BACKGROUND: Doppler velocimetry studies of placental and fetal circulation can provide important information regarding fetal well­being providing an opportunity to improve fetal outcome. The present study was undertaken to evaluate the role of middle cerebral to umbilical artery pulsatility index ratio (MCA/UA PI Ratio) as a predictor of perinatal outcome in hypertensive pregnant patients admitted from January 2009- December 2011 at the De La Salle-University Medical Center
OBJECTIVES: To correlate the neonatal outcomes of hypertensive pregnant women at 28-34 weeks AOG with the middle cerebral artery and umbilical artery pulsalitility index ratio.
STUDY DESIGN: A retrospective cohort was done on records of patients with hypertension who delivered from January 2009 - Decem­ber 2011. Doppler ultrasound results of said patients that were available at the OB-GYN ultrasound section were recorded and the MCA/UA PI Ratio computed. Doppler results were then compared to neonatal outcomes
RESULTS: Results of the study shows that 10 out of the 17 hypertensive patients with decreased MCA/UA PI Ratio developed Intrau­terine growth restriction. 62.5% of those patients who had normal MCA/UA PI Ratio results delivered term, while 87.5% of those who had decreased MCA/UA PI Ratio delivered preterm (P <0.002). However results of the MCA/UA PI ratio has no association on APGAR scores at 1 and 3 minutes.
CONCLUSION: Decreased MCA/UA PI Ratio results have an association on the development of adverse neonatal outcomes in hyper­tensive pregnant women.

 

 

Human ; Male ; Female ; Pregnancy ; Umbilical Arteries ; Middle Cerebral Artery ; Ultrasonography, Prenatal ; Fetus ; Placenta ; Hypertension ; Ultrasonography, Doppler

Noninvasive techniques of antenatal detection of the fetal development and well-being such as biophysical profile, non-stress and stress remain major challenges in modern obstetric practice. To obtain and analyze umbilical artery velocity waveform by pulsed-wave doppler ultrasound, a total of 160 determinations were carried out on 157 normal pregnant women between 16th to 41st week gestation. The ratio of peak systolic to end-diastolic flow velocity (S/D ratio), pulsatility index and resistance index were measured as indices of the resistance in feto-placental circulation. The results were as follows: As gestation advances, the mean values for peak systolic and end-diastolic velocities raised progressively. As gestation advances, the mean values for the S/D ratio declined progressively, exhibiting high diastolic flow velocity caused by low resistance. Pulsatility index, and resistance index were also declined progressively, as gestation advances. The analysis of umbilical artery blood flow velocity waveforms provides a new noninvasive technique to evaluate fetal development and well-being, and may be expected a reliable method for assessment of fetal life.
Blood Flow Velocity* ; Female ; Fetal Development ; Humans ; Methods ; Pregnancy* ; Pregnant Women ; Ultrasonography ; Umbilical Arteries*

PURPOSE: Incorrect positioning of umbilical artery catheter (UAC) results in an increased incidence of complications and erroneous pressure measurements. We radiologically localized major aortic branches and calculated the length of catheter from umbilicus to celiac artery, renal artery and aortic bifurcation for optimal positioning of UAC. To determine the neonatal body measurement that best predicts optimal UAC lengths, we studied three commonly used parameters-birth weight (BW), total body length (TBL) and shoulder-umbilicus length (SUL). METHODS: Fifty one high type of UAC were routinely identified by sonographic scanning from the epigastrium in longitudinal projection and 42 low type of UAC from the flank in coronal projection. The distances from the catheter tip to the celiac artery, the renal artery and to the aortic bifurcation were measured by electronic calipers and were compared with the length of the catheter from umbilicus to the tip on the chest anteroposterior radiograph. RESULTS: The celiac arteries originated from T10-T12, renal arteries Ll-L2, and aortic bifurcations L3-L5. There was positive correlation between BW, TBL or SUL and the length of catheter to the celiac artery (r2=0.476, 0.749 or 0.753), to the renal artery (r2= 0.785, 0.847 or 0.720), and to the aortic bifurcation (r2=0.714, 0.809 or 0.747). CONCLUSION: Although any one of the three parameters can be used clinically, we prefer the TBL and SUL parameters for its reliability and usefulness in emergency settings. The use of a new distribution plot of origins of major branches and regression equations for calculation of the lengths may help deciding the optimal position of UAC.
Catheters* ; Celiac Artery ; Emergencies ; Humans ; Incidence ; Infant, Newborn* ; Renal Artery ; Thorax ; Ultrasonography* ; Umbilical Arteries* ; Umbilicus

OBJECTIVE: The objective of this study was to determine the relationship between the fetal doppler flow velocimetry and birth weight in low risk pregnancy population. METHODS: From December 1995 to May 1996, We prospectively performed doppler study in 254 uncomplicated, term pregnant women, who visited Pohang Hospital, Dongguk University. Using pulsed color doppler, we measured umbilical artery RI, middle cerebral artery RI and middle cerebral-umbilical artery RI ratio within one week before delivery. RESULTS: The result was that low birth weight group (below 2500gm) had very significant lationship with umbilical artery RI(P<0.01), middle cerebral artery RI(P<0.05) and middle cerebral-umbilical artery RI ratio(P<0.05), but there was no significant relationship in these blood flow indices between normal birth weight group (2501gm- 3999gm) and macrosomia group (above 4000gm). CONCLUSIONS: We concluded that application of doppler ultrasonopaphy in the assessment of fetal weight is somewhat helpful for identification of low birth weight, not for macrosomia.
Arteries ; Birth Weight ; Female ; Fetal Weight* ; Gyeongsangbuk-do ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Middle Cerebral Artery ; Pregnancy ; Pregnant Women ; Prospective Studies ; Rheology ; Ultrasonography* ; Umbilical Arteries

OBJECTIVE: To study the effects of maternal epidural anaesthesia on the maternal uterine circulation and the fetal umbilical placental circulation by using Doppler ultrasound techniques. STUDY DESIGN: Twenty-seven patients delivered by elective caesarean section under lumbar epidural anaesthesia were studied. All had a normal pregnancy with no indication of fetal compromise and no indication of maternal disease. Each patient received a 1 litre intravenous crystalloid infusion over 20~30 minutes before an epidural bupivacaine injection. The uterine and fetal umbilical artery velocity waveforms were recorded. And then intravenous cannula and an epidural catheter were inserted. The local anaesthetic agent were injected through the epidural catheter(0.5% bupivacaine 10ml, 20% lidocaine 10 ml). At achieve sensory blockade to the T-4 level after the injection of the anaesthetic agent, the uterine and fetal placental circulation flow velocity-time waveforms were again recorded by using Doppler ultrasound(Multigon 500A, 4 MHz). Significance was tested by means of the paired student t-test. RESULTS: 1. Significant differences were observed between the two groups(Before anaesthesia, S/D ratio of fetal umbilical artery was 2.48+/-0.50. Following anaesthesia, S/D ratio of fetal unbilical artery was 2.24+/-0.40, p < 0.005). 2. Significant differences were observed between the two groups(Before anaesthesia, S/D ratio of maternal uterine artery was 2.29+/-0.41. Following anaesthesia, S/D ratio of maternal uterine artery was 1.95+/-0.25, p < 0.001). CONCLUSION: This study suggests a beneficial fetal effect from the improved maternal uterine perfusion after epidural anesthesia.
Anesthesia, Epidural ; Arteries ; Blood Flow Velocity* ; Bupivacaine ; Catheters ; Cesarean Section* ; Female ; Humans ; Lidocaine ; Perfusion ; Placental Circulation ; Pregnancy ; Ultrasonography ; Umbilical Arteries* ; Uterine Artery

OBJECTIVE: To evaluate pattern of associated structural anomalies, abnormal karyotypes and perinatal outcomes of fetuses with prenatally diagnosed single umbilical artery and to evaluate the relation of absent side of a single umbilical artery in association with anomalies and abnormal karyotypes. MATERIALS AND METHODS: 30 fetuses with a single umbilical artery were detected by prenatal ultrasound examnination between March 1998 and June 2001 at Eul-Ji University Hospital. All medical records were reviewed for maternal demographics, associated anomalies, karyotypic analysis, pregnancy complications, and neonatal outcome. RESULTS: Of the 30 fetuses, 11 (36.7%) were terminated because of severe anomalies and 2 (6.7%) experienced neonatal death. 17 fetuses (56.7%) had an associated structural anomaly. The structural anomalies found in association with single umbilical artery were cardiovascularac system (9 cases, 30.0%), urogenital system (6 cases, 20.0%), central nervous system (5 case, 16.7%) and ectopia cordis (1 case, 5.9%) and 7 cases (20%) among these had multiple malformations. Karyotype analysis was availabe in 25 cases and 5 (20%) of these were chromosomally abnormal. All of the karyotypically abnormal fetuses had a structural defect diagnosed on prenatal ultrasound examination in addition to the single umbilical artery. Of 13 fetuses without any associated structural or chromosomal anomalies, 3 (23.1%) demonstrated growth restriction. Of the 26 cases identified the absent side of a single umbilical artery, the right umbilical artery was absent in 13 (50%) and the left in 13 (50%) fetuses. The frequency with associated structural and chromosomal anomalies was equal on right (53.8%; 15.4%) and left (69.2%; 15.4%) sides. CONCLUSION: Scanning the umbilical cord should be one of the essential parts of 2 nd trimester ultrasonographic examination. When single umbilical artery is detected, a detailed ultrasonographic examnination including fetal echocardiography and fetal karyotyping should be recommended for search of associated structural and chromosomal abnormalities. In cases where single umbilical artery is an isolated finding on prenatal ultrasound, careful attention to fetal growth is necessary.
Abnormal Karyotype ; Central Nervous System ; Chromosome Aberrations ; Demography ; Echocardiography ; Ectopia Cordis ; Fetal Development ; Fetus* ; Karyotype ; Karyotyping ; Medical Records ; Pregnancy Complications ; Single Umbilical Artery* ; Ultrasonography ; Umbilical Arteries ; Umbilical Cord ; Urogenital System

OBJECTIVE: To evaluate pattern of associated structural anomalies, abnormal karyotypes and perinatal outcomes of fetuses with prenatally diagnosed single umbilical artery and to evaluate the relation of absent side of a single umbilical artery in association with anomalies and abnormal karyotypes. MATERIALS AND METHODS: 30 fetuses with a single umbilical artery were detected by prenatal ultrasound examnination between March 1998 and June 2001 at Eul-Ji University Hospital. All medical records were reviewed for maternal demographics, associated anomalies, karyotypic analysis, pregnancy complications, and neonatal outcome. RESULTS: Of the 30 fetuses, 11 (36.7%) were terminated because of severe anomalies and 2 (6.7%) experienced neonatal death. 17 fetuses (56.7%) had an associated structural anomaly. The structural anomalies found in association with single umbilical artery were cardiovascularac system (9 cases, 30.0%), urogenital system (6 cases, 20.0%), central nervous system (5 case, 16.7%) and ectopia cordis (1 case, 5.9%) and 7 cases (20%) among these had multiple malformations. Karyotype analysis was availabe in 25 cases and 5 (20%) of these were chromosomally abnormal. All of the karyotypically abnormal fetuses had a structural defect diagnosed on prenatal ultrasound examination in addition to the single umbilical artery. Of 13 fetuses without any associated structural or chromosomal anomalies, 3 (23.1%) demonstrated growth restriction. Of the 26 cases identified the absent side of a single umbilical artery, the right umbilical artery was absent in 13 (50%) and the left in 13 (50%) fetuses. The frequency with associated structural and chromosomal anomalies was equal on right (53.8%; 15.4%) and left (69.2%; 15.4%) sides. CONCLUSION: Scanning the umbilical cord should be one of the essential parts of 2 nd trimester ultrasonographic examination. When single umbilical artery is detected, a detailed ultrasonographic examnination including fetal echocardiography and fetal karyotyping should be recommended for search of associated structural and chromosomal abnormalities. In cases where single umbilical artery is an isolated finding on prenatal ultrasound, careful attention to fetal growth is necessary.
Abnormal Karyotype ; Central Nervous System ; Chromosome Aberrations ; Demography ; Echocardiography ; Ectopia Cordis ; Fetal Development ; Fetus* ; Karyotype ; Karyotyping ; Medical Records ; Pregnancy Complications ; Single Umbilical Artery* ; Ultrasonography ; Umbilical Arteries ; Umbilical Cord ; Urogenital System

PURPOSE: To evaluate the clinical findings and ultrasonographic findings of aortic thrombosis which developed after umblical artery catheterization in neonates. METHODS: We retrospectively evaluated clnical records and ultrasonographic findings in five cases of aortic thrombosis, which developed after umblical artery catheterization. Four were premature newborns, and one was a term neonate but small for gestational age. Three were male infants. The mean age was 29.8 days (15-71 days) and the duration of umblical artery catheterization was 16.4 days (7-31 days). The gestational age of 5 cases was between 26 and 38 weeks (mean 33 weeks) and birth weight was between 930 and 2,600 g (mean 1,950 g). All cases were diagnosed by ultrasonography only, and in 2 cases color Doppler ultrasonography was performed additionally. RESULTS: There were several associated conditions including hypothermia (n=2), perinatal asphyxia (n=2), respiratory distress syndrome (n=5), and neonatal infection (n=5). The clinical manifestations of 5 cases were hypertension (n=4), thrombocytopenia (n=4), hematuria (n=2), renal failure (n=l), and congestive heart failure (n=l). In all five cases, ultrasonography showed hyperechoic thrombus with partial occulsion of aorta. The size of thrombi varied 1.2-4x 4-25 mm. All thrombi were located around the origin site of renal artery. CONCLUSION: Aortic thrombosis, one of the complications of umblical artery catheterization can easily be diagnosed by ultrasonography, so ultrasonography would be needed as a screening study in neonate with umblical artery catheterization.
Aorta ; Arteries ; Asphyxia ; Birth Weight ; Catheterization* ; Catheters* ; Gestational Age ; Heart Failure ; Hematuria ; Humans ; Hypertension ; Hypothermia ; Infant ; Infant, Newborn* ; Male ; Mass Screening ; Prognosis* ; Renal Artery ; Renal Insufficiency ; Retrospective Studies ; Thalamus* ; Thrombocytopenia ; Thrombosis* ; Ultrasonography ; Ultrasonography, Doppler, Color ; Umbilical Arteries*

BACKGROUND: Doppler ultrasound has recently been used to assess change in blood velocity in the uterine and umbilical arteries. Alterations in the ratio of systolic to diastolic velocity (= S/D ratio) are believed to reflect changes in placental vascular resistance. We have used this technique to assess potential beneficial or detrimental effects of epidural anesthesia on blood flow to the placenta. METHODS: Continuous wave Doppler ultrasound was used to measure the S/D ratio in the uterine and umbilical arteries of 40 patients undergoing epidural anesthesia prior to elective cesarean section. Left uterine displacement was employed throughout. Doppler ultrasound obtained at the level of umbilical artery and uterine artery. Prior to induction of anesthesia each patient received 800~1,000 ml of lactated Ringer's solution within 20~30 minutes. For epidural anesthesia 2% lidocaine 10 ml and 0.5% bupivacaine 10 ml were used. An upper level of sensory anesthesia to at least T10 was confirmed before umbilical and uterine artery waveform measurement. RESULTS: Epidural anesthesia was followed by a reduction in umbilical artery systolic : diastolic ratio from 2.48+/-0.5 to 2.24+/-0.40 (p<0.05) and in uterine artery systolic : diastolic ratio from 2.29+/-0.41 to 1.96+/- 0.25 (p<0.05). CONCLUSIONS: Epidural anesthesia for cesarean section resulted in a significant decrease in the maternal uterine artery S/D ratio and fetal umbilical artery S/D ratio. This study suggests beneficial fetal effect from the improved maternal uterine perfusion after epidural anesthesia.
Anesthesia ; Anesthesia, Epidural* ; Blood Flow Velocity* ; Bupivacaine ; Cesarean Section* ; Female ; Humans ; Lidocaine ; Perfusion ; Placenta ; Pregnancy ; Ultrasonography ; Umbilical Arteries ; Uterine Artery ; Vascular Resistance

OBJECTIVES: Early diagnosis of intrauterine growth retardation is important to ensure optimal monitoring and delivery with the introduction of real-time and Doppler ultrasound systems, a noninvasive method of measuring human fetal blood flow has become available. The aim of this study is to compare blood flow velocity waveforms at the fetal descending aorta and umbilical artery in normal and in patients with pregnancy induced hypertension. METHODS: Using a combination of linear array real-time and pulsed Doppler ultrasound, blood flow velocity measurements were carried out at the fetal descending aorta and umbilical artery in 35 normal pregnancies and 18 cases of pregnancy induced hypertensive patients. RESULTS: The mean systolic/diastolic ratio of umbilical artery and aorta was significantly higher in PIH patients than in normal pregnancies(3.8 +/- 0.81 versus 2.97 +/- 0.52, p<0.05) and to predict perinatal morbidity, umbilical velocimetry is more sensitive than that of descending thoracic aorta. CONCLUSION: This study suggests that umbilical artery velocimetry could be used as a marker to predict adverse perinatal outcome.
Aorta ; Aorta, Thoracic* ; Blood Flow Velocity ; Early Diagnosis ; Female ; Fetal Blood ; Fetal Growth Retardation ; Humans ; Hypertension, Pregnancy-Induced ; Pregnancy ; Rheology* ; Ultrasonography ; Umbilical Arteries