<scp>ISUOG</scp> Practice Guidelines (updated): use of Doppler velocimetry in obstetrics

Bhide, A.; Acharya, Ganesh; Baschat, Ahmet; Bilardo, C. M.; Brezinka, C; Cafici, D.; Ebbing, Cathrine; Hernández‐Andrade, Edgar; Kalache, Karim; Kingdom, John; Kiserud, T.; Kumar, Sailesh; Lee, W.; Lees, C.; Leung, Kwok‐Yin; Malinger, G.; Mari, Giancarlo; Prefumo, Federico; Sepúlveda, Waldo; Trudinger, B J

doi:10.1002/uog.23698

Cited by 141 publications

(137 citation statements)

References 31 publications

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“…umbilical artery PI, middle cerebral artery (MCA) PI and the CPR) was recorded. EFW was computed by means of the Hadlock IV formula 25 , while Doppler assessment was performed following the recommendations of the International Society of Ultrasound in Obstetrics and Gynecology 26 . In order to adjust for gestational age, EFW percentile was considered, while Doppler parameters were converted into multiples of the median (MoM).…”

Section: Methodsmentioning

confidence: 99%

Ultrasound prediction of adverse perinatal outcome at diagnosis of late‐onset fetal growth restriction

Dall’Asta

Stampalija

Mecacci

et al. 2022

Ultrasound in Obstet & Gyne

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What are the novel findings of this work?The findings of this study show that, at the time of diagnosis of late-onset fetal growth restriction (FGR), estimated-fetal-weight percentile is the only ultrasound parameter associated independently with composite adverse perinatal outcome, defined as stillbirth or at least two of the following: obstetric intervention due to intrapartum fetal distress, neonatal acidemia, birth weight < 3 rd centile and transfer to the neonatal intensive care unit, while uterine artery pulsatility index multiples of the median > 95 th percentile is associated with intrapartum fetal distress leading to obstetric intervention. What are the clinical implications of this work?In this cohort study, including non-anomalous singleton pregnancies defined as late-onset FGR according to the study inclusion criteria, we observed a low frequency of maternal, perinatal and postnatal complications. Our data can be used for antenatal counseling of prospective parents.

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Section: Methodsmentioning

confidence: 99%

Ultrasound prediction of adverse perinatal outcome at diagnosis of late‐onset fetal growth restriction

Dall’Asta

Stampalija

Mecacci

et al. 2022

Ultrasound in Obstet & Gyne

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“…The measurement of the mean value of the left and right UtA-PI was performed by specialists in maternal fetal medicine certified by the Fetal Medicine Foundation, using color Doppler ultrasound according to a standardized protocol for each of the trimesters and following the international guidelines. 21 22 For the 1 st trimester examination, a midsagittal section of the uterus with a transvaginal transducer was obtained and the cervical canal and internal cervical OS were identified. The transducer was then moved laterally, and color flow mapping was used to identify each paracervical vascular plexus and the right and left UtA adjacent to the cervix at the level of the internal cervical OS.…”

Section: Methodsmentioning

confidence: 99%

Could Aspirin Treatment Modify the Assessment of the Uterine Arteries?

Vallejo

Uriel

Porras-Ramírez

et al. 2022

Rev Bras Ginecol Obstet

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Objective To analyze whether acetylsalicylic (ASA) intake modifies the mean uterine arteries pulsatility index (UtA-PI) at the 2nd or 3rd trimester in a cohort of pregnant women with abnormal mean UtA-PI at between 11 and 14 weeks of gestation. Methods This is a retrospective cohort study. Singleton pregnancies with abnormal mean UtA-PI at between 11 and 14 weeks of gestation were studied. The participants were divided into 3 groups: 1) If the participant did not take ASA during pregnancy; 2) If the participant took ASA before 14 weeks of gestation; and 3) If the participant took ASA after 14 weeks of gestation. The mean UtA-PI was evaluated at the 2nd and 3rd trimesters, and it was considered to improve when it decreased below the 95th percentile. The prevalence ratio (PR) and the number needed to treat (NNT) were calculated. Results A total of 72 participants with a mean UtA-PI > 95th percentile at the 1st trimester of gestation were evaluated. Out of the 18 participants who took ASA, 8 participants started it before 14 weeks of gestation and 10 after. A total of 33.3% of these participants had improved the mean UtA-PI at the 2nd and 3rd trimesters of gestation, although it was not statistically significant (p = 0.154). The prevalence ratio was 0.95 (95% confidence interval [CI]: 0.31–1.89), but between the 1st and 2nd trimesters of gestation, the PR was 0.92 (95%CI: 0.21–0.99) and it was statistically significant. Conclusion The present work demonstrates a modification of the mean UtA-PI in participants who took ASA compared with those who did not. It is important to check if ASA can modify the normal limits of uterine arteries because this could have an impact on surveillance.

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“…The obstetrician is faced with an ethical dilemma when observing an unusual coiling of the umbilical cord that may indicate a true umbilical cord knot—the “hanging noose” sign—upon ultrasound examination, without other specific symptoms and abnormal sonographic findings and normal Doppler assessment (when the measurements are performed in a free cord loop and the Doppler indices—pulsatility; resistance; and the peak-systolic/end-diastolic velocity ratio are within normal ranges [ 9 ]): the decision must be made to either inform the patient of the suspicion of a true umbilical cord knot and the risks related to this condition, and the decision to preventing patient’s anxiety and iatrogenic preterm birth by close and apparently unjustified monitoring. In fact, the debate could be resumed to positioning this pathology among clinically relevant UCA or among incidental findings.…”

Section: Discussionmentioning

confidence: 99%

“…ISUOG Practice Guidelines: ultrasound assessment of fetal biometry and growth, from 2019 [ 7 ], mentions that future areas of research should include functional imaging of the placenta, which could improve perinatal outcomes. In the last two years, the guidelines have been updated to include Doppler ultrasonography in feto–placental circulation [ 8 , 9 ] and the role of ultrasound in congenital infection [ 10 ]; these guidelines stipulate the need for placental cord insertion in preparation for ultrasound-guided invasive procedures [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Clinically Relevant Prenatal Ultrasound Diagnosis of Umbilical Cord Pathology

et al. 2022

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Umbilical cord abnormalities are not rare, and are often associated with structural or chromosomal abnormalities, fetal intrauterine growth restriction, and poor pregnancy outcomes; the latter can be a result of prematurity, placentation deficiency or, implicitly, an increased index of cesarean delivery due to the presence of fetal distress, higher admission to neonatal intensive care, and increased prenatal mortality rates. Even if the incidence of velamentous insertion, vasa praevia and umbilical knots is low, these pathologies increase the fetal morbidity and mortality prenatally and intrapartum. There is a vast heterogeneity among societies’ guidelines regarding the umbilical cord examination. We consider the mandatory introduction of placental cord insertion examination in the first and second trimester to practice guidelines for fetal ultrasound scans. Moreover, during the mid-trimester scan, we recommend a transvaginal ultrasound and color Doppler assessment of the internal cervical os for low-lying placentas, marginal or velamentous cord insertion, and the evaluation of umbilical cord entanglement between the insertion sites whenever it is incidentally found. Based on the pathological description and the neonatal outcome reported for each entity, we conclude our descriptive review by establishing a new, clinically relevant classification of these umbilical cord anomalies.

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ISUOG Practice Guidelines (updated): use of Doppler velocimetry in obstetrics

Cited by 141 publications

References 31 publications

Ultrasound prediction of adverse perinatal outcome at diagnosis of late‐onset fetal growth restriction

Ultrasound prediction of adverse perinatal outcome at diagnosis of late‐onset fetal growth restriction

Could Aspirin Treatment Modify the Assessment of the Uterine Arteries?

Clinically Relevant Prenatal Ultrasound Diagnosis of Umbilical Cord Pathology

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