Clinical significance of absent or reversed end diastolic velocity waveforms in umbilical artery

Karsdorp, V. H. M.; Vugt, J.M.G. van; Geijn, H.P. van; Kostense, P.J.; Arduim, D; Montenegro, Nuno; Todros, Tullia

doi:10.1016/s0140-6736(94)90457-x

Cited by 419 publications

(225 citation statements)

References 25 publications

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“…Perinatal mortality rates in studies analyzing pregnancies complicated by AEDF or REDF are extremely high, ranging from 50% to 75%. 1,2 In addition, the diagnosis of AEDF or REDF before 30 weeks' gestation is associated with a higher perinatal mortality rate than when diagnosed later and has a worse prognosis. Poor outcome in these pregnancies is often related to associated findings such as severe growth restriction, extreme prematurity, congenital abnormalities, or hypertension/preeclampsia.…”

Section: Discussionmentioning

confidence: 99%

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Prolonged Intermittent Reversed End-Diastolic Flow in a Monochorionic Twin Pregnancy Associated with Twin-to-Twin Transfusion Syndrome and Absence of Hyrtl’s Anastomosis

1999

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A 26-week twin pregnancy was diagnosed with twin-to-twin transfusion syndrome. The donor twin had reversed end-diastolic flow (REDF) on cord umbilical Doppler examination. This finding persisted for 2 weeks, with occasional Doppler findings of absent, as well as reversed, end-diastolic flow. Delivery was precipitated by the absence of growth in the donor twin and the deteriorating condition of the recipient twin. Pathologic examination of the placenta after delivery disclosed an unbalanced vascular communication between the twins and absence of Hyrtl's anastomosis in the umbilical cord of the donor twin.We postulate that the absence of Hyrtl's anastomosis effectively isolated the circulations of the two umbilical arteries, allowing REDF, a finding usually associated with imminent demise, to persist for 2 weeks without evidence of fetal distress.REDF is generally thought to be an immediate precursor of fetal demise, indicating extreme increased placental resistance. We report a case of REDF that persisted for a period of 2 weeks before delivery of a twin infant with intrauterine growth restriction, twinto-twin transfusion syndrome, and an absent Hyrtl's anastomosis at the insertion of the umbilical cord of the donor twin. Hyrtl's anastomosis is the normally occurring artery-to-artery shunt present at the placental cord insertion that equalizes the pressures within the cotelydonary systems fed by the two umbilical arteries. CASE REPORTMs. YC was a 16-year-old, gravida 1, para 0, receiving prenatal care for a twin pregnancy in Mexico until 26 weeks. She was referred for an ultrasound examination on transferring care to a local clinic at 26 weeks, at which time she had a 30-week symphysis-fundal height. The ultrasound examination revealed that Twin B had an average ultrasound age of 26 weeks and 6 Ϯ 14 days, and an estimated fetal weight of 1023 Ϯ 137 gm. Twin A was found to have a head circumference equivalent to 23 weeks and 1 day and an abdominal circumference equivalent to 20 weeks and 2 days, with an average ultrasound age of 22 weeks and 1 Ϯ 14 days and an estimated fetal weight of 419 Ϯ 56 gm. Both twins appeared anatomically normal. Severe oligohydramnios was noted around twin A, but the amniotic fluid volume was normal surrounding twin B. In addition, twin B had a pericardial effusion with the right atrium bigger than the left. There was a central cord insertion for twin B and a marginal cord insertion for twin A. Cord umbilical Doppler showed a systolic/diastolic flow ratio of 3.0 for twin B and REDF in twin A. A diagnosis of possible twin-to-twin transfusion syndrome was made, with twin A assumed to be the donor and twin B the recipient.The patient was admitted to hospital, betamethasone was given, and monitoring commenced. No abnormalities were noted on nonstress testing of both twins, and the patient was therefore managed expectantly. Biophysical profiles performed the next day were 8/8 for twin B and 6/8 for twin A (Ϫ2 for fluid). Later that day, twin A was re-evaluated by Doppler and no REDF was noted...

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Section: Discussionmentioning

confidence: 99%

“…His head circumference was 27 cm. The cord gases for twin B were as follows: Artery-pH 7.24; PCO 2 , 67.0; PO 2 Clinical Perinatal/Neonatal Case Presentation…”

Section: Case Reportmentioning

confidence: 99%

Prolonged Intermittent Reversed End-Diastolic Flow in a Monochorionic Twin Pregnancy Associated with Twin-to-Twin Transfusion Syndrome and Absence of Hyrtl’s Anastomosis

1999

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“…Nas pacientes que apresentam gravidez de alto risco, a incidência de DZ ou DR varia entre 1 e 34% 19 , em estudo multicêntrico envol- foram os primeiros a ressaltar a gravidade da DR na artéria umbilical. Do mesmo modo, observamos uma elevada mortalidade nos casos de diástole reversa da artéria umbilical.…”

Section: Discussionunclassified

Fatores Prognósticos para o Óbito Perinatal em Gestações com Diástole Zero ou Reversa na Dopplervelocimetria das Artérias Umbilicais

Yamamoto¹,

Francisco²,

Miyadahira³

et al. 2000

Rev. Bras. Ginecol. Obstet.

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IntroduçãoO fluxo sangüíneo nos vasos do cordão umbilical (artérias e veia umbilicais) depende diretamente do débito cardíaco fetal e da resistên-cia ou complacência placentária. Do total de fluxo que flui pela aorta fetal, 50 a 60% é destinado para as artérias umbilicais que, na continuidade, participam do sistema viloso terciário que constitui uma extensa rede terminal vascular de baixa resistência, local de processamento das trocas entre mãe e feto. A diástole zero (DZ) e a diástole reversa (DR) correspondem às alterações de maior gravidade observadas na dopplervelocimetria das artérias umbilicais. Apontam intenso comprometimento da função placentária que acompanha freqüentemente quadros clínicos maternos muito graves. O aumento da resistên-cia vascular placentária, secundária ao desenvolvimento inadequado do sistema viloso terciá-rio, e a obliteração ou redução do número das pequenas arteríolas são os fatores determinantes da redução do fluxo diastólico final da artéria umbilical 1,2 . Para que ocorra a placentação normal, fenômenos vasculares obrigatórios e importantes (invasão trofoblástica) devem ocorrer ao nível das artérias espiraladas, as responsáveis pela perfusão do espaço interviloso (EIV) 3 . Fisiologica-

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“…A continuous decline in umbilical artery resistance over gestation closely correlates with normal birth weight, low risk of fetal distress, neonatal complications, and longer term manifestations of placental deficiency. 71 Conversely, rising resistance and severity of changes in Doppler velocimetry, with progression to the loss and eventually the reversal of end-diastolic flow, significantly correlates with worse perinatal outcome 72 (Fig. 13).…”

Section: Uterine and Umbilical Blood Flow Profilesmentioning

confidence: 99%

Evaluation of Fetal Growth and Fetal Well-Being

Cetin

Boito

Radaelli

2008

Seminars in Ultrasound, CT and MRI

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Clinical significance of absent or reversed end diastolic velocity waveforms in umbilical artery

Cited by 419 publications

References 25 publications

Prolonged Intermittent Reversed End-Diastolic Flow in a Monochorionic Twin Pregnancy Associated with Twin-to-Twin Transfusion Syndrome and Absence of Hyrtl’s Anastomosis

Prolonged Intermittent Reversed End-Diastolic Flow in a Monochorionic Twin Pregnancy Associated with Twin-to-Twin Transfusion Syndrome and Absence of Hyrtl’s Anastomosis

Fatores Prognósticos para o Óbito Perinatal em Gestações com Diástole Zero ou Reversa na Dopplervelocimetria das Artérias Umbilicais

Evaluation of Fetal Growth and Fetal Well-Being

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