Absent or reversed end diastolic flow velocity in the umbilical artery and necrotising enterocolitis.

Malcolm, Girvan; Ellwood, David; Devonald, Katherine J.; Beilby, Ruth; Dj, Henderson-Smart

doi:10.1136/adc.66.7_spec_no.805

Cited by 119 publications

(80 citation statements)

References 8 publications

(2 reference statements)

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“…It is known that fetuses of high risk pregnancies with AREDFV have an increased risk of intrauterine or early neonatal death compared to fetuses with forward end diastolic flow velocity (FEDFV) in the cord umbilical artery or aorta. [1][2][3] They are more likely to be born preterm, 3 4 and small for gestational age (SGA). 5 6 Associations have been reported between AREDFV and fetal hypoxia and acidosis, 7 neonatal acidosis, [8][9][10][11] cerebral haemorrhage, 3 12-14 hypotension, 3 respiratory distress syndrome, 9 bronchopulmonary dysplasia, 13 necrotising enterocolitis, 1 13 14 and prolonged hospitalisation.…”

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confidence: 99%

Outcome at school age following antenatal detection of absent or reversed end diastolic flow velocity in the umbilical artery

Schreuder

McDonnell²,

Gaffney³

et al. 2002

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Aim: To determine whether fetal compromise, manifested by abnormalities of Doppler recordings of umbilical artery velocity waveforms in utero, is associated with neurodevelopmental or educational abnormalities at school age. Methods: A cohort of neonates born following high risk pregnancies had been previously identified for a study of the perinatal sequelae of absent (AEDFV) and reversed (REDFV) end diastolic flow velocities. Seventy six children were assessed at 5-12 years of age by a developmental paediatrician who was blinded to perinatal course and Doppler assessments. Forty children born following pregnancies with forward end diastolic flow velocities (FEDFV), were compared with 27 with AEDFV and nine with REDFV. Tests of cognitive, neurological, and sensory function were performed, and reports of behavioural and educational progress were obtained from parents and teachers. Results: There were no significant differences between FEDFV and AEDFV groups, but on tests of mental ability and neuromotor function the REDFV group had worse scores than either FEDFV or AEDFV. Comparing REDFV and FEDFV groups, the British Ability Scales general conceptual ability mean scores were 87.7 versus 101, and the Quick Neurological Screening Test mean scores were 32.8 versus 21.5. Conclusions: Absence of EDFV is well recognised as a marker of fetal compromise which is associated with acute perinatal sequelae. This study suggests it is not associated with adverse neurodevelopmental outcome. However, we found reversal of EDFV on antenatal assessment to be associated with a wide range of problems at school age, suggesting that REDFV represents intrauterine decompensation which may have adverse effects on the developing brain.

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mentioning

confidence: 99%

Outcome at school age following antenatal detection of absent or reversed end diastolic flow velocity in the umbilical artery

Schreuder

McDonnell²,

Gaffney³

et al. 2002

Archives of Disease in Childhood - Fetal and Neonatal Edition

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“…Identified risk factors include birth asphyxia,l-4 chronic intrauterine hypoxia,5 6 apnoea,2 4 It is widely believed that intestinal ischaemia is the unifying mechanism that explains the ability of these many different factors to injure the neonatal bowel. Risk factors might cause ischaemia directly or as a consequence of the 'diving reflex' when blood flow is diverted from the abdominal organs during hypoxia, thus preserving cerebral oxygenation.…”

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Superior mesenteric artery blood flow velocity in necrotising enterocolitis.

Kempley

Gamsu

1992

Archives of Disease in Childhood

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Doppler measurements of blood flow velocity were obtained from the superior mesenteric artery (SMA), coeliac axis, and anterior cerebral artery (ACA) of 19 infants with suspected necrotising enterocolitis, which was classified as confirmed (n=9) or unconfirmed (n=8). Infants with confirmed disease were compared with controls who were either enterally fed or who were receiving intravenous fluids.SMA velocity was significantly higher in the infants with confirmed necrotising enterocolitis (36.5 cm/s) than in unfed controls (20.4 cm/s) or infants with unconfirmed enterocolitis (19.6 cm/s).Three infants with confirmed disease had data from before the onset of symptoms. One had low SMA velocity on the first day of life, and one showed no increase in SMA velocity after enteral feeds were started.SMA velocity is increased when infants develop symptoms of necrotising enterocolitis, suggesting that total gut ischaemia is not present at the time that the disease is clinically apparent, although it may precede the onset of symptoms and play a part in the pathogenesis of the disorder.

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“…As síndromes hipertensivas comparecem com maior freqüência como doença materna participante da etiologia da insuficiência placentária grave resultando em DZ ou DR 26 também referiram as colagenoses como a segunda doença materna mais freqüente, aparecendo em 12% dos seus casos.…”

Section: Intercorrências Clínicas Associadas à Dz E Dr Hipertensãounclassified

Diástole zero ou reversa à dopplervelocimetria das artérias umbilicais

Francisco

Nomura

Miyadahira

et al. 2001

Rev. Assoc. Med. Bras.

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INTRODUÇÃOAntes do advento da técnica dopplervelocimétrica, o diagnóstico dos transtornos da placentação baseava-se nas suas conseqüências, ou seja, nas ocorrências de crescimento inadequado do feto ou de distúrbios de sua oxigenação caracterizados pelo sofrimento fetal. Mudanças radicais tiveram lugar quando pioneiramente, em 1977, Fitzgerald; Drumm 1 , combinando a técnica da ultra-sonografia com o dispositivo de doppler contínuo, desenvolveram um novo método que possibilitava o estudo do fluxo sangüíneo nas artérias e na veia umbilicais, de forma não-invasiva e segura. Subseqüentemente, muitas pesquisas foram levadas a cabo demonstrando que a dopplervelocimetria das artérias uterinas e umbilicais é muito útil no diagnóstico da insuficiên-cia placentária identificando as gestações nas quais os fetos são submetidos a elevado risco de hipoxemia. Vislumbrava-se assim o uso desta nova técnica na avaliação qualita-UNITERMOS: Diástole zero. Diástole reversa. Dopplervelocimetria. Artérias umbilicais. Ultra-sonografia.KEYWORDS: Absent end-diastolic velocity waveform. Reversed end-diastolic velocity waveform. Dopplervelocimetry. Umbilical arteries. Ultrasonography.tiva da placenta precedendo os distúrbios no compartimento fetal.Em face às possibilidades de se atestar em humanos o que já se sabia há muito tempo em animais por meio de experimentos laboratoriais, a dopplervelocimetria, uma técnica ainda inusitada e tida como promissora, mobilizou inúmeros pesquisadores que se dedicaram aos seus estudos experimentais em laboratórios com modelos animais e clínicos, desvendando todos os detalhes que se têm conhecimento atualmente. Por razões exclusivamente técnicas, os métodos qualitativos sobrepujaram os quantitativos prevalecendo na abordagem do produto conceptual, feto e placenta.Como forma de interpretação dos sonogramas, à par dos índices criados, levando-se em conta a velocidade máxima sistólica, a velocidade mínima no final da diástole e a velocidade média em todo o ciclo cardíaco, desde logo, as formas da onda também chamaram a atenção de muitos pesquisadores. Desta maneira, em pouco tempo verificou-se que a ausência de fluxo na diástole (DZ) e, notadamente, o fluxo reverso (DR) são alterações doppler- . Em virtude disso, a identificação destes casos possibilita melhor vigilância pela instituição de cuidados diferenciados por meio de propedêu-tica ampla e completa, objetivando a diminuição dos riscos de comprometimento perinatal mais grave 4,5 . Embora se constatem, na literatura compulsada, numerosos trabalhos a respeito dessas alterações placentárias graves, muitas lacunas permanecem a desafiar o tirocínio do obstetra tanto em sua atuação assistencial como na qualidade de pesquisador no que concerne à resolução obstétri-ca, já que muitas novidades na área propedêutica foram inseridas no contexto da avaliação global dos fetos submetidos às restrições ao seu desenvolvimento como sói ocorrer nestes casos. CONCEITOA DZ e a DR caracterizam insuficiência placentária gravíssima.Diástole Zero (DZ): sonogramas de ar-

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Absent or reversed end diastolic flow velocity in the umbilical artery and necrotising enterocolitis.

Cited by 119 publications

References 8 publications

Outcome at school age following antenatal detection of absent or reversed end diastolic flow velocity in the umbilical artery

Outcome at school age following antenatal detection of absent or reversed end diastolic flow velocity in the umbilical artery

Superior mesenteric artery blood flow velocity in necrotising enterocolitis.

Diástole zero ou reversa à dopplervelocimetria das artérias umbilicais

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