Ductus venosus Doppler and postnatal outcomes in fetuses with absent or reversed end-diastolic flow in the umbilical arteries

Alves, Sâmia K.A.; Francisco, Rossana Pulcineli Vieira; Miyadahira, Seizo; Krebs, Vera Lúcia Jornada; Vaz, Flávio A. C.; Zugaib, Marcelo

doi:10.1016/j.ejogrb.2008.07.014

Cited by 12 publications

(14 citation statements)

References 30 publications

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“…Perinatal mortality was defined as stillbirth or death within 28 days of life. This may lead to some discrepancies with other studies reporting neonatal mortality or intact survival as an outcome, and which exclude prenatal death [5,9,10]. Doppler values were assessed against normal reference curves and they were measured by experienced examiners.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiovascular Doppler indices have long been demonstrated to have an association with the risk of perinatal death [6,8,9]. Among these, the ductus venosus (DV) has demonstrated the strongest short-term correlation with perinatal death, as suggested by diverse studies [2,6,8,9,10,11] and endorsed by a recent systematic review [7]. In addition, the DV was the best predictor of intact survival in a large cohort of IUGR fetuses delivered beyond 29 weeks of gestation [5].…”

Section: Introductionmentioning

confidence: 99%

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Risk of Perinatal Death in Early-Onset Intrauterine Growth Restriction according to Gestational Age and Cardiovascular Doppler Indices: A Multicenter Study

et al. 2012

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Objective: To assess the value of gestational age and cardiovascular Doppler indices in predicting perinatal mortality in a multicenter cohort of early-onset intrauterine growth-restricted (IUGR) fetuses. Methods: A multicenter prospective cohort study including 157 early-onset (<34 weeks) IUGR cases with abnormal umbilical artery (UA) Doppler was conducted. Cardiovascular assessment included the ductus venosus (DV), the aortic isthmus flow index (IFI), and the myocardial performance index (MPI). Isolated and combined values to predict the risk of perinatal death were evaluated by logistic regression and by decision tree analysis, where the gestational age at delivery, UA, and middle cerebral artery (MCA) were also included as covariates. Results: Perinatal mortality was 17% (27/157). All parameters were significantly associated with perinatal death, with individual odds ratios (OR) of 25.2 for gestational age below 28 weeks, 12.1 for absent/reversed DV atrial flow, 5.3 for MCA pulsatility index <5th centile, 4.6 for UA absent/reversed diastolic end-flow, 1.8 for IFI <5th centile, and 1.6 for MPI >95th centile. Decision tree analysis identified gestational age at birth as the best predictor of death (<26 weeks, 93% mortality; 26–28 weeks, 29% mortality, and >28 weeks, 3% mortality). Between 26 and 28 weeks, DV atrial flow allowed further stratification between high (60%) and low risk (18%) of mortality. Conclusions: Gestational age largely determines the risk of perinatal mortality in early-onset IUGR before 26 weeks and later than 28 weeks of gestation. The DV may improve clinical management by stratifying the probability of death between 26 and 28 weeks of gestation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk of Perinatal Death in Early-Onset Intrauterine Growth Restriction according to Gestational Age and Cardiovascular Doppler Indices: A Multicenter Study

et al. 2012

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“…There was variability in the definition of some of the outcome measures. For ICH, three studies of FGR 2–4 defined it as any of Papile’s grades of ICH, one 5 defined it as Papile’s grades 3 and 4, one 6 defined it according to the criteria of the Vermont Oxford Network Database, and the remaining eight 7–13,28 failed to define the criteria. Of studies of normally grown fetuses, five 2,14–17 defined it as any of Papile’s grades of ICH, seven 18–24 defined it as Papile’s grades 3 and 4, one 6 used the criteria of the Vermont Oxford Network Database, while the remaining three 25–27 did not define any criteria.…”

Section: Methodsmentioning

confidence: 99%

“…For sepsis, one study of FGR 9 defined it as the presence of a positive blood culture, one 12 as the presence of sepsis (precise definition unclear), two 3,4 as the presence of septicaemia, and one 10 failed to define the criteria used. For studies with normally grown fetuses, two 18,26 defined it as the presence of a positive blood culture, one 17 by the presence of septicaemia, pneumonia or meningitis, one 23 by clinical suspicion alone, and one 15 as the presence of a positive blood culture or abnormal white cell differential.…”

Section: Methodsmentioning

confidence: 99%

Early adverse perinatal complications in preterm growth-restricted fetuses

Damodaram

Story

Kulinskaya

et al. 2011

Australian and New Zealand Journal of Obstetrics and Gynaecology

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“…The use of Doppler Velocimetry have permit to evaluate the placental-fetal circulation and to assess the level of fetal oxygenation [3]. In particular pregnancies with absent or reverse end-diastolic flow have been associated with high perinatal mortality rates [4].…”

Section: Introductionmentioning

confidence: 99%

Multiparameter analysis of heart rate variability signal for the investigation of high risk fetuses

Ferrario

Magenes

Campanile

et al. 2009

2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society

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The purpose of this study is to evaluate the information content provided by the fluximetry information and the analysis of fetal heart rate (FHR) signals, obtained from cardiotocographic recordings, during prenatal monitoring, in a high risk population. The parameters assessed on FHR signals are divided in: (i) time domain parameters (ii) frequency domain parameters, and (iii) the complexity parameters: Approximate Entropy (ApEn), Sample Entropy (SampEn), Multiscale Entropy (MSE), the Lempel Ziv Complexity (LZC) and the Detrended Fluctuation Analysis (DFA). The fetuses were classified as fetal growth restricted (FGR). The results have shown that the FGR fetuses preterm delivered have produced a markedly reduced heart rate variability in respect with those fetuses which were characterized by an alteration in the fluximetric indices. The normal range in cord blood sampling analysis excludes the prolonged hypoxia as a causing factor. Finally, it seems that the residual cardiovascular response in FGR fetuses could be correlated to an alteration in the flow of the main vessels.

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Ductus venosus Doppler and postnatal outcomes in fetuses with absent or reversed end-diastolic flow in the umbilical arteries

Cited by 12 publications

References 30 publications

Risk of Perinatal Death in Early-Onset Intrauterine Growth Restriction according to Gestational Age and Cardiovascular Doppler Indices: A Multicenter Study

Risk of Perinatal Death in Early-Onset Intrauterine Growth Restriction according to Gestational Age and Cardiovascular Doppler Indices: A Multicenter Study

Early adverse perinatal complications in preterm growth-restricted fetuses

Multiparameter analysis of heart rate variability signal for the investigation of high risk fetuses

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