Umbilical Artery Doppler in the Assessment of Fetal Growth Restriction

Maulik, Dev; Mundy, David; Heitmann, Erica; Maulik, Devika

doi:10.1016/j.clp.2010.12.004

Cited by 33 publications

(25 citation statements)

References 53 publications

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“…Umbilical artery (UA) Doppler ultrasound is used to assess uteroplacental insufficiency and consequent intrauterine growth restriction (IUGR) during the third trimester of pregnancy and improves perinatal outcomes [8]. Normal UA Dopplers are characterized by forward blood flow from fetus to placenta during both fetal systole and diastole [9].…”

Section: Introductionmentioning

confidence: 99%

“…Although not commonly used to identify acute changes in fetal status, with placental insufficiency, increased umbilical placental resistance, uterine contraction, fetal cardiac dysfunction, or fetal stress, a decrease in UA end diastolic flow (EDF) should occur and result in the waveform eventually becoming absent or even reversing ( Fig. 1) [8,9,[12][13][14][15][16]. Consequently, monitoring UA flow during MMC surgery could provide a measure of fetal well-being, impact of the surgery and anesthesia on the fetal state, or serve as an early warning that an intervention to optimize the fetal condition is needed.…”

Section: Introductionmentioning

confidence: 99%

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Incidence and Management of Umbilical Artery Flow Abnormalities during Open Fetal Surgery

Sinskey¹,

Rollins

Whitlock³

et al. 2017

Fetal Diagn Ther

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Introduction: Umbilical artery (UA) Doppler ultrasound is used to assess uteroplacental insufficiency. Absent or reversed end diastolic flow (AREDF) in the UA is associated with increased perinatal mortality in fetuses with intrauterine growth restriction. We describe the incidence of UA Doppler abnormalities during open fetal surgery. Methods: We conducted a retrospective review of patients undergoing open in utero myelomeningocele (MMC) repair between 2008 and 2015. Intermittent UA Dopplers were performed during key portions of all cases. Our primary outcome was the rate of any AREDF. Secondary outcomes included analysis of absent versus reversed end diastolic flow (EDF), vasopressor use, and volatile anesthetic and clinical outcomes. Results: Thirty-four of 47 fetuses developed UA Doppler abnormalities intraoperatively. Nineteen had absent EDF and 15 had reversed EDF. No AREDF was present before induction, and all AREDF resolved by postoperative day 1. Ten of 19 (52.6%) patients who received sevoflurane had reversed EDF, versus 5/28 (17.9%) for desflurane, odds ratio (95% CI) 5.11 (1.36-19.16), p = 0.02. One intraoperative fetal death occurred in the AREDF group. Discussion: AREDF is a common phenomenon during open MMC repair. Anesthetic agent choice may influence this risk. Future studies of UA flow during fetal surgery are needed to further evaluate the impact of intraoperative AREDF on fetal well-being.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidence and Management of Umbilical Artery Flow Abnormalities during Open Fetal Surgery

Sinskey¹,

Rollins

Whitlock³

et al. 2017

Fetal Diagn Ther

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“…31 It is reasonable to assume that decreased uteroplacental perfusion during uterine contractions is likely to further jeopardize gaseous exchange in fetuses with preexisting abnormal umbilical artery velocimetry. 32 However, despite encouraging results, controversy still exists as to the optimal timing of delivery. Arguments tending towards an immediate delivery in the absence of the diastolic velocity waveform or by the appearance reverse end-diastolic blood flow are counterbalanced by the risks associated with prematurity.…”

Section: Resultmentioning

confidence: 99%

Significance of Umbilical Artery Velocimetry in Perinatal Outcome of Growth Restricted Fetuses

Afroze¹,

Begum

2016

J. Bangladesh Coll. Phys.

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Objectives: To study pregnancy outcomes in growth restricted fetuses with normal umbilical artery velocimetry, low end-diastolic umbilical flow, and absent or reversed diastolic flow. Methods: Fifty pregnant women with growth restricted fetuses were evaluated by umbilical artery velocimetry between 28 and 39 weeks of pregnancy. Outcome of pregnancy was recorded for the normal Doppler group (n=17; 34%), the low end diastolic flow group (n=23; 46%), the group with absent diastolic flow (n=8; 16%) and the group with reversed diastolic flow (n=2; 4%). Results: The average birth weight, diagnosis to delivery interval and gestational age at delivery were comparatively lower in case of abnormal umbilical Doppler velocimetry group. Again there was higher incidence of LSCS for fetal distress, Apgar score <7 at 1 minute, admission to neonatal intensive care unit and perinatal death with those of the abnormal umbilical Doppler velocimetry. Conclusion: Doppler study of umbilical artery allows a noninvasive assessment of uteroplacental insufficiency and is an accurate method for diagnosis and management of fetal growth retardation.

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“…1 The recognition of pathological blood flow in the umbilical artery is dependent on reliable standards. Despite traditional reporting of SD in Australia 3 and the United States of America 4,5 and RI in New Zealand 6 PI has several advantages. 2 We wished to assess usage of 3 umbilical artery (UA) Doppler indices: systolic: diastolic ratio (also called SD or A:B ratio), resistance index (RI) and pulsatility index (PI).…”

Section: Introductionmentioning

confidence: 99%

Umbilical artery Doppler flow: An examination of current and best practice

McCarthy

Walker

Shub

2013

Aust N Z J Obstet Gynaecol

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A Web-based survey of Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) fellows and trainees who perform or act on umbilical artery Doppler showed heterogeneous reporting practices. Systolic: diastolic ratio is frequently used. Pulsatility index is favoured internationally and by many RANZCOG subspecialists. Unpublished charts are used more often than published. We summarise ideal methods of chart development but recognise that chart choice is guided by professional opinion leaders, day-to-day accessibility and other factors.

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Umbilical Artery Doppler in the Assessment of Fetal Growth Restriction

Cited by 33 publications

References 53 publications

Incidence and Management of Umbilical Artery Flow Abnormalities during Open Fetal Surgery

Incidence and Management of Umbilical Artery Flow Abnormalities during Open Fetal Surgery

Significance of Umbilical Artery Velocimetry in Perinatal Outcome of Growth Restricted Fetuses

Umbilical artery Doppler flow: An examination of current and best practice

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