Assessment of ultrasound and Doppler parameters in the third trimester of pregnancy as predictors of adverse perinatal outcome in unselected pregnancies

Peixoto, Alberto Borges; Caldas, Taciana Mara Rodrigues da Cunha; Silva, Tácito Augusto Godoy; Caetano, Mário Sérgio Silva Gomes; Martins, W.P.; Santana, Eduardo Felix Martins; Júnior, Edward Araujo

doi:10.5603/gp.2016.0035

Cited by 6 publications

(3 citation statements)

References 26 publications

(40 reference statements)

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“…Yet, a major weakness of their study is a relatively small group of only 24 patients that were enrolled to the cohort. Recent studies, in contrast, investigate the power of Doppler parameters in predicting adverse perinatal outcomes using non-selected groups of patients, where the included complications, like small gestational age (SGA), fetal growth restriction (FGR), gestational hypertension or gestational diabetes mellitus, could influence significantly the results (2,9,12,14,16,18,(21)(22)(23) . In our study, we found no significant correlation of Doppler parameters with Apgar score < 7 at 1 min.…”

Section: Discussionmentioning

confidence: 99%

Utility of Doppler parameters at 36–42 weeks’ gestation in the prediction of adverse perinatal outcomes in appropriate-for-gestational-age fetuses

Migda¹,

Gieryn²,

Migda³

2018

J Ultrason

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AimTo investigate the potential value of Doppler ultrasound and to assess cerebroplacental ratio (CPR) in the prediction of adverse perinatal outcome defined as Apgar score < 7 at 1 minute.Material and methodsThis was a retrospective cross-sectional study in selected pregnant women undergoing an ultrasound examination between 36 and 42 weeks of gestation. We measured estimated fetal weight (EFW), mean umbilical artery pulsatility index (UA PI), mean middle cerebral artery pulsatility index (MCA PI), CPR, and Apgar score in 1 minute. Multiples of medians (MoM) were calculated for MCA PI and UA PI.ResultsThe study group consisted of 446 women, 236 were primipara and 210 were multipara. The average age was 29.6 years (range 16–46 years). The average week of delivery is 39.5 weeks of gestation (range 36–42). Mean MCA PI and UA PI were 1.3 (0.1–2.45) and 0.8 (0.39–1.66), respectively. The mean values were 1.03 (0.1–1.9) for MCA PI MoM and 1.04 (0.5–2.1) for UA PI MoM. Primiparas had lower values of MCA PI (1.27 vs. 1.34), MCA PI MoM (1.00 vs. 1.05), CPR (1.62 vs. 1.73), EFW (3479.53 g vs. 3579.25 g) and birth weight (3513.50 g vs. 3617.79 g). For CPR cut-off point of 1.08: sensitivity was (0.945), specificity 0.1, positive predictive values 0.979, negative predictive values 0.04 and accuracy 0.926. The ROC curves for CPR were: area under the curve was 0.52 at CI 95% (0.342–0.698), p = 0.8271.ConclusionScreening in pregnancies with appropriate-for-gestational-age fetuses at 36–42 weeks of gestation using Doppler parameters is not useful in the prediction of adverse perinatal outcomes like an Apgar score < 7 at 1 minute.

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Section: Discussionmentioning

confidence: 99%

Utility of Doppler parameters at 36–42 weeks’ gestation in the prediction of adverse perinatal outcomes in appropriate-for-gestational-age fetuses

Migda¹,

Gieryn²,

Migda³

2018

J Ultrason

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“…First, we examined a select group of fetuses with suspected CoA, referred to two tertiary centers for fetal echocardiographic studies. While national obstetrics screening protocols often suggest that first-and second-trimester ultrasound examinations are offered to all pregnant women, it may be advantageous to perform third-trimester screening to examine the heart for late-onset cardiac malformations such as CoA, as well as abnormal fetal growth [35][36][37][38][39][40] . Second, the coefficients from the logistic regression equation were derived from measurements of the 4CV and speckle-tracking analysis of the ventricles using the protocol described herein and, until recently, the software for computing the Z-scores used in this study was under experimental protocol and not commercially available.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Improved detection of coarctation of the aorta using speckle‐tracking analysis of fetal heart on last examination prior to delivery

DeVore

Haxel

Satou

et al. 2021

Ultrasound in Obstet & Gyne

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Objective The false‐positive rate for prenatal diagnosis of coarctation of the aorta (FP‐CoA) commonly exceeds 50%, with an accurate detection rate of < 50%. This study was conducted to determine if the sensitivity for prenatal detection of true CoA and the FP‐CoA rate could be improved by evaluating the fetal epicardial size and shape in the four‐chamber view (4CV) and the endocardial right (RV) and left (LV) ventricular size, shape and contractility. Methods We analyzed retrospectively Digital Imaging and Communications in Medicine (DICOM) clips of the 4CV from the last examination prior to delivery in a series of 108 fetuses with CoA suspected prenatally by pediatric cardiologists using traditional diagnostic criteria. Postnatal evaluation distinguished those fetuses which subsequently required CoA surgery (true positives; true CoA) from those that were FP‐CoA. Postnatal cardiac abnormalities were identified for each group. For the prenatal evaluation, we measured the 4CV end‐diastolic epicardial area, circumference, length, width and global sphericity index. Speckle‐tracking analysis was used to compute the endocardial RV and LV end‐diastolic area, length, 24‐segment sphericity index, 24‐segment transverse width and the following functional parameters: fractional area change; global longitudinal, free‐wall and septal‐wall strain; basal–apical‐length, basal free‐wall and basal septal‐wall fractional shortening; septal‐wall annular plane systolic excursion; 24‐segment transverse‐width fractional shortening; and LV end‐diastolic and end‐systolic volumes, stroke volume, cardiac output and ejection fraction. In addition, the RV/LV end‐diastolic area ratio was computed. Using a control group of 200 normal fetuses, the mean and SD for each of the above cardiac measurements was used to compute the Z‐scores for each measurement in each of the 108 study fetuses. Logistic regression analysis was then performed on the Z‐score values to identify variables that separated the true CoA group from the FP‐CoA group. RESULTS Of the 108 study fetuses, 54 were confirmed postnatally to have true CoA and 54 were FP‐CoA. Right/left area disproportion > 90th centile was present in 80% (n = 43) of the true‐CoA fetuses and 76% (n = 41) of the FP‐CoA fetuses. Fetuses with true CoA had a significantly greater number of associated cardiac abnormalities (93%, n = 50) compared with the FP‐CoA fetuses (61%, n = 33) (P < 0.001). The most common associated malformations were bicuspid aortic valve (true CoA, 46% (n = 25) vs FP‐CoA, 22% (n = 12); P < 0.01), aortic arch hypoplasia (true CoA, 31% (n = 17) vs FP‐CoA, 11% (n = 6); P < 0.01), ventricular septal defect (true CoA, 33% (n = 18) vs FP‐CoA, 11% (n = 6); P < 0.05) and mitral valve abnormality (true CoA, 30% (n = 16) vs FP‐CoA, 4% (n = 2); P < 0.01). Logistic regression analysis identified 28 variables that correctly identified 96% (52/54) of the fetuses with true CoA, with a false‐positive rate of 4% (2/54) and a false‐negative rate of 4% (2/54). These variables included the epic...

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“…Intrauterine growth restriction (IUGR) is an important clinical problem, being the most important cause of perinatal morbidity and mortality [6] . Abnormal Doppler findings in the third trimester are usually associated with adverse perinatal outcome [7,8] .…”

Section: Introduction the Introduction Of Colour Doppler Velocimetry To Obstetrics Offers A Non Invasive Methods Formentioning

confidence: 99%

Doppler Ultrasonography of Foetal Middle Cerebral and Umbilical Arteries in High Risk Pregnancy

El-Sayed¹,

Habib

Menisy

2018

The Medical Journal of Cairo University

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Background: Foetal hypoxemia is associated with increased impedance to flow in the umbilical artery (UA) and decreased impedance in the fetal middle cerebral artery (MCA). Aim of Study:To evaluate Doppler of foetal Middle cerebral (MCA) and Umbilical (UMA) arteries in high risk pregnancies.Patients and Methods: This prospective cross-sectional study was carried on 100 patients at Menoufia university hospital in the period from March 2017 to Febraury 2018 using a 2-5MHz transabdominal probe (GE LOGIC p5 and GE LOGIC p7). The study including two groups, group (A) High risk group: Including 50 patients with pregnancy above 27 weeks presenting with high risk pregnancy, and group (B) control group: Including 50 patients with normal pregnancy above 27 weeks, Doppler examination for both MCA and UMA was done.Results: Out of the fifty pregnant women in Group A, there were 18 cases with abnormal UMA Doppler, 14 cases with abnormal MCA Doppler indices and 10 cases with abnormal cerbroplacental (CPR ). For estimating the association between high risk pregnancy and resistive index ( RI ) and pulsatility index (PI) of both UMA and MCA for predicting foetal outcome, RI of UMA showed sensitivity and specificity of 70% and 60% and accuracy of 63% and MCA RI showed sensitivity of 74%, specificity of 48% and accuracy of 61%. Conclusion:Doppler ultrasonography of foetal middle cerebral and umbilical arteries plays important role in high risk pregnancies and predicting foetal outcome.

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Assessment of ultrasound and Doppler parameters in the third trimester of pregnancy as predictors of adverse perinatal outcome in unselected pregnancies

Cited by 6 publications

References 26 publications

Utility of Doppler parameters at 36–42 weeks’ gestation in the prediction of adverse perinatal outcomes in appropriate-for-gestational-age fetuses

Utility of Doppler parameters at 36–42 weeks’ gestation in the prediction of adverse perinatal outcomes in appropriate-for-gestational-age fetuses

Improved detection of coarctation of the aorta using speckle‐tracking analysis of fetal heart on last examination prior to delivery

Doppler Ultrasonography of Foetal Middle Cerebral and Umbilical Arteries in High Risk Pregnancy

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