Contraction stress test versus ductus venosus Doppler evaluation for the prediction of adverse perinatal outcome in growth‐restricted fetuses with non‐reassuring non‐stress test

Figueras, F.; Martínez, J. M.; Puerto, B.; Coll, O.; Cararach, Vicenç; Vanrell, Juan A.

doi:10.1002/uog.60

Cited by 46 publications

(23 citation statements)

References 30 publications

(40 reference statements)

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“…On the basis of GRIT study [6] and the findings that perinatal mortality increases from 12% in fetuses with AEDV/REDV in the UA to 39% when DV PIV is increased, it might seem reasonable to recommend delivery when the DV Doppler becomes abnormal, provided the fetus is considered viable [7,36,37,38]. Particularly reversal of the A-wave in DV results in exponentially increased risk for intrauterine fetal demise and there is a good body of evidence that delivery should be effectuated promptly [35,39,40,41]. In this study, experts suggested 28 weeks' gestational age to deliver, however again with wide uncertainty range.…”

Section: Discussionmentioning

confidence: 99%

Survey on the Current Trends in Managing Intrauterine Growth Restriction

Savchev

Figueras²,

Gratacós³

2014

Fetal Diagn Ther

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Objective: To provide a snapshot of the current trends in managing intrauterine growth restriction (IUGR) and to assess the agreement on the gestational age and the way of delivery in different clinical scenarios. Methods: A PubMed search was performed to identify all original articles on IUGR in the last 6 years. The most active 20 authors were selected as experts and were invited to respond to a survey on their preferred gestational age for elective delivery in several IUGR cases depending on Doppler measurements (including umbilical artery (UA), middle cerebral artery, cerebroplacental ratio, uterine artery and ductus venosus), biophysical profile and cardiotocography. Results: 15 of the 20 selected experts agreed to participate in the survey, of which 3 failed to meet the deadline to complete the survey. Management of IUGR was relatively uniform for abnormal UA, uterine artery or cerebroplacental ratio. Although average gestational age at delivery reflected a clear progression with accepted markers of severity, discrepancies of up to 4 weeks were found for abnormal middle cerebral artery Doppler and absent end-diastolic velocity in the UA, and of up to 8 weeks for reverse end-diastolic velocity in the UA and abnormalities in the ductus venosus Doppler. Conclusions: Management of IUGR is still far from being uniform among centers, with most controversy surrounding the management of early-onset IUGR. There is a need of prospective studies to address this issue.

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Section: Discussionmentioning

confidence: 99%

Survey on the Current Trends in Managing Intrauterine Growth Restriction

Savchev

Figueras²,

Gratacós³

2014

Fetal Diagn Ther

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“…In contrast, one only abnormal CTG led to an emergency Cesarean section. Recently, the low value of an oxytocin challenge test when the venous Doppler is altered has also been demonstrated 28 . Nevertheless, some authors believe it more advisable in cases of FGR to use a combination of Doppler, CTG and biophysical profile to predict intrauterine compromise and fetal outcome in the face of timing delivery 29 .…”

Section: Discussionmentioning

confidence: 97%

A temporal model of deterioration in Doppler velocimetric parameters in fetal growth restriction related to cardiotocographic monitoring

LT¹,

Carrasco²,

JC³

2004

The Ultrasound Review of Obstetrics & Gynecology

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The present study aimed to describe the time sequence of abnormal changes in Doppler velocimetric parameters and its relationship with fetal heart rate recorded in growth-restricted fetuses. Fifteen singleton pregnancies with an ultrasound diagnosis of fetal growth restriction (abdominal circumference 5 2SD) were evaluated prospectively and longitudinally. Fetal outcome included four perinatal deaths, seven emergency Cesarean sections due to abnormal cardiotocogram (CTG) and four admissions to the neonatal intensive-care unit. We observed 'early' Doppler changes (15 to 10 days prior to delivery) in the umbilical artery (UA), middle cerebral artery (MCA) and cerebroplacental ratio. 'Late' Doppler changes included absent or reverse end-diastolic flow in the UA, high resistance in the ductus venosus (DV) and decrease of umbilical venous blood flow. These changes appeared in 10% of cases 4-7 days prior to delivery and in up to 40% of cases on the day of delivery. Although occurring less frequently, umbilical vein pulsations, reverse 'a' wave at the DV and increased flow resistance in the MCA were also observed closer to delivery. 'Late' Doppler changes appeared in two-thirds of cases with 'early' Doppler changes and in 40% of cases with an abnormal CTG. These changes preceded the abnormal CTG patterns by 1-10 days. All perinatal deaths were of patients who showed 'late' Doppler changes (4/10), whereas an abnormal CTG without 'late' Doppler changes led to emergency Cesarean delivery because of the risk of loss of fetal well-being (7/10). From the time sequence observed we describe a standard model of Doppler changes in fetal growth restriction. It is obviously not a rule for fetal deterioration to take place the same way in every individual affected fetus. Nevertheless, it is apparent that 'late' Doppler changes usually precede an abnormal CTG and are associated with greater perinatal mortality.

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“…Não foi identificada diferença significante entre os grupos no que diz respeito a hemorragia intraventricular (p=0,43), necessidade de surfactante (p=0,37), uso de respirador (p=0,23), disfunção miocárdica (p=0,22), enterocolite necrotizante (p=0,43) e permanência Rev Bras Ginecol Obstet. 2006; 28(4): 238-43 pulsatilidade do DV é, também, fator indicativo para internação em UTI neonatal, pH arterial menor que 7,10 ao nascimento e morbidade neonatal 25 . No presente estudo, houve homogeneidade entre os dois grupos para IG ao nascimento e Apgar <7 no 5º minuto.…”

Section: Discussionunclassified

Estudo do sonograma do ducto venoso em fetos com centralização hemodinâmica: avaliação de repercussões perinatais

Carvalho¹,

Moreira²,

Sá³

et al. 2006

Rev. Bras. Ginecol. Obstet.

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RESUMOObjetivo: avaliar a associação da relação sístole ventricular/atrial (S/A) do ducto venoso (DV) com resultados perinatais em fetos prematuros com centralização de fluxo à dopplervelocimetria. Métodos: o estudo foi delineado como um estudo observacional, transversal, com os dados colhidos de forma prospectiva. A relação S/A do DV foi estudada em 41 fetos centralizados com idade gestacional (IG) entre 25 e 33ª semana completa, no período de novembro de 2002 a julho de 2005. Os recém-nascidos foram acompanhados até o 28º dia pós-parto na UTI da Clínica Perinatal Laranjeiras, buscando-se complicações neonatais. A população de estudo foi dividida em dois grupos a partir do resultado do DV. Foram incluídos no grupo normal os fetos com relação S/A menor ou igual a 3,6 e no grupo alterado aqueles com valores de S/A maiores que 3,6. A comparação entre os grupos foi realizada com os testes estatísticos de Mann-Whitney, χ2 e exato de Fisher. Todos os resultados foram considerados estatisticamente significativos se p<0,05. Foram avaliados a IG ao nascimento, peso ao nascer e índice de Apgar menor que 7 no 5º minuto. Os parâmetros perinatais avaliados foram: natimortalidade, neomortalidade, convulsão, hemorragia intraventricular, necessidade de surfactante, uso de respirador, disfunção miocárdica, enterocolite necrotizante e permanência na UTI após o período neonatal. Resultados: dos 41 fetos incluídos, 26 (63,4%) não apresentaram alteração da relação S/A do DV, ao passo que 15 (36,6%) fetos cursaram com a relação S/A do DV alteradas (>3,6). Não houve diferença significativa entre os grupos quanto à IG ao nascimento e Apgar <7. Encontrou-se associação significante entre o grupo com DV alterado e mortalidade neonatal (p=0,049; teste exato de Fisher). Quanto às demais variáveis estudadas não foi observada diferença entre os dois grupos. Conclusão: os nossos resultados sugerem que a anormalidade do fluxo no DV detectada pela dopplervelocimetria não está associada a resultados perinatais adversos, além da mortalidade neonatal. Esta associação pode ser considerada estatisticamente significante, porém com valor próximo ao limite (p=0,049). Quando excluídos os fetos com peso de nascimento inferior a 400 gramas, não é mais observada a associação entre o DV e neomortalidade (p=0,37). A alteração da relação S/A do DV não apresentou, em nossa amostra, associação com mortalidade perinatal em fetos prematuros viáveis. PALAVRAS-CHAVE:Fluxometria por laser-doppler; Sangue fetal; Sofrimento fetal ABSTRACT Purpose: to evaluate the relationship between S/A ratio in ductus venosus (DV) and perinatal outcomes in fetuses with brain sparing reflex. Methods: the study was designed as an observational, sectional study with prospectively collected data. Forty-one fetuses with brain sparing reflex and gestational age between 25 and 33 weeks were studied between November 2002 and July 2005. The newborns were observed during the neonatal period in the intensive care unit of "Clínica Perinatal Laranjeiras" in order to find adverse outcomes. The st...

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Contraction stress test versus ductus venosus Doppler evaluation for the prediction of adverse perinatal outcome in growth‐restricted fetuses with non‐reassuring non‐stress test

Abstract: Objective To compare Doppler evaluation of the ductus venosus and contraction stress test (CST) in the prediction of adverse perinatal outcome in growth-restricted fetuses with evidence of hemodynamic redistribution and a nonreactive non-stress test (NST). Methods

Cited by 46 publications

References 30 publications

Survey on the Current Trends in Managing Intrauterine Growth Restriction

Survey on the Current Trends in Managing Intrauterine Growth Restriction

A temporal model of deterioration in Doppler velocimetric parameters in fetal growth restriction related to cardiotocographic monitoring

Estudo do sonograma do ducto venoso em fetos com centralização hemodinâmica: avaliação de repercussões perinatais

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