Can umbilical artery pulsatility index predict the outcome of fetuses with structural heart disease?

Copel, Joshua A.; Jc, Hobbins; Kleinman, Charles S.

doi:10.7863/jum.1991.10.6.323

Cited by 10 publications

(7 citation statements)

References 3 publications

(3 reference statements)

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“…In a series of 34 fetuses, Al-Gazali et al found that although UA blood flow was abnormal in one-half of fetuses with CHD, there was no correlation between the severity of CHD and the abnormalities of UA waveforms 10 . Copel et al reported similar results for 11 fetuses with CHD, observing an abnormal UA-PI in three cases and no correlation with fetal outcome 11 . In these two series, the relatively high rate of abnormal UA-PI should be interpreted with caution because the abnormal UA-PI was often associated with extracardiac malformations and /or chromosomal abnormalities.…”

Section: Discussionmentioning

confidence: 62%

Middle cerebral artery Doppler in fetuses with transposition of the great arteries

Jouannic

Benachi

Bonnet

et al. 2002

Ultrasound in Obstet & Gyne

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The lower pulsatility indices observed in the middle cerebral artery of fetuses with transposition of the great arteries may reflect a trend towards cerebral vasodilation. This phenomenon could be an indicator of hypoxemia and/or hypercapnia restricted to areas perfused by the preisthmus aorta and be related to the characteristics of the circulation in fetuses with transposition of the great arteries.

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Section: Discussionmentioning

confidence: 62%

Middle cerebral artery Doppler in fetuses with transposition of the great arteries

Jouannic

Benachi

Bonnet

et al. 2002

Ultrasound in Obstet & Gyne

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“…Similarly, fetuses with an insufficient truncal valve had systolic forward flow and significant reversed flow in the descending aorta and the UA. It is important to note that the UA PI cannot be used as a predictor for fetal outcome [10] , which was confirmed by Copel et al [13] , who found that all 3 fetuses with elevated UA PIs included in their study had fatal disease, while 5 of 8 fetuses with fatal anomalies had normal UA PI values.…”

Section: Discussionmentioning

confidence: 67%

“…To date, there have been few studies investigating peripheral blood flow in fetuses with congenital heart defects, and most have aimed to assess the prognostic value of an abnormal UA PI [3,[9][10][11][12][13] . These studies have shown that umbilical arterial blood flow velocity waveforms in fetuses with isolated CHD do not show sufficient alterations to be of diagnostic value [9] .…”

Section: Introductionmentioning

confidence: 99%

Cerebrovascular Blood Flow Dynamic Changes in Fetuses with Congenital Heart Disease

Shaohui

Peng

et al. 2009

Fetal Diagn Ther

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Objective: The aim of this study was to determine whether the type of congenital heart disease (CHD) or heart function influence fetal cerebrovascular blood flow dynamics. Methods: Doppler flow velocimetry was performed in the umbilical artery (UA) and middle cerebral artery (MCA), and the ratio of the UA pulsatility index (PI) to the MCA PI (U/C PI) was determined in 45 fetuses with CHD at 20–40 weeks’ gestational age. The control group consisted of 275 healthy fetuses matched for gestational age. Individual PI measurements were converted into Z-scores for statistical analysis. Results: Fetuses with CHD (n = 45) had an increased UA PI (p = 0.001) and U/C PI (p < 0.001) when compared to controls. There was no significant difference in the MCA PI between fetuses with CHD (n = 45) and controls (n = 275), while fetuses with CHD complicated by congestive heart failure (CHF) (n = 10) had a decreased MCA PI (p < 0.001) compared to controls. Conclusions: The lower PIs observed in the MCA of fetuses with CHD complicated by CHF represents a marker of cerebral vasodilation that is due to cerebral hypoxemia and limiting perfusion. The heart function and type of CHD have an impact on fetal cerebrovascular blood flow distribution and this may contribute to the cause of abnormal neurologic development in these fetuses.

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“…The value of umbilical artery and fetal arterial Doppler ultrasound for the diagnosis of CHD remains controversial. Recent studies of umbilical artery Doppler have not shown any predictive value for the outcome of fetuses with CHD [2,3] , whereas Al-Gazali et al [4] reported an association with intrauterine death and absent end-diastolic fl ow, but there was no correlation between the type of CHD and the Doppler fi ndings. Furthermore, Doppler of the middle cerebral artery did not show suffi cient alterations to be of diagnostic value in cases with isolated CHD [3] .…”

Section: Introductionmentioning

confidence: 82%

Ductus venosus Blood Flow Velocity Waveforms as a Predictor for Fetal Outcome in Isolated Congenital Heart Disease

et al. 2005

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Objective: To investigate whether pulsatility of ductus venosus (DV) flow velocity waveforms is of diagnostic value in predicting survival in fetuses with congenital heart disease (CHD). Methods: In a cross-sectional study, Doppler investigation of DV and umbilical artery blood flow was performed in 58 fetuses with isolated structural CHD, without other sonographically detectable structural or chromosomal abnormalities or tachyarrhythmia. The pulsatility index for veins of DV (DV-PIV) waveforms was expressed as multiples of the 95th centile (Mo95th) of the reference ranges for gestational age. The PIV was related to intrauterine and neonatal mortality within the first 6 months of life. Terminations of pregnancies and neonates with additional abnormalities detected after birth were excluded from statistical analysis. For statistical analysis, the different types of heart defects were separated into atrial and/or ventricular (AV) septal defects, right or left ventricular in- and outflow tract abnormalities and others. Results: After exclusion of 9 pregnancies (2 cases with failure of measurements of DV-PIV, 2 neonates with additional malformations, and 5 terminations of pregnancies), 49 cases were available for statistical analysis. The umbilical artery pulsatility index was within normal ranges in all but 1 case with AV canal and hydrops. In 7 pregnancies intrauterine fetal deaths occurred and 6 of them were hydropic. The median gestational age at birth for liveborn neonates was 39.0 weeks (range 27.8–41). There were 6 postnatal deaths, all but 1 within 28 days of delivery. The remaining fetuses survived for at least 6 months. The overall mortality rate was 27% (13/49). The DV-PIV was significantly higher in non-survivors than in survivors (median of Mo95th and interquartile ranges 1.48 (1.04–1.95) vs. 0.81 (0.70–1.15); p = 0.01). Analysis of subgroups showed significant differences for AV septal defects and abnormalities affecting predominantly the right ventricle (p = 0.046 and 0.043, respectively). Ten out of 13 non-survivors showed an abnormal DV-PIV (sensitivity 77%) as compared to 12 out of 36 survivors (specificity 67%). All hydropic fetuses (n = 6) showed an abnormal DV-PIV and ended in intrauterine deaths. Conclusions: Evaluation of the DV pulsatility is a useful additional variable for predicting the risk for mortality in fetuses with isolated structural CHD, in particular in fetuses with defects of the AV septum and with defects affecting predominantly right ventricular function. As there is no fetal hydrops without abnormal DV, this is another sign for the association of DV and cardiac failure.

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Can umbilical artery pulsatility index predict the outcome of fetuses with structural heart disease?

Cited by 10 publications

References 3 publications

Middle cerebral artery Doppler in fetuses with transposition of the great arteries

Middle cerebral artery Doppler in fetuses with transposition of the great arteries

Cerebrovascular Blood Flow Dynamic Changes in Fetuses with Congenital Heart Disease

Ductus venosus Blood Flow Velocity Waveforms as a Predictor for Fetal Outcome in Isolated Congenital Heart Disease

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