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- Cheema, Riffat, et al.
(författare)
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Multivascular Doppler surveillance in high risk pregnancies
- 2012
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Ingår i: Journal of Maternal-Fetal & Neonatal Medicine. - : Informa UK Limited. - 1476-7058 .- 1476-4954. ; 25:7, s. 970-974
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Analysis of fetal arterial and venous Doppler predictability for adverse perinatal outcome. Methods: Blood flow in the uterine, umbilical and middle cerbral arteries, umbilical vein, ductus venosus and Galen vein were examined with in 72 h of delivery in 88 high-risk pregnancies. The managing clinicians were only informed about the results of the umbilical artery Doppler. The Doppler results were correlated to adverse perinatal outcome. Results: Doppler abnormalities were seen in both preterm and term pregnancies. Umbilical venous pulsations (n = 13) were strongly correlated to Apgar score <7 at 5 min, abnormal blood gases, need for ventilation assistance and operative delivery for fetal distress. Twenty-four fetuses had brain sparing in the middle cerebral artery, and forty-five had abnormal umbilical artery Doppler. These were correlated to admission in the neonatal intensive care unit, operative delivery and prematurity. Brain sparing in middle cerebral artery was also correlated to ventilation disturbances in the newborns. Abnormal ductus venosus blood velocity was only seen in 9 cases and not related to adverse outcome. Galen vein pulsations (n = 26) seem to appear earlier than pulsations in the umbilical vein and were not related to adverse outcome. conclusion: Umbilical vein pulsations were better correlated to adverse perinatal outcome than were other Doppler findings including ductus venosus.
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- Cheema, Riffat
(författare)
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Role of cerebral Blood Flow in Fetal Surveillance
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- ABSTRACT In high-risk pregnancies the chronic hypoxemic fetus redistributes its circulation to maintain the blood supply to the vital organs: brain, heart and adrenals. The aims of the studies included in this thesis were: 1) to establish reference curves for fetal cerebral venous blood velocity in normal pregnancies; 2) to determine in high-risk pregnancies the frequency of abnormal Doppler in the cerebral veins and uterine, umbilical and middle cerebral arteries and the umbilical vein and ductus venosus with correlation with adverse perinatal outcome; 3) to analyze the correlation between brain sparing and redistribution of circulation and placental vascular impedance; 4) to evaluate the correlation between brain sparing and fetal umbilical cord blood gases at birth. Pulsating Galen vein was seen in 8% of the normal and 58% of the high-risk pregnancies. The degree of brain sparing was strongly related to the increasing placental vascular resistance. Despite signs of brain sparing, the chronic hypoxemic fetuses managed to maintain their cord blood gases at birth. A strong correlation was found between signs of brain sparing and operative delivery for fetal distress, admission to neonatal intensive care unit, and small-for-gestational-age newborn. The results suggest that uterine, umbilical and middle cerebral arteries and Galen vein show early Doppler changes during surveillance, whereas the ductus venosus and umbilical vein might show late Doppler changes in cases of suspected chronic hypoxemia. Umbilical venous pulsations were most predictive of adverse perinatal outcome.
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- Cheema, Riffat, et al.
(författare)
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Signs of fetal brain sparing are not related to umbilical cord blood gases at birth.
- 2009
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Ingår i: Early Human Development. - : Elsevier BV. - 1872-6232 .- 0378-3782. ; 85, s. 467-470
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Fetal chronic hypoxia leads to centralization of circulation in order to spare the vital organs brain, adrenals and the heart. This can be documented by Doppler ultrasound. Increased blood velocity in the fetal middle cerebral artery (MCA) is an acknowledged sign of centralization of circulation in chronic hypoxia, and is called brain sparing. AIM: Our aim was to assess the relationship between signs of brain sparing in the MCA and umbilical cord blood gases at birth. STUDY DESIGN: A prospective study. SUBJECTS: Singleton 57 high-risk pregnancies (outcome was compared with 21 normal pregnancies). METHODS: MCA Doppler was performed within 24 h of elective caesarean section in high-risk pregnancies. Umbilical cord blood gases were analysed at birth. MAIN OUTCOME MEASURES: Cord blood gases were related to signs of centralization of fetal circulation in the MCA. RESULTS: No correlation between signs of brain sparing in the MCA and cord blood gases. Apgar score at 5'<7 was seen in three newborns, but only one of these had antenatal signs of brain sparing. Newborns with antenatal brain sparing were admitted more often (p<0.04) and had a longer duration of stay in NICU (p<0.03) compared to newborns without brain sparing. CONCLUSION: Decreased pulsatility index in MCA is an acknowledged sign of fetal centralization of circulation during chronic hypoxia. However, signs of brain sparing are not related to cord blood gases at birth, which might suggest that redistribution of fetal circulation can maintain normal blood gases for a long time during chronic hypoxia.
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