Dopplervelocimetry Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(9):557-566
DOI 10.1590/S0100-72032000000900004
Purpose: to study the fetal well-being assessment in pregnancies complicated by diabetes, and to analyze the neonatal results. Methods: we studied 387 pregnant women with diabetes at the Fetal Surveillance Unit. The last examination (cardiotocography, fetal biophysical profile, amniotic fluid index and dopplervelocimetry) was correlated with the neonatal outcome. Results: the studied population included 46 (12%) type I diabetes, 45 (12%) type II and 296 (76%) gestational diabetes. Type I diabetes with abnormal or suspected cardiotocography was related to abnormal 1st minute Apgar (50 and 75%, p<0.05) and to the need for neonatal intensive care unit (50 and 75%, p<0.05). The abnormal biophysical profile in type II diabetic pregnancy was related to the need for neonatal intensive care (67%, p<0.05), and abnormal umbilical artery Doppler study was related to abnormal 1st minute Apgar (67%, p<0.05). Gestational diabetes with abnormal cardiotocography presented 36% abnormal 1st minute Apgar (p<0.05), 18% abnormal 5th minute Apgar (p<0.01) and 18% neonatal death (p<0.01). Abnormal amniotic fluid index was related to abnormal 5th minute Apgar (p<0.05) and need for neonatal intensive care unit (p<0.05). Gestational diabetes with abnormal umbilical artery Doppler was related (p<0.05) to: abnormal 1st and 5th minute Apgar, respectively, 25 and 8%, Need for neonatal intensive care in 17% and neonatal death in 8%. Conclusions: the fetal well-being examinations correlated with adverse perinatal outcome, showing the need for fetal surveillance in diabetic pregnant women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(9):557-566
DOI 10.1590/S0100-72032000000900004
Purpose: to study the fetal well-being assessment in pregnancies complicated by diabetes, and to analyze the neonatal results. Methods: we studied 387 pregnant women with diabetes at the Fetal Surveillance Unit. The last examination (cardiotocography, fetal biophysical profile, amniotic fluid index and dopplervelocimetry) was correlated with the neonatal outcome. Results: the studied population included 46 (12%) type I diabetes, 45 (12%) type II and 296 (76%) gestational diabetes. Type I diabetes with abnormal or suspected cardiotocography was related to abnormal 1st minute Apgar (50 and 75%, p<0.05) and to the need for neonatal intensive care unit (50 and 75%, p<0.05). The abnormal biophysical profile in type II diabetic pregnancy was related to the need for neonatal intensive care (67%, p<0.05), and abnormal umbilical artery Doppler study was related to abnormal 1st minute Apgar (67%, p<0.05). Gestational diabetes with abnormal cardiotocography presented 36% abnormal 1st minute Apgar (p<0.05), 18% abnormal 5th minute Apgar (p<0.01) and 18% neonatal death (p<0.01). Abnormal amniotic fluid index was related to abnormal 5th minute Apgar (p<0.05) and need for neonatal intensive care unit (p<0.05). Gestational diabetes with abnormal umbilical artery Doppler was related (p<0.05) to: abnormal 1st and 5th minute Apgar, respectively, 25 and 8%, Need for neonatal intensive care in 17% and neonatal death in 8%. Conclusions: the fetal well-being examinations correlated with adverse perinatal outcome, showing the need for fetal surveillance in diabetic pregnant women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(9):551-555
DOI 10.1590/S0100-72032000000900003
Purpose: to evaluate the evolution in the embryo heart rate in the first trimester of pregnancy. Patients and Methods: in a prospective study 206 pregnant women were evaluated in the first trimester of pregnancy, by transvaginal color Doppler sonography, using Aloka, SSD-2000 apparatus, with a 5-MHz transvaginal transducer. All examinations were performed by the same examiner, with the determination of embryo heart rate. The patients were classified into groups according to the gestational age, in half-week intervals from the 5th week of pregnancy on. Pregnancy outcome was evaluated by ultrasonography at the end of second and third trimesters. Mean and standard deviation were determined for each evaluated gestational age. Results: it was possible to determine normal values for embryo heart rate. Mean embryo heart rate showed changes with gestational age, ranging from 110 ± 14 bpm at the 6.0th week to 150 ± 12 bpm at the 14.0th week. Conclusions: transvaginal pulsed color Doppler equipment enabled cardiovascular evaluation in early pregnancy, being a noninvasive method and innocuous to the embryo. These values would be useful in new studies on dopplervelocimetry in this period of pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(9):551-555
DOI 10.1590/S0100-72032000000900003
Purpose: to evaluate the evolution in the embryo heart rate in the first trimester of pregnancy. Patients and Methods: in a prospective study 206 pregnant women were evaluated in the first trimester of pregnancy, by transvaginal color Doppler sonography, using Aloka, SSD-2000 apparatus, with a 5-MHz transvaginal transducer. All examinations were performed by the same examiner, with the determination of embryo heart rate. The patients were classified into groups according to the gestational age, in half-week intervals from the 5th week of pregnancy on. Pregnancy outcome was evaluated by ultrasonography at the end of second and third trimesters. Mean and standard deviation were determined for each evaluated gestational age. Results: it was possible to determine normal values for embryo heart rate. Mean embryo heart rate showed changes with gestational age, ranging from 110 ± 14 bpm at the 6.0th week to 150 ± 12 bpm at the 14.0th week. Conclusions: transvaginal pulsed color Doppler equipment enabled cardiovascular evaluation in early pregnancy, being a noninvasive method and innocuous to the embryo. These values would be useful in new studies on dopplervelocimetry in this period of pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(3):137-143
DOI 10.1590/S0100-72032001000300002
Purpose: to study, in high risk pregnancies with cerebral redistribution of blood flow, the fetal surveillance and perinatal outcome, according to umbilical artery dopplervelocimetry. Methods: a total of 717 high-risk pregnancies attended at the Fetal Surveillance Unit were included. The last examination performed until 72 h prior to delivery was taken into account. Multiple gestations and fetal anomalies were excluded. The redistribution of blood flow was diagnosed if the pulsatility index of middle cerebral artery was below the 5th percentile for gestational age. The umbilical artery dopplervelocimetry was abnormal when A/B ratio was more than the 95th p. Results: in the group with normal umbilical artery dopplervelocimetry (560 cases -- 78.1%), significant correlation was found only between redistribution of blood flow and suspected or abnormal cardiotocography (17.1%). In the group with abnormal umbilical artery dopplervelocimetry (157 cases -- 21.9%) we found significant correlation between redistribution of blood flow (105 cases -- 66.9%) and cardiotocography abnormalities (57.2%), abnormal 1st(43.8%) and 5th (12.4%) minute Apgar scores. In these cases, the mean values of gestational age at delivery (34.4 ± 3.6 weeks), birth weight (1,810.5 ± 769.3 g), and pH at birth (7.20 ± 0.1) were significantly lower. Conclusion: The redistribution of fetal blood flow characterized by means of middle cerebral artery dopplervelocimetry is related to perinatal results when some level of placental insufficiency occurs, and does not present association to perinatal outcome when pregnancy shows normal fetal-placental blood flow.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(3):137-143
DOI 10.1590/S0100-72032001000300002
Purpose: to study, in high risk pregnancies with cerebral redistribution of blood flow, the fetal surveillance and perinatal outcome, according to umbilical artery dopplervelocimetry. Methods: a total of 717 high-risk pregnancies attended at the Fetal Surveillance Unit were included. The last examination performed until 72 h prior to delivery was taken into account. Multiple gestations and fetal anomalies were excluded. The redistribution of blood flow was diagnosed if the pulsatility index of middle cerebral artery was below the 5th percentile for gestational age. The umbilical artery dopplervelocimetry was abnormal when A/B ratio was more than the 95th p. Results: in the group with normal umbilical artery dopplervelocimetry (560 cases -- 78.1%), significant correlation was found only between redistribution of blood flow and suspected or abnormal cardiotocography (17.1%). In the group with abnormal umbilical artery dopplervelocimetry (157 cases -- 21.9%) we found significant correlation between redistribution of blood flow (105 cases -- 66.9%) and cardiotocography abnormalities (57.2%), abnormal 1st(43.8%) and 5th (12.4%) minute Apgar scores. In these cases, the mean values of gestational age at delivery (34.4 ± 3.6 weeks), birth weight (1,810.5 ± 769.3 g), and pH at birth (7.20 ± 0.1) were significantly lower. Conclusion: The redistribution of fetal blood flow characterized by means of middle cerebral artery dopplervelocimetry is related to perinatal results when some level of placental insufficiency occurs, and does not present association to perinatal outcome when pregnancy shows normal fetal-placental blood flow.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(7):431-438
DOI 10.1590/S0100-72032001000700004
Purpose: to evaluate the association between the presence of diastolic notch in the maternal uterine arteries, and the histopathological changes of the uteroplacental vessels. Methods: transversal study of 144 women with single pregnancy interrupted by cesarean section between 27 and 41 weeks. In this sample, 84 had pregnancies complicated by preeclampsia and the other 60 were normal. In this group, Doppler study of both uterine arteries and placental bed biopsy was performed. Results: of the total of 144 patients, 88 patients (61%) had a biopsy fragment that was considered representative of the placental bed. The diastolic notch was present in 40 patients (70%) of the total of cases with inadequate physiologic alterations and absent in 28 patients (90%) of the total of cases with physiologic alterations (p=0.0000). The Doppler study showed 70% sensitivity, 90% specificity, 44% positive predictive value and 97% negative predictive value. The association between bilateral diastolic notch of uterine arteries and acute atherosis in the placental bed was also significant (24 out of 25 cases -- p=0.000). The Doppler study showed 96% sensitivity, 70% specificity, 26% positive predictive value and 99% negative predictive value, while for arteriolosclerosis its results were 80% sensitivity, 55% specificity, 17% positive predictive value and 96% negative predictive value. Conclusions: the diastolic notch in the maternal uterine is a safe indicator of pathological vessel alteration in the placental bed. The adequate trophoblast migration into the myometrium, revealed by physiologic changes, results in the absence of bilateral diastolic notch of the maternal uterine arteries.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(7):431-438
DOI 10.1590/S0100-72032001000700004
Purpose: to evaluate the association between the presence of diastolic notch in the maternal uterine arteries, and the histopathological changes of the uteroplacental vessels. Methods: transversal study of 144 women with single pregnancy interrupted by cesarean section between 27 and 41 weeks. In this sample, 84 had pregnancies complicated by preeclampsia and the other 60 were normal. In this group, Doppler study of both uterine arteries and placental bed biopsy was performed. Results: of the total of 144 patients, 88 patients (61%) had a biopsy fragment that was considered representative of the placental bed. The diastolic notch was present in 40 patients (70%) of the total of cases with inadequate physiologic alterations and absent in 28 patients (90%) of the total of cases with physiologic alterations (p=0.0000). The Doppler study showed 70% sensitivity, 90% specificity, 44% positive predictive value and 97% negative predictive value. The association between bilateral diastolic notch of uterine arteries and acute atherosis in the placental bed was also significant (24 out of 25 cases -- p=0.000). The Doppler study showed 96% sensitivity, 70% specificity, 26% positive predictive value and 99% negative predictive value, while for arteriolosclerosis its results were 80% sensitivity, 55% specificity, 17% positive predictive value and 96% negative predictive value. Conclusions: the diastolic notch in the maternal uterine is a safe indicator of pathological vessel alteration in the placental bed. The adequate trophoblast migration into the myometrium, revealed by physiologic changes, results in the absence of bilateral diastolic notch of the maternal uterine arteries.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(2):113-120
DOI 10.1590/S0100-72032002000200007
Purpose: to study fetal surveillance examinations in pregnancies complicated by pregestational diabetes mellitus, and to correlate them with large for gestational age (LGA) newborns. Methods: Between March 1999 and June 2001, 46 singleton pregnancies with pregestational diabetes mellitus without fetal anomalies were followed prospectively. From the 28th gestational week on, the following examinations were performed weekly: fetal biophysical profile, amniotic fluid index (AFI), and dopplervelocimetry of umbilical and middle cerebral arteries. The newborns with birthweight above the 90th percentile according to local standard values were characterized as LGA infants. Fisher's exact test and Student's t test were used for statistical analysis. Results: The mean gestational age at delivery was 37.6 weeks and 15 (32.6%) newborns were LGA. LGA fetuses showed significant increase in the AFI mean performed in the 32nd (16.5 cm, p=0.02), 33rd (16.7 cm, p=0.03), 34th (17.0 cm, p=0.02), 35th (17.9 cm, p=0.000), 36th (15.8 cm, p=0.03) and 37th (17.5 cm, p=0.003) weeks. Non-LGA fetuses presented the following mean AFI values: 13.5cm (32nd week), 13.1cm (33th week), 13.4 (34th week), 12.8 (35th week), 12.5 (36th week) and 12.8cm (37th week). AFI values equal to or above 18.0 cm were associated with the occurrence of LGA infants, when detected at the following gestational ages: 34th (60%, p=0.03), 35th (71.4%, p=0.01), 36th (80%, p=0.02) and 37th (66.7%, p=0.04) week. Non-LGA infants presented the following proportion of AFI values equal to or above 18.0 cm: 40.0% (34th week), 28.6% (35th week), 20.0% (36th week), and 33.3% (37th week). Conclusions: abnormal increase in AFI, mainly with values equal to or above 18.0 cm, is related to LGA infants at delivery. The maternal treatment should be adjusted to achieve the best result for maternal-fetal control, according to the AFI values during pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(2):113-120
DOI 10.1590/S0100-72032002000200007
Purpose: to study fetal surveillance examinations in pregnancies complicated by pregestational diabetes mellitus, and to correlate them with large for gestational age (LGA) newborns. Methods: Between March 1999 and June 2001, 46 singleton pregnancies with pregestational diabetes mellitus without fetal anomalies were followed prospectively. From the 28th gestational week on, the following examinations were performed weekly: fetal biophysical profile, amniotic fluid index (AFI), and dopplervelocimetry of umbilical and middle cerebral arteries. The newborns with birthweight above the 90th percentile according to local standard values were characterized as LGA infants. Fisher's exact test and Student's t test were used for statistical analysis. Results: The mean gestational age at delivery was 37.6 weeks and 15 (32.6%) newborns were LGA. LGA fetuses showed significant increase in the AFI mean performed in the 32nd (16.5 cm, p=0.02), 33rd (16.7 cm, p=0.03), 34th (17.0 cm, p=0.02), 35th (17.9 cm, p=0.000), 36th (15.8 cm, p=0.03) and 37th (17.5 cm, p=0.003) weeks. Non-LGA fetuses presented the following mean AFI values: 13.5cm (32nd week), 13.1cm (33th week), 13.4 (34th week), 12.8 (35th week), 12.5 (36th week) and 12.8cm (37th week). AFI values equal to or above 18.0 cm were associated with the occurrence of LGA infants, when detected at the following gestational ages: 34th (60%, p=0.03), 35th (71.4%, p=0.01), 36th (80%, p=0.02) and 37th (66.7%, p=0.04) week. Non-LGA infants presented the following proportion of AFI values equal to or above 18.0 cm: 40.0% (34th week), 28.6% (35th week), 20.0% (36th week), and 33.3% (37th week). Conclusions: abnormal increase in AFI, mainly with values equal to or above 18.0 cm, is related to LGA infants at delivery. The maternal treatment should be adjusted to achieve the best result for maternal-fetal control, according to the AFI values during pregnancy.
