except for maximum systolic velocity, differed significantly in the moderate and severe polyhydramnios subgroups compared to the other subgroups. The impairment of fetal umbilical and middle cerebral artery Doppler indices, except for the umbilical artery systolic-to-diastolic ratio, was not associated with whether the polyhydramnios was diabetic or idiopathic. There was no significant difference between the two groups for the other indices, and this impairment was only related to the severity of polyhydramnios. Conclusion Disturbance in fetal Doppler indices in mothers with polyhydramnios is related to the severity of this complication and has no relation with its cause. Therefore, maintenance treatments can be useful to reduce the relative volume of amniotic fluid in both groups. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of abnormal cerebroplacental ratio (CPR) and predicting values for adverse perinatal outcomes in uncomplicated full-term pregnancies. Materials and Methods: This prospective cross-sectional study was conducted at Bhumibol Adulyadej Hospital, Royal Thai Air Force, Thailand between July and December 2023. The study population comprised pregnant women between the ages 18 and 45 presenting uncomplicated full-term pregnancies. Transabdominal ultrasonography in Doppler color mode was performed on all participants. Umbilical artery pulsatility index (UAPI) and middle cerebral artery pulsatility index (MCAPI) were both measured. CPR was calculated by MCAPI divided by UAPI. A CPR value was considered low if it was less than 1.03. Obstetric and perinatal outcomes were recorded including route of delivery, gestational age (GA) at delivery, obstetric complications, Apgar score, neonatal birth weight, neonatal intensive care unit (NICU) admission, and fetal non-reassuring tracing (FNR). Results: A total of 250 pregnant women were recruited. The mean maternal age and GA was 27.7 years, 39.6 weeks, respectively. Low CPR prevalence was recorded at 16.4 percent. There were 41 and 209 cases in low (<1.03) and normal (≥1.03) CPR groups, respectively. UAPI and MCAPI of the normal/low CPR group were 0.8/1.3 and 1.1/0.9 with statistical significance. CPR for predicted value of FNR (1.03) gave sensitivity, specificity, PPV, and NPV at 95.5, 91.2, 51.2 and 99.5 percent, respectively. This study presented no adverse perinatal outcomes. Conclusion: Low CPR prevalence was 16.4 percent. Normal CPR values measured within a week before birth was a good indicator of normal perinatal outcomes. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion The aim of the present study was to compare the fetal umbilical artery blood flow parameters in the third trimester and perinatal outcomes between pregnant women with and without thalassemia minor in South China.This was a retrospective cohort study. Doppler ultrasound was used to detect fetal umbilical artery hemodynamics in pregnant women with or without thalassemia minor during the third trimester. The main parameters assessed were umbilical artery peak systolic flow velocity/end‐diastolic flow velocity (S/D), resistance index (RI), pulsation index (PI), and relevant perinatal outcomes.This study included 540 pregnant women, 180 with thalassemia minor and 360 being healthy controls. In the third trimester, the thalassemia minor group had higher umbilical artery S/D (P = 0.002), RI (P = 0.002), and PI (P = 0.012) than healthy pregnant women, as well as lower levels of hemoglobin (Hb) (P < 0.001) and higher ferritin levels (P < 0.001). Compared to the non‐thalassemia group, neonatal body weight in the thalassemia minor group was significantly lower (P = 0.001). Additionally, the incidence of maternal anemia (odds ratio [OR] 3.92; 95% confidence interval [CI]: 2.57–5.99, P < 0.001), low birth weight (OR 15.35; 95% CI: 1.71–137.93, P = 0.015), fetal distress (OR 2.18; 95% CI: 1.12–4.26, P = 0.023), neonatal asphyxia (OR 12.81; 95% CI: 1.40–117.33, P = 0.024), oligohydramnios (OR 18.25; 95% CI: 2.21–150.36, P = 0.007) and Apgar score <7 at 1 min after birth (OR 7.97; 95% CI: 1.53–41.54, P = 0.014) was significantly higher in the thalassemia minor group.Pregnant women with thalassemia minor have higher umbilical artery S/D, RI and PI during the third trimester and a higher risk of adverse perinatal outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To assess the effectiveness of half peak systolic velocity deceleration time (hPSV-DT) in predicting neonatal outcomes in pregnant women with preeclampsia and to compare its usefulness with the conventional umbilical artery (UA) pulsatility index (PI) approach. Methods: A prospective cohort study was conducted among pregnant women with preeclampsia who were admitted to the Department of Perinatology, Ministry of Health Ankara City Hospital between 01 September 2022 and 01 January 2023 at 28–41 weeks gestational age. 55 patients were divided into two groups: the study group with UA hPSV-DT value < 5th percentile (n = 22) and the control group with UA hPSV-DT value ≥ 5th percentile (n = 33). UA hPSV-DT calculates the time in milliseconds needed to halve the maximal velocity of the UA waveform using Doppler ultrasonography. Results: Birth weight, gestational age at birth, 1st minute APGAR, 5th minute APGAR, and umbilical cord pH values were significantly lower in the anormal hPSV-DT group (p < 0.05). Additionally, the rates of admission to NICU, respiratory distress syndrome (RDS), delivery time < 34 weeks, and birth weight < 2500 g were significantly more frequent in the anormal hPSV-DT group compared to the normal hPSV-DT group (p < 0.05). UA-PI > 95th percentile was detected in only 2 (8%) of 23 patients whose newborns were admitted to the NICU (p = 0.149), while hPSV-DT < 5th percentile was detected in 16 (69%) of 23 patients (p < 0.001). According to ROC analysis, the area under the curve was 0.82 (95% CI 0.06–0.28) for admission to the NICU. The best balance of sensitivity/specificity in ROC curves was 221.5 (82.6% sensitivity, 69.1% specificity, p < 0.001). Conclusion: UA hPSV-DT was successful in predicting composite adverse perinatal outcomes in pregnant women with preeclampsia. It is a promising novel method that is accurate, quantitative, reproducible, and easily applicable. With further studies, this method may be a primary diagnostic tool in the management of high-risk pregnancies and in determining the optimal timing of delivery. [ABSTRACT FROM AUTHOR]

Citral is a low-toxicity monoterpene that has a vasodilator effect on various smooth muscles, and The present study aimed to evaluate its vasorelaxant effect on umbilical vessels of normotensive parturients (NTP) and with preeclampsia parturients (PEP). Segments of human umbilical artery (HUA) and vein (HUV) of NTP or PEP were mounted in a bath to record the force of contraction, under tension of 3.0 gf and contracted with the contracting agents: K+ (60 mM), 5 -HT (10 μM) and Ba2+ (1–30 mM). Next, the effect of citral (1–3000 μM) on these contractions and on basal tone was evaluated. In HUA and HUV, citral (1–1000 μM), in NTP condition, inhibited contractions evoked by K+ (IC 50 of 413.5 and 271.3, respectively) and by 5-HT (IC 50 of 164.8 and 574.3). In the PEP condition, in HUA and HUV, citral also inhibited the contractions evoked by K+ (IC 50 of 363.3 and 218.3, respectively) and 5-HT (IC 50 of 432.1 and 520.4). At a concentration of 1000 μM, citral completely or almost completely (>90 %) inhibited all contractions. At a concentration of 100–1000 μM, citral, in general, was already able to reduce the contraction induced by 1–3 mM Ba2+ in both AUH and VUH, under NTP and PEP conditions. Citral has been shown to be an effective HUA and HUV vasodilator in NTP and PEP. As its toxicity is low, it suggests that this substance can be considered a potential therapeutic agent. • Citral possess a myorelaxant effect in umbilical vessels. • The data highlight the vasoregative effect of natural substances (citral) in vessel. • The citral have potential as future therapeutic agents, in hypertensive syndromes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between Doppler patterns in fetuses with Down syndrome (DS) and their placental histopathologic findings. Methods: A retrospective cross‐sectional study was performed by collecting data from medical records of singleton pregnancies between January 2014 and January 2022, whose fetuses had a confirmed diagnosis of DS either prenatally or postnatally. Placental histopathology, maternal characteristics, and prenatal ultrasound (biometric parameters and umbilical artery [UA] Doppler) were evaluated. Results: Of 69 eligible pregnant women, 61 met the inclusion and exclusion criteria. In the sample, 15 fetuses had an estimated fetal weight < 10th percentile for gestational age (GA) and were considered small for gestational age (SGA). Thirty‐eight fetuses had increased resistance on the UA Doppler. Histologic changes were detected in 100% of the placentas, the most common being delayed villous maturation, alterations associated with poor fetal vascular perfusion, and villous dysmorphism. More than 50% of the placentas showed alterations related to placental insufficiency. We did not observe a statistically significant association between UA Doppler examination and placental alterations. All placentas analyzed in the SGA subgroup showed findings compatible with placental insufficiency. Conclusion: We found no statistically significant association between placental histopathologic findings and UA Doppler abnormalities in fetuses with DS. The placental alterations identified were delayed villous maturation, alterations associated with poor fetal vascular perfusion, and villous dysmorphism. [ABSTRACT FROM AUTHOR]

Umbilical vascular catheterization remains an important technique in case a newly born infant requires resuscitation. Most textbooks recommend a complete transection of the umbilical cord and subsequent opening of vessel lumen with an iris forceps to place the catheter. That method, however, is challenging in emergencies.Here we present an easy, quick and safe method of placing the umbilical catheters. The side-entry method could be an alternative to the conventional approach and is worth to enter pediatric textbooks and neonatal resuscitation guidelines.

Abstract The objective of this study is to investigate the expression and influence of adenosine triphosphate-sensitive potassium channel (KATP) in human umbilical arterial smooth muscle cells (HUASMCs) of patients with hypertensive disorders of pregnancy (HDP). Western blotting was used to detect the protein expression levels of KATP inwardly rectifying potassium channel (Kir)6.1 and sulphonylurea receptor (SUR)2B subunits in HUASMCs from patients with normal parturients (NP), gestational hypertension (GH), chronic hypertension (CH), preeclampsia (PE) and chronic hypertension with superimposed preeclampsia (CHSP), respectively. There was no significant difference in the protein expression of Kir6.1 subunit in NP group, GH group, CH group, PE group and CHSP group (P > 0.05). The protein expression of SUR2B subunit was gradually decreased in NP group, GH group, CH group, PE group and CHSP group, with statistically significant difference among the groups (P

Introduction: The inaccuracy of late pregnancy dating is often discussed, and the impact on diagnosis of fetal growth restriction is a concern. However, the magnitude and direction of this effect has not previously been demonstrated. In this study, we aimed to investigate the effect of late pregnancy dating by head circumference on the detection of late onset growth restriction, compared to first trimester crown‐rump length dating. Material and methods: This was a cohort study of 14 013 pregnancies receiving obstetric care at a tertiary center over a three‐year period. Universal scans were performed at 12 weeks, including crown‐rump length; at 20 weeks including fetal biometry; and at 36 weeks, where biometry, umbilical artery doppler and cerebroplacental ratio were used to determine the incidence of fetal growth restriction according to the Delphi consensus. For the entire cohort, the gestational age was first calculated using T1 dating; and was then recalculated using head circumference at 20 weeks (T2 dating); and at 36 weeks (T3 dating). The incidence of fetal growth restriction following T2 and T3 dating was compared to T1 dating using four‐by‐four sensitivity tables. Results: When the cohort was redated from T1 to T2, the median gestation at delivery changed from 40 + 0 to 40 + 2 weeks (p < 0.001). When the cohort was redated from T1 to T3, the median gestation at delivery changed from 40 + 0 to 40 + 3 weeks (p < 0.001). T2 dating resulted in fetal growth restriction sensitivity of 80.2% with positive predictive value of 78.8% compared to T1 dating. T3 dating resulted in sensitivity of 8.6% and positive predictive value of 27.7%, respectively. The sensitivity of abnormal CPR remained high despite T2 and T3 redating; 98.0% and 89.4%, respectively. Conclusions: Although dating at 11–14 weeks is recommended, late pregnancy dating is sometimes inevitable, and this can prolong the estimated due date by an average of two to three days. One in five pregnancies which would be classified as growth restricted if the pregnancy was dated in the first trimester, will be reclassified as nongrowth restricted following dating at 20 weeks, whereas nine out of 10 pregnancies will be reclassified as non‐growth restricted with 36‐week dating. [ABSTRACT FROM AUTHOR]

Problem: In the current study we aimed to investigate Syndecan 1 (SDC1) levels in pregnant women diagnosed with fetal growth restriction (FGR) and the relationship between SDC1 levels and clinical and doppler parameters in FGR cases associated with endothelial dysfunction, angiogenesis and uteroplacental insufficiency Method of Study: A total of 90 pregnant women included in the study, (45 with FGR, 45 healthy control) matched by week of gestation and maternal age. Venous blood samples were collected and plasma concentrations of SDC1 were determined by a specific immunoassay. Doppler examination was performed to evaluate the relationship between the SDC1 levels and placental blood supply. Results: Doppler parameters; mean UtA‐PI (p < .001), CPR (p = .002) and CPUR (p < .001) were different between the groups, however MCA PI, umbilical artery PI and umbilical artery S/D were not (p > .05). While gestational age at delivery, birth weight, APGAR score at 1 and 5 min were significantly lower (all, p < .001) in the study group, non‐reassure fetal heart rate tracing (p = .09) and NICU admission (p = .02) were significantly higher. SDC 1 level was 2,00 ± 1,47 ng/mL and 2,34 ± 1,12 ng/mL in the FGR and control groups, respectively (p = .008). In the study group SDC 1 level was 1,69 ± 2,00 in those with gestational age below 32 weeks and 2,13 ± 1,18 in those with gestational age above 32 weeks and there was a statistically significant difference between the groups (p = .015). Plasma SDC 1 concentration of 2,1850 ng/mL or less had a sensitivity of 70%, a specificity of 72%, area under the ROC curve .65 (p < .005). Conclusions: Low maternal plasma SDC1 level may be associated with placental insufficiency and FGR. Low levels of SDC1 may be helpful as a predictor for the development of FGR during gestation. [ABSTRACT FROM AUTHOR]

Objective: To assess the association between placental biomarkers (placental growth factor (PlGF) and soluble fms‐like tyrosine kinase‐1 (sFlt‐1)/PlGF ratio) and fetoplacental Doppler indices (umbilical artery (UA) pulsatility index (PI) and uterine artery (UtA) PI) in various combinations for predicting preterm birth (PTB) in pregnancies complicated by fetal growth restriction (FGR). Methods: This was a prospective observational cohort study, performed at Mater Mother's Hospital in Brisbane, Queensland, Australia, from May 2022 to June 2023, of pregnancies complicated by FGR and appropriate‐for‐gestational‐age (AGA) pregnancies. Maternal serum PlGF levels, sFlt‐1/PlGF ratio, UA‐PI and UtA‐PI were measured at 2–4‐weekly intervals from recruitment until delivery. Harrell's concordance statistic (Harrell's C) was used to evaluate multivariable Cox proportional hazards regression models featuring various combinations of placental biomarkers and fetoplacental Doppler indices to ascertain the best combination to predict PTB (< 37 weeks). Multivariable Cox regression models were used with biomarkers as time‐varying covariates. Results: The study cohort included 320 singleton pregnancies, comprising 179 (55.9%) affected by FGR, defined according to a Delphi consensus, and 141 (44.1%) with an AGA fetus. In the FGR cohort, both low PlGF levels and elevated sFlt‐1/PlGF ratio were associated with significantly shorter time to PTB. Low PlGF was a better predictor of PTB than was either sFlt‐1/PlGF ratio or a combination of PlGF and sFlt‐1/PlGF ratio (Harrell's C, 0.81, 0.78 and 0.79, respectively). Although both Doppler indices were significantly associated with time to PTB, in combination they were better predictors of PTB than was either UA‐PI > 95th centile or UtA‐PI > 95th centile alone (Harrell's C, 0.82, 0.75 and 0.76, respectively). Predictive utility for PTB was best when PlGF < 100 ng/L, UA‐PI > 95th centile and UtA‐PI > 95th centile were combined (Harrell's C, 0.88) (hazard ratio, 32.99; 95% CI, 10.74–101.32). Conclusions: Low maternal serum PlGF level (< 100 ng/L) and abnormal fetoplacental Doppler indices (UA‐PI > 95th centile and UtA‐PI > 95th centile) in combination have the greatest predictive utility for PTB in pregnancies complicated by FGR. Their assessment may help guide clinical management of these complex pregnancies. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

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Objective: To evaluate the diagnostic accuracy of the cerebroplacental ratio compared to the umbilical artery waveform in predicting adverse fetal outcomes, specifically intrauterine growth restriction (IUGR), in hypertensive pregnancies. Methodology: This descriptive cross-sectional study of six months’ duration from August 2018 to February 2019 was carried out at the Department of Obstetrics & Gynecology, Lady Aitchison Hospital, Lahore on 160 females, who underwent ultrasonography by experienced radiologists. Cerebroplacental ratio and umbilical artery waveform was noted in form of resistive index (RI). Patients were categorized as positive or negative for respective methods. Females then underwent clinical evaluation for IUGR by experienced gynaecologists, and all the data was collected through proforma, entered and analyzed through SPSS 21. Sensitivity, specificity, positive predictive value (PPV),negative predictive value (NPV) and diagnostic accuracy of cerebroplacental ratio and umbilical artery waveform was measured. Results: The patients had mean age of 29.16 ± 6.92 years. The mean gestational age at enrollment was 35.58 ± 1.08 weeks. At recruitment, the mean systolic blood pressure of females was 168.97 ± 13.71 mmHg and diastolic blood pressure was 108.32 ± 8.56 mmHg. There were 142 (68.75%) patients with pregnancy induced hypertension while 18 (11.25%) had eclampsia. The mean BMI of patient was 24.14 ± 3.39kg/m2. The specificity, sensitivity, NPV, PPV and diagnostic accuracy of cerebroplacental ratio were 95.1%, 96.97%, 95.1%, 96.97% and 96.25% respectively whereas of umbilical artery waveform were 49.2%, 71.7%, 51.7%, 96.6% and 63.1%. Conclusion: The cerebroplacental ratio was more accurate than umbilical artery waveform for prediction of IUGR in hypertensive pregnancy.

Background: Doppler ultrasound was introduced into clinical obstetric practice over 20 years ago. Common obstetric complications such as pre-eclampsia and intra-uterine growth restriction (IUGR) originate in abnormal placental vasculature development, reflected in abnormal Doppler velocimetry. Objectives: To determine the pulsatility index (PI), resistivity index (RI), systolic/diastolic ratio(S/D), end diastolic velocity (EDV), and peak systolic velocity (PSV) of the umbilical artery of normal singleton pregnancy during the second and third trimesters in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. Materials and Methods: A prospective longitudinal study of 141 patients was conducted at 21–25 weeks (second trimester) and 31–35 weeks (third trimester) gestation. An ultrasound machine with Doppler capability fitted with a curvilinear transducer with a frequency of 3.5–5.0MHZ was used to measure the PI, RI, S/D ratio, EDV, and PSV of the participants. Results: The second and third-trimester uterine artery Doppler indices of the participants were, respectively: PI = 1.29 ± 0.36, versus 0.94 ± 0.24 (P

Objectives: To compare perinatal outcomes in growth restricted Fetuses based on normal and abnormal umbilical artery doppler studies. Study Design: Prospective Cohort Study. Place and Duration of Study: This Study was conducted in Civil Hospital Karachi. Duration of the study was 6 months, from 24 November 2018 to 25 May 2019. Materials and Methods: 232 growth restricted Fetuses were divided into two equal groups, 116 with normal umbilical artery doppler studies (Group A) and 116 with abnormal umbilical artery doppler studies (Group B). Inclusion criteria were pregnant patients with age 20-35 years and excluding malformations. Doppler assessment used 3-5 MHz probe (GE PRO-V, USA) for umbilical artery and vein, noting absent/reversed flow.Follow-up included delivery, neonatal assessment, and mortality recording. Results: The mean age in our study was 28.92 ± 5.71 years, while gestational age was 33.97 ± 2.58 years. The normal umbilical artery doppler group experienced a 14.66% rate of premature deliveries compared to 52.59% in the abnormal group (p-value: 0.0001). NICU admissions were reported at 26.72% in the normal umbilical artery doppler group and notably higher at 76.72% in the abnormal group (p-value: 0.0001). A striking observation was the threefold increase in perinatal deaths within the abnormal umbilical artery doppler group (18.10%) as opposed to the normal group (7.76%) (p-value: 0.024). Conclusion: Adverse perinatal outcomes were associated with abnormal umbilical artery Doppler in Fetuses with growth restriction. Timely preventive measures should be taken to reduce perinatal morbidity and mortality.

AbstractEndothelial dysfunction initiates the pathogenesis of a myriad of cardiovascular diseases, yet the precise underlying mechanisms remain unclear. Current model utilises mechanical denudation of arteries resulting in an arterial-injury model with onset of intimal hyperplasia (IH). Our study shows that 5 min enzymatic denudation of human umbilical artery (hUA) lumen at 37 °C efficiently denudes hUA while maintaining vessel integrity without significantly increase intima-media thickness after 7 days in culture. This ex-vivo model will be a valuable tool in understanding the mechanism of re-endothelialization prior to smooth muscle cells (SMC) activation thus placating IH at an early stage.

Background: Neonatal umbilical artery blood-gas analysis is a diagnostic procedure performed shortly after birth to assess the acid-base balance, oxygenation, and metabolic status of a newborn infant. This retrospective study aimed to investigate the association of prenatal maternal fever with neonatal umbilical artery blood-gas analysis. Methods: A retrospective analysis was conducted on data from 333 parturients and their newborns. Demographic characteristics, clinical information, and neonatal umbilical artery blood gas analysis data were analyzed to evaluate the association between prenatal maternal fever and neonatal blood-gas analysis. Pregnant women with fever (≥38.0 °C) during labor were compared with those without fever. Neonatal umbilical artery blood gas parameters were assessed in relation to the degree and duration of maternal fever. Results: The incidence of the adverse delivery outcome of parturients with high prenatal fever and long duration of fever was significantly higher than that of the low fever, short-term fever, and normal parturients (p < 0.05). The pH of neonatal umbilical veins in the high fever groups was reduced compared with the control group (p < 0.05). Lactic acid (Lac) of neonatal umbilical vein in the low fever and high fever groups was enhanced compared with the control group (p < 0.05). The pH of neonatal umbilical veins in the short-term fever and long-term fever groups was elevated compared with the control group (p < 0.05). The umbilical artery pH and base excess (BE) were positively correlated with maternal peak fever temperature (r = 0.20, r = 0.22, p < 0.05). The umbilical Lac was negatively correlated with maternal peak fever temperature (r = –0.22, p < 0.05). Moreover, the umbilical artery pH and BE were positively correlated with maternal duration of fever (r = 0.29, r = 0.21, p < 0.05). The umbilical artery Lac was negatively correlated with maternal duration of fever (r = –0.25, p < 0.05). Conclusions: The findings suggested that maternal fever during labor was associated with alterations in neonatal umbilical artery blood gas analysis. Understanding the influence of prenatal fever on delivery outcomes is crucial for optimizing maternal and neonatal health.

Objective: The main aim of this study was to investigate the perinatal outcomes of dichorionic twin pregnancies complicated by selective fetal growth restriction (sFGR). Design: Retrospective cohort study. Setting: Tertiary reference centre. Population: Dichorionic twin pregnancies complicated by sFGR between 2000 and 2019 in St George's University Hospital. Methods: Regression analyses were performed using generalised linear models and mixed‐effects generalised linear models where appropriate to account for pregnancy level dependency in variables. Time to event analyses were performed with mixed‐effects Cox regression models. Main outcome measures: Stillbirth, neonatal death or neonatal unit admission with morbidity in one or both twins. Results: A total of 102 (of 2431 dichorionic twin pregnancies) pregnancies complicated by sFGR were included in the study. The Cochrane–Armitage test revealed a significant trend for increased adverse perinatal outcome rates with more severe forms of umbilical artery flow impedance, i.e. reversed, absent, positive with resistant flow and positive flow without resistance. A multivariable model including maternal and conception characteristics had poor predictive accuracy for stillbirth (area under the curve: 0.68, 95% confidence interval [CI] 0.55–0.81) and composite adverse perinatal outcomes (area under the curve: 0.58, 95% CI 0.47–0.70). When umbilical artery Doppler parameters were added to the models, the area under the curve values improved to 0.95 (95% CI 0.89–0.99) and 0.83 (95% CI 0.73–0.92) for stillbirth and composite adverse perinatal outcomes, respectively. Conclusion: In dichorionic twin pregnancies complicated by sFGR, the umbilical artery Z‐scores were associated with both intrauterine death and adverse perinatal outcomes. Linked article: This article is commented on by Laura Sarno, pp. 201 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.17600 [ABSTRACT FROM AUTHOR]

Objective: To estimate the proportion of heart disease in fetuses with a prenatal diagnosis of a single isolated umbilical artery. Methods: We performed a search strategy in MEDLINE (OVID), EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to the present. We assessed the risk of bias and performed a meta‐analysis. We completed the subgroup analysis according to the region. Results: We found 1384 studies by the search strategy. After carefully reviewing the full‐text, 15 studies were included. A total of 2008 fetuses with a single isolated umbilical artery were included, and 177 had cardiac malformations. There was an overall incidence of 9% 95%CI (0.05–0.14) I2 90%. The incidence by country of origin was between 5% and 19%. The most common heart disease reported was a ventricular septal defect. Seven studies were found describing 25 cases. We described other malformations, such as tetralogy of Fallot, coarctation of the aorta, and hypoplastic left ventricle, among others. Conclusion: The incidence of congenital heart disease in fetuses with a single isolated umbilical artery was high. In addition, half of these correspond to significant heart disease. Based on the above, we suggest that fetuses with a single isolated umbilical artery should have a complete anatomic evaluation emphasizing cardiac evaluation. [ABSTRACT FROM AUTHOR]

Objective To explore the diagnostic value of color Doppler ultrasound for fetal intrauterine distress (FIUD) in high-risk puerperae in plateau areas. Methods A total of 130 puerperae in plateau areas and 130 puerperae in plain areas were enrolled. According to presence or absence of FIUD in different areas, they were divided into the plateau distress group (47 cases), the plateau normal group (83 cases), the plain distress group (31 cases) and the plain normal group (99 cases). All cases underwent blood flow detection of middle cerebral artery (MCA) and umbilical artery (UA) before delivery, and cerebral -placental ratio (CPR) was calculated. The incidence of FIUD was compared between high-risk puerperae in plateau area and in plain area. Gestational age, birth weight, cesarean section rate and blood spectrum parameters of MCA and UA were compared between the four groups. The predictive value of color Doppler ultrasound parameters for FIUD was analyzed by receiver operating characteristic (ROC) curves. Results The incidence rates of FIUD and severe FIUD were higher in patients of plateau areas than those in plain areas (36.15%, 13.85% vs. 23.85%, 4.62%, P＜0.05). Compared with the plateau distress group, gestational age and birth weight were increased in the plateau normal group and the plain distress group (P＜0.05). Compared with the plateau distress group, PI, RI, S/D and CPR of MCA were increased, while PI, RI and S/ D of UA were decreased in the plateau normal group and the plain distress group (P＜0.05). Results of ROC curve analysis showed that overall performance advantage of S/D of UA was the most obvious in the diagnosis of FIUD in high-risk puerperae in plateau areas. The diagnostic sensitivity of RI of MCA was the highest, and the diagnostic specificity of CPR was the highest (P＜0.05). Conclusion Color Doppler ultrasound has good diagnostic value for FIUD in high-risk puerperae in plateau areas, which can be applied as an effective clinical screening means for FIUD. [ABSTRACT FROM AUTHOR]

Endothelial dysfunction initiates the pathogenesis of a myriad of cardiovascular diseases, yet the precise underlying mechanisms remain unclear. Current model utilises mechanical denudation of arteries resulting in an arterial-injury model with onset of intimal hyperplasia (IH). Our study shows that 5 min enzymatic denudation of human umbilical artery (hUA) lumen at 37 ℃ efficiently denudes hUA while maintaining vessel integrity without significantly increase intima-media thickness after 7 days in culture. This ex-vivo model will be a valuable tool in understanding the mechanism of re-endothelialization prior to smooth muscle cells (SMC) activation thus placating IH at an early stage. [ABSTRACT FROM AUTHOR]

The aim of this study was to elucidate the application of ultrasound examination of umbilical artery (UA) hemodynamics with urine microalbumin (UmA) determination in evaluating the outcomes of sPE patients. Altogether 80 sPE patients and 75 healthy pregnant women were recruited. UmA, RI (resistance index) and PI (pulsatility index) were separately measured by ELISA and the ultrasonic Doppler flow detector. The correlation between parameters was analysed using Pearson's coefficient method. The independent risk factors of sPE were identified using the Logistic regression model. sPE patients had increased UmA, RI and PI (all p < 0.05). UmA level was positively correlated with RI and PI in sPE patients. RI, PI and UmA were independent risk factors of sPE (all p < 0.05). sPE can predict adverse pregnancy outcomes. High UmA levels may increase the risk of poor prognosis. Overall, ultrasound examination of UA hemodynamics with UmA determination can predict the adverse pregnancy outcomes of sPE patients. What is already known on this subject? Doppler ultrasound and urine microalbumin (UmA) measurement are important tools in assessing the clinical severity of severe preeclampsia (sPE). What do the results of this study add? This study aims to unravel the application of ultrasound examination of hemodynamics in the umbilical artery (UA) combined with the determination of UmA in evaluating the outcomes of sPE patients. What are the implications of these findings for clinical practice and/or further research? Ultrasound examination of hemodynamics in UA combined with the determination of UmA can predict the adverse pregnancy outcomes of sPE patients. [ABSTRACT FROM AUTHOR]

Abstract The objective of the present study was to demonstrate the blood flow velocities, blood flow rate (BFR; bpm) with the accurate ratio of both systolic and diastolic velocities points (S/D) in addition to Doppler indices (resistive and pulsatility index [RI and PI]) in both fetal [fetal heart (FH), fetal abdominal aorta (Ab. A), and umbilical artery (UM.A)] and maternal [Middle uterine artery (MU.A)] sides during the last month of gestation. Ten Zaraibi (Egyptian Nubian) goats weighing 40-50kg and aged from 5–7 years were examined twice per month till reached the last month of pregnancy. Then all females were examined every 5 days starting from day -35 till day -1 before kidding.The pregnant goats were examined by ultrasonic and Doppler indices were recorded with Doppler scanning (7.5 -12 MHz, with colored and spectral graph to form the perfect wave to assess Doppler measurements). The obtained data were analyzed using analysis of variance. Results indicated that on the fetal side; the maximum point of velocity (MSV; cm/sec) in the FH and BFRwere elevated from day -35 till day -10 with a slight decline at days -5 and -1 at the peripartum period (P

Abstract Background The negative impact of prenatal alcohol and tobacco exposure (PAE and PTE) on fetal development and birth outcomes are well described, yet pathophysiologic mechanisms are less clear. Our aim was to investigate (1) the associations between quantity, frequency and timing (QFT) of PAE and PTE with blood flow velocities in arteries of the fetal-placental-maternal circulation and (2) the extent to which combined effect of QFT of PAE and/or PTE and Doppler flow velocity waveforms (FWV) predict infant birth weight. Methods The Safe Passage Study is a cohort based in urban Cape Town, South Africa. Recruitment occurred between 2007 and 2015. Information on QFT of PAE and PTE was collected prospectively at up to 4 occasions during pregnancy using a modified Timeline Follow-Back approach. Ultrasound examinations consisted of Doppler flow velocity waveforms of the uterine, umbilical (UA) and fetal middle cerebral arteries for the pulsatility index (PI) at 20–24 and 34–38 weeks. Exclusion criteria included: twin pregnancies, stillbirths, participants exposed to other drugs. The sample was divided into three groups (controls, PAE and PTE) and included 1396 maternal-fetal-dyads assessed during the second trimester; 1398 assessed during the third trimester. Results PTE was associated with higher UA PI values in second and third trimesters (p

Objectives: To determine and compare the diagnostic performance of doppler sonography of fetal umbilical artery (UA) and middle cerebral artery (MCA) in prediction of adverse perinatal outcome in suspected intrauterine growth retardation (IUGR). Methodology: One hundred singleton pregnancies between 28 and 40 weeks of gestation complicated by intrauterine growth restriction were prospectively examined with doppler ultrasonography of the UA and MCA and were correlated with fetal outcome. Results: Of the 100 cases, 52 had elevated umbilical systolic/diastolic (S/D) ratio, 58 had elevated umbilical resistance index (RI), 63 had elevated umbilical pulsatality index ( PI). 58 had abnormal MCA S/D, 47 had abnormal MCA RI, 43 had abnormal MCA PI and 57 had cerebroplacental ratio (CPR) 48 hrs was maximum (56.1%) in the CPR

Objectives This study aimed to assess and contrast the predictive abilities of umbilical artery Doppler velocimetry and modified biophysical profile (MBPP) in forecasting antenatal outcomes among pregnant women with high-risk factors. Methods For this study, a group of researchers conducted analyses of patient data from two distinct medical facilities located in Bihar, India for over 2 years. This data was sourced from the obstetrics and gynecology departments at Sumitram Hospital, Bihar, and the radiology department at SKMCH, Bihar. The scope of the research encompassed 100 cases of pregnant women with high-risk factors, each with one gestation, and subsequently underwent childbirth within 2 days after assessment of health parameters. Results Most women had significant risk factors, with 51% exhibiting hypertension induced by pregnancy and 38% experiencing restriction of fetal growth. The group with the highest number of prenatal complications was identified to be Group D, characterized by abnormal results of Doppler and MBPP. The other group that closely followed this outcome was the group having irregular MBPP test results (Group C). Among neonates with antenatal complications, 40 showed atypical MBPP test results compared to 18 with abnormal Doppler findings. Over 10 patients had meconium-stained liquor (MSL), and all 18 of these cases had abnormal MBPP. MBPP demonstrated specificity, sensitivity PPV, and NPV of 50.94 %, 90.65 %, 62.08 %, and 89.09 %, respectively. Conclusion The findings of the current study indicate that modified biophysical profiling (MBPP) surpasses umbilical artery Doppler ultrasonography in its ability to predict perinatal outcomes among high-risk pregnant women. Recommendation It is recommended that MBPP should be routinely performed in all pregnancies with high-risk factors, regardless of the results of the Doppler tests. Moreover, to improve antenatal outcomes, the implementation of both of these tests in pregnancies associated with high-risk factors is deemed to be crucial.

The aim of this study was to elucidate the application of ultrasound examination of umbilical artery (UA) hemodynamics with urine microalbumin (UmA) determination in evaluating the outcomes of sPE patients. Altogether 80 sPE patients and 75 healthy pregnant women were recruited. UmA, RI (resistance index) and PI (pulsatility index) were separately measured by ELISA and the ultrasonic Doppler flow detector. The correlation between parameters was analysed using Pearson’s coefficient method. The independent risk factors of sPE were identified using the Logistic regression model. sPE patients had increased UmA, RI and PI (all p

The objective of the present study was to demonstrate the blood flow velocities, blood flow rate (BFR; bpm) with the accurate ratio of both systolic and diastolic velocities points (S/D) in addition to Doppler indices (resistive and pulsatility index [RI and PI]) in both fetal [fetal heart (FH), fetal abdominal aorta (Ab. A), and umbilical artery (UM.A)] and maternal [Middle uterine artery (MU.A)] sides during the last month of gestation. Ten Zaraibi (Egyptian Nubian) goats weighing 40-50kg and aged from 5–7 years were examined twice per month till reached the last month of pregnancy. Then all females were examined every 5 days starting from day -35 till day -1 before kidding.The pregnant goats were examined by ultrasonic and Doppler indices were recorded with Doppler scanning (7.5 -12 MHz, with colored and spectral graph to form the perfect wave to assess Doppler measurements). The obtained data were analyzed using analysis of variance. Results indicated that on the fetal side; the maximum point of velocity (MSV; cm/sec) in the FH and BFRwere elevated from day -35 till day -10 with a slight decline at days -5 and -1 at the peripartum period (P < 0.05), while FH.PI and S/D ratio declined till day -1(P < 0.05). In addition, the fetal Ab. A, and UM.A PI, RI, and S/D ratio declined from day -35 till day -1 at the peripartum period with a significant increase in the peak systolic velocity (PSV) and BFR(P < 0.05). However, non-significant changes in the end diastolic velocity (EDV) were detected. On the maternal side, the MU.A PI and S/D declined from day -35 till day -1 with an elevation of both PSV and BFRat the same time points (P < 0.05). In conclusion, the Doppler evaluation of fetal and maternal blood flow vessels is important to give complete information that directly affects the health status of the mother and fetus. [ABSTRACT FROM AUTHOR]

This study constitutes a description of prenatal echo-sonographic parameters in fetuses wrapped with the umbilical cord in the third trimester of pregnancy and demonstrates the practical importance of the umbilical cord collision. Echocardiographic examinations were performed within 6 months, and a group of patients in the third trimester with a mean age of 28.1 ± 0.79 weeks of gestation (p = 0.075) was distinguished. The group included 46 fetuses from single pregnancies with the umbilical cord around the fetal neck and 70 fetuses without the umbilical cord around the fetal neck. The course of the umbilical cord coiling around the fetal neck was recorded by color Doppler. We also conducted a follow-up with the newborns. In the study group, there was an elevated peak systolic velocity of the umbilical artery (UMB PSV) at a level of 44.17 cm/s vs. 38.90 cm/s in the control group (p = 0.004), and caesarean sections were significantly more frequent (54.5% vs. 31.4%). The persistence of the nuchal cord during delivery was observed in 37% of newborns in the study group, while the occurrence of umbilical wrapping during delivery was found in 18.6% of newborns in the control group (p = 0.027). In the studied cases, caesarean sections were 2.62 times more frequent (OR = 2.62), whereas nuchal cords during delivery were 2.57 times more often observed (OR = 2.57). Fetal umbilical cord wrapping in the third trimester of pregnancy does not have a significant hemodynamic impact; however, the UMB PSV might be slightly elevated in this group, and the frequency of umbilical cord collision during delivery and the need to perform a caesarean section at term seem to be more common. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the effect of epidural analgesia (EA) on maternal and fetal hemodynamics. Methods: A prospective single‐center observational study was conducted from March 2022 to May 2022 on low‐risk singleton pregnancies who received prenatal care at 37–40 weeks and delivered at our hospital. Pre‐ and post‐EA, maternal and fetal hemodynamics, including maternal parameters of mean arterial pressure (MAP), heart rate (HR) and saturation of pulse oxygen (SPO2), fetal heart rate (FHR), Doppler flow parameters of umbilical artery (UA), middle cerebral artery (MCA), and uterine artery (UtA) during labor were measured before epidural insertion (T0), and 15 (T1), 30 (T2), and 60 (T3) minutes after. Computational analysis was performed using a one‐way ANOVA test. Results: In total, 100 singleton pregnant women were enrolled. After EA, maternal MAP, HR, and SPO2 were significantly lower than baseline values at all times except for HR in T3 and remained lower for the study's duration (P <.05). As for FHR, there was no significant difference between pre‐ and post‐epidural. The mean UtA‐PI (pulsatility index), UA‐PI, UA‐RI (resistance index), and UA‐S/D (systolic/diastolic ratio) were not significantly modified after EA. Nevertheless, MCA‐PI and RI significantly decreased in 15 minutes after initiating EA compared with T0 values (P <.05), and MCA‐PSV (resistance index and peak systolic velocities) was significantly increased compared with T0 at all times (P <.05). The above changes were all within the normal range. Conclusion: Although maternal MAP, HR, and SPO2 significantly decreased after EA, fetal hemodynamics remained relatively stable. [ABSTRACT FROM AUTHOR]

Background/Aim: It has been reported that both the internal carotid artery (ICA) and the common carotid artery (CCA) are associated with hypoxia, also observed in late-onset fetal growth restriction (FGR). However, it has not yet been investigated whether these Doppler measurements differ in cases of late-onset FGR. This study evaluated the ICA and the CCA Doppler parameters in late-onset FGR fetuses and compared these measurements with those of healthy fetuses. Methods: This cross-sectional observational study comprised 75 singleton pregnancies diagnosed with late-onset FGR between the 32nd and 37th weeks of gestation, alongside 75 healthy fetuses paired 1:1 based on obstetric history and gestational age between June 2022 and May 2023. The Delphi consensus of 2016 was used for the definition of late-onset FGR. The exclusion criteria were congenital anomalies, presence of any additional disease, maternal body mass index over 35 kg/m², abdominal scars hindering ultrasound visualization, use of medications such as antenatal steroids, sympathomimetics, and indomethacin that affect vascular function, drug use, smoking during pregnancy, concurrent preeclampsia, and multiple pregnancies. Upon the patients' admission to the hospital, their demographic characteristics were documented, and ultrasonographic examinations and Doppler measurements were subsequently performed. The Doppler velocimetry of the umbilical artery (UA) encompassed measurements of the systolic to diastolic ratio (S/D), pulsatility index (PI), and peak systolic velocity (PSV). The carotid artery Doppler velocimetry of the middle cerebral artery (MCA), ICA, and CCA encompassed measurements of the PI, resistance index (RI), and PSV. We assessed the diagnostic performance of Doppler measurements for late-onset FGR through receiver operating characteristic (ROC) analysis. Results: In the late-onset FGR group, the mean UA-SD was higher (2.7 [0.6] vs. 2.5 [0.5], P=0.006), and the mean UA-PI (0.8 [0.2] vs. 0.9 [0.2], P=0.011) and mean PSV (35.6 [8.2] vs. 41.1 [7.1], P<0.001) were lower compared to the control group. In the late-onset FGR group, carotid Doppler measurements were more pronounced than UA Doppler measurements. Moreover, ICA Doppler measurements exhibited superior diagnostic performance in predicting late-onset FGR compared to other Doppler measurements (Area under the curve [AUC]=0.777, P<0.001 for ICA-PI; AUC=0.751, P<0.001 for ICA-RI; AUC=0.749, P<0.001 for ICA-PSV). Conclusion: In fetuses with late-onset FGR, UA Doppler measurements showed minimal differences compared to healthy fetuses, but differences in carotid Doppler measurements, especially in the ICA, were more pronounced. Therefore, in the management of fetuses suspected of having late-onset FGR, a more detailed Doppler examination might be required. [ABSTRACT FROM AUTHOR]

Background: Umbilical cord torsion is one of the known causes of perinatal fetal death, adding to the increase in perinatal morbidity and mortality. However, there is no study on the relationship between umbilical cord torsion and the changes in umbilical artery Doppler parameters. Methods: The subjects included 962 pregnant women who were discharged from our hospital from January 2015 to November 2021 and were eligible for inclusion (415 in the study group and 547 in the control group). The measurement data of umbilical artery Doppler parameters (peak systolic velocity (PSV), systolic/diastolic ratio (S/D), resistance index (RI), pulse index (PI)) were collected from 21 to 40 weeks of gestation, and the differences among the collected parameters were statistically analyzed. Results: The peak systolic velocity (PSV) of umbilical artery were positively correlated with gestational age, while the Doppler resistance parameters (S/D, RI, PI) of the umbilical artery were negatively correlated with gestational age. The mean values of umbilical artery Doppler parameters (PSV, S/D, RI, PI) in the study group were significantly lower than those in the control group at the same gestational age (p < 0.05). Conclusions: The decrease of Doppler parameters in the umbilical artery in late pregnancy was significantly related to umbilical cord torsion, which may be used as a reason for prenatal ultrasound screening for umbilical cord torsion. In the future, we need to combine further perinatal and prognostic data to carry out a prospective study.

Background: The negative impact of prenatal alcohol and tobacco exposure (PAE and PTE) on fetal development and birth outcomes are well described, yet pathophysiologic mechanisms are less clear. Our aim was to investigate (1) the associations between quantity, frequency and timing (QFT) of PAE and PTE with blood flow velocities in arteries of the fetal-placental-maternal circulation and (2) the extent to which combined effect of QFT of PAE and/or PTE and Doppler flow velocity waveforms (FWV) predict infant birth weight. Methods: The Safe Passage Study is a cohort based in urban Cape Town, South Africa. Recruitment occurred between 2007 and 2015. Information on QFT of PAE and PTE was collected prospectively at up to 4 occasions during pregnancy using a modified Timeline Follow-Back approach. Ultrasound examinations consisted of Doppler flow velocity waveforms of the uterine, umbilical (UA) and fetal middle cerebral arteries for the pulsatility index (PI) at 20–24 and 34–38 weeks. Exclusion criteria included: twin pregnancies, stillbirths, participants exposed to other drugs. The sample was divided into three groups (controls, PAE and PTE) and included 1396 maternal-fetal-dyads assessed during the second trimester; 1398 assessed during the third trimester. Results: PTE was associated with higher UA PI values in second and third trimesters (p < 0.001), compared to the PAE and control group. The total amount of cigarettes smoked during pregnancy was positively correlated with UA PI values (r = 0.087, p < 0.001). There was a positive correlation between cigarettes smoked per day in trimester one (r = 0.091, p < 0.01), and trimester two (r = 0.075, p < 0.01) and UA PI (in trimester two), as well as cigarettes smoked per day in trimester two (r = 0.058, p < 0.05) and trimester three (r = 0.069, p < 0.05) and the UA PI in trimester three. Generalized additive models indicated that PAE in trimester two, PTE in trimester one and Doppler FWV in trimester three were significant predictors of birth weight in this sample. Conclusion: In our study, PTE in trimesters two and three resulted in increased vascular resistance of the placenta. These findings highlight nuance in associations between PAE, PTE and blood flow velocities in arteries of the fetal-placental-maternal circulation and birth weight, suggesting that quantity and timing are important factors in these relationships. [ABSTRACT FROM AUTHOR]

Background Malaria in pregnancy (MiP) has been associated with fetal growth restriction, the underlying pathogenic mechanisms of which remain poorly understood. Malaria in pregnancy is suspected to induce abnormalities in placental vascularization, leading to impaired placental development. Our study evaluated MIP's effect on uterine artery (UtA) and umbilical artery (UA) blood flow. Methods The analysis included 253 Beninese women followed throughout pregnancy and screened monthly for submicroscopic and microscopic malaria. Uterine artery Doppler measurement was performed once between 21 and 25 weeks' gestation (wg), and UA Doppler measurement was performed 1–3 times from 28 wg. Linear and logistic regression models were used to assess the effect of malaria infections on UtA Doppler indicators (pulsatility index and presence of a notch), whereas a logistic mixed model was used to assess the association between malaria infections and abnormal UA Doppler (defined as Z-score ≥2 standard deviation or absent/reversed UA end-diastolic flow). Results Primigravidae represented 7.5% of the study population; 42.3% of women had at least 1 microscopic infection during pregnancy, and 29.6% had at least 1 submicroscopic infection (and no microscopic infection). Both microscopic and submicroscopic infections before Doppler measurement were associated with the presence of a notch (adjusted odds ratio [aOR] 4.5, 95% confidence interval [CI] = 1.2–16.3 and aOR 3.3, 95% CI =.9–11.9, respectively). No associations were found between malaria before the Doppler measurement and abnormal UA Doppler. Conclusions Malaria infections in the first half of pregnancy impair placental blood flow. This highlights the need to prevent malaria from the very beginning of pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the natural evolution of and risk factors for the adverse outcome of monochorionic twins with selective intrauterine growth restriction (sIUGR) under expectant management. Methods: Retrospective study conducted in a single tertiary referral center. The clinical characteristics and neonatal outcomes of 153 patients with sIUGR under expectant management were evaluated, and the risk factors leading to adverse outcomes were explored. Results: Fifty‐one patients (33.3%) showed a changed pattern in umbilical artery Doppler at the last examination, occurring in all types of sIUGR. Compared with type Ia, the gestational age of diagnosis was earlier, the estimated fetal body weight difference at diagnosis was greater, and the rate of severe neonatal complications in both fetuses was significantly higher in type Ib (P < 0.05). Univariate and multivariate logistic regression analyses showed that type II (odds ratio [OR] 5.41, 95% confidence interval [CI] 2.34–12.51; P < 0.001) and type III (OR 9.11, 95% CI 3.02–27.50; P < 0.001) were associated with adverse perinatal outcomes in sIUGR. Conclusion: Type II and III sIUGR are independent risk factors predicting adverse outcomes of sIUGR. Different types of sIUGR could convert to each other. The outcome of type Ib is poorer than that of type Ia. Synopsis: Type II and III are independent risk factors for adverse outcomes of sIUGR while type Ib had a poorer outcome compared with type Ia. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to analyse the Doppler indices in umbilical artery, middle cerebral artery and uterine artery using Doppler ultrasound in a group of patients with pregnancy induced hypertension, assess the value of Doppler ultrasound in predicting the perinatal outcome in patients with pregnancy induced hypertension and evaluate the role of Doppler ultrasound in the management of pregnancy induced hypertension. Methods: This was a hospital based prospective study conducted among 150 patients who presented with pregnancy induced hypertension to the Department of Radiodiagnosis, Mysore Medical College and Research Institute, Mysore, over a period of 18 months from November 2017 to April 2019 after obtaining clearance from institutional ethics committee and written informed consent from the study participants. Results: The perinatal mortality was highest in the elevated RI (31%) group when compared to elevated S/D (25%) and elevated PI(28.5%) group. Amongst the umbilical artery waveforms highest LSCS for fetal distress was done in those with an elevated RI. Umbilical RI also had a 100% sensitivity in predicting APGAR<7 at 5 min. MCA Doppler studies revealed that when there was an increase in the Umbilical artery resistance there was a decrease in the values of MCA indices showing a brain sparing effect. In all the fetuses with a brain sparing effect the CPR was <1.08. Perinatal outcome as follows was - 48 delivered babies weighing <10th percentile and those with normal CPR had 26 babies weighing <10th percentile. 29 babies delivered by LSCS. 25 babies have APGAR values <7 at 5min. Statistical correlation was drawn and found to be significant (p<.05) in all the parameters in predicting poor perinatal outcome. Conclusion: Doppler ultrasound study is very useful in predicting pregnancy induced hypertension with adverse perinatal outcome when the Doppler velocimetry is abnormal. [ABSTRACT FROM AUTHOR]

The velocity time integral (VTI) is a clinical Doppler ultrasound measurement of blood flow, measured by the area under the wave curve and equivalent to the distance traveled by the blood. This retrospective study assessed the middle cerebral artery (MCA) VTI of fetuses in pregnancies complicated by maternal alloimmunization. Doppler indices of the MCA were retrieved from electronic medical records. Systolic deceleration-diastolic time, systolic acceleration time, VTI, and peak systolic velocity (PSV) were measured at 16–40 weeks gestation. Cases with PSV indicating fetal anemia (cutoff 1.5 MoM) and normal PSV were compared. The study included 255 Doppler ultrasound examinations. Of these, 41 were at 16–24 weeks (group A), 100 were at 25–32 weeks (group B), and 114 were at 33–40 weeks (group C). VTI increased throughout gestation (5.5 cm, 8.6 cm, and 12.1 cm in groups A, B, and C, respectively, p = 0.003). VTI was higher in waveforms calculated to have MCA-PSV ≥ 1.5 MoM compared to those with MCA-PSV < 1.5 MoM (9.1 cm vs. 14.1 cm, respectively, p < 0.001), as was VTI/s (22.04 cm/s vs. 33.75 cm/s, respectively; p < 0.001). The results indicate that the MCA VTI increases significantly among fetuses with suspected anemia, indicating higher perfusion of hemodiluted blood to the brain. This feasible measurement might provide a novel additional marker for the development of fetal anemia. [ABSTRACT FROM AUTHOR]

Objective: Absent or reversed end diastolic flow (AREDF) in umbilical artery (UA) Doppler are known phenomena during fetal interventions such as fetal spina bifida (fSB) repair. The clinical importance of these Doppler findings and the impact on children's outcome is not yet clarified.Methods: Between 2010 and 2019, 132 patients underwent SB repair at our center. The group with AREDF-UA was compared to the group with normal UA Doppler during the intervention. Primary endpoint was the FIGO-Score of the cardiotocography (CTG) 1, 2, and 6 hours postoperatively and their correlation to the ARED-UA flow. Secondary endpoints were the neonatal parameters and two-year neurodevelopmental outcome assessed using the Bayley Scale of Infant and Toddler Development Third Edition (Bayley-III).Results: None of the fetuses showed AREDF before SB repair. In 107 patients (82%) normal UA-Doppler and in 23 (18%) AREDF-UA was observed during or immediately after SB surgery. AREDF-UA was more often observed after version of the fetus (p = 0.045). 17 (13 %) cases showed AEDF-UA and 6 (5%) cases REDF-UA. On the first day after SB surgery the AREDF-UA disappeared in all 23 cases. No significant difference in the CTGs at 1, 2, and 6 hours postoperatively and on the first postoperative day between the two groups was found (p > 0.05). GA at delivery, UA-pH, 5-minute Apgar and birth weight were comparable between both groups and there was no difference regarding the two-year neurodevelopmental outcome (p >0.05). Also the neurodevelopmental outcome did not differ between children with an absent or a reversed EDF-UA.Conclusions: The postoperative CTGs after a short-term phase of AREDF-UA during fSB repair normalize similarly as in normal UA-Doppler cases. AREDF-UA during fSB repair did not negatively influence postnatal or 2-year neurodevelopmental outcome compared with a normal UA-flow. This article is protected by copyright. All rights reserved. [ABSTRACT FROM AUTHOR]

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