11-13+6 GEBELİK HAFTALARI ARASINDA FETAL BAZİLER ARTER DOPPLER ÖLÇÜMLERİNİN UYGULANABİLİRLİĞİ VE TEKRARLANABİLİRLİĞİ ÜZERİNE BİR ÇALIŞMA

Yıl 2023, Cilt: 6 Sayı: 1, 10 - 16, 28.02.2023

Tuğba Saraç Sivrikoz , Selen Gürsoy Erzincan , Gürcan Türkyılmaz , Nihat Demirkol , Recep Has , İbrahim Kalelioğlu

https://doi.org/10.26650/JARHS2023-1202942

Öz

Amaç: Fetal baziler arter Doppler (BA-D) ölçümleri, erken fetal anemi tahmini için ilk trimesterde orta serebral arter Doppleri’ne daha kolay bir alternatif olabilir. Amacımız, ilk trimesterde BA-D’nin fizibilitesini test etmek ve referans aralıklarını oluşturmaktır. Gereç ve Yöntem: Çalışma retrospektif olarak planlanmış olup, ilk üç ayda trans abdominal Doppler ultrasonda baş-popo mesafesi (BPM) 45 ile 81 mm arasında ölçülen 145 tekil gebelik dahil edildi. BA midsagittal düzlemde görüntülenerek, puls Doppler beyin sapının ön ekojenik hattının hemen kaudaline yerleştirilmiş ve insonasyon açısı 30°’nin altında tutulmuştur. Pulsatilite indeksi (PI) ve pik sistolik hız (PSH) ölçüldü. Bulgular: 138 fetüs kriterlere uygun idi. Ortalama BPM 60.5±10,6 mm (aralık:45-81 mm), ortalama ense saydamlığı (ES) 1.51±0.46 mm’di. PI ve PSH; gebelik yaşı, BPM, ES, biparietal çap ile değişiklik göstermiş, her değişken için regresyon modelleri oluşturulmuştur (p<0.05). Her gebelik haftasında BA PI ve PSH Doppler ölçümleri için 5.50. ve 95. persentiller belirlendi. BA PI ve PSH ölçümleri için korelasyon katsayısı sırasıyla 0.792 (%95 GA=0.661-0.876; p<0.01) ve 0.457 (%95 GA=0.208-0.650; p<0.01) idi. Sonuç: BA PI ve PSV değerleri sağlıklı fetüsler birinci trimester sonografisi sırasında belirlenmiştir. Gözlemci içi tekrarlanabilirlik BA için kabul edilebilir olup erken fetal anemi tanısında kullanılması için yeni çalışmalarla desteklenmelidir.

Anahtar Kelimeler

Baziler arter, Doppler ultrason, ilk üçay sonografisi, piksistolik velosite, pulsatilite indeksi

Destekleyen Kurum

Bulunmuyor

Proje Numarası

Bulunmuyor

Teşekkür

Bulunmuyor

A STUDY ON THE FEASIBILITY AND REPEATABILITY OF FETAL BASILAR ARTERY DOPPLER MEASUREMENTS BETWEEN 11 AND 13+6 WEEKS OF GESTATION

Öz

Objective: The fetal basilary artery Doppler (BA-D) measurements could be an easier alternative method to middle cerebral artery Doppler at the first trimester for the prediction of early fetal anemia. Our aim is to test its feasibility and construct reference ranges of BA-D at the first trimester Materials and Methods: The study was analyzed retrospectively by using a transabdominal Doppler ultrasound which measured the fetuses at a crown-rump length (CRL) ranging from 45 to 81mm in 145 singleton pregnancies at the first trimester. The BA was imaged in the midsagittal plane, the pulse Doppler was placed just caudal to the anterior echogenic line of the brainstem, and the insonation angle was kept below 30°. The pulsatility index (PI) and peak systolic velocity (PSV) were also measured. Results: A total of 138 out of the 145 fetuses were included. The mean CRL was 60.5±10.6 mm (range: 45-81mm). The mean nuchal translucency (NT) was 1.51±0.46 mm. The PI and PSV varied significantly, with the gestational age, CRL, NT, biparietal diameter (p < 0.05), and regression models being constructed for each variable. The 5th, 50th, and 95th percentiles for the BA PI and PSV Doppler measurements at each gestational week were determined. Intraclass correlation coefficient for the BA PI and PSV measurements were 0.792 (95% CI=0.661-0.876; p<0.01) and 0.457 (95% CI=0.208-0.650; p<0.01), respectively. Conclusion: The BA PI and PSV values were determined during the first trimester sonography of healthy fetuses. Intraobserver reproducibility is acceptable for BA and should be supported by new studies for its use in the diagnosis of early fetal anemia.

Anahtar Kelimeler

Basilar artery, Doppler ultrasound, first trimester ultrasound, peak systolic velocity, pulsatility index

Proje Numarası

Bulunmuyor

Kaynakça

• 1. Figueroa-Diesel H, Hernandez-Andrade E, Acosta-Rojas R, Cabero L, Gratacos E. Doppler changes in the main fetal brain arteries at different stages of hemodynamic adaptation in severe intrauterine growth restriction. Ultrasound Obstet Gynecol 2007;30(3):297-302. google scholar
• 2. Vollgraff Heidweiller-Schreurs CA, De Boer MA, Heymans MW, Schoonmade L, Bossuyt PMM, Mol BWJ, et al. Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcome: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018;51(3):313-22. google scholar
• 3. Baschat AA, Gembruch U, Reiss I, Gortner L, Weiner CP, Harman CR. Relationship betweenarterial and venous Doppler and perinatal outcome in fetal growth restriction. Ultrasound Obstet Gynecol 2000;16(5):407-13. google scholar
• 4. Prefumo F, Fichera A, Fratelli N, Sartori E. Fetal anemia: Diagnosis and management. Best Pract Res Clin Obstet Gynaecol 2019;58:2-14. google scholar
• 5. Abbasi N, Johnson JA, Ryan G. Fetal anemia. Ultrasound Obstet Gynecol 2017;50(2):145-53. google scholar
• 6. Dubiel M, Gunnarsson GO, Gudmundsson S. Blood redistribution in the fetal brain during chronic hypoxia. Ultrasound Obstet Gynecol 2002;20(2):117-21. google scholar
• 7. Kempe A, Rösing B, Berg C, Kamil D, Heep A, Gembruch U, et al. First-trimester treatment of fetal anemia secondary to parvovirus B19 infection. Ultrasound Obstet Gynecol 2007;29(2):226-8. google scholar
• 8. Benavides-Serralde JA, Hernandez-Andrade E, Figueroa-Diesel H, Oros D, Feria LA, Scheier M, et al. Reference values for Doppler parameters of anterior cerebral artery throughout gestation. Gynecol Obstet Invest 2010;69(1):33-9. google scholar
• 9. Benavides-Serralde JA, Hernandez-Andrade E, Cruz-Martinez R, Cruz-Lemini M, Scheier M, Figueras F, et al. Doppler evaluation of the posterior cerebral artery in normally grown and growth-restricted fetuses. Prenat Diagn 2014;34(2):115-20. google scholar
• 10. Ciobanu A, Wright A, Syngelaki A, Wright D, Akolekar R, Nicolaides KH. Fetal Medicine Foundation reference ranges for umbilical artery and middle cerebral artery pulsatility index and cerebroplacental ratio. Ultrasound Obstet Gynecol 2019;53(4):465-72. google scholar
• 11. Abu-Rustum RS, Ziade MF, Ghosn I, Helou N. Normogram of middle cerebral artery Doppler indexes and cerebroplacental ratio at 12 to 14 weeks in an unselected pregnancy population. Am J Perinatol 2019;36(2):155-60. google scholar
• 12. Tongsong T, Wanapirak C, Sirichotiyakul S, Tongprasert F, Srisupundit K. Middle cerebral artery peak systolic velocity of healthy fetuses in the first half of pregnancy. J Ultrasound Med 2007;26(8):1013-7. google scholar
• 13. Rujiwetpongstorn J, Phupong V. Doppler waveform indices of middle cerebral artery of normal fetuses in the first half of pregnancy in the Thai population. Arch Gynecol Obstet 2007;276(4):351-4. google scholar
• 14. Chaoui R, Benoit B, Mitkowska-Wozniak H, HelingKS, Nicolaides KH. Assessment of intracranial translucency (IT) in the detection of spina bifida at 11-13 week scan. Ultrasound Obstet Gynecol 2009;34(3):249-52. google scholar
• 15. Official Statement AIUM. As Low As Reasonably Achievable (ALARA) Principle. Approved 3/16/2008; Reapproved 4/2/2014. Available at: http://www.aium.org/officialStatements/39.Accessed June 5, 2018. google scholar
• 16. Official Statement AIUM. Statement on the Safe Use of Doppler Ultrasound During 11-14 week scans (or earlier in pregnancy). Approved 4/18/2011; Revised 3/21/2016, 10/30/2016. Available at: http://www.aium.org/officialStatements/42.Accessed June 5, 2018. google scholar
• 17. Salvesen K, Lees C, Abramowicz J, Brezinka C, Ter Haar G, Marsal K. ISUOG statement on the safe use of Doppler in the 11 to 13+6-week fetal ultrasound examination. Ultrasound Obstet Gynecol 2011;37(6):628. google scholar
• 18. Bellera CA, Hanley JA. A method is presented to plan the required sample size when estimating regression-based reference limits. J Clin Epidemiol 2007;60(6):610-5. google scholar
• 19. Pooh RK, Aono T. Transvaginal power Doppler angiography of the fetal brain. Ultrasound Obstet Gynecol 1996;8(6):417-21. google scholar
• 20. Danon E, Weisz B, Achiron R, Pretorius DH, Weissmann-Brenner A, Gindes L. Three-dimensional ultrasonographic depiction of fetal brain blood vessels. Prenat Diagn 2016;36(5):407-17. google scholar
• 21. Qureshi AI, Miran MS, Degenhardt J, Axt-Fliedner R, Kohl T. Transabdominal insonation of fetal basilar artery: a feasibility study. J Neuroimaging 2016;26(2):180-3. google scholar
• 22. Mari G, Adrignolo A, Abuhamad AZ, Pirhonen J, Jones DC, Ludomirsky A, et al. Diagnosis of fetal anemia with Doppler ultrasound in the pregnancy complicated by maternal blood group immunization. Ultrasound Obstet Gynecol 1995;5(6):400-5. google scholar