Comparision of Doppler Indices and Cord Blood PH Parameters Among Intrauterine Growth Restricted Fetuses
Öz
Objectives: Assessment
of pregnancy outcomes among intrauterine growth restricted fetuses with Doppler
indices and cord blood gases
Methods: This study
was conducted in May 2014
and January 2015. A total of 32 cases who had intrauterine growth restricted
fetuses were included in this study.
Cases were grouped as normal flow in the umblical artery (n=17) and
absent or reversed end-diastolic flow in the umbilical artery (11 and 4 cases
respectively). In addition to these cases, 3 cases had reversed a waveform in
ductus venosus.
Results:
There
was no neonatal mortality among the cases had normal flow in the umblical
artery. However, mortality rate was %40 (n=6) among the cases had absent or reversed end-diastolic flow. The mean birth weights were 2118gr in the normal group and 968gr in
the abnormal umblical artery Doppler group (p:0.001). The mean Apgar score at 5
minutes was higher in the normal flow group (7,65) than the abnormal umblical
artery Doppler group (6,27) and this difference was statistically significant
(p:0.001). The neonatal intensive care admissions were significantly increased
in the abnormal group. The mean durations of hospitalization were 6,58 days in
normal group and 39,93 days in abnormal group. The mean umbilical arterial pH
and base excess were significantly higher in the normal group (p:0.016,
p:0.004). The mean umblical arterial pH of normal group and abnormal group were
7,33 and 7,24 respectively.
Conclusion: There is a strong relationship
between pregnancy outcome in IUGR fetuses and abnormal uterine artery doppler
waveform (absent or reversed) and ductus venosus waveform. Furthermore, Doppler
examination can be safely used to management of these fetuses and to determine
delivery time. Also, delivery of IUGR fetuses before detection of absent a wave in the ductus venosus should be
considered.
Anahtar Kelimeler
Kaynakça
- 1- Jacobsson B, Ahlin K, Francis A ,et al : Cerebral palsy and restricted growth status at birth : Population-based case-control study. BJOG 115:1250,2008
- 2-Wu YW, Croen LA , Shah SJ ,et al : Cerebral palsy in term infants. Pediatrics 118:690,2006
- 3-Pardi G, Cetin I : Human fetal growht and organ development: 50 years of discovers . Am J Obstet Gynecol 2006;194:1088
- 4- The American College of Obstetricians and Gynecologists. Intrauterine Growth Restriction. ACOG Practice Bulletin 12. Washington, DC: ACOG; 2000
- 5. Kiserud T. Hemodynamics of the ductus venosus. Eur J Obstet Gynecol Reprod Biol 1999; 84: 139-47
- 6. Belloti M, Pennati G, Pardi G, Fumero R. Dilatation of the ductus venosus in human fetuses: Ultrasonographic evidence and mathematical modeling. Am J Physiol 1998; 275: 1759-67
- 7. Rizzo G, Capponi A, Talone PE, Arduini D, Romanini C. Doppler indices from inferior vena cava and ductus veno-sus in predicting pH and oxygen tension in umbilical blood at cordocentesis in growth retarded fetuses. Ultrasound Obstet Gynecol 1996;7:401-10
- 8- Hecher K, Snijders R, Campbell S, Nicolaides K. Fetal venous, intracardiac, and arterial blood flow measurements in intrauterine growth retardation: relationship with fetal blood gases. Am J Obstet Gynecol 1995; 173: 10-5
- 9- Rizzo G, Capponi A, Arduini D, Romanini C. Ductus veno-sus velocity waveforms in appropriate and small for gesta-tional age fetuses. Early Hum Dev 1994; 39: 15-267
- 10-Baschat AA, Gembruch U, Harman CR. The sequence of changes in Doppler and biophysical parameters as severe fetal growth restriction worsens. Ultrasound Obstet Gyne-col 2001; 18: 571-7
- 11. Hecher K, Bilardo CM, Stigter RH, Ville Y, Hackelôer BJ, Kok HJ. Monitoring of fetuses with intrauterine growth restriction: a longitudinal study. Ultrasound Obstet Gynecol 2001; 18: 564-70
- 12. Hofstaetter C, Dubiel M, Gudmundsson S. Two types of umbilical venous pulsations and outcome of high-risk pregnancy. Early Hum Dev 2001; 61: 111-7
- 13. Müller T, Nanan R, Rehn M, Kristen P, Dietl J. Arterial and ductus venosus Doppler in fetuses with absent or reverse end-diastolic flow in the umbilical artery: correlation with short-term perinatal outcome. Acta Obstet Gynecol Scand 2002; 81: 860-6
- 14. Ertan AK, He JP, Tanriverdi HA, Hendrik HJ, Limbach H, Schmidt W. Comparison of Perinatal Outcome in Fetuses with Reverse or Absent Enddiastolic Flow in the Umbilical Artery / Fetal Descending Aorta. J Perinat Med 2003;31:307-12
- 15. Valcamonico A, Danti L, Frusca T, et al. Absent end-di-astolic velocity in umbilical artery: risk of neonatal morbidity and brain damage. Am J Obstet Gynecol 1994; 170: 796-801
- 16. Alfirevic Z, Neilson JP. Doppler ultrasonography in high-risk pregnancies: systematic review with meta-analysis. Am J Obstet Gynecol 1995;172:1379-87
- 17. Baschat AA, Gembruch U, Viscardi RM, Gortner L, Har-man CR. Antenatal prediction of intraventricular hemorrhage in fetal growth restriction: what is the role of Doppler? Ultrasound Obstet Gynecol 2002;19:334-9
- 18. Ozyuncu O, Fetal arterial and venous Doppler in growth restricted fetuses for the prediction of perinatal complications Turk J pediatri 2010: 52;384-392
- 19. O.M.Turan Duration of persistent abnormal ductus venosus flow and its impact on perinatal outcome in fetal growth restriction ultrasound obstet gynecol 2011;38:298-302
- 20.Cosmi E, Ambrosini G, D’Antoro D, Saccardi C, Mari G. Doppler, cardiotocography, and biophysical profile changes in growth - restricted fetuses. Obstet Gynecol 2005; 106: 1240-45.
- 21.Muller T, Nanan R, Rehn M, Kristen P, Dietl J. Arterial and ductus venosus Doppler in fetuses with absent or reverse end-diastolic flow in the umbilical artery: correlation with short-term perinatal outcome. Acta Obstet Gynecol Scand 2002; 81: 860-6
- 22. Bonatz G, Schulz V, Weisner D, Jonat W. Fetal heart rate (FHR) pathology in labor related to preceeding Doppler sonographic results of the umbilical artery and fetal aorta in appropriate and small for gestational age babies. A longitudinal analysis. J Perinat Med 1997; 25: 440-6
- 23. Arabin B, Siebert M, Jimenez E, Saling E. Obstetrical characteristics of a loss of end- diastolic velocities in the fetal aorta and/or umbilical artery using Doppler ultrasound. Gynecol Obstet Invest 1988;25:173-80
- 24. Divon MY, Ferber A. Doppler evaluation of the fetus. Clin Obstet Gynecol 2002;45:1015-25
- 25. Strigini FA, De Luca G, Lencioni G, Scida P, Giusti G, Genazzani AR. Middle cerebral artery velocimetry: different clinical relevance depending on umbilical veloci- metry. Obstet Gynecol 1997;90:953-7
- 26.Hofstaetter C, Gudmundsson S, Hansmann. Venous Dopp-ler velocimetry in the surveillance of severly compromised fetuses. Ultrasound Obstet Gynecol 2002; 20: 233-9
İntrauterin Gelişme Geriliği Olan Fetusların Doppler Akımları ile Doğumdaki Fetal Kan Ph Değerlerinin Karşılaştırılması
Öz
Amaç: Intrauterin
gelişme geriliği olan fetusların Doppler akımları ile doğumdaki kan pH
değerlerinin perinatal ve neonatal sonuçlar açısından değerlendirilmesi
amaçlandı.
Materyal Method: Mayıs 2014 ve Ocak 2015 tarihleri
arasında intrauterin gelişme geriliği (IUGR) tanısı konan 32 hasta çalışmaya
alındı. Hastalar umblikal arterde akım kaybı olmayan (17 hasta) ve umblikal
arterde akım kaybı (11 hasta) veya ters akım olan (4 hasta) olmak üzere iki
gruba ayrıldı. Ayrıca 3 hastada duktus venosusta ters a dalgası mevcuttu.
Bulgular:
Umblikal
arterde akım kaybı olmayan grupta neonatal mortalite görülmezken, umblikal
arterde akım kaybı veya ters akım olan grupta %40 mortalite izlendi. Akım kaybı olmayan grubun doğum
ağırlıkları ortalaması (2118gr), patolojik akım grubundan (968 gr)
istatistiksel olarak anlamlı düzeyde yüksek saptandı (p:0.001). Akım kaybı
olmayan grubun apgar 5.dk skor ortalaması (7,65), patolojik akım grubundan (6,27)
istatistiksel olarak anlamlı düzeyde yüksek saptandı (p:0.001). Akım kaybı olmayan grubun yeni
doğan yoğun bakım ünitesine yatış süreleri (6,58 gün), patolojik akım grubundan
(39,93 gün) istatistiksel olarak anlamlı
düzeyde düşük bulundu (p:0.001). Akım kaybı olmayan grupta baz açığı
ortalaması(-0,75), patolojik akım grubundan (-5,76) istatistiksel olarak
anlamlı düzeyde yüksek saptandı (p:0.004). Akım kaybı olmayan grubun pH
ortalaması (7,33), patolojik akım grubundan (7,24) yüksek saptandı (p:0.016).
Sonuç: İntrauterin gelişme geriliği olan fetusların
takibinde ve doğum zamanlamasında Doppler
ultrasonda umblikal arter ve ductus venosus ölçümleri güvenle kullanılabilir. İntrauterin gelişme geriliği
olan fetuslar duktus venosusta a dalgası kaybı olmadan doğurtmak gerekmektedir.
Anahtar Kelimeler
Kaynakça
- 1- Jacobsson B, Ahlin K, Francis A ,et al : Cerebral palsy and restricted growth status at birth : Population-based case-control study. BJOG 115:1250,2008
- 2-Wu YW, Croen LA , Shah SJ ,et al : Cerebral palsy in term infants. Pediatrics 118:690,2006
- 3-Pardi G, Cetin I : Human fetal growht and organ development: 50 years of discovers . Am J Obstet Gynecol 2006;194:1088
- 4- The American College of Obstetricians and Gynecologists. Intrauterine Growth Restriction. ACOG Practice Bulletin 12. Washington, DC: ACOG; 2000
- 5. Kiserud T. Hemodynamics of the ductus venosus. Eur J Obstet Gynecol Reprod Biol 1999; 84: 139-47
- 6. Belloti M, Pennati G, Pardi G, Fumero R. Dilatation of the ductus venosus in human fetuses: Ultrasonographic evidence and mathematical modeling. Am J Physiol 1998; 275: 1759-67
- 7. Rizzo G, Capponi A, Talone PE, Arduini D, Romanini C. Doppler indices from inferior vena cava and ductus veno-sus in predicting pH and oxygen tension in umbilical blood at cordocentesis in growth retarded fetuses. Ultrasound Obstet Gynecol 1996;7:401-10
- 8- Hecher K, Snijders R, Campbell S, Nicolaides K. Fetal venous, intracardiac, and arterial blood flow measurements in intrauterine growth retardation: relationship with fetal blood gases. Am J Obstet Gynecol 1995; 173: 10-5
- 9- Rizzo G, Capponi A, Arduini D, Romanini C. Ductus veno-sus velocity waveforms in appropriate and small for gesta-tional age fetuses. Early Hum Dev 1994; 39: 15-267
- 10-Baschat AA, Gembruch U, Harman CR. The sequence of changes in Doppler and biophysical parameters as severe fetal growth restriction worsens. Ultrasound Obstet Gyne-col 2001; 18: 571-7
- 11. Hecher K, Bilardo CM, Stigter RH, Ville Y, Hackelôer BJ, Kok HJ. Monitoring of fetuses with intrauterine growth restriction: a longitudinal study. Ultrasound Obstet Gynecol 2001; 18: 564-70
- 12. Hofstaetter C, Dubiel M, Gudmundsson S. Two types of umbilical venous pulsations and outcome of high-risk pregnancy. Early Hum Dev 2001; 61: 111-7
- 13. Müller T, Nanan R, Rehn M, Kristen P, Dietl J. Arterial and ductus venosus Doppler in fetuses with absent or reverse end-diastolic flow in the umbilical artery: correlation with short-term perinatal outcome. Acta Obstet Gynecol Scand 2002; 81: 860-6
- 14. Ertan AK, He JP, Tanriverdi HA, Hendrik HJ, Limbach H, Schmidt W. Comparison of Perinatal Outcome in Fetuses with Reverse or Absent Enddiastolic Flow in the Umbilical Artery / Fetal Descending Aorta. J Perinat Med 2003;31:307-12
- 15. Valcamonico A, Danti L, Frusca T, et al. Absent end-di-astolic velocity in umbilical artery: risk of neonatal morbidity and brain damage. Am J Obstet Gynecol 1994; 170: 796-801
- 16. Alfirevic Z, Neilson JP. Doppler ultrasonography in high-risk pregnancies: systematic review with meta-analysis. Am J Obstet Gynecol 1995;172:1379-87
- 17. Baschat AA, Gembruch U, Viscardi RM, Gortner L, Har-man CR. Antenatal prediction of intraventricular hemorrhage in fetal growth restriction: what is the role of Doppler? Ultrasound Obstet Gynecol 2002;19:334-9
- 18. Ozyuncu O, Fetal arterial and venous Doppler in growth restricted fetuses for the prediction of perinatal complications Turk J pediatri 2010: 52;384-392
- 19. O.M.Turan Duration of persistent abnormal ductus venosus flow and its impact on perinatal outcome in fetal growth restriction ultrasound obstet gynecol 2011;38:298-302
- 20.Cosmi E, Ambrosini G, D’Antoro D, Saccardi C, Mari G. Doppler, cardiotocography, and biophysical profile changes in growth - restricted fetuses. Obstet Gynecol 2005; 106: 1240-45.
- 21.Muller T, Nanan R, Rehn M, Kristen P, Dietl J. Arterial and ductus venosus Doppler in fetuses with absent or reverse end-diastolic flow in the umbilical artery: correlation with short-term perinatal outcome. Acta Obstet Gynecol Scand 2002; 81: 860-6
- 22. Bonatz G, Schulz V, Weisner D, Jonat W. Fetal heart rate (FHR) pathology in labor related to preceeding Doppler sonographic results of the umbilical artery and fetal aorta in appropriate and small for gestational age babies. A longitudinal analysis. J Perinat Med 1997; 25: 440-6
- 23. Arabin B, Siebert M, Jimenez E, Saling E. Obstetrical characteristics of a loss of end- diastolic velocities in the fetal aorta and/or umbilical artery using Doppler ultrasound. Gynecol Obstet Invest 1988;25:173-80
- 24. Divon MY, Ferber A. Doppler evaluation of the fetus. Clin Obstet Gynecol 2002;45:1015-25
- 25. Strigini FA, De Luca G, Lencioni G, Scida P, Giusti G, Genazzani AR. Middle cerebral artery velocimetry: different clinical relevance depending on umbilical veloci- metry. Obstet Gynecol 1997;90:953-7
- 26.Hofstaetter C, Gudmundsson S, Hansmann. Venous Dopp-ler velocimetry in the surveillance of severly compromised fetuses. Ultrasound Obstet Gynecol 2002; 20: 233-9
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Orjinal Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 14 Mart 2019 |
| Yayımlandığı Sayı | Yıl 2019 |