Umbilical Artery Half-Peak Systolic Velocity Deceleration Time in Fetal Growth Restriction

Abstract

Objective: To study the umbilical artery (UA) half-peak systolic velocity deceleration time (hPSV-DT) in pregnancies complicated by fetal growth restriction (FGR). Methods: The study included 266 singleton, high-risk pregnancies with an estimated fetal weight <10th percentile, which were examined between 24 and 40 weeks' gestation and delivered within a week from the last ultrasound evaluation. UA hPSV-DT was measured with Doppler ultrasound in the same wave used to measure the pulsatility index. UA hPSV-DT values were correlated with perinatal outcome. Results: UA hPSV-DT <5th percentile was found in 87 and 98% of fetuses with moderate and severe FGR, respectively. 94% of fetuses with a UA hPSV-DT <90 ms had poor perinatal outcome including perinatal death or prolonged admission to the neonatal intensive care unit. None of the fetuses had a UA hPSV-DT <70 ms. Perinatal death occurred in 39 fetuses; UA hPSV-DT was abnormal in all of them, with 95% of these fetuses having values of ≤120 ms. In the group of fetuses with absent/reverse end-diastolic velocity in the UA, the perinatal mortality rate was 51% for those with a UA hPSV-DT ≤90 ms and only 23% for those having a UA hPSV-DT >90 ms (p < 0.01). Conclusions: UA hPSV-DT seems to be a useful technique in the evaluation of pregnancies at risk for FGR and perinatal death. Additionally, hPSV-DT was shown to be a good predictor of perinatal death, with values of <90 ms corresponding to imminent risk of intrauterine demise and values of <70 ms being likely to be incompatible with intrauterine life.

Diagnostic yield of exome sequencing in isolated fetal growth restriction: Systematic review and meta‐analysis

“…Whether a diagnosis of a genetic disorder in growth-restricted fetuses should be considered an exclusion criterion in the definition of FGR, as stated by ISUOG guidelines, seems controversial to us because it is based on the assumption that the "intrinsic" growth potential in genetic syndromes is decreased while, on the contrary, in true FGR, there is an extrinsic cause preventing these fetuses from achieving their intrinsic growth potential. This assumption is challenged by the finding of abnormal third-trimester Doppler studies in fetuses with common trisomies that account for 90% of fetuses with trisomy 13, 55% with trisomy 18, and 75% with trisomy 21, 31,32 indicating that placental insufficiency may also be present in pregnancies affected by a genetic disorder.…”

Early Environmental Enrichment Enhances Abnormal Brain Connectivity in a Rabbit Model of Intrauterine Growth Restriction

“…Intrauterine growth restriction (IUGR) due to placenta insufficiency is a well-recognized cause of perinatal morbidity/mortality complications [1] along with neurobehavioral and cognitive impairments extending beyond childhood [2,3] and early adulthood [4][5][6]. These neurodevelopmental problems have not only been associated with severe cases, but also milder forms of IUGR are at risk for abnormal neurodevelopment [7].…”

Doppler de arteria umbilical en fetos con síndrome de Down

“…Respecto al crecimiento fetal, destacamos tres hechos: primero, en la serie total, a pesar de una alta incidencia de Doppler umbilical anormal, solo hay un 24% de RCIU; segundo, en el grupo de fetos con Doppler anormal, más del 60% son AEG, e incluso hay fetos grandes para la edad gestacional; y tercero, en el grupo con Doppler umbilical normal, el peso promedio (3151 g) y la frecuencia de RCIU (5,3%) son muy similares a los de los fetos euploides. Estos datos contrastan con lo observado en fetos euploides, en los que el hallazgo de un Doppler umbilical alterado es un fuerte marcador de insuficiencia placentaria y se asocia a una alta frecuencia de RCIU 7 . Como hipótesis general, Flöck, et al 1 y Wagner, et al 5 sugieren que el menor peso de los fetos con SD podría deberse a insuficiencia placentaria.…”

“…Nuestro grupo de trabajo ha descrito un índice de conductancia placentaria, el tiempo medio de desaceleración (t/2) (en inglés half peak systolic velocity deceleration time [hPSV]), con un nomograma de 877 fetos 6 , que demuestra ser similar o mejor que el índice de pulsatilidad (IP) para el diagnóstico de insuficiencia placentaria en fetos euploides con RCIU 7 . Ya hemos publicado una serie de Doppler umbilical en fetos con SD 8 , y en este artículo extendemos ampliamente esta casuística aumentando el número de fetos un 30% y el número de estudios Doppler un 44%.…”