Association of Doppler parameters with placental signs of underperfusion in late-onset small-for-gestational-age pregnancies

Parra‐Saavedra, Miguel; Crovetto, F.; Triunfo, Stefania; Savchev, S.; Peguero, Anna; Nadal, Alfons; Gratacós, E.; Figueras, F.

doi:10.1002/uog.13358

Cited by 71 publications

(68 citation statements)

References 56 publications

(61 reference statements)

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“…These cases are explained by a lower degree of placental dysfunction, which is insufficient to severely compromise growth or manifest changes in fetal Doppler [44,45,46]. However, this dysfunction may still be sufficient to generate signs of chronic hypoxia and fetal redistribution, which might lead to increased perinatal morbidity and mortality [47].…”

Section: Discussionmentioning

confidence: 99%

Correlation between Maternal Characteristics during Early Pregnancy, Fetal Growth Rate and Newborn Weight in Healthy Pregnancies

Caradeux

Serra²,

Palmeiro³

et al. 2016

Gynecol Obstet Invest

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Background: The objective of this study was to evaluate the association between maternal characteristics in early pregnancy and fetal growth (FG) and birth weight (BW). Methods: A prospective cohort study was performed in unselected pregnant women who attended an ultrasound evaluation at 11-14 weeks of pregnancy. Medical history, biochemical blood tests, biophysical variables and fetal weight at 20-25 and 30-36 weeks as well as the BW were assessed. Bivariate and multivariate linear models were constructed. Results: In all, 543 patients with normal pregnancy and labor were selected. The multiple regression analysis showed a statistically significant association between maternal body mass index (BMI) in early pregnancy and the uterine artery pulsatility index (UtAPI) in the first trimester with BW (p < 0.0008) and with the ratio of fetal growth between the second and third trimesters (p < 0.0001). No correlation was found between these variables and first trimester levels of hemoglobin or glycemia. Conclusion: Maternal first trimester BMI and UtAPI correlate with the rate of intrauterine FG and with the BW. This evidence highlights the influence of maternal first trimester variables on fetuses with normal growth and the potential role of these variables in fetal programming.

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Section: Discussionmentioning

confidence: 99%

Correlation between Maternal Characteristics during Early Pregnancy, Fetal Growth Rate and Newborn Weight in Healthy Pregnancies

Caradeux

Serra²,

Palmeiro³

et al. 2016

Gynecol Obstet Invest

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“…The UA Doppler failed to identify fetal compromise in a significant number of late SGA fetuses [32]. Additionally, in fetuses with L-IUGR the placental insufficiency seems not to be reflected in UA Doppler [37].…”

Section: L-iugrmentioning

confidence: 85%

“…UA Doppler and the sequence of Doppler modifications in multiple fetal vessels are not reliable for the fetal surveillance [4,37]. Recent papers focus on Doppler markers of cerebral vasodilatation that seems to be a landmark of L-IUGR.…”

Section: L-iugrmentioning

confidence: 99%

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The usefulness of fetal Doppler evaluation in early versus late onset intrauterine growth restriction. Review of the literature.

2016

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Intrauterine growth restriction (IUGR) represents a serious condition that can lead to increased perinatal morbidity, mortality and postnatal impaired neurodevelopment. There are two distinct phenotypes of IUGR: early onset and late onset IUGR with different onset, patterns of evolution and fetal Doppler profile. In early onset preeclampsia the main Doppler modifications are at the level of umbilical artery, with progressive augmentation of the pulsatility index to absent or reverse end diastolic flow. The modifications of the cerebral, cardiac and ductus venosus circulation are generally present, but with different sequences. The late onset IUGR is determined by third trimester placental insufficiency that entails fetal hypoxia. The cerebro-placental ratio (CPR) and the pulsatility index of the middle cerebral artery (PI MCA) seems to be the main markers for both diagnosis and obstetrical management while umbilical Doppler PI is frequently normal. Also the sequence of Doppler alterations is neither specific nor complete. New protocols for the diagnosis and management of late onset IUGR need to be implemented.

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“…Likewise, it would have been interesting to have histological information of the placental tissues. A mounting body of evidence shows that signs of placental underperfusion, both maternal and fetal, are found in most late-onset IUGR and that these signs correlate with prenatal Doppler status [26], and perinatal [27] and long-term neurological [26] outcomes. It has also been reported that such placental signs are associated with an antiangiogenic profile [28].…”

Section: Discussionmentioning

confidence: 99%

Placental 11B-Hydroxysteroid Dehydrogenase Type 2 mRNA Levels in Intrauterine Growth Restriction versus Small-for-Gestational-Age Fetuses

Gómez-Roig¹,

Mazarico²,

Cárdenas³

et al. 2015

Fetal Diagn Ther

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Introduction: The objective of this study was to evaluate placental 11B-hydroxysteroid dehydrogenase type 2 (11B-HSD-2) mRNA levels in intrauterine growth-restricted fetuses (IUGR) as compared with small-for-gestational-age (SGA) fetuses according to clinical criteria. Material and Methods: Placental levels of 11B-HSD-2 mRNA levels were measured in SGA (birth weight <10th centile) and gestational-age-matched, appropriate-for-gestational-age (AGA) births. SGA was classified as IUGR (birth weight <3rd centile or <10th percentile with abnormal uterine artery Doppler or cerebroplacental ratio) or non-IUGR SGA. After RNA extraction, mRNA levels were determined by reverse transcription and quantitative PCR. Results: A total of 38 placentas were analyzed (20 AGA and 18 SGA). Among the SGA pregnancies, 13 qualified as IUGR. The activity of 11B-HSD-2 in IUGR pregnancies [0.105 (SD 0.328)] was significantly reduced compared to non-IUGR SGA [0.304 (SD 0.261); p = 0.018] and AGA [0.294 (SD 0.328); p = 0.001]. These differences remained significant after adjusting for potential confounders (such as smoking or maternal cortisol levels). Activity levels did not significantly differ between non-IUGR SGA and AGA. Discussion: IUGR fetuses had reduced 11B-HSD-2 activity in comparison with SGA and normally grown fetuses. This finding provides opportunities to develop new placental biomarkers for the phenotypic characterization of fetal smallness.

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Association of Doppler parameters with placental signs of underperfusion in late-onset small-for-gestational-age pregnancies

Abstract: Objective To elucidate the association between Doppler parameters and histological signs of placental underperfusion in late-onset small-for-gestational-age (SGA) babies. Methods 1.1-3.7)) and decreased UVBF normalized to estimated fetal weight (P = 0.027; OR 0.97 (95% CI,

Cited by 71 publications

References 56 publications

Correlation between Maternal Characteristics during Early Pregnancy, Fetal Growth Rate and Newborn Weight in Healthy Pregnancies

Correlation between Maternal Characteristics during Early Pregnancy, Fetal Growth Rate and Newborn Weight in Healthy Pregnancies

The usefulness of fetal Doppler evaluation in early versus late onset intrauterine growth restriction. Review of the literature.

Placental 11B-Hydroxysteroid Dehydrogenase Type 2 mRNA Levels in Intrauterine Growth Restriction versus Small-for-Gestational-Age Fetuses

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