Doppler flow velocimetry of the umbilical artery, uteroplacental arteries and fetal middle cerebral artery in prolonged pregnancy.

A total of 153 pregnant women, of at least 287 days' menstrual age, were studied in a prospectively designed cross-sectional trial. In addition to the non-stress test, contraction stress test, sonographic estimate of amniotic fluid and grade of placental maturation, Doppler measurements of the resistance index (RI) were taken in the umbilical artery, the uteroplacental arteries in the region of placental implantation and the fetal middle cerebral artery. Data were analyzed with regard to asphyxia and otherwise complicated fetal outcome. Furthermore, a possible relationship between grade of placental maturation, Doppler flow velocity waveforms and fetal outcome was investigated. Doppler resistance indices in the umbilical artery, uteroplacental arteries in the region of placental implantation and fetal middle cerebral artery did not change significantly with increasing gestation from 41 to 43 weeks. The grade of placental maturation on ultrasound examination was not related to fetal outcome or Doppler indices in the first two vessels. In all vessels examined in this study, the majority of Doppler measurements in pregnancies with subsequent asphyxia or otherwise complicated fetal outcome were within the 95% prediction interval for patients with normal fetal outcome. None of the patients showed absent diastolic flow in the umbilical artery. With the use of a cut-off value of RI = 0.62 in the umbilical artery, asphyxia could be predicted with 37% sensitivity and 75% specificity. Oligohydramnios and antpartum cardiotocography predicted asphyxia with 16% and 8% sensitivity and 95% and 96% specificity, respectively. Sensitivity for prediction of otherwise complicated fetal outcome by umbilical artery Doppler was only 7%.(ABSTRACT TRUNCATED AT 250 WORDS)

Doppler umbilical artery velocimetry in pregnancies complicated by intrahepatic cholestasis.

Doppler umbilical velocimetry is a useful clinical tool for antepartum fetal surveillance of pregnancies at risk of fetal compromise. Intrahepatic cholestasis of pregnancy is associated with an increased incidence of fetal death, which might due to the toxic effect of elevated maternal serum concentrations of bile acids. To study a possible effect of the concentration of bile acids on the umbilical circulation we performed pulse-wave Doppler velocimetry of the umbilical artery in 15 patients with intrahepatic cholestasis between 34 and 38 weeks of gestation. The findings were compared to the Doppler flow velocities of the umbilical artery of 129 normal pregnancies. Peak-systolic (A) and end-diastolic (B) velocities of two to three cardiac cycles were measured by electronic calipers and the Pourcelot (PR)-index (PR = (A - B)(A)) was calculated. Two of 29 Doppler measurements in patients with intrahepatic cholestasis were above two standard deviations (2 SD) of the values in normal pregnancies. No significant correlation was found between Doppler flow velocities and serum levels of bile acids (r = 0.20) or the levels of alanine aminotransferase (ALAT) (r = -0.05). The mean level of bile acids was 24 mumol/l with a maximum of 98 mumol/l. The mean level of ALAT was 165 IU/l with a maximum of 576 IU/l. Since even high levels of bile acids do not influence umbilical circulation, Doppler investigations of the umbilical artery seem to be of little value in studying the disease-specific risk of fetal compromise in pregnancies complicated by intrahepatic cholestasis.

Effect of third-trimester premature rupture of membranes on fetal breathing movements: a prospective case-control study.

Fetal breathing movements were examined in 44 women with premature rupture of membranes. All had previously uncomplicated singleton pregnancies (28 to 41 weeks). Of these 44 women, 13 had complications based on later amnionitis/neonatal infection or antepartum fetal distress. Thirty-one normal antepartum patients, matched for gestational age, served as a normal control group. These women had intact membranes and were without any known or suspected maternal, fetal, or neonatal complications. Fetal breathing movements were found in 90% of cases in the control group, compared with 65% in the 31 women with premature rupture of membranes (p less than 0.05). In the group of 13 women with premature rupture of membranes and complications, the incidence of fetal breathing movements was 38%. Therefore, it is possible that the absence of fetal breathing movements can be due to premature rupture of membranes alone. There was a statistically higher incidence of low-birth-weight infants and low Apgar scores in the group of 13 women with premature rupture of membranes and complications compared with the group of 31 women with premature rupture of membranes.

The incompetent cervix during pregnancy diagnosed by ultrasound.

Ninety-one pregnant patients in mid-trimester were examined for suspected cervical incompetence using ultrasound. This diagnosis means that detached membranes at the internal os are bulging into a dilated cervical canal. In 13 cases cervical dilatation was found. These patients were operated on using McDonald's purse-string suture. Only one of these patients had premature rupture of the membranes and was delivered at 35 weeks. In all other operated cases the pregnancy continued beyond 37 weeks. Ultrasound is an objective method of diagnosing incompetence of the cervix in pregnancy.