Objectives

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Fetuses that required postnatal transfusions due to hemolytic disease showed an enhanced progressive increase in MCA PSVs compared to those without transfusion requirement. This information might enable their identification during pregnancy.

Objectives: Several scientific studies have described different temporal changes in the fetal cerebral arteries in relation to the systemic hemodynamic changes occurring among fetuses with severe Intrauterine Growth Retardation (IUGR). In terms of the Pulsatility Index (PI), the Anterior Cerebral Artery (ACA) and the Posterior Cerebral Artery (PCA) seemed to vasodilate earlier, with a significant reduction at an early stage. This suggests that the reduction in the PI in these vessels was probably associated with local increments in blood supply.The objective of this study was to draw a reference curve for the Doppler PI of the PCA throughout pregnancy. Methods: Reference values for the PI of the PCA against gestational age were obtained for the fetuses of 131 normal pregnant women from 24 to 36 weeks of gestational age. PCA-PI was recorded at the level of the transverse cerebral fissure on the side of the midbrain. Results: The graph representing the values of PCA against gestational age among AGA fetuses was a linear-like curve. There was a high correlation (R2). The PCA-PI increased continuously up to 30 weeks of gestation. Conclusions: Reference values for the PCA-PI against gestational age can be developed to assess well-being among fetuses with IUGR using Doppler flow velocity evaluation of the PCA.

To assess outcomes of pregnancies complicated by altered flow velocity waveform of the umbilical artery at mid gestation. Methods: A retrospective study was performed of 24 singleton pregnancies presenting to Sant'Orsola-Malpighi Hospital (Bologna, Italy) between April 2007 and March 2010 with altered flow velocity waveform of the umbilical artery (reduced end-diastolic flow (EDF), transient absence of end-diastolic flow (AEDF), persistent AEDF) from 20-25 weeks' gestation. Results: The mean gestational age (GA) at presentation was 22 weeks. Primary cytomegalovirus infection was detected in one case and uterine artery Doppler was altered in 18 cases (79%). No chromosomal aberrations or fetal malformations was seen. Four patients opted for termination of pregnancy. No intrauterine fetal death was observed. GA at delivery and birth weight are summarised in Table 1. The overall perinatal mortality rate was 15%. The mortality rate among pregnancies complicated by AEDF and AEDF with oligohydramnios was 13% and 40%, respectively. All survivors had short-term morbidity, mainly respiratory diseases. A case of cerebral palsy was diagnosed and it was associated with periventricular leukomalacia. Finally, one baby had evidence of developmental delay in absence of major brain lesions. Conclusions: In pregnancies complicated by very early onset of altered flow velocity waveform of the umbilical artery, the survival rate was 75%. Among the survivors, short-term morbidity was high, thought the rate of severe neurological sequelae was low.