scholarly journals Placental pathology in case of fetal growth restriction - sonographic and morphological indicators of the critical condition

2016 ◽  
Vol 97 (6) ◽  
pp. 869-872 ◽  
Author(s):  
E V Ul’yanina ◽  
N R Akhmadeev ◽  
G R Khayrullina
Keyword(s):  
Blood Flow ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Umbilical Artery ◽  
The State ◽  
Placental Insufficiency ◽  
Growth Restriction ◽  
Morphological Examination ◽  
Uterine Arteries ◽  
Placental Structure

Aim. To study the peculiarities of placental structure and the state of utero-placental and fetal-placental blood flow in fetal growth restriction.Methods. A prospective study of 50 pregnant women admitted to the department of pathology of pregnancy with fetal growth restriction followed by a retrospective analysis of the obtained data considering risk factors and clinical course of the pregnancy and the results of morphological examination of afterbirth. For the diagnosis of fetal growth restriction ultrasound and Doppler ultrasound of blood flow in the uterine arteries and umbilical artery, and cardiotocography were performed.Results. The most informative sonographic markers of the critical state of the fetus in case of fetal growth restriction are abnormal blood flow indicators of «mother-placenta-fetus» system (critical blood flow disorder in uterine arteries and umbilical artery grade III, blood flow disorder in the medial cerebral artery of the fetus), and also significant hypamnion and changes in placenta combined with poor results of cardiotocography. Obtained data correlated with the results of morphological examination of aftherbirth. Impaired blood flow and significant hypamnion on ultrasound indicate acute placental insufficiency, suggest poor fetal condition, including antenatal death. Petrifaction, infarction and calcification on ultrasound point to chronic placental insufficiency and compensated fetal condition, and they correlate with more favorable perinatal outcomes.Conclusion. The findings of the study demonstrated that ultrasound, Doppler, clinical laboratory and subsequent morphological examination provide very detailed information about the state of placental structure and need for urgent care.

scholarly journals Prevention of fetal growth restriction in placental insufficiency

2018 ◽  
pp. 27-32
Author(s):  
Z. V. Khachatryan ◽  
N. A. Lomova ◽  
A. A. Khachatryan ◽  
V. L. Tyutyunnik ◽  
N. E. Kan
Keyword(s):  
Blood Flow ◽  
High Risk ◽  
Pregnant Women ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Placental Insufficiency ◽  
Growth Restriction ◽  
Diagnostic Methods ◽  
Obstetric Complications ◽  
Proinflammatory Mediators

The occurrence and development of such complications of pregnancy as preeclampsia, placental insufficiency, fetal growth restriction can be mediated by the systemic vascular damage. Understanding the pathophysiological mechanisms in the mother-placenta-fetus system contributes to the improvement of diagnostic methods and the selection of pathogenetically valid therapy for certain obstetric complications. In the systemic inflammatory response syndrome accompanying obstetric complications, the uncontrolled and excessive activation of proinflammatory mediators occurs, which leads to generalized tissue damage and development of multiple organ failure.The use of antiplatelet agents at a preventive dose in pregnant women with high risk of placental insufficiency and fetal growth restriction contributes to the reduction of systemic and placental blood flow disorders by affecting the vascular endothelium, increasing the synthesis of prostacyclin and nitric oxide, thereby implementing its angioprotective properties and increasing blood flow in the arteries and existing collaterals.The obtained data showed that adding of dipyridamole to the algorithm for managing pregnant women with high risk of placental insufficiency and fetal growth restriction, starting from the II trimester of gestation allows to reduce the risk of endotheliopathy and thrombophilia, improve obstetric and perinatal outcomes. 

scholarly journals Задержка (замедление) роста плода: современные принципы диагностики, классификации и динамического наблюдения

2019 ◽  
pp. 33-44
Keyword(s):  
Doppler Ultrasound ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Uterine Artery ◽  
Umbilical Artery ◽  
Placental Insufficiency ◽  
Growth Restriction ◽  
Ductus Venosus ◽  
Cerebroplacental Ratio

В статье детально представлены унифицированные критерии диагностики задержки (замедления) роста плода, выработанные в 2016 г. ведущими мировыми экспертами и рекомендованные к применению в клинической и научной работе. Обсуждается современный подход к анализу допплерометрических параметров кровотока в системе “мать-плацентаплод”, включая расчет церебральноплацентар ного отношения. Приводятся международные принципы обследования беременных с задержкой роста плода, протоколы и алгоритмы дальнейшего наблюдения, выбора срока и метода родоразрешения, разработанные на основании доказательных многоцентровых европейских исследований. Ключевые слова: задержка (замедление) роста плода, церебрально-плацентарное отношение, артерия пуповины, маточная артерия, венозный проток, плацентарная недостаточность, ультразвуковое допплеровское исследование, fetal growth restriction, cerebroplacental ratio, umbilical artery, uterine artery, ductus venosus, placental insufficiency, Doppler ultrasound

scholarly journals Sildenafil citrate therapy in absent end diastolic flow in umbilical artery in an early onset fetal growth restriction (FGR) fetus

2018 ◽  
Vol 7 (12) ◽  
pp. 5173
Author(s):  
Rana A. Choudhary ◽  
Khyati Patrawala ◽  
Kavita Desai ◽  
Kedar Ganla
Keyword(s):  
Blood Flow ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Early Onset ◽  
Umbilical Artery ◽  
Fetal Outcome ◽  
Growth Restriction ◽  
Sildenafil Citrate ◽  
Optimal Time ◽  
Diastolic Flow

Fetal growth restriction (FGR), a pregnancy complication still poses as a challenge for obstetricians worldwide. This is because of its association with severe morbidity and mortality outcomes. Obstetrical management becomes a dilemma in determining the optimal time of delivery and weighing the risks of prematurity against the risks of a potentially hostile intrauterine environment. There may be placental insufficiency characterized by insufficient blood flow in the umbilical artery. This is termed as abnormal umbilical artery flow with absent or reversed end diastolic flow on Doppler USG. Worsening of this condition demands an earlier delivery of the fetus. Authors report a case of structurally normal foetus showing severe early onset FGR with absent end diastolic flow in umbilical artery on Doppler, which was managed using vaginal Sildenafil citrate. Sildenafil citrate led to improvement in uterine artery and umbilical artery Doppler parameters; thereby improving the utero-placental blood flow with a favorable fetal outcome at delivery. The gestation was prolonged by 51 days. Thus, Sildenafil citrate can be used as promising agent in early onset FGR in selected cases.

scholarly journals Increased uterine artery blood flow in hypoxic murine pregnancy is not sufficient to prevent fetal growth restriction†

2019 ◽  
Vol 102 (3) ◽  
pp. 660-670 ◽  
Author(s):  
Sydney L Lane ◽  
Alexandrea S Doyle ◽  
Elise S Bales ◽  
Ramón A Lorca ◽  
Colleen G Julian ◽  
...  
Keyword(s):  
Blood Flow ◽  
Fetal Growth ◽  
Murine Model ◽  
Pregnancy Complications ◽  
Fetal Growth Restriction ◽  
Uterine Artery ◽  
Growth Restriction ◽  
Late Gestation ◽  
Artery Blood Flow ◽  
Uterine Arteries

Abstract Incomplete maternal vascular responses to pregnancy contribute to pregnancy complications including intrauterine growth restriction (IUGR) and preeclampsia. We aimed to characterize maternal vascular dysfunction in a murine model of fetal growth restriction as an approach toward identifying targetable pathways for improving pregnancy outcomes. We utilized a murine model of late-gestation hypoxia-induced IUGR that reduced E18.5 fetal weight by 34%. Contrary to our hypothesis, uterine artery blood flow as measured in vivo by Doppler ultrasound was increased in mice housed under hypobaric hypoxia (385 mmHg; 5500 m) vs normoxia (760 mmHg; 0 m). Using wire myography, uterine arteries isolated from hypoxic mice had similar vasodilator responses to the two activators A769662 and acetylcholine as those from normoxic mice, although the contribution of an increase in nitric oxide production to uterine artery vasodilation was reduced in the hypoxic vs normoxic groups. Vasoconstrictor responses to phenylephrine and potassium chloride were unaltered by hypoxia. The levels of activated adenosine monophosphate-activated protein kinase (AMPK) were reduced with hypoxia in both the uterine artery and placenta as measured by western blot and immunohistochemistry. We concluded that the rise in uterine artery blood flow may be compensatory to hypoxia but was not sufficient to prevent fetal growth restriction. Although AMPK signaling was reduced by hypoxia, AMPK was still receptive to pharmacologic activation in the uterine arteries in which it was a potent vasodilator. Thus, AMPK activation may represent a new therapy for pregnancy complications involving reduced uteroplacental perfusion.

scholarly journals Reflected hemodynamic waves influence the pattern of Doppler ultrasound waveforms along the umbilical arteries

2019 ◽  
Vol 316 (5) ◽  
pp. H1105-H1112 ◽  
Author(s):  
John G. Sled ◽  
Greg Stortz ◽  
Lindsay S. Cahill ◽  
Natasha Milligan ◽  
Viji Ayyathurai ◽  
...  
Keyword(s):  
At Risk ◽  
Blood Flow ◽  
Pregnant Women ◽  
Doppler Ultrasound ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Umbilical Artery ◽  
Blood Velocity ◽  
Diagnostic Information ◽  
Growth Restriction

The pulsatile pattern of blood motion measured by Doppler ultrasound within the umbilical artery is known to contain useful diagnostic information and is widely used to monitor pregnancies at risk of fetal growth restriction or stillbirth. Animal studies have identified reflected pressure waves traveling counter to the direction of blood flow as an important factor in the shape of these waveforms. In the present study, we establish a method to measure reflected waves in the human umbilical artery and assess their influence on blood velocity pulsation. Ninety-five pregnant women were recruited from a general obstetrics clinic between 26 and 37 wk of gestation and examined by Doppler ultrasound. Blood velocity waveforms were recorded for each umbilical artery at three locations along the umbilical cord. With the use of a computational procedure, a pair of forward and reverse propagating waves was identified to explain the variation in observed Doppler ultrasound waveforms along the cord. Among the data sets that met data quality requirements, waveforms in 93 of the 130 arteries examined agreed with the wave reflection model to within 1.5% and showed reflections ranging in magnitude from 3 to 52% of the forward wave amplitude. Strong reflections were associated with large differences in pulsatility between the fetal and placental ends of the cord. As reflections arise from transitions in the biomechanical properties of blood vessels, these observations provide a plausible mechanism for the link between abnormal waveforms and clinically significant placental pathology and could lead to more precise screening methods for detecting pregnancies complicated by placental disease.NEW & NOTEWORTHY The pulsatile pattern of blood motion measured by Doppler ultrasound within the umbilical artery is known to contain useful diagnostic information and is widely used to monitor pregnancies at risk of fetal growth restriction. We demonstrate based on a study of 95 pregnant women that the shape of these umbilical artery waveforms is explained by the presence of a reflected pressure wave traveling counter to the direction of blood flow.

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.

Umbilical artery extracellular matrix remodeling in fetal growth restriction

2004 ◽  
Vol 191 (6) ◽  
pp. S10
Author(s):  
Wendy Kinzler ◽  
John Smulian ◽  
C. Andrew Kistler ◽  
Rita Hahn ◽  
Peihong Zhou ◽  
...  
Keyword(s):  
Extracellular Matrix ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Umbilical Artery ◽  
Growth Restriction ◽  
Extracellular Matrix Remodeling ◽  
Matrix Remodeling
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