Monitoring of fetuses with intrauterine growth restriction: longitudinal changes in ductus venosus and aortic isthmus flow

Abstract

Objectives (median, 3; range, 2-10). The median gestational age at inclusion was 28.9 (range, 23.6-33.4) weeks and delivery occurred at a median gestational age of 30.5 (range, 25.9-33.9)

Sequence of changes in myocardial performance index in relation to aortic isthmus and ductus venosus Doppler in fetuses with early‐onset intrauterine growth restriction

“…The results for DV-PI and AoI-PI are in line with previous longitudinal studies suggesting that both parameters increase progressively 16,17 , but with substantial differences in the patterns of progression 17 . As expected and in line with previous studies, AoI-PI crossed the 95 th percentile on average 1 week earlier than did DV-PI.…”

“…Since, as shown in this study, DV-PI and MPI progress in parallel, it is not surprising that previous studies have demonstrated that while MPI may improve the prediction of fetal death, its added value is modest when combined with DV flow 34 . We and others have previously reported that in IUGR fetuses AoI flow becomes abnormal on average 1 week earlier than does DV flow 16,17 , which may help to explain its reported poor short-term use in the prediction of fetal death 34 . However, AoI flow has shown a strong association with neurological outcome 15 .…”

“…During the study period a total of 430 scans were performed on 115 IUGR fetuses (median 3, range [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. The proportion of cases with two, three or more than three examinations was 43.5, 34.8 and 21.7%, respectively.…”

“…The association of increased AoI impedance with adverse perinatal and long-term neurodevelopmental outcome has been well demonstrated 14,15 . Longitudinal studies suggest that AoI abnormalities precede the occurrence of abnormal DV flow 16,17 , an observation which might open opportunities for the combined use of these two parameters. It has been shown that MPI is increased at initial stages of fetal deterioration 18,19 , but its longitudinal changes throughout fetal deterioration have not been investigated.…”

The role of ultrasound in the diagnosis and management of the growth restricted fetus

“…The blood flow pattern of the aortic isthmus thus reflects the differences in vascular resistance between these systems. A recent study has found that AI‐PI consistently became abnormal (PI > 95th centile or retrograde flow) 1–2 weeks after abnormal UA and MCA flows were observed, and one week earlier than abnormal DV flow (> 95th percentile) 37 . AI Doppler studies could potentially be used to improve current algorithms for the prediction of poor perinatal outcome in preterm IUGR fetuses, and provide further guidance on optimising the time of delivery.…”