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Journal articles on the topic 'AREDV= absent or reversed end diastolic velocity'

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Published: 7 June 2025

Last updated: 9 July 2025

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1

Ifran, Evita Karianni Bermanshah, Wresti Indriatmi, Tetty Yuniarti, et al. "Superior mesenteric artery blood flow in infants of very preterm and very low birthweight and its related factors." Paediatrica Indonesiana 63, no. 2 (2023): 80–7. http://dx.doi.org/10.14238/pi63.2.2023.80-7.

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 Abstract  Background Significant hemodynamic changes in preterm infants during early life could have consequences, especially on the intestinal blood flow. Alteration of superior mesenteric artery (SMA) blood flow may lead to impairment in gut function and feeding intolerance. Objectives To assess SMA blood flow velocity in very preterm and/or very low birth weight (VLBW) infants in early life and to elucidate the factors influencing them. Methods This is a cross-sectional study conducted in NICU at Cipto Mangunkusumo Hospital, Jakarta. Superior mesenteric artery (SMA) blood flow was evaluated by peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) measurement using Color Doppler US at < 48 hours after birth. Maternal and neonatal data that could be potentially associated with SMA blood flow were obtained. Bivariate analyses were conducted with a P value of < 0.05 considered significant. Results We examined 156 infants eligible for the study. PSV, EDV, and RI of SMA blood flow were not related to both gestational age and birth weight. Infant with small for gestational age (SGA) showed significantly lower EDV median [15.5 (range 0.0-32.8) vs 19.4 (range 0.0-113.0)] and higher RI [0.80 (range 0.58-1.00) vs 0.78 (range 0.50-1.00)] compared to appropriate for gestational age (AGA). Infants born from mother with preeclampsia showed lower PSV median [(78.2 (range 32.0-163.0) vs 89.7 (range 29.2-357.0)]) and EDV [16.2 (range 0.0-48.5) vs 19.4 (range 0.0-113.0)] compared to without PE, while absent/reverse end-diastolic velocity (AREDV) revealed a lower EDV median [16.9 (range 0.0 – 32.4) vs 19.4 (range 0.0 – 113.0)] compared to no AREDV. Furthermore, infants with hs-PDA showed lower EDV median [16.2 (range 0.0-113.0) vs 19.4 (range 0.0-71.1)] but higher RI median [0.80 (range 0.50-1.00) vs 0.78 (range 0.55-1.00)] compared to non hs-PDA. No difference in SMA blood flow across other factors was observed.

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2

Steinman, D. S., R. M. Yamamoto, R. P. V. Francisco, S. Miyadahira, and M. Zugaib. "P89A longitudinal study of computerized cardiotocography in pregnancies with absent or reversed end-diastolic velocity (AREDV) in the umbilical artery Doppler studies: preliminary results." Ultrasound in Obstetrics and Gynecology 16 (October 2000): 86. http://dx.doi.org/10.1046/j.1469-0705.2000.00004-1-88.x.

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3

Francisco, R. P. V., R. M. Yamamoto, C. C. Chuba, S. Miyadahira, and M. Zugaib. "P81Predicting delivery before 30 weeks in pregnancies with absent or reversed end-diastolic velocity (ARED) flow in the umbilical artery." Ultrasound in Obstetrics and Gynecology 16 (October 2000): 84. http://dx.doi.org/10.1046/j.1469-0705.2000.00004-1-80.x.

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4

Francisco, R. P. V., R. M. Yamamoto, K. Sakamoto, S. Miyadahira, and M. Zugaib. "P108The importance of studying the ductus venosus for predicting acidosis at birth in pregnancies with absent or reversed end-diastolic (ARED) velocity flow in the umbilical arteries." Ultrasound in Obstetrics and Gynecology 16 (October 2000): 90. http://dx.doi.org/10.1046/j.1469-0705.2000.00004-1-107.x.

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5

Francisco, R. P. V., R. M. Yamamoto, S. Miyadahira, and M. Zugaib. "P85Pulsatility index in the umbilical artery Doppler studies for predicting birth weight in pregnancies with absent or reversed end-diastolic velocity flow (ARED) in the umbilical arteries." Ultrasound in Obstetrics and Gynecology 16 (October 2000): 85. http://dx.doi.org/10.1046/j.1469-0705.2000.00004-1-84.x.

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6

Francisco, R. P. V., R. M. Yamamoto, C. C. Leite, S. Miyadahira, and M. Zugaib. "P107The study of the ductus venosus for predicting umbilical artery pH at birth below 7.10 in pregnancies with absent or reversed end-diastolic velocity flow (ARED) in the umbilical arteries Doppler studies." Ultrasound in Obstetrics and Gynecology 16 (October 2000): 90. http://dx.doi.org/10.1046/j.1469-0705.2000.00004-1-106.x.

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7

Karsdorp, V. H. M., J. M. G. van Vugt, H. P. van Geijn, et al. "Clinical significance of absent or reversed end diastolic velocity waveforms in umbilical artery." Lancet 344, no. 8938 (1994): 1664–68. http://dx.doi.org/10.1016/s0140-6736(94)90457-x.

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8

Wang, Kuo-Gon, Chen-Yu Chen, and Yi-Yung Chen. "The Effects of Absent or Reversed End-diastolic Umbilical Artery Doppler Flow Velocity." Taiwanese Journal of Obstetrics and Gynecology 48, no. 3 (2009): 225–31. http://dx.doi.org/10.1016/s1028-4559(09)60294-1.

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9

Wilson, D. C., A. Harper, and G. McClure. "Absent or reversed end diastolic flow velocity in the umbilical artery and necrotizing enterocolitis." Archives of Disease in Childhood 66, no. 12 (1991): 1467. http://dx.doi.org/10.1136/adc.66.12.1467.

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10

Malcolm, G., D. Ellwood, K. Devonald, R. Beilby, and D. Henderson-Smart. "Absent or reversed end diastolic flow velocity in the umbilical artery and necrotising enterocolitis." Archives of Disease in Childhood 66, no. 7 Spec No (1991): 805–7. http://dx.doi.org/10.1136/adc.66.7_spec_no.805.

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11

Francisco, Rossana Pulcineli Vieira, Seizo Miyadahira, and Marcelo Zugaib. "Predicting pH at Birth in Absent or Reversed End-Diastolic Velocity in the Umbilical Arteries." Obstetrics & Gynecology 107, no. 5 (2006): 1042–48. http://dx.doi.org/10.1097/01.aog.0000209192.00890.3a.

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12

Yamamoto, R. M., R. P. V. Francisco, K. Sakamoto, S. Miyadahira, and Zugaib. "P82Fetal death in pregnancies with absent or reversed end-diastolic velocity waveforms in the umbilical artery." Ultrasound in Obstetrics and Gynecology 16 (October 2000): 84. http://dx.doi.org/10.1046/j.1469-0705.2000.00004-1-81.x.

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13

McParland, Peter, Shirley Steel, and J. Malcolm Pearce. "The clinical implications of absent or reversed end-diastolic frequencies in umbilical artery flow velocity waveforms." European Journal of Obstetrics & Gynecology and Reproductive Biology 37, no. 1 (1990): 15–23. http://dx.doi.org/10.1016/0028-2243(90)90090-n.

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14

Yousif, Rihab A., Awadia G. Suliman, Raga A. Aburaida, Ibrahim M. Daoud, and Naglaa E. Mohammed. "Doppler ultrasound of umbilical artery in prediction of fetal outcome in pregnancy induced hypertension Sudanese population." International Journal of Research in Medical Sciences 8, no. 1 (2019): 96. http://dx.doi.org/10.18203/2320-6012.ijrms20195890.

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The pregnancy induced hypertension increase the fetal mortality and morbidity and the using of Doppler umbilical artery indices decrease the fetal mortality and morbidity however, there is few complete data about the most frequently altered Doppler US parameters to predict fetal outcome in pregnancy induced hypertension . Methods This ia cohort prospective study done in two hundred and six women of second and third trimester presenting to antenatal clinic in Soba University Hospital at the department of Obstetrics & Gynecology, in the fetus unit and critical pregnancy in the period From June 2008 to April 2013 to assess the Doppler indices of umbilical artery in pregnancy induced hypertension for prediction of prenatal outcome; 105 pregnancy induced hypertension patients and 101 women with uneventful pregnancies as normal control group included in this study . Baseline investigations and color Doppler of umbilical artery were done. Statistical analysis of data were done using SPSS, Receiver Operating Characteristic (ROC) curve analysis was performed and the area under the curve (AUC) used to determine sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of umbilical artery Doppler indices to predict fetal outcome.Results The study determine that there was significant difference in Doppler indices in PIH and control group ( p<0.01, the mean indices of umbilical artery is higher in PIH group compared with normal pregnancy group , the mean different of S/D ratio was 0.40, mean difference of RI was 0.06 and the mean different of PI index was 0.16, high percentage of adverse fetal outcome had been reported in in Pregnancy Induced Hypertension group than in control , which was more in absent and reversed flow velocity in umbilical artery in Pregnancy Induced Hypertension compared with group of Pregnancy Induced Hypertension with present end diastolic flow velocity. Systolic/Diastolic ratio was most accurate in predicting adverse outcome in pregnancy induced hypertension patients, followed by the Pulastility index then the Resistance index (75%, 66% and 57% respectively).ConclusionThis study concluded that pregnancy induced hypertension leads to worsen placental insufficiently, which appears on the higher Doppler indices of umbilical artery to PIH patients when compared with normal pregnancy. A low diastolic flow and higher indices characterized the pregnancies with abnormal outcomes. Doppler of the umbilical artery was useful to predict fetal well being in PIH patients, high percentage of adverse fetal outcome had been reported in absent and reversed end diastolic flow velocity in umbilical artery compared with group of present flow velocity.

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15

Shenoy, Heera T., Sheela Shenoy, and Sonia X. James. "Doppler patterns in growth restricted foetuses: determinants and outcome in a tertiary hospital in South Kerala, India." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 2 (2019): 453. http://dx.doi.org/10.18203/2320-1770.ijrcog20190267.

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Background: Foetal growth restriction refers to a condition in which the foetus is unable to achieve its genetically determined growth potential. Doppler velocimetry in FGR not only decides the optimum time of delivery but also the optimum mode of delivery and so authors evaluated the Doppler patterns in growth restricted fetuses.Methods: Nested case-control study conducted among normal and abnormal Doppler groups at a tertiary care teaching hospital in the year 2017.Results: Among 82 growth restricted foetuses, 54 of them had normal Doppler patterns (65.85%) and 28 had abnormal Doppler patterns (34.15%).13(46.5%) had umbilical S/D elevation,2 (7.14%) had AEDV,1(3.57%) with REDV and 12 (42.8%) with CPR<1. Mean maternal age was slightly higher in the abnormal Doppler group. FGR babies with abnormal velocity waveforms had shorter diagnosis to delivery interval than those with normal Doppler and decision for delivery was taken at a lower gestational age. (p value-0.001). Mothers of FGR babies with abnormal Doppler studies underwent emergency caesarean section for non-reassuring foetal heart patterns. (p value-0.001) The mean birth weight was higher (2201.80gm) in Doppler normal FGR and it was 1929.46grams in abnormal umbilical Doppler group and 1363.33gm in AREDV (pvalue-0.001). Growth restricted with normal Doppler had shorter NICU stays than with abnormalities (p value-0.003). Term FGR went home early than early preterm. (p value-0.001).Conclusions: Growth restricted foetuses with normal umbilical velocimetry are at a lower risk than those with abnormal velocimetry in terms of prolonged diagnosis-delivery interval and shorter NICU days. The need for neonatal resuscitation at birth was more in babies with abnormal Doppler velocimetry and absent diastole /reversed diastolic flow of umbilical artery velocimetry.

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16

Schreuder, A. M. "Outcome at school age following antenatal detection of absent or reversed end diastolic flow velocity in the umbilical artery." Archives of Disease in Childhood - Fetal and Neonatal Edition 86, no. 2 (2002): 108F—114. http://dx.doi.org/10.1136/fn.86.2.f108.

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17

Sezik, Mekin, Görkem Tuncay, and Elif Gül Yapar. "Prediction of Adverse Neonatal Outcomes in Preeclampsia by Absent or Reversed End-Diastolic Flow Velocity in the Umbilical Artery." Gynecologic and Obstetric Investigation 57, no. 2 (2004): 109–13. http://dx.doi.org/10.1159/000075675.

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18

Jang, Dong Gyu, Yun Sung Jo, Sung Jong Lee, Narinay Kim, and Gui Se Ra Lee. "Perinatal outcomes and maternal clinical characteristics in IUGR with absent or reversed end-diastolic flow velocity in the umbilical artery." Archives of Gynecology and Obstetrics 284, no. 1 (2010): 73–78. http://dx.doi.org/10.1007/s00404-010-1597-8.

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19

Aditi, Saini, Thakyal Abhilasha, Moza Harshita, and Gupta Anumodan. "Risk Factors for Intra-Uterine Growth Retardation and its Outcomes in a Tertiary Care Hospital." International Journal of Pharmaceutical and Clinical Research 16, no. 10 (2024): 1289–95. https://doi.org/10.5281/zenodo.14194263.

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<strong>Introduction:</strong> Reduced fetal growth is seen in about 10% of the pregnancies but only a minority has a pathological background and is known as intrauterine growth restriction or fetal growth restriction (IUGR / FGR). The reported incidence of SGA ranges from 10% to 27% worldwide. Fetal growth is regulated at multiple levels. Increased fetal and neonatal mortality and morbidity as well as adult pathologic conditions are often associated with IUGR. The present study was done to evaluate the risk factors and neonatal outcome of IUGR. <strong>Material and Method:</strong> The present prospective study was conducted at the department of obstetrics and gynaecology of SMGS Hospital among 300 pregnant women with IUGR during the study period of one year. Risk factors and neonatal outcome were noted and results were analysed using SPSS 25.0. <strong>Result:</strong> The study revealed the maximum number of cases (56.6%) belonged to the age between 20 to 30 years. IUGR was common in Multigravida (75%), rural area (55.6%). IUGR was observed in 49% with normal AFI and severe oligohydramnios <5 cm was observed in 19%. Doppler velocimetry showed abnormal umbilical S/D ratio in 39 (13%). Most of the patients (66%) required a caesarean section. A total of 187 (62.4%) neonates had birth weight ranging between 2.5 to 3.0 kg. (36%) neonates had morbidity and (1.7%) had mortality. <strong>Conclusion: </strong>By studying the risk factors, we will be able to identify the high-risk group. Focus on early detection and high-quality antenatal care will help to overcome the problem of IUGR in the community.    

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Yoo, Changyoung, Dong Gyu Jang, Yun Sung Jo, Jinyoung Yoo, and Guisera Lee. "Pathologic Differences between Placentas from Intrauterine Growth Restriction Pregnancies with and without Absent or Reversed End Diastolic Velocity of Umbilical Arteries." Korean Journal of Pathology 45, no. 1 (2011): 36. http://dx.doi.org/10.4132/koreanjpathol.2011.45.1.36.

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21

Yamamoto, R. M., R. P. V. Francisco, D. S. Steinman, S. Miyadahira, and M. Zugaib. "P83Fetal hemodynamic profile in pregnancies with absent or reversed end-diastolic velocity waveforms in the umbilical artery that presented fetal death." Ultrasound in Obstetrics and Gynecology 16 (October 2000): 84–85. http://dx.doi.org/10.1046/j.1469-0705.2000.00004-1-82.x.

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22

Sezik, Mekin. "Comment on: Perinatal outcomes and maternal clinical characteristics in IUGR with absent or reversed end-diastolic flow velocity in the umbilical artery." Archives of Gynecology and Obstetrics 285, no. 1 (2011): 275–76. http://dx.doi.org/10.1007/s00404-011-2080-x.

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23

Chen, Chen-Yu, Kuo-Gon Wang, Shwu-Meei Wang, and Chie-Pein Chen. "Two-year neurological outcome of very-low-birth-weight children with prenatal absent or reversed end-diastolic flow velocity in the umbilical artery." Taiwanese Journal of Obstetrics and Gynecology 52, no. 3 (2013): 323–28. http://dx.doi.org/10.1016/j.tjog.2012.04.039.

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Yamamoto, R. M., R. P. V. Francisco, D. Okatani, S. Miyadahira, and M. Zugaib. "P84Early neonatal death according to metabolic acidosis at birth in pregnancies with absent or reversed end-diastolic velocity flow in the umbilical artery." Ultrasound in Obstetrics and Gynecology 16 (October 2000): 85. http://dx.doi.org/10.1046/j.1469-0705.2000.00004-1-83.x.

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25

PETERSEN, Scott G., Shell F. WONG, Prashanth URS, Peter H. GRAY, and Glenn J. GARDENER. "Early onset, severe fetal growth restriction with absent or reversed end-diastolic flow velocity waveform in the umbilical artery: Perinatal and long-term outcomes." Australian and New Zealand Journal of Obstetrics and Gynaecology 49, no. 1 (2009): 45–51. http://dx.doi.org/10.1111/j.1479-828x.2008.00938.x.

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26

Afroze, Zakia, and Rokeya Begum. "Doppler Velocimetry of Umbilical Artery in Normal and Growth Restricted Pregnancy." Bangladesh Journal of Obstetrics & Gynaecology 35, no. 2 (2022): 68–73. http://dx.doi.org/10.3329/bjog.v35i2.58787.

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Objectives: To evaluate the umbilical arterial blood flow velocity and its various indices during 3rd trimester of pregnancy and to compare these indices in normal and growth restricted pregnancies. Methods: In this study, 50 women with normal singleton pregnancy and 50 women with intrauterine growth restricted (IUGR) pregnancy with expected birth weight <10th percentile of the normal for the gestational age were studied by Doppler evaluation of their umbilical artery, Pulsality Index (PI), Resistance Index (RI) and S/D ratio of the control group and IUGR group were calculated and reference range constructed. Values of Doppler indices of IUGR group were compared with those of the control group. Perinatal outcome was evaluated in relation to the indices. Results: Doppler velocimetry of umbilical artery showed elevated indices in 33 out of 50 cases of IUGR group showing its high sensitivity in diagnosing haemodynamically compromised growth restricted fetuses. Absent end diastolic velocily (AEDV) and reversed end diastolic velocily (REDV), were seen in 8 and 2 cases respectively and were associated with poor perinatal out come in terms of need for LSCS for fetal distress, Apgar score <7 at 1 minute, admission to NICU (Neonatal Intensive Care Unit) and perinatal death. Conclusion: In normal pregnancy there is gestational age related fall in impedance in Umbilical arteries. Doppler study of umbilical artery is highly sensitive in the detection of IUGR and for the prediction of adverse perinatal outcome in small for gestational age. Bangladesh J Obstet Gynaecol, 2020; Vol. 35(2): 68-73

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Rémy, Konan Blé, Olou Luc, Konan Perel, et al. "Indication for Doppler evaluation in the management of intrauterine growth restriction of vascular origin in Sub-Saharan Africa." Medical Journal of Zambia 46, no. 3 (2019): 209–14. http://dx.doi.org/10.55320/mjz.46.3.559.

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Objective: To assess the contribution of Doppler in foetal monitoring and decision-making during delivery in case of in-utero vascular growth retardation. Design: We conducted a retrospective cohort study from January 2015 to December 2017 in the Gynaecology and Obstetrics Department of the Yopougon University Hospital (Abidjan, Ivory Coast). It included 130 patients who gave birth in a setting of pre-eclampsia with intrauterine growth restriction (IUGR) from 28 weeks of amenorrhoea. Results: The average age of patients was 31years. Nulliparous (33% of our patients) and pauciparous (41% of our patients) women were the group most affected. The mean gestational age at the first Doppler examination was 32 weeks of amenorrhoea. Doppler abnormalities were 65% in uterine Doppler and 90% in umbilical Doppler. The meancerebrovascular ratio was reversed in 90% of the cases. Perinatal mortality was 22.3% (n = 29) with 21 foetal death in utero and 8 neonatal deaths. The time interval between absent end-diastolic or reverse flow velocity and in-utero foetal death was 3.8 days. Conclusion: Foetal and umbilical Doppler ultrasound greatly modified the management of intrauterine growth retardation related to hypertension.

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Blé Rémy, Konan, Olou Luc, Konan Perel, et al. "Indication for Doppler evaluation in the management of intrauterine growth restriction of vascular origin in Sub-Saharan Africa." Medical Journal of Zambia 46, no. 3 (2020): 209–14. http://dx.doi.org/10.55320/mjz.46.3.220.

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Objective: To assess the contribution of Doppler in foetal monitoring and decision-making during delivery in case of in-utero vascular growth retardation. Design: We conducted a retrospective cohort study from January 2015 to December 2017 in the Gynaecology and Obstetrics Department of the Yopougon University Hospital (Abidjan, Ivory Coast). It included 130 patients who gave birth in a setting of pre-eclampsia with intrauterine growth restriction (IUGR) from 28 weeks of amenorrhoea. Results: The average age of patients was 31years. Nulliparous (33% of our patients) and pauciparous (41% of our patients) women were the group most affected. The mean gestational age at the first Doppler examination was 32 weeks of amenorrhoea. Doppler abnormalities were 65% in uterine Doppler and 90% in umbilical Doppler. The meancerebrovascular ratio was reversed in 90% of the cases. Perinatal mortality was 22.3% (n = 29) with 21 foetal death in utero and 8 neonatal deaths. The time interval between absent end-diastolic or reverse flow velocity and in-utero foetal death was 3.8 days. Conclusion: Foetal and umbilical Doppler ultrasound greatly modified the management of intrauterine growth retardation related to hypertension.

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Francisco, R. P. V., R. M. Yamamoto, C. C. Leite, S. Miyadahira, and M. Zugaib. "P86Assessment of fetal well-being in patients with poor obstetric history: comparison between cases of absent or reversed end-diastolic velocity in the umbilical artery." Ultrasound in Obstetrics and Gynecology 16 (October 2000): 85. http://dx.doi.org/10.1046/j.1469-0705.2000.00004-1-85.x.

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Yamamoto, R. M., R. P. V. Francisco, D. Okatani, S. Miyadahira, and M. Zugaib. "P88Cardiotocography predicting buffer base deficit (> 10 mM) at birth in pregnancies with absent or reversed end-diastolic velocity in the umbilical artery Doppler studies." Ultrasound in Obstetrics and Gynecology 16 (October 2000): 86. http://dx.doi.org/10.1046/j.1469-0705.2000.00004-1-87.x.

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Yamamoto, R. M., R. P. V. Francisco, C. C. Chuba, S. Miyadahira, and M. Zugaib. "P87Cardiotocography in pregnancies with absent or reversed end-diastolic velocity in the umbilical artery: a mathematical model for estimating the probability for fetal acidosis at birth." Ultrasound in Obstetrics and Gynecology 16 (October 2000): 85. http://dx.doi.org/10.1046/j.1469-0705.2000.00004-1-86.x.

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Begum, Arzu Manth Ara, Khodeza Tul Kobra, and Monowera Begum. "Perinatal outcome of 50 cases of abnormal umbilical artery Doppler ultrasound study." Journal of Dhaka National Medical College & Hospital 21, no. 1 (2015): 19–22. https://doi.org/10.3329/jdnmch.v21i1.77823.

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Objective : The main objective of this study was proper detection of the compromised fetus to allow for timely intervention and to reduce perinatal morbidity and mortality. Materials and Methods This is a cross sectional descriptive type of study which was conducted in the department of Obstetrics and Gynaecology in DNMCH from January 2006 to December 2006. Results : In this study gestational age was determined by clinical examination, LMP and USG. There was a high incidence of caesarean section in this study. The reason of this high incidence was due to obstetrics indications like severe preeclampsia, severe PIH, Oligohydramnios, indications of emergency caesarean section was (58.97%). High risk cases were decided to terminate by Umbillical artery Doppler study. In the present study in most cases delivery occurs within 3-4 days of the last test. The prevalence of perinatal death in fetuses with absent or reversed end diastolic flow velocity was 40%. 5 minute Apgar score<7 was 8% and admission into NICU was 32%. Timely intervention dictated by Umbilical Artery Doppler Study results may be the reason for such variation. Conclusion : UADS as an antepartum surveillance technique is highly sensitive, non-invasive, convenient technique, less time consuming to perform it and from legal point there is a record. UADS may be used as supplementary test which may improve perinatal outcome. Hence the use of Doppler provides information that is not readily obtained from more conventional test of fetal well being. It is therefore has an important role to play in the management of compromised fetus. J. Dhaka National Med. Coll. Hos. 2015; 21 (01):19-22

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33

van de Meent, Mette, Dianne G. Kleuskens, Wessel Ganzevoort, et al. "OPtimal TIming of antenatal COrticosteroid administration in pregnancies complicated by early-onset fetal growth REstriction (OPTICORE): study protocol of a multicentre, retrospective cohort study." BMJ Open 13, no. 3 (2023): e070729. http://dx.doi.org/10.1136/bmjopen-2022-070729.

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IntroductionEarly-onset fetal growth restriction (FGR) requires timely, often preterm, delivery to prevent fetal hypoxia causing stillbirth or neurologic impairment. Antenatal corticosteroids (CCS) administration reduces neonatal morbidity and mortality following preterm birth, most effectively when administered within 1 week preceding delivery. Optimal timing of CCS administration is challenging in early-onset FGR, as the exact onset and course of fetal hypoxia are unpredictable. International guidelines do not provide a directive on this topic. In the Netherlands, two timing strategies are commonly practiced: administration of CCS when the umbilical artery shows (A) a pulsatility index above the 95thhcentile and (B) absent or reversed end-diastolic velocity (a more progressed disease state). This study aims to (1) use practice variation to compare CCS timing strategies in early-onset FGR on fetal and neonatal outcomes and (2) develop a dynamic tool to predict the time interval in days until delivery, as a novel timing strategy for antenatal CCS in early-onset FGR.Methods and analysisA multicentre, retrospective cohort study will be performed including pregnancies complicated by early-onset FGR in six tertiary hospitals in the Netherlands in the period between 2012 and 2021 (estimated sample size n=1800). Main exclusion criteria are multiple pregnancies and fetal congenital or genetic abnormalities. Routinely collected data will be extracted from medical charts. Primary outcome for the comparison of the two CCS timing strategies is a composite of perinatal, neonatal and in-hospital mortality. Secondary outcomes include the COSGROVE core outcome set for FGR. A multivariable, mixed-effects model will be used to compare timing strategies on study outcomes. Primary outcome for the dynamic prediction tool is ‘days until birth’.Ethics and disseminationThe need for ethical approval was waived by the Ethics Committee (University Medical Center Utrecht). Results will be published in open-access, peer-reviewed journals and disseminated by presentations at scientific conferences.Trial registration numberClinicalTrials.gov:NCT05606497

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Mari, G., F. Hanif, M. Kruger, E. Cosmi, J. Santolaya‐Forgas, and M. C. Treadwell. "Middle cerebral artery peak systolic velocity: a new Doppler parameter in the assessment of growth‐restricted fetuses." February 23, 2007. https://doi.org/10.1002/uog.3953.

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AbstractObjectiveThe aims of this study were to determine if there is a relationship between middle cerebral artery (MCA) peak systolic velocity (PSV) and perinatal mortality in preterm intrauterine growth‐restricted (IUGR) fetuses, to compare the performance of MCA pulsatility index (PI), MCA‐PSV and umbilical artery (UA) absent/reversed end‐diastolic velocity (ARED) in predicting perinatal mortality, to determine the longitudinal changes that occur in MCA‐PI and MCA‐PSV in these fetuses, and to test the hypothesis that MCA‐PSV can provide additional information on the prognosis of hypoxemic IUGR fetuses.MethodsThis was a retrospective cross‐sectional study of 30 IUGR fetuses (estimated fetal weight < 3rd percentile; UA‐PI > 95% CI) in which the last MCA‐PI, MCA‐PSV and UA values were obtained within 8 days before delivery or fetal demise. Among the 30 fetuses, there were 10 in which at least three consecutive measurements were performed before delivery and these were used for a longitudinal study. MCA‐PSV and MCA‐PI values were plotted against normal reference ranges and were considered abnormal when they were above the MCA‐PSV or below the MCA‐PI reference ranges.ResultsGestational age at delivery ranged between 23 + 1 and 32 + 5 (median, 27 + 6) gestational weeks. Birth weight ranged from 282 to 1440 (median, 540) g. There were 11 perinatal deaths. Forward stepwise logistic regression indicated that MCA‐PSV was the best parameter in the prediction of perinatal mortality (odds ratio, 14; 95% CI, 1.4–130; P < 0.05) (Nagerlke R2 = 31). In the 10 fetuses studied longitudinally, an abnormal MCA‐PI preceded the appearance of an abnormal MCA‐PSV. In these fetuses, the MCA‐PSV consistently showed an initial increase in velocity; before demise or the appearance of a non‐reassuring test in seven fetuses, there was a decrease in blood velocity. The MCA‐PI presented an inconsistent pattern.ConclusionsIn IUGR fetuses, the trends of the MCA‐PI and MCA‐PSV provide more clinical information than does one single measurement. A high MCA‐PSV predicts perinatal mortality better than does a low MCA‐PI. We propose that MCA‐PSV might be valuable in the clinical assessment of IUGR fetuses that have abnormal UA Doppler. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.

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"Clinical significance of absent or reversed end diastolic velocity waveforms in umbilical artery." International Journal of Gynecology & Obstetrics 50, no. 3 (1995): 320. http://dx.doi.org/10.1016/0020-7292(95)92800-g.

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Schlant, Elizabeth, Abby Birk, Ahmet Baschat, et al. "Perinatal Outcomes in Appropriately Grown Monochorionic Diamniotic Twins With Intermittent Absent and Reversed End‐Diastolic Umbilical Artery Flow Compared to Selective Fetal Growth Restriction Type III." Prenatal Diagnosis, December 16, 2024. https://doi.org/10.1002/pd.6717.

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ABSTRACTObjectivesUmbilical artery Doppler intermittent absent and reversed end‐diastolic flow (iAREDF) is associated with increased perinatal morbidity and mortality in monochorionic twins with selective fetal growth restriction. The clinical significance of umbilical artery iAREDF in appropriately grown monochorionic twins is not well described.MethodsThis is a single‐institution retrospective cohort study describing characteristics and outcomes of monochorionic diamniotic twins with appropriate for gestational age growth and umbilical artery iAREDF in comparison to monochorionic diamniotic twins with selective fetal growth restriction and iAREDF, or sFGR type III. The cohorts were compared for antenatal resolution of iAREDF, estimated gestational age at delivery, fetal and maternal complications, delivery characteristics, and survival outcomes.ResultsTen appropriately grown monochorionic diamniotic twin pairs with umbilical artery iAREDF and 23 with sFGR Type III delivered at a mean gestational age of 30.4 (± 5) weeks and 30.7 (± 4) weeks, respectively (p = 0.93). No significant differences were observed in the Doppler course (deterioration or improvement) prior to delivery, fetal or maternal complications, delivery characteristics (with the exception of the persistence of the growth differences), or survival outcomes between groups.ConclusionsMonochorionic diamniotic twins with intermittent absent and reversed end‐diastolic umbilical artery velocity may be at increased risk for adverse perinatal outcomes even if criteria for selective fetal growth restriction are not met.

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Rochelson, Burton, Tharwat Stewart Boulis, Hima Tam Tam, and Morris Edelman. "Triphasic umbilical artery waveform: association with severe fetal growth restriction, fetal demise, and extreme velamentous cord insertion." Case Reports in Perinatal Medicine 3, no. 2 (2014). http://dx.doi.org/10.1515/crpm-2013-0078.

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AbstractExtreme Doppler abnormalities of the umbilical artery such as absent or reversed end diastolic velocity are associated with adverse perinatal outcomes. We present a case of a triphasic umbilical artery waveform identified at 24 weeks. The fetus was severely growth restricted with an estimated fetal weight of 314 g. A week later, fetal demise occurred. Placental pathology revealed a placental weight of 83 g, an extensive maternal floor infarction, and an extreme velamentous cord insertion 7 cm from the edge of the placental disc, with vessels entering at opposite poles of the placental disc and a single anastomotic bridging vessel on the chorionic plate connecting these two vascular poles. A triphasic umbilical artery waveform may be associated with a premorbid state and severe placental vascular abnormality. We hypothesize that the third and positive component in late diastole is present due to forward flow across the communicating bridging vessel into the contralateral entering vessel.

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Backley, S., E. Bergh, J. Garnett, et al. "Fetal cardiovascular changes during open and fetoscopic in‐utero spina bifida closure." Ultrasound in Obstetrics & Gynecology, January 11, 2024. http://dx.doi.org/10.1002/uog.27579.

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ABSTRACTObjectiveLaparotomy‐assisted fetoscopic closure of spina bifida utilizing heated‐humidified carbon dioxide gas has been associated with less maternal morbidity than open in‐utero spina bifida closure. Fetal cardiovascular changes during these surgical interventions are not well defined. Our objective was to compare fetal bradycardia (defined as fetal heart rate (FHR)<110 bpm over 10 minutes) and changes in umbilical artery Doppler parameters throughout open in‐utero closure with those observed during laparotomy‐assisted fetoscopic closure.MethodsWe conducted a prospective cohort study of 22 open and 46 fetoscopic consecutive in‐utero closures between 2019 and 2023. Both cohorts had similar preoperative counseling and clinical management. FHR and umbilical artery velocimetry were systematically obtained during preoperative assessment, every 5 minutes during the intraoperative period, and in the postoperative assessment. FHR, pulsatility indexes and end‐diastolic flows were segmented into hourly periods during surgery, and the lowest values were averaged for analysis. Umbilical vein maximum velocities were measured in the fetoscopic cohort. Each fetal heart rate recording time point was correlated to maternal parameters, including heart rate, systolic and diastolic blood pressures.ResultsFetal bradycardia occurred in 4/22 cases (18.2%) of open in‐utero closure and in 21/46 cases (45.7%) of fetoscopic closure. FHR gradually decreased in both cohorts after general anesthesia and decreased further during surgery. FHR were significantly lower after two hours of surgery in the fetoscopic closure than in the open in‐utero closure group. In addition, the FHR (BPM) change in the final stages of the fetal surgery from the baseline FHR was significantly lower in the fetoscopic cohort (‐32.3 (‐35.7, ‐29.1)) compared to the open cohort (‐23.5 (‐28.1, ‐18.8)) (p=0.002). Abnormal end‐diastolic flow (defined as absent or reversed end‐diastolic flow) in the umbilical artery Doppler velocity occurred in 3/22 (13.6%) of the open closure cohort and in 23/46 (50%) of the fetoscopic closure cohort (p=0.004). There were no differences in umbilical artery end‐diastolic flow and pulsatility index between closure techniques during the various stages of assessment.ConclusionsWe observed a decrease in the FHR and abnormalities in umbilical artery Doppler parameters in both open in‐utero and fetoscopic closure groups. Fetal bradycardia was more prominent during fetoscopic closure following heated‐humidified carbon dioxide insufflation, but the FHR recovered after cessation of the heated‐humidified carbon dioxide. Changes in FHR and umbilical artery Doppler parameters during in‐utero spina bifida closure were observed to be transient, no cases required emergency delivery and no fetoscopic closure were converted to open closure. These observations should inform algorithms for perioperative management of fetal bradycardia associated with in‐utero spina bifida closure.This article is protected by copyright. All rights reserved.

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Nakahara, Angela, Miranda Long, Ardem Elmayan, Joseph Biggio, and Frank B. Williams. "Expanded fetal growth restriction definition identifies high proportion of umbilical artery Doppler anomalies." American Journal of Perinatology, October 7, 2024. http://dx.doi.org/10.1055/a-2435-0468.

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Objective: Fetal growth restriction (FGR) increases the risk for perinatal morbidity and mortality. The Society of Maternal Fetal Medicine expanded the definition of FGR to independently include abdominal circumference (AC) <10th percentile for gestational age (GA), regardless of estimated fetal weight (EFW). While studies have shown increased detection of small for GA neonates with expanded definition, no studies have evaluated the likelihood of abnormal umbilical artery Dopplers (UAD) with expanded definition. The objective of this study was to compare the likelihood of identifying UAD abnormalities in fetuses with normal EFW and restricted AC versus EFW alone. Study Design: Single institution retrospective cohort study of fetal growth ultrasounds meeting criteria for FGR either by EFW <10th percentile or AC <10th percentile with normal EFW. Those with FGR by AC alone were compared with those with FGR by EFW. Primary outcome was prevalence of UAD abnormalities, including elevated systolic/diastolic ratio, and absent and/or reversed end diastolic velocity. Receiver operator characteristic curves were generated to compare predictive value of UAD abnormalities by FGR definition. Results: Six hundred nineteen scans met criteria for FGR between 11/2020-06/2021, with 441 (71%) meeting definition by EFW and 178 (29%) by AC criteria alone. Baseline characteristics were similar between groups. FGR by AC alone was identified earlier (30.4 ±3.3 vs 35.4 ±3.0 weeks gestation, p <0.001) with higher proportion identified before 32 weeks (70% vs 11%, p <0.001). Proportion of abnormal UAD were similar between groups (15% vs 15%, aOR 1.12, 95% CI 0.61-2.23). Use of EFW alone would have failed to identify 29% of abnormal UAD. A combined definition of FGR had the highest detection of abnormal UAD (area under curve 0.78 vs AC alone 0.73 vs EFW alone 0.69). Conclusions: A definition of FGR that considers both EFW and AC improves detection of abnormal UAD.

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DeVore, Greggory R., Percy Pacora Portella, Edgar Hernandez Andrade, Lami Yeo, and Roberto Romero. "Cardiac Measurements of Size and Shape in Fetuses With Absent or Reversed End‐Diastolic Velocity of the Umbilical Artery and Perinatal Survival and Severe Growth Restriction Before 34 Weeks' Gestation." Journal of Ultrasound in Medicine, October 30, 2020. http://dx.doi.org/10.1002/jum.15532.

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