Biomedical subjects
Publications and source records attributed to D Arduini.
Extracardiac and cardiac flow velocity waveforms were recorded in a severely growth-retarded fetus 1 day and a few hours before fetal death. At the first scan, the typical Doppler patterns of a growth-retarded fetus were found, but the brain-sparing effect was lost at the last examination and a huge tricuspid insufficiency was demonstrated.
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OBJECTIVE: Our purpose was to evaluate the incidence and patterns of chromosomal abnormalities in fetuses with absent end-diastolic velocity in umbilical artery and to analyze maternal and fetal factors associated with abnormal karyotype. STUDY DESIGN: One hundred ninety-two fetuses of known karyotype with absent end-diastolic velocity in the umbilical artery at a gestational age > 20 weeks were considered. The following potential risk factors were analyzed in a multiple logistic regression model: maternal age, gravidity, parity, gestational age at diagnosis, presence of gestational hypertension and preeclampsia, presence of fetal malformations, different biometric measurements, head/abdominal circumference ratio, amniotic fluid volume, and several Doppler index values calculated from uterine arteries, fetal heart, and fetal peripheral arteries and veins. RESULTS: Sixteen cases had an abnormal karyotype. In two cases a triploidy was present, whereas the remaining 14 cases had autosomal aberrations. The risk factors statistically significantly and independently associated with the presence of an abnormal karyotype were maternal age > 35 years, gestational age at diagnosis < 27 weeks, presence of multiple malformations, and absence of gestational hypertension and preeclampsia. All the fetuses with an abnormal karyotype but one were correctly identified by at least one risk factor. CONCLUSIONS: An abnormal karyotype is present in 8.3% of fetuses with absent end-diastolic velocity in umbilical artery and is associated with maternal and fetal risk factors. The knowledge of these factors may be useful in the management of such fetuses.
OBJECTIVE: Our purpose was to evaluate Doppler-detectable differences in the fetal circulation of discordant twins with a growth defect resulting from either placental insufficiency or twin-to-twin transfusion syndrome. STUDY DESIGN: Serial weekly Doppler recordings were performed for at least 3 weeks preceding delivery in 15 pairs of dichorionic twins (group A) in which the smaller twin had fetal distress (i.e., antepartum fetal heart rate late decelerations) and in 10 pairs of diamniotic and monochorionic twins (group B) in which the diagnosis of twin-to-twin transfusion syndrome was confirmed postnatally. Doppler recordings were obtained from umbilical artery, descending aorta, and middle cerebral artery, and the pulsatility index values were calculated. Furthermore, peak velocity from cardiac outflow tract and the percent of reverse flow in the inferior vena cava were calculated. For all these index values the intertwin differences (delta value) were calculated by subtracting the values obtained in the larger twin with those of the smaller twin. RESULTS: In group A significant changes of delta values were evidenced for all the parameters tested. In particular, delta values of pulsatility index from the umbilical artery and descending aorta progressively increased approaching the occurrence of late decelerations, whereas the delta value for the middle cerebral artery reached a nadir 2 weeks before delivery. Similarly, delta values of peak velocity from outflow tracts significantly decreased, whereas those of the percent reverse flow in the inferior vena cava increased during the time considered. In group B fetuses no significant intertwin differences in pulsatility index values were evidenced in the vessels investigated, resulting in absence of modifications in delta values during the time interval considered. Moreover, significant changes were found in delta values of both the peak velocity from the outflow tract and the percent of reverse flow in the inferior vena cava. However, these changes were limited to the last recording, where the former delta value increased and the latter decreased. CONCLUSIONS: Serial Doppler recordings may show hemodynamic changes in the fetal circulation of discordant twins. Different trends occur according to the underlying pathophysiologic mechanisms of the growth defect. The knowledge of these temporal changes may be useful in the management of such fetuses.
The hysteroscopic findings of placental site nodule, an unusual and cytologically alarming lesion, is reported. A 29-year-old woman, para 2, presented with a 3 month history of intermenstrual bleeding. The last spontaneous delivery occurred 12 months previously. Pelvic examination was negative. Ultrasound examination revealed increased thickness and irregularity of the endometrium (16-18 mm). Diagnostic hysteroscopy performed the same day revealed the endometrial surface to be irregular due to a focal nodular lesion with increased regular vascularization in the fundal area. The nodule was about 2 cm in diameter, had an irregular surface and a variegated appearance, and was white-red in color with hemorrhagic and necrotic areas. A targeted biopsy of the lesion was performed. Histologic examination revealed a "placental site nodule." A subsequent D&C confirmed the diagnosis. Fifteen days after surgery, hPL and hCG serum levels were evaluated and were negative. This is the first hysteroscopic report of a placental site nodule. We conclude that hysteroscopic evaluation of abnormal uterine bleeding is very important, because it allows the examination of the uterine cavity and lesions, making possible a guided biopsy. Hysteroscopy is also useful during the follow-up of this type of pathology.
The objective of this study was to evaluate whether Braxton-Hicks contractions induce changes in fetal heart rate variation in normal and growth-retarded fetuses. 110 uncomplicated singleton pregnancies were cross-sectionally studied as well as 16 pregnancies complicated by fetal growth retardation secondary to uteroplacental insufficiency. Fetal heart rate variability was analyzed by a commercially available computerized system (2CTG Hewlett Packard, Italy) 10 min before and 10 min after the Braxton-Hicks contraction. All the included fetal heart rate tracings fulfilled the following criteria: (1) presence of a single Braxton-Hicks contraction in the 20 min considered; (2) absence of fetal heart rate decelerations after the contraction, and (3) stable fetal heart rate behavioral pattern in the period analyzed. 82 tracings of normal fetuses were analyzed during an active fetal heart rate pattern (type B) and the remaining 28 during a quiet pattern (type A). In both patterns no significant differences in delta value, long-term irregularity, short-term variability and interval index were found before and after the contraction. All the tracings of growth-retarded fetuses were analyzed during the fetal heart rate pattern A. Short-term variation and interval index significantly decreased during the first 5 min after the contraction while no significant differences were found in the other indices investigated. The decrease in these indices was significantly more marked in those fetuses developing fetal distress within 7 days. In conclusion, Braxton-Hicks contractions induce a significant decrease of short-term variation and interval index only in growth-retarded fetuses. This can be useful in the early identification of fetal compromise in such fetuses.
In an effort to determine the factors influencing the abnormal ventricular filling patterns of fetuses of type I diabetic mothers, Doppler flow velocity waveforms were recorded from fetal atrioventricular valves in 37 pregnancies complicated by type I diabetes immediately before an elective cesarean section. The ratio between the peak velocities during early passive ventricular filling and active atrial filling was calculated at the level of both atrioventricular valves and related to different factors including ventricular chamber wall thickness, heart rate, umbilical vein hematocrit and time to peak velocities values obtained at the outflow tract. Multiple stepwise regression demonstrated that the interventricular wall thickness, heart rate and hematocrit values significantly and independently affected the ratios between early and active ventricular filling from mitral and tricuspid valves. As a consequence all these factors should be taken into account in the interpretation of atrioventricular Doppler indices.
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Serum CA-125 concentrations were investigated preoperatively in 91 consecutive women undergoing laparoscopy for infertility, pelvic pain and/or annexial cysts. The presence and extent of endometriosis were carefully assessed, including the American Fertility Society stage of disease, and implant and adhesion scores. Postoperative CA-125 measurements were obtained in 32 of 53 endometriosis patients and evaluated with respect to clinical evolution of the disease. Serum levels of CA-125 were significantly increased in patients with endometriosis (46.5 +/- 39.5 vs. 13.5 +/- 7.3 U/ml in controls, p < 0.001) and correlated with the severity of disease. A positive correlation (r = 0.7, p < 0.001) was observed between adhesion score and CA-125 levels, while the relationship with implant score was not significant (r = 0.3, p = 0.07). CA-125 level was also significantly increased in women with peritoneal endometriosis (70.7 +/- 47.3 vs. 33.5 +/- 25.6 U/ml for those with ovarian endometriosis), and in these patients the post-operative CA-125 level was significantly related to the clinical evolution of the disease, being higher in patients whose disease recurred compared to those with negative follow-up, irrespective of the adhesion score. We conclude that in endometriosis patients, serum CA-125 level is directly related to the adhesion score and peritoneal involvement, suggesting a central role of pelvic and peritoneal irritation in the increased level of this serum marker.
Reference limits for the PI from the umbilical, middle cerebral, and renal arteries were constructed using BPD, AC, FL, and transverse cerebellar diameter as independent variables and their efficacy tested in a population of SGA fetuses. Therefore, 153 normal fetuses and 90 SGA fetuses with established dates between 20 and 40 weeks of gestation were considered. Normal fetuses showed a linear negative relationship between the PI from all the vessels investigated and all the biometric parameters considered. Although the BPD related better with the PI from the umbilical artery (r = 0.646) and the renal artery (r = 0.765) and the transverse cerebellar diameter related better with middle cerebral artery PI values (r = 0.510), no evident differences in fitting were found among the variables tested. In SGA fetuses the nomograms on BPD, AC, and FL significantly underestimated PI values in all the vessels studied when compared to the nomograms based on gestational age, while a similar ability in identifying abnormal PI values was found for nomograms based on gestational age and transverse cerebellar diameter. These newly developed nomograms based on transverse cerebellar diameter may prove useful in the evaluation of Doppler indices of fetuses with uncertain gestational age.
On the basis of the data obtained in sheep fetuses showing a high interdependence between umbilical vein oxygenation and ductus venosus flow, we investigated the effect of maternal hyperoxygenation on ductus venosus velocity waveforms in normal third-trimester human fetuses. Ductus venosus velocity waveforms were recorded by using color and pulsed Doppler ultrasonography before and after 15 min of maternal administration of humidified 60% oxygen. During maternal hyperoxygenation, there was a significant increase of both estimated peak velocities during systole, diastole and atrial contraction and the mean temporal velocity during the total cardiac cycle and systolic and diastolic portions. On the other hand, during maternal hyperoxygenation, no significant changes were found in fetal heart rate or in the ratios between peak velocities and mean temporal velocities during systole and diastole. These findings suggest a close relationship between fetal oxygenation and ductus venosus velocity waveforms that may be useful in monitoring fetal hypoxemia.
OBJECTIVES: Our objectives were to evaluate the time interval elapsing between the occurrence of absent end-diastolic velocity in the umbilical artery and either the development abnormal fetal heart rate patterns or delivery and to establish the maternal and fetal factors that may affect this interval. STUDY DESIGN: Thirty-seven fetuses free of structural and chromosomal abnormalities in which the development of absent end-diastolic velocity in umbilical artery was evidenced by serial Doppler recordings were studied. At the first occurrence the following factors were considered: gestational age, presence of hypertension or preeclampsia, amniotic fluid index, severity of growth retardation, and 10 different Doppler indices calculated from extracardiac and intracardiac vascular districts. Actuarial statistical methods were applied, with the occurrence of antepartum late heart rate deceleration as the censoring variable. RESULTS: The interval between the first occurrence of absent end-diastolic velocity in umbilical artery and delivery ranged from 1 to 26 days. Indications for delivery were the development of antepartum late heart rate decelerations in 23 fetuses (62.1%) and different maternal or fetal complications in the remaining 14 fetuses. Multivariate analysis revealed that gestational age and the presence of hypertension and pulsations in umbilical vein were the dominant factors in determining the length of this time interval. CONCLUSION: The duration of the time interval between the occurrence of absent end-diastolic velocity in umbilical artery and abnormal heart rate pattern differs considerably among fetuses, and it is mainly determined by gestational age and presence of maternal hypertension and pulsations in umbilical vein.
We previously demonstrated a prognostic significance of maternal oxygen test in predicting imminent fetal distress. The purpose of this study was to investigate eventual other factors related to the length of the time interval elapsing between the Doppler diagnosis of brain sparing effect and abnormal fetal heart rate patterns. To this end we considered 101 growth-retarded fetuses free of structural and chromosomal abnormalities with a ratio between the pulsatility indices of umbilical and middle cerebral artery above the 95th centile in presence of a normal fetal heart rate pattern. The factors, other than the oxygen test, analyzed for a potential influence on this time interval were gestational age, presence of hypertension or preeclampsia, amniotic fluid index, severity of growth retardation (centile of the ultrasonographic estimated fetal weight) and 9 different Doppler indices calculated from extra- and intracardiac districts. Statistical actuarial methods were used to determine the effect of these prognostic factors on the duration of this time interval. The occurrence of abnormal fetal heart rate patterns (antepartum late heart rate decelerations) was used as censoring variable. The time interval between the entry in the study and delivery ranged from 1 to 39 days. Indications for delivery were fetal distress in 53 fetuses (52.4%) and different maternal or fetal complications in the remaining 48 fetuses.(ABSTRACT TRUNCATED AT 250 WORDS)
OBJECTIVE: To compare uterine artery resistance index values in twin and singleton pregnancies, to examine eventual modifications of these values in twin pregnancies complicated by gestational hypertension and preeclampsia, and to determine whether resistance index values in twin pregnancies could predict the development of gestational hypertension and preeclampsia. METHODS: In a cross-sectional study, reference limits for gestation were constructed for the uterine artery resistance index (higher, lower, and mean values) in 96 uncomplicated twin pregnancies and compared to the reference limits constructed from 315 normal singleton pregnancies. Uterine artery resistance indexes obtained in 53 twin pregnancies complicated by either gestational hypertension or preeclampsia were compared with the newly established nomograms. The clinical efficacy of the uterine artery resistance index to predict hypertensive complications was evaluated prospectively in 64 twin pregnancies studied at 20-24 weeks' gestation. RESULTS: In both singleton and twin pregnancies, uterine artery resistance indexes decreased linearly with advancing gestation. However, twin pregnancies showed significantly different slopes and constant values, resulting in lower resistance indexes at all gestational ages examined. No significant differences were found when comparing resistance indexes in all patients with gestational hypertension or preeclampsia to the reference limits. Statistically significant differences were obtained for the higher (P < or = .05) and mean (P < or = .01) resistance indexes when the comparison was restricted to preeclamptic patients. In the twin pregnancies studied at 20-24 weeks' gestation, the diagnostic efficacy of the uterine artery resistance index for predicting the development of gestational hypertension and/or preeclampsia was disappointingly low (k < 0.10). CONCLUSIONS: Resistance index values in the uterine artery are lower in twin pregnancies than in singleton pregnancies. Gestational hypertension and preeclampsia may occur in twin pregnancies despite normal uterine artery velocity waveforms, suggesting a limited role of this measurement in the management and prediction of hypertensive complications in twin pregnancies.
Intrauterine growth retardation continues to be one of the major problems in obstetrics and still greatly contributes to perinatal mortality and morbidity. This paper reviews the role of Doppler ultrasonography in the antenatal assessment of fetuses with intrauterine growth retardation. Recent developments in this field are described with particular emphasis on the pathophysiologic background of the hemodynamic modification of fetuses with intrauterine growth retardation. Doppler ultrasonography allows the prediction of the development of intrauterine growth retardation in selected populations and the identification among a population of small-for-gestational-age fetuses, those really at risk of unfavorable outcome. Finally, the modifications occurring after the establishment of the growth retardation with the progression of fetal deterioration are described in an attempt to clarify the natural history of this condition. To this end, the longitudinal changes of Doppler indices of placental vessels, fetal arterial vessels, fetal heart, and venous circulation are described, and their complex interrelationship is analyzed. The knowledge of these mechanisms may be useful in deciding the timing of delivery.
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A cystic lesion in the anterior upper part of the abdomen was detected in utero by ultrasonography. Color and pulsed Doppler studies performed over the mass revealed a marked turbulent flow through the cystic lesion in connection with the umbilical vein, suggesting the existence of an intra-abdominal ectasia of the umbilical vein.