Academic literature on the topic 'Aortic isthmus PI'

Background: The objective of the present study was to find out association between aortic isthmus Doppler changes and perinatal outcome in growth restricted fetuses with placental insufficiency.Methods: It is a prospective case control study, cases were 43 pregnant women with fetal growth restriction (FGR) with abnormal umbilical artery (UA) Doppler while 43 pregnant women with FGR but normal UA doppler, matched with period of gestation were taken as control. The direction of blood flow in aortic isthmus studied which may be antegrade, absent or retrograde and correlation between qualitative parameters of umbilical artery, aortic isthmus and ductus venosus were studied. Quantitative parameters, PI and RI were also calculated. Patients were managed as per hospital protocols. Perinatal outcome and any adverse event e.g. stillbirth, neonatal death, respiratory distress syndrome, intensive care unit stay >14 days etc. was noted.Results: The number of intrauterine death (IUD) and still birth was increased in women with absent and retrograde flow in aortic isthmus, 66.7% and 71.4% respectively (p value <0.001). Retrograde blood flow in the aortic isthmus is consistently associated with absent or reverse end diastolic velocity in umbilical artery and ductus venosus.Conclusions: Doppler of aortic isthmus is an additional parameter to assess severity of FGR. It plays an important role in termination of preterm FGR fetuses.

Objective: We aim to evaluate the foetal aortic isthmus Doppler data after maternal COVID-19 disease. Material and Methods: Twenty six pregnant patient who recovered from COVID-19 and 43mhealthy patient were included in this prospective case–control study. The study group consisted of those who had COVID-19 disease and completed the quarantine period. Results: Doppler ultrasound evaluations were performed at the similar gestational week. We observed significantly high pulsatility indices (PI) of umbilical and aortic isthmus in study group than the control group (p=0,02, p=0,02). There was no significant change in cerebroplacental ratio (CPR) between the two groups (p>0.05). Conclusion: COVID-19 may affect placental function in pregnant women and could deterioration on foetal circulation and Doppler parameters. In particular, changes in aortic isthmus doppler flow indicating foetal circulation and cerebral oxygenation help to reflect the foetal effects of COVID-19.

AbstractBackgroundAs conflicting results have been reported about the association of reversed flow on the aortic isthmus (AoI) and adverse perinatal results in fetal growth restriction (FGR), we aim to compare perinatal outcomes (including tolerance to labor induction) of late-onset FGR between those with anterograde and reversed AoI flow.MethodsThis was an observational retrospective cohort study on 148 singleton gestations diagnosed with late-onset FGR (diagnosis ≥32+0 weeks), with an estimated fetal weight (EFW) <10thcentile and mild fetal Doppler alteration: umbilical artery (UA) pulsatility index (PI) >95thcentile, middle cerebral artery (MCA)-PI <5thcentile or cerebral-placental ratio <5thcentile. Anterograde AoI flow was present in n=79 and reversed AoI flow in n=69. Delivery was recommended from 37 weeks in both groups. Perinatal results were compared between the groups.ResultsThe global percentage of vaginal delivery of fetuses with anterograde and reversed blood flow was 55.7% vs. 66.7% (P=0.18) and the percentage of cesarean section (C-section) for non-reassuring fetal status was 12.7% vs. 15.9% (P=0.29), respectively. When evaluating those that underwent labor induction, the vaginal delivery rate was 67.9% vs. 77.2% (P=0.17), respectively. There were no significant differences regarding any other perinatal variables and there were no cases of severe morbidity or mortality.ConclusionWe observed that the presence of reversed AoI flow does not worsen perinatal outcomes on fetuses with late-onset growth restriction with mild Doppler alterations. Attempt of labor induction is feasible in these fetuses regardless of the direction of AoI flow.

Objective.To evaluate the ultrasound multiparametric assessment of the impact of hypertensive disorders of pregnancy (HDP) on fetal cardiac function and growth and development. Methods. In this prospective study, 98 cases of HDP treated in our institution were recruited into a study group, and 100 pregnant women with healthy singleton pregnancies were included in a control group. All eligible patients were also assigned to either study group A (HDP fetuses with growth restriction) or study group B (HDP fetuses with normal growth). Fetal echocardiography was performed on all eligible participants to obtain hemodynamic and cardiac function parameters for the evaluation of fetal growth and development, and the impact of HDP on fetal heart function and growth and development was analyzed. Results. HDP fetuses were associated with smaller head circumference, biparietal diameter, femoral length, and abdominal circumference versus healthy fetuses. The study group had a higher resistance index (RI) and pulsatility index (PI) of umbilical artery (UA), ductus venous (DV), pulmonary vein (PV), and lower RI and PI of aortic isthmus (AoI) than the control group. The study group showed higher left and right ventricular isovolumic contraction time (IVCT), isovolumic relaxation time (IVRT), and myocardial performance index (MPI) values and lower mitral and tricuspid E wave and E/A values than the control group. The systolic blood pressure was positively correlated with PI, RI of UA, DV, and PV, and left and right ventricular IVCT, IVRT, and MPI and negatively correlated with PI and RI of AoI and mitral and tricuspid E wave and E/A values of HDP fetuses. The peak systolic/diastolic flow rate (S/D), PI, and RI of umbilical blood flow in study group A were higher than those in study group B. Umbilical blood flow S/D showed the highest AUC and specificity for predicting fetal growth restriction, and PI had the highest sensitivity for predicting fetal growth restriction. Conclusion. HDP compromises fetal cardiac function and growth, and ultrasound multiparametric assessment provides accurate detection of fetal cardiac function and hemodynamics changes. The patient’s condition can be monitored through the assessment of ultrasound parameters of fetal growth and development.

Abstract Background and objectives Retrograde flow (RF) in the aortic isthmus is frequently observed in fetuses in various hemodynamic states including congenital heart defects (CHD). This study sought to: 1) establish the association between this observation and variables of CHD by fetal echocardiography (FE); and 2) to computer flow dynamic (CFD) model to probe the causes and mechanisms underlying this observation. Methods A total of 256 (gestational age (GA) 26.3±9.8 weeks) fetuses with CHD and 168 (GA: 25.8±10.3weeks) with normal FE were examined from January, 2011 to May, 2016. The study group was divided into: 1) no RF, 2) end systolic RF, end diastolic RF, systolic RF, diastolic RF, and systolic and diastolic RF sub-groups (Figure upper). GA, cerebroplacental ratio (CPR) of pulsatility index (PI) in middle cerebral and umbilical arteries, cardiothoracic area ratio (CTR), left and right atrial dimensions (LA/RA), left and right ventricular dimensions (LV/RV), aortic and pulmonary artery dimensions (AO/PA), and aortic isthmus and ductal arch dimensions (AI/DA), velocity ratio of aorta and pulmonary artery (AO/PAv), aortic isthmus and ductal arch in systolic (AI/DAvs) and diastolic (AI/DAvd). Using principal component analysis (PCA), the component score coefficient matrix and optional variance percent (OVP) was calculated by PCA and the RF pattern was simulated by CFD (Figure lower). Results RF modeling by CFD was feasible (Figure B). Component analysis by PCA showed that four types of variables were associated with RF: 1) Structural variables contribute 23.7% OVP, including LV/RV, LA/ RA, AO/PA, and IS/DA; 2) Resistance variables 16.8% OVP, i.e. CPR; 3) Growth variables 12.2% OVP, i,e, GA and CTR; and 4) Velocity variables 10.9% OVP, i.e. AO/PAv, AI/DAvd. Retrograde flow by fetal echo and CFD Conclusions Retrograde flow in the aortic isthmus is associated with structural, resistance, growth, and velocity variables in fetal circulation in various CHD and normal 3rd trimester pregnancies. Simulation and modeling by CFD is feasible and may be useful to understand the causes and mechanisms of retrograde flow and its utility in diagnosis and prognosis in CHD. Acknowledgement/Funding Research on prevention and control of reproductive health and major birth defects

Objective The aim of this study was to investigate fetal echocardiographic findings in predicting the need for surgical repair in fetuses with coarctation of the aorta (CoA), and to evaluate perinatal outcomes. Methods In this retrospective study, fetuses diagnosed with CoA in a tertiary center between January 2015 and June 2021 were analyzed. Fetal echocardiographic measurements and quantitative findings, middle cerebral artery (MCA) and umbilical artery (UA) Doppler indices, and perinatal outcomes were recorded. Results A total of 57 fetuses with CoA were included in the study. Fifty-one (89.5%) pregnancies resulted in live births and 32 (62.8%) of the neonates underwent surgical repair. Left ventricle / right ventricle width ratio and aortic isthmus z-score were significantly lower in fetuses who underwent surgical repair (p=0.004 and p=0.001, respectively). Retrograde flow in the aortic isthmus (OR:7.43 95% CI:1.98 – 27.76), left to right foramen ovale shunt (OR:8.50 95% CI:1.68 – 42.98), and ventricular septal defect (OR:9.63 95% CI:1.90 – 48.74) were associated with the need for surgical repair. A new scoring system integrating these echocardiographic findings had 89% specificity and 54% sensitivity in predicting surgical repair. Fetal growth restriction (FGR) rates, preterm birth rates, mean MCA PI, and mean UA PI were similar in fetuses with and without surgical repair. Conclusion A scoring system integrating echocardiographic findings in fetuses with CoA may improve the prediction for surgical repair need. There is no evidence of an increased risk of FGR, preterm birth, and brain sparing effect in fetuses with CoA who require surgical repair.