Ultrasound in Prediction of Perinatal Outcomes in Fetuses with Restriction of Intrauterine Growth

Studies of Doppler flow velocimetry have been proceeding as a principle mechanism for identification the compromised small fetus from a small fetus that is improbable to suffer from dangerous perinatal complications. The aim of this study is the Prediction of Perinatal Outcome in Fetuses Suspected to Have Intrauterine Growth Restriction: Doppler US Study of Fetal Cerebral, and Umbilical Arteries. This is a longitudinal prospective study done at department of Obstetrics and Gynecology in Salah Al-Deen General Hospital in Tikrit city between February-July 2020. The study included a convenient sample 100 pregnant women in 3rd trimester suspected of IUGR (n=100). Studies of various fetal vessels were performed using color Doppler ultrasound curvilinear probe with a high pass filter. The following vessels were studied with the mother in a recumbent position during fetal inactivity and apnea. 1st Umbilical Artery (UA), 2nd Middle Cerebral Artery (MCA). Fetal outcome was studied under major and minor adverse outcomes. The current study found that the umbilical artery systolic/diastolic ratio was concordant with major and minor adverse outcome among 55 cases regarding of abnormal finding, and among 25 case regarding negative findings. The umbilical artery RI was concordant with major and/or minor adverse outcome among 34 cases regarding of abnormal finding, and among 28 case regarding negative findings. The umbilical artery PI was concordant with major and/or minor adverse outcome among 52 cases regarding of abnormal finding, and among 29 case regarding negative findings. Serial Doppler examinations of fetal (S/D ratio, UA RI, & UA PI), and (MCA PI, & MCA/UA PI) provide better information than does a single measurement.

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541A Nationwide Evaluation of International Standards and Commonly-used Growth Charts for Predicting Adverse Perinatal Outcomes

International Journal of Epidemiology ◽

10.1093/ije/dyab168.130 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Stephanie Choi ◽

Adrienne Gordon ◽

Lisa Hilder ◽

Amanda Henry ◽

Jon A. Hyett ◽

...

Keyword(s):

At Risk ◽

Adverse Outcome ◽

Perinatal Outcomes ◽

Predictive Ability ◽

Adverse Outcomes ◽

International Standards ◽

Large For Gestational Age ◽

Growth Charts ◽

Mortality And Morbidity

Abstract Background Abnormal fetal growth is a risk factor for perinatal mortality and morbidity. There is considerable debate about the choice and performance of growth charts to classify newborns as small or large for gestational age (SGA and LGA) as a proxy for the at-risk infants. Several international charts have been proposed to be adopted worldwide. We aim to evaluate the performance of commonly-used growth charts (including international INTERGROWTH-21st-standards) for predicting adverse outcomes among SGA and LGA babies. Methods A population cohort of 2.4 million singleton births (24+0–40+6 weeks) delivered in Australia, 2004–2013. Performance was evaluated by prevalence, relative risk and diagnostic accuracy for adverse outcome based on AUC. Results There was wide variation in SGA and LGA classification across charts. For example, compared to other charts, the INTERGROWTH-21st-standards classified half of the number of term-SGA babies (prevalence: 3-4% vs. 7-10%) (<10th-centile) and double the number of LGA babies (prevalence: 24-25% vs. 8-18%) (>90th-centile), resulting in a smaller cohort of term-SGA at higher-risk of adverse outcome, and a larger LGA cohort with lower-risk of adverse outcome. All charts performed poorly for detecting adverse outcomes (AUC range for a composite outcome: 0.49-0.68) and across birthweight centiles. Conclusions Significant differences in the classification of newborns and the chart performance raises concerns about whether the INTERGROWTH-21st-standards are applicable to a multi-ethnic population such as Australia. Key messages Significant differences in the classification of newborns and the relatively poor predictive ability of growth charts means that over reliance on infant size alone may misclassify, and thus miss at-risk infants.

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Significance of umbilical artery doppler velocimetry in the perinatal outcome of growth restricted fetuses

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180895 ◽

2018 ◽

Vol 7 (3) ◽

pp. 1074

Author(s):

Jyothi Susan Thomas ◽

A. Malliga ◽

S. Sethurajan

Keyword(s):

Perinatal Outcome ◽

Umbilical Artery ◽

Perinatal Outcomes ◽

Significant Rise ◽

Growth Restriction ◽

Doppler Velocimetry ◽

Perinatal Complications ◽

Chi Square ◽

Chi Square Test ◽

Umbilical Artery Doppler

Background: The objectives of the study are to determine the relationship between the umbilical artery Doppler and perinatal outcome in growth restricted foetuses and to compare the outcome with those of normal foetuses.Methods: A prospective observational study in which subjects were divided into two groups, pregnancies affected with intrauterine growth restriction (IUGR) and pregnancies with normal fetuses. Both the groups were followed with Doppler velocimetry of umbilical artery after 28 weeks till delivery. The perinatal outcome of both the groups with normal and abnormal umbilical artery Doppler (reduced/ absent/ reversed end – diastolic flow) were analysed with Chi-square test and student t - test using SPSS software version 15.0.Results: Umbilical artery Doppler velocimetry showed significant abnormality in growth restricted foetuses in comparison to normal foetuses. There was significant increase in the delivery of IUGR foetuses <37 weeks gestation(p<0.05). There was a significant increase in operative deliveries in both the groups with abnormal umbilical artery Doppler. A significant rise in adverse perinatal outcomes, Apgar <7 at 5 min and low birth weight in IUGR foetuses in comparison to normal foetuses (p<0.05).Conclusions: There is a strict correlation between abnormal umbilical artery Doppler velocimetry and an increased incidence of perinatal complications in growth restricted foetuses compared to normal foetuses. Hence, umbilical artery Doppler velocimetry should be used in all patients with fetal growth restriction, to identify impending hypoxia, to optimise the time of delivery and to optimise the perinatal outcome in these patients.

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

Perinatal Journal ◽

10.2399/prn.21.0291004 ◽

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.

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

Fetal Diagnosis and Therapy ◽

10.1159/000439023 ◽

2015 ◽

Vol 39 (3) ◽

pp. 186-191 ◽

Cited By ~ 22

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.

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Intrauterine thrombosis of umbilical artery - case report

Sao Paulo Medical Journal ◽

10.1590/1516-3180.2016.00081203 ◽

2016 ◽

Vol 134 (4) ◽

pp. 355-358 ◽

Cited By ~ 5

Author(s):

Gustavo Henrique de Oliveira ◽

Cristiane de Moraes Dias ◽

Denise Cristina Mós Vaz-Oliani ◽

Antonio Hélio Oliani

Keyword(s):

Case Report ◽

Umbilical Cord ◽

Intrauterine Growth Restriction ◽

Umbilical Artery ◽

Correct Diagnosis ◽

Perinatal Morbidity ◽

Mechanical Compression ◽

Perinatal Complications ◽

Intrauterine Growth ◽

High Chance

ABSTRACT: CONTEXT: Umbilical cord thrombosis is related to greater fetal and perinatal morbidity and mortality. It is usually associated with umbilical cord abnormalities that lead to mechanical compression with consequent vascular ectasia. Its correct diagnosis and clinical management remains a challenge that has not yet been resolved. CASE REPORT: This study reports a case of umbilical artery thrombosis that occurred in the second half of a pregnancy. The umbilical cord was long, thin and overly twisted and the fetus presented severe intrauterine growth restriction. The clinical and histopathological findings from this case are described. CONCLUSIONS: This case report emphasizes the difficulty in diagnosing and clinically managing abnormalities of intrauterine life with a high chance of perinatal complications.

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

Twin Research and Human Genetics ◽

10.1017/thg.2021.7 ◽

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.

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Relation of the Renal Artery Color Doppler With the Umbilical Artery and Amniotic Fluid Index in Fetuses Affected by Intrauterine Growth Retardation

International Journal of Women s Health and Reproduction Sciences ◽

10.15296/ijwhr.2020.63 ◽

2020 ◽

Vol 8 (4) ◽

pp. 396-400

Author(s):

Neda Shoari ◽

Shamci Abbasalizadeh ◽

Zahra Faridiazar ◽

Sanaz Mousavi ◽

Farnaz Sahhaf

Keyword(s):

Amniotic Fluid ◽

Renal Artery ◽

Growth Retardation ◽

Intrauterine Growth Retardation ◽

Umbilical Artery ◽

Color Doppler ◽

Treatment Center ◽

Diagnostic Study ◽

Amniotic Fluid Index ◽

Intrauterine Growth

Objectives: This study was performed to investigate the relationship between the renal artery color Doppler with the umbilical artery and amniotic fluid index (AFI) in fetuses affected by intrauterine growth retardation (IUGR). Materials and Methods: This was a descriptive cross-sectional diagnostic study and the target population included pregnant mothers who were diagnosed to have fetuses with IUGR referring to the Al-Zahra treatment center in Tabriz. At least 40 samples were referred between October 2019 and May 2020. The patients were evaluated using the transabdominal ultrasound of the umbilical artery and fetal renal artery, and then using the color Doppler values of the umbilical artery and fetal renal artery. Results: The present research was performed on 40 pregnant females with an IUGR fetus with umbilical artery percentile upper that 95% whose minimum to maximum age range was 22-38 years. There is no relationship between umbilical artery and renal artery color Doppler. In addition, umbilical artery color Doppler is not related to amniotic fluid, also renal artery color Doppler demonstrated no significant correlation with amniotic fluid index. Conclusions: Based on our results, the PI of the umbilical artery had no significant correlation with that of the renal artery. In addition, there was no significant correlation with the PI of the renal artery and AFI.

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

10.36106/ijsr/1333990 ◽

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.

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