The effect of maternal position on fetal middle cerebral artery Doppler indices and its association with adverse perinatal outcomes: a pilot study

2020 ◽  
Vol 48 (4) ◽  
pp. 317-321
Author(s):  
Rodney McLaren ◽  
Bharati Kalgi ◽  
Chima Ndubizu ◽  
Peter Homel ◽  
Shoshana Haberman ◽  
...  
Keyword(s):  
High Risk ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Repeated Measures ◽  
Adverse Outcome ◽  
Perinatal Outcomes ◽  
Low Risk ◽  
Doppler Velocity ◽  
Chronic Hypertension ◽  
Adverse Perinatal Outcomes

AbstractObjectiveThe aim of this study was to compare position-related changes in fetal middle cerebral artery (MCA) Doppler pulsatility indices (PI).MethodsA prospective study of 41 women with conditions associated with placental-pathology (chronic hypertension, pregestational diabetes, and abnormal analytes) and 34 women without those conditions was carried out. Fetal MCA Doppler velocity flow waveforms were obtained in maternal supine and left lateral decubitus positions. MCA PI Δ was calculated by subtracting the PI in the supine position from the PI in the left lateral position. Secondary outcomes included a composite of adverse perinatal outcomes (fetal growth restriction, oligohydramnios, and preeclampsia). χ2 and Student t-tests and repeated-measures analysis of variance were used.ResultsMCA PI Δ was significantly less for high-risk pregnant women ([P = 0.03]: high risk, left lateral PI, 1.90 ± 0.45 vs. supine PI, 1.88 ± 0.46 [Δ = 0.02]; low risk, left lateral PI, 1.90 ± 0.525 vs. supine PI, 1.68 ± 0.40 [Δ = 0.22]). MCA PI Δ was not significantly different between women who had a composite adverse outcome and women who did not have a composite adverse outcome (P = 0.843).ConclusionOur preliminary study highlights differences in position-related changes in fetal MCA PI between high-risk and low-risk pregnancies. These differences could reflect an attenuated ability of women with certain risk factors to respond to physiologic stress.

scholarly journals Comparative performance of Cerebral Perfusion Ratio as compared to MCA PI and UA PI in prediction of adverse perinatal outcomes in intra uterine growth restricted fetuses

2019 ◽  
Vol 7 (8) ◽  
pp. 2887
Author(s):  
Jyotsna S. Shinde ◽  
Madan P. Manmohan ◽  
Sanjay S. Pasoria ◽  
Thahir V. Ummer
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Cerebral Perfusion ◽  
Umbilical Artery ◽  
Perinatal Outcomes ◽  
Clinical History ◽  
Comparative Performance ◽  
Uterine Growth ◽  
Adverse Perinatal Outcomes ◽  
Doppler Indices

Background: Intra uterine growth restriction (IUGR) is a common clinical sign seen due to chronic foetal hypoxemia and is considered a major contributor of perinatal morbidity and mortality. The aim of the present study was to determine and compare the sensitivity and specificity of umbilical artery pulsatility index (UA PI), middle cerebral artery (MCA) PI and cerebral perfusion ratio (CPR) in predicting adverse and poor perinatal outcomes in fetuses with IUGR.Methods: The study included 100 pregnant women with post 24 weeks of gestation with clinical history of IUGR.  Doppler examination parameters, including waveforms and measurements, of the umbilical artery, middle cerebral artery were recorded. The Cerebral Perfusion Ratio (CPR) was calculated from MCA PI and UA PI and a final comparison of accuracy of Doppler indices was done with perinatal outcome.Results: The sensitivity of the UA PI was higher (49.3%) than that of the MCA PI (43.6%) and the CPR (37.7%). The specificity of the CPR was higher (87.1%) than that of the MCA PI (83.9%) and the UA PI (74.2%).Conclusions: From the findings of the study, it can be concluded that UA PI is the most sensitive and CPR is the most specific parameter in predicting adverse perinatal outcomes in IUGR fetuses. Thus, in addition to pulsatility indices, CPR should be used as a tool for surveillance and included in the routine reporting formats of obstetric Doppler studies.

scholarly journals Management and outcome of pregnancies in women with red cell isoimmunization: a 15-year observational study from a tertiary care university hospital

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
María Ángeles Sánchez-Durán ◽  
María Teresa Higueras ◽  
Cecilia Halajdian-Madrid ◽  
Mayte Avilés García ◽  
Andrea Bernabeu-García ◽  
...  
Keyword(s):  
High Risk ◽  
Observational Study ◽  
Gestational Age ◽  
Risk Group ◽  
Perinatal Outcomes ◽  
Low Risk ◽  
Fetal Anemia ◽  
Adverse Perinatal Outcomes ◽  
Clinically Significant

Abstract Background The aims of this study were to determine the prevalence of the different anti-erythrocytic alloantibodies, to describe pregnancy outcomes according to a low-risk and high-risk classification for fetal anemia and to determine the factors that influence adverse perinatal outcomes. Methods This retrospective observational study included women referred to our center following the identification of maternal anti-erythrocytic alloantibodies between 2002 and 2017. Pregnancies were classified as high risk for fetal anemia in cases with clinically significant antibodies, no fetal-maternal compatibility and titers ≥1:16 or any titration in cases of Kell system incompatibility. In high-risk pregnancies, maternal antibody titration and the fetal middle cerebral artery peak systolic velocity (MCA-PSV) were monitored. Low-risk pregnancies underwent routine pregnancy follow-up. Results Maternal antibodies were found in 337 pregnancies, and 259 (76.9%) of these antibodies were clinically significant. The most frequent antibodies were anti-D (53%) and anti-K (19%). One hundred forty-three pregnancies were classified as low risk for fetal anemia, 65 (25%) cases were classified as no fetal-maternal incompatibility, 78 had clinically nonsignificant antibodies, 4 (2.8%) resulted in first-trimester pregnancy loss, and 139 (97.2%) resulted in livebirths. Of the 194 high-risk pregnancies, 38 had titers < 1:16 (resulting in 38 livebirths), and 156 had titers ≥1:16 or anti-K antibodies. In the last group, 6 cases miscarried before 18 weeks, 93 had a MCA-PSV < 1.5 multiples of the median (MoM), resulting in 3 perinatal deaths that were unrelated to fetal anemia, one termination and 89 livebirths; and 57 had a MCA-PSV > 1.5 MoM, resulting in 3 intrauterine deaths, 6 terminations and 48 livebirths. Ninety-two intrauterine transfusions were performed in 45 fetuses (87% anti-D). Adverse outcomes were related to a MCA-PSV > 1.5 MoM (p < 0.001), hydrops (p < 0.001) and early gestational age at first transfusion (p = 0.029) Conclusion Anti-D remains the most common antibody in fetuses requiring intrauterine transfusion. A low or high-risk classification for fetal anemia based on the type of antibody, paternal phenotype and fetal antigen allows follow-up of the pregnancy accordingly, with good perinatal outcomes in the low-risk group. In the high-risk group, adverse perinatal outcomes are related to high MCA-PSV, hydrops and early gestational age at first transfusion.

scholarly journals The role of sildenafil citrate in the treatment of fetal growth restriction: a randomized controlled trial

2019 ◽  
Vol 8 (5) ◽  
pp. 1840
Author(s):  
Ahmed Abdelshafy ◽  
Khaled Ibrahim Abdullah ◽  
Sherif Ashoush ◽  
Heba E. Hosni
Keyword(s):  
Middle Cerebral Artery ◽  
Fetal Growth ◽  
Cerebral Artery ◽  
Fetal Growth Restriction ◽  
Umbilical Artery ◽  
Controlled Trial ◽  
Maternity Hospital ◽  
Growth Restriction ◽  
Sildenafil Citrate ◽  
Doppler Velocity

Background: This study was aimed to evaluate the effect of sildenafil citrate on Doppler velocity indices in patients with fetal growth restriction (FGR) associated with impaired placental circulation.Methods: A double-blinded, parallel group randomized clinical trial (clinicaltrials.gov NCT02590536) was conducted in Ain Shams Maternity Hospital, in the period between October 2015 and June 2017. Ninety pregnant women with documented intrauterine growth retardation at 24-37 weeks of gestation were randomized to either sildenafil citrate 25 mg orally every 8 hours or placebo visually-identical placebo tablets with the same regimen. The primary outcome of the study was the change in umbilical artery and fetal middle cerebral artery indices.Results: There was a significant improvement in umbilical and middle cerebral artery indices after sildenafil administration p<0.001. Present study observed that, sildenafil group, in comparison to placebo, has a significantly higher mean neonatal birth weight. 1783±241g vs 1570±455g (p<0.001). There was a significantly higher mean gestational age at delivery in women in sildenafil group 35.3±1.67 weeks, whereas it was lower in the placebo group 33.5±1.7 weeks. The side effects as headache, palpitation and facial flushing were significantly higher in sildenafil group compared to placebo group.Conclusions: The use sildenafil citrate in pregnancies with fetal growth restriction (FGR) improved the feto-placental Doppler indices (pulsatility index of umbilical artery and middle cerebral artery) and improved neonatal outcomes.

scholarly journals The impact of betamethasone on fetal pulmonary, umbilical and middle cerebral artery Doppler velocimetry and its relationship with neonatal respiratory distress syndrome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Homeira Vafaei ◽  
Fahimeh Kaveh Baghbahadorani ◽  
Nasrin Asadi ◽  
Maryam Kasraeian ◽  
Azam Faraji ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Distress Syndrome ◽  
Exposed Group ◽  
Doppler Velocity ◽  
Corticosteroid Administration ◽  
The Impact

Abstract Background Prenatal corticosteroid administration is known to be an effective strategy in improving fetal pulmonary maturity. This study aimed to evaluate the impact of maternal betamethasone administration on fetal pulmonary and other arteries Doppler velocity and the correlation between RDS development and Doppler indices results. Methods Fifty one singleton pregnancies between 26 and 34 gestational weeks with a diagnosis of preterm labor were included in the exposed group and received betamethasone. Fifty one uncomplicated pregnancies were included in the non-exposed group. Fetal pulmonary, umbilical and middle cerebral arteries Doppler parameters were evaluated before and 24 to 48 h after steroid administration in the exposed group and two times at same intervals in the non-exposed group. Maternal records were matched to neonatal charts if delivery happened, and demographic and outcome data were abstracted. Results When compared with the nonexposed group, fetuses treated with corticosteroids demonstrated significantly decreased umbilical artery Pulsatility index (PI) and significantly increased the middle cerebral artery PI, pulmonary artery Acceleration time (AT) and pulmonary artery AT/ET (Ejection time), while all other indices remained similar. We found significantly decreased pulmonary artery AT in the fetuses with respiratory distress syndrome (RDS) compared to those that did not. Conclusions The results of our study showed that maternal antenatal betamethasone administration caused significant changes in the fetus blood velocity waveforms and also affected the blood flow in the pulmonary artery which led to an increase in the pulmonary artery AT and AT/ET. Among those fetuses with RDS, we found a significant decrease in the pulmonary artery AT, but we did not observe any pulmonary artery AT/ET differences.

scholarly journals Uric Acid and Xanthine Levels in Pregnancy Complicated by Gestational Diabetes Mellitus—The Effect on Adverse Pregnancy Outcomes

2018 ◽  
Vol 19 (11) ◽  
pp. 3696 ◽  
Author(s):  
Anna Pleskacova ◽  
Vendula Bartakova ◽  
Katarina Chalasova ◽  
Lukas Pacal ◽  
Katerina Kankova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Uric Acid ◽  
High Risk ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Perinatal Outcomes ◽  
Anthropometric Parameters ◽  
Pregnancy And Postpartum ◽  
Adverse Perinatal Outcomes ◽  
Adverse Pregnancy

Uric acid (UA) levels are associated with many diseases including those related to lifestyle. The aim of this study was to evaluate the influence of clinical and anthropometric parameters on UA and xanthine (X) levels during pregnancy and postpartum in women with physiological pregnancy and pregnancy complicated by gestational diabetes mellitus (GDM), and to evaluate their impact on adverse perinatal outcomes. A total of 143 participants were included. Analyte levels were determined by HPLC with ultraviolet detection (HPLC-UV). Several single-nucleotide polymorphisms (SNPs) in UA transporters were genotyped using commercial assays. UA levels were higher within GDM women with pre-gestational obesity, those in high-risk groups, and those who required insulin during pregnancy. X levels were higher in the GDM group during pregnancy and also postpartum. Positive correlations between UA and X levels with body mass index (BMI) and glycemia levels were found. Gestational age at delivery was negatively correlated with UA and X levels postpartum. Postpartum X levels were significantly higher in women who underwent caesarean sections. Our data support a possible link between increased UA levels and a high-risk GDM subtype. UA levels were higher among women whose glucose tolerance was severely disturbed. Mid-gestational UA and X levels were not linked to adverse perinatal outcomes.

Noninvasive diagnosis of anemia in hydrops fetalis with the use of middle cerebral artery Doppler velocity

2001 ◽  
Vol 185 (6) ◽  
pp. 1411-1415 ◽  
Author(s):  
Sherif A. Abdel-Fattah ◽  
Peter W. Soothill ◽  
Stephen G. Carroll ◽  
Phillipa M. Kyle
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Hydrops Fetalis ◽  
Doppler Velocity ◽  
Noninvasive Diagnosis

scholarly journals Prelabor rupture of membranes at term: A possible hematological triage in addition to vagino-rectal beta-hemolytic streptococcus screening for early labor induction

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0261906
Author(s):  
Francesco D’Ambrosi ◽  
Nicola Cesano ◽  
Enrico Iurlaro ◽  
Alice Ronchi ◽  
Ilaria Giuditta Ramezzana ◽  
...  
Keyword(s):  
High Risk ◽  
Cesarean Section ◽  
Neonatal Intensive Care ◽  
Perinatal Outcomes ◽  
Expectant Management ◽  
Low Risk ◽  
Clinical Protocol ◽  
Hemolytic Streptococcus ◽  
Beta Hemolytic Streptococcus ◽  
Prelabor Rupture Of Membranes

Introduction A potential complication of term prelabor rupture of membranes (term PROM) is chorioamnionitis with an increased burden on neonatal outcomes of chronic lung disease and cerebral palsy. The purpose of the study was to analyze the efficacy of a standing clinical protocol designed to identify women with term PROM at low risk for chorioamnionitis, who may benefit from expectant management, and those at a higher risk for chorioamnionitis, who may benefit from early induction. Material and methods This retrospective study enrolled all consecutive singleton pregnant women with term PROM. Subjects included women with at least one of the following factors: white blood cell count ≥ 15×100/μL, C-reactive protein ≥ 1.5 mg/dL, or positive vaginal swab for beta-hemolytic streptococcus. These women comprised the high risk (HR) group and underwent immediate induction of labor by the administration of intravaginal dinoprostone. Women with none of the above factors and those with a low risk for chorioamnionitis waited for up to 24 hours for spontaneous onset of labor and comprised the low-risk (LR) group. Results Of the 884 consecutive patients recruited, 65 fulfilled the criteria for HR chorioamnionitis and underwent immediate induction, while 819 were admitted for expectant management. Chorioamnionitis and Cesarean section rates were not significantly different between the HR and LR groups. However, the prevalence of maternal fever (7.7% vs. 2.9%; p = 0.04) and meconium-stained amniotic fluid was significantly higher in the HR group than in LR group (6.1% vs. 2.2%; p = 0.04). This study found an overall incidence of 4.2% for chorioamnionitis, 10.9% for Cesarean section, 0.5% for umbilical artery blood pH < 7.10, and 1.9% for admission to the neonatal intensive care unit. Furthermore, no confirmed cases of neonatal sepsis were encountered. Conclusions A clinical protocol designed to manage, by immediate induction, only those women with term PROM who presented with High Risk factors for infection/inflammation achieved similar maternal and perinatal outcomes between such women and women without any risks who received expectant management. This reduced the need for universal induction of term PROM patients, thereby reducing the incidence of maternal and fetal complications without increasing the rate of Cesarean sections.

Sign in / Sign up

Export Citation Format

Share Document