| 1. |
- Breborowicz, Andrzej, et al.
(författare)
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Fetal pulmonary and cerebral artery Doppler velocimetry in normal and high risk pregnancy
- 2014
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Ingår i: Ginekologia Polska. - 0017-0011. ; 85:1, s. 26-30
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Tidskriftsartikel (refereegranskat)abstract
- Studies on fetal lung/brain circulation by means of power Doppler technique have suggested a marked reduction in lung perfusion in high-risk pregnancies as a sign of circulation redistribution. The ratio between lung/brain perfusion might therefore give a new method to predict fetal circulation centralization. Objective: The aim of the present study was to obtain fetal lung and cerebral artery ratio in normal and high-risk pregnancies. Study design: Doppler samples from proximal right pulmonary artery blood velocities and middle cerebral artery (MCA) were recorded cross-sectionally in 228 normal singleton pregnancies at gestational age 22 to 40 weeks. MCA / right pulmonary artery pulsatility index (PO ratio was calculated. Doppler samples from proximal right pulmonary artery and MCA were also recorded in 89 high-risk singleton pregnancies and the results related to perinatal outcome. Results: In the normal controls, right pulmonary artery PI remained stable until 30 weeks of gestation with slight increase thereafter until term. The MCA to right pulmonary artery PI ratio increased between 22 and 28 weeks of gestation with the rapid fall towards term. In the high-risk pregnancies group, right pulmonary artery PI showed no significant correlation to perinatal outcome, but signs of brain-sparing in the MCA were correlated to all adverse outcome parameters. Conclusion: Velocimetry of the middle cerebral artery is better than velocimetry of right pulmonary artery in predicting adverse outcome of pregnancy The brain/lung PI ratio does not improve the prediction of adverse outcome of pregnancy.
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| 2. |
- Breborowicz, Andrzej, et al.
(författare)
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Fetal pulmonary and cerebral artery Doppler velocumetry in normal and high risk pregnancy.
- 2014
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Ingår i: Ginekologia Polska. - 0017-0011. ; 85:1, s. 26-30
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Tidskriftsartikel (refereegranskat)abstract
- Studies on fetal lung/brain circulation by means of power Doppler technique have suggested a marked reduction in lung perfusion in high-risk pregnancies as a sign of circulation redistribution. The ratio between lung/brain perfusion might therefore give a new method to predict fetal circulation centralization.
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| 3. |
- Brodszki, Jana, et al.
(författare)
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Can the degree of retrograde diastolic flow in abnormal umbilical artery flow velocity waveforms predict pregnancy outcome?
- 2002
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 19:3, s. 229-234
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Reverse end-diastolic flow is the most pathological type of the umbilical artery flow velocity waveform. We aimed to investigate whether additional prognostic information can be obtained from umbilical artery waveforms in cases with reverse end-diastolic flow. SUBJECTS AND METHODS: Umbilical artery Doppler velocity waveforms from 44 fetuses with reverse end-diastolic flow were analyzed and the following parameters measured: the highest amplitude and the area below the maximum velocity curve of forward and reverse flow (A, B and C, D, respectively) and the duration of forward and reverse flow (Tc and Td, respectively). Ratios A/B, C/D and Tc/Td were calculated. The cut-off values for A/B, C/D and Tc/Td with the best predictive values for perinatal death were established with the help of receiver operating characteristics curves. The three curves were compared with each other. RESULTS: Of the three ratios, A/B and C/D had the best capacity to predict perinatal death. Both ratios had acceptable sensitivities, specificities and positive predictive values. In this regard, A/B and C/D were comparable. The cut-off values for A/B and C/D were 4.3 and 4.52, respectively. Survivors had I significantly higher A/B and C/D ratios than non-survivors (P = 0.0001 and 0.0003, respectively). Significantly more fetuses with A/B or C/D below the established cut-off values had pulsations in the venous system (P < 0.05). In fetuses with a gestational age < =210 gestational days the survival rate was significantly higher in those with A/B or C/D above the cut-off values (P = 0.03 and 0.003, respectively). CONCLUSIONS: The A/B or C/D ratio can be used for quantification of the reverse end-diastolic flow waveforms in the umbilical artery and may offer additional information to the evaluation of fetal condition.
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| 4. |
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| 5. |
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| 6. |
- 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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| 7. |
- 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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| 8. |
- Dahlbäck, Charlotte, et al.
(författare)
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Abnormal ductus venosus pulsatility index in the absence of concurrent umbilical venous pulsations does not indicate worsening fetal condition.
- 2013
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 42:3, s. 322-328
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Recordings of blood flow velocity waveform in the ductus venosus (DV) and the umbilical vein (UV) are routinely used in order to predict the fetal condition in high-risk pregnancies. This study investigates the relationship between pathological blood flow in the two vessels and perinatal outcome. METHODS: High-risk pregnancies (n=11865) admitted during 1993-2011 for blood flow examinations, including recordings of DV pulsatility index for veins (PIV) and UV pulsations, were included. The results were related to perinatal outcome, using the last Doppler examination prior to delivery in analysis. RESULTS: Abnormal DV PIV was observed in 3,96%, intra-abdominal UV-pulsations in 1,3% and pulsations in the cord in 0,7% of the cases. As expected, the rate of UV-pulsations increased with increasing DV PIV z-score. Fetuses with a pathological DV PIV, but without UV pulsations showed no signs of compromise. This was also true for cases with a DV PIV >4 SD above the mean (53.7 % had a steady flow in the UV). In contrast, the occurrence of UV-pulsations seems to be an indicator of fetal compromise regardless of level of DV PIV. CONCLUSIONS: Abnormal fetal venous blood velocity is related to adverse outcome of high-risk pregnancies. However, abnormal DV PIV is not an indicator of fetal compromise unless UV-pulsations are concurrently present and should be regarded as an artifact and not an indication for emergency delivery.
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| 9. |
- Dahlbäck, Charlotte, et al.
(författare)
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Alterations in ductus venosus velocity indices in relation to umbilical venous pulsations and perinatal outcome.
- 2015
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349.
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Tidskriftsartikel (refereegranskat)abstract
- Abnormal blood velocity in the ductus venosus is more frequently detected than pulsations in the umbilical vein, but both are considered indicators of fetal compromise. The aim of this study was to investigate blood flow patterns in the ductus venosus and the association between individual blood velocity ratios and pulsations in the umbilical vein and perinatal outcome.
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| 10. |
- Dahlbäck, Charlotte, et al.
(författare)
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Increased pulsatility in the fetal ductus venosus is not related to altered cardiac strain in high-risk pregnancies.
- 2016
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Ingår i: Journal of Maternal-Fetal & Neonatal Medicine. - : Informa UK Limited. - 1476-7058 .- 1476-4954. ; 29:8, s. 1328-1333
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Tidskriftsartikel (refereegranskat)abstract
- Blood flow velocity patterns in fetal veins are considered to reflect cardiac function, but have not been convincingly documented. The aim of this study was to generate reference values for fetal cardiac strain and compare it with results in fetuses with signs of increased venous pulsatility.
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| 11. |
- Dahlbäck, Charlotte, et al.
(författare)
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Investigations on atrial function in fetuses with signs of impaired placental function.
- 2015
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Ingår i: Prenatal Diagnosis. - : Wiley. - 1097-0223 .- 0197-3851. ; 35:6, s. 605-611
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Tidskriftsartikel (refereegranskat)abstract
- Cardiac dysfunction has been shown in cases of placental insufficiency, but few reports exist on fetal atrial function. The aim of this study was to generate reference values for atrial strain and compare them to results in fetuses with signs of increased placental resistance and abnormal venous circulation.
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| 12. |
- Dubiel, Mariusz, et al.
(författare)
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Blood velocity in the fetal vein of Galen and the outcome of high-risk pregnancy
- 2001
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Ingår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - 0301-2115. ; 99:1, s. 14-18
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Pulsation in the flow velocity waveform in the umbilical vein is related to perinatal mortality but the flow velocity waveform in the fetal vein of Galen is normally even and without fluctuation. OBJECTIVES: To establish whether blood flow velocity pulsations in the vein of Galen in high-risk pregnancies are related to outcome. STUDY DESIGN: The vein of Galen was located by colour Doppler ultrasound in 102 pregnancies complicated by severe pregnancy-induced hypertension. The blood velocity waveform was recorded by pulsed Doppler within 2 days of delivery and the presence pulsations related to pregnancy outcome, including emergency operative intervention and neonatal distress. Umbilical artery and vein and uterine artery blood flow velocity waveform were also recorded at the same time. The clinicians managing the women were unaware of the venous flow results. RESULTS: Pulsation were present in the vein of Galen in 68 cases and in the umbilical vein in 21. Both were significantly related to adverse outcome. Pulsations in the vein of Galen were seen in all seven perinatal deaths. CONCLUSIONS: Since umbilical venous pulsation are a late sign of fetal compromise, and pulsations in the vein of Galen seem to appear earlier, thus being an intermediate sign of fetal compromise that might be of great value for fetal surveillance.
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| 13. |
- Dubiel, M, et al.
(författare)
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Computer analysis of three-dimensional power angiography images of foetal cerebral, lung and placental circulation in normal and high-risk pregnancy
- 2005
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Ingår i: Ultrasound in Medicine and Biology. - : Elsevier BV. - 0301-5629. ; 31:3, s. 321-327
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Tidskriftsartikel (refereegranskat)abstract
- Three-dimensional (3-D) ultrasound (US) has greatly improved evaluation of organ circulation. The aim of this study was to explore the possible use of this new technique in normal and high-risk pregnancies. Fetal brain, lung and placenta 3-D power Doppler signal intensity were recorded in 115 normal singleton pregnancies (24 to 42 weeks gestation) and in 67 high-risk pregnancies. Mean image pixel signal intensity was calculated for each organ and a brain-lung ratio. In normal pregnancy, placental and lung signal intensity increased until 33, with a rapid decrease after 38, weeks of gestation. Fetal cerebral signal intensity increased with gestational age. Placental and fetal lung signal intensity was significantly lower in high-risk pregnancies than in the control group, with increased fetal brain and brain-lung ratios. The present results suggest a reduction of placental perfusion after 38 weeks of gestation in normal pregnancy, with redistribution of fetal circulation. Lung signal intensity increased abruptly at 32 weeks of gestation, which might reflect lung maturity. The new method showed signs of centralization of fetal circulation at the end of gestation. The results might suggest a possible clinical use for fetal surveillance in high-risk pregnancies.
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| 14. |
- Dubiel, M, et al.
(författare)
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Evaluation of fetal circulation redistribution in pregnancies with absent or reversed diastolic flow in the umbilical artery
- 2003
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Ingår i: Early Human Development. - 1872-6232. ; 71:2, s. 149-156
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To record blood flow velocimetry in the superior mesenteric, hepatic and middle cerebral arteries for detection of circulation redistribution and prediction of perinatal outcome in fetuses with absent or reversed diastolic flow in the umbilical artery. Study design: The fetal superior mesenteric, hepatic and middle cerebral artery blood velocimetry was recorded in 33 pregnancies complicated by pregnancy-induced hypertension and/or intra-uterine growth retardation between 27 and 41 weeks of gestation. Uterine artery and umbilical vein velocimetries were also recorded. Results: An abnormal mesenteric artery pulsatility, index (PI) was found in four cases; two newborns died due to prematurity, growth retardation and necrotizing enterocolitis. An abnormal fetal hepatic artery PI was found in 17 cases. The brain-sparing effect in the middle cerebral artery was found in 16 cases; three newborns died after delivery. Signs of redistribution in mesenteric, hepatic and middle cerebral artery velocimetry were not related to most of the perinatal outcome variables. Umbilical vein velocimetry correlated with low arterial and venous pH. All perinatal mortalities had umbilical venous pulsations. Conclusions: Signs of visceral circulation redistribution could not predict adverse outcome. Umbilical venous pulsations were, however, seen in nearly all fetuses; this was the only variable suggesting adverse outcome in the present study of severely compromised fetuses. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved.
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| 15. |
- Dubiel, M, et al.
(författare)
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Fetal and maternal Doppler velocimetry and cytokines in high-risk pregnancy
- 2005
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Ingår i: Journal of Perinatal Medicine. - 1619-3997. ; 33:1, s. 17-21
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Fetal hypoxia and preterm delivery are reported to be strongly associated with brain damage and neurodevelopmental delay. Doppler signs of fetal brain sparing have been described during chronic hypoxia, but whether they are related to brain damage is unknown. The aim of this study was to evaluate if markers of tissue injury, i.e., tumor necrosis factor-alpha. (TNF-alpha) and interleukin-6 (IL-6) are related to signs of increased perinatal vascular impedance and/or fetal brain sparing in high-risk pregnancies. Study design: TNF-alpha and IL-6 levels were evaluated in maternal blood serum of 67 high-risk pregnancies. Serum samples were taken at the time of umbilical, middle cerebral artery and uterine artery Doppler velocimetry examination. The values for TNF-alpha and IL-6 were correlated with reference median values obtained with gestational age in the form of a Z-score. Results: TNF-alpha levels showed values within the normal range in only four cases. IL-6 values were found normal in 14 cases. The Z-score for mean middle cerebral artery pulsatility index (PI) showed a significant correlation to TNF-alpha and IL-6 levels, P < 0.0001 and P < 0.003, respectively. This might suggest a strong correlation between signs of fetal brain sparing and increased maternal serum TNF-alpha and IL-6 levels. Abnormal uterine artery PI and the presence of a "notch" were also highly significantly related to TNF-alpha and IL-6 levels, which were nearly two-fold higher compared to normal uterine artery blood flow and the absence of a "notch". Abnormal cerebro/placental ratios showed significant correlations to TNF-alpha and IL-6 levels. Conclusion: The present results suggest a strong correlation between levels of TNF-a and IL-6 not only for signs of fetal brain sparing, but also for uteroplacental blood flow. This finding supports the role of tissue injury in cases of fetal brain sparing, but whether this is a reflection of brain damage or secondary to placental pathology needs further evaluation.
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| 16. |
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| 17. |
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| 18. |
- Dublel, Mariusz, et al.
(författare)
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Fetal biometry between 20-42 weeks of gestation for Polish population
- 2008
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Ingår i: Ginekologia Polska. - 0017-0011. ; 79:11, s. 746-753
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Ultrasound estimating of fetal weight is one of the most frequent examinations during pregnancy. Hitherto, foreign fetometry curves have mostly been used in Poland as there are no national available reference charts that are based on ultrasound fetal biometry. The aim of the present study was to construct new charts based on ultrasound fetometry reference for Polish population. Study design: A group of 959 healthy volunteers with uncomplicated singleton pregnancy joined in a cross-sectional study. The study was designed prospectively to evaluate normal reference charts for fetal ultrasound measurements and estimated fetal weight. Four biometric parameters were studied: biparietal diameter (BPD), head circumference (HQ abdominal circumference (AC) and femur length (FL). Estimated fetal weight (EFW) was calculated using Hadlock et al. formula from 1985. Results: In the course of normal pregnancy an acceleration of growth rate was seen, but with a slight decline at the end of pregnancy, Reference curves for mean, 90th and 95th percentile were constructed for BPD, HC, AC and FL. Estimated fetal weight curves were outlined for both boys and girls. Conclusion: Reference charts for Polish population are similar to foreign curves. Less variation was seen in comparison with national charts based on postnatal weight. Ultrasound method seems to be better than birthweight curves especially in preterm pregnancies. This will improve the diagnosis of a small for gestational age newborn.
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| 19. |
- Epstein, Elisabeth, et al.
(författare)
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An algorithm including results of gray-scale and power Doppler ultrasound examination to predict endometrial malignancy in women with postmenopausal bleeding.
- 2002
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 20:4, s. 370-376
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To determine if power Doppler ultrasound examination of the endometrium can contribute to a correct diagnosis of endometrial malignancy in women with postmenopausal bleeding and endometrium >/= 5 mm. METHODS: Eighty-three women with postmenopausal bleeding and endometrium >/= 5 mm underwent gray-scale and power Doppler ultrasound examination using predetermined, standardized settings. Suspicion of endometrial malignancy at gray-scale ultrasound examination (endometrial morphology) was noted, and the color content of the endometrium at power Doppler examination was estimated subjectively (endometrial color score). Computer analysis of the most vascularized area of the endometrium was done off-line in a standardized manner. Stepwise multivariate logistic regression analysis was carried out to determine which subjective and objective ultrasound and power Doppler variables satisfied the criteria to be included in a model to calculate the probability of endometrial malignancy. RESULTS: Endometrial thickness, vascularity index (vascularized area/endometrial area), and use of hormone replacement therapy (HRT) satisfied the criteria to be included in the model used to calculate the 'objective probability of endometrial malignancy'. Endometrial morphology, endometrial color score and HRT use satisfied the criteria to be included in the model to calculate the 'subjective probability of malignancy'. Endometrial thickness >/= 10.5 mm had a sensitivity with regard to endometrial cancer of 0.88 and a specificity of 0.61. At a fixed sensitivity of 0.88, the specificity of the 'objective probability of malignancy' (0.81) was superior to all other ultrasound and power Doppler variables (P = 0.001-0.02). The 'objective probability of malignancy' detected more malignancies at endometrium 5-15 mm than endometrial morphology (5/7 vs. 1/7, i.e. 0.71 vs. 0.14; P = 0.125) with a similar specificity (49/57 vs. 51/57, i.e. 0.86 vs. 0.89). CONCLUSION: Power Doppler ultrasound can contribute to a correct diagnosis of endometrial malignancy, especially if the endometrium measures 5-15 mm. The use of regression models including power Doppler results to estimate the risk of endometrial cancer deserves further development.
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| 20. |
- Essén, Birgitta, et al.
(författare)
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Are some perinatal deaths in immigrant groups linked to sub-optimal perinatal care services? Perinatal audit of infants to women from Africa’s Horn delivered in Sweden 1990-96
- 2002
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 109:6, s. 677-682
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To test the hypothesis that sub-optimal factors in perinatal care services resulting in perinatal deaths were more common among immigrant mothers from the Horn of Africa, as compared to Swedish mothers. Design: A perinatal audit, comparing cases of perinatal deaths among children of African immigrants residing in Sweden, with a stratified sample of cases among native Swedish women. Setting: Sixty-three cases of perinatal deaths among immigrant east African women delivered in Swedish hospitals in 1990–1996, and 126 cases of perinatal deaths among native Swedish women. Time of death and type of hospital were stratified. Main outcome measures: Sub-optimal factors in perinatal care services, categorised as maternal, medical care, and communication. Results: The rate of sub-optimal factors likely to result in potentially avoidable perinatal death was significantly higher among African immigrants. In the group of antenatal deaths, the OR was 6.2 (CI 1.9-20); the OR for intrapartal deaths was 13 (CI 1.1-166); and the OR for neonatal deaths was 18 (CI 3.3-100), when compared with Swedish mothers. The most common factors were delay in seeking health care, mothers refusing caesarean sections, insufficient surveillance of IUGR (intrauterine growth restriction), inadequate medication, misinterpretation of CTG (cardiotocography), and interpersonal miscommunication. Conclusions: Sub-optimal factors in perinatal care likely to result in perinatal death were significantly more common among east African than native Swedish mothers, affording insight into socio-cultural differences in pregnancy strategies, but also the sub-optimal performance of certain health-care routines in the Swedish perinatal care system.
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| 21. |
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| 22. |
- Essén, Birgitta, et al.
(författare)
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Is there an association between female circumcision and perinatal death?
- 2002
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Ingår i: Bulletin of the World Health Organization. - 0042-9686. ; 80:8, s. 629-632
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: In Sweden, a country with high standards of obstetric care, the high rate of perinatal mortality among children of immigrant women from the Horn of Africa raises the question of whether there is an association between female circumcision and perinatal death. METHODS: To investigate this, we examined a cohort of 63 perinatal deaths of infants born in Sweden over the period 1990–96 to circumcised women. FINDINGS: We found no evidence that female circumcision was related to perinatal death. Obstructed or prolonged labour, caused by scar tissue from circumcision, was not found to have any impact on the number of perinatal deaths. CONCLUSION: The results do not support previous conclusions that genital circumcision is related to perinatal death, regardless of other circumstances, and suggest that other, suboptimal factors contribute to perinatal death among circumcised migrant women.
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| 23. |
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| 24. |
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| 25. |
- Ghosh, Gisela, et al.
(författare)
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Amniotic fluid index in low-risk pregnancy as an admission test to the labor ward.
- 2002
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 81:9, s. 852-855
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Tidskriftsartikel (refereegranskat)abstract
- Background. Oligohydramnios has been shown to be a predictor of intrapartal fetal distress. In a selected group of low-risk pregnancies, however, it has not yet been established that oligohydramnios contributes to intrapartal fetal distress. Methods. Ultrasonically estimated four-quadrant amniotic fluid index as a test for admission to the labor ward was evaluated as a predictive factor for fetal distress during labor in a prospective 'blind' study comprising 600 low-risk pregnancies. Oligohydramnios was defined as an amniotic fluid index <= 50 mm. The parturients were divided into two groups according to the status of the fetal membranes. The amniotic fluid index results were correlated to fetal outcome: Apgar score at 1 and 5 min, pH of blood in umbilical artery and vein, operative delivery because of fetal distress, cesarean delivery because of fetal distress, and number of babies referred to the neonatal intensive care unit. Results. Two-hundred and sixty-seven women had ruptured membranes. Among these a significant increase in operative delivery because of fetal distress was seen in cases of oligohydramnios compared with the normal amount of amniotic fluid (odds ratio 3.86, confidence interval = 1.25-11.9). No significant differences were seen regarding other variables of perinatal outcome. The group with intact membranes comprised 333 parturients. Among these, no significant differences in perinatal outcome could be seen in relationship to the amniotic fluid index, although a 50% increase in emergency operations for fetal distress was seen in women with oligohydramnios. A significant correlation might have been evident even in that group if a larger sample had been studied. Conclusion. The results indicate that measurement of the amniotic fluid index in low-risk pregnant women admitted for labor might identify parturients with an increased risk of intrapartal fetal distress.
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| 26. |
- Ghosh, Gisela, et al.
(författare)
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Evaluation of third trimester uterine artery flow velocity indices in relationship to perinatal complications.
- 2006
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Ingår i: Journal of Maternal-Fetal & Neonatal Medicine. - : Informa UK Limited. - 1476-7058 .- 1476-4954. ; 19:9, s. 551-555
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Uterine artery Doppler is becoming a routine part of pregnancy surveillance in high-risk pregnancies. Which blood flow velocity waveform index to measure is debated and the 'notch' in early diastole is not widely accepted, as it is a subjective measure. The aim of the present study was to evaluate the different indices in the prediction of adverse outcome of pregnancies suspected for intrauterine fetal growth restriction (IUGR). Methods. Uterine artery blood flow was recorded in 217 pregnancies admitted for Doppler ultrasound surveillance due to suspected IUGR. The median gestational age at examination was 38 weeks (range 25-42 weeks). Only cases having bilateral uterine artery notching were included in the evaluation. The uterine artery Doppler spectrum was analyzed for different indices, including evaluation of notch and end-diastolic velocities. Umbilical artery Doppler velocimetry was also performed. The outcome variables chosen were: a small-for-gestational-age (SGA) newborn, preterm birth, and abdominal delivery. ROC-curve calculations were used to compare the different indices. Results. The uterine artery blood velocity pulsatility index (PI) and resistance indices (RI) were the best predictors of adverse outcome of pregnancy. Apart from premature birth, the systolic/end-diastolic ratio was less predictive of adverse outcome. The indices including only diastolic blood velocities were the least predictive of adverse outcome. The group with notch velocity above end-diastolic velocity was compared with those having notch velocity below the end-diastolic velocity. No difference in outcome was seen between the two groups. Conclusions. RI and PI as measures of third trimester utero-placental vascular impedance are the best predictors of adverse outcome of IUGR-suspected pregnancies.
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| 27. |
- Ghosh, Gisela, et al.
(författare)
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Nuchal cord in post-term pregnancy - relationship to suspected intrapartum fetal distress indicating operative intervention.
- 2008
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Ingår i: Journal of Perinatal Medicine. - 1619-3997. ; 36:2, s. 142-144
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Color Doppler Ultrasound was performed on 202 post-term pregnancies to detect the presence of a nuchal cord. A nuchal cord was diagnosed if the umbilical cord could be followed 360 degrees around the fetal neck. The results were not disclosed to the managing obstetrician, midwife, and patient. The perinatal outcome was analyzed according to Apgar score, umbilical cord artery and vein pH and base excess (BE), perinatal death, cesarean section, operative delivery for fetal distress (ODFD) and admission to neonatal intensive care unit (NICU). A nuchal cord was detected in 69 patients (34.2%). The incidence was not affected by parity or reduced amniotic fluid volume. There was no statistically significant increased risk for 1- and 5-min Apgar scores <7, umbilical artery pH <7.1, umbilical vein pH <7.20, umbilical artery base excess <-11, umbilical vein base excess <-11, perinatal death, cesarean section, ODFD or admission to NICU. Nuchal cord in post-term pregnancies is not associated with an increased risk for signs of fetal distress and operative intervention during labor and delivery.
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| 28. |
- Ghosh, Gisela, et al.
(författare)
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Pulsations in the umbilical vein during labor are associated with increased risk of operative delivery for fetal distress.
- 2009
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Ingår i: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. - : Wiley. - 1469-0705. ; 34:2, s. 177-181
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Under physiological conditions the blood flow velocity waveform in the umbilical vein (UV) has an even non-pulsating pattern. Pulsations in the UV have been described in human fetuses exposed to chronic hypoxia and heart failure. Current techniques for fetal surveillance during labor and delivery involve a risk of both over- and underestimation of fetal hypoxia. We aimed to examine whether pulsations in the UV appear in the human fetus during suspected intrapartum hypoxia, and if so whether they are associated with increased risk of operative delivery for fetal distress (ODFD). METHODS: This was a prospective double blind study including 52 normal pregnancies. A Doppler examination of the UV was performed on 26 fetuses with pathological and 26 fetuses with normal cardiotocography (CTG) during labor. Presence or absence of pulsations in the UV were noted and related to perinatal outcome. RESULTS: Pulsations in the UV were seen in eight (30.8%) of the fetuses with pathological CTG, of which six (75%) underwent ODFD. No pulsations were seen in the other 18 (69.2%) fetuses with pathological CTG and these were all delivered without ODFD. No pulsations were seen in the UV in the fetuses with normal CTG and these were all delivered without ODFD. Among the fetuses with pathological CTG, there was an increased risk of ODFD in fetuses with vs. those without pulsations in the UV (P < 0.0001). CONCLUSIONS: Pulsations in the UV can be observed in human fetuses during suspected intrapartum hypoxia and these pulsations are associated with an increased risk of ODFD. Doppler examination of the UV might give important additional information on fetal condition during labor and delivery. Copyright (c) 2009 ISUOG. Published by John Wiley & Sons, Ltd.
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| 29. |
- Ghosh, Gisela, et al.
(författare)
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Uterine and umbilical artery Doppler are comparable in predicting perinatal outcome of growth-restricted fetuses.
- 2009
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 116:3, s. 424-430
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare umbilical and uterine artery Doppler in predicting outcome of pregnancies suspected of fetal growth restriction (FGR). DESIGN: A prospective study included 353 singleton pregnancies complicated by an FGR fetus. SETTING: University Hospital setting. SAMPLE: Pregnancies suspected of FGR diagnosed by ultrasound fetal biometry during a 5-year period. MAIN OUTCOME MEASURE: Perinatal outcome in relation to uterine and umbilical artery Doppler. METHODS: The women underwent Doppler examination of the umbilical and uterine arteries. Results from the uterine, but not the umbilical artery, were blind to the woman and managing obstetrician. The Doppler results were related to perinatal outcomes including small for gestational age newborns, caesarean delivery, premature delivery (<37 weeks of gestation) and admission of the newborn to a neonatal intensive care unit. RESULTS: Abnormal uterine artery Doppler velocimetry was seen in 120 (33.4%) pregnancies and abnormal umbilical artery Doppler in 102 (28.4%). There was a statistically significant correlation between abnormal Doppler of both the umbilical and uterine arteries and adverse outcome of pregnancy. The two vessels were comparable in predicting adverse outcome. Women with normal umbilical artery Doppler (251) were analysed separately. Abnormal uterine artery Doppler, seen in 61 (24.3%) of those women, showed a statistically significant correlation for adverse outcome of pregnancy. CONCLUSIONS: Doppler examinations of the uterine and/or the umbilical arteries seem to be comparable as predictors of outcome in pregnancies complicated by FGR. Including uterine artery Doppler in the surveillance of growth-restricted fetuses might detect a group of pregnancies at high risk, even though the umbilical artery Doppler was normal.
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| 30. |
- Gudmundsson, Saemundur, et al.
(författare)
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Correlation of birth injury with maternal height and birthweight.
- 2005
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 112:6, s. 764-767
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Tidskriftsartikel (refereegranskat)abstract
- Background Infant or maternal injury during vaginal delivery is a constant threat to all involved, but difficult to predict. Objective To estimate the risk of birth injuries in an institution favouring trial of vaginal birth when there was doubt of the best mode of delivery. Design A retrospective cohort study. Setting University Hospital. Population Singleton 14,359 vaginal deliveries in cephalic presentation during 5½ years. Methods The total caesarean section rate during this period was 9%. The likelihood of injury was evaluated by logistic regression analysis with injury as the dependent variable and maternal height and child birthweight as explanatory variables in birth injury risk estimation. Main outcome measures Infant injury defined as one of the following: shoulder dystocia, clavicle fracture or brachial plexus injury; and maternal injury as anal sphincter rupture (ASR). Results There were a total of 318 infant injuries in 282 infants and 423 ASRs. A strong correlation was found between injury and both fetal macrosomia and short maternal stature, but macrosomia was a stronger indicator of injury. Birth injury risk estimation curves were constructed based on maternal height and birthweight. Conclusions The present results confirm a strong correlation between fetal macrosomia and short maternal stature and the likelihood of injury during vaginal birth. Risk estimation curves were constructed that might be of great value for the obstetrician in choosing the mode of delivery in these cases.
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| 31. |
- Gudmundsson, Saemundur, et al.
(författare)
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Factors affecting color Doppler energy ultrasound recordings in an in-vitro model
- 1998
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Ingår i: Ultrasound in Medicine and Biology. - 0301-5629. ; 24:6, s. 899-902
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Tidskriftsartikel (refereegranskat)abstract
- Compared to conventional color Doppler ultrasound imaging, the new color Doppler modality "color Doppler energy" (CDE) has improved the possibility of visualizing blood vessels having low blood-flow velocities, but appears to be influenced by the settings of the ultrasound instrument and motion artefacts. The aim of this methodological study was to evaluate the effects of the different factors on the CDE signal. The CDE mode of a commercially available ultrasound system (Acuson 128 XP) was tested in an in vitro study. The effect of depth, angle of insonation, flow velocity, instrument power output, gain and other instrument settings were evaluated. The CDE signals obtained were stored on videotape and subsequently subjected to off-line computer analysis. The CDE signal intensity was found to be influenced mainly by fluid flow velocity, but was also affected by depth and instrument settings. Gain and power had, however, limited influence in this setting. Thus, the intensity of the CDE signal is influenced by several factors. Our results emphasize the need for optimum fixed preinstalled instrument settings when attempting to quantify organ perfusion by use of this new technique.
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| 32. |
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| 33. |
- Gudmundsson, Saemundur, et al.
(författare)
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New score indicating placental vascular resistance.
- 2003
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 82:9, s. 807-812
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Tidskriftsartikel (refereegranskat)abstract
- Background. Umbilical artery Doppler velocimetry is a routine method for fetal surveillance in high-risk pregnancy. Uterine artery Doppler seems to give comparable information, but it can be difficult to interpret as there are two arteries, which might show notching and/or increased pulsatility index (PI) as signs of increased vascular impedance. Combining the information on vascular resistance on both sides in a new score might simplify and improve evaluation of placental circulation. Methods. Uterine and umbilical artery Doppler velocimetry was evaluated in 633 high-risk pregnancies. The managing clinician was informed only about the umbilical artery flow. The umbilical artery flow spectrum was semiquantitatively divided into four blood flow classes (BFC), expressing signs of increasing vascular resistance. The uterine artery Doppler flow spectrum was divided into five uterine artery scores (UAS), taking into account presence/absence of notching and/or increase in PI. By adding UAS to BFC, a new placental score (PLS) was constructed with values ranging from 0 to 7, indicating general placental vascular resistance. The scores were related to three outcome variables: small-for-gestational age (SGA), premature delivery (<37 weeks), and cesarean section. Results. All three score systems showed a significant relationship between signs of increasing vascular resistance and outcome. The new PLS showed the best association to adverse outcomes, with optimal cut-off at values exceeding score 3. Conclusion. Doppler velocimetry on both sides of the placenta showed a strong relationship to an adverse outcome of pregnancy. The new PLS showed a better relationship to adverse perinatal outcome than the BFC and the UAS. The PLS can simplify evaluation of uteroplacental and fetoplacental Doppler velocimetry.
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| 34. |
- Gudmundsson, Saemundur, et al.
(författare)
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Placental morphologic and functional imaging in high-risk pregnancies.
- 2009
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Ingår i: Seminars in Perinatology. - : Elsevier BV. - 1558-075X .- 0146-0005. ; 33:4, s. 270-280
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Tidskriftsartikel (refereegranskat)abstract
- The placenta is vital for fetal growth and development. Improvement in ultrasound and magnetic resonance imaging have improved our understanding of placental morphology that can be important as in the case of placental accrete/percreta. Functional imaging is presently mainly performed by the use of Doppler ultrasound and can give information on placental perfusion, which can be vital for clinical diagnosis. This review summarizes the present knowledge on placental imaging and it's clinical value in high-risk pregnancies.
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| 35. |
- Gudmundsson, Saemundur, et al.
(författare)
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Placental pulsatility index : a new, more sensitive parameter for predicting adverse outcome in pregnancies suspected of fetal growth restriction
- 2017
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 96:2, s. 216-222
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The pulsatility indices of the umbilical and uterine arteries are used as the surrogate measures of utero-placental perfusion. Combining the two might simplify the evaluation of total placental vascular impedance, possibly improve prediction of adverse outcomes, and help identify pregnancies with suspected fetal growth restriction that need more intense surveillance. Material and methods: Umbilical and uterine blood flow velocities were recorded using pulsed-wave Doppler in a longitudinal study of 53 low-risk pregnancies (248 observations) during 20–40 weeks of gestation. Pulsatility indices was calculated for each of these vessels. A new placental pulsatility index was constructed as: (umbilical artery pulsatility index + mean of the left and right uterine artery pulsatility indices)/2, and mean +2 SD defined as abnormal. Gestational age-specific reference percentiles were calculated for the second half of pregnancy and related to values obtained from 340 pregnancies with suspected intra-uterine growth restriction to test its ability to predict adverse pregnancy outcome. Results: The placental pulsatility index was closely associated with gestational age and decreased with advancing gestation in normal pregnancy. The placental pulsatility index had a higher sensitivity and comparable specificity in predicting adverse outcome in pregnancies suspected of intra-uterine fetal growth restriction when compared with conventional umbilical and uterine artery pulsatility indices. Conclusions: The new placental pulsatility index, reflecting placental vascular impedance on both the fetal and maternal side of placenta, improves prediction of adverse outcome in pregnancies suspected of intra-uterine fetal growth restriction.
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| 36. |
- Gudmundsson, Saemundur, et al.
(författare)
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Preeclampsia--abnormal uterine artery Doppler is related to recurrence of symptoms during the next pregnancy.
- 2004
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Ingår i: Journal of Perinatal Medicine. - 1619-3997. ; 32:5, s. 400-403
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Tidskriftsartikel (refereegranskat)abstract
- Background: Impaired trophoblast invasion is suggested as the main cause of reduced placental perfusion, which results in fetal growth restriction and preeclampsia. Immunological response against the invading tissue has been given as the explanation. Preeclampsia frequently recurs during the next pregnancy. Doppler ultrasound can predict increased vascular impedance in the uteroplacental circulation. Whether signs of increased vascular resistance in pregnancies complicated by preeclampsia are predictive of recurrence during the next pregnancy is unknown. Methods and material: Uterine artery Doppler was performed in 570 pregnant women with preeclampsia. Of these, 139 became pregnant again. The uterine artery Doppler results during the first pregnancy were related to symptoms of preeclampsia in the succeeding pregnancy. Results: Preeclampsia developed again in 43 of the 139 women. Pregnancies with signs of increased uterine artery vascular impedance during the first pregnancy were 3.4 times more likely to develop preeclampsia again (CI 1.587.6). Similar results for a small for gestational age newborn were 9.7 (CI 1.190). Conclusion: Increased uterine artery vascular impedance in pregnancies complicated by preeclampsia increases the likelihood of recurrence and growth restriction during the next pregnancy. The Doppler information gathered during the first pregnancy might thus select cases for special surveillance and possibly prophylactic antiplatelet treatment in the next pregnancy.
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| 37. |
- Harling, Solweig, et al.
(författare)
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Acute decrease of coronary flow after indomethacin delivery in newborn lambs.
- 2007
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Ingår i: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 96:10, s. 1460-1463
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To document the effects of indomethacin (IND) on coronary flow. Methods: We studied nine premature lambs during the first day of life. The gestational age varied between 132 and 134 days (term 145 days) and weight 3.1-4.7 kg. Coronary flow velocities were recorded with an intracoronary Doppler guide wire in the proximal left anterior descending coronary artery (LAD). Average peak flow velocity was measured before, during and after an intravenous IND injection of 0.2 mg per kilogram of body weight. Results: IND increased systemic blood pressure (p < 0.05) and rate pressure product (RPP; p < 0.05) indicating that IND increased cardiac workload. IND decreased coronary average peak flow velocity in all lambs (p < 0.05). The maximal fall in coronary velocity appeared after 3 min (range 1-7 min) and was regained 10 min (range 4-53 min) after the drug delivery. The maximal reduction of coronary average peak flow velocity was 52% (median 26). The recovery time was directly related to the maximal reduction of the coronary average peak flow velocity (R = 0.91, R-2 0.84, p < 0.002). Conclusion: Coronary flow velocity decreased markedly in premature born lambs given a bolus dose of IND.
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| 38. |
- Harling, Solweig, et al.
(författare)
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Quantification of left to right shunt in patent ductus arteriosus by color doppler
- 2009
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Ingår i: Ultrasound in Medicine and Biology. - : Elsevier BV. - 0301-5629. ; 35, s. 403-408
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Tidskriftsartikel (refereegranskat)abstract
- Ultrasound is a reliable tool to diagnose patent ductus arteriosus in premature infants but no reliable noninvasive method exists to quantify ductal flow. The aim of this study was to quantify the size of the shunt via persistent ductus arteriosus from pixel counts in color Doppler flow images. A cotton band was placed around the ductus arteriosus of newborn lambs to adjust the magnitude of flow. For flow measurements, ultrasonic transit time flow probes were applied around the ascending aorta and ductus arteriosus. Twenty-four different flow states were attained in four newborn lambs. An Acuson Sequoia scanner equipped with a 7 MHz transducer was used to register Doppler data and images with maximal color distribution during diastole in the pulmonary artery longitudinal sections (PALS). Each image-pixel was matched with the color velocity bar and the pixels were assigned to the corresponding flow velocity. The total area showing color relative to the area of the PALS correlated well with the amount of ductal flow (r = 0.87, r(2) = 0.75, p < 0.001). When Qp/Qs was >1.4:1, more than 40% of the area in PALS in diastole exhibited color information. Similarly, the color pixel velocities squared correlated with the size of the shunt. Quantification of the percentage of pixels in a color Doppler registration via a computer-based analysis shows a high correlation with the size of ductal shunting. (E-mail: solweig.harling@med.lu.se).
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| 39. |
- Hernandez-Andrade, Edgar, et al.
(författare)
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Uterine artery score and perinatal outcome.
- 2002
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 19:5, s. 438-442
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate a modified uterine artery score based on the pulsatility index and presence or absence of notching in the Doppler velocity waveform recorded from both uterine arteries in relation to the perinatal outcome. METHODS: A retrospective analysis was performed in 741 third-trimester high-risk pregnancies. The uterine artery score was constructed assigning one point to each abnormal parameter-high pulsatility index and presence of notch-thus ranging from 0 (normal findings in both uterine arteries) to 4 (notch and high pulsatility index in both uterine arteries). In a subgroup with lateral placenta (n = 359), two definitions of abnormal pulsatility index were compared. In the uniform uterine artery score, a pulsatility index > 1.20 in both uterine arteries was considered abnormal, disregarding the placental location; in the subgroup with lateral placenta, the high pulsatility index was defined as > 1.00 on the placental side and > 1.40 on the non-placental side. RESULTS: Receiver-operating characteristic curves did not reveal any difference in the diagnostic capacity between the group with a uniform uterine artery score and the subgroup with lateral placenta (P = 0.54). In the total material, the odds ratios and linear regression analysis showed an increased risk for an adverse perinatal outcome with increasing uterine artery score (P < 0.01). At a uterine artery score > 2, there was a significantly increased risk for operative delivery for fetal distress, neonatal intensive care unit admission, 5-min Apgar score < 7, preterm delivery and delivery of a small-for-gestational age fetus. CONCLUSION: In high-risk third-trimester pregnancies, Doppler velocity waveforms of the uterine arteries can be evaluated using the uterine artery score disregarding the placental location. The uterine artery score possesses a high predictive value regarding adverse perinatal outcome.
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| 40. |
- Hofstaetter, C, et al.
(författare)
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Venous Doppler velocimetry in the surveillance of severely compromised fetuses
- 2002
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 20:3, s. 233-239
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate whether venous Doppler velocimetric signs of cardiac decompensation might predict fetal demise in severely compromised fetuses. Material and methods This was a prospective study involving 154 growth-restricted fetuses, 37 of which were found to have reversed flow in the umbilical artery (BFC III). Doppler velocimetry of the right hepatic vein and ductus venosus were investigated serially and the presence of umbilical venous pulsations also registered. Only the final examination prior to birth or fetal demise was accepted for analysis and related to obstetric outcome defined as gestational age at birth, birth weight and perinatal mortality. In cases of BFC III the venous velocimetry of 15 nonsurviving fetuses was compared to that of the 22 survivors. Results There was a significant correlation between venous blood velocity and placental vascular resistance. In the right hepatic vein there was a significant decrease in peak systolic and end-systolic velocities and an increase of maximum velocity during atrial contraction and pulsatility (P < 0.05). A decrease of all velocities and increase of pulsatility were noted in the ductus venosus (P < 0.05). A reversed flow in the ductus venosus was found in 9/37 fetuses and double umbilical venous pulsations in 16/37 fetuses. However, the hepatic vein seemed to be a better predictor of impending mortality than the ductus venosus. Changes in diastolic venous blood velocity and a double pulsation in the umbilical vein were closely related to perinatal mortality, although these parameters did not provide a useful threshold to optimize the timing of delivery. Conclusion Diastolic venous velocimetry changes significantly in severely compromised fetuses. These changes might be of great clinical value in deciding on the timing of delivery to minimize damage to the fetus and newborn.
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| 41. |
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| 42. |
- Kocylowski, Rafal D., et al.
(författare)
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Biochemical tissue-specific injury markers of the heart and brain in postpartum cord blood
- 2009
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Ingår i: American Journal of Obstetrics and Gynecology. - : Elsevier BV. - 1097-6868 .- 0002-9378. ; 200:3, s. 1-273
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: We sought to establish references ranges and to test the hypothesis that biochemical tissue-specific markers for the heart in umbilical cord blood of newborns with cardiac defects and intrauterine growth restriction (IUGR) are abnormal. STUDY DESIGN: A prospective study was conducted. Serum samples of the umbilical vein (n = 280) and artery (n = 156) from 599 healthy newborns at 37(+0)-42(+0) weeks of gestation were collected. Total creatine kinase (CK), CK-MB heart type (CK-MB), cardiac troponin T (cTnT), myoglobin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and S100 were measured. Reference ranges for each marker were constructed. Concentrations of tissue-specific markers from umbilical cord blood of neonates with cardiac defects (n = 10) and IUGR (n = 41) were plotted against the established reference ranges. RESULTS: Reference ranges for each studied marker were established for both umbilical artery and vein. In fetuses with cardiac defects, both NT-proBNP (4/6 [66%] in the artery, 7/10 [70%] in the vein) and cTnT (2/10 [20%] in the vein) were increased. In fetuses with IUGR in the vein, NT-proBNP (10/41 [24%]) and cTnT (5/41 [12%]) were increased, whereas S100 (9/41 [21%]) was decreased. CONCLUSION: In a subset of neonates with cardiac defects or growth restriction, irrespective of the pH at birth, tissue-specific injury markers for the heart in umbilical cord blood are abnormal.
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| 43. |
- Kocylowski, Rafal, et al.
(författare)
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Hepatic aminotransferases of normal and IUGR fetuses in cord blood at birth
- 2012
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Ingår i: Early Human Development. - : Elsevier BV. - 1872-6232 .- 0378-3782. ; 88:7, s. 461-465
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Tidskriftsartikel (refereegranskat)abstract
- Background: The accepted standard for assessing the wellbeing of the newborn is the Apgar score and blood gas analysis. However, the prediction of neonatal morbidity or mortality is limited. In small-for-gestation (SGA) fetuses at 18-38 weeks of gestation, pO(2) is <5th centile both in the umbilical artery and vein in 30%. In a previous study in singleton term neonates cardiac specific enzymes (B-type natriuretic peptide, BNP and cardiac troponin T, cTnT) are increased in growth-restricted fetuses compared with normals. Aims: To test the hypothesis, that fetuses with intra uterine growth restriction (IUGR) have elevated AST (GOT) and ALT (GPT) aminotransferases as a result of hypoxic liver cell injury, and to establish references ranges. Study design: Prospective cohort study, serum of umbilical artery (n = 156) and vein (n = 180), 599 normal singletons at 37(+0)-42(+0) weeks, neonates with IUGR (n = 41). analysis for pH, birthweight and maternal weight, spontaneous vs cesarean section, vein vs artery and for the sex. Outcome measures: Aspartate aminotransferase (AST. GOT) and Alanine aminotransferase (ALT, GPT) were measured in normals and IUGR neonates. Results: Neonates with IUGR (n = 41) had AST values that were not different from the reference group, but had significantly lower ALT (-1.49, 95% CI - 1.98 to - 1.00 vs 0.14, 95% CI - 0.42-0.13), (p<0.001), (Fig. 3). Conclusions: In neonates with IUGR, hypoxic hepatic injury markers in cord blood were not elevated. Rather, a substantially reduced ALT suggests a down-regulated hepatic activity. (C) 2011 Elsevier Ireland Ltd. All rights reserved.
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| 44. |
- Korszun, P, et al.
(författare)
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Doppler velocimetry for predicting outcome of pregnancies with decreased fetal movements
- 2002
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 81:10, s. 926-930
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Tidskriftsartikel (refereegranskat)abstract
- Aim. The aim of this study was to evaluate umbilical artery (UA) and uterine artery (Ut.A) Doppler velocimetry in a low-risk pregnancy group with decreased fetal movements. Material and methods. Eight hundred and eighty-eight women were examined because of decreased fetal movements. All fetuses were alive on maternal admission. In all cases, UA and Ut.A Doppler velocimetries were performed, as well as a nonstress test (NST). The managing clinician was informed only of the UA Doppler. Results. In the group of 135 women who gave birth within 2 days, UA velocimetry was abnormal in seven fetuses. In 11 cases, Ut.A vascular resistance was abnormal and in 18 cases 'notch' was stated. There were 19 emergency sections in this group. Signs of increased placental vascular resistance were correlated with need for operational delivery because of fetal distress. Among the remaining 753 women who delivered after more than 2 days after examination, UA velocimetry showed abnormality in five fetuses. In 42 cases the Ut.A pulsatility index was abnormal and in 118 cases an early end diastolic 'notch' was present. There was one perinatal death in this group. Conclusions. Decreased fetal movement perception by mothers should be taken seriously. Abnormal placental Doppler was an infrequent finding in these low-risk pregnancies. However, adding UA and Ut.A Doppler velocimetries to conventional NST surveillance might be reassuring for managing clinicians.
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| 45. |
- Korszun, P, et al.
(författare)
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Fetal superior mesenteric artery blood flow velocimetry in normal and high-risk pregnancy
- 2002
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Ingår i: Journal of Perinatal Medicine. - 1619-3997. ; 30:3, s. 235-241
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Tidskriftsartikel (refereegranskat)abstract
- The aim: To record blood flow velocimetry in the fetal superior mesenteric artery in normal pregnancy and to evaluate if blood flow recordings in the vessel might predict adverse outcome in high-risk pregnancy. Methods: The fetal superior mesenteric artery blood velocimetry was recorded in a cross sectional manner in 75 normal pregnancies between 27 and 41 weeks of gestation. Reference curves were performed for pulsatility and resistance indices. The superior mesenteric artery was also located in 48 singleton pregnancies complicated by pregnancy-induced hypertension and/or intra-uterine growth retardation. Middle cerebral artery, umbilical artery and vein and uterine artery velocimetry were also recorded. Results: Superior mesenteric artery PI and RI values expressed an increase in resistance to blood flow with gestational age after 32 weeks of gestation. In all except eight high-risk pregnancies the fetal mesenteric artery PI values were within normal range. Among the pregnancies with absent or reversed blood flow in the umbilical artery, all had abnormal mesenteric artery pulsatility index (PI) (> 97.5(th) percentiles), one fetus died intrauterine and two others died after delivery due to prematurity, growth retardation and necrotizing enterocolitis. In the remaining fetuses with increased mesenteric artery PI, necrotizing enterocolitis was diagnosed in three cases. Conclusions: Increased vascular resistance in the mesenteric artery might be a late sign of fetal circulation redistribution and frequently related to necrotizing enterocolitis in the newborn.
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| 46. |
- Li, Hui, et al.
(författare)
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Acute centralization of blood flow in compromised human fetuses evoked by uterine contractions.
- 2006
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Ingår i: Early Human Development. - : Elsevier BV. - 1872-6232 .- 0378-3782. ; 82:11, s. 747-752
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Tidskriftsartikel (refereegranskat)abstract
- Background: During fetal hypoxia blood is redistributed to the brain ('brain-sparing'). Sequential changes of the cerebral and placental circulation in parallel in comparisons between basal conditions and acute hypoxic stress have not yet been thoroughly studied in human fetuses. Aim: To explore acute fetal middle cerebral artery (MCA) circulatory changes relative to umbilical artery (UA) blood flow in a clinical experimental model with hypoxic stress provoked by uterine contractions during an oxytocin challenge test (OCT). Study design: Prospective comparative between imminently compromised (OCT positive) and un-compromised (OCT negative) fetuses. Subjects and methods: 82 term pregnancies suspected of intrauterine growth restriction were exposed to simultaneous electronic fetal heart rate monitoring and Doppler recordings of pulsatility index (PI) in the UA and MCA during basal conditions and during uterine contractions and relaxations at an OCT. Outcome measures: Sequential changes of UA and MCA PI, OCT positive vs. negative cases. Nonparametric statistics with a P < 0.05 considered significant. Results: The UA PI was significantly higher in OCT positive cases (N=10) compared with OCT negative cases (N=72) during uterine contractions and relaxations, but not during basal measurements. During contractions and relaxations the MCA PI decreased significantly in both groups (brain-sparing), but significantly more in OCT positive cases. Conclusions: During acute hypoxic stress, changes towards a centralization of blood flow to the brain develop in imminently compromised (OCT positive) fetuses at an expense of the umbilicoplacental. blood flow, and the brain-sparing flow is more pronounced than in uncompromised (OCT negative) fetuses.
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| 47. |
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| 48. |
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