Reference ranges for Doppler parameters of the fetal aortic isthmus during the second half of pregnancy

Río, M. del; Martínez, J.; Figueras, F.; López, Marta; Palacio, Montse; Gómez, O.; Coll, O.; Puerto, B.

doi:10.1002/uog.2827

Cited by 51 publications

(62 citation statements)

References 16 publications

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“…The MCA was registered at the proximal segment after its origin from the circle of Willis. The fetal heart function was evaluated by: the DV in a sagittal or in an axial plane of the fetal abdomen after its origin from the portal sinus, by the aortic IFI as previously reported by Fouron [9] in a sagittal view of the aortic arch, or alternatively in a ‘V’ view of the junction between the aorta and the pulmonary artery as suggested by Del Río et al [13]. The left Mod-MPI was evaluated as previously described by Hernandez-Andrade et al [10] at the level of the 4-chambers view.…”

Section: Methodsmentioning

confidence: 99%

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Changes in Central and Peripheral Circulation in Intrauterine Growth-Restricted Fetuses at Different Stages of Umbilical Artery Flow Deterioration: New Fetal Cardiac and Brain Parameters

Benavides-Serralde

Scheier²,

Cruz‐Martínez³

et al. 2011

Gynecol Obstet Invest

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Objective: To evaluate changes in central and peripheral circulation, including new and standard parameters of the fetal brain and heart in fetuses with intrauterine growth restriction (IUGR) in relation to progressive deterioration of the umbilical artery (UA). Methods: Seventy-two IUGR fetuses were studied longitudinally. IUGR was defined as an estimated fetal weight <10th centile for gestational age. Fetuses were classified according the UA pulsatility index (PI) as: group 1, normal UA-PI (<95th centile; <1.645 z-scores), group 2, UA-PI (≧95th centile and <99th centile; ≧1.645 and <3 z-scores), group 3, UA absent end-diastolic flow, and group 4, UA reversed end-diastolic flow. Middle cerebral artery (MCA), anterior cerebral artery segments 1 (ACA1) and 2 (ACA2), aortic isthmus blood flow index (IFI), modified myocardial performance index (Mod-MPI), ductus venosus (DV), renal artery (RA), femoral artery (FA) and amniotic fluid index (AFI) were weekly evaluated until delivery. Results: A total of 263 scans were performed (median, 3 (range: 1–23) per patient). There were 6 intrauterine and 2 neonatal deaths. Although all cerebral arteries showed a reduction in the PI, ACA1 showed the earliest vasodilatation. From group 2 onwards, all cerebral vessels had a similar pattern of vasodilatation. Mod-MPI became abnormal at group 1 with no further changes. IFI and DV became constantly abnormal starting from group 2. No changes in the RA-PI or FA-PI were documented. Conclusion: The process of hemodynamic deterioration in IUGR fetuses seems to be earlier represented by the ACA1 and the Mod-MPI. Signs of further deterioration were observed in the DV, IFI and MCA. The peripheral blood in the RA and FA did not show any change. AFI showed a late deterioration process.

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Section: Methodsmentioning

confidence: 99%

“…In order to adjust for gestational age, all Doppler values were expressed in z-scores (SD values from the mean) [10,12,13,14,15,16]. Normality was considered between –1.645 z-scores (5th centile) and +1.645 z-scores (95th centile).…”

Section: Methodsmentioning

confidence: 99%

Changes in Central and Peripheral Circulation in Intrauterine Growth-Restricted Fetuses at Different Stages of Umbilical Artery Flow Deterioration: New Fetal Cardiac and Brain Parameters

Benavides-Serralde

Scheier²,

Cruz‐Martínez³

et al. 2011

Gynecol Obstet Invest

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“…All Doppler parameters were converted into Z-scores according to previously published data [2,19,20,21,22,23,24,25,26]. Only the last Doppler evaluation, performed within 72 h before delivery or death, was included in the statistical analysis.…”

Section: Methodsmentioning

confidence: 99%

“…The mechanical and thermal indices were maintained below 1. All individual Doppler data was normalized by converting the measurements into Z-scores (standard deviation from the gestational age mean) according to reference ranges for each center [2,19,20,21,22,23,24,25,26]. The following Doppler parameters were evaluated: umbilical artery (UA), middle cerebral artery (MCA), DV, AoI, and MPI.…”

Section: Methodsmentioning

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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“…We find the LAA AoI view to be more readily obtainable than the 3VT view when the fetus is in the prone position. Additionally, only in the LAA view is a narrow incisura and small reversal of flow during systole visualised after 25 weeks' gestation [11]. …”

Section: Visualisationmentioning

confidence: 99%

The Aortic Isthmus: A Significant yet Underexplored Watershed of the Fetal Circulation

Tynan

Alphonse

Henry³

et al. 2016

Fetal Diagn Ther

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The aortic isthmus (AoI) is a unique fetal watershed with a waveform reflecting its complex haemodynamic physiology. The systolic component represents left and right ventricular systolic ejection, and the diastolic component represents comparative downstream vascular impedance between the brachiocephalic and subdiaphragmatic fetal circulations. Several indices have been devised to quantify different components of the waveform, including the pulsatility index, resistance index, isthmic flow index, and recently the isthmic systolic index. There have been promising preliminary studies applying these indices to both cardiac (congenital) and extracardiac pathologies, including intrauterine growth restriction and twin-twin transfusion syndrome. However, the waveform's multifactorial origin has proven to be challenging, and the difficulty in separating various components of the waveform could explain that AoI evaluation does not have a clear clinical utility. Further research is underway to realise the full potential of this vessel in fetal cardiac and haemodynamically compromised pathological conditions. In this review article we outline the physiological origin of this Doppler waveform, describe in detail the various published indices, summarise the published literature to date, and finally outline potential future research and hopefully clinical applications.

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Reference ranges for Doppler parameters of the fetal aortic isthmus during the second half of pregnancy

Abstract: Objective To establish reference ranges for blood flow velocity waveforms (FVW)

Cited by 51 publications

References 16 publications

Changes in Central and Peripheral Circulation in Intrauterine Growth-Restricted Fetuses at Different Stages of Umbilical Artery Flow Deterioration: New Fetal Cardiac and Brain Parameters

Changes in Central and Peripheral Circulation in Intrauterine Growth-Restricted Fetuses at Different Stages of Umbilical Artery Flow Deterioration: New Fetal Cardiac and Brain Parameters

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

The Aortic Isthmus: A Significant yet Underexplored Watershed of the Fetal Circulation

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