Background-Placental insufficiency may lead to fetal cardiovascular compromise. We sought to determine whether ultrasonographic parameters of fetal cardiovascular function correlate with umbilical arterial levels of biochemical markers of myocardial dysfunction and damage in placental insufficiency. Methods and Results-In 48 fetuses with placental insufficiency, umbilical artery blood was obtained at delivery for assessment of N-terminal peptide of proatrial natriuretic peptide (NT-proANP) and cardiac troponin-T (cTnT). Group 1 fetuses (nϭ12) had normal NT-proANP and cTnT serum concentrations. Group 2 fetuses (nϭ25) showed increased NT-proANP (Ͼ1145 pmol/L) and normal cTnT values. Group 3 fetuses (nϭ11) had increased NT-proANP and cTnT (Ͼ0.10 ng/mL) levels. The ultrasonographic parameters of fetal cardiovascular function were compared between the groups. Pulsatility indices for veins of the ductus venosus, left hepatic vein, and inferior vena cava correlated significantly with NT-proANP levels. In group 3, ductus venosus, left hepatic vein, and inferior vena cava pulsatility indices for veins were higher (PϽ0.01) than in groups 1 and 2. The proportion of left ventricular cardiac output of combined cardiac output was greater (PϽ0.05) and that of right ventricle was smaller (PϽ0.05) in group 3 than in group 2. In group 3, tricuspid regurgitation was noted most often (PϽ0.05), and right ventricular fractional shortening was less (PϽ0.01) than in group 2. Conclusions-Pulsatility in human fetal systemic veins correlated significantly with the cardiac secretion of ANP. Fetuses with myocardial damage demonstrate increased systemic venous pressure, a change in the distribution of cardiac output toward the left ventricle, and a rise in right ventricular afterload.

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The role of transvaginal pulsed colour Doppler ultrasound in the prediction of the outcome of in-vitro fertilization (IVF) therapy was assessed longitudinally in 30 patients during stimulated cycles. The pulsatility index (PI) of the uterine arteries did not change significantly until the mid-luteal phase. Within 6 days after the beginning of stimulation the maximum peak systolic velocity of the uterine blood flow had increased significantly from 27.6 +/- 8.9 to 36 +/- 12.8 cm/s. No difference was found in uterine PI between pregnant and non-pregnant women. The PI of intra-ovarian flow was also similar in both groups. However, there was an insignificant increase in uterine receptivity when the PI of the uterine artery was between 2.0 and 2.99 on the day of embryo transfer. Nevertheless, the appraisal of the prognostic outcome of the treatment could not be made with Doppler.

Objective: To investigate first trimester human fetal cardiac function in relation to cardiac volume blood flow, and peripheral arterial and venous blood flow patterns. Methods: Transvaginal Doppler ultrasonography was performed in 16 uncomplicated pregnancies at 6+, 7+, 8+, 9+, and 10+ gestational weeks. The shape of the inflow waveform and the presence of atrioventricular valve regurgitation (AVVR) were noted. The outflow mean velocity (Vmean) was calculated. The proportions of the isovolumetric relaxation (IRT%) and contraction times (ICT%) of the cardiac cycle were defined. Ductus venosus and umbilical artery pulsatility indices (PI) were obtained. Results: Every inflow waveform was monophasic before 9+ weeks. At 9+ weeks 11 of 16 and at 10+ weeks all waveforms were biphasic. At 7+ and 8+ weeks AVVR was documented in one case. At 9+ and 10+ weeks AVVR was present in four and seven fetuses, respectively. Mean (SD) outflow Vmean increased between 6+ and 8+ weeks from 3.6 (1.5) to 8.4 (3.0) cm/s (p , 0.05). IRT% decreased significantly from 6+ to 7+ weeks (39.8 (2.6) to 19.2 (6.2), p , 0.001). ICT% decreased between 8+ and 9+ weeks from 13.2 (4.0) to 8.5 (2.5) (p , 0.05). Ductus venosus PIs were unchanged. Umbilical artery Vmean increased between 7+ and 10+ weeks from 1.59 (0.51) to 5.06 (1.06) cm/s (p , 0.001) and PIs remained unchanged. Conclusions: The first trimester of pregnancy is characterised by significant improvements in cardiac diastolic and systolic function with a concomitant increase in cardiac volume blood flow. At 10+ weeks AVVR is a common finding. Placental volume blood flow increases significantly with no change in the placental vascular impedance.

Fetuses with retrograde aortic isthmus net blood flow demonstrate a rise in right ventricular afterload and increased pulsatility in ductus venosus blood velocity waveforms.

Transvaginal pulsed color Doppler ultrasound was used to examine 72 patients with a pelvic mass preoperatively. Tumor morphology was assessed, prominent areas of vascularization within the tumor were observed and the pulsatility index and the resistance index of tumor and uterine arteries were measured. Flow velocity waveforms with low pulsatility are considered to reflect neovascularization. The ultrasound diagnoses were compared with histopathological or cytological diagnoses. There were 61 benign, eight malignant and three borderline cases. In 75% of the malignant and 23% of the benign tumors, an intratumoral flow with a low pulsatility was detectable. The mean pulsatility index of tumor blood vessels was 1.2 in benign, 0.7 in malignant and 0.6 in borderline neoplasms. The corresponding mean resistance index values were 0.6, 0.5 and 0.5. The differences were not significant and the overlap between the malignant and benign lesions was large. The pulsatility index and resistance index of uterine arteries were significantly decreased in malignant tumors. The results show that, using a cut-off resistance index value of 0.6, the sensitivity and specificity of color Doppler in the detection of malignant and potentially malignant tumors were 82% and 72%, respectively. However, a practical cut-off level for either pulsatility or resistance indices, that could assist in differentiating between malignant or benign lesions, does not seem to exist.

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