Doppler Ultrasound of the Umbilical Artery: Clinical Application / Ultrassonografia Doppler da artéria umbilical: Aplicação clínica

Abstract Objective To provide a survey of relevant literature on umbilical artery Doppler ultrasound use in clinical practice, technical considerations and limitations, and future perspectives. Methods Literature searches were conducted in PubMed and Medline, restricted to articles written in English. Additionally, the references of all analyzed studies were searched to obtain necessary information. Results The use of this technique as a routine surveillance method is only recommended for high-risk pregnancies with impaired placentation. Meta-analyses of randomized trials have established that obstetric management guided by umbilical artery Doppler findings can improve perinatal mortality and morbidity. The values of the indices of Umbilical artery Doppler decrease with advancing gestational age; however, a lack of consensus on reference ranges prevails. Conclusion Important clinical decisions are based on the information obtained with umbilical artery Doppler ultrasound. Future efforts in research are imperative to overcome the current limitations of the technique.

Resumo Objetivo Compilar informação relevante proveniente da literatura atual sobre a ultrassonografia Doppler das artérias umbilicais (AUs) na prática clínica, considerações e limitações técnicas e perspectivas futuras. Métodos A pesquisa bibliográfica foi realizada nos bancos de dados PubMed e Medline e restringiu-se a artigos escritos na língua inglesa. Recorreu-se também à bibliografia dos artigos selecionados, quando necessário, para obter informação relevante. Resultados A utilização desta técnica como método de vigilância de rotina está apenas recomendada emgravidezes de alto risco comdisfunção placentar.Metanálises de estudos randomizados mostraram que o seguimento obstétrico baseado nos achados do Doppler da artéria umbilical pode melhorar a mortalidade e a morbilidade perinatal. É consensual que os valores dos índices Doppler da AU decrescem com o avanço da idade gestacional. No entanto, há ainda muita incerteza quanto aos valores de referência. Conclusão As informações obtidas através da AU Doppler US são a base para muitas decisões clínicas importantes. Trabalhos de investigação nesta área são essenciais para tentar colmatar atuais limitações da técnica.

Study of perinatal outcomes in normal and borderline oligamnios

Background: Oligamnios is a common cause of perinatal mortality and morbidity, but the outcome of borderline oligamnios, defined as Amniotic Fluid Index (AFI) between 5 and 8, is less clear. This study aims to find out the effect of borderline oligamnios on perinatal outcomes in pregnancies beyond 37 weeks.Methods: An observational prospective study of 131 antenatal mothers with AFI between 5 and 8, after 37 weeks of gestation was conducted in Sree Gokulam Medical College and Research Foundation from October 2017 to September 2019. These observations were compared with that of 131 antenatal mothers with normal AFI beyond 37 weeks of gestation. The observations according to fetal heart rate abnormalities, meconium staining of amniotic fluid, mode of delivery, low birth weight babies, APGAR score, the need of neonatal intensive care unit (NICU) admissions due to neonatal complications were statistically analysed.Results: Both groups were comparable with respect to age, parity and gestational age. In those with borderline oligamnios, fetal heart rate abnormality was seen in 21% (28), meconium stained amniotic fluid in 18% (23), 70% (91) delivered vaginally and 30% (40) underwent caesarean section, 31% (41) babies weighed below 2.5 kg and 21% (27) neonates needed NICU admissions. In those with normal AFI, none showed fetal heart rate abnormality, 2% (3) showed meconium staining, 93% (122) delivered vaginally and 7% (9) underwent caesarean section, 11% (14) babies weighed below 2.5 kg and 3% (4) neonates needed NICU admissions.Conclusions: Borderline oligamnios is associated with poor perinatal outcome. AFI can be used as an adjunct to other fetal surveillance methods. It helps to identify those infants at risk of poor perinatal outcome.

Pregnancy outcomes of normal versus abnormal cardiotocography in a tertiary centre in Nepal

Background: Pregnancy and childbirth is normal physiological process with great pathological potential. The obstetricians are more concerned with the early recognition of fetal distress during labour and such an adverse outcome should be detected at the earliest point of time by an effective surveillance method. Cardiotocography as a part of biophysical profile has become an established diagnostic tool for fetal surveillance. To compare early perinatal outcome of normal and abnormal cardiotocography in terms of APGAR scores, need for neonatal resuscitation, NICU admission, perinatal death and mode of delivery.Methods: It was a cross-sectional study. 200 nulliparous/multiparous women with singleton pregnancy in cephalic presentation at gestational age 37-42 weeks in latent stage of labor were enrolled in the study and subjected to admission test in left lateral position using fetal monitor. Baseline FHR and contraction pattern were determined for 20 minutes and classification of patients was done into normal, and suspicious or abnormal according to the FIGO guidelines 2015.Results: Low APGAR scores, rate of LSCS, need for neonatal resuscitation, neonatal admission were more in the abnormal cardiotocography group. Cardiotocography in the current study has high sensitivity and high negative predictive value for detecting fetal distress.Conclusions: From the analysis of this study, it would be safe to conclude that an ominous cardiotocography should be managed appropriately without delay and obstetrician should be vigilant in suspicious as well as in normal admission test group for timely intervention for bettering the neonatal outcome.

Discrepancy between Non-stress Test Result and Umbilical Artery Doppler Study in a Pregnancy Complicated by Diabetes; A Case Report / 대한주산의학회잡지

Pregestational diabetes is a well-known risk factor for perinatal mortality, and regarded as an important cause of stillbirth. Unfortunately, more than half of stillbirths remain unexplained. Nevertheless, there is no consensus regarding the optimal timing and content of antepartum testing in pregnancies complicated by diabetes. A 32-year-old primigravida presented with diabetes diagnosed during pregnancy. Antenatal fetal surveillance tests including nonstress test, biophysical profile, and Doppler waveforms of umbilical arteries were performed twice weekly, beginning at 32 weeks gestation. At 37(+4) weeks' gestation, a discrepancy in the surveillance test results arose when reversed end-diastolic flow in the umbilical arteries was seen, despite a reactive nonstress test. A male baby was delivered by cesarean section. The umbilical arterial pH at delivery was 7.171. Antenatal fetal surveillance in pregnancies complicated by diabetes should include evaluation of Doppler waveforms in the umbilical vessels, regardless of the presence or absence of maternal vasculopathy.

Labetalol - An Emerging First-line Drug for Pregnancy-induced Hypertension.

Research questions: To study labetalol as a first-line drug for hypertension in pregnancy and endorse its superiority over alpha-methyldopa. Settings: Dept. of Obstetrics and Gynecology, Bharati Vidyapeeth Medical College and Hospital, Pune. Study design and methodology: Patients with diastolic blood pressure recorded above 100 mmHg have been admitted and administered labetalol 100 mg twice-daily orally, the dose escalating to 1.2 g/day. The control of pressures and side effects have been noted. Results: Labetalol is instrumental in causing a sustained and smooth fall in blood pressure and is free of the side effects of alpha-methyldopa. Conclusion: Thus, labetalol supercedes alpha-methyldopa as a first-line drug for hypertension in pregnancy.