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 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 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 Time interval analysis of ductus venosus and cardiac cycles in relation with umbilical artery pH at birth in fetal growth restriction

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tomoki Suekane ◽  
Daisuke Tachibana ◽  
Yasushi Kurihara ◽  
Natsuko Yokoi ◽  
Naomi Seo ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Interval Analysis ◽  
Fetal Growth Restriction ◽  
Umbilical Artery ◽  
Growth Restriction ◽  
Ductus Venosus ◽  
Time Interval ◽  
Z Score ◽  
Time Intervals ◽  
Z Scores

Abstract Background The aims of this study were to evaluate the time intervals of flow velocity waveforms (FVW) of ductus venosus (DV) and cardiac cycles, as well as the pulsatility index of DV-FVW (DV-PI), in correlation with umbilical artery (UA) pH at birth in fetal growth restriction (FGR) complicated with placental insufficiency. Methods Data were retrospectively retrieved from pregnancies complicated by FGR. FGR was defined as an estimated fetal weight below − 2.0 S.D. with an elevated UA-PI. Time interval assessments of DV-FVW were as follows: the duration of systolic wave was divided by the duration of diastolic wave and defined as DV-S/D. We also measured the following time intervals of ventricular inflow through tricuspid valve (TV) and mitral valve (MV): (iii), from the second peak of ventricular inflow caused by atrial contraction (A-wave) to the opening of atrio-ventricular valves and: (iv), from the opening of atrio-ventricular valves to the peak of A-wave. (iii)/(iv) was expressed as TV-S/D and MV-S/D, for TV and MV, respectively. The time interval data were transformed into z-scores. Results Thirty-one FGR fetuses were included in this study. Both DV-PI and DV-S/D showed significant correlation with UA-pH (r = − 0.677, p = < 0.001 and r = 0.489, p = 0.005 for DV-PI and z-score of DV-S/D, respectively) and more significances were observed in FGR ≤ 28 + 6 gestational weeks (r = − 0.819, p < 0.001 and r = 0.726, p = 0.005, for DV-PI and z-score of DV-S/D, respectively) than in FGR > 28 + 6 gestational weeks (r = − 0.634, p = 0.007 and r = 0.635, p = 0.020, for DV-PI and z-score of DV-S/D, respectively). On the other hand, TV-S/D and MV-S/D showed no significant correlation with UA-pH, although these z-scores indicated significant decreases compared with normal references. Conclusions Time interval analysis of DV-FVW might be a valuable parameter, as well as DV-PI, for the antenatal prediction of fetal acidemia in the management of FGR fetuses.

scholarly journals Defining the relationship between fetal Doppler indices, abdominal circumference and growth rate in severe fetal growth restriction using functional linear discriminant analysis

2013 ◽  
Vol 10 (88) ◽  
pp. 20130376 ◽  
Author(s):  
Alon Talmor ◽  
Anneleen Daemen ◽  
Edile Murdoch ◽  
Hannah Missfelder-Lobos ◽  
Dirk Timmerman ◽  
...  
Keyword(s):  
Growth Rate ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Pulsatility Index ◽  
Umbilical Artery ◽  
Growth Restriction ◽  
Abdominal Circumference ◽  
Ductus Venosus ◽  
Linear Discriminant ◽  
The Relationship

The relationship between Doppler measurements, size and growth rate in fetal growth restriction has not been defined. We used functional linear discriminant analysis (FLDA) to investigate these parameters taking account of the difficulties inherent in exploring relationships between repeated observations from a small number of cases. In 40 fetuses with severe growth restriction, serial abdominal circumference (AC), umbilical, middle cerebral artery (MCA) and ductus venosus Doppler pulsatility index measurements were recorded. In 11 singleton fetuses with normal growth, umbilical artery pulsatility index only was measured. Data were expressed as z -scores in relation to gestation and analysed longitudinally using FLDA. In severe growth restriction, the Spearman correlation coefficients between umbilical artery pulsatility index and AC z -score, MCA pulsatility index and AC z -score and ductus venosus pulsatility index z -score and AC z -score were, respectively: −0.36, p = 4.4 × 10 −7 ; 0.70, p = 1.1 × 10 −17 and −0.50, p = 8.1 × 10 −4 . No relationship was seen between Doppler parameters and growth rate. There was no relationship between umbilical artery pulsatility index and AC nor growth rate in normally grown fetuses. In severe fetal growth restriction, Doppler changes are related to absolute fetal AC size, not growth rate.

scholarly journals Successful amnioinfusion for severe fetal growth restriction with umbilical cord complications: two case reports

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Daisuke Katsura ◽  
Yuichiro Takahashi ◽  
Shigenori Iwagaki ◽  
Rika Chiaki ◽  
Kazuhiko Asai ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Umbilical Cord ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Umbilical Artery ◽  
Cord Compression ◽  
Growth Restriction ◽  
Ductus Venosus ◽  
Fetal Ultrasound ◽  
Fetal Doppler

Abstract Background There is no established treatment for fetal growth restriction during pregnancy. We report two cases that represent an example of an amnioinfusion-based management strategy for severe fetal growth restriction with umbilical cord complications. Case presentation We encountered two cases of fetal growth restriction with abnormal fetal Doppler velocity. In one case, fetal ultrasound revealed a hypercoiled umbilical cord with a single umbilical artery and oligohydramnios, while fetal Doppler revealed a reversed end-diastolic flow in the umbilical artery and reversed a-waves of the ductus venosus. Umbilical cord compression was confirmed at 22 weeks and 2 days of gestation, and nine amnioinfusions were performed to relieve the umbilical cord compression. A cesarean section was performed at 31 weeks and 2 days of gestation because of severe preeclampsia. The Asian infant is now a normally developed 6-month-old. In another Asian case, fetal ultrasound revealed a hypercoiled cord, while fetal Doppler revealed a reversed end-diastolic flow in the umbilical artery and intermittent reversed a-waves of the ductus venosus. Umbilical cord compression was confirmed at 24 weeks and 5 days of gestation, and seven amnioinfusions were performed. A cesarean section was performed at 31 weeks and 1 day of gestation because of nonreassuring fetal status. At the age of 1 month, the Asian infant was stable on respiratory circulation. In both cases, fetal Doppler findings improved significantly following amnioinfusions. Conclusions Amnioinfusion is a symptomatic treatment for umbilical cord compression. However, to determine the therapeutic effect of amnioinfusion, complete resolution of the umbilical cord compression should be ascertained by ultrasonography.

The ability of various cerebroplacental ratio thresholds to predict adverse neonatal outcomes in term fetuses exhibiting late-onset fetal growth restriction

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Rauf Melekoglu ◽  
Ercan Yilmaz ◽  
Seyma Yasar ◽  
Irem Hatipoglu ◽  
Bekir Kahveci ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Umbilical Artery ◽  
Late Onset ◽  
Growth Restriction ◽  
Neonatal Outcomes ◽  
Fetal Medicine ◽  
Cerebroplacental Ratio ◽  
Adverse Neonatal Outcomes

AbstractObjectivesOur primary aim was to evaluate the ability of various cerebroplacental ratio (CPR) reference values suggested by the Fetal Medicine Foundation to predict adverse neonatal outcomes in term fetuses exhibiting late-onset fetal growth restriction (LOFGR). Our secondary aim was to evaluate the effectiveness of other obstetric Doppler parameters used to assess fetal well-being in terms of predicting adverse neonatal outcomes.MethodsThis was a retrospective cohort study of 317 pregnant women diagnosed with LOFGR at 37–40 weeks of gestation between January 1, 2016, and September 1, 2019. Receiver operating characteristic (ROC) curves were drawn to determine the predictive performance of CPR <1, CPR <5th or <10th percentile, and umbilical artery pulsatility (PI) >95th percentile in terms of predicting adverse neonatal outcomes.ResultsPregnant women exhibiting LOFGR who gave birth in our clinic during the study period at a mean of 38 gestational weeks (minimum 37+0; maximum 40+6 weeks); the median CPR was 1.51 [interquartile range (IQR) 1.12–1.95] and median birthweight 2,350 g (IQR 2,125–2,575 g). The CPR <5th percentile best predicted adverse neonatal outcomes [area under the curve (AUC) 0.762, 95% confidence interval (CI) 0.672–0.853, p<0.0001] and CPR <1 was the worst predictor (AUC 0.630, 95% CI 0.515–0.745, p=0.021). Of other Doppler parameters, neither the umbilical artery systole/diastole ratio nor the mid-cerebral artery to peak systolic velocity ratio (MCA–PSV) predicted adverse neonatal outcomes (AUC 0.598, 95% CI 0.480–0.598, p=0.104; AUC 0.521, 95% CI 0.396–0.521, p=0.744 respectively).ConclusionsThe CPR values below the 5th percentile better predicted adverse neonatal outcomes in pregnancies complicated by LOFGR than the UA PI and CPR <1 by using Fetal Medicine Foundation reference ranges.

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.

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