دورية أكاديمية
Rate of deterioration of umbilical artery Doppler indices in fetuses with severe early-onset fetal growth restriction.
| العنوان: | Rate of deterioration of umbilical artery Doppler indices in fetuses with severe early-onset fetal growth restriction. |
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| المؤلفون: | Martins JG; Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Gevaerd Martins, Kawakita, Gould, Sinkovskaya, and Abuhamad). Electronic address: martinjg@evms.edu., Kawakita T; Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Gevaerd Martins, Kawakita, Gould, Sinkovskaya, and Abuhamad)., Barake C; Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX (Dr Barake)., Gould L; Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Gevaerd Martins, Kawakita, Gould, Sinkovskaya, and Abuhamad)., Baraki D; Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, OH (Dr Baraki)., Connell P; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Dr Connell)., Sinkovskaya E; Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Gevaerd Martins, Kawakita, Gould, Sinkovskaya, and Abuhamad)., Abuhamad A; Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Gevaerd Martins, Kawakita, Gould, Sinkovskaya, and Abuhamad). |
| المصدر: | American journal of obstetrics & gynecology MFM [Am J Obstet Gynecol MFM] 2024 Mar; Vol. 6 (3), pp. 101283. Date of Electronic Publication: 2024 Jan 12. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Inc Country of Publication: United States NLM ID: 101746609 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2589-9333 (Electronic) Linking ISSN: 25899333 NLM ISO Abbreviation: Am J Obstet Gynecol MFM Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: [New York, NY] : Elsevier Inc., [2019]- |
| مواضيع طبية MeSH: | Fetal Growth Retardation*/diagnosis , Fetal Growth Retardation*/epidemiology , Hypertension*, Pregnancy ; Humans ; Female ; Infant ; Fetal Weight ; Retrospective Studies ; Umbilical Arteries/diagnostic imaging ; Placenta ; Fetus |
| مستخلص: | Background: Incorporation of umbilical artery Doppler in the surveillance of fetal growth restriction has been shown to reduce the risk of perinatal deaths. Systole/Diastole ratio, Pulsatility Index and Resistance Index are obtained upon Doppler interrogation of the umbilical artery however it is unknown which index predicts more advanced stages of placental deterioration. Objective: This study aimed to examine risk factors for the development of absent or reversed end-diastolic velocity and the time intervals of deterioration from normal umbilical artery end-diastolic velocity (indicated by systole/diastole ratio, pulsatility index, or resistance index) to decreased and absent or reversed end-diastolic velocity in fetuses with early-onset severe fetal growth restriction. Study Design: This was a retrospective cohort study performed from 2005 to 2020. All singleton pregnancies with severe (estimated fetal weight or abdominal circumference below the third percentile) and early-onset (diagnosed between 20 0/7 and 31 6/7 weeks of gestation) fetal growth restriction were included. Patients with fetal genetic or structural anomalies, suspected congenital infections, absent or reversed end-diastolic velocity at diagnosis, poor pregnancy dating, and absence of follow-up ultrasounds were excluded. Estimated fetal weight, abdominal circumference, and Doppler indices were reviewed longitudinally from diagnosis to delivery. To examine risk factors for absent or reversed end-diastolic velocity, we performed backward stepwise logistic regression and calculated odds ratios with 95% confidence intervals. Kaplan-Meier curves were compared using log-rank tests. Results: A total of 985 patients met the inclusion criteria, and 79 (8%) progressed to absent or reversed end-diastolic velocity. Factors associated with development of absent or reversed end-diastolic velocity included gestational age at diagnosis (adjusted odds ratio, 4.88 [95% confidence interval, 2.55-9.37] at 20 0/7 to 23 6/7 weeks; adjusted odds ratio, 1.56 [95% confidence interval, 0.86-2.82] at 24 0/7 to 27 6/7 weeks compared with 28 0/7 to 31 6/7 weeks) and presence of chronic hypertension (adjusted odds ratio, 2.37 [95% confidence interval, 1.33-4.23]). Rates of progression from diagnosis of fetal growth restriction with normal umbilical artery Doppler to absent or reversed end-diastolic velocity were significant after 4 weeks from diagnosis (5.84% [95% confidence interval, 4.50-7.57]). Regarding the Doppler indices, the progression from normal values to abnormal indices was similar at 1 and 2 weeks. However, the rate of progression from normal to abnormal systole/diastole ratio compared with the rates of progression from normal to abnormal pulsatility index or resistance index was higher at 4 and 6 weeks. Deterioration from abnormal indices to absent or reversed end-diastolic velocity was shorter with abnormal resistance index and pulsatility index when compared with the systole/diastole ratio at 2, 4, and 6 weeks after diagnosis and at 6 weeks, respectively. Conclusion: Earlier gestational age at diagnosis and chronic hypertension are considered as risk factors for Doppler deterioration and development of absent or reversed end-diastolic velocity in the umbilical artery. With normal Doppler indices, significant deterioration and progression to absent or reversed end-diastolic velocity is unlikely until 4 weeks after diagnosis. Abnormal systole/diastole ratio seems to appear first. However, abnormal pulsatility index or resistance index was associated with absent or reversed end-diastolic velocity. (Copyright © 2024 Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: Doppler deterioration; fetal growth restriction; pulsatility index; resistance index; systole/diastole ratio; umbilical artery Doppler |
| تواريخ الأحداث: | Date Created: 20240114 Date Completed: 20240320 Latest Revision: 20240320 |
| رمز التحديث: | 20240320 |
| DOI: | 10.1016/j.ajogmf.2024.101283 |
| PMID: | 38219949 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 2589-9333 |
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| DOI: | 10.1016/j.ajogmf.2024.101283 |