Selective IUGR in dichorionic twins: what can Doppler assessment and growth discordancy say about neonatal outcomes?

2018 ◽  
Vol 46 (9) ◽  
pp. 1028-1034 ◽  
Author(s):  
Paola Algeri ◽  
Matteo Frigerio ◽  
Maria Lamanna ◽  
Petya Vitanova Petrova ◽  
Sabrina Cozzolino ◽  
...  
Keyword(s):  
Intrauterine Growth Restriction ◽  
Neonatal Intensive Care ◽  
Neonatal Resuscitation ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Abdominal Circumference ◽  
Doppler Study ◽  
Umbilical Artery Doppler ◽  
Nicu Admission ◽  
Twin Pregnancies

Abstract Objective: The aim of the present study was to assess, in a population of dichorionic twin pregnancies with selective growth restriction, the effect of inter-twin differences by use of Doppler velocimetry and fetal growth discordancy on perinatal outcomes. Methods: This was a retrospective study including dichorionic twin pregnancies from January 2008 to December 2015 at the Department of Obstetrics and Gynecology of Fondazione MBBM. Only dichorionic twin pregnancies affected by selective intrauterine growth restriction (IUGR) delivering at ≥24 weeks were included in the study. Results: We found that twin pregnancies with inter-twin estimated fetal weight (EFW) discordance ≥15% were significantly associated with a higher risk of preterm delivery before 32 (P=0.004) and 34 weeks (P=0.04). Similarly, twin pregnancies with inter-twin abdominal circumference (AC) discordance ≥30° centiles were associated with a higher rate of neonatal intensive care unit (NICU) admission (P=0.02), neonatal resuscitation (P=0.02) and adverse neonatal composite outcome (P=0.04). Of interest, when comparing twin pregnancies according to Doppler study, growth restricted twins had a higher rate of composite neonatal outcome and in multivariate analysis, an abnormal Doppler was an independent risk factor for this outcome. Conclusions: Our study associated growth discrepancy with specific pregnancy outcomes, according to defined cut-offs. In addition, we demonstrated that an abnormal umbilical artery Doppler is independently associated with a composite neonatal adverse outcome in growth restricted fetuses.

scholarly journals Early Uterine and Umbilical Artery Doppler Indices as Predictor for Preeclampsia and Intrauterine Growth Restriction

2021 ◽  
pp. 116-126
Author(s):  
Sara E. Khalil ◽  
Mohammed M. Elnamory ◽  
Mona K. omar ◽  
Hesham M. Eltokhy
Keyword(s):  
Gestational Age ◽  
Predictive Value ◽  
Intrauterine Growth Restriction ◽  
Umbilical Artery ◽  
Growth Restriction ◽  
Intrauterine Growth ◽  
Doppler Study ◽  
Significant Difference ◽  
Umbilical Artery Doppler ◽  
Doppler Indices

Background: Preeclampsia (PE) is a disorder that causes hypertension and proteinuria after week 20 of pregnancy. Several Uterine Artery (UtAs) Doppler characteristics have been investigated for their ability to predict PE. The purpose of this research is to look into the uterine and umbilical arterial Doppler indices in the early second trimester for the prediction of late preeclampsia or intrauterine growth restriction. Methods: This is a prospective cohort clinical study and was done at Obstetrics and Gynecology department, faculty of medicine Tanta university hospital from January 2020 till April 2021. 150 pregnant women aged from 18 to 30 years old with gestational age from 13 to 16 weeks of pregnancy. Study was done by the same observer by machine MINDRAY DC60 Measurement of fetal biometry (BPD, FL, AC, HC) Gestational age was confirmed with Detection of congenital malformation.    Results: There is a significant difference between the groups regarding uterine and umbilical artery doppler Indices. Uterine RI only yielded significance for predicting IUGR with sensitivity of 62% and specificity of 88%, with Positive predictive value (PPV) 37% and Negative predictive value (NPV) 92%. Umbilical resistance index achieved sensitivity of 56% and specificity of 82%, with PPV 31% and NPV 30% with on statistical significance. Conclusions: Combination of uterine and umbilical artery Doppler study in early pregnancy is one of the best indicator for prediction of preeclampsia and IUGR. Therefore, Doppler study may be used for the prediction of preeclampsia and IUGR to reduce the maternal and perinatal morbidity and mortality.

scholarly journals The comparison of the perinatal outcomes in monochorionic twin pregnancies with and without selective intrauterine growth restriction

2021 ◽  
Vol 29 (1) ◽  
pp. 20-26
Author(s):  
Elif Fide Pişirgen ◽  
Münip Akalın ◽  
Oya Demirci ◽  
Pınar Kumru ◽  
Emine Eda Akalın
Keyword(s):  
Flow Pattern ◽  
Intrauterine Growth Restriction ◽  
Umbilical Artery ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Monochorionic Twin ◽  
Intrauterine Growth ◽  
Increased Risk ◽  
Artery Flow ◽  
Twin Pregnancies

Objective Both fetuses may be affected negatively as a result of the non-equal share of the placenta and vascular anastomoses in monochorionic pregnancies with selective intrauterine growth restriction (sIUGR). In our study, we aimed to investigate the perinatal outcomes of both larger and smaller fetuses in monochorionic pregnancies with and without sIUGR (non-sIUGR) separately. Methods A total of 196 monochorionic twin pregnancies were evaluated retrospectively between January 2013 and January 2019. The cases were grouped as sIUGR and non-sIUGR pregnancies. The pregnancies with sIUGR were also separated into sub-groups as the cases with normal umbilical flow pattern and the cases with abnormal umbilical flow pattern. The perinatal outcomes were investigated separately between the groups for larger and smaller fetuses. Results Of 153 monochorionic pregnancies included in the study, 17.6% (n=27) were sIUGR cases and 82.4% (n=126) were non-sIUGR cases. While the umbilical artery flow pattern was normal in 59.3% (n=16) of the pregnancies which developed sIUGR, 40.7% (n=11) of them had abnormal umbilical artery flow pattern. The preeclampsia rate was found significantly higher in sIUGR pregnancies than non-sIUGR pregnancies (25.9% vs. 11.1%, p=0.042). The need for intensive care for both larger and smaller newborns was significantly higher in sIUGR pregnancies compared to non-sIUGR pregnancies (p<0.001). Three (11.1%) of newborns in sIUGR pregnancies passed away during neonatal period. All of the newborns that passed away were the smaller newborns from sIUGR pregnancies with abnormal umbilical artery flow pattern. Conclusion The pregnancies with selective intrauterine growth restriction (sIUGR) are more associated with high risks in terms of perinatal outcomes compared to the pregnancies with non-sIUGR. In pregnancies developing sIUGR, the risk increases for larger fetus as well as smaller fetus. More prospective studies are needed to investigate whether this increased risk in the pregnancies with sIUGR is associated with prematurity which is more common or is a result of sIUGR.

Cord Occlusion in Monochorionic Twins with Early Selective Intrauterine Growth Restriction and Abnormal Umbilical Artery Doppler: A Consecutive Series of 90 Cases

2015 ◽  
Vol 39 (3) ◽  
pp. 186-191 ◽  
Author(s):  
Mauro Parra-Cordero ◽  
Mar Bennasar ◽  
José María Martínez ◽  
Elisenda Eixarch ◽  
Ximena Torres ◽  
...  
Keyword(s):  
Intrauterine Growth Restriction ◽  
Umbilical Artery ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Ductus Venosus ◽  
Consecutive Series ◽  
Type Ii ◽  
Monochorionic Twins ◽  
Intrauterine Growth ◽  
Umbilical Artery Doppler

Objective: To describe perinatal outcomes achieved with cord occlusion (CO) in monochorionic twins with severe selective intrauterine growth restriction (sIUGR) and abnormal umbilical artery Doppler in the IUGR twin (types II and III). Methods: We studied a consecutive series of 90 cases of sIUGR with abnormal Doppler treated with CO of the IUGR fetus. Abnormal Doppler was defined as continuous (type II, n = 41) or intermittent (type III, n = 49) absent/reversed end-diastolic flow. All cases presented at least one of the following severity criteria: gestational age (GA) <22 weeks, inter-twin estimated weight discordance >35%, reversed end-diastolic umbilical artery flow or ductus venosus pulsatility index >95th centile. We prospectively recorded pregnancy course and perinatal outcome. Results: Median GA at surgery was 20.6 weeks and mean duration 22.4 min. Miscarriage (<24 weeks) occurred in 3.3% (3/90) and preterm delivery <32 weeks in 7.1% (6/84) of continuing pregnancies. GA at delivery was 36.4 weeks and neonatal survival of the larger twin was achieved in 93.3%. Conclusion: In a consecutive series studied by an experienced team, CO in monochorionic twins with severe sIUGR type II or III was associated with delivery >32 weeks in 92.9% and neonatal survival of the normal twin in 93.3% of pregnancies.

Perinatal Outcome of Selective Intrauterine Growth Restriction in Monochorionic Twins: Evaluation of a Retrospective Cohort in a Developing Country

2021 ◽  
pp. 1-5
Author(s):  
Carolina Aquino ◽  
Ana Elisa Rodrigues Baião ◽  
Paulo Roberto Nassar de Carvalho
Keyword(s):  
Intrauterine Growth Restriction ◽  
Retrospective Cohort ◽  
Umbilical Artery ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Type I ◽  
Monochorionic Twin ◽  
Intrauterine Growth ◽  
Twin Pregnancies ◽  
Estimated Fetal Weight

Abstract Selective intrauterine growth restriction (sIUGR) in monochorionic twin pregnancies is associated with greater morbidity and mortality for both fetuses when compared to singleton and dichorionic pregnancies. This retrospective cohort study aimed to assess the perinatal outcomes of monochorionic twin pregnancies affected by this disorder and conducted expectantly, by analyzing the results according to the end-diastolic flow in the umbilical artery Doppler of the smaller twin (type I: persistently forward/type II: persistently absent or reversed/type III: intermittently absent or reversed). Seventy-five monochorionic diamniotic twin pregnancies with sIUGR were included in this study. sIUGR was defined by estimated fetal weight below the 3rd centile for gestational age, or below the 10th centile, when associated with at least one of the following three criteria: abdominal circumference below the 10th percentile, umbilical artery pulsatility index of the smaller twin above the 95th percentile, or estimated fetal weight discordance of 25% or more. Perinatal outcomes were analyzed from the prenatal period to hospital discharge and included perinatal death, neurological injury, retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and sepsis. The mortality rate was 1.33% in this cohort. The overall morbidity rate was lower in type I twin pregnancies. In conclusion, this study shows that sIUGR type I has lower morbidity than types II and III in expectant management.

scholarly journals DOPPLER STUDY OF THE UTERINE AND UMBILICALARTERY TO PREDICT INTRAUTERINE GROWTH RETARDATION

2020 ◽  
pp. 8-10
Author(s):  
Rabiya Baseri Nelofar ◽  
Sushma Vuyyuru ◽  
Sri Hari Raavi ◽  
Nandam Hema Mohana Lakshmi
Keyword(s):  
Predictive Value ◽  
Intrauterine Growth Restriction ◽  
Uterine Artery ◽  
Umbilical Artery ◽  
Perinatal Outcomes ◽  
Indirect Evidence ◽  
Growth Restriction ◽  
Doppler Imaging ◽  
Intrauterine Growth ◽  
Doppler Study

The primary objective of this study is to transvalue the role of colour doppler sonography in the evaluation of pregnancy with intrauterine growth restriction. The study included 50 antenatal women with singleton pregnancy diagnosed as having a fetus with intrauterine growth restriction based on greyscale ultrasound findings. Further, an obstetric Doppler Ultrasound was done, and diagnostic statistics were applied to determine the Umbilical artery PI, RI, and Uterine artery PI, RI and correlating with perinatal outcomes. The specificity, sensitivity, positive predictive value, negative predictive value, and diagnostic accuracy were determined for all Doppler measurements. Among women with an identifiable cause, 42% had pregnancy-induced hypertension (PIH), 40% had moderate to severe anaemia complicating pregnancy. At the same time, 20% of the study group had no detectable cause for IUGR. The persistence of early diastolic notch beyond 26 weeks showed 60% sensitivity as a predictor for the perinatal outcome. The sensitivity of RI, PI of the uterine artery in predicting perinatal outcomes was 73 % and 76.7 %, respectively. Whereas, the sensitivity of RI, PI of the Umbilical artery in predicting perinatal outcomes was 63% and 70%, respectively. Doppler imaging provides indirect evidence of fetal compromise and is known to improve outcomes of high-risk pregnancies with intrauterine growth restriction. Hence, it is of eminent value for monitoring during the pregnancy.

USE OF SLIDENAFIL CITRATE IN CASES OF INTRAUTERINE GROWTH RESTRICTION AT OBSTETRICS AND GYNAECOLOGY DEPARTMENT OF JLNMCH, BHAGALPUR, BIHAR

2021 ◽  
pp. 23-24
Author(s):  
Anshu Anshu ◽  
Usha Kumari ◽  
Debarshi Jana
Keyword(s):  
Intrauterine Growth Restriction ◽  
Randomized Study ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Control Group ◽  
Singleton Pregnancy ◽  
Intrauterine Growth ◽  
Umbilical Artery Doppler ◽  
Doppler Indices ◽  
Antenatal Treatment

Objective: Intrauterine growth restriction (IUGR) is one of the most serious complications of pregnancy. Up to date, there is no evidence of achieving antenatal treatment of IUGR with abnormal placentation. Although, Sildenal citrate has shown promising results, there are no rm conclusion till now. The aim of our study is to evaluate the use of Sildenal citrate in the treatment of IUGR cases associated with impaired placental circulation. Materials And Methods: this was a prospective non-randomized study conducted at JLNMCH, Bhagalpur, Bihar starting from February 2019 to January 2020. The studied population included singleton pregnancy and suffering from IUGR associated with impaired placental circulation. Results: This study included 30 pregnant women. Cases were divided into two groups. The rst group received sildenal citrate and the second control group did not receive sildenal citrate. After 4 weeks after the 1st dose of Sildenal signicant decrease in umbilical artery Doppler indices. There was a statistically signicant difference in the mean birth weight at delivery and neonatal admission to the NICU in sildenal group. Conclusion: sildenale citrate treatment may present a new hope towards better perinatal outcomes for pregnancies complicated by IUGR and impaired placental circulation that may help to decrease neonatal admission to the NICU.

scholarly journals Diagnostic Value of Fetal Thymus Size in Intrauterine Growth Restriction

2021 ◽  
pp. 43-50
Author(s):  
Mohamed Mosaad Elshishiny ◽  
Mohamed Mohsen Elnamoury ◽  
Ayman Abd Elaziz Aldorf ◽  
Essmat Hamdy AboZeid
Keyword(s):  
Intrauterine Growth Restriction ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Control Group ◽  
Fetal Thymus ◽  
Intrauterine Growth ◽  
Doppler Study ◽  
Significant Difference ◽  
Adverse Perinatal Outcomes ◽  
Thymus Size

Background: Changes in thymus size and histopathology have been observed both in animal models of intrauterine growth restriction (IUGR). The aim of the present study was to evaluate the size of the fetal thymus by sonography in pregnancies with IUGR and to search for a possible relationship between a fetal thymus size and adverse perinatal outcomes. Methods: This prospective observational study was carried out on 100 participants who were divided into two groups. Group A: Study group which include 50 patients with IUGR. Group B: Control group which Include 50 normal patients with appropriate gestational age. All patients were subjected to: History taking: (Personal, Obstetric History, Maternal Medical History) and trans-abdominal ultrasound. Results: IUGR group show statistically significant decrease in the estimate of fetal weight (EFW) compared to the control group (P<0.05). Doppler study of umbilical artery shows significant increase of (pulsatility index (PI), resistance index (RI) and systolic/diastolic (S/D) in IUGR group when compared to control group. Doppler study of middle cerebral artery (MCA) shows significant increase in (RI, SD) in IUGR group when compared to control group while PI doesn’t show significant difference between two groups.  Thymus size decrease in IUGR group when compared to the control group. IUGR group had low survival and lower APGR Score when compared to the control group. Correlation between thymus size with the studied doppler parameters and pregnancy outcome in the current study. Umbilical Doppler RI, PI and SD showed statistically significance in this study (P<0.05) and this means that the blood flow in the umbilical arterial (UA) is important for the fetus. As regard the MCA RI and SD Doppler, they show statistically significance in this study (P<0.05) while the MCA PI Doppler did not show any statistically significance in this study (P>0.05). Conclusions: IUGR is associated with small thymus and small fetal thymus may be an early indicator of adverse perinatal outcomes in pregnancies complicated by IUGR.

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