Doppler velocimetry discordance between paired umbilical artery vessels and clinical implications in fetal growth restriction

Steller, Jonathan; Driver, Camille; Gumina, Diane L.; Peek, Emma; Harper, Teresa; Hobbins, John C.; Galan, Henry L.

doi:10.1016/j.ajog.2022.03.029

Cited by 7 publications

(2 citation statements)

References 28 publications

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“…A limitation of using ultrasound parameters is their potential for variation. In the case of Doppler velocimetry this includes interobserver variability, temporal variation due to factors such as maternal and fetal movement, and variation in umbilical artery waveforms between arteries and along the length of the cord (44)(45)(46)(47). There is also considerable variation between different Doppler reference ranges, both in terms of the values of their 'normal' ranges and their methodological quality (48).…”

Section: Findings In the Context Of Existing Literaturementioning

confidence: 99%

Ultrasound and biochemical predictors of pregnancy outcome at diagnosis of early-onset fetal growth restriction

Spencer

Maksym

Hecher

et al. 2023

Preprint

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Background: Severe early-onset fetal growth restriction (FGR) causes significant fetal and neonatal mortality and morbidity. Predicting the outcome of affected pregnancies at the time of diagnosis is difficult, preventing accurate patient counselling. We investigated the use of maternal serum protein and ultrasound measures at diagnosis to predict fetal or neonatal death and three secondary outcomes: fetal death or delivery ≤28+0 weeks; development of abnormal umbilical artery Doppler velocimetry; slow fetal growth. Methods: Women with singleton pregnancies (n=142, estimated fetal weights [EFWs] <3rd centile, <600g 20+0-26+6 weeks of gestation, no known chromosomal, genetic or major structural abnormalities), were recruited from four European centres. Maternal serum from the discovery set (n=63) was analysed for seven proteins linked to angiogenesis, 90 additional proteins associated with cardiovascular disease and five proteins identified through pooled liquid chromatography tandem mass spectrometry. Patient and clinician stakeholder priorities were used to select models tested in the validation set (n=60), with final models calculated from combined data. Results: The most discriminative model for fetal or neonatal death included EFW z-score (Hadlock 3 formula/Marsal chart), gestational age and umbilical artery Doppler category (AUC 0.91, 95%CI 0.86-0.97) but was less well calibrated than the model containing only EFW z-score (Hadlock3/Marsal). The most discriminative model for fetal death or delivery ≤28+0 weeks included maternal serum placental growth factor (PlGF) concentration and umbilical artery Doppler category (AUC 0.89, 95%CI 0.83-0.94). Conclusion: Ultrasound measurements and maternal serum PlGF concentration at diagnosis of severe early-onset FGR predict pregnancy outcomes of importance to patients and clinicians.

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Section: Findings In the Context Of Existing Literaturementioning

confidence: 99%

Ultrasound and biochemical predictors of pregnancy outcome at diagnosis of early-onset fetal growth restriction

Spencer

Maksym

Hecher

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…A limitation of using ultrasound parameters is their potential for variation. In the case of Doppler velocimetry, this includes interobserver variability, temporal variation due to factors such as maternal and fetal movement, and variation in UmA waveforms between arteries and along the length of the cord (41)(42)(43)(44). There is also considerable variation between different Doppler reference ranges, both in terms of the values of their "normal" ranges and their methodological quality (45).…”

Section: Introductionmentioning

confidence: 99%

Maternal PlGF and umbilical Dopplers predict pregnancy outcomes at diagnosis of early-onset fetal growth restriction

Spencer,

Maksym,

Hecher

et al. 2023

Journal of Clinical Investigation

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BACKGROUND. Severe, early-onset fetal growth restriction (FGR) causes significant fetal and neonatal mortality and morbidity. Predicting the outcome of affected pregnancies at the time of diagnosis is difficult, thus preventing accurate patient counseling. We investigated the use of maternal serum protein and ultrasound measurements at diagnosis to predict fetal or neonatal death and 3 secondary outcomes: fetal death or delivery at or before 28+0 weeks, development of abnormal umbilical artery (UmA) Doppler velocimetry, and slow fetal growth. METHODS.Women with singleton pregnancies (n = 142, estimated fetal weights [EFWs] below the third centile, less than 600 g, 20+0 to 26+6 weeks of gestation, no known chromosomal, genetic, or major structural abnormalities) were recruited from 4 European centers. Maternal serum from the discovery set (n = 63) was analyzed for 7 proteins linked to angiogenesis, 90 additional proteins associated with cardiovascular disease, and 5 proteins identified through pooled liquid chromatography and tandem mass spectrometry. Patient and clinician stakeholder priorities were used to select models tested in the validation set (n = 60), with final models calculated from combined data. RESULTS.The most discriminative model for fetal or neonatal death included the EFW z score (Hadlock 3 formula/Marsal chart), gestational age, and UmA Doppler category (AUC, 0.91; 95% CI, 0.86-0.97) but was less well calibrated than the model containing only the EFW z score (Hadlock 3/Marsal). The most discriminative model for fetal death or delivery at or before 28+0 weeks included maternal serum placental growth factor (PlGF) concentration and UmA Doppler category (AUC, 0.89; 95% CI, 0.83-0.94). CONCLUSION.Ultrasound measurements and maternal serum PlGF concentration at diagnosis of severe, early-onset FGR predicted pregnancy outcomes of importance to patients and clinicians. TRIAL REGISTRATION. ClinicalTrials.gov NCT02097667.

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Addressing pitfalls in the study of discrepant umbilical artery Dopplers

Steller¹,

Hobbins²,

Galan³

2023

American Journal of Obstetrics and Gynecology

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Doppler velocimetry discordance between paired umbilical artery vessels and clinical implications in fetal growth restriction

Cited by 7 publications

References 28 publications

Ultrasound and biochemical predictors of pregnancy outcome at diagnosis of early-onset fetal growth restriction

Ultrasound and biochemical predictors of pregnancy outcome at diagnosis of early-onset fetal growth restriction

Maternal PlGF and umbilical Dopplers predict pregnancy outcomes at diagnosis of early-onset fetal growth restriction

Addressing pitfalls in the study of discrepant umbilical artery Dopplers

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