OBJECTIVE: To evaluate the utility of middle cerebral artery (MCA) and umbilical artery (UA) Doppler to predict anemia in intrauterine growth restricted (IUGR) fetuses. METHODS: Fetuses with an abdominal circumference < 5th percentile had UA and MCA Doppler prior to delivery. The UA pulsatility index (PI), MCA PI, ratio between ...

Protein restriction in rat pregnancy programmes the development of elevated systolic blood pressure and vascular dysfunction in the offspring. A recent study has shown that hypertension is reversed by maternal glycine supplementation. Whether this protective effect is exerted directly on the embryo and fetus, or indirectly via effects on the ...

While the impact of exogenous glucocorticoids on the fetal cardiovascular system has been well defined, relatively few studies have characterised the role of endogenous fetal glucocorticoids in the regulation of arterial blood pressure (BP) during late gestation. We have therefore infused metyrapone, an inhibitor of cortisol biosynthesis, into fetal sheep ...

OBJECTIVE: To determine whether fetal response to needling resembles the fetal 'brain sparing' response seen with hypoxaemia. DESIGN: Prospective observational study. SETTING: Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, London. POPULATION: Eighty-five pregnant women undergoing invasive procedures associated with fetal prenatal diagnosis and/or management. METHODS: The femoral artery ...

OBJECTIVES: It has been previously shown that glucocorticoids alter umbilical artery flow velocity waveforms in singleton pregnancies complicated by umbilical artery absent end diastolic flow. Whether similar effects are evident in multiple pregnancies where one fetus has umbilical artery absent end diastolic flow is not known. METHODS: Women with a ...

BACKGROUND: An impaired placental circulation is involved in the mechanism of late fetal heart rate (FHR) decelerations. OBJECTIVES: To explore umbilical artery (UA) Doppler velocimetry changes in response to uterine contractions during the oxytocin challenge test (OCT) and assess the potentially clinical value of 'OCT Doppler velocimetry'. METHODS: 111 women ...

OBJECTIVE: The study was undertaken to assess whether prenatal Doppler variables can identify cases of fetal growth restriction (FGR) approaching term who are at risk for adverse neonatal outcome. STUDY DESIGN: From a cohort of FGR cases delivered at >or=34 weeks, fetal biometry and pulsatility indices (PI) of fetal arteries ...

OBJECTIVES: To study the correlation of peak systolic velocity in the middle cerebral artery with hemoglobin concentration in fetuses at risk of anemia due to Rhesus isoimmunization. DESIGN: Peak systolic velocity of middle cerebral artery (MCA-PSV) was measured before 66 cordocentesis procedures in 20 isoimmunized fetuses. Reference values were derived ...

OBJECTIVES: To determine reference values for first-trimester uterine artery resistance index (RI) in healthy pregnant women with uncomplicated pregnancies and to investigate the relationship between uterine artery Doppler indices and birth weight. METHODS: This was a cross-sectional study of 265 consecutive pregnant women attending routine ultrasound examination at 11-14 weeks' ...

The pathophysiologic continuum of poor uterine and placental blood flow associated with fetal growth restriction has to be considered the major cause of poor birth outcomes. The main attention in this context is drawn to the possibilities of an early diagnosis of imminent fetal compromise prior to and under delivery. ...

BACKGROUND: Umbilical artery Doppler velocimetry is a routine method for fetal surveillance in high-risk pregnancy. Uterine artery Doppler seems to give comparable information, but it can be difficult to interpret as there are two arteries, which might show notching and/or increased pulsatility index (PI) as signs of increased vascular impedance. ...

OBJECTIVES: To determine whether the vascular anatomy of monochorial placenta influences the success of amniotic septostomy for the treatment of chronic mid-trimester twin-twin transfusion syndrome, we report placental anastomoses and perinatal data of 13 pregnancies treated by amniotic septostomy in combination with amnioreduction (AR). The placental anastomoses were delineated postnatally ...

BACKGROUND: Intrauterine fetal death is a complication that cannot often be predicted by standard obstetric management. Cord accident may be responsible for about 5% of cases. Umbilical cord torsion is an extremely rare cause of intrauterine fetal death. CASE: An 18-year-old, nulliparous woman presented with a complaint of decreased fetal ...

OBJECTIVE: Despite a change of fetal physiologic and biochemical functions with gestational age, stationary umbilical cord acid-base reference values are used as measures of obstetric care quality. The aim of this study was to assess the risk of low Apgar score relative to low pH when using stationary versus gestational ...

BACKGROUND: The usefulness of umbilical artery Doppler velocimetry for the monitoring of diabetic pregnancies is controversial. The aim of the present study was to assess whether umbilical artery Doppler velocity waveform analysis can predict adverse perinatal outcomes for pregnancies complicated by pre-existing diabetes mellitus. METHODS: All diabetic pregnancies (type 1 ...

OBJECTIVE: To establish whether there is a relationship between estimated fetal weight (EFW) and umbilical artery Doppler waveform impedance indices in the third trimester. METHODS: The pulsatility index (PI) and S/D (systolic/diastolic) ratio were obtained together with the EFW from 274 low-risk pregnancies. Measurements were made at fortnightly intervals from ...

OBJECTIVE: To study the relationship between pregnancy-induced hypertension (PIH) and catecholamine levels. METHODS: Catecholamines levels in maternal and fetal blood were determined in 116 patients with PIH and 40 normal control subjects using high performance liquid chromatography. The normal control subjects and PIH cases were selected from patients at term ...

The purpose of this study was to investigate whether the localization of endothelin-1 (ET-1) immunoreactivity differs in human placental tissues from third-trimester normal and intrauterine growth restricted (IUGR) pregnancies. Immunohistochemistry for ET-1 was performed on human placentas from 30 IUGR and 30 uncomplicated pregnancies matched for gestational age. The distribution ...

CONTEXT: The cause for intrauterine fetal demise (IUFD) occurring in early gestation in a high percentage of spontaneous abortions is unknown. OBJECTIVE: To determine the association, if any, of umbilical cord abnormalities with early IUFD. DESIGN: All cases of IUFD occurring within 16 weeks of gestation that presented to our ...

The objective of the present study was to determine the effect of early pregnancy on the sensitivity to, and endogenous production of calcitonin gene-related peptide (CGRP). Contractile responses of arteries of 10-day pregnant and nonpregnant rats were studied in myographs. During contractions induced by 40 mmol/l K(+), exogenous CGRP elicited ...

AIM: The aim of this study is to investigate the ultra structural difference of placentas in IUGR fetuses that were all found to have abnormal umbilical artery Doppler waveforms. METHODS: Nine placentas from 7 IUGR fetuses and 2 from healthy normal fetuses were evaluated by scanning electron microscopy. RESULTS: All ...

OBJECTIVE: The acceptance or rejection of obstetric technologies in clinical practice is not always based on the results of randomized controlled trials (RCTs). In this study, possible reasons for this discordance are examined. STUDY DESIGN: Eleven technologies introduced over the past 30 years were examined. RCT results were determined from ...

OBJECTIVE: To assess the addition value of umbilical artery Doppler ultrasound added to standard ultrasound biometry measurements in the management of twin pregnancies. DESIGN: A prospective randomised controlled multicentre trial of women with twin pregnancies. SETTING: Tertiary level referral hospitals in Australia, New Zealand and Southeast Asia. POPULATION: Pregnant women ...

OBJECTIVE: Neurokinin B (NKB) is a neuropeptide with a vasopressor effect belonging to the tachykinin family. This neuropeptide has attracted attention since recent reports indicated that it is also secreted in the placenta and is probably a cause of pre-eclampsia. To provide a basis for elucidation of the relationship between ...

BACKGROUND: Pregnancy occurring after pelvic arterial embolization for postpartum hemorrhage is rare. The harmlessness of this procedure for subsequent pregnancies is poorly documented. MATERIALS AND METHODS: Eight pregnant women with a history of arterial embolization were followed up with fetal growth and Doppler assessment. RESULTS: Fetal growth and umbilical Doppler ...

OBJECTIVE: To evaluate if an increased amount of fetal DNA concentration can be found in women screened positive for intrauterine growth restriction because of abnormal uterine artery Doppler waveforms. METHODS: We enrolled eight pregnant women (each bearing a male fetus), with the evidence of abnormal uterine artery Doppler waveforms, and ...

PURPOSE OF REVIEW: Doppler applications in pregnancy are expanding exponentially. Flow velocity waveforms provide important information 12 weeks to term, from maternal vessels, placental circulation and fetal systemic vessels, with implications for both mother and fetus. As applications proliferate, awareness of the complexity of fetal and placental circulations, in normal ...

Thrombophilia is associated with several complications of pregnancy including first and second trimester fetal loss, intrauterine fetal death, intrauterine growth restriction, preeclampsia, and placental abruption. Few studies have documented thrombotic lesions observed on the pathologic examination of the placenta in women with severe pregnancy complications. Moreover, a significantly higher rate ...

OBJECTIVE: To assess the value of biomagnetic recordings of the umbilical artery over Doppler ultrasound screening in order to predict complications of impaired uteroplacental blood flow in fetuses with intrauterine growth restriction (IUGR). METHODS: Our study population included 11 IUGR preeclamptic (34-37-weeks gestation; birth weight 1969 +/- 129 g) and ...

BACKGROUND: Hypogastric artery ligation is a therapeutic option for severe post-partum haemorrhage. Little is known about the outcomes of subsequent fertility and pregnancy. We studied these parameters in women who required hypogastric artery ligation for severe post-partum haemorrhage in our institution over a 13-year period. METHODS: All patients who required ...

OBJECTIVE: Structural changes of the spiral arteries needed for the pregnancy do not completely resolve following parturition. We tested the hypothesis that these anatomical changes are related to the number of previous pregnancies. METHODS: Video image analysis was performed on Masson-stained sections from 28 hysterectomy specimens, examining the proportion of ...

OBJECTIVES: To describe how data from antenatal fetal ultrasound biometry, amniotic fluid index and umbilical artery Doppler can be appropriately combined using multivariable models and to investigate how the addition of these ultrasound parameters influences the ability to predict intrauterine growth restriction (IUGR). METHODS: This was a prospective cohort study ...

The risk for an adverse pregnancy outcome is markedly higher in women with history of preeclampsia. This may stem from impaired placentation in early gestation and from high impedance to flow in uteroplacental circulation. The renin-angiotensin system is one of the mediators of the remodeling of spiral arteries throughout pregnancy. ...

OBJECTIVES: To estimate fetal brain volume from head circumference and published postmortem data; to determine normal values for the fetal brain/liver volume ratio relative to gestational age; to establish the relationship between the brain/liver volume ratio and fetal circulatory parameters during normal and restricted (SGA) fetal growth. PATIENTS AND METHOD: ...

OBJECTIVE: To assess the possible association of in-utero bowel dilatation and circulatory changes with fetal compromise. METHODS: A retrospective survey of all ultrasound examinations was performed at the Chaim Sheba Medical Center (n approximately 10,000) between 1995 and 1999. Cases with ultrasonographic evidence of bowel dilatation, but without evidence of ...

Normal pregnancy involves dramatic changes to maternal vascular function, while abnormal vascular adaptations may contribute to pregnancy-associated diseases such as preeclampsia. Many genetic mouse models have recently emerged to study vascular pathologies of pregnancy. However, vascular adaptations to pregnancy in normal mice are not fully understood. Thus, we studied changes ...

OBJECTIVE: To quantify and compare longitudinal uterine artery volume flow changes in appropriate for gestational age (AGA) pregnancies and those complicated by intrauterine growth restriction (IUGR). DESIGN: Serial longitudinal study. SETTING: Large UK Teaching Hospital Obstetrics and Gynaecology Department and Institute of Anatomy, RWTH Aachen, Germany. POPULATION: Pregnant women with ...

OBJECTIVE: To compare Doppler evaluation of the ductus venosus and contraction stress test (CST) in the prediction of adverse perinatal outcome in growth-restricted fetuses with evidence of hemodynamic redistribution and a non-reactive non-stress test (NST). METHODS: Data were collected from all singleton pregnancies seen in our Fetal Surveillance Unit who ...

OBJECTIVE: The purpose of this study was to evaluate the fetal vascular adaptation to moderate and severe maternal anemia. STUDY DESIGN: Biometry; amniotic fluid index; uterine, cerebral, and umbilical Doppler; and maternal hemoglobin level were measured at admission and 8 days after treatment. RESULTS: Group 1 consisted of 16 pregnancies ...

OBJECTIVE: To compare uterine artery Doppler velocity and impedance indices in the presence and absence of uterine artery waveform notches, in the prediction of adverse pregnancy outcome in high-risk women. METHODS: One hundred and fifty-seven women identified at Doppler screening as being at 'high risk' underwent a further uterine artery ...

Two ultrasound techniques, the amniotic fluid index (AFI) and the single deepest pocket (SDP), are currently used to detect oligohydramnios, predict variable decelerations, risk of Caesarean delivery for fetal distress, Apgar scores, umbilical cord artery pH, perinatal mortality, and cerebral palsy. Both techniques poorly identify oligohydramnios. Both techniques identify pregnancies ...

The presence of a single umbilical artery is recognised as a soft marker for congenital anomalies, aneuploidy, earlier delivery and low birthweight. Most of the available data are derived from case series or highly selected populations and are therefore likely to be unrepresentative. In this retrospective case-comparison study, we firstly ...

OBJECTIVE: To investigate the efficacy and safety of intrapartum fetal pulse oximetry, as a predictor of metabolic acidosis at birth of fetuses with intrauterine growth retardation (IUGR). STUDY DESIGN: We studied 18 IUGR fetuses (group I) and a control group of 30 appropriate for gestational age (AGA) fetuses (group II) ...

AIMS: The aim of the presented study was to clarify the relationship between the pulsatility index of the uterine arteries and the maternal cubital artery and peripheral concentrations of the metabolites of nitric oxide (NO) and its second messenger cyclic guanosinmonophophate (cGMP) during the normal course of pregnancy and postpartum. ...

Inhibin A and inhibin B are glycoprotein hormones produced by human placenta and by several fetal organs during pregnancy. They are secreted in maternal circulation in increasing amounts from early until term pregnancy, and in umbilical cord blood levels are significantly lower than in maternal serum and do not differ ...

OBJECTIVE: This study was undertaken to evaluate uterine perfusion, which regulates uterine receptivity, in women with recurrent pregnancy loss. METHODS: We evaluated the blood flow resistance in the uterine arteries of 104 pregnant women at 4 to 5 weeks' gestation by transvaginal pulsed Doppler ultrasonography (control group, n = 52; ...

AIMS: We aimed to establish a cut-off for short term variation (STV) in msec in electronic FHR tracings as a single parameter for the prediction of neonatal acidemia and hypercarbia at birth. METHODS: 195 consecutive cases of singleton pregnancies between 26 to 42 weeks' gestation delivered by cesarean section, with ...

The content and the distribution of the glycoconjugate sugar residues were investigated in the human umbilical cord from normally grown pregnancies and from pregnancies complicated by intra-uterine growth retardation with absent or reversed flow in the umbilical artery. The gestational age range was 29-41 weeks. For this purpose, a battery ...

OBJECTIVE: To assess the value of ultrasonography and Doppler imaging in characterizing the intervillous circulation in normal and abnormal early pregnancy. DESIGN: Cross-sectional study. SETTING: Tertiary care academic hospital. PATIENT(S): Eighty-five normal pregnancies and 125 missed miscarriages at 7 to 13 weeks of gestation. INTERVENTION(S): Grey-scale ultrasonography was used to ...

BACKGROUND: In early pregnancy, a substantial drop in arterial blood pressure occurs, that might be attributed to enhanced vascular nitric oxide synthesis. We investigated whether nitric oxide mediates the vasodilation that occurs in early human pregnancy. METHODS: Resting and stimulated forearm vascular resistance were measured (venous occlusion plethysmograph) in six ...