| Prognostic value of placental ultrasound in pregnancies complicated by absent end-diastolic flow velocity in the umbilical arteries. | |
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MedLine Citation:
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PMID: 15450392 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Our objective was to evaluate the utility of gray-scale placental ultrasound for the detection of pathological lesions in the placentas of preterm pregnancies with abnormal fetoplacental blood flow (defined by absent or reversed end-diastolic flow velocities [ARED] in the umbilical arteries) before 32 weeks of gestation. Sixty consecutive structurally and chromosomally normal singleton pregnancies were evaluated. Pre-defined criteria were used to describe placental appearances using gray-scale real-time ultrasound. Proximal uterine artery Doppler waveforms were recorded using pulsed and color Doppler ultrasound. Each patient had a thrombophilia profile. Following delivery, a single perinatal pathologist reviewed each placenta at a gross and microscopic level blinded to the placental ultrasound findings. Placental shape or texture was abnormal on gray-scale ultrasound in 43/59 (73%) and echogenic cystic lesions (ECL) were found in 16 (27%). Uterine artery Doppler was abnormal in 47/60 (78%) cases. Thirty-eight pregnancies were subsequently delivered by planned Caesarean section in the fetal and/or maternal interest (birthweights 540-2300 g, mean gestational age 30.6 weeks) and 21 pregnancies resulted in the vaginal delivery of a stillborn fetus where fetal weight and/or gestational age did not justify Caesarean section (birthweights 85-600 g, mean gestational age 24.9 weeks). ECL had a low positive predictive value for both villous infarcts (63%) and for focal/massive perivillous fibrin deposition (40%). Nevertheless, the combination of abnormal uterine artery Doppler and abnormal gray-scale findings (abnormal placental morphology or ECL) was strongly predictive of stillbirth (17/21; sensitivity 81%, PPV 52%, p = 0.006 Fisher's exact test). Pregnancies with ARED in the umbilical arteries have a high perinatal mortality associated with pathology of the placental villi. Ultrasound examination of the placenta and its maternal blood supply may contribute to the perinatal management of these pregnancies. |
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Authors:
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S Viero; V Chaddha; F Alkazaleh; M J Simchen; A Malik; E Kelly; R Windrim; J C P Kingdom |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Placenta Volume: 25 ISSN: 0143-4004 ISO Abbreviation: Placenta Publication Date: 2004 Sep-Oct |
Date Detail:
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Created Date: 2004-09-28 Completed Date: 2005-02-03 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8006349 Medline TA: Placenta Country: England |
Other Details:
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Languages: eng Pagination: 735-41 Citation Subset: IM |
Affiliation:
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Department of Laboratory Medicine and Pathobiology, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto, Ontario, Canada M5G 1X5. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Blood Flow Velocity Diastole Female Fetal Growth Retardation / physiopathology* Gestational Age Hemodynamics Humans Infant, Newborn Infant, Small for Gestational Age Laser-Doppler Flowmetry Placenta / blood supply*, ultrasonography* Placental Circulation* Pregnancy Pregnancy Complications, Cardiovascular / physiopathology* Prognosis Ultrasonography, Doppler, Color Ultrasonography, Prenatal* Umbilical Arteries / physiopathology* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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