Hypercoiled cord can cause a reversible abnormal Doppler in ductus venosus in cases of fetal growth restriction

Iwagaki, Shigenori; Takahashi, Yuichiro; Chiaki, Rika; Asai, Kazuhiko; Matsui, Masako; Mori, Takahiro; Kawabata, Ichiro

doi:10.1111/jog.13722

Cited by 6 publications

(7 citation statements)

References 25 publications

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“…Ductus venosus is not only the main distributor of fetal oxygenated blood flow, but also the direct channel between peripheral vein and central venous system. Its change can indirectly evaluate the degree of fetal intrauterine hypoxia [ 28 ]. In our study, we found that ductus venosus S/a increased significantly in FGR group, which may be related to the decline of cardiac diastolic function, the increase of venous ductus reflux resistance and the decrease of blood flow in FGR.…”

Section: Discussionmentioning

confidence: 99%

Prenatal Prediction of Fetal Growth Restriction and Postnatal Outcomes by Ultrasound Assessment of Fetal Myocardial Performance Index and Blood Flow Spectrum

Wang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. Fetal growth restriction (FGR) affects 5% to 10% of newborns and is a major determinant of perinatal morbidity and mortality. Myocardial performance index (MPI), also known as the Tei index, is a useful, noninvasive, and Doppler-derived myocardial performance tool for fetal cardiac function evaluation. The purpose of the study is to evaluate ultrasonic prediction on FGR and postnatal outcomes using MPI and blood flow spectrum. Methods. This retrospective study included 240 pregnant women developing FGR and 240 healthy pregnant women. The blood flow spectrum of middle cerebral artery (MCA), umbilical artery (UA), and ductus venous including systolic to diastolic ratio (S/D), resistant index (RI), pulse index (PI), and peak ventricular systolic velocity/atrial contraction valley velocity (S/a) were examined using the GE Voluson E8 ultrasound system. Results. The MPI, S/D, RI, PI of UA, and S/a were all higher but S/D, RI, and PI of MCA were lower in the FGR group than those in the control group P < 0.001 . The MPI, S/D, RI, PI of UA, S/D, RI, PI of MCA, and ductus venous S/a yielded AUC of 0.813, 0.835, 0.791, 0.804, 0.789, 0.796, 0.803, and 0.784 when they were used to predict the incidence of FGR. Of note, the pregnant women with poor pregnancy outcomes exhibited higher values of MPI, S/D, RI, PI of UA, and S/a with lower scores of 1 min Apgar concomitant with lower values regarding S/D, RI, and PI of MCA than those with favorable pregnancy outcomes P < 0.001 . The MPI (r = −0.623), S/D (r = −0.660), RI (r = −0.601), PI (r = −630) of UA, and S/a (r = −0.573) shared negative correlations with 1 min Apgar scores P < 0.001 . Of note, the S/D (r = 0.562), RI (r = 0.597), and PI (r = 0.619) of MCA were positively correlated with 1 min Apgar scores P < 0.001 . It was revealed that the MPI, S/D, RI, PI of UA, S/D, RI, PI of MCA, and ductus venous S/a yielded AUC of 0.806, 0.833, 0.774, 0.788, 0.807, 0.729, 0.748, and 0.770 when they were used to predict the incidence of poor pregnancy outcomes for pregnant women developing FGR. Conclusion. Our study demonstrates good ultrasonic prediction on FGR and postnatal outcomes using MPI and blood flow spectrum.

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Section: Discussionmentioning

confidence: 99%

Prenatal Prediction of Fetal Growth Restriction and Postnatal Outcomes by Ultrasound Assessment of Fetal Myocardial Performance Index and Blood Flow Spectrum

Wang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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“…We believe that the umbilical cord bloodflow disturbance, which was caused by umbilical cord compression secondary to entire or local oligohydramnios arising from umbilical cord complications (such as a hypercoiled cord and a single umbilical artery), contributed to the severe condition of the patients. Takahashi et al and Iwagaki et al reported an improvement in abnormal UA and DV Doppler findings after administration of AI in cases with FGR with oligohydramnios and umbilical cord complications [4,8]. Repetitive umbilical cord compression induces fetal asphyxia [4,10], and AI relieves umbilical cord compression, decreases the vascular resistance of UA, increases umbilical venous blood flow, and improves oxygenation and the intrauterine environment [9].…”

Section: Discussionmentioning

confidence: 99%

“…Amnioinfusion (AI) is effective for treating variable decelerations in the fetal heart rate caused by umbilical cord compression with oligohydramnios [5,6]. AI has also been reported to improve abnormal fetal Doppler Open Access *Correspondence: katsuo14@belle.shiga-med.ac.jp 1 Department of Obstetrics and Gynecology, Shiga University of Medical Science Hospital, Otsu 520-2192, Japan Full list of author information is available at the end of the article velocity in cases of FGR with oligohydramnios [4,7,8] and in those with umbilical cord compression without oligohydramnios [9]. However, the guidelines for managing FGR and umbilical cord compression using AI are unclear.…”

Section: Introductionmentioning

confidence: 99%

Successful amnioinfusion for severe fetal growth restriction with umbilical cord complications: two case reports

et al. 2021

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Background There is no established treatment for fetal growth restriction during pregnancy. We report two cases that represent an example of an amnioinfusion-based management strategy for severe fetal growth restriction with umbilical cord complications. Case presentation We encountered two cases of fetal growth restriction with abnormal fetal Doppler velocity. In one case, fetal ultrasound revealed a hypercoiled umbilical cord with a single umbilical artery and oligohydramnios, while fetal Doppler revealed a reversed end-diastolic flow in the umbilical artery and reversed a-waves of the ductus venosus. Umbilical cord compression was confirmed at 22 weeks and 2 days of gestation, and nine amnioinfusions were performed to relieve the umbilical cord compression. A cesarean section was performed at 31 weeks and 2 days of gestation because of severe preeclampsia. The Asian infant is now a normally developed 6-month-old. In another Asian case, fetal ultrasound revealed a hypercoiled cord, while fetal Doppler revealed a reversed end-diastolic flow in the umbilical artery and intermittent reversed a-waves of the ductus venosus. Umbilical cord compression was confirmed at 24 weeks and 5 days of gestation, and seven amnioinfusions were performed. A cesarean section was performed at 31 weeks and 1 day of gestation because of nonreassuring fetal status. At the age of 1 month, the Asian infant was stable on respiratory circulation. In both cases, fetal Doppler findings improved significantly following amnioinfusions. Conclusions Amnioinfusion is a symptomatic treatment for umbilical cord compression. However, to determine the therapeutic effect of amnioinfusion, complete resolution of the umbilical cord compression should be ascertained by ultrasonography.

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“…Due to chronic obstruction of the circulation and hence chronic fetal hypoxia, a longer umbilical cord with overcoiling is associated with intrauterine fetal growth restriction [1,2,5]. The 190-cm-long umbilical cord in this report is the first review in the literature.…”

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confidence: 83%

Extremely Long, 190-cm Umbilical Cord Wrapped Six Times around the Neck

Habek

Miletić

Živković

et al. 2021

Z Geburtshilfe Neonatol

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Hypercoiled cord can cause a reversible abnormal Doppler in ductus venosus in cases of fetal growth restriction

Abstract: Temporary DV-RAV is suspected to be related to the combination of a hypercoiled cord and oligohydramnios. DV-RAV may not be always be a terminal finding in FGR with a hypercoiled cord.

Cited by 6 publications

References 25 publications

Prenatal Prediction of Fetal Growth Restriction and Postnatal Outcomes by Ultrasound Assessment of Fetal Myocardial Performance Index and Blood Flow Spectrum

Prenatal Prediction of Fetal Growth Restriction and Postnatal Outcomes by Ultrasound Assessment of Fetal Myocardial Performance Index and Blood Flow Spectrum

Successful amnioinfusion for severe fetal growth restriction with umbilical cord complications: two case reports

Extremely Long, 190-cm Umbilical Cord Wrapped Six Times around the Neck

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