Aortic isthmus Doppler in normal and small‐for‐gestational‐age fetuses and its association with prediction of adverse perinatal outcome

Abstract

Objective To establish reference ranges for aortic isthmus Doppler indices in appropriate‐for‐gestational‐age (AGA) fetusesand to evaluate its association with perinatal outcome in small‐for‐gestational‐age (SGA) fetuses. Methods Prospective cohort observational study in which 30 pregnant women with SGA fetuses and 60 women with AGA fetuses were recruited from the prenatal clinic of the hospital. The AGA group was eventually followed from 24 weeks by 4‐weekly Doppler assessment, and the SGA group was examined as per institutional protocol. We analyzed the data using STATA version 14.0 statistical software. Continuous variables were examined for normality assumption using the Kolmogorov‐Smirnov test. To develop a nomogram for appropriate gestational age, we adopted a mixed linear model analysis. For each of the variables Ao pulsatility index (PI), Ao peak systolic velocity (PSV), Ao systolic nadir (Ns), and Ao isthmic systolic index (ISI) mean predicted values, 3rd centile and 97th centile were calculated based on the parameter estimation of mixed model. Observed data for each of the variables in the SGA group were plotted in the nomogram developed for the AGA group to show the trend of SGA data in comparison to AGA data. Results The total number of observations made on 60 AGA and 30 SGA fetuses were 240 and 67, respectively. Nomograms for the 3rd and 97th centiles were derived for Ao PI, Ao PSV, Ao Ns, and Ao ISI. Mean Ao PI values were significantly higher in SGA group (2.37 vs 2.22; P < .05); mean Ao PSV was significantly lower in the SGA group (67.1 vs 76.3; P < .05), but mean Ao Ns and mean Ao ISI values were significantly higher in the SGA group (–5.24 vs 2.0 and –0.04 vs –0.01; P < .05). Conclusions Aortic Doppler assessment seems to provide beneficial information for monitoring small fetuses. Ao PI and Ao ISI, which were raised in fetuses with SGA, can be used in prognosis.

Evaluation of Foetal Doppler After Maternal Covid-19 Disease: How Does Foetal Aortic Isthmus Doppler Change?

“…Sharma et al evaluated 30 pregnant women with small for gestational age (SGA) foetuses and found the AoI PI values to be significantly higher in the SGA group than in the control group. They observed that AoI assessment seems to provide beneficial information for monitoring small foetuses (24). There are studies in which the sensitivity and clinical benefit of AoI Doppler PI values in FGR could not be found, especially for late-onset FGR (25,26).…”

Retrograde flow in aortic isthmus in normal and fetal heart disease by principal component analysis and computational fluid dynamics

“…The left ventricle (LV) perfuses the coronary and brachiocephalic circulations, while the right ventricle (RV) the subdiaphragmatic circulation and placenta 3,4 . Retrograde flow (RF) may occur in the aortic isthmus (AI), the segment between the left subclavian artery and the ductus arteriosus (DA) insertion in the descending aorta 5–10 in fetuses with intra‐uterine growth restriction (IUGR), small for gestational age (SGA), 10–27 and some congenital heart disease (CHD), 28–30 such as transposition of great artery (TGA). However, RF in various fetal heart disease (FHD), including abnormalities in heart structure and function, and its association with flow variables has not been systematically studied 8,21 …”