Predictors of Neonatal Outcome in Early- Onset Placental Dysfunction

Baschat, A. A.; Cosmi, Erich; Bilardo, C. M.; Wolf, Hans; Berg, Christoph; Rigano, S.; Germer, U.; Moyano, Dolores; Turan, Şifa; Hartung, J.; Bhide, A.; Müller, Thomas; Bower, Sarah; Nicolaides, Kypros H.; Thilaganathan, B.; Gembruch, Ulrich; Ferrazzi, Enrico; Hecher, Kurt; Galan, Henry L.; Harman, Chris

doi:10.1097/01.aog.0000253215.79121.75

Cited by 437 publications

(437 citation statements)

References 27 publications

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“…During the last few decades, several large studies have been performed to determine which surveillance technique and signs should be used to determine the optimal timing of delivery of a fetus with IUGR in order to achieve the best short‐term outcome27, 28, 29. Recently, studies in which the outcome also includes long‐term neurodevelopment have been performed30, 31, 32, 33.…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging‐estimated placental perfusion in fetal growth assessment

Sohlberg

Mulic‐Lutvica

Olovsson

et al. 2015

Ultrasound in Obstet & Gyne

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ObjectiveTo evaluate in‐vivo placental perfusion fraction, estimated by magnetic resonance imaging (MRI), as a marker of placental function.MethodsA study population of 35 pregnant women, of whom 13 had pre‐eclampsia (PE), were examined at 22–40 weeks' gestation. Within a 24‐h period, each woman underwent an MRI diffusion‐weighted sequence (from which we calculated the placental perfusion fraction), venous blood sampling and an ultrasound examination including estimation of fetal weight, amniotic fluid index and Doppler velocity measurements. The perfusion fractions in pregnancies with and without fetal growth restriction were compared and correlations between the perfusion fraction and ultrasound estimates and plasma markers were estimated using linear regression. The associations between the placental perfusion fraction and ultrasound estimates were modified by the presence of PE (P < 0.05) and therefore we included an interaction term between PE and covariates in the models.ResultsThe median placental perfusion fractions in pregnancies with and without fetal growth restriction were 21% and 32%, respectively (P = 0.005). The correlations between placental perfusion fraction and ultrasound estimates and plasma markers were highly significant (P = 0.002 and P = 0.0001, respectively). The highest coefficient of determination (R 2 = 0.56) for placental perfusion fraction was found for a model that included pulsatility index in the ductus venosus, plasma level of soluble fms‐like tyrosine kinase‐1, estimated fetal weight and presence of PE.ConclusionThe placental perfusion fraction has the potential to contribute to the clinical assessment of cases with placental insufficiency. © 2015 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging‐estimated placental perfusion in fetal growth assessment

Sohlberg

Mulic‐Lutvica

Olovsson

et al. 2015

Ultrasound in Obstet & Gyne

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“…In the MCA, a PI more than 2 SDs above the mean for gestational age was defined as brain sparing, indicating abnormally reduced impedance to flow in the cerebral circulation. 21 Ductus venosus velocity during atrial systole was characterized as forward or absent/reversed. 21 FHR was considered abnormal, if at least 1 of the following patterns was present: less than 2 accelerations of the heart rate to an amplitude of 10 or more beats per minute lasting 15 seconds or more during a period of at least 30 minutes; variability of 5 or fewer beats per minute during a period of at least 60 minutes; and U-shaped (late) decelerations in the heart rate after Braxton Hicks contractions.…”

Section: Study Populationmentioning

confidence: 99%

Lactate detection in the brain of growth-restricted fetuses with magnetic resonance spectroscopy

Cetin

Barberis

Brusati

et al. 2011

American Journal of Obstetrics and Gynecology

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OBJECTIVE:The objective of the study was to determine the feasibility of detecting fetal brain lactate, a marker of fetal metabolic acidemia, using a noninvasive technique, proton magnetic resonance spectroscopy ( 1 H MRS), in intrauterine growth-restricted (IUGR) fetuses. STUDY DESIGN:In vivo human fetal brain lactate detection was determined by 1 H MRS in 5 fetuses with IUGR. Oxygenation and acid-base balance data were obtained at birth. RESULTS:1 H MRS analysis showed the presence of a lactate peak in the brain of the most severely affected IUGR fetus, with abnormal umbilical artery Doppler and fetal heart rate tracing. This finding was consistent with the low oxygen content and high lactic acid concentration observed in umbilical blood obtained at delivery.

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“…Although elevated umbilical artery resistance has been suspected to be a marker of deteriorating placental health, recent Doppler evaluation of fetal cerebral and venous circulations has amplified this understanding. [9][10][11] The decision to deliver a preterm, intrauterine growth-restricted fetus is a subject of ongoing controversy and debate, wherein the risk of intrauterine compromise needs to be balanced against potential risks of premature delivery. Baschat et al 10 recently showed umbilical artery flow reversal to be a significant predictor of perinatal mortality, bronchopulmonary dysplasia, intraventricular hemorrhage and NEC.…”

Section: Physiology Of Ductal Stealmentioning

confidence: 99%

Spectral Doppler waveforms in systemic arteries and physiological significance of a patent ductus arteriosus

et al. 2010

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Patent ductus arteriosus in extremely premature babies is associated with major neonatal morbidities, such as necrotizing enterocolitis and intraventricular hemorrhage. This may be attributable, at least in part, to systemic hypoperfusion secondary to ductal steal. A hemodynamically significant ductus arteriosus (HSDA) is known to be associated with altered systemic blood flow and end-organ hypoperfusion. Although descending aorta blood flow profiles may show abnormal diastolic retrograde flow, Doppler studies of blood flow in the systemic arteries may help improve our understanding of the relationship of a HSDA with these morbidities. In this article, we discuss aspects of diastolic blood flow reversal in the systemic arteries in premature infants with a hemodynamically significant duct. Whether these hemodynamic effects are significant enough to form the basis for initiating treatment is still unclear; these should form the basis for prospective studies.

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Predictors of Neonatal Outcome in Early- Onset Placental Dysfunction

Abstract: II.

Cited by 437 publications

References 27 publications

Magnetic resonance imaging‐estimated placental perfusion in fetal growth assessment

Magnetic resonance imaging‐estimated placental perfusion in fetal growth assessment

Lactate detection in the brain of growth-restricted fetuses with magnetic resonance spectroscopy

Spectral Doppler waveforms in systemic arteries and physiological significance of a patent ductus arteriosus

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