Fetal hypotrophy dopplerometry

Česká verze

Authors: L. Jabůrek; M. Procházka; M. Lubušký
Authors place of work: Gynekologicko-porodnicko-gynekologická klinika LF UP a FN Olomouc, přednosta prof. MUDr. R. Pilka, Ph. D.
Published in the journal: Ceska Gynekol 2011; 76(5): 393-396

Summary

Objective:
The aim of the study was the longitudinal analysis of the progression of dopplerometric abnormalities in intrauterine growth retardation (IUGR) since the onset of placental insufficiency.

Design:
Prospective study.

Setting:
Dept. of Gynaecology and Obstetrics, Medical Faculty and University Hospital, Olomouc.

Methods:
The study group consisted of 77 pregnat women with intrauterine growth retardation resulting from placental insufficiency. Of these, in 59 women, the intervals of progression were followed from the early to the advanced dopplerometric abnormalities. According to the findings the patients were classified into one of the three types of placental insufficiency.

Results:
In total, 486 dopplerometric measurements in 77 pregnant patients were performed. Mild placental insufficiency where abnormality of umbilical artery (UA) and cerebroplacental ratio (CPR) did not exceed 3 SD and the progressive interval was 31 days was found in 21 pregnat patients. Progressive placental insufficiency with a whole spectrum of abnormalities and the progressive interval of 18 days was found in 28 pregnat patients. Severe form of placental insufficiency (early onset of abnormalities before the 30th gestational week) a whole spectrum of abnormalities and progressive interval 8 days was found in 10 pregnat patients.

Conclusions:
Gestational week at the occurence of the first abnormality (elevation of the pulsatility index of UA over 2 SD) and the time interval to next abnormality (decrease of CPR under 2 SD) are important factors for the assessment of severity of placental insufficiency. Dynamic follow-up of abnormalities permits a better evaluation of the actual risk, the anticipation of the further development of placental insufficiency and in this way to apply suitable measures to prevent unfavourable perinatal outcomes.

Key words:
dopplerometry, fetal hypotrophy, placental insufficiency.

Zdroje

1. Acharya, G., Wilsgaard, T., Berntsen, GKR., et al. Reference ranges for serial measurements of umbilical artery Doppler indices in the second half of pregnancy. Am J Obstet Gynecol, 2005, 192, p. 937-944.

2. Arduini, D., Rizzo, G., Romanini, C. Changes of pulsatility index from fetal vessels preceding the onset of late deceleration in growth-retarded fetuses. Obstet Gynecol, 1992, 79, p. 605-610.

3. Baschat, AA., Gembruch, U., Harman, CR. The sequence of changes in Doppler and biophysical parametrs as severe fetal growth restriction worsens. Ultrasound Obstet Gynecol, 2001, 18, p. 571-577.

4. Baschat, AA., Gembruch, U. The cerebroplacental Doppler ratio revisited. Ultrasound. Obstet Gynecol, 2003, 21, p. 124-127.

5. Baschat, AA., Güclü, S., Kush, LM. Venous doppler in the prediction of acid-base status of growth-restricted fetuses with elevated placental blood flow resistence. Am J Obstet Gynecol, 2004, 191, p. 277-284.

6. Baschat, AA., Cosmi, E., Bilardo, CM., et al. Predictors of neonatal outcome in early-onset placental dysfunction. Obstet Gynecol, 2007, 109, p. 253-261.

7. Callan, PW. (ed). Ultrasonography in obstetrics and gynaecology, 5th ed. Philadelphia: Saunders Elsvier, 2008, p. 322-325.

8. Ebbing, C., Rasmussen, S., Kiserud, T. Middle cerebral artery blood flow velocities and pulsatility index and the cerebroplacental pulsatility ratio: longitudinal reference ranges and terms for serial measurements. Ultrasound Obstet Gynecol, 2007, 30, p. 287-296.

9. Hecher, K., Campbell, S., Doyle, P., et al. Assessment of fetal compromise by Doppler ultrasound investigation of the fetal circulation. Arterial, intracardiac, and venous blood flow velocity studies. Circulation, 1995, 91, p. 129-138.

10. Hecher, K., Hackeloer, B. Cardiotocogram compared to Doppler investigation of the fetal circulation in the premature growth-retarded fetus: longitudinal observations. Ultrasound Obstet. Gynecol, 1997, 9, p. 152-161.

11. Hecher, K., Bilardo, CM., Stigter, RH., et al. Monitoring of fetuses with intrauterine growth restriction: a longitudinal study. Ultrasound Obstet Gynecol, 2001, 18, p. 564-570.

12. Kessler, J., Rasmussen, S., Hanson, M., Kiserud, T. Longitudinal reference ranges for ductus venous flow velocities and waveform indices. Ultrasound Obstet Gynecol, 2006, 28, p. 890-898.

13. Kiserud, T., Eik-Nes, SH., Blaas, S., et al. Ductus venosus blood velocity and the umbilical circulation in the seriously growth-retarded fetus. Ultrasound Obstet Gynecol, 1994, 4, p. 109-114.

14. Kučera, J., Kubelík, J., et al. Nové tabulky normální porodní hmotnosti pro Českou republiku. Čs Pediatr, 1999, 54 (10), s. 572-578.

15. Ozcan, T., Sbracia, M., dęAncona, RL., et al. Arterial and venous Doppler velocimetry in the severely growth-restricted fetus and associations with averse perinatal outcome. Ultrasound Obstet Gynecol, 1998, 12, p. 39-44.

16. Turan, OM., Turan, S., Gungor, S., et al. Progression of Doppler abnormalities in intrauterine growth restriction. Ultrasound Obstet Gynecol, 2008, 32, p. 160-167.

17. Wladimiroff, JW., Tonge, HM., Stewart, PA. Doppler ultrasound assessment of cerebral blood flow in the human fetus. Br J Obstet Gynaecol, 1986, 93, p. 471-475.