Fetal and umbilical Doppler ultrasound in high-risk pregnancies

Alfirević, Z̄arko; Stampalija, Tamara; Gyte, Gillian ML

doi:10.1002/14651858.cd007529.pub3

Cited by 190 publications

(50 citation statements)

References 64 publications

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“…34 Routine fetal umbilical artery Doppler ultrasound examination in low-risk populations does not improve perinatal outcomes, including perinatal mortality, so it should not be performed in low-risk or in normally grown fetuses. 35 …”

Section: Umbilical Arterymentioning

confidence: 99%

A Practical Approach to Fetal Growth Restriction

Copel

Bahtiyar

2014

Obstetrics &Amp; Gynecology

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Fetal growth restriction is one of the most complex problems encountered by obstetricians. Ultrasound-estimated fetal weight less than the 10th percentile for the gestational age is the most widely accepted diagnostic criterion. Management protocols vary from institution to institution. Doppler velocimetry provides valuable information about fetal status. We offer a practical approach to management and timing of delivery based on available data in the literature.

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Section: Umbilical Arterymentioning

confidence: 99%

A Practical Approach to Fetal Growth Restriction

Copel

Bahtiyar

2014

Obstetrics &Amp; Gynecology

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“…36–40 A key meta-analysis, as well as a recent Cochrane review, concluded that using umbilical artery Doppler in high-risk pregnancies reduced the risk of perinatal death by 29 to 38 percent, without increasing interventions like iatrogenic preterm delivery. 30,41 These findings solidified the role of umbilical artery Doppler ultrasonography in high-risk pregnancies. Despite the reduction in risk of perinatal death with use of umbilical artery Doppler velocimetry, however, existing studies demonstrate that overall survival and long-term outcomes are unchanged.…”

Section: Umbilical Artery Doppler Assessment In Fgrmentioning

confidence: 66%

Role of the fetoplacental endothelium in fetal growth restriction with abnormal umbilical artery Doppler velocimetry

2015

American Journal of Obstetrics and Gynecology

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Growth-restricted fetuses with absent or reversed end-diastolic velocities in the umbilical artery are at substantially increased risk for adverse perinatal and long-term outcome, even in comparison to growth-restricted fetuses with preserved end-diastolic velocities. Translational studies show that this Doppler velocimetry correlates with fetoplacental blood flow, with absent or reversed end-diastolic velocities signifying abnormally elevated resistance within the placental vasculature. The fetoplacental vasculature is unique in that it is not subject to autonomic regulation, unlike other vascular beds. Instead, humoral mediators, many of which are synthesized by local endothelial cells, regulate placental vascular resistance. Existing data demonstrate that in growth-restricted pregnancies complicated by absent or reversed umbilical artery end-diastolic velocities, an imbalance in production of these vasoactive substances occurs, favoring vasoconstriction. Morphologically, placentas from these pregnancies also demonstrate impaired angiogenesis, whereby vessels within the terminal villi are sparsely branched, abnormally thin, and elongated. This structural deviation from normal placental angiogenesis restricts blood flow and further contributes to elevated fetoplacental vascular resistance. Although considerable work has been done in the field of fetoplacental vascular development and function, much remains unknown about the mechanisms underlying impaired development and function of the human fetoplacental vasculature, especially in the context of severe FGR with absent or reversed umbilical artery end-diastolic velocities. Fetoplacental endothelial cells are key regulators of angiogenesis and vasomotor tone. A thorough understanding of their role in placental vascular biology carries the significant potential of discovering clinically relevant and innovative approaches to prevention and treatment of fetal growth restriction with compromised umbilical artery end-diastolic velocities.

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“…The following definitions were applied to the study group: (1) IUGR: fetuses with an estimated fetal weight <10th percentile, according to reference tables for the Spanish population, and an umbilical artery PI >95th percentile [21,22,23]; (2) SGA: fetuses with an estimated fetal weight <10th percentile, according to reference tables for the Spanish population, and normal Doppler velocimetry (umbilical artery PI, middle cerebral artery PI, cerebroplacental ratio and UAs) [21,22,23]; (3) PE: systolic blood pressure (BP) ≥140 mm Hg and/or diastolic BP ≥90 mm Hg measured twice in 6 h after 10 min of rest with the mother sitting, and the measure taken in the arm at heart level with a quantitative determination of proteinuria >300 mg in 24 h, and (4) GH: systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg measured twice in 6 h after 10 min of rest with the mother sitting, and the measure taken in the arm at heart level with negative proteinuria [24,25,26,27]. All percentiles of fetal weights were confirmed at birth.…”

Section: Methodsmentioning

confidence: 99%

Use of Placental Growth Factor and Uterine Artery Doppler Pulsatility Index in Pregnancies Involving Intrauterine Fetal Growth Restriction or Preeclampsia to Predict Perinatal Outcomes

Gómez‐Roig

Mazarico

Sabrià

et al. 2015

Gynecol Obstet Invest

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Aim: The potential of uterine artery (UA) Doppler pulsatility index (PI) and maternal serum placental growth factor (PlGF) level to predict perinatal outcome was explored in pregnancies complicated by intrauterine fetal growth restriction (IUGR) or preeclampsia (PE). Methods: This longitudinal, prospective, and case-controlled study was conducted over a period of 24 months. At-risk pregnancies involving small-for-gestational-age (SGA) fetuses, IUGR, gestational hypertension (GH), or PE were investigated, analyzing UA Doppler PI findings and maternal PlGF levels determined at the time of diagnosis (third trimester). Results: UA Doppler PI and maternal serum PlGF values differed significantly in pregnancies complicated by IUGR and/or PE (vs. SGA or GH, p < 0.01). In the context of IUGR or PE, both parameters also differed significantly by perinatal outcome (adverse vs. normal, p < 0.01), although no predictive advantage over UA Doppler PI alone was conferred by adding a PlGF assay. Conclusion: UA Doppler PI and maternal serum PlGF determinations in the third trimester help identify pregnancies at the highest risk of adverse perinatal outcomes due to IUGR and/or PE. Although joint testing confers no predictive benefit over UA Doppler PI alone, the two diagnostics are interchangeable for this purpose.

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Fetal and umbilical Doppler ultrasound in high-risk pregnancies

Cited by 190 publications

References 64 publications

A Practical Approach to Fetal Growth Restriction

A Practical Approach to Fetal Growth Restriction

Role of the fetoplacental endothelium in fetal growth restriction with abnormal umbilical artery Doppler velocimetry

Use of Placental Growth Factor and Uterine Artery Doppler Pulsatility Index in Pregnancies Involving Intrauterine Fetal Growth Restriction or Preeclampsia to Predict Perinatal Outcomes

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