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D Arduini

Publications and source records attributed to D Arduini.

At least 19 recordsLinked to original sources
PubMed2001

Maternal diastolic function in asymptomatic pregnant women with bilateral notching of the uterine artery waveform at 24 weeks' gestation: a pilot study.

OBJECTIVE: To study second-trimester maternal cardiac adaptation in asymptomatic patients at risk, on the basis of abnormal uterine artery Doppler, for the development of gestational hypertension or having a small-for-gestational age fetus. Fetal and maternal outcomes were verified at the end of pregnancy. METHODS: Thirty-six normotensive women with abnormal uterine artery waveforms underwent maternal echocardiographic examination at 24 weeks' gestation. RESULTS: Twenty-one women (58.3%) subsequently showed normal outcome; 12 patients developed gestational hypertension (33.3%) and three (8.3%) had small-for-gestational age newborns. Left ventricular outflow tract, left ventricular diastolic dimensions and atrial and ventricular function were significantly lower in the pathological outcome group. Diastolic function parameters were significantly different between the two groups: peak mitral E-wave and A-wave and A-wave duration showed lower values in the pathological outcome group. Isovolumetric relaxation time of the left ventricle was significantly longer in the pathological outcome group. The prevalence of an altered geometric pattern was 14.3% (3/21) in the normal and 80% (12/15) in the pathological outcome groups (P < 0.001). CONCLUSIONS: Women who subsequently develop a complication of pregnancy tend to display abnormal cardiac adaptation. An abnormal placentation process, expressed by an elevated resistance index and the presence of notches in the uterine artery waveform, are likely to cause an adaptative mechanism involving the whole cardiovascular system. A pathological outcome of pregnancy is associated with the failure of this process.

Adult↗
PubMed2000

Maternal cardiac systolic and diastolic function: relationship with uteroplacental resistances. A Doppler and echocardiographic longitudinal study.

OBJECTIVE: To test the hypothesis of the existence of a relationship between central and peripheral hemodynamic parameters by the longitudinal evaluation of maternal echocardiographic and uteroplacental resistance modifications during normal pregnancy. METHODS: Forty-three healthy normotensive primigravidae were evaluated at 12 +/- 1, 21 +/- 1, and 33 +/- 1 weeks of gestation with uterine artery color Doppler and maternal echocardiographic examinations to identify morphologic, systolic, and diastolic variables. RESULTS: Cardiac output and stroke volume significantly increased during pregnancy. Uterine resistance index (RI) decreased from the first to the second trimesters (0.72 +/- 0.10 versus 0.54 +/- 0.09, P < 0.001). Left atrial dimensions increased during pregnancy (33.8 +/- 1.9 cm, 38.1 +/- 1.8 cm, 39.3 +/- 2.1 cm, P < 0.001). Left atrial function also increased. Left ventricular mass increased (132 +/- 18 g, 162 +/- 16 g, 174 +/- 27 g, P < 0.001). Diastolic function parameters showed significant modifications: E wave velocity and E/A ratio decreased; A wave velocity and deceleration time of the E wave (DtE) increased; the left ventricular isovolumetric relaxation time (IVRT) decreased significantly (88.7 +/- 6.7 ms, 75.6 +/- 7.7 ms, 71.1 +/- 5.0 ms, P < 0.001) showing a correlation with left atrial dimensions and RI (r = -0.38, r = 0.47, respectively; P < 0.001). CONCLUSIONS: Diastolic cardiac function varies during pregnancy. A relationship between preload (left atrial enlargement), afterload (RI reduction), morphologic, and diastolic function modifications (IVRT reduction, DtE prolongation) appears to exist as a consequence of the hemodynamic modifications which occur during physiologic pregnancy. Diastolic function analysis maybe useful to identify women who fully adapt to pregnancy, and to understand the mechanisms that might be involved in women who show abnormal uterine artery Doppler waveforms.

Adult↗
PubMed2000

TNFalpha expression in hyperplastic endometrium.

PROBLEM: Tumor necrosis factor-alpha (TNFalpha) is produced by the endometrium, and it has been shown that this cytokine has cyclic variations through the menstrual cycle. METHOD OF STUDY: In this study we assessed TNFalpha, estradiol and progesterone levels in the endometrium and serum of 21 patients with recent abnormal uterine bleeding (AUB). Eleven women showed histological diagnosis of endometrial hyperplasia, and ten women showed normal endometrium. RESULTS: The TNFalpha value in the serum of patients with hyperplasia and in normal endometrium did not show significant differences (64.8 +/- 21.4 vs 77.6 +/- 14.8 pg). The amounts of TNFalpha released by hyperplastic endometrial tissue were significantly higher than in control patients (258.8 +/- 78.0 vs 140.6 +/- 79.8 pg/g; P < 0.001). Immunohistochemistry of hyperplastic endometria showed a stronger staining than normal ones. Serum E2 levels in patients with hyperplastic endometrium were 49.5 +/- 31.6 ng/mL, and in controls were 107.3 +/- 66.0 ng/mL. The levels of estradiol released by hyperplastic endometria were significantly lower than in normal endometria (152.7 +/- 60.0 vs 279.9 +/- 178.7 ng/g; P < 0.003). CONCLUSIONS: Hyperplastic endometria produce higher amounts of TNFalpha with respect to controls. These findings may explain the frequent bleeding observed in the patients with endometrial hyperplasia, since TNFalpha promotes apoptosis and endometrial shedding.

Endometrial Hyperplasia↗
PubMed1999

Monitoring of hormone replacement therapy in postmenopausal women by transvaginal sonography and color flow doppler: study in different phases of sequential therapy.

OBJECTIVE: To assess uterine artery blood flow and endometrial thickness in postmenopausal patients receiving sequential hormone replacement therapy (HRT) at different phases of the treatment. DESIGN: Prospective controlled study. SETTING: Ultrasound and menopause units of the obstetrics and gynecology department of the University of Tor Vergata, Rome, Italy. PATIENT(S): Forty postmenopausal women were treated with cyclic sequential HRT (transdermal E2, 50 microg/d, days 1-21; and dydrogesterone, 10 mg/d, days 12-24). INTERVENTION(S): All patients underwent transvaginal color Doppler sonography in the estrogen (phase E) and progestogen (phase E/P) phases and after uterine bleeding when no hormone was administered (phase 0). MAIN OUTCOME MEASURE(S): Endometrial thickness; systolic, diastolic, and mean velocities; and pulsatility and resistance indices of the uterine arteries. RESULT(S): No statistically significant difference in endometrial thickness between phase E (6.5+/-1.6 mm) and phase E/P (6.0+/-1.7 mm) was observed. In phase 0, compared with phases E and E/P, a statistically significant decrease in endometrial thickness was found (4.1+/-1.2 mm). Doppler flow impedance parameters of uterine arteries during the different phases of the HRT cycle showed no differences between the phases considered. CONCLUSION(S): The decrease in endometrial thickness in phase 0 suggests a protective effect of our cyclic sequential regimen on the endometrium. Dydrogesterone does not interfere markedly with the vasodilatory effect of estrogen on uterine arteries.

Aged↗
PubMed1998

Growth retardation and discordant twin pregnancy. An immunomorphological and biochemical characterisation of the human umbilical cord.

Growth retardation and low birth weight represent an important factor associated with the high risk of mortality and morbidity, particularly in twin pregnancy, since twins are frequently characterised by fetal growth retardation and sometimes by a discordant growth between the twins. The present work sets out to elucidate the role of growth discordance between twins in the behaviour of human umbilical vein endothelial cells; biochemical, ultrastructural and immunohistochemical data obtained from a discordant twin pregnancy are discussed. Endothelial cells were obtained from umbilical cord of 5 singleton pregnancies and from 5 dichorionic twin pregnancies, among which was one discordant twin pregnancy. Membrane fluidity was assayed using a fluorescent probe and each sample was immunohistochemically processed employing specific monoclonal antibodies. An increased fluidity was observed in endothelial cells from the smaller twin as compared with the larger one. As concerns electron microscopy, the features of endothelial cells from the smaller twin were similar to those of twins with similar growth, while endothelial cells from the larger one were more similar to those from singleton pregnancies. Our findings confirm the presence of the feto-fetal transfusion as a pathogenetic mechanism involved in twin growth discordancy.

Adult↗
PubMed1997

Indomethacin modifies the fetal hemodynamic response induced by percutaneous umbilical blood sampling.

OBJECTIVE: Percutaneous umbilical blood sampling induces a marked decrease of impedance to flow in the umbilical artery. Because these changes are believed to be the result of the release of prostanoids, we conducted a study to determine whether indomethacin administration before percutaneous umbilical blood sampling affects the hemodynamic response induced by this procedure. STUDY DESIGN: Percutaneous umbilical blood sampling was performed in 20 singleton pregnancies that were treated for 3 days before the procedure with indomethacin (25 mg orally 6 hours apart) as tocolytic agent and in 22 untreated pregnancies. All the procedures were uncomplicated, and sampling of the umbilical vein was confirmed by blood pressure measurement at the time of the procedure. The umbilical artery pulsatility index and the fetal heart rate were measured immediately before and after the procedure. The first and last aliquots of umbilical vein plasma obtained at the beginning and closing of the procedure were assayed for endothelin-1, 6-keto-prostaglandin F1 alpha and thromboxane B2. RESULTS: In untreated pregnancies percutaneous umbilical blood sampling induced a decrease of the umbilical artery pulsatility index (p < 0.0001) and an increase in 6-keto-prostaglandin F1 alpha (p < 0.001) and endothelin-1 levels (p = 0.001), whereas no significant changes were present in fetal heart rate and thromboxane B2 levels. In pregnancies treated with indomethacin, 6-keto-prostaglandin F1 alpha, and thromboxane B2, concentrations at the beginning of the procedure were both significantly less (p < 0.0001) than those found in untreated pregnancies. In pregnancies treated with indomethacin percutaneous umbilical blood sampling did not affect umbilical artery pulsatility index, and 6-keto-prostaglandin F1 alpha and thromboxane B2 levels did not vary during the procedure. However, endothelin-1 (p < 0.001) and fetal heart rate (p < 0.0001) increased after the procedure. CONCLUSION: Indomethacin affects the fetal hemodynamic response to percutaneous umbilical blood sampling by inhibiting the release of prostanoids and the fall in umbilical artery pulsatility index. Under this condition the fetus adapts to the procedure by increasing the heart rate.

6-Ketoprostaglandin F1 alpha↗
PubMed1997

Splenic artery velocity waveforms in small-for-gestational-age fetuses: relationship with pH and blood gases measured in umbilical blood at cordocentesis.

OBJECTIVE: Our purpose was to relate velocity waveforms from the splenic artery with pH and blood gas levels measured at cordocentesis in small-for-gestational-age fetuses and to compare the diagnostic efficiency of splenic artery waveforms with that of other fetal arterial and venous vessels in predicting acid-base status. STUDY DESIGN: Cross-sectional recordings from the splenic artery were obtained by color and pulsed Doppler techniques in 316 appropriately grown fetuses, 12 small-for-gestational-age fetuses with normal umbilical artery velocity waveforms (group 1), and 30 small-for-gestational-age fetuses with abnormal umbilical artery velocity waveforms (group 2). Measurements of splenic artery pulsatility index values in small-for-gestational-age fetuses were compared with those of appropriate-for-gestational-age fetuses. Associations of splenic artery pulsatility index with Po2, Pco2, and pH values measured at cordocentesis were examined and compared with those of umbilical artery, middle cerebral artery, and inferior vena cava. RESULTS: In appropriately grown fetuses pulsatility index values from the splenic artery decrease with advancing gestation (r = 0.51, p < 0.0001). Splenic artery pulsatility index values are lower in group 2 (p < 0.001) but not in group 1 small-for-gestational-age fetuses (p = 0.211). The amplitude of the decrease in the pulsatility index is significantly associated with fetal hypoxemia (r = 0.646, p < 0.001), acidemia (r = 0.593, p < 0.001) and hypercapnia (r = 0.577, p < 0.001). However, logistic regression demonstrates that hypoxia is better predicted by middle cerebral artery pulsatility index, whereas hypercapnia and acidosis are more closely associated with the percent of reverse flow in inferior vena cava. CONCLUSION: A decrease in the splenic artery pulsatility index occurs in small-for-gestational-age fetuses in the presence of abnormal pH and blood gas values, but a more accurate assessment of acid-base status may be obtained with the study of the middle cerebral artery and inferior vena cava.

Blood Flow Velocity↗
PubMed1997

Atrial natriuretic peptide levels in fetal blood in relation to inferior vena cava velocity waveforms.

OBJECTIVE: To determine whether blood levels of atrial natriuretic peptide in small for gestational age (SGA) fetuses are related to Doppler indices measured in arterial and venous vessels. METHODS: Atrial natriuretic peptide was assayed in fetal blood obtained at funipuncture in 42 third-trimester fetuses, of whom 11 were appropriate for gestational age (AGA) and 31 were SGA. Small for gestational age fetuses were divided into three groups according to Doppler findings in the umbilical artery and inferior vena cava: 1) normal in both vessels (n = 10); 2) abnormal in the umbilical artery but normal in the inferior vena cava (n = 10); and 3) abnormal in both vessels (n = 11). Atrial natriuretic peptide levels were related to Doppler indices and acid-base status of the fetal blood. RESULTS: Small for gestational age fetuses with abnormal waveforms in both vessels had higher atrial natriuretic peptide blood levels (median 544.8 pg/mL, range 404.2-1112.3) compared with AGA fetuses (median 316.8 pg/mL, range 159.3-470.1; P < or = .001), SGA fetuses with normal waveforms only in both vessels (median 299.8 pg/mL, range 242.6-480.5; P < or = .001), and SGA fetuses with abnormal waveforms only in the umbilical artery (median 367.6 pg/mL, range 192.7-748.9; P = .002). Blood levels of atrial natriuretic peptide were significantly related to the preload index in the inferior vena cava (p = 0.554, P < or = .001). This relation remained significant when the analysis was restricted to the SGA fetuses with abnormal waveforms in the umbilical artery and the inferior vena cava (p = 0.673, P = .03). CONCLUSIONS: Small for gestational age fetuses with abnormal velocity waveforms in the inferior vena cava have significantly higher concentrations of atrial natriuretic peptide. This may represent a compensatory mechanism in the SGA fetus for regulation of an abnormal hemodynamic condition.

Adult↗
PubMed1997

Role of antepartum computerized fetal heart rate analysis in the prediction of fetal distress during labor.

OBJECTIVE: To ascertain the diagnostic ability of a computerized fetal heart rate (FHR) analysis system in the identification of patients at risk of fetal distress in labor. STUDY DESIGN: Five-hundred and seventy-seven healthy term pregnancies were enrolled in a prospective, cross-sectional study and subdivided into two groups, with (n = 90) or without (n = 487) fetal distress in labor. Computerized FHR recordings were performed periodically and regression analysis was performed in a univariate and multivariate way to assess the ability of the last FHR recordings in the prediction of subsequent fetal distress. RESULTS: The two groups showed a significant difference in almost all of the FHR parameters studied. The multivariate analysis showed that only the FHR baseline and the percentage of small acceleration were independently and significantly related to the labor outcome. The combination of these two parameters reaches a sensitivity of 45%, specificity of 91%, positive predictive value of 48% and negative predictive value of 90%, with an overall accuracy of 84%. CONCLUSIONS: The increase in FHR baseline and in small FHR accelerations can be major factors in the prediction of subsequent fetal distress in healthy term fetuses.

Computers↗
PubMed1997

Prophylactic transabdominal amnioinfusion in oligohydramnios for preterm premature rupture of membranes: increase of amniotic fluid index during latency period.

OBJECTIVE: This study was designed to: (i) evaluate the effect of amnioinfusion on the latency period in patients with oligohydramnios for preterm premature rupture of membranes, and (ii) to investigate the relationship between changes in the amniotic fluid index and fetal heart rate short-term variability by computerized Hewlett-Packard cardiotocography, longitudinally estimated before and after prophylactic amnioinfusion. MATERIALS AND METHODS: All singleton pregnancies with prolonged premature rupture of membranes after 25 weeks of gestation and seen at the Institute of Obstetrics and Gynecology, University of Ancona (Italy), between January 1994 and June 1995 were included in the study. Transabdominal amnioinfusion with 150-350 ml warmed normal saline (25-50 ml/min) was performed at weekly intervals. Amniotic fluid volume was assessed ultrasonographically by means of the four-quadrant technique on a weekly basis before and after each amnioinfusion, as well as the short-term variability by a Hewlett-Packard computerized cardiotocographic system. RESULTS: 18 women were enrolled and underwent prophylactic transabdominal amnioinfusion at weekly intervals until delivery. Eighteen controls, who did not undergo prophylactic amnioinfusion, were recruited from our 1992-1993 series and included in the study. The median interval between premature rupture of membranes and delivery was 3.0 weeks (range 1-8 weeks), with an average delivery age of 33.0 weeks (range 27-36 weeks). The latency period was significantly longer in patients who underwent prophylactic amnioinfusion (mean +/- SD, 4.1 +/- 1.7 weeks) than in controls(1.7 +/- 1.0 weeks; p < 0.001). An increase in both the weekly amniotic fluid index (linear regression analysis r = 0.8, p = 0.03) and the weekly short-term variability (linear regression analysis r = 0.82, p = 0.02) was observed among patients who underwent prophylactic amnioinfusion. A direct relationship was observed between the amniotic fluid index and short-term variability (linear regression analysis r = 0.54, p = 0.04). The mean values of fetal movements recorded by computerized tomography during the 20 min of observation significantly increased after amnioinfusion in comparison with those before it (2.6 +/- 0.9 and 0.9 +/- 0.7 respectively; p = 0.001). CONCLUSION: The present study has shown a positive effect of prophylactic transabdominal amnioinfusion on the latency period in patients with preterm premature rupture of membranes and oligohydramnios. Among the patients who underwent amnioinfusion, an interesting improvement in fetal heart rate short-term variability was associated with the progressive increase in amniotic fluid volume, as an expression of fetal well-being.

Abdomen↗
PubMed1996

The value of fetal fibronectin in cervical and vaginal secretions and of ultrasonographic examination of the uterine cervix in predicting premature delivery for patients with preterm labor and intact membranes.

OBJECTIVE: We compared the diagnostic performances of fetal fibronectin assay of cervical and vaginal secretions and of transvaginal ultrasonographic evaluation of the uterine cervix in the prediction of preterm delivery of patients presenting with preterm labor and intact membranes. STUDY DESIGN: One hundred eight patients admitted to the hospital for preterm labor and with intact membranes underwent assay of fibronectin in the cervical and vaginal secretions and transvaginal ultrasonographic evaluation of the uterine cervix. The ultrasonographic parameters evaluated were cervical length, presence of funneling, and cervical index ([Funnel length + 1]/Cervical length). Outcome measures were occurrence of preterm delivery, defined as birth before the thirty-seventh week of gestation, and the admission-to-delivery interval. RESULTS: Forty-seven patients (43.5%) were delivered preterm. Receiver characteristic curve analysis showed that a level of fetal fibronectin in cervical secretions > or = 60 ng/ml had the highest diagnostic performance in predicting preterm delivery (sensitivity 80.9%, specificity 83.6%). Multiple stepwise logistic regression analysis indicated that the cervical index significantly improved the prediction of preterm delivery achieved by the fetal fibronectin assay. In patients with cervical secretion fibronectin levels > or = 60 ng/ml, survival analysis showed a shorter admission-to-delivery interval in the presence of an abnormal cervical index (p < or = 0.001). CONCLUSIONS: The assay of fetal fibronectin in cervical secretions is more accurate than ultrasonographic evaluation of the uterine cervix in the prediction of preterm delivery. Combined use of the fetal fibronectin assay and the cervical index improves the diagnostic efficiency and allows prediction of the admission-to-delivery interval, identifying a subgroup of patients who may require aggressive treatment.

Adult↗
PubMed1996

Interleukin-6 concentrations in cervical secretions identify microbial invasion of the amniotic cavity in patients with preterm labor and intact membranes.

OBJECTIVE: The objectives of this study were to determine whether cytokine levels in cervical secretions were increased in the presence of microbial invasion of the amniotic cavity in patients with preterm labor and intact membranes and to relate concentrations to cytokine levels in amniotic fluid, cervicovaginal microflora, and the presence of chorioamnionitis. STUDY DESIGN: Cervical secretions were sampled immediately before amniocentesis in 92 patients admitted for preterm labor with singleton pregnancies and intact membranes. Amniotic fluid was cultured and the following cytokines were measured in amniotic fluid and cervical secretions: interleukin-1 beta, interleukin-1 receptor antagonist, tumor necrosis factor-alpha, and interleukin-6. The cervicovaginal microflora and placentas (n = 42) were also analyzed. RESULTS: A total of 19.56% (18/92) of the amniotic fluid cultures had positive results. All the cytokines tested showed significantly higher levels in cervical secretions in the presence of intraamniotic infection. There were significant relationships between the concentrations of interleukin-6 and interleukin-1 receptor antagonist in amniotic fluid and cervical secretions. A concentration of interleukin-6 in cervical secretions > 410 pg/ml had a sensitivity of 66.8% and a specificity of 90.5% and a relative risk of 7.7 for intraamniotic infection, higher than the other cytokines tested. There were no relationships between the presence of bacterial vaginosis and cervicovaginal pathogens and cervical cytokine levels. In the presence of chorioamnionitis, cervical concentrations of interleukin-6 and interleukin-1 receptor antagonist were significantly increased in spite of negative amniotic fluid culture results. CONCLUSION: The measurement of interleukin-6 in cervical secretions may help to noninvasively identify intraamniotic infection among pregnancies with preterm labor and intact membranes.

Adult↗
PubMed1996

Endometrial Evaluation in Asymptomatic Postmenopausal Women by Transvaginal Sonography and Color Flow Doppler

We attempted to correlate transvaginal ultrasound endometrial assessment with histologic and hysteroscopic findings in 910 asymptomatic postmenopausal women. The women all had been postmenopausal for at least 1 year, and had no sonographically documented adnexal masses, no hormone therapy, and no history of uterine bleeding. Endometrial thickness of 5 mm and less was considered normal, and no further investigations were performed. All women with endometrial thickness 8 mm or greater were advised to undergo hysteroscopy and endometrial biopsy if necessary. When endometrial thickness was 6 to 7 mm, hysteroscopy was recommended if irregular endometrial echotexture was observed; otherwise another ultrasound examination within 3 to 6 months was suggested. We observed 83 (9.1%) asymptomatic women with endometrial thickness 8 mm or greater and 77 (8.5%) with a thickness of 6 to 7 mm, in whom a total of 89 hysteroscopies were performed. Three endometrial cancers, 8 hyperplasias, 27 endometrial polyps, and 5 submucosal myomas were detected in those with endometrial thickness of 8 mm or greater. Of the 21 women with endometrial thickness 6 to 7 mm who underwent hysteroscopy, 7 had endometrial polyps, 4 hyperplasia, and 3 submucosal myomas. Based on sensitivity and specificity analyses, an endometrial thickness of 8 or 10 mm in asymptomatic postmenopausal women seems to be an effective cut-off to select candidates for more invasive diagnostic procedures.

Journal Article↗
PubMed1996

Correlation between Ultrasonographic Findings and Laparoscopic Appearance in Patients with Laparoscopically Treated Ovarian Cysts

We performed laparoscopy in 96 women (64 age <40 yrs, 22 > 40 yrs) with a diagnosis of ovarian cyst. The size and morphology of each mass were established, and color flow Doppler characteristics were determined by ultrasonography. Laparoscopically we evaluated the external and internal surfaces and vascularization. The laparoscopic appearance confirmed the ultrasonographic findings in 85% of women.

Journal Article↗
PubMed1996

Doppler indices from inferior vena cava and ductus venosus in predicting pH and oxygen tension in umbilical blood at cordocentesis in growth-retarded fetuses.

The objective of this study was to assess the value of Doppler indices calculated from the inferior vena cava and ductus venosus in the identification of acidemia and hypoxemia as determined by pH and gas analysis of fetal blood obtained by cordocentesis in growth-retarded fetuses. Doppler measurements were performed in the inferior vena cava and ductus venosus in 209 normally grown fetuses and in 89 growth-retarded fetuses. All growth-retarded fetuses were free from structural and chromosomal abnormalities, and uteroplacental insufficiency characterized by Doppler changes in the umbilical and middle cerebral arteries was the most likely etiology of the growth defect. In this group of fetuses, Doppler recordings were performed immediately before cordocentesis. Ten different indices were calculated from venous velocity waveforms, and reference limits for gestation were constructed by the cross-sectional analysis of data from normally grown fetuses. Logistic regression and receiver operator characteristic curve analysis were performed to examine the relationship between Doppler indices and acid-base status. The pre-load index (peak velocity during atrial contraction/peak velocity during systole) in the inferior vena cava was the best explanatory variable for acidemia (chi 2 = 48.33; p < or = 0.001). Hypoxemia was predicted less well by venous indices and the best results were achieved by the S/A ratio in the ductus venosus (chi 2 = 9.46; p < or = 0.005). In conclusion, our data suggest that acidosis in growth-retarded fetuses may be non-invasively identified by Doppler measurements of the inferior vena cava and that a higher efficiency can be achieved by the use of the pre-load index.

Acidosis↗
PubMed1996

Blood flow velocity waveforms from peripheral pulmonary arteries in normally grown and growth-retarded fetuses.

The objective of this study was to describe blood flow velocity waveforms of fetal peripheral pulmonary arteries in normally grown and growth-retarded fetuses. Doppler studies were performed in 182 normally grown fetuses (gestational age 18-40 weeks) and in 61 growth-retarded fetuses (gestational age 24-36 weeks) that were free from structural and chromosomal abnormalities and whose umbilical and middle cerebral artery Doppler findings suggested uteroplacental insufficiency as the most likely etiology of the growth defect. The pulsatility index was used to quantify the velocity waveforms. Successful recordings were obtained in 90.1% of the normally grown and 93.4% of the growth-retarded fetuses. In normally grown fetuses the pulsatility index values significantly decreased with advancing gestation. In growth-retarded fetuses the pulsatility index values were significantly elevated compared to those of normal fetuses. A significant relationship was observed between the severity of hypoxia and pulsatility index values from the peripheral pulmonary arteries in 29 fetuses in which Doppler recordings were obtained immediately before cordocentesis. In conclusion, these data show that in normal fetuses the Doppler-measured impedance to flow in the peripheral pulmonary circulation decreases with advancing gestation. Impedance to flow in the lungs is elevated in the presence of growth retardation and this increase is related to the severity of fetal hypoxia.

Acid-Base Equilibrium↗
PubMed1996

Release of vasoactive agents during cordocentesis: differences between normally grown and growth-restricted fetuses.

OBJECTIVE: The purpose of this study was to evaluate whether cordocentesis is associated with the release of vasoactive substances and whether there are differences between normally grown and growth-restricted fetuses. STUDY DESIGN: 6-Keto-prostaglandin F1 alpha (the stable metabolite of prostacyclin), endothelin-1, and cyclic guanosine monophosphate were measured in fetal blood at the beginning and closing of cordocentesis in 30 normally grown fetuses and 25 growth-restricted fetuses. This latter group was characterized by abnormal Doppler index values in umbilical artery and middle cerebral artery, suggestive of chronic hypoxemia as the causative factor of the impaired growth. In six growth-restricted fetuses bradycardia occurred at the end of the procedure. Umbilical artery pulsatility index was measured by Doppler ultrasonography immediately before and after the procedure. RESULTS: The median interval between the two blood samples obtained by cordocentesis was 90 seconds (range 60 to 320 seconds). During this interval a significant rise of 6-keto-prostaglandin F1 alpha (p < or = 0.0001) and endothelin-1 (p = 0.03) was evidenced in normally grown fetuses. The increase in 6-keto-prostaglandin F1 alpha was significantly related (r = 0.52, p = 0.002) to the fall of umbilical artery pulsatility index occurring after the procedure. In growth-restricted fetuses cordocentesis induced a marked increase of endothelin-1 (p = 0.0002), which was significantly related to the severity of acidosis (r = 0.52, p = 0.018), whereas no modifications were evidenced for the other agents tested. The increase of endothelin-1 was higher in those growth-restricted fetuses showing bradycardia at the end of the procedure than in growth-restricted fetuses that did not (p = 0.04). The variations of the vasoactive substances assayed were not significantly related to the type of procedure (transamniotic or transplacental), the amount of blood aspirated during the procedure, the interval elapsing between the first and second samples, the gestational age at which the procedure was performed, and the degree of fetal smallness. CONCLUSION: Cordocentesis induces the rapid release of vasoactive substances and the effect differs between normally grown and growth-restricted fetuses. This may explain the different hemodynamic response and the higher rate of complications occurring in the latter group after cordocentesis.

6-Ketoprostaglandin F1 alpha↗