Evaluation of the selected parameters of the fetal diastolic functions in normally grown or macrosomic fetuses of gestational diabetic mothers with poor glycaemic control

Objective: This study aimed to investigate whether the third trimester fetal cardiac diastolic function measured by selected conventional Doppler indices is affected in appropriate-for-gestational-age or macrosomic fetuses of gestational diabetic mothers with poor glycaemic control. Methods: This cross-sectional study included 93 pregnant women divided into two groups. Group 1 included 45 appropriate-for-gestational-age or macrosomic fetuses from gestational diabetic mothers with poor glycaemic control (study group). Group 2 included 48 appropriate-for-gestational-age fetuses from gestational age-matched healthy mothers (control group). Functional fetal cardiac parameters and fetoplacental Doppler parameters were measured. Data were compared between the two groups. Results: Maternal characteristics did not differ significantly between the study and the control group. There were no significant differences in the early and late velocity, early/late velocity ratio of both mitral and tricuspid valves, the fetal pulmonary vein pulsatility index, and the ductus venosus pulsatility index between the study and the control group. Moreover, the rate of abnormal Doppler findings in pulmonary vein (pulmonary vein pulsatility index >95th centile), ductus venosus (ductus venosus pulsatility index >95th centile), and peripheral vessels (umbilical artery pulsatility index >95th centile, middle cerebral artery pulsatility index <5th centile, cerebra-placental index >95th centile) were comparable in both groups. Conclusions: The third trimester fetal diastolic functions measured by selected conventional Doppler techniques do not seem to be altered in appropriate-for-gestational-age or macrosomic fetuses of gestational diabetic mothers who have poor glycaemic control.

Reference ranges Of Uterine Artery Doppler Indices (Pulsatility index and Resistivity index) in pregnant women of Eastern part of Uttar Pradesh INDIA

ObjectivePreeclampsia and eclampsia are one of major cause of maternal mortality. Various parameters like pulsatility index (PI) and resistivity index (RI) of color Doppler are helpful in detection of preeclampsia and intrauterine growth restriction. The reference ranges of the various parameters like uterine artery PI and RI are mainly from western countries. The reference range for Indian Population is lacking. So the objective of the study is to construct reference range of uterine artery for women from eastern India.Material and MethodIn this study, total 201 pregnant patients were included. Color Doppler of normal pregnant women was done at 18 to 22 weeks and then followed up at 28 to 32 weeks gestation. The uterine artery PI and RI was measured during pregnancy. The obtained data were tabulated and 5th, 25th, 50th, 75th, 90th and 95th percentile was calculated. The reference range was constructed according to gestational age starting from 18 to 22 weeks and then from 28 to 34 weeks. Statistical analysis was performed using SPSS.ResultThe main parameter observed are pulsatility and resistivity index of left and right uterine arteries first at 18 to 22 weeks and then followed up at 28 to 34 weeks. Our data suggests that as the gestational age increases both pulsatility and resistivity index decreases. The cut off value for reference range was taken up to 95th percentile. Anything above 95th percentile is abnormal. The reference range for left uterine artery pulsatility index was found to be 1.19 to 1.16 at 18 to 22 weeks, 1.09 at 28 weeks while 0.89 at 34 weeks. Similarly, the reference range for resistivity index was found to be 0.61 at 18 to 22 weeks while it decreases to 0.54 at 28 to 34 weeks.ConclusionReference range of uterine artery doppler indices for the local population is very useful tool to early prediction of Preeclampsia and IUGRs of that population and can aid in timely treatment of mother and baby. Our data shows decrease in pulsatility and resistivity index with increase in the gestational age.

Reference values for Ductus Venosus pulsatility index between 11 and 13 + 6 weeks of Gestation: A Single-center Observational Study in a Tertiary Care Hospital

BackgroundThe ductus venosus pulsatility index(DVPI) has been evolved as an important marker of the first trimester screening sonography. The aim of this study is to define a reference for ductus venosus pulsatility index at 11–13 +6 weeks of gestation.MethodsIn this cross sectional observational study, 415 women with singleton pregnancies and crown lump length(CRL) between 45 and 84 mm were included. Exclusion criteria were abnormal biochemical screening results, presence of fetal structural malformation or chromosomal abnormalities such as thickened nuchal fold, abnormal perinatal outcomes, and newborns with a chromosomal abnormality. Transabdominal U/S was performed in all participants by an expert radiologist in obstetric sonography. CRL, nuchal translucency(NT), and blood flow indices of ductus venosus (DV) in each fetus were measured. The collected data were analyzed by IBM SPSS software version 20. Linear regression was performed to demonstrate the association between CRL DVPI. Further, 5th, 50th, and 95th percentiles of DV blood flow indices were calculated for each gestational age.ResultThe mean value of DVPI ranged from 1.05 at CRL 42mm to 1.3 at CRL 82mm. DVPI and CRL did not show any significant linear association (Regression coefficient B=0.001, R2=0.003, P=0.31)Conclusion: We defined means and ranges of DVPI, while determining the 5th, 50th, and 95th percentiles of DVPI for each CRL at our institution which were approximately similar to previous studies.

Umbilical artery pulsatility index and half-peak systolic velocity in second- and third-trimester fetuses with trisomy 18 and 13

Objectives To analyze umbilical artery (UA) Doppler velocimetry and its possible role in placenta-mediated fetal growth restriction (FGR) in second- and third-trimester fetuses with trisomy 18 and 13. Methods UA pulsatility index (PI) and half-peak systolic velocity deceleration time (hPSV-DT) were measured in fetuses with trisomy 18 and 13. Correlation with gestational age, birthweight, and perinatal outcome was analyzed. Results A total of 80 measurements were taken from 33 fetuses with trisomy 18 and 19 with trisomy 13. Overall, there was a high prevalence of abnormal UA Doppler velocimetry. In fetuses with trisomy 18, 54% (27/50) of the UA PI values and 58% (29/50) of the UA hPSV-DT values were abnormal. In fetuses with trisomy 13, 80% (24/30) of the UA PI values and 87% (26/30) of the UA hPSV-DT values were abnormal. The prevalence of abnormal UA Doppler velocimetry increased with gestational age in both types of aneuploidy. However, this trend was only significant for trisomy 13 (p<0.05). All fetuses with trisomy 18 and 86% of fetuses with trisomy 13 were classified at birth as FGR. There were no perinatal survivors in this series. Conclusions A high prevalence of abnormal UA Doppler velocimetry was found in second- and third-trimester fetuses with trisomy 18 and 13, which further increased with gestational age. These results may well correlate with alterations described previously in the placenta, suggesting placental insufficiency has an important role in the development of FGR in these autosomal aneuploid fetuses.

Relation between Fetal Renal Artery Doppler ‎Indices and Non-PROM Oligohydramnios in ‎Third Trimester of Pregnancy

Background: Amniotic fluid is the liquid which surround the fetus after the first few weeks of gestation. Amniotic fluid is derived mostly from the fetus and has many functions that are essential for normal growth and development. The aim of this work is to study the relation between fetal renal artery flow velocity waveforms and amniotic fluid volume in normal pregnancies and those complicated by oligohydramnios. Methods: This prospective observational study was carried out on 40pregnant women (10) of them were with normal amount of amniotic fluid (group I), while (30) of them suffered from oligohydramnios (group II).By using color doppler ultrasound imaging, the fetal renal circulation can be assessed. Intermittent assessment of renal artery flow velocity waveforms during the early stages of pregnancy may help in predicting changes in amniotic fluid dynamics. Results: There was a non-significant difference between cases with normal amount of amniotic fluid and cases with oligohydramnios in Gestational age, Maternal age, fetal femur length, bi parietal diameter, abdominal circumference and Fetal weight. There were increased values of fetal renal artery Resistance index (RI) and Pulsatility index (PI) in cases of oligohydramnios than cases with normal amount of amniotic fluid. There was no correlation between Peak systolic velocity (PSV) and Amniotic fluid index (AFI). There was a significant difference in End diastolic velocity (EDV) between cases with normal amount of amniotic fluid and cases with oligohydramnios. Also, there was a significant difference in Systolic diastolic ratio (S/D) and Amniotic fluid index (AFI) between cases with normal amount of amniotic fluid and cases with oligohydramnios. Conclusions: There is a relation between renal artery flow velocity waveforms and oligohydramnios using Pulsed wave Doppler Ultrasonography. There are higher values of renal artery Resistance index and Pulsatility index in cases of oligohydramnios more than cases with normal amount of amniotic fluid.