scholarly journals Predictive value of angiogenic factors, clinical risk factors and uterine artery Doppler for pre-eclampsia and fetal growth restriction in second and third trimester pregnancies in an Ecuadorian population

2015 ◽  
Vol 29 (4) ◽  
pp. 537-543 ◽  
Author(s):  
Carolin Kienast ◽  
Walter Moya ◽  
Oswaldo Rodriguez ◽  
Alfredo Jijón ◽  
Annegret Geipel
Keyword(s):  
Risk Factors ◽  
Fetal Growth ◽  
Predictive Value ◽  
Fetal Growth Restriction ◽  
Uterine Artery ◽  
Angiogenic Factors ◽  
Growth Restriction ◽  
Clinical Risk Factors ◽  
Third Trimester ◽  
Uterine Artery Doppler

scholarly journals Does Pentaerytrithyltetranitrate reduce fetal growth restriction in pregnancies complicated by uterine mal-perfusion? Study protocol of the PETN-study: a randomized controlled multicenter-trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
T. Groten ◽  
◽  
T. Lehmann ◽  
E. Schleußner
Keyword(s):  
Birth Weight ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Uterine Artery ◽  
Therapeutic Option ◽  
Multicenter Trial ◽  
Growth Restriction ◽  
Organic Nitrate ◽  
Phosphodiesterase Type 5 Inhibitors ◽  
Uterine Artery Doppler

Abstract Background Affecting approximately 10% of pregnancies, fetal growth restriction (FGR), is the most important cause of perinatal mortality and morbidity. Impaired placental function and consequent mal-perfusion of the placenta is the leading cause of FGR. Although, screening for placental insufficiency based on uterine artery Doppler measurement is well established, there is no treatment option for pregnancies threatened by FGR. The organic nitrate pentaerithrityl tetranitrate (PETN) is widely used for the treatment of cardiovascular disease and has been shown to have protective effects on human endothelial cells. In a randomized placebo controlled pilot-study our group could demonstrate a risk reduction of 39% for the development of FGR, and FGR or death, by administering PETN to patients with impaired uterine artery Doppler at mid gestation. To confirm these results a prospective randomized placebo controlled double-blinded multicentre trial was now initiated. Method The trial has been initiated in 14 centres in Germany. Inclusion criteria are abnormal uterine artery Doppler, defined by mean PI > 1.6, at 190 to 226 weeks of gestation in singleton pregnancies. Included patients will be monitored in 4-week intervals. Primary outcome measures are development of FGR (birth weight < 10th percentile), severe FGR (birth weight < 3rd centile) and perinatal death. Placental abruption, birth weight below the 3rd, 5th and 10th centile, development of FGR requiring delivery before 34 weeks` gestation, neonatal intensive care unit admission, and spontaneous preterm delivery < 34 weeks` and 37 weeks` gestation will be assessed as secondary endpoints. Patient enrolment was started in August 2017. Results are expected in 2020. Discussion During the past decade therapeutic agents with possible perfusion optimizing potential have been evaluated in clinical trials to treat FGR. Meta-analysis and sub-analysis of trials targeting preeclampsia revealed ASS to have a potential in reducing FGR. Phosphodiesterase-type-5 inhibitors have recently been tested in a worldwide RCT for therapy of established FGR, failing to show an effect on neonatal outcome. The ongoing multicenter trial will, by confirming our previous results, finally provide a therapeutic option in cases at risk for FGR. Trial registration DRKS00011374 registered at September 29th, 2017 and NCT03669185, registered September 13th, 2018.

scholarly journals Evaluation of Placental Perfusion Based on Intravoxel Incoherent Motion Diffusion Weighted Imaging (IVIM-DWI) and Its Predictive Value for Late-Onset Fetal Growth Restriction

2018 ◽  
Vol 79 (04) ◽  
pp. 396-401
Author(s):  
Hui Shi ◽  
Xianyue Quan ◽  
Wen Liang ◽  
Xinming Li ◽  
Bin Ai ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Predictive Value ◽  
Fetal Growth Restriction ◽  
Diffusion Weighted Imaging ◽  
Uterine Artery ◽  
Late Onset ◽  
Late Pregnancy ◽  
Growth Restriction ◽  
Placental Perfusion ◽  
Perfusion Fraction

Abstract Objective The aim of this study was to investigate placental blood perfusion in middle and late pregnancy and explore its predictive value for fetal growth restriction (FGR). Methods All pregnant women included in the study were examined using placental intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI). Three IVIM parameters (D, f, D*) were obtained for each pregnant woman and analyzed using Image J software. Perfusion fraction f is a radiological marker of placental perfusion. The pulsatility index (PI) of the uterine artery is used to indirectly evaluate placental function. Results f-values were significantly lower in the late-onset FGR group compared to the normal late pregnancy group (19.07 vs. 27.78%). In addition, uterine artery PI values were markedly increased in the late-onset FGR group compared to the normal late pregnancy group (1.96 vs. 1.03), and neonatal weight was significantly lower in the late-onset FGR group (2.75 vs. 3.18 kg). There was a significant positive correlation between f-value, uterine artery PI and neonatal weight (r = 0.968, p < 0.01; r = 0.959, p < 0.01). There was a significant negative correlation between f-value and age of gestation (r = − 0.534, p < 0.01). Conclusion Perfusion fraction f was strongly correlated with uterine artery blood flow resistance as measured by color Doppler and had a certain predictive value for late-onset FGR.

scholarly journals P08.07: Maternal uterine artery Doppler changes in pre-eclampsia and fetal growth restriction

2018 ◽  
Vol 52 ◽  
pp. 160-160
Author(s):  
J. Tay ◽  
G. Masini ◽  
C. Lees ◽  
I.B. Wilkinson ◽  
C.M. McEniery
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Uterine Artery ◽  
Growth Restriction ◽  
Uterine Artery Doppler

scholarly journals The use of folates for the prevention of fetal growth restriction during pregnancy

2018 ◽  
pp. 65-67
Author(s):  
N. E. Kan ◽  
Z. V. Khachatryan ◽  
V. L. Tyutyunnik ◽  
N. A. Lomova ◽  
A. E. Donnikov
Keyword(s):  
Risk Factors ◽  
Folic Acid ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Clinical Risk Factors ◽  
Control Group ◽  
Mthfr Polymorphism ◽  
Clinical Risk ◽  
Group I

Purpose of the study: Rational for the use of folates for the prevention of fetal growth restriction on the basis of the identification of a MTHFR polymorphism.Material and methods: 200 patients (case-control) were enrolled in the study. The (main) group I included 100 patients with fetal growth restriction (FGR), the (control) group II included 100 conditionally healthy patients. The features of the anamnesis, the initial clinical characteristics, the course of pregnancy, childbirth and the postpartum period in patients with placental insufficiency were studied in detail, and the features of the early neonatal period were analysed comprehensively. At the second stage, the polymorphism of the MMP2, MMP3, MMP9, and MTHFR genes was studied and their dependence with the development of the FGR was established. Statistical processing of the results was carried out on a personal computer using the SPSS Statistics 17.0 for Windows software package.Results:The clinical risk factors for the development of FGR include: chronic pyelonephritis, medium degree myopia, varicose veins, threat of abortion, ultrasound-detected subchorionic hemorrhage in the I trimester of gestation, anemia. Along with clinical risk factors for ZRP, the carriage of MTGFR (677 C> T) polymorphism is also considered, which justifies its identification in patients at risk.Conclusion: The data obtained make it possible to use the identification of MTHFR polymorphism as a predictor of placental abnormalities during pregnancy and to start taking folic acid supplements at the preconception stage in good time. Femibion 1 vitaminmineral complex has proved to be an effective product that is suitable for women in the period of preparation for pregnancy and in the first trimester of gestation, reducing the risk of fetal malformations and endothelial dysfunction caused by a violation of folic acid metabolism. 

scholarly journals Uterine Artery Doppler in Screening for Preeclampsia and Fetal Growth Restriction

2018 ◽  
Vol 40 (05) ◽  
pp. 287-293 ◽  
Author(s):  
Marianna Pedroso ◽  
Kirsten Palmer ◽  
Ryan Hodges ◽  
Fabricio Costa ◽  
Daniel Rolnik
Keyword(s):  
Fetal Growth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Fetal Growth Restriction ◽  
Uterine Artery ◽  
Growth Restriction ◽  
Current Evidence ◽  
Individual Risk ◽  
Predictive Test ◽  
Uterine Artery Doppler

Objective To perform a comprehensive review of the current evidence on the role of uterine artery Doppler, isolated or in combination with other markers, in screening for preeclampsia (PE) and fetal growth restriction (FGR) in the general population. The review included recently published large cohort studies and randomized trials. Methods A search of the literature was conducted using Medline, PubMed, MeSH and ScienceDirect. Combinations of the search terms “preeclampsia,” “screening,” “prediction,” “Doppler,” “Doppler velocimetry,” “fetal growth restriction,” “small for gestational age” and “uterine artery” were used. Articles in English (excluding reviews) reporting the use of uterine artery Doppler in screening for PE and FGR were included. Results Thirty articles were included. As a single predictor, uterine artery Doppler detects less than 50% of the cases of PE and no more than 40% of the pregnancies affected by FGR. Logistic regression-based models that allow calculation of individual risk based on the combination of multiple markers, in turn, is able to detect ∼ 75% of the cases of preterm PE and 55% of the pregnancies resulting in small for gestational age infants. Conclusion The use of uterine artery Doppler as a single predictive test for PE and FGR has poor accuracy. However, its combined use in predictive models is promising, being more accurate in detecting preterm PE than FGR.

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