Components of variability of umbilical arterial Doppler velocimetry-A prospective analysis

Maulik, Dev; Yarlagadda, Atmaram; Youngblood, James P.; Willoughby, Lee

doi:10.1016/0002-9378(89)90862-4

Cited by 47 publications

(19 citation statements)

References 6 publications

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“…Our results are in agreement with other studies that have shown that error components in Doppler examinations are substantial, both for continuous wave (Maulik et al 1988) and pulsed wave (Nienhuis et al 1988). These studies reported data from the umbilical artery or from the umbilical artery and descending aorta, but do not consider the important influence of fetuses with or without absent end diastolic velocities on the ICC.…”

Section: Discussionsupporting

confidence: 93%

“…This new technique has promise for the assessment of the small for gestational age fetus (Wladimiroff et al 1988). However, there are problems in relation to the clinical application of this technique (Nienhuis et al 1988; Maulik et al 1988; Low 1991). Crucial to the discussion of any apparent lack of agreement between the indices derived from the flow velocity waveforms and the condition of the fetus should be the intra‐ and inter‐observer reliability.…”

mentioning

confidence: 99%

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Intra‐observer and inter‐observer reliability of the pulsatility index calculated from pulsed Doppler flow velocity waveforms in three fetal vessels

Scherjon

Kok²,

Oosting³

et al. 1993

BJOG

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Objective Study of the intra observer and inter observer reliability of the pulsatility index, calculated from pulsed Doppler recordings of three fetal vessels. Design Flow velocity waveforms (FVW) were recorded from the umbilical artery, the fetal descending aorta and the fetal internal carotid artery. Intra‐observer reliability was assessed in six fetuses; ten repeated measurements were performed by one observer. Inter‐observer reliability was studied in 14 fetuses; two observers performed two repeated measurements in each fetus. Setting A tertiary referral hospital. Subjects High risk pregnancies with a gestational age ranging from 29 to 42 weeks. Main outcome measures Analysis of variance with repeated measurements and a graphical method were used for data analysis. Intra‐observer repeatability was expressed as Intraclass Correlation Coefficient (IntraCC). Inter‐observer agreement was expressed as Interclass Correlation Coefficient (InterCC). Results IntraCC for umbilical artery, descending aorta and internal carotid artery were 0.91, 0.78, and 0.54, respectively. InterCC values for these vessels were 0.39, 0.45 and 0.34, respectively. No systematic differences between the two observers except for the fetal descending aorta, were apparent. IntraCC decreased remarkable when fetuses with absent end diastolic velocities were excluded from the analysis. Conclusion The pulsatility index (PI) used for fetal measurements has a poor reliability. This is of serious concern when clinical use of FVW measurements is considered as a diagnostic tool.

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Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 99%

Intra‐observer and inter‐observer reliability of the pulsatility index calculated from pulsed Doppler flow velocity waveforms in three fetal vessels

Scherjon

Kok²,

Oosting³

et al. 1993

BJOG

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show abstract

“…Through its easy accessability and the quick generation of seemingly plausible waveforms, there is a marked tendency in daily clinical practice to overlook the potential pitfalls of umbilical artery Doppler: It has long been known that there is a variation of 30Ϫ40 % in Doppler indices (Pi, Ri, S/D) in the same fetus along the length of the umbilical cord [28]. As even with high-end color Doppler equipment it is difficult to assess the exact interrogation angle of the Doppler beam with the umbilical artery, there is obviously some variation between measurements taken at different parts of the same umbilical cord coil.…”

Section: Umbilical Arterymentioning

confidence: 99%

Fetal hemodynamics

Brezinka¹

2001

Journal of Perinatal Medicine

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Starting in the left cardiac ventricle the reader is taken on a guided tour on a fetal erythrocyte as measured by Doppler ultrasound. Up in the ascending aorta we move through the aortic isthmus to the descending aorta and the internal umbilical arteries, which fuse around the umbilical cord. With fresh oxygen from the placenta our erythrocyte moves in an accelerating continuous flow along the umbilical vein to the ductus venosus. After having reached the left ventricle again it now passes through a coronary artery to the right atrium and eventually the ductus arteriosus or the pulmonary circulation. Concepts of pulsatility, impedance and resistance are presente in the context of their clinical applicability in Doppler waveforms of various fetal vessels.

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“…1 The recognition of pathological blood flow in the umbilical artery is dependent on reliable standards. Despite traditional reporting of SD in Australia 3 and the United States of America 4,5 and RI in New Zealand 6 PI has several advantages. 2 We wished to assess usage of 3 umbilical artery (UA) Doppler indices: systolic: diastolic ratio (also called SD or A:B ratio), resistance index (RI) and pulsatility index (PI).…”

Section: Introductionmentioning

confidence: 99%

“…All indices are pattern recognition descriptors for detecting pathology in the umbilical placental circulation. Despite traditional reporting of SD in Australia 3 and the United States of America 4,5 and RI in New Zealand 6 PI has several advantages. First, it is a more valid measure than SD or RI when compared against a 'gold standard' of directly measured vascular resistance.…”

Section: Introductionmentioning

confidence: 99%

Umbilical artery Doppler flow: An examination of current and best practice

McCarthy

Walker

Shub

2013

Aust N Z J Obstet Gynaecol

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A Web-based survey of Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) fellows and trainees who perform or act on umbilical artery Doppler showed heterogeneous reporting practices. Systolic: diastolic ratio is frequently used. Pulsatility index is favoured internationally and by many RANZCOG subspecialists. Unpublished charts are used more often than published. We summarise ideal methods of chart development but recognise that chart choice is guided by professional opinion leaders, day-to-day accessibility and other factors.

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Components of variability of umbilical arterial Doppler velocimetry-A prospective analysis

Cited by 47 publications

References 6 publications

Intra‐observer and inter‐observer reliability of the pulsatility index calculated from pulsed Doppler flow velocity waveforms in three fetal vessels

Intra‐observer and inter‐observer reliability of the pulsatility index calculated from pulsed Doppler flow velocity waveforms in three fetal vessels

Fetal hemodynamics

Umbilical artery Doppler flow: An examination of current and best practice

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