Monitoring of fetuses with intrauterine growth restriction: a longitudinal study

Hecher, Kurt; Bilardo, C. M.; Stigter, R. H.; Ville, Y.; Hackelöer, Bernhard-Joachim; Kok, H. J.; Sénat, Marie-Victoire; Visser, Gerard H.A.

doi:10.1046/j.0960-7692.2001.00590.x

Cited by 439 publications

(393 citation statements)

References 24 publications

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“…The ensuing myocardial decompensation results in increased end-diastolic ventricular pressures and decreased flow velocities during atrial contraction causing increased pulsatility in the precordial veins. [7][8][9] In the current cohort, the last ductus venosus PI preceding delivery was the strongest individual Doppler predictor of poor outcome (P ¼ 0.02) and major morbidity (P ¼ 0.03) and proved to be of value in the prediction of final outcome even when controlling for the fetal weight estimation. The 12 fetuses with abnormal ductus venosus flow followed a particularly poor course, in line with other studies: [30][31][32] eight were admitted to NICU, nine needed ventilation (one baby received CPAP-ventilation in the normal neonatal ward), all had major morbidity and four had poor outcome.…”

Section: Venous Dopplermentioning

confidence: 61%

“…The mean interval to delivery was only 1 (0 to 4) days, illustrating that with abnormal ductus venosus waveforms the onset of fetal compromise seems imminent. [7][8][9] It needs to be investigated whether an intervention preceding such abnormal waveforms improves outcome.…”

Section: Venous Dopplermentioning

confidence: 99%

“…This study shows that abnormal initial Doppler waveforms as well as the closely linked ultrasound features of placental insufficiency (asymmetry, oligohydramnios, SGA) predicted a shorter interval to delivery, this getting progressively shorter as more vessels showed abnormal waveforms, as reported before. [7][8][9]14 This suggests that longer expectant management can be anticipated in pregnancies presenting with a favourable placental function. Prolonging the pregnancy in these well-nourished preterm fetuses may indeed result in improved outcome.…”

Section: Interval To Deliverymentioning

confidence: 99%

“…Placental insufficiency often complicates pre-eclampsia and may cause fetal distress, hypoxaemia, metabolic acidosis, perinatal demise, morbidity and long-term impairment. 2,5,6 The coexistence, temporal changes and prognostic implications of abnormal ultrasound and Doppler findings are now well described in placental insufficiency, [7][8][9] but while knowledge of umbilical artery Doppler results 10 is of clear clinical benefit, the use of other ultrasound and Doppler parameters has not yet been shown to improve perinatal outcome. In preterm pre-eclampsia, some studies have investigated the prognostic value of such parameters close to delivery, [11][12][13][14][15][16][17] but combinations of parameters, their inter-relations and the influence of confounding variables in this setting have not been investigated widely.…”

Section: Introductionmentioning

confidence: 99%

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Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

Geerts

Odendaal

2007

J Perinatol

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Objective: Assess the prognostic value of ultrasound and Doppler parameters in severe preterm pre-eclampsia.Study design: Prospective cohort study in Cape Town, South Africa, involving 113 women with severe pre-eclampsia between 24 and 34 weeks of gestation and managed expectantly when suitable. Serial ultrasound and multivessel Doppler assessments were performed 2 to 3 times weekly. Observations included fetal weight estimation, growth pattern, amniotic fluid volume, appearance of the heart and bowel, pulsatility index of the uterine, umbilical and middle cerebral arteries and ductus venosus. Perinatal outcome (death or neurological compromise, n ¼ 12) and major morbidity (n ¼ 62) were related to findings at recruitment and on the last assessment preceding delivery.Results: In univariate analysis, fetal growth asymmetry and waveform analysis of all three fetal vessels significantly correlated with both end points. The initial fetal weight estimation with a cutoff weight of 1080 g had the highest sensitivity (83.3%) and negative predictive value (97.5%) for poor outcome (P<0.001) while the final ductus venosus pulsatility index had the highest specificity (92%) and positive predictive value (33%). The combination of a raised placentocerebral ratio and ductus venosus pulsatility index close to delivery had the highest (57.1%) positive predictive value. Logistic regression showed the best overall predictive model for poor outcome to be a combination of initial fetal weight estimation and final ductus venosus pulsatility index (overall accuracy 94.6%, RR 20.20 (7.36, 55.41)). The initial fetal weight estimation with a cutoff weight of 1283 g provided the best correct prediction of major morbidity (83.2% overall accuracy, sensitivity 79.0%, specificity 88.2%, positive and negative predictive values of 89.1 and 77.6% respectively). This was better than using the gestational age at recruitment or delivery, birth weight or any of the Doppler results. The prediction of morbidity was not improved by the addition of any other variable in logistic regression analysis. Conclusion:For the short-term outcome measures assessed in this study, the estimated fetal weight at the time of diagnosis is the most important prognostic factor in severe pre-eclampsia with some additional value of ductus venosus assessment.

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Section: Venous Dopplermentioning

confidence: 61%

Section: Venous Dopplermentioning

confidence: 99%

Section: Interval To Deliverymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

Geerts

Odendaal

2007

J Perinatol

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“…During the last few decades, several large studies have been performed to determine which surveillance technique and signs should be used to determine the optimal timing of delivery of a fetus with IUGR in order to achieve the best short‐term outcome27, 28, 29. Recently, studies in which the outcome also includes long‐term neurodevelopment have been performed30, 31, 32, 33.…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging‐estimated placental perfusion in fetal growth assessment

Sohlberg

Mulic‐Lutvica

Olovsson

et al. 2015

Ultrasound in Obstet & Gyne

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ObjectiveTo evaluate in‐vivo placental perfusion fraction, estimated by magnetic resonance imaging (MRI), as a marker of placental function.MethodsA study population of 35 pregnant women, of whom 13 had pre‐eclampsia (PE), were examined at 22–40 weeks' gestation. Within a 24‐h period, each woman underwent an MRI diffusion‐weighted sequence (from which we calculated the placental perfusion fraction), venous blood sampling and an ultrasound examination including estimation of fetal weight, amniotic fluid index and Doppler velocity measurements. The perfusion fractions in pregnancies with and without fetal growth restriction were compared and correlations between the perfusion fraction and ultrasound estimates and plasma markers were estimated using linear regression. The associations between the placental perfusion fraction and ultrasound estimates were modified by the presence of PE (P < 0.05) and therefore we included an interaction term between PE and covariates in the models.ResultsThe median placental perfusion fractions in pregnancies with and without fetal growth restriction were 21% and 32%, respectively (P = 0.005). The correlations between placental perfusion fraction and ultrasound estimates and plasma markers were highly significant (P = 0.002 and P = 0.0001, respectively). The highest coefficient of determination (R 2 = 0.56) for placental perfusion fraction was found for a model that included pulsatility index in the ductus venosus, plasma level of soluble fms‐like tyrosine kinase‐1, estimated fetal weight and presence of PE.ConclusionThe placental perfusion fraction has the potential to contribute to the clinical assessment of cases with placental insufficiency. © 2015 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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Fetal and umbilical Doppler ultrasound in high-risk pregnancies

Alfirević

Stampalija

Gyte

et al. 2009

Cochrane Database of Systematic Reviews

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Monitoring of fetuses with intrauterine growth restriction: a longitudinal study

Abstract: Ductus venosus pulsatility index and short-term variation of fetal heart rate are important indicators for the optimal timing of delivery before 32 weeks of gestation. Delivery should be considered if one of these parameters becomes persistently abnormal.

Cited by 439 publications

References 24 publications

Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

Magnetic resonance imaging‐estimated placental perfusion in fetal growth assessment

Fetal and umbilical Doppler ultrasound in high-risk pregnancies

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