scholarly journals Significance of Umbilical Artery Velocimetry in Perinatal Outcome of Growth Restricted Fetuses

2016 ◽  
Vol 33 (1) ◽  
pp. 12-17
Author(s):  
Zakia Afroze ◽  
Rokeya Begum
Keyword(s):  
Neonatal Intensive Care ◽  
Umbilical Artery ◽  
Perinatal Death ◽  
Fetal Distress ◽  
Accurate Method ◽  
Doppler Velocimetry ◽  
Average Birth Weight ◽  
Diastolic Flow ◽  
Doppler Study ◽  
Gestational Age At Delivery

Objectives: To study pregnancy outcomes in growth restricted fetuses with normal umbilical artery velocimetry, low end-diastolic umbilical flow, and absent or reversed diastolic flow. Methods: Fifty pregnant women with growth restricted fetuses were evaluated by umbilical artery velocimetry between 28 and 39 weeks of pregnancy. Outcome of pregnancy was recorded for the normal Doppler group (n=17; 34%), the low end diastolic flow group (n=23; 46%), the group with absent diastolic flow (n=8; 16%) and the group with reversed diastolic flow (n=2; 4%). Results: The average birth weight, diagnosis to delivery interval and gestational age at delivery were comparatively lower in case of abnormal umbilical Doppler velocimetry group. Again there was higher incidence of LSCS for fetal distress, Apgar score <7 at 1 minute, admission to neonatal intensive care unit and perinatal death with those of the abnormal umbilical Doppler velocimetry. Conclusion: Doppler study of umbilical artery allows a noninvasive assessment of uteroplacental insufficiency and is an accurate method for diagnosis and management of fetal growth retardation.J Bangladesh Coll Phys Surg 2015; 33(1): 12-17

scholarly journals Efficacy of doppler velocimetry of the umbilical artery in the defined high-risk groups to determine the fetal outcome

2019 ◽  
Vol 8 (5) ◽  
pp. 1724
Author(s):  
Maneesha R. Suryavanshi ◽  
Shriraj S. Katakdhond
Keyword(s):  
High Risk ◽  
Perinatal Outcome ◽  
Neonatal Intensive Care ◽  
Resistance Index ◽  
Fetal Distress ◽  
Risk Groups ◽  
Hypertensive Disorder ◽  
Doppler Velocimetry ◽  
Diastolic Flow ◽  
Doppler Study

Background: Doppler ultrasound provides a non-invasive method of studying the status of various blood vessels. It provides a spectrum analysis of the velocities of moving red blood cells. Doppler sonography can provide useful information in a variety of gynecological and obstetric conditions. In obstetrics, Doppler velocimetry of the uteroplacental and fetoplacental circulation can be used to further investigate complications of pregnancy such as fetal growth restriction, other forms of fetal distress that result from fetal hypoxemia or asphyxia.Methods: In a prospective observational study, 93 pregnancies fitting in the criteria for high risk were evaluated by doppler velocimetry between 28-40 weeks of gestation. The flow velocity time wave forms were examined and quantitated by use of systolic/diastolic (S/D) ratio, resistance index (RI), pulsatility index (PI) values. The outcome of pregnancy was noted.Results: Fetuses with abnormal velocimetry are at higher risk with regard to birth weight, Apgar score, fetal distress, need of cesarean section, need of NICU admission. The patients with absent end-diastolic flow (AEDF)/reversal of end-diastolic flow (REDF) had poor perinatal outcome. Positive predictive value for small for gestational age (SGA) and fetal distress was 75% and 60% respectively. 23.8% babies needed to be kept in neonatal intensive care unit (NICU).Conclusions: Doppler velocimetry can be useful prenatal test for the patients of hypertensive disorder of pregnancy and IUGR. Abnormal doppler waveform changes indicate adverse perinatal outcome. Appropriate and timely interventions guided by doppler study help to reduce perinatal morbidity and mortality.

scholarly journals Umbilical artery Doppler indices in relation to fetal outcome in high risk pregnancy

2018 ◽  
Vol 7 (2) ◽  
pp. 628
Author(s):  
Rashmi L. ◽  
Ashish Bhattacharjee
Keyword(s):  
High Risk ◽  
Neonatal Intensive Care ◽  
Umbilical Artery ◽  
Fetal Outcome ◽  
High Risk Pregnancy ◽  
Doppler Velocimetry ◽  
Average Birth Weight ◽  
Risk Pregnancy ◽  
Umbilical Artery Doppler ◽  
Doppler Indices

Background: Umbilical artery Doppler indices in relation to fetal outcome in high risk pregnancy. The aim of this study was to study the umbilical artery Doppler velocimetry in predicting the fetal outcome in high risk pregnancy. This is a prospective study done over a period of 1 year in Silchar Medical College and Hospital from 1st September 2011 to 31st August 2012. 100 women with singleton pregnancy with high risk admitted in SMCH were subjected to umbilical artery Doppler along with morphology and biometry scan after fulfilling the inclusion and exclusion criteria.Methods: 100 women with high risk pregnancy were evaluated by umbilical artery velocimetry between 28 and 41 weeks of pregnancy. Outcome of pregnancy was recorded for the normal Doppler group (n = 79; 79%), the low-end diastolic flow group (n = 19; 19%) and the group with absent/reversed diastolic flow (n = 2; 2%).Results: Mothers with abnormal velocimetry had more number of caesarean sections than those with normal velocimetry. The diagnosis to delivery interval, gestational age at delivery and average birth weight were comparatively lower with higher incidence of admission to neonatal intensive care unit in foetuses with abnormal umbilical Doppler velocimetry. Sensitivity, specificity, positive and negative predictive values of Doppler for detecting abnormal fetal outcome were 43%, 83%, 33% and 88% respectively. Statistical analysis used: sensitivity, specificity and predictive values.Conclusions: Fetuses with normal flow velocimetry are at lower risk than those with abnormal velocimetry in terms of poor Apgar score and neonatal intensive care admission. The average birth weight of the neonates with abnormal Doppler studies was lower than that of neonates with normal velocimetry. Doppler velocimetry studies of umbilical artery can provide the obstetrician important information regarding fetal wellbeing to help him improve fetal outcome. 

scholarly journals A prospective study on the role of umbilical artery doppler velocimetry in the perinatal outcome of growth restricted fetuses

2019 ◽  
Vol 8 (12) ◽  
pp. 4930
Author(s):  
Sumathi R. ◽  
Mercy R. Rodrigo
Keyword(s):  
Pregnancy Outcomes ◽  
Umbilical Artery ◽  
Fetal Distress ◽  
Doppler Velocimetry ◽  
Perinatal Complications ◽  
Average Birth Weight ◽  
Diastolic Velocity ◽  
Flow Velocimetry ◽  
Umbilical Artery Doppler ◽  
Group 2

Background: To compare pregnancy outcomes in growth-restricted fetuses retaining normal umbilical artery doppler flow and the outcomes of pregnancies with end-diastolic velocity diminished or severely reduced/absent.Methods: In a prospective observational study, one hundred pregnant women with growth-restricted fetuses were followed with doppler velocimetry of the umbilical artery between weeks 28 and 41 of pregnancy. Outcomes were compared for the normal doppler group (55%) (Group 1), the low-end diastolic flow group (32%) (Group 2), and the group with severely reduced or absent end-diastolic velocity waveforms (13%) (Group 3).Results: Fetuses with abnormal umbilical flow velocimetry had higher incidence of oligohydramnios (82.2%). The average birth weight and gestational age at delivery were lower in the abnormal doppler group. Significantly more women with severe reduction/AEDV, 31/45 (68.8%), underwent caesarean section, with 20 of them (44.4 %) for fetal distress, compared with 17/55 (30.9%) women in the normal doppler group, with 9 of them (16.4%) for fetal distress. Also, fetuses with abnormal umbilical artery velocimetry had early delivery at less than 36 weeks of gestation (38.2% versus 65.85%), increased NICU admission (32.7% versus 80%), need for PPV (5.5% versus 40%), low Apgar score (9.1 % versus 50.2%) than those with normal doppler. All the three stillbirths in the study population were in the abnormal doppler group.Conclusions: Umbilical artery doppler velocimetry helps in differentiating fetus with pathological growth restriction at risk for perinatal complications from small and healthy fetuses.

scholarly journals THE CORRELATION OF ARTERIAL CORD BLOOD GAS VALUES AND APGAR SCORES IN TERM BABIES WITHOUT FETAL DISTRESS AND THEIR EFFECTS ON NICU ADMISSIONS

2021 ◽  
Author(s):  
ASLAN YILMAZ ◽  
Nesrin Kaya ◽  
Ipek Ulkersoy ◽  
Zeynep Alp Ünkar ◽  
Hazal Cansu ACAR ◽  
...  
Keyword(s):  
Cord Blood ◽  
Neonatal Intensive Care ◽  
Umbilical Artery ◽  
Fetal Distress ◽  
Well Being ◽  
Blood Gas ◽  
Threshold Values ◽  
Apgar Scores ◽  
Nicu Admission ◽  
Two Parameters

Abstract Background Umbilical artery cord blood gas (UACG) values and Apgar scores (AS) are the two parameters that provide the fastest information about the well-being of a baby after birth. We hypothesized that AS may not be sufficient for a complete and correct evaluation of the newborns and UACG should be used routinely for all births even without any signs of fetal distress. Material-methods In this retrospective study, the data of 1781 babies born between January 2018 and December 2019 at Cerrahpasa Faculty of Medicine were analyzed. Newborn with fetal distress, congenital anomalies, severe and moderate acidemia (pH ≤7.1 at UACG), and pre and postterm newborns are excluded. The UACG and the 1 and 5-minute AS data of 1438 cases were evaluated. Mild acidemia was accepted as a pH between 7.1 and 7.2. Following UACG threshold values were accepted as abnormal pH <7.2, BE <-6 mmol/l, lactate ≥5 mmol/l, HCO3 <18 mmol/l, pCO2 ≥50 mmHg. We evaluated the correlation between UACG and 1 and 5-minute AS and their effects on admission to neonatal intensive care unit (NICU). Results There was a significant correlation between both 1 and 5-minute AS and UACG values such as pH, lactate, and pCO 2 (p<0.001). In addition, significant correlation was found between the 5-minute AS below 7 and some UACG abnormal threshold values (pH, HCO 3 , base excess) (p<0.001). We found that some cases with mild acidemia had a normal 1 and 5-minute Apgar scores (AS≥7) in %1.9 and %2 of cases, respectively. A significant correlation was found between admissions to NICU with 1 and 5-minute AS of <7 (p<0.001). Conclusions The 5-minute AS of 7 or higher may not be sufficient to verify the well-being of a newborn. Relying only on AS, may create the risk of missing some newborns with mild metabolic acidosis. 1 and 5-minute AS could be used as a predictive value for NICU admission. We propose that routine UACG should be evaluated for each birth at term, even without any signs of fetal distress and normal AS.

scholarly journals A study of fetomaternal outcome in induction of labour in third trimester oligohydramnios

2019 ◽  
Vol 8 (11) ◽  
pp. 4196
Author(s):  
Nalini Sharma ◽  
Hanslata Gehlot
Keyword(s):  
Amniotic Fluid ◽  
Neonatal Intensive Care ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Fetal Distress ◽  
Labor Induction ◽  
Operative Delivery ◽  
Amniotic Fluid Index ◽  
Gestational Age At Delivery ◽  
A Prospective Study

Background: The Induction of labor in oligohydramnios poses a dilemma for obstetrician. Studies are limited with variable results. This study aims at finding whether isolated oligohydramnios is an indication for operative delivery or labor induction followed by vaginal delivery is possible.Methods: A prospective study carried out on females delivered in study duration in Umaid Hospital, Jodhpur, Rajasthan. Outcomes studied were gestational age at delivery, colour of amniotic fluid, FHR tracings, mode of delivery, indication for cesarean section or instrumental delivery, Apgar score at one minute and five minutes, birth weight, admission to Neonatal Intensive Care Unit (NICU), perinatal morbidity and perinatal mortality. Descriptive statistics were applied and data was represented on frequency tables, graphs and diagrams.Results: 40% of subjects had amniotic fluid index (AFI) <5 cm and 60% demonstrated AFI between 5-7 cm. 60% of patients induced delivered vaginally with (38.33%) having AFI <5 cm. Operative delivery was resorted to in 40% of patients. Perinatal outcomes resulted in total 97% of babies discharged in healthy condition.Conclusions: Labor induction is feasible in idiopathic oligohydramnios. Fetal distress is the most feared and predicted outcome with labor induction in oligohydramnios. This study deduced that in majority- reason for c-sections was failed labor induction due the poor Bishop's score, not fetal reasons. We hope by putting at rest apprehensions of obstetrician regarding this notion rate of c-sections could be reduced.

Placental Location in Maternal-Fetal Surgery for Myelomeningocele

2021 ◽  
Author(s):  
Joseph B. Lillegard ◽  
Stephanie A. Eyerly-Webb ◽  
David A. Watson ◽  
Mert Ozan Bahtiyar ◽  
Kelly A. Bennett ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Membrane Separation ◽  
Perinatal Death ◽  
Fetal Surgery ◽  
Obstetric Outcomes ◽  
Uterine Incision ◽  
Increased Risk ◽  
Gestational Age At Delivery

Introduction: Uterine incision based on placental location in open maternal-fetal surgery (OMFS) has never been evaluated in regards to maternal or fetal outcomes. Objective: To investigate whether an anterior placenta was associated with increased rates of intraoperative, perioperative, antepartum, obstetric, or neonatal complications in mothers and babies who underwent OMFS for myelomeningocele (fMMC) closure. Methods: Data from the international multi-center prospective registry of patients who underwent OMFS for fMMC closure (fMMC Consortium Registry, 12/15/2010-7/31/2019) was used to compare fetal and maternal outcomes between anterior and posterior placental locations. Results: Placental location for 623 patients was evenly distributed between anterior (51%) or posterior (49%). Intraoperative fetal bradycardia (8.3% vs 3.0%, p=0.005) and performance of fetal resuscitation (3.6% vs 1.0%, p=0.034) occurred more frequently in cases with an anterior placenta when compared to those with a posterior placenta. Obstetric outcomes including membrane separation, placental abruption, and spontaneous rupture of membranes were not different among the two groups. However, thinning of the hysterotomy site (27.7% vs 17.7%, p=0.008) occurred more frequently in cases of anterior placenta. Gestational age at delivery (p=0.583) and length of stay in the neonatal intensive care unit (p=0.655) were similar between the two groups. Fetal incision dehiscence and wound revision were not significantly different between groups. Critical clinical outcomes including fetal demise, perinatal death, and neonatal death were all infrequent occurrences and not associated with placental location. Conclusions: Anterior placental location is associated with increased risk of intraoperative fetal resuscitation and increased thinning at the hysterotomy closure site. Individual institutional experiences may have varied but the aggregate data from the fMMC Consortium did not show a significant impact on the gestational age at delivery or maternal or fetal clinical outcomes.

scholarly journals Prediction of perinatal outcome with umbilical artery Doppler in IUGR fetuses- a prospective analytical study in a tertiary medical college in Tamilnadu, India

2017 ◽  
Vol 6 (3) ◽  
pp. 1097
Author(s):  
Rajarajeswari R. ◽  
V. Thendral
Keyword(s):  
Birth Weight ◽  
Perinatal Mortality ◽  
Perinatal Outcome ◽  
Umbilical Artery ◽  
Uncontrolled Hypertension ◽  
Medical College ◽  
Diastolic Flow ◽  
Lower Segment Cesarean Section ◽  
Doppler Study ◽  
Umbilical Artery Doppler

Background: Umbilical artery Doppler blood flow studies were a better predictor of neonatal outcome than estimated fetal weight alone in intrauterine growth restricted (IUGR) fetuses. Perinatal mortality and morbidity are increased if the umbilical artery Doppler abnormality worsens.Methods: This study was conducted in Department of Obstetrics and Gynaecology, Thanjavur medical college from August 2015 to August 2016. One hundred singleton pregnancies complicated by IUGR beyond 32 weeks were subjected for Doppler study of umbilical artery. Perinatal outcome in terms of baby outcome, birth weight, early neonatal death, admission in NICU and duration of admission in NICU were analysed.Results: The main indication of termination of pregnancy was oligohydramnios (70%). The other causes of termination were 8% for uncontrolled hypertension and 4 % for post term. 60 % were delivered vaginally and 40% by lower segment cesarean section. Various indication for LSCS were Non-reactive CTG, fetal distress, severe oligohydramnios and failed induction. 92% were delivered alive babies and 8% still born babies. Birth weight of the babies varied from 900gm to 2.5Kg. But patients with absent or reversed end diastolic flow in umbilical artery Doppler, 80% of the babies weighed less than 1.5Kg. Perinatal mortality in our study is 19% which includes 8% of intrapartum mortality and 11% of neonatal mortality and perinatal morbidity is 24%. When the diastolic flow in the umbilical artery is, absent or reversed, it is associated with increased perinatal mortality of 80%.Conclusions: The results of present study clearly demonstrated the efficacy of umbilical artery Doppler in predicting the fetal outcome. To improve the predictive value of this tool, a better method is needed to assess the wellbeing of the IUGR fetuses such as integrated antenatal test which combines BPP and Doppler study employing other vessels. 

Prenatal Repair of Spina Bifida: A 2-Center Experience with Open Intrauterine Neurosurgery in Chile

2020 ◽  
Vol 47 (12) ◽  
pp. 873-881
Author(s):  
Waldo Sepulveda ◽  
Edgardo Corral ◽  
Juan L. Alcalde ◽  
Felipe Otayza ◽  
Jose M. Müller ◽  
...  
Keyword(s):  
Spina Bifida ◽  
Gestational Age ◽  
Perinatal Death ◽  
Third Ventriculostomy ◽  
Maternal Complications ◽  
Average Birth Weight ◽  
Neonatal Deaths ◽  
Cerebrospinal Fluid Diversion ◽  
Gestational Age At Delivery

<b><i>Objective:</i></b> To report the experience with prenatal repair of open spina bifida (OSB) from 2 centers in Chile. <b><i>Methods:</i></b> Women with a second-trimester fetus with OSB were offered intrauterine neurosurgical repair following the protocol from the Management of Myelomeningocele Study (MOMS) trial. Pediatric follow-up with infants reaching 12 and 30 months of life was also reviewed. <b><i>Results:</i></b> Fifty-eight fetuses with OSB underwent intrauterine repair at an average (±SD) gestational age of 24.8 ± 0.9 weeks. There were 3 (5.1%) intrauterine deaths. The average gestational age at delivery of the remaining 55 cases was 33.3 ± 3.6 weeks, and the average birth weight was 2,172 ± 751 g. Delivery before 30 weeks occurred in 11 cases (20.0%). Two (3.6%) neonatal deaths (&#x3c;28 days) occurred. At 12 months, a ventriculoperitoneal shunt or an endoscopic third ventriculostomy was required in 25% of the cases. At 30 months, 72.4% of the infants were able to walk. <b><i>Discussion:</i></b> Prenatal neurosurgical repair of OSB is a complex and challenging intervention. Major complications include perinatal death and severe prematurity. No major maternal complications occurred in our series. A reduction in the need for cerebrospinal fluid diversion and an improved ability to walk seem to be the greatest long-term advantages of this procedure.

scholarly journals Perinatal Outcome of Growth Restricted Fetuses with Abnormal Umbilical Artery Doppler waveform compared to Growth Restricted Fetuses with Normal Umbilical Artery Doppler Wave forms at a tertiary referral hospital in urban Ethiopia

2020 ◽  
Author(s):  
Lemi Belay Tolu ◽  
Garumma Tolu Feyissa ◽  
Roba Ararso ◽  
Abdulfetah Abdulkadir ◽  
Yoseph Worku
Keyword(s):  
Intensive Care ◽  
Neonatal Death ◽  
Neonatal Intensive Care ◽  
Umbilical Artery ◽  
P Value ◽  
Doppler Studies ◽  
Early Neonatal Death ◽  
Doppler Study ◽  
Doppler Waveform ◽  
Umbilical Artery Doppler

Abstract Background: Intrauterine growth restriction is defined as a fetal weight below the 10th percentile for a given gestational age and can be identified using umbilical artery doppler velocimetry which is a non-invasive technique. The objective of this study was to determine the perinatal outcome of growth-restricted fetuses with abnormal umbilical artery doppler study compared to those with normal umbilical artery Doppler waveforms at a tertiary referral hospital in Ethiopia.Methods: A comparative prospective cohort study was conducted among pregnant mothers complicated with intrauterine growth restriction (IUGR) admitted to labor and delivery room for pregnancy termination during from September 2018-February 2019. Two midwives collected the data using a structured and pretested questionnaire. The data were entered and analyzed using SPSS version 23. After conducting descriptive analysis, exploring the entire data and checking for, statistical associations between abnormal umbilical artery doppler and outcome variables, binary logistic regression was conducted to control for confounders.Results: A total of 170 pregnant mothers complicated with growth-restricted fetuses were included in the study, among which 133 were with normal umbilical artery doppler studies and 37 were with abnormal umbilical artery doppler studies. On the 7th neonatal day, 129(97%) of normal and 29(78.4%) of abnormal umbilical artery doppler were alive whereas 4(3%) of normal and 9(24.3%) of abnormal umbilical artery Doppler studies ended in early neonatal death. Twenty (15%) of normal and 24(64.9%) of abnormal umbilical artery doppler study neonates required neonatal intensive care admission. Growth restricted fetuses complicated with abnormal doppler were two times more likely to require neonatal intensive care unit admissions compared to growth-restricted fetuses with normal umbilical artery doppler flow, P-value 0.002, (OR=2.059,95%CI 1.449-2.926). Growth restricted fetuses complicated with abnormal doppler were four times more likely to end in early neonatal death compared to growth-restricted fetuses with normal umbilical artery doppler flow, P-value 0.001, (OR=4.136, 95%CI 3.423-4.998).Conclusion: The abnormal umbilical artery doppler waveform is associated with cesarean section delivery, neonatal intensive care unit admission, respiratory distress syndrome, neonatal sepsis, neonatal hyperbilirubinemia and early neonatal death. Growth restricted fetus with abnormal umbilical artery born at gestational age less than 34 weeks were more likely to require NICU admission, develop respiratory distress syndrome and end in early neonatal death. Growth restricted fetuses complicated with abnormal umbilical artery doppler waveform should undergo umbilical vein and ductus venous doppler studies to prevent preterm delivery based on umbilical artery doppler study finding alone.

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