Doppler Velocimetry of the Ductus Arteriosus in Normal Fetuses and Fetuses Suspected for Pulmonary Hypoplasia

Abstract

Objective: The purpose of this study was to determine whether the pulsatility index (PI) of the ductus arteriosus could predict the occurrence of pulmonary hypoplasia secondary to congenital disorders or complications during pregnancy. Sample and Methods: In this longitudinal study, 78 uncomplicated pregnancies and 43 pregnancies complicated by various disorders or complications with regard to pulmonary hypoplasia were studied by Doppler sonography between 18 and 35 weeks of gestation. A PI >97.5th percentile was considered abnormal. Results: Using a multilevel modelling, the reference curve of the PI of the ductus arteriosus was created based on 301 measurements. Of the 43 complicated pregnancies, 21 infants (49%) were diagnosed with pulmonary hypoplasia on postmortem examination and/or the clinical and radiological presentation. Using the PI, a sensitivity of 38%, a specificity of 95%, a positive predictive value of 89% and a negative predictive value of 62% were found. Conclusion: The PI of the ductus arteriosus is not useful in predicting the occurrence of pulmonary hypoplasia secondary to congenital disorders or complications during pregnancy.

Are non-invasive or minimally invasive autopsy techniques for detecting cause of death in prenates, neonates and infants accurate? A systematic review of diagnostic test accuracy

“…In contrast, antenatal ultrasound was favourable in the majority of studies (n=35) for a loss in utero population 42 43 46 56 60 68 78–80 83 84 89 90 93 95 97 99 100 109 114 118 120 125 127 130 135 138 142 150 155 157 161 169 170 173. Only 12 studies favoured autopsy,70–72 96 115 123 126 134 149 154 163 164 and 5 studies presented a 50:50 split between agreement and disagreement 44 132 144 162 171…”

“…Similarly, studies assessing a neonatal population tended to favour the index test 51 52 68 73 78 89 90 154. Seven studies favoured the reference standard 46 86 91 119 130 136 137.…”

“…However this only amounted to 54 studies in total as some artices described different tests from the same study. Of the 134 indirect evidence papers or abstracts, 133 were synthesised41–174 as well as a single trial record 175. None of the seven included trials identified from trial registries reported interim or final results and only four remain active 176–179.…”

“…For both risk of bias and applicability to the review question, the majority (n=129) had some concerns,41 42 44–67 69–87 89–149 151–170 172–174 and five had a high level of concern43 68 88 150 171 (figure 3).…”

“…In a stillbirth population, the number of studies favouring the index test was higher than those favouring the reference standard. Eighteen studies favoured antenatal ultrasound,41 52–54 57 75 77 78 85 89 90 98 108 124 128 133 137 166 and 11 favoured autopsy 50 61 65 82 86 91 110 148 159 160 167…”