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PubMed1995

Cerebellar growth in normal and growth-restricted fetuses of multiple gestations.

OBJECTIVE: Our purpose was to evaluate growth of the cerebellum in growth-restricted fetuses of twin and triplet gestations versus growth in normal in utero sibling(s) and in singleton gestations. STUDY DESIGN: An ultrasonographic study was conducted in a population of pregnant women with twin and triplet gestations. The control group was either the normal in utero sibling(s) when one fetus was growth restricted or normal twin and singleton pregnancies. Standard biometric measurements were obtained on all fetuses throughout pregnancy, including the transverse cerebellar diameter. However, only the last measurement was used for the analysis. Statistical analyses were conducted comparing growth of the transverse cerebellar diameter among the growth-restricted fetuses versus growth in the normal in utero fetal sibling(s) or other normal twin and singleton gestations. RESULTS: Pregnancies were categorized on the basis of the growth status of women with twin and triplet gestations: Group 1 (151) contained women with two fetuses appropriately grown for gestational age; group 2 (52) had one appropriately grown fetus and one with intrauterine growth restriction; group 3 (19) had two fetuses with intrauterine growth restriction. In addition, there were 30 triplet gestations (group 4), five of which had growth-restricted fetuses, and group 5 contained 1405 singleton pregnancies. In all five groups there was a statistically significant relationship between transverse cerebellar diameter and gestational age (p < 0.0001). There was also no significant difference between growth of the transverse cerebellar diameter in the appropriately grown and growth-restricted siblings and among normal singleton and twin pregnancy groups. In most cases of growth-restricted fetuses, except for the transverse cerebellar diameter measurements, all other biometric parameters were < 10th percentile. CONCLUSION: These data confirm the relative preservation of normal cerebellar growth in growth-restricted fetuses and a similar rate of growth in singleton and multifetal gestations. The transverse cerebellar diameter therefore represents an independent biometric parameter that can be used in both singleton and multifetal pregnancies to assess normal and deviant fetal growth.

Biometry↗
PubMed1987

Emergence of behavioural states in fetuses of type-1-diabetic women.

The aim of this study was to investigate the effects of tightly controlled maternal (type-1-)diabetes mellitus on the development of fetal behavioural states. Seventeen diabetic women, who required insulin (White's class C predominantly) and were treated with continuous subcutaneous insulin infusion (CSII) therapy, participated in the study. Adjustment to an insulin-pump occurred before conception or during early pregnancy. In all diabetic women (near-)normoglycemia was achieved during pregnancy, with glycosylated hemoglobin-values within the normal range (6-8.5%). Fifty-three 2-h recordings of fetal heart rate, uterine contractions and of real-time ultrasound scanning for fetal body movements, breathing and eye movements were obtained from the 17 fetuses. The fetuses were longitudinally studied between 32 and 40 weeks post menstrual age, at intervals of 2 weeks. The 3 state variables, fetal heart rate, body movements and eye movements, were analyzed for the presence of combinations meeting the definitions of the four fetal behavioural states. Findings in the fetuses of diabetic women were compared with those obtained from 28 low risk fetuses. The criteria of states were met in only 3 of 8 fetuses studied at 38 weeks and in one of two studied at 40 weeks. For comparison: in low risk fetuses studied at 38 and 40 weeks, states were present in 70% and 90% of the cases, respectively. This poorly developed state organization exhibited by the near term fetuses of the diabetic group, was related to maternal parity, but not to pre- or postconceptional onset of CSII-treatment. Fetuses of nulliparous diabetic women showed more often asynchrony of transitions (greater than 3 min) and interruption of periods of concordant association. This resulted in significantly higher percentages of 'no-coincidence' and in low incidence of behavioural states as compared with control fetuses of nulliparous women. In the few multiparous diabetic cases studied near term the development of fetal behavioural states was normal. We conclude therefore that, despite tight control of maternal diabetes, the development of behavioural states is disturbed in fetuses of nulliparous diabetic women.

Adult↗
PubMed1994

The relationship between age-related heart rate changes and developing brain function: a model of anencephalic human fetuses in utero.

We attempted to identify the brain segment which controls heart rate changes in human fetuses with advancing gestation. Twelve anencephalic and 165 normal fetuses (control-group fetuses) between 25-32 weeks' gestation were studied. The instantaneous fetal heart rate (FHR) data were obtained from each fetus for a continuous 90-120 min period, using an external cardiotocograph. Calculations included the 'individual probability distribution matrices' in which the FHRs at 1 beat/min intervals between 110 and 180 beats/min, the beat-to-beat differences (DFHRs) between +/- 5 beats/min and the probability values were arranged in rows, columns and the corresponding elements, respectively. Using 2-gestational-week intervals probability distribution matrices (age-group probability distribution matrices) obtained from 335 normal fetuses in our previous study as a reference, the difference between a given 'individual probability distribution matrix' and the corresponding age-group probability distribution matrix' was quantified as the 'difference rate' according to the formula in the text. From 25-26 to 27-28 weeks' gestation, the 'difference rates' in four anencephalic fetuses, with only the spinal cord preserved, were significantly higher in value than those of control-group fetuses, whereas the rates in four fetuses with both the spinal cord and medulla oblongata preserved, indicated no significant differences. From 29-30 to 31-32 weeks' gestation, the rates of the four fetuses with the spinal cord and medulla oblongata preserved, showed significant differences from the control-group fetuses. These findings suggest that there is a critical period between 27-28 and 29-30 weeks' gestation with regard to the developing brain function pertaining to FHR changes. In the early stage, the medulla oblongata plays a role in FHR changes, whereas, in the latter stage, the brain cephalad to the medulla also appears to take on the role of FHR regulator.

Anencephaly↗
PubMed1992

Autonomic and arginine vasopressin modulation of the hypoxia-induced atrial natriuretic factor release in immature and mature ovine fetuses.

OBJECTIVE: This study investigated the maturational change in the atrial natriuretic factor response to hypoxia in ovine fetuses and the role of the autonomic nervous system and arginine vasopressin in modulating this response. STUDY DESIGN: Chronically catheterized ovine fetuses from 110 to 135 days' gestation were subjected to 30 minutes of hypoxia. The fetuses were either intact, treated with hexamethonium to block the autonomic nervous system, or treated with a pressor antagonist of arginine vasopressin. RESULTS: Hypoxia elevated plasma atrial natriuretic factor levels by 1635 +/- 265 pg/ml in immature fetuses; this response was greater than the increase of 748 +/- 189 pg/ml in mature fetuses (p < 0.0001). Blockade of the autonomic nervous system reduced the atrial natriuretic factor response and suppressed the vascular pressure changes to hypoxia in immature but not in mature fetuses. A vasopressin pressor antagonist suppressed the atrial natriuretic factor but not vascular pressure responses to hypoxia in mature fetuses. CONCLUSIONS: This study demonstrates that the immature fetus manifested a greater atrial natriuretic factor response to hypoxia than did the mature fetus. This enhanced response appeared to be dependent on the modulatory effects of the autonomic nervous system on vascular pressures during hypoxia. In addition, arginine vasopressin appeared to augment the atrial natriuretic factor response to hypoxia in the mature fetus independent of vascular pressure changes.

Animals↗
PubMed1993

Correlation of Doppler and placental immunohistochemical features in normal and intrauterine growth-retarded fetuses.

The aim of this study was to correlate and compare Doppler and anatomical placental findings obtained from 48 normal and 35 intrauterine growth-retarded (IUGR) fetuses. The IUGR group consisted of 19 fetuses from pregnancies complicated by pre-eclampsia and 16 from healthy mothers. Color Doppler evaluation of umbilical, spiral and uterine arteries was performed. Placental specimens from both normal and growth-retarded fetuses were obtained at the time of delivery. Placental specimens were evaluated using histochemical and immunohistochemical techniques. A progressive decrease in the pulsatility index was observed in umbilical, spiral and uterine arteries throughout pregnancy in the normal-growth fetuses. High umbilical artery pulsatility index values were obtained in 29 out of the 35 growth-retarded fetuses, six of them showing absent or reversed end-diastolic umbilical artery flow pattern. A total of 13 IUGR fetuses showed high resistance uterine artery flow velocity waveforms. Increased pulsatility index values were obtained from the spiral arteries of 16 growth-retarded fetuses. Abnormal histological and histochemical placental patterns were observed in all the growth-retarded fetuses with umbilical artery Doppler abnormalities. The presence of a peculiar dendritic cell subpopulation, strongly resembling the Langerhans cells, expressing the HLA-DR+/CD1+ phenotype, was detected in all growth-retarded fetuses, whether there was maternal pathology or not. Our data show uterine and spiral artery data as being ineffective in the monitoring of IUGR fetuses. The placental extracellular matrix seems to play an important role in the regulation of the umbilical circulation. The presence of CD1+ cells as a sign of a possible immunological mechanism in the pathogenesis of the intrauterine growth retardation is discussed.

Journal Article↗
PubMed1994

Transverse cerebellar diameter in small-for-gestational-age fetuses: pregnancy dating is possible only when growth retardation is secondary to uteroplacental insufficiency.

The objective of this study was to establish whether measurement of the transverse cerebellar diameter to determine gestational age differs in small-for-gestational-age fetuses with normal or abnormal Doppler velocity waveforms. Our secondary objective was to compare the efficacy of measurement of transverse cerebellar diameter with that of femur length in pregnancy dating among small-for-gestational-age fetuses. A total of 107 small-for-gestational-age fetuses with established dates and free from structural and chromosomal abnormalities were considered for this study. According to the Doppler results, fetuses were divided into two groups: group A (n = 64), with normal Doppler values as expressed by a ratio of pulsatility indices between the umbilical artery and middle cerebral artery of 95th centile. Measurements of transverse cerebellar diameter and femur length were compared to previously established 95th centile prediction intervals. In both groups of small-for-gestational-age fetuses, the values for transverse cerebellar diameter were lower than in normally grown fetuses after normalization for gestational age. The difference was more evident in group A (p <or= 0.001) than in group B (p <or= 0.05). Only 68.7% of transverse cerebellar diameter values of group A fetuses fell within the normal limits for gestation, while this occurred in 90.6% of group B fetuses. When compared to the femur length, the transverse cerebellar diameter measurement appeared to be better for predicting gestational age in both groups of small-for-gestational-age fetuses (p <or= 0.001). However, this measurement may be used to estimate gestational age only in small-for-gestational-age fetuses with abnormal Doppler findings.

Journal Article↗
PubMed1995

Ventricular ejection force in growth-retarded fetuses.

The objective of this study was to determine whether in growth-retarded fetuses secondary to uteroplacental insufficiency the cardiac ventricles exert a force different from that of appropriately grown fetuses. Doppler echocardiographic studies were performed in 156 appropriately grown fetuses (gestational age 18-38 weeks) and in 72 growth-retarded fetuses (gestational age 24-36 weeks) free from structural and chromosomal abnormalities and characterized by Doppler changes in the umbilical artery and middle cerebral artery suggesting uteroplacental insufficiency as the most likely etiology of the growth defect. Right and left ventricular ejection force values were calculated from velocity waveforms recorded at the level of aortic and pulmonary valves, according to Newton's second law of motion. In appropriately grown fetuses, left and right ventricular ejection force values significantly increased with advancing gestation and the two ventricles exerted similar force. In growth-retarded fetuses, the ventricular ejection force was significantly and symmetrically decreased in both ventricles. Among growth-retarded fetuses, a poorer perinatal outcome was observed in those fetuses in which the ejection force of both ventricles was below the 5th centile of the normal limits for gestation. In 12 growth-retarded fetuses followed longitudinally during the last week preceding intrauterine death or Cesarean section due to antepartum heart-rate late decelerations, a significant decrease of ejection force was found in both ventricles. Finally, a significant relationship was found between the severity of acidosis and right and left ventricular ejection force values in 22 fetuses in which Doppler recordings were performed immediately before cordocentesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Case-Control Studies↗
PubMed1996

Adrenal artery velocity waveforms in the appropriate and small-for-gestational-age fetus.

The purpose of this study was to compare adrenal artery flow velocity waveforms in the appropriately grown and the small-for-gestational-age fetus. Adrenal artery flow velocity waveforms were prospectively obtained from 131 appropriate- and 21 small-for-gestational-age fetuses with pulsed Doppler ultrasonography. The success rate in recording the adrenal artery was 84% (131/155) and 100% in the appropriate- and small-for-gestational-age fetuses, respectively. The pulsatility index (PI) was used to quantify the waveforms. The PI in the appropriate-for-gestational-age fetuses decreased linearly with gestational age (PI = 1.7-0.016 x gestational age). In ten small-for-gestational-age fetuses the adrenal artery PI was below the 95% confidence interval. Small-for-gestational-age fetuses with abnormal adrenal artery PI had a significantly higher incidence of fetal heart rate decelerations, preterm delivery and Cesarean sections when compared to small-for-gestational-age fetuses with normal adrenal artery PI. Our data indicate that the PI of the adrenal artery in the normal fetus decreases with advancing gestation, and they suggest that in the small-for-gestational-age fetus there is an increased blood flow to the adrenal gland. We postulate that management of the small-for-gestational-age fetus may be aided by the study of the adrenal artery flow velocity waveforms.

Adrenal Glands↗
PubMed1997

Outcome of fetuses with heart disease diagnosed in utero.

OBJECTIVE: To review the outcomes of 193 fetuses with cardiac abnormalities detected by echocardiography. METHODS: A total of 422 fetuses between 16 and 41 gestational weeks, referred to paediatric cardiologists for detailed echocardiography, were included in this study. RESULTS: Structural heart defects were found in 55 (28%), isolated arrhythmia in 105 (54%), and other non-structural abnormalities (dilated cardiomyopathy, hypertrophic cardiomyopathy, aneurysm of the foramen ovale, isolated pericardial effusion or echogenic foci) in 33 (17%) of 193 fetuses. Total mortality was 26%. The prognosis was poor in fetuses with structural heart defects; 37 of 55 cases (67%) died in utero or postnatally. Chromosomal abnormality was associated with structural heart defect in 38% of fetuses, of whom 38% died. Among fetuses with isolated arrhythmia survival was 95%. Poor outcome was associated with complete heart block (n = 14) in 2 (14%) fetuses with hydrops and heart rate of less than 55 per minute, and with supraventricular tachycardia (n = 21) in three (14%) neonates delivered prematurely at a mean gestational age of 33 weeks. Furthermore, nine of 12 fetuses (75%) with structural heart defects and arrhythmia died. Among fetuses with non-structural cardiac abnormalities, survival was 73%. Poor outcome was evident in fetuses with dilated cardiomyopathy in eight of 13 (62%) and with hypertrophic cardiomyopathy in one of eight (13%) of cases. CONCLUSIONS: Factors associated with a poor prognosis were: structural heart defect associated with chromosomal abnormality or arrhythmia, congestive heart failure associated with supraventricular tachycardia or complete heart block, especially if delivery occurs preterm; and fetal hydrops with congestive heart failure and atrioventricular valve regurgitation.

Arrhythmias, Cardiac↗
PubMed1988

Computerized analysis of behavioural states in asymmetrical growth retarded fetuses.

The fetal behaviour of 15 asymmetrical intrauterine growth retarded (IUGR) fetuses was compared to that of a control group of healthy fetuses. Fetuses underwent simultaneous cardiotocographic and ultrasonographic examinations for 2 consecutive hours at 36-38 weeks' gestation. Behavioural states analysis was carried out by means of a computerized system (Digital PDP 11) that allowed the recording of several fetal variables including heart rate (FHR), gross body movements (FM), eye movements (FEM) and breathing movements (FBM). FHR was classified in four different patterns (FHRP) according to Nijhuis et al.; fetal movements were automatically synchronized with FHR and grouped for each FHRP. Several quantitative parameters (i.e. incidence, mean duration, lag time, % time spent moving) were then computed for each movement. There were no statistical differences in the distribution of FHRP between healthy and IUGR fetuses. On the other hand quantitative differences were found when the movements investigated were related to FHRP. In IUGR fetuses FEM were mainly represented by low frequency movements (IEM) during both low (FHRP A) and high variability (FHRP B) FHRP, whereas healthy fetuses exhibited mostly rapid eye movements (REM) during FHRP B and absent type of FEM during FHRP A. Moreover IUGR fetuses showed a reduction of state 1F (quiet sleep) and an increase of periods of no coincidence between behavioural state variable when compared to the control group fetuses. These findings, therefore suggest the existence of quantitative differences in fetal behaviour in asymmetrical IUGR fetuses when compared to healthy fetuses.

Cardiotocography↗
PubMed1994

Clinical application of pulsatility index of flow volume to detect the hemodynamic changes in IUGR fetus.

We attempted to assess feto-placental circulation in fetuses with intrauterine growth retardation (IUGR) by calculating the pulsatility index of flow volume (PIQ) based on the quantitative measurement of blood flow. Doppler sound was processed by an analog to digital converter and a frequency analyzer. Multiplication of frequency and signal strength of the Doppler sound at a certain time theoretically represents a value proportional to flow volume. Using this value, we calculated PIQ of the descending aorta, umbilical artery, and middle cerebral artery in normal fetuses, IUGR fetuses, and distressed fetuses during 24-41 weeks gestation. The PIQ of the fetal descending aorta in the IUGR fetus was significantly higher than that of the normal fetus. When cutoff value was set to mean +1 SD, abnormal PIQ was observed in 88% of IUGR fetuses. In contrast, the abnormal pulsatility index of maximal flow velocity (PIV) of the descending aorta was observed in only 62% of IUGR fetuses. In the distressed fetuses, both PIQ and PIV of the umbilical artery increased, and these indices of the middle cerebral artery markedly decreased. It is suggested that the increased PIQ of the descending aorta is an early indicator of changes in the fetal circulation in IUGR fetuses.

Aorta↗
PubMed1987

Malformations in rat fetuses induced by trypan blue.

Malformations of fetuses obtained from Wistar rat dams treated with trypan blue during gestation were studied. Fetuses were examined on day 20 of gestation. One hundred and twenty-seven fetuses showed abnormalities of the external features, skeleton and internal organs, separately or in combination. External malformations were found in 108 fetuses. The most frequent external malformation was anomaly of tail. Spina bifida, club foot, exencephaly and anal atresia were also observed frequently. Skeletal malformations were detected in 48 fetuses. Deformity of vertebrae in the lumbar, sacral and/or caudal regions was found in 46 fetuses. Internal malformations were observed in 27 fetuses. Anomaly of heart and/or great vessels, hydrocephaly and micro- or anophthalmia were observed frequently. About 90% of the fetuses with skeletal malformations also showed some external malformations. In contrast, about 48% of the fetuses with internal malformations also had some external malformations. These results suggest that, for teratological study, internal examination is more important in detecting malformations of fetuses than skeletal examination.

Abnormalities, Drug-Induced↗
PubMed1992

Effect of decapitation and chronic in-vivo treatment with a gonadotrophin-releasing hormone agonist on testicular steroidogenesis in the rat fetus.

To study the effect of in-vivo gonadotrophin-releasing hormone (GnRH) treatment on testicular testosterone production during late fetal life in the rat, 18.5-, or 20.5-day-old fetuses were decapitated and injected with either long-acting microcapsules containing the GnRH agonist D-Trp-6-GnRH or vehicle only. Two days later, fetal and maternal plasma was collected and fetal testes were removed and incubated for 6 h in medium with either 100 ng LH/ml or without LH. The GnRH agonist concentrations in the plasma of GnRH-treated decapitated male fetuses were comparable in the two age-related groups (5 nmol/l). After treatment of the fetus with D-Trp-6-GnRH, the agonist was recovered in maternal plasma, showing that this peptide can cross the fetal-maternal barrier. In 22.5-day-old decapitated vehicle-treated male fetuses, the plasma testosterone level dropped to that observed in control female fetuses, and treatment of decapitated male fetuses with the GnRH agonist did not further reduce it. At both days 20.5 and 22.5, basal in-vitro testosterone secretion by testes from decapitated vehicle-treated fetuses was lower than secretion by testes from intact control fetuses from the same litter, but LH-stimulated secretion was similar in both groups. Both basal and LH-stimulated secretion by testes from GnRH-treated decapitated fetuses was lower than secretion by testes from vehicle-treated decapitated fetuses and larger reductions were measured on day 22.5 than on day 20.5 (-48 vs -18% for basal secretion, and -76 vs -40% for LH-stimulated secretion).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2004

Complementary role of MRI after sonography in assessing bilateral urinary tract anomalies in the fetus.

OBJECTIVE: The objectives of our study were to evaluate the contribution of adding MRI findings to inconclusive sonographic data when assessing fetal urinary tract anomalies and to determine how this addition may affect the management of pregnancy. SUBJECTS AND METHODS. We prospectively used MRI to study 16 third-trimester fetuses in whom sonography suggested bilateral urinary tract anomalies but failed to provide a definite diagnosis. These anomalies included enlarged hyperechoic kidneys (n = 6), bilateral pelvicaliceal dilatation (n = 6), renal cystic lesions (n = 2), and renal agenesis associated with severe oligohydramnios (n = 2). RESULTS: The addition of MRI to sonography modified the diagnosis in five fetuses. In a fetus with suspected bilateral ureteropelvic obstruction, the diagnosis of bilateral ureterohydronephrosis associated with reflux or ureterovesical junction obstruction was made. In a fetus with an enlarged bladder at 32 weeks' gestational age, a possible diagnosis of megacystic microcolon was excluded on the basis of the normal appearance of the colon. In two fetuses with enlarged hyperechoic kidneys, MRI showed localized medullary hyperintense lesions suggesting autosomal recessive polycystic kidney disease in one fetus and medullary cystic dysplasia in another fetus with Jeune's syndrome. In a patient with suspected unilateral renal agenesis, MRI showed bilateral agenesis. In four fetuses, the addition of MRI to sonography led to a diagnosis that modified the decision to continue or terminate the pregnancy. CONCLUSION: MRI can accurately show many urinary tract anomalies in third-trimester fetuses. It may be a useful complementary tool in the assessment of bilateral urinary tract anomalies of fetuses, particularly in cases with inconclusive sonographic findings.

Adult↗
PubMed1990

Influence of breed of fetus on periparturient endocrine responses and subsequent milk production of Ayrshire dams.

Purebred Ayrshire females were assigned to two groups based on the breed of fetus carried during gestation. In group 1, Limousin embryos were transferred nonsurgically into Ayrshire recipients (10 heifers and 1 cow), and in group 2, 11 Ayrshire heifers and 1 cow were inseminated artificially to Ayrshire bulls. Blood samples were collected daily from d 265 of gestation until d 15 postpartum from 5 heifers of each group. Milk yield was recorded on alternate weeks during the first 20 wk postpartum. Calf birth weight was higher (44.2 vs. 35.4 kg) and gestation was longer (297.4 vs. 280.2) in Ayrshire dams bearing Limousin fetuses than in those bearing Ayrshire fetuses. Daily milk production for the first 20 wk was lower (18.1 vs. 20.8 kg) in Ayrshire dams bearing Limousin fetuses than in those bearing Ayrshire fetuses. Prepartum decrease in progesterone concentrations and increase in estrone concentrations were faster in Ayrshire heifers bearing Limousin fetuses than in those bearing Ayrshire fetuses. Profiles of peripartum concentrations of bovine placental lactogen differed between Ayrshire carrying different families of Limousin fetuses but were similar in those carrying families of Ayrshire fetuses. The concentrations of 15-keto-13,14-dihydroprostaglandin F2 alpha were lower during the postpartum period in heifers than gave birth to Limousin calves than in those that had Ayrshire calves. In conclusion, the breed of fetus influences physiological and endocrine responses of the dam, which might have some effect on milk production of the dam.

Animals↗
PubMed2000

Foot length in fetuses with abnormal growth.

Sonographic fetal foot length is highly predictive of gestational age. In order to assess the reliability of this parameter in predicting gestational age in cases of abnormal fetal growth, we examined fetal foot length in small- and large-for-gestational-age fetuses. A nomogram of foot length versus gestational age between 15 and 37 weeks was constructed using cross-sectional data obtained from 5372 singleton fetuses. Fetal foot lengths for small-for-gestational-age fetuses (estimated fetal weight below the 10th percentile) and large-for-gestational-age fetuses (above the >90th percentile) fetuses were plotted against the foot length nomogram in order to determine the number of small-for-gestational-age fetuses and large-for-gestational-age fetuses with foot lengths below the 10th and above the 90th percentiles, respectively. Of the 586 small-for-gestational-age fetuses, 355 (60.6%) had foot lengths below the 10th percentile on the nomogram. When foot lengths from large-for-gestational-age fetuses were plotted on the foot length nomogram, 29.4% (219 of 744) had measurements above the 90th percentile. Fetal foot length can be influenced by growth restriction as well as states of accelerated fetal growth. Our findings imply that there are limitations to the use of fetal foot length for gestational age assessment, particularly in fetuses with growth abnormalities.

Female↗
PubMed2003

Umbilical cord morphologic characteristics and umbilical artery Doppler parameters in intrauterine growth-restricted fetuses.

OBJECTIVE: To compare prenatal morphometric changes of umbilical cord components in intrauterine growth-restricted fetuses with and without abnormal umbilical artery Doppler parameters. METHODS: Consecutive singleton intrauterine growth-restricted fetuses at a gestational age of older than 20 weeks were compared with matched appropriate-for-gestational-age fetuses. Intrauterine growth restriction was defined in the presence of a sonographic abdominal circumference below the 5th percentile for gestational age at the time of sonography and a birth weight below the 10th percentile. The sonographic examination included pulsed Doppler measurements of the umbilical artery resistance index and measurements of the umbilical cord cross-sectional area and the umbilical cord vessel area. RESULTS: A total of 84 intrauterine growth-restricted fetuses and 168 appropriate-for-gestational-age fetuses were included in the study. All umbilical cord components (umbilical cord cross-sectional area, vein area, artery area, and Wharton jelly area) were smaller in the intrauterine growth-restricted fetuses. The prevalence of lean umbilical cords (cross-sectional area < 10th percentile for gestational age) was significantly higher in intrauterine growth-restricted fetuses compared with appropriate-for-gestational-age fetuses (73.8% versus 11.3%; P < .0001). A significant and progressive reduction of the umbilical vein area corresponding to the degree of umbilical artery Doppler parameter abnormality was found. The umbilical artery area was not related to the hemodynamic changes of the blood flow in the umbilical arteries. CONCLUSIONS: The proportion of lean umbilical cords was higher in intrauterine growth-restricted fetuses than in appropriate-for-gestational-age fetuses. Umbilical vein caliber decreases significantly with worsening of umbilical artery Doppler parameters.

Adult↗
PubMed2005

Middle cerebral artery peak systolic and ductus venosus velocity waveforms in the hydropic fetus.

OBJECTIVE: The purpose of this study was to assess whether Doppler assessment of the middle cerebral artery (MCA) peak systolic velocity (PSV) and ductus venosus (DV) velocity waveforms during sonography of hydropic fetuses may specify the cause of fetal hydrops. METHODS: A level II sonographic examination was performed in 16 hydropic fetuses, and the MCA PSV and DV velocity waveforms were assessed. The MCA PSV values divided hydropic fetuses into anemic (group 1) and nonanemic (group 2) fetuses. In group 2 fetuses, the DV was defined as normal or abnormal. Sonographic examination and Doppler assessment of these vessels specified the cause of hydrops and indicated the use of specific investigations for diagnosing the etiology of fetal hydrops. RESULTS: Seven of 16 fetuses had MCA PSV values greater than 1.50 multiples of the median (group 1). Nine of 16 fetuses had normal MCA PSV values (group 2); among them, 7 of 9 had either absent or reversed flow in the DV, and 2 had a normal DV. In group 1, the cause of fetal anemia was investigated by maternal serum tests, and 5 cordocentesis procedures were performed. In group 2, 7 of 9 fetuses had reversed flow in the DV, which suggested a cardiac abnormality confirmed by echocardiography. Five cordocentesis procedures were performed for fetal karyotype, and in 2 fetuses, the cause of hydrops was idiopathic. CONCLUSIONS: Our data suggest that assessment of the MCA PSV and DV velocity waveforms in the hydropic fetus may further our knowledge of the etiology of hydrops and may indicate which investigations among the many available should be used for diagnosing the cause of fetal hydrops.

Blood Flow Velocity↗