Geç Başlangıçlı Fetal Büyüme Geriliğinde Fetal Femoral Arter Doppler Değerlendirmesi: Vaka Kontrol Çalışması
Year 2024,
Volume: 6 Issue: 1, 12 - 20, 26.02.2024
Nihat Farisoğulları
,
Atakan Tanacan
,
Bedri Sakcak
,
Ramazan Denizli
,
Zahid Ağaoğlu
,
Özgür Kara
,
Dilek Sahin
Abstract
Amaç: Femoral arter ve diğer ultrasonografik Doppler ölçümlerini geç başlangıçlı fetal büyüme geriliği olan fetüsler ile komplike olmayan fetüsler arasında karşılaştırmak.
Gereç ve yöntem: Bu prospektif kohort çalışması geç başlangıçlı fetal gelişme geriliği saptanan 83 çalışma grubu gebe ile benzer gebelik haftasına sahip 85 komplike olmayan kontrol grubu gebe dahil olmak üzere 168 hasta ile gerçekleştirilmiştir. Aynı zamanda yenidoğan yoğun bakım ünitesi gereksinimine göre çalışma grubu ikiye ayrıldı. Gruplar arasında demografik özellikler, obstetrik özellikler, femoral arter ve diğer ultrasonografik doppler ölçümleri ve gebelik sonuçları karşılaştırıldı.
Bulgular: Uterin arter pulsatilite indeksi, umbilikal arter sistolik/diyastolik oranı ve orta serebral arterin pik sistolik hızı çalışma ve kontrol grupları arasında benzerdi. Ancak çalışma grubunda orta serebral arter pulsatilite indeksi anlamlı olarak düşük bulunurken, femoral arter pulsatilite indeksi anlamlı olarak yüksekti (sırasıyla, p<0.001 ve p=0.002). Çalışma grubunda yenidoğan yoğun bakım ünitesi gereksinimine göre iki grup karşılaştırıldığında femoral arter ve diğer doppler ölçümleri benzer izlendi. Tahmini fetal ağırlık, yenidoğan yoğun bakım ünitesi gerektiren grupta istatistiksel olarak daha düşüktü (p=0,033).
Sonuç: Geç başlangıçlı fetal büyüme geriliği olgularında femoral arter pulsatilite indeksi sağlıklı kontrollere göre daha yüksekti. Femoral arterin Doppler incelemesinin olumsuz perinatal sonuçları göstermede etkili olmadığı bulundu.
References
- Lackman F, Capewell V, Gagnon R, Richardson B. Fetal umbilical cord oxygen values and birth to placental weight ratio in relation to size at birth. American journal of obstetrics and gynecology 2001;185(3):674-82.
- Sharma D, Shastri S, Sharma P. Intrauterine Growth Restriction: Antenatal and Postnatal Aspects. Clin Med Insights Pediatr 2016;10:67-83.
- Lees C, Marlow N, Arabin B, et al. Perinatal morbidity and mortality in early‐onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE). Ultrasound in obstetrics & gynecology 2013;42(4):400-8.
- Aviram A, Sherman C, Kingdom J, Zaltz A, Barrett J, Melamed N. Defining early vs late fetal growth restriction by placental pathology. Acta Obstet Gynecol Scand 2019;98(3):365-73.
- Crovetto F, Triunfo S, Crispi F, et al. First‐trimester screening with specific algorithms for early‐and late‐onset fetal growth restriction. Ultrasound in obstetrics & gynecology 2016;48(3):340-8.
- Severi FM, Bocchi C, Visentin A, et al. Uterine and fetal cerebral Doppler predict the outcome of third-trimester small-for-gestational age fetuses with normal umbilical artery Doppler. Ultrasound Obstet Gynecol 2002;19(3):225-8.
- Crovetto F, Crispi F, Scazzocchio E, et al. First-trimester screening for early and late small-for-gestational-age neonates using maternal serum biochemistry, blood pressure and uterine artery Doppler. Ultrasound Obstet Gynecol 2014;43(1):34-40.
- Muijsers GJ, van Huisseling H, Hasaart TH. The effect of maternal hypoxemia on the umbilical and femoral artery blood flow velocity waveforms and the relationship with mean arterial pressure in fetal sheep. Gynecol Obstet Invest 1993;35(1):1-6.
- Iversen NK, Wang T, Baatrup E, Crossley DA, 2nd. The role of nitric oxide in the cardiovascular response to chronic and acute hypoxia in White Leghorn chicken (Gallus domesticus). Acta Physiol (Oxf) 2014;211(2):346-57.
- Manabe A, Hata T, Kitao M. Longitudinal Doppler ultrasonographic assessment of alterations in regional vascular resistance of arteries in normal and growth-retarded fetuses. Gynecol Obstet Invest 1995;39(3):171-9.
- Martins JG, Biggio JR, Abuhamad A. Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction: (Replaces Clinical Guideline Number 3, April 2012). Am J Obstet Gynecol 2020;223(4):B2-b17.
- Hadlock FP, Harrist RB, Martinez-Poyer J. In utero analysis of fetal growth: a sonographic weight standard. Radiology 1991;181(1):129-33.
- Graupner O, Meister M, Lecker L, Carow J, et al. Role of the cerebro-placental-uterine ratio in predicting adverse perinatal outcome in low-risk pregnancies at term. Arch Gynecol Obstet 2022 Aug 30.
- Gordijn SJ, Beune IM, Thilaganathan B, et al. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol 2016;48(3):333-9.
- Savchev S, Figueras F, Cruz-Martinez R, Illa M, Botet F, Gratacos E. Estimated weight centile as a predictor of perinatal outcome in small-for-gestational-age pregnancies with normal fetal and maternal Doppler indices. Ultrasound Obstet Gynecol 2012;39(3):299-303.
- Oros D, Figueras F, Cruz-Martinez R, Meler E, Munmany M, Gratacos E. Longitudinal changes in uterine, umbilical and fetal cerebral Doppler indices in late-onset small-for-gestational age fetuses. Ultrasound Obstet Gynecol 2011;37(2):191-5.
- Figueras F, Gratacós E. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther 2014;36(2):86-98.
- Baschat AA. Planning management and delivery of the growth-restricted fetus. Best Pract Res Clin Obstet Gynaecol 2018;49:53-65.
- Norvilaitė K, Ramašauskaitė D, Bartkevičienė D, Šliachtenko A, Kurmanavičius J. Fetal Tibial Artery Doppler in Late IUGR Fetuses: A Longitudinal Study. Journal of clinical medicine 2023;12(1):82.
- Mari G. Arterial blood flow velocity waveforms of the pelvis and lower extremities in normal and growth-retarded fetuses. Am J Obstet Gynecol 1991;165(1):143-51.
- Martin CB Jr. Normal fetal physiology and behavior, and adaptive responses with hypoxemia. Semin Perinatol 2008 Aug;32(4):239-42.
- Morales-Roselló J, Diaz García-Donato J. Study of fetal femoral and umbilical artery blood flow by Doppler ultrasound throughout pregnancy. Arch Gynecol Obstet 1999;262(3-4):127-31.
- Triunfo S, Parra-Saavedra M, Rodriguez-Sureda V, et al. Angiogenic Factors and Doppler Evaluation in Normally Growing Fetuses at Routine Third-Trimester Scan: Prediction of Subsequent Low Birth Weight. Fetal Diagn Ther 2016;40(1):13-20.
- Unterscheider J, Daly S, Geary MP, et al. Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study. Am J Obstet Gynecol 2013;208(4):290.e1-6.
- Strigini FA, De Luca G, Lencioni G, Scida P, Giusti G, Genazzani AR. Middle cerebral artery velocimetry: different clinical relevance depending on umbilical velocimetry. Obstet Gynecol 1997;90(6):953-7.
- Baschat AA, Gembruch U. The cerebroplacental Doppler ratio revisited. Ultrasound Obstet Gynecol 2003;21(2):124-7.
- Monteith C, Flood K, Pinnamaneni R, et al. An abnormal cerebroplacental ratio (CPR) is predictive of early childhood delayed neurodevelopment in the setting of fetal growth restriction. Am J Obstet Gynecol 2019;221(3):273.e1-.e9.
- Cruz-Martínez R, Figueras F, Hernandez-Andrade E, Oros D, Gratacos E. Fetal brain Doppler to predict cesarean delivery for nonreassuring fetal status in term small-for-gestational-age fetuses. Obstet Gynecol 2011;117(3):618-26.
- Cruz-Martinez R, Figueras F, Hernandez-Andrade E, Puerto B, Gratacós E. Longitudinal brain perfusion changes in near-term small-for-gestational-age fetuses as measured by spectral Doppler indices or by fractional moving blood volume. Am J Obstet Gynecol 2010;203(1):42.e1-6.
- Morales-Roselló J, Buongiorno S, Loscalzo G, Abad García C, Cañada Martínez AJ, Perales Marín A. Does Uterine Doppler Add Information to the Cerebroplacental Ratio for the Prediction of Adverse Perinatal Outcome at the End of Pregnancy? Fetal Diagn Ther 2020;47(1):34-44.
- MacDonald TM, Hui L, Robinson AJ, et al. Cerebral-placental-uterine ratio as novel predictor of late fetal growth restriction: prospective cohort study. Ultrasound Obstet Gynecol 2019;54(3):367-75.
- Yang Z, Lv W, Zhao B, Yao J, Yang Y, Yin Z. Uteroplacental-Cerebral Ratio: A Doppler Parameter for Prognostic Prediction of Late-Onset Fetal Growth Restriction: Single Center Prospective Cohort Study. J Clin Med 2022;12(1).
Fetal Femoral Artery Doppler Evaluation in Late-Onset Fetal Growth Restriction: A Case-Control Study
Year 2024,
Volume: 6 Issue: 1, 12 - 20, 26.02.2024
Nihat Farisoğulları
,
Atakan Tanacan
,
Bedri Sakcak
,
Ramazan Denizli
,
Zahid Ağaoğlu
,
Özgür Kara
,
Dilek Sahin
Abstract
Objective: To compare the femoral artery and other ultrasonographic Doppler measurements between fetuses with late-onset fetal growth restriction and uncomplicated fetuses.
Material and method: This prospective cohort study was conducted with 168 patients, including 83 pregnancies presenting with late-onset fetal growth restriction and 85 uncomplicated control pregnancies at similar gestational weeks. The study group was further divided into two according to the neonatal intensive care unit requirements. Demographic characteristics, obstetric characteristics, femoral artery and other ultrasonographic Doppler measurements, and pregnancy outcomes were compared between the groups.
Results: Uterine artery pulsatility index, umbilical artery systolic/diastolic ratio, and peak systolic velocity of the middle cerebral artery were similar between the study and control groups. However, while the middle cerebral artery pulsatility index was significantly lower in the study group, the femoral artery pulsatility index value was significantly higher (p<0.001 and p=0.002, respectively). When the two subgroups of the study group were compared according to the neonatal intensive care unit requirements, their femoral artery and other Doppler measurements were similar. Estimated fetal weight was statistically lower in the group requiring neonatal intensive care unit (p=0.033).
Conclusion: The femoral artery pulsatility index measurement was higher in the late-onset fetal growth restriction cases than in the healthy controls. The Doppler examination of the femoral artery was not found to be effective in demonstrating adverse perinatal outcomes.
References
- Lackman F, Capewell V, Gagnon R, Richardson B. Fetal umbilical cord oxygen values and birth to placental weight ratio in relation to size at birth. American journal of obstetrics and gynecology 2001;185(3):674-82.
- Sharma D, Shastri S, Sharma P. Intrauterine Growth Restriction: Antenatal and Postnatal Aspects. Clin Med Insights Pediatr 2016;10:67-83.
- Lees C, Marlow N, Arabin B, et al. Perinatal morbidity and mortality in early‐onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE). Ultrasound in obstetrics & gynecology 2013;42(4):400-8.
- Aviram A, Sherman C, Kingdom J, Zaltz A, Barrett J, Melamed N. Defining early vs late fetal growth restriction by placental pathology. Acta Obstet Gynecol Scand 2019;98(3):365-73.
- Crovetto F, Triunfo S, Crispi F, et al. First‐trimester screening with specific algorithms for early‐and late‐onset fetal growth restriction. Ultrasound in obstetrics & gynecology 2016;48(3):340-8.
- Severi FM, Bocchi C, Visentin A, et al. Uterine and fetal cerebral Doppler predict the outcome of third-trimester small-for-gestational age fetuses with normal umbilical artery Doppler. Ultrasound Obstet Gynecol 2002;19(3):225-8.
- Crovetto F, Crispi F, Scazzocchio E, et al. First-trimester screening for early and late small-for-gestational-age neonates using maternal serum biochemistry, blood pressure and uterine artery Doppler. Ultrasound Obstet Gynecol 2014;43(1):34-40.
- Muijsers GJ, van Huisseling H, Hasaart TH. The effect of maternal hypoxemia on the umbilical and femoral artery blood flow velocity waveforms and the relationship with mean arterial pressure in fetal sheep. Gynecol Obstet Invest 1993;35(1):1-6.
- Iversen NK, Wang T, Baatrup E, Crossley DA, 2nd. The role of nitric oxide in the cardiovascular response to chronic and acute hypoxia in White Leghorn chicken (Gallus domesticus). Acta Physiol (Oxf) 2014;211(2):346-57.
- Manabe A, Hata T, Kitao M. Longitudinal Doppler ultrasonographic assessment of alterations in regional vascular resistance of arteries in normal and growth-retarded fetuses. Gynecol Obstet Invest 1995;39(3):171-9.
- Martins JG, Biggio JR, Abuhamad A. Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction: (Replaces Clinical Guideline Number 3, April 2012). Am J Obstet Gynecol 2020;223(4):B2-b17.
- Hadlock FP, Harrist RB, Martinez-Poyer J. In utero analysis of fetal growth: a sonographic weight standard. Radiology 1991;181(1):129-33.
- Graupner O, Meister M, Lecker L, Carow J, et al. Role of the cerebro-placental-uterine ratio in predicting adverse perinatal outcome in low-risk pregnancies at term. Arch Gynecol Obstet 2022 Aug 30.
- Gordijn SJ, Beune IM, Thilaganathan B, et al. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol 2016;48(3):333-9.
- Savchev S, Figueras F, Cruz-Martinez R, Illa M, Botet F, Gratacos E. Estimated weight centile as a predictor of perinatal outcome in small-for-gestational-age pregnancies with normal fetal and maternal Doppler indices. Ultrasound Obstet Gynecol 2012;39(3):299-303.
- Oros D, Figueras F, Cruz-Martinez R, Meler E, Munmany M, Gratacos E. Longitudinal changes in uterine, umbilical and fetal cerebral Doppler indices in late-onset small-for-gestational age fetuses. Ultrasound Obstet Gynecol 2011;37(2):191-5.
- Figueras F, Gratacós E. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther 2014;36(2):86-98.
- Baschat AA. Planning management and delivery of the growth-restricted fetus. Best Pract Res Clin Obstet Gynaecol 2018;49:53-65.
- Norvilaitė K, Ramašauskaitė D, Bartkevičienė D, Šliachtenko A, Kurmanavičius J. Fetal Tibial Artery Doppler in Late IUGR Fetuses: A Longitudinal Study. Journal of clinical medicine 2023;12(1):82.
- Mari G. Arterial blood flow velocity waveforms of the pelvis and lower extremities in normal and growth-retarded fetuses. Am J Obstet Gynecol 1991;165(1):143-51.
- Martin CB Jr. Normal fetal physiology and behavior, and adaptive responses with hypoxemia. Semin Perinatol 2008 Aug;32(4):239-42.
- Morales-Roselló J, Diaz García-Donato J. Study of fetal femoral and umbilical artery blood flow by Doppler ultrasound throughout pregnancy. Arch Gynecol Obstet 1999;262(3-4):127-31.
- Triunfo S, Parra-Saavedra M, Rodriguez-Sureda V, et al. Angiogenic Factors and Doppler Evaluation in Normally Growing Fetuses at Routine Third-Trimester Scan: Prediction of Subsequent Low Birth Weight. Fetal Diagn Ther 2016;40(1):13-20.
- Unterscheider J, Daly S, Geary MP, et al. Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study. Am J Obstet Gynecol 2013;208(4):290.e1-6.
- Strigini FA, De Luca G, Lencioni G, Scida P, Giusti G, Genazzani AR. Middle cerebral artery velocimetry: different clinical relevance depending on umbilical velocimetry. Obstet Gynecol 1997;90(6):953-7.
- Baschat AA, Gembruch U. The cerebroplacental Doppler ratio revisited. Ultrasound Obstet Gynecol 2003;21(2):124-7.
- Monteith C, Flood K, Pinnamaneni R, et al. An abnormal cerebroplacental ratio (CPR) is predictive of early childhood delayed neurodevelopment in the setting of fetal growth restriction. Am J Obstet Gynecol 2019;221(3):273.e1-.e9.
- Cruz-Martínez R, Figueras F, Hernandez-Andrade E, Oros D, Gratacos E. Fetal brain Doppler to predict cesarean delivery for nonreassuring fetal status in term small-for-gestational-age fetuses. Obstet Gynecol 2011;117(3):618-26.
- Cruz-Martinez R, Figueras F, Hernandez-Andrade E, Puerto B, Gratacós E. Longitudinal brain perfusion changes in near-term small-for-gestational-age fetuses as measured by spectral Doppler indices or by fractional moving blood volume. Am J Obstet Gynecol 2010;203(1):42.e1-6.
- Morales-Roselló J, Buongiorno S, Loscalzo G, Abad García C, Cañada Martínez AJ, Perales Marín A. Does Uterine Doppler Add Information to the Cerebroplacental Ratio for the Prediction of Adverse Perinatal Outcome at the End of Pregnancy? Fetal Diagn Ther 2020;47(1):34-44.
- MacDonald TM, Hui L, Robinson AJ, et al. Cerebral-placental-uterine ratio as novel predictor of late fetal growth restriction: prospective cohort study. Ultrasound Obstet Gynecol 2019;54(3):367-75.
- Yang Z, Lv W, Zhao B, Yao J, Yang Y, Yin Z. Uteroplacental-Cerebral Ratio: A Doppler Parameter for Prognostic Prediction of Late-Onset Fetal Growth Restriction: Single Center Prospective Cohort Study. J Clin Med 2022;12(1).