Perinatal outcomes and maternal clinical characteristics in IUGR with absent or reversed end-diastolic flow velocity in the umbilical artery

Jang, Dong Gyu; Jo, Yun Sung; Lee, Sung Jong; Kim, Narinay; Lee, Gui Se Ra

doi:10.1007/s00404-010-1597-8

Cited by 33 publications

(25 citation statements)

References 23 publications

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“…Fetal growth restriction (FGR) is a major cause of perinatal morbidity and mortality [1] . FGR is associated with increased risk of stillborn babies, premature birth, hypoxic brain injury, and intrauterine death in a subsequent pregnancy [2] .…”

Section: Introductionmentioning

confidence: 99%

Smoking-Induced Changes in the Maternal Immune, Endocrine, and Metabolic Pathways and Their Impact on Fetal Growth: A Topical Review

Sabra

Gratacós²,

Roig³

2017

Fetal Diagn Ther

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Perinatal maternal smoking exposure (PMSE) is one of the major environmental risk factors encountered by the fetus. PMSE is usually associated with adverse pregnancy outcomes that may manifest at different stages of life. Nevertheless, fetal growth restriction is the most common smoking-induced side effect. PMSE induces changes in the maternal multiple organ systems. These alterations may affect placentation, which subsequently affects fetal growth. It is worthy to note, however, that the extent of maternal smoking-induced changes depends mainly on the maternal level of susceptibility. Hence, the perinatal pregnancy outcomes vary depending on the interaction between the triad: the maternal, fetal, and placental modifications, making it more complex. In this review, we try to unveil the effect of smoking-induced maternal changes on the maternal immune, endocrine, and metabolic pathways and their impact on fetal growth.

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Section: Introductionmentioning

confidence: 99%

Smoking-Induced Changes in the Maternal Immune, Endocrine, and Metabolic Pathways and Their Impact on Fetal Growth: A Topical Review

Sabra

Gratacós²,

Roig³

2017

Fetal Diagn Ther

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“…Intrauterine growth restriction (IUGR) due to placental insufficiency [1,2] is a leading cause for perinatal death and long-term cardiovascular [3] and neurodevelopmental adverse outcomes [4]. Early-onset IUGR (<34 weeks of gestation) is associated with perinatal mortality rates as high as 46%, which warrant strict in utero monitoring to tailor planned delivery [5].…”

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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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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“…Currently, end-diastolic velocities in the UA are reported qualitatively as present, absent, or reverse [22,23]. Nevertheless, it is likely that the degree of deterioration with AREDV is variable, but there is no technique to quantify this observation.…”

Section: Discussionmentioning

confidence: 99%

Umbilical Artery Half-Peak Systolic Velocity Deceleration Time in Fetal Growth Restriction

Bustos

González²,

Sepúlveda³

2015

Fetal Diagn Ther

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Objective: To study the umbilical artery (UA) half-peak systolic velocity deceleration time (hPSV-DT) in pregnancies complicated by fetal growth restriction (FGR). Methods: The study included 266 singleton, high-risk pregnancies with an estimated fetal weight <10th percentile, which were examined between 24 and 40 weeks' gestation and delivered within a week from the last ultrasound evaluation. UA hPSV-DT was measured with Doppler ultrasound in the same wave used to measure the pulsatility index. UA hPSV-DT values were correlated with perinatal outcome. Results: UA hPSV-DT <5th percentile was found in 87 and 98% of fetuses with moderate and severe FGR, respectively. 94% of fetuses with a UA hPSV-DT <90 ms had poor perinatal outcome including perinatal death or prolonged admission to the neonatal intensive care unit. None of the fetuses had a UA hPSV-DT <70 ms. Perinatal death occurred in 39 fetuses; UA hPSV-DT was abnormal in all of them, with 95% of these fetuses having values of ≤120 ms. In the group of fetuses with absent/reverse end-diastolic velocity in the UA, the perinatal mortality rate was 51% for those with a UA hPSV-DT ≤90 ms and only 23% for those having a UA hPSV-DT >90 ms (p < 0.01). Conclusions: UA hPSV-DT seems to be a useful technique in the evaluation of pregnancies at risk for FGR and perinatal death. Additionally, hPSV-DT was shown to be a good predictor of perinatal death, with values of <90 ms corresponding to imminent risk of intrauterine demise and values of <70 ms being likely to be incompatible with intrauterine life.

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Perinatal outcomes and maternal clinical characteristics in IUGR with absent or reversed end-diastolic flow velocity in the umbilical artery

Cited by 33 publications

References 23 publications

Smoking-Induced Changes in the Maternal Immune, Endocrine, and Metabolic Pathways and Their Impact on Fetal Growth: A Topical Review

Smoking-Induced Changes in the Maternal Immune, Endocrine, and Metabolic Pathways and Their Impact on Fetal Growth: A Topical Review

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

Umbilical Artery Half-Peak Systolic Velocity Deceleration Time in Fetal Growth Restriction

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