Clinical utility of aortic isthmus Doppler in the prediction of perinatal outcomes

Vasudeva, Akhila; Shivananda, Roopa Padavagodu; Shashidar, Disha Shree Belathur; Mundkur, Anjali; Samanth, Jyothi; Hegde, Nivedita; Narayan, Pratap Kumar

doi:10.1016/j.xagr.2022.100102

Cited by 3 publications

(4 citation statements)

References 37 publications

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“…Consistent with our findings, the results of Vasudeva et al 1 study showed that cerebral vasodilation is also a key determinant of preterm APO and that DV PI changes might not be as accurate as previously thought for the identification of fetal compromise. Further investigation is needed to clarify the most reliable parameter to predict preterm APO.…”

supporting

confidence: 84%

“…Vasudeva et al 1 present an interesting comparison of the accuracy of different Doppler indices for the prediction of adverse perinatal outcomes (APOs) in early-onset small for gestational age neonates. The cerebroplacental ratio (CPR), a parameter thought to be a key determinant of APO in late pregnancy, showed by far the best prediction ability when compared with the performance of the ductus venosus pulsatility index (DV PI), previously thought to be key for the prediction of APO early in pregnancy based on the Trial of Randomized Umbilical and Fetal Flow in Europe study results.…”

mentioning

confidence: 99%

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The ductus venosus, a poor predictor of adverse perinatal outcome in preterm pregnancy

Morales-Roselló,

Martínez-Varea,

Khalil

2023

AJOG Global Reports

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supporting

confidence: 84%

mentioning

confidence: 99%

The ductus venosus, a poor predictor of adverse perinatal outcome in preterm pregnancy

Morales-Roselló,

Martínez-Varea,

Khalil

2023

AJOG Global Reports

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“…In the current study, FGR was not associated with decreased flow in the DAo or UV. In FGR, diastolic but not systolic isthmic flow reversal is present (32,33), suggesting that the pronounced outflow tract obstruction rather than the FGR was the reason for the observed systolic isthmic flow reversal in this patient.…”

Section: Fetal Cmr Flow Measurements As Predictors Of Left-sided Card...mentioning

confidence: 86%

Fetal cardiac magnetic resonance imaging of the descending aorta in suspected left-sided cardiac obstructions

Fricke,

Ryd,

Weismann

et al. 2023

Front. Cardiovasc. Med.

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BackgroundSevere left-sided cardiac obstructions are associated with high morbidity and mortality if not detected in time. The correct prenatal diagnosis of coarctation of the aorta (CoA) is difficult. Fetal cardiac magnetic resonance imaging (CMR) may improve the prenatal diagnosis of complex congenital heart defects. Flow measurements in the ascending aorta could aid in predicting postnatal CoA, but its accurate visualization is challenging.ObjectivesTo compare the flow in the descending aorta (DAo) and umbilical vein (UV) in fetuses with suspected left-sided cardiac obstructions with and without the need for postnatal intervention and healthy controls by fetal phase-contrast CMR flow. A second objective was to determine if adding fetal CMR to echocardiography (echo) improves the fetal CoA diagnosis.MethodsProspective fetal CMR phase-contrast flow in the DAo and UV and echo studies were conducted between 2017 and 2022.ResultsA total of 46 fetuses with suspected left-sided cardiac obstructions [11 hypoplastic left heart syndrome (HLHS), five critical aortic stenosis (cAS), and 30 CoA] and five controls were included. Neonatal interventions for left-sided cardiac obstructions (n = 23) or comfort care (n = 1 with HLHS) were pursued in all 16 fetuses with suspected HLHS or cAS and in eight (27%) fetuses with true CoA. DAo or UV flow was not different in fetuses with and without need of intervention. However, DAo and UV flows were lower in fetuses with either retrograde isthmic systolic flow [DAo flow 253 (72) vs. 261 (97) ml/kg/min, p = 0.035; UV flow 113 (75) vs. 161 (81) ml/kg/min, p = 0.04] or with suspected CoA and restrictive atrial septum [DAo flow 200 (71) vs. 268 (94) ml/kg/min, p = 0.04; UV flow 89 vs. 159 (76) ml/kg/min, p = 0.04] as well as in those without these changes. Adding fetal CMR to fetal echo predictors for postnatal CoA did not improve the diagnosis of CoA.ConclusionFetal CMR-derived DAo and UV flow measurements do not improve the prenatal diagnosis of left-sided cardiac obstructions, but they could be important in identifying fetuses with a more severe decrease in blood flow across the left side of the heart. The physiological explanation may be a markedly decreased left ventricular cardiac output with subsequent retrograde systolic isthmic flow and decreased total DAo flow.

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“…Although the fetal aorta and the myocardial performance index represent the balance between the myocardium and the systemic and cerebral blood circulation, we failed to detect an association of these markers with operative delivery due to IFC. While some studies found strong correlations of abnormal Doppler imaging of the fetal aorta with adverse perinatal outcome [8,27], others failed to show an additional clinical benefit for the perinatal management of SGA and FGR fetuses [28]. Studies on fetal cardiac function detected subclinical cardiac dysfunction among SGA fetuses [11] with reduced cardiac output as an early sign of placental insufficiency [12].…”

Section: Discussionmentioning

confidence: 99%

Association between Doppler assessment and secondary cesarean delivery for intrapartum fetal compromise in small-for-gestational-age fetuses

Scholz,

Rónay,

Wallwiener

et al. 2024

Arch Gynecol Obstet

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Purpose To elucidate the association between arterial and venous Doppler ultrasound parameters and the risk of secondary cesarean delivery for intrapartum fetal compromise (IFC) and neonatal acidosis in small-for-gestational-age (SGA) fetuses. Methods This single-center, prospective, blinded, cohort study included singleton pregnancies with an estimated fetal weight (EFW) < 10th centile above 36 gestational weeks. Upon study inclusion, all women underwent Doppler ultrasound, including umbilical artery (UA) pulsatility index (PI), middle cerebral artery (MCA) PI, fetal aortic isthmus (AoI) PI, umbilical vein blood flow (UVBF), and modified myocardial performance index (mod-MPI). Primary outcome was defined as secondary cesarean section due to IFC. Results In total, 87 SGA pregnancies were included, 16% of which required a cesarean section for IFC. Those fetuses revealed lower UVBF corrected for abdominal circumference (AC) (5.2 (4.5–6.3) vs 7.2 (5.5–8.3), p = 0.001). There was no difference when comparing AoI PI, UA PI, ACM PI, or mod-MPI. No association was found for neonatal acidosis. After multivariate logistic regression, UVBF/AC remained independently associated with cesarean section due to IFC (aOR 0.61 [0.37; 0.91], p = 0.03) and yielded an area under the curve (AUC) of 0.78 (95% CI, 0.67–0.89). A cut-off value set at the 50th centile of UVBF/AC reached a sensitivity of 86% and specificity of 58% for the occurrence of cesarean section due to IFC (OR 8.1; 95% CI, 1.7–37.8, p = 0.003). Conclusion Low levels of umbilical vein blood flow (UVBF/AC) were associated with an increased risk among SGA fetuses to be delivered by cesarean section for IFC.

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Clinical utility of aortic isthmus Doppler in the prediction of perinatal outcomes

Cited by 3 publications

References 37 publications

The ductus venosus, a poor predictor of adverse perinatal outcome in preterm pregnancy

The ductus venosus, a poor predictor of adverse perinatal outcome in preterm pregnancy

Fetal cardiac magnetic resonance imaging of the descending aorta in suspected left-sided cardiac obstructions

Association between Doppler assessment and secondary cesarean delivery for intrapartum fetal compromise in small-for-gestational-age fetuses

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