Inter- and intra-observer variability in fetal ductus venosus blood flow measurements in high-risk fetuses at 26–32 weeks

Bruin, Claartje; Ganzevoort, Wessel; Schuit, Ewoud; Charante, Nico A Mensing van; Wolf, Hans

doi:10.1016/j.ejogrb.2019.10.028

Cited by 5 publications

(4 citation statements)

References 23 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

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“…Серцева дисфункція, яка пов'язана з підвищенням передсердного тиску, а також зниженою податливістю шлуночків може бути переважним механізмом, що визначає профіль швидкості венозної протоки при затримці росту плода з ознаками гіпоксичного порушення. Розуміння патофізіології венозної протоки стає основою гіпотез, розроблених за допомогою біостатистики, для більш впевненого пояснення доплерівських змін кровоплину плода для прогнозування клінічних результатів [38].…”

Section: рис 2 нормальні доплерівські хвилі кровоплину плодаunclassified

Diagnosis of the venous duct in fetuses of the early period of human ontogeny

Prokopchuk,

Antoniuk,

Kryvetskyi

et al. 2023

Buk. Med. Herald

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To carry out an analysis of data from the world literature regarding the role of Doppler assessment of blood flow in the venous duct of the fetus in chromosomal abnormalities in the first trimester of pregnancy, as a marker – the spectral form of wave blood flow and its pulsation, which is generated by changes in the pressure and volume of blood to the heart of the fetus. Prenatal diagnosis of venous blood flow makes it possible to assess the state of the fetal cardiovascular system. Blood flow in the ductus venosus is an integrative indicator that reflects the formation of blood circulation of both the uteroplacental and placental-fetal components of gestational hemodynamics during physiological and complicated pregnancy. The performance of this test is 63%, and in combination with the assessment of the thickness of the clavicle – 89.1%. When reverse values of blood flow in the ductus venosus are detected in the phase of contraction of the atrium and dilated cervical space, it is necessary to carry out karyotyping to rule out chromosomal abnormalities. Dopplerography allows us to objectively assess the functioning state of the fetus during physiological and complicated pregnancy based on the study of the state of blood flow in the vessels of the placenta, in the middle cerebral artery, thoracic aorta, renal arteries, inferior vena cava and venous duct. The spectrum of venous blood flow reflects changes in volume and pressure in the atria during the cardiac cycle. With normal fetal development, blood flow in the venous duct has a pulsating character in the form of a unidirectional three-phase curve that corresponds to different periods of the cardiac cycle. The spectrum of normal blood flow in the venous duct in a healthy newborn has a biphasic curve, with the direction from the portal sinus to the inferior vena cava. During three weeks of regular examinations in most babies, obliteration of the venous duct occurs, and the ductus turns into a venous connection. Two-dimensional echocardiogram, color and pulsed dopplerography allow recording the waveforms of blood flow in several structures of the heart. Doppler analysis of blood flow in the venous duct is important to perform in fetuses of the first trimester, as it increases the sensitivity of the combined test in assessing the risk of chromosomal disorders. Assessment of blood flow in the ductus venosus provides an understanding of physiological and pathological processes in the fetal body and identifies fetuses that are prone to or at risk of disease.

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“…f In T3 sIGUR, there is a cyclical or intermittent pattern of AREDF in the umbilical artery network was reconstructed based on the KEGG database through Cytoscape (Version 3.6.1). The intra-and interobserver reliability of the ultrasound measurement was calculated using the Bland-Altman method (Bruin et al 2019) via an R console, while the classifications of sIUGR were determined by the Kappa value calculated using SPSS software. The graphic illustrations of heatmaps, line graphs, and circos plots were created using ggplot2 and GOplot R-packages (Wickham 2009;Walter et al 2015).…”

Section: Metabolite Identification Data Mining and Statistical Analmentioning

confidence: 99%

Neonatal hair profiling reveals a metabolic phenotype of monochorionic twins with selective intrauterine growth restriction and abnormal umbilical artery flow

Yang

Yuan

et al. 2020

Mol Med

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Background: Selective intrauterine fetal growth restriction (sIUGR) in monochorionic diamniotic twins, especially types 2&3 with abnormal umbilical artery Doppler, results in increased risk of fetal/perinatal mortality and postnatal disability. We investigate whether the hair metabolome profiles of neonates were associated with the pathophysiological differences across the different clinical forms of sIUGR in twins. Methods: Hair samples were collected at delivery from 10 pairs of type 1 sIUGR twins, 8 pairs of types 2&3 sIUGR twins, and 11 pairs of twins without sIUGR. The hair metabolome was characterized using gas chromatographymass spectrometry. Results: Our results demonstrated that the hair metabolite profiles of the different sIUGR subclinical forms were associated with the averaged fetal growth rate after 28 weeks of gestation but not with birthweight. The hair profiles were capable of discriminating type2&3 sIUGR twins from twins without sIUGR. In particular, the metabolites 2-aminobutyric acid, cysteine, alanine, and tyrosine all displayed areas under the receiver operating characteristic curve were above 0.9. The metabolic pathway analysis highlighted the associations of sIUGR twins with abnormal umbilical artery flow with increased metabolites from a nutrient depletion pathway, glutathione metabolism, and nerve development. Conclusion: This study offers novel insight into the severity of intrauterine ischemia and hypoxia for T2&3 sIUGR twins, through evaluation of the neonatal hair metabolome.

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Inter- and intra-observer variability in fetal ductus venosus blood flow measurements in high-risk fetuses at 26–32 weeks

Cited by 5 publications

References 23 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

Diagnosis of the venous duct in fetuses of the early period of human ontogeny

Neonatal hair profiling reveals a metabolic phenotype of monochorionic twins with selective intrauterine growth restriction and abnormal umbilical artery flow

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