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Basky Thilaganathan - One of the best experts on this subject based on the ideXlab platform.
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Risk of operative delivery for intrapartum Fetal compromise in small-for-gestational-age fetuses at term: external validation of the IRIS algorithm
2019Co-Authors: Erkan Kalafat, Basky Thilaganathan, Jose Morales-rosello, Elisa Scarinci, Asma KhalilAbstract:Objectives: Small-for-gestational-age fetuses (SGA) are at high risk of intrapartum Fetal compromise requiring operative delivery. In a recent study, we developed a model using a combination of three antenatal (gestational age at delivery, parity, cerebroplacental ratio) and three intrapartum (epidural use, labor induction and augmentation using oxytocin) variables for the prediction of operative delivery due to presumed Fetal compromise in SGA fetuses – the Individual RIsk aSsessment (IRIS) prediction model. The aim of this study was to test the predictive accuracy of the IRIS prediction model in an external cohort of singleton pregnancies complicated by SGA. Methods: This was an external validation study using a cohort of pregnancies from two tertiary referral centers in Spain and England. The inclusion criteria were singleton pregnancies diagnosed with an SGA fetus, defined as estimated Fetal weight (EFW) below the 10th centile for gestational age at 36 weeks or beyond, which had Fetal Doppler assessment and available data on their intrapartum care and pregnancy outcomes. The main outcome in this study was the operative delivery for presumed Fetal compromise. External validation was performed using the coefficients obtained in the original development cohort. The predictive accuracies of models were investigated with receiver operating characteristics (ROC) curves. The Hosmer–Lemeshow test was used to test the goodness-of-fit of models and calibration plots were also obtained for visual assessment. A mobile application using the combined model algorithm was developed to facilitate clinical use. Results: Four hundred twelve singleton pregnancies with an antenatal diagnosis of SGA were included in the study. The operative delivery rate was 22.8% (n = 94). The group which required operative delivery for presumed Fetal compromise had significantly fewer multiparous women (19.1 versus 47.8%, p
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perinatal loss at term role of uteroplacental and Fetal Doppler assessment
Ultrasound in Obstetrics & Gynecology, 2018Co-Authors: Caitriona Monaghan, Asma Khalil, Jose Moralesrosello, Basky Thilaganathan, Julia BinderAbstract:OBJECTIVE: To examine the association of uterine artery (UtA) Doppler indices and cerebroplacental ratio (CPR) on perinatal outcome at term. METHODS: This retrospective cohort study conducted in a single tertiary referral centre included all singleton pregnancies undergoing ultrasound assessment in the third trimester, which subsequently delivered at term. Fetal biometry and Dopplers including the umbilical artery (UA), middle cerebral artery (MCA) and uterine artery were recorded. Data was corrected for gestational age and CPR was calculated as a ratio between the MCA pulsatility index (PI) and UA PI. Logistic regression analysis was conducted to examine for independent predictors of adverse perinatal outcome. RESULTS: The study included 7013 pregnancies; 12 were complicated by perinatal death. When compared to pregnancies resulting in live birth, pregnancies complicated by perinatal death had significantly more small for gestational age (SGA) infants (27.3% vs 5%, p = 0.001) and a higher incidence of low CPR (16.7% vs 4.5%, p = 0.041). A subgroup analysis comparing 1527 low risk pregnancies demonstrated that the UtA PI MoM, CPR <5(th) centile and estimated Fetal weight (EFW) centile were all significantly associated with the risk of perinatal death at term (all p < 0.05). After adjusting for confounding variables, only EFW (OR 0.96, 95% CI 0.93-0.99; p = 0.003) and UtA PI MoM (OR 13.10, 95%CI 1.95-87.89; p = 0.008) remained independent predictors of perinatal death in the low risk cohort. CONCLUSION: High uterine artery PI at term is independently associated with increased risk of adverse perinatal outcome regardless of Fetal size. These results suggest that perinatal mortality at term is related, not only to EFW and Fetal redistribution (CPR), but also to indices of uterine perfusion.
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is cerebroplacental ratio a marker of impaired Fetal growth velocity and adverse pregnancy outcome
American Journal of Obstetrics and Gynecology, 2017Co-Authors: Asma Khalil, Jose Moralesrosello, Naila Khan, Mintu Nath, Priya Agarwal, A Bhide, A T Papageorghiou, Basky ThilaganathanAbstract:Background The cerebroplacental ratio has been proposed as a marker of failure to reach growth potential near term. Low cerebroplacental ratio, regardless of the Fetal size, is independently associated with the need for operative delivery for presumed Fetal compromise and with neonatal unit admission at term. Objective The main aim of this study was to evaluate whether the cerebroplacental ratio at term is a marker of reduced Fetal growth rate. The secondary aim was to investigate the relationship between a low cerebroplacental ratio at term, reduced Fetal growth velocity, and adverse pregnancy outcome. Study Design This was a retrospective cohort study of singleton pregnancies in a tertiary referral center. The abdominal circumference was measured at 20–24 weeks' gestation and both abdominal circumference and Fetal Dopplers recorded at or beyond 35 weeks, within 2 weeks of delivery. Abdominal circumference and birthweight values were converted into Z scores and centiles, respectively, and Fetal Doppler parameters into multiples of median, adjusting for gestational age. Abdominal circumference growth velocity was quantified using the difference in the abdominal circumference Z score, comparing the scan at or beyond 35 weeks with the scan at 20–24 weeks. Both univariable and multivariable logistic regression analyses were performed to investigate the association between low cerebroplacental ratio and the low abdominal circumference growth velocity (in the lowest decile) and to identify and adjust for potential confounders. As a sensitivity analysis, we refitted the model excluding the data on pregnancies with small-for-gestational-age neonates. Results The study included 7944 pregnancies. Low cerebroplacental ratio multiples of median was significantly associated with both low abdominal circumference growth velocity (adjusted odds ratio, 2.10; 95% confidence interval, 1.71–2.57, P P P P P = .006), even after adjusting for both the umbilical artery pulsatility index multiples of the median and middle cerebral artery pulsatility index multiples of median. The results were similar, even after the exclusion of pregnancies resulting in small-for-gestational-age neonates (adjusted odds ratio, 1.39; 95% confidence interval, 1.06–1.84, P = .018). Low cerebroplacental ratio multiples of the median remained significantly associated with the risk of operative delivery for presumed Fetal compromise ( P P Conclusion The cerebroplacental ratio is a marker of impaired Fetal growth velocity and adverse pregnancy outcome, even in fetuses whose size is considered appropriate using conventional biometry.
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role of uteroplacental and Fetal Doppler in identifying Fetal growth restriction at term
Best Practice & Research in Clinical Obstetrics & Gynaecology, 2017Co-Authors: Asma Khalil, Basky ThilaganathanAbstract:Identification of the fetus at risk of adverse outcome at term is a challenge to both clinicians and researchers alike. Despite the fact that Fetal growth restriction (FGR) is a known risk factor for stillbirth, at least two thirds of the stillbirth cases at term are not small for gestational age (SGA) - a commonly used proxy for FGR. However, the majority of SGA fetuses are constitutionally small babies and do not suffer from adverse perinatal outcome. The cerebroplacental ratio (CPR) is emerging as a marker of failure to reach growth potential at term. CPR is an independent predictor of intrapartum Fetal distress, admission to the neonatal unit at term, stillbirth, perinatal death and neonatal morbidity. Raised uterine artery Doppler resistance in the third trimester is independently associated with significantly lower birthweight and CPR. The combination of the estimated Fetal weight, CPR and uterine Doppler in the third trimester can identify the majority of fetuses at risk of stillbirth.
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the association between Fetal Doppler and admission to neonatal unit at term
American Journal of Obstetrics and Gynecology, 2015Co-Authors: Asma Khalil, Jose Moralesrosello, Naila Khan, A Bhide, A T Papageorghiou, Malaz Elsaddig, Basky ThilaganathanAbstract:Objective Fetal cerebroplacental ratio is emerging as a better proxy than birthweight for placental insufficiency and as a marker of Fetal compromise at term. The extent to which these Fetal Doppler changes are related to neonatal outcomes has not been systematically assessed. The main aim of this study was to evaluate the association between estimated Fetal weight percentile, cerebroplacental ratio recorded at 34 +0 –35 +6 weeks' gestation, and neonatal unit admission at term. Study Design This was a retrospective cohort study in a tertiary referral center over an 11 year period from 2002 to 2012. The umbilical artery pulsatility index (PI), middle cerebral artery PI, and cerebroplacental ratio were recorded at 34 +0 –35 +6 weeks. Weight values were converted into percentiles and Doppler parameters into multiples of the median (MoM), adjusting for gestational age. Logistic regression analysis was performed to identify, and adjust for, potential confounders. Results We identified 2518 pregnancies in which a scan was performed at 34 +0 –35 +6 weeks and delivery occurred at or beyond 37 weeks. In the 2485 pregnancies included in the analysis, the umbilical artery PI MoM was significantly higher, and the middle cerebral artery PI and cerebroplacental ratio MoM significantly lower in the babies requiring neonatal unit admission ( P P = .087). According to multivariate logistic regression, cerebroplacental ratio MoM (odds ratio, 0.39; 95% confidence interval, 0.19–0.79; P = .008) and gestational age at delivery (odds ratio, 0.70; 95% confidence interval, 0.61–0.80; P P = .183 and P = .460, respectively). Irrespective of birthweight or estimated Fetal weight percentile, the Fetal cerebroplacental ratio appears to be a better predictor of the need for neonatal unit admission ( P Conclusion Lower cerebroplacental ratio and gestational age at delivery, but not Fetal size, were independently associated with the need for admission to the neonatal unit at term in a high-risk patient group. The extent to which Fetal hemodynamic assessment could be used to predict perinatal morbidity and optimize the timing of delivery merits further investigation.
Asma Khalil - One of the best experts on this subject based on the ideXlab platform.
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Risk of operative delivery for intrapartum Fetal compromise in small-for-gestational-age fetuses at term: external validation of the IRIS algorithm
2019Co-Authors: Erkan Kalafat, Basky Thilaganathan, Jose Morales-rosello, Elisa Scarinci, Asma KhalilAbstract:Objectives: Small-for-gestational-age fetuses (SGA) are at high risk of intrapartum Fetal compromise requiring operative delivery. In a recent study, we developed a model using a combination of three antenatal (gestational age at delivery, parity, cerebroplacental ratio) and three intrapartum (epidural use, labor induction and augmentation using oxytocin) variables for the prediction of operative delivery due to presumed Fetal compromise in SGA fetuses – the Individual RIsk aSsessment (IRIS) prediction model. The aim of this study was to test the predictive accuracy of the IRIS prediction model in an external cohort of singleton pregnancies complicated by SGA. Methods: This was an external validation study using a cohort of pregnancies from two tertiary referral centers in Spain and England. The inclusion criteria were singleton pregnancies diagnosed with an SGA fetus, defined as estimated Fetal weight (EFW) below the 10th centile for gestational age at 36 weeks or beyond, which had Fetal Doppler assessment and available data on their intrapartum care and pregnancy outcomes. The main outcome in this study was the operative delivery for presumed Fetal compromise. External validation was performed using the coefficients obtained in the original development cohort. The predictive accuracies of models were investigated with receiver operating characteristics (ROC) curves. The Hosmer–Lemeshow test was used to test the goodness-of-fit of models and calibration plots were also obtained for visual assessment. A mobile application using the combined model algorithm was developed to facilitate clinical use. Results: Four hundred twelve singleton pregnancies with an antenatal diagnosis of SGA were included in the study. The operative delivery rate was 22.8% (n = 94). The group which required operative delivery for presumed Fetal compromise had significantly fewer multiparous women (19.1 versus 47.8%, p
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perinatal loss at term role of uteroplacental and Fetal Doppler assessment
Ultrasound in Obstetrics & Gynecology, 2018Co-Authors: Caitriona Monaghan, Asma Khalil, Jose Moralesrosello, Basky Thilaganathan, Julia BinderAbstract:OBJECTIVE: To examine the association of uterine artery (UtA) Doppler indices and cerebroplacental ratio (CPR) on perinatal outcome at term. METHODS: This retrospective cohort study conducted in a single tertiary referral centre included all singleton pregnancies undergoing ultrasound assessment in the third trimester, which subsequently delivered at term. Fetal biometry and Dopplers including the umbilical artery (UA), middle cerebral artery (MCA) and uterine artery were recorded. Data was corrected for gestational age and CPR was calculated as a ratio between the MCA pulsatility index (PI) and UA PI. Logistic regression analysis was conducted to examine for independent predictors of adverse perinatal outcome. RESULTS: The study included 7013 pregnancies; 12 were complicated by perinatal death. When compared to pregnancies resulting in live birth, pregnancies complicated by perinatal death had significantly more small for gestational age (SGA) infants (27.3% vs 5%, p = 0.001) and a higher incidence of low CPR (16.7% vs 4.5%, p = 0.041). A subgroup analysis comparing 1527 low risk pregnancies demonstrated that the UtA PI MoM, CPR <5(th) centile and estimated Fetal weight (EFW) centile were all significantly associated with the risk of perinatal death at term (all p < 0.05). After adjusting for confounding variables, only EFW (OR 0.96, 95% CI 0.93-0.99; p = 0.003) and UtA PI MoM (OR 13.10, 95%CI 1.95-87.89; p = 0.008) remained independent predictors of perinatal death in the low risk cohort. CONCLUSION: High uterine artery PI at term is independently associated with increased risk of adverse perinatal outcome regardless of Fetal size. These results suggest that perinatal mortality at term is related, not only to EFW and Fetal redistribution (CPR), but also to indices of uterine perfusion.
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is cerebroplacental ratio a marker of impaired Fetal growth velocity and adverse pregnancy outcome
American Journal of Obstetrics and Gynecology, 2017Co-Authors: Asma Khalil, Jose Moralesrosello, Naila Khan, Mintu Nath, Priya Agarwal, A Bhide, A T Papageorghiou, Basky ThilaganathanAbstract:Background The cerebroplacental ratio has been proposed as a marker of failure to reach growth potential near term. Low cerebroplacental ratio, regardless of the Fetal size, is independently associated with the need for operative delivery for presumed Fetal compromise and with neonatal unit admission at term. Objective The main aim of this study was to evaluate whether the cerebroplacental ratio at term is a marker of reduced Fetal growth rate. The secondary aim was to investigate the relationship between a low cerebroplacental ratio at term, reduced Fetal growth velocity, and adverse pregnancy outcome. Study Design This was a retrospective cohort study of singleton pregnancies in a tertiary referral center. The abdominal circumference was measured at 20–24 weeks' gestation and both abdominal circumference and Fetal Dopplers recorded at or beyond 35 weeks, within 2 weeks of delivery. Abdominal circumference and birthweight values were converted into Z scores and centiles, respectively, and Fetal Doppler parameters into multiples of median, adjusting for gestational age. Abdominal circumference growth velocity was quantified using the difference in the abdominal circumference Z score, comparing the scan at or beyond 35 weeks with the scan at 20–24 weeks. Both univariable and multivariable logistic regression analyses were performed to investigate the association between low cerebroplacental ratio and the low abdominal circumference growth velocity (in the lowest decile) and to identify and adjust for potential confounders. As a sensitivity analysis, we refitted the model excluding the data on pregnancies with small-for-gestational-age neonates. Results The study included 7944 pregnancies. Low cerebroplacental ratio multiples of median was significantly associated with both low abdominal circumference growth velocity (adjusted odds ratio, 2.10; 95% confidence interval, 1.71–2.57, P P P P P = .006), even after adjusting for both the umbilical artery pulsatility index multiples of the median and middle cerebral artery pulsatility index multiples of median. The results were similar, even after the exclusion of pregnancies resulting in small-for-gestational-age neonates (adjusted odds ratio, 1.39; 95% confidence interval, 1.06–1.84, P = .018). Low cerebroplacental ratio multiples of the median remained significantly associated with the risk of operative delivery for presumed Fetal compromise ( P P Conclusion The cerebroplacental ratio is a marker of impaired Fetal growth velocity and adverse pregnancy outcome, even in fetuses whose size is considered appropriate using conventional biometry.
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role of uteroplacental and Fetal Doppler in identifying Fetal growth restriction at term
Best Practice & Research in Clinical Obstetrics & Gynaecology, 2017Co-Authors: Asma Khalil, Basky ThilaganathanAbstract:Identification of the fetus at risk of adverse outcome at term is a challenge to both clinicians and researchers alike. Despite the fact that Fetal growth restriction (FGR) is a known risk factor for stillbirth, at least two thirds of the stillbirth cases at term are not small for gestational age (SGA) - a commonly used proxy for FGR. However, the majority of SGA fetuses are constitutionally small babies and do not suffer from adverse perinatal outcome. The cerebroplacental ratio (CPR) is emerging as a marker of failure to reach growth potential at term. CPR is an independent predictor of intrapartum Fetal distress, admission to the neonatal unit at term, stillbirth, perinatal death and neonatal morbidity. Raised uterine artery Doppler resistance in the third trimester is independently associated with significantly lower birthweight and CPR. The combination of the estimated Fetal weight, CPR and uterine Doppler in the third trimester can identify the majority of fetuses at risk of stillbirth.
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the association between Fetal Doppler and admission to neonatal unit at term
American Journal of Obstetrics and Gynecology, 2015Co-Authors: Asma Khalil, Jose Moralesrosello, Naila Khan, A Bhide, A T Papageorghiou, Malaz Elsaddig, Basky ThilaganathanAbstract:Objective Fetal cerebroplacental ratio is emerging as a better proxy than birthweight for placental insufficiency and as a marker of Fetal compromise at term. The extent to which these Fetal Doppler changes are related to neonatal outcomes has not been systematically assessed. The main aim of this study was to evaluate the association between estimated Fetal weight percentile, cerebroplacental ratio recorded at 34 +0 –35 +6 weeks' gestation, and neonatal unit admission at term. Study Design This was a retrospective cohort study in a tertiary referral center over an 11 year period from 2002 to 2012. The umbilical artery pulsatility index (PI), middle cerebral artery PI, and cerebroplacental ratio were recorded at 34 +0 –35 +6 weeks. Weight values were converted into percentiles and Doppler parameters into multiples of the median (MoM), adjusting for gestational age. Logistic regression analysis was performed to identify, and adjust for, potential confounders. Results We identified 2518 pregnancies in which a scan was performed at 34 +0 –35 +6 weeks and delivery occurred at or beyond 37 weeks. In the 2485 pregnancies included in the analysis, the umbilical artery PI MoM was significantly higher, and the middle cerebral artery PI and cerebroplacental ratio MoM significantly lower in the babies requiring neonatal unit admission ( P P = .087). According to multivariate logistic regression, cerebroplacental ratio MoM (odds ratio, 0.39; 95% confidence interval, 0.19–0.79; P = .008) and gestational age at delivery (odds ratio, 0.70; 95% confidence interval, 0.61–0.80; P P = .183 and P = .460, respectively). Irrespective of birthweight or estimated Fetal weight percentile, the Fetal cerebroplacental ratio appears to be a better predictor of the need for neonatal unit admission ( P Conclusion Lower cerebroplacental ratio and gestational age at delivery, but not Fetal size, were independently associated with the need for admission to the neonatal unit at term in a high-risk patient group. The extent to which Fetal hemodynamic assessment could be used to predict perinatal morbidity and optimize the timing of delivery merits further investigation.
Jose Moralesrosello - One of the best experts on this subject based on the ideXlab platform.
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perinatal loss at term role of uteroplacental and Fetal Doppler assessment
Ultrasound in Obstetrics & Gynecology, 2018Co-Authors: Caitriona Monaghan, Asma Khalil, Jose Moralesrosello, Basky Thilaganathan, Julia BinderAbstract:OBJECTIVE: To examine the association of uterine artery (UtA) Doppler indices and cerebroplacental ratio (CPR) on perinatal outcome at term. METHODS: This retrospective cohort study conducted in a single tertiary referral centre included all singleton pregnancies undergoing ultrasound assessment in the third trimester, which subsequently delivered at term. Fetal biometry and Dopplers including the umbilical artery (UA), middle cerebral artery (MCA) and uterine artery were recorded. Data was corrected for gestational age and CPR was calculated as a ratio between the MCA pulsatility index (PI) and UA PI. Logistic regression analysis was conducted to examine for independent predictors of adverse perinatal outcome. RESULTS: The study included 7013 pregnancies; 12 were complicated by perinatal death. When compared to pregnancies resulting in live birth, pregnancies complicated by perinatal death had significantly more small for gestational age (SGA) infants (27.3% vs 5%, p = 0.001) and a higher incidence of low CPR (16.7% vs 4.5%, p = 0.041). A subgroup analysis comparing 1527 low risk pregnancies demonstrated that the UtA PI MoM, CPR <5(th) centile and estimated Fetal weight (EFW) centile were all significantly associated with the risk of perinatal death at term (all p < 0.05). After adjusting for confounding variables, only EFW (OR 0.96, 95% CI 0.93-0.99; p = 0.003) and UtA PI MoM (OR 13.10, 95%CI 1.95-87.89; p = 0.008) remained independent predictors of perinatal death in the low risk cohort. CONCLUSION: High uterine artery PI at term is independently associated with increased risk of adverse perinatal outcome regardless of Fetal size. These results suggest that perinatal mortality at term is related, not only to EFW and Fetal redistribution (CPR), but also to indices of uterine perfusion.
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is cerebroplacental ratio a marker of impaired Fetal growth velocity and adverse pregnancy outcome
American Journal of Obstetrics and Gynecology, 2017Co-Authors: Asma Khalil, Jose Moralesrosello, Naila Khan, Mintu Nath, Priya Agarwal, A Bhide, A T Papageorghiou, Basky ThilaganathanAbstract:Background The cerebroplacental ratio has been proposed as a marker of failure to reach growth potential near term. Low cerebroplacental ratio, regardless of the Fetal size, is independently associated with the need for operative delivery for presumed Fetal compromise and with neonatal unit admission at term. Objective The main aim of this study was to evaluate whether the cerebroplacental ratio at term is a marker of reduced Fetal growth rate. The secondary aim was to investigate the relationship between a low cerebroplacental ratio at term, reduced Fetal growth velocity, and adverse pregnancy outcome. Study Design This was a retrospective cohort study of singleton pregnancies in a tertiary referral center. The abdominal circumference was measured at 20–24 weeks' gestation and both abdominal circumference and Fetal Dopplers recorded at or beyond 35 weeks, within 2 weeks of delivery. Abdominal circumference and birthweight values were converted into Z scores and centiles, respectively, and Fetal Doppler parameters into multiples of median, adjusting for gestational age. Abdominal circumference growth velocity was quantified using the difference in the abdominal circumference Z score, comparing the scan at or beyond 35 weeks with the scan at 20–24 weeks. Both univariable and multivariable logistic regression analyses were performed to investigate the association between low cerebroplacental ratio and the low abdominal circumference growth velocity (in the lowest decile) and to identify and adjust for potential confounders. As a sensitivity analysis, we refitted the model excluding the data on pregnancies with small-for-gestational-age neonates. Results The study included 7944 pregnancies. Low cerebroplacental ratio multiples of median was significantly associated with both low abdominal circumference growth velocity (adjusted odds ratio, 2.10; 95% confidence interval, 1.71–2.57, P P P P P = .006), even after adjusting for both the umbilical artery pulsatility index multiples of the median and middle cerebral artery pulsatility index multiples of median. The results were similar, even after the exclusion of pregnancies resulting in small-for-gestational-age neonates (adjusted odds ratio, 1.39; 95% confidence interval, 1.06–1.84, P = .018). Low cerebroplacental ratio multiples of the median remained significantly associated with the risk of operative delivery for presumed Fetal compromise ( P P Conclusion The cerebroplacental ratio is a marker of impaired Fetal growth velocity and adverse pregnancy outcome, even in fetuses whose size is considered appropriate using conventional biometry.
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the association between Fetal Doppler and admission to neonatal unit at term
American Journal of Obstetrics and Gynecology, 2015Co-Authors: Asma Khalil, Jose Moralesrosello, Naila Khan, A Bhide, A T Papageorghiou, Malaz Elsaddig, Basky ThilaganathanAbstract:Objective Fetal cerebroplacental ratio is emerging as a better proxy than birthweight for placental insufficiency and as a marker of Fetal compromise at term. The extent to which these Fetal Doppler changes are related to neonatal outcomes has not been systematically assessed. The main aim of this study was to evaluate the association between estimated Fetal weight percentile, cerebroplacental ratio recorded at 34 +0 –35 +6 weeks' gestation, and neonatal unit admission at term. Study Design This was a retrospective cohort study in a tertiary referral center over an 11 year period from 2002 to 2012. The umbilical artery pulsatility index (PI), middle cerebral artery PI, and cerebroplacental ratio were recorded at 34 +0 –35 +6 weeks. Weight values were converted into percentiles and Doppler parameters into multiples of the median (MoM), adjusting for gestational age. Logistic regression analysis was performed to identify, and adjust for, potential confounders. Results We identified 2518 pregnancies in which a scan was performed at 34 +0 –35 +6 weeks and delivery occurred at or beyond 37 weeks. In the 2485 pregnancies included in the analysis, the umbilical artery PI MoM was significantly higher, and the middle cerebral artery PI and cerebroplacental ratio MoM significantly lower in the babies requiring neonatal unit admission ( P P = .087). According to multivariate logistic regression, cerebroplacental ratio MoM (odds ratio, 0.39; 95% confidence interval, 0.19–0.79; P = .008) and gestational age at delivery (odds ratio, 0.70; 95% confidence interval, 0.61–0.80; P P = .183 and P = .460, respectively). Irrespective of birthweight or estimated Fetal weight percentile, the Fetal cerebroplacental ratio appears to be a better predictor of the need for neonatal unit admission ( P Conclusion Lower cerebroplacental ratio and gestational age at delivery, but not Fetal size, were independently associated with the need for admission to the neonatal unit at term in a high-risk patient group. The extent to which Fetal hemodynamic assessment could be used to predict perinatal morbidity and optimize the timing of delivery merits further investigation.
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changes in Fetal Doppler indices as a marker of failure to reach growth potential at term
Ultrasound in Obstetrics & Gynecology, 2014Co-Authors: Asma Khalil, Jose Moralesrosello, A Bhide, A T Papageorghiou, Maddalena Morlando, Basky ThilaganathanAbstract:Objective To evaluate whether changes in the middle cerebral artery (MCA), umbilical artery (UA) and cerebroplacental ratio (CPR) Doppler indices at term might be used to identify those appropriate-for-gestational-age (AGA) fetuses that are failing to reach their growth potential (FRGP). Methods This was a retrospective cohort study of data obtained in a single tertiary referral center over a 10-year period from 2002 to 2012. The UA pulsatility index (PI), MCA-PI and CPR were recorded between 37+0 and 41+6 weeks within 14 days before delivery. The Doppler parameters were converted into multiples of the median (MoM), adjusting for gestational age, and their correlation with birth-weight (BW) centiles was evaluated by means of regression analysis. Doppler indices were also grouped according to BW quartiles and compared using Kruskal–Wallis and Dunn's post-hoc tests. Results The study included 11 576 term fetuses, with 8645 (74.7%) classified as AGA. Within the AGA group, fetuses with lower BW had significantly higher UA-PI, lower MCA-PI and lower CPR MoM values. Large-for-gestational-age (LGA) fetuses were considered as the group least likely to be growth-restricted. The CPR MoM < 5th centile (0.6765 MoM) in these fetuses was used as a threshold for diagnosing FRGP. Using this definition, in the AGA pregnancies the percentage of fetuses with FRGP was 1% in the 75–90th BW centile group, 1.7% in the 50–75th centile group, 2.9% in the 25–50th centile group and 6.7% in the 10–25th centile group. Conclusion AGA pregnancies may present with Fetal cerebral and placental blood flow redistribution indicative of Fetal hypoxemia. Fetal Doppler assessment may be of value in detecting AGA pregnancies that are subject to placental insufficiency, Fetal hypoxemia and FRGP. Future studies are needed to evaluate the appropriate threshold for the diagnosis of FRGP and the diagnostic performance of this new approach for the management of growth disorders. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd
T Ghi - One of the best experts on this subject based on the ideXlab platform.
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effects of antenatal betamethasone on Fetal Doppler indices and short term Fetal heart rate variation in early growth restricted fetuses
Ultraschall in Der Medizin, 2021Co-Authors: N Fratelli, F Prefumo, Hans Wolf, Kurt Hecher, Gerard H A Visser, Dino A Giussani, Jan B Derks, Caroline J Shaw, T Frusca, T GhiAbstract:Purpose To investigate the effects of the antenatal administration of betamethasone on Fetal Doppler and short term Fetal heart rate variation (CTG-STV) in early growth restricted (FGR) fetuses. Materials and Methods Post hoc analysis of data derived from the TRUFFLE study, a prospective, multicenter, randomized management trial of severe early onset FGR. Repeat Doppler and CTG-STV measurements between the last recording within 48 hours before the first dose of betamethasone (baseline value) and for 10 days after were evaluated. Multilevel analysis was performed to analyze the longitudinal course of the umbilico-cerebral ratio (UC ratio), the ductus venosus pulsatility index (DVPIV) and CTG-STV. Results We included 115 fetuses. A significant increase from baseline in CTG-STV was found on day + 1 (p = 0.019) but no difference thereafter. The DVPIV was not significantly different from baseline in any of the 10 days following the first dose of betamethasone (p = 0.167). Multilevel analysis revealed that, over 10 days, the time elapsed from antenatal administration of betamethasone was significantly associated with a decrease in CTG-STV (p = 0.045) and an increase in the DVPIV (p = 0.001) and UC ratio (p Conclusion Although steroid administration in early FGR has a minimal effect on increasing CTG-STV one day afterwards, the effects on Doppler parameters were extremely slight with regression coefficients of small magnitude suggesting no clinical significance, and were most likely related to the deterioration with time in FGR. Hence, arterial and venous Doppler assessment of Fetal health remains informative following antenatal steroid administration to accelerate Fetal lung maturation.
Dino A Giussani - One of the best experts on this subject based on the ideXlab platform.
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effects of antenatal betamethasone on Fetal Doppler indices and short term Fetal heart rate variation in early growth restricted fetuses
Ultraschall in Der Medizin, 2021Co-Authors: N Fratelli, F Prefumo, Hans Wolf, Kurt Hecher, Gerard H A Visser, Dino A Giussani, Jan B Derks, Caroline J Shaw, T Frusca, T GhiAbstract:Purpose To investigate the effects of the antenatal administration of betamethasone on Fetal Doppler and short term Fetal heart rate variation (CTG-STV) in early growth restricted (FGR) fetuses. Materials and Methods Post hoc analysis of data derived from the TRUFFLE study, a prospective, multicenter, randomized management trial of severe early onset FGR. Repeat Doppler and CTG-STV measurements between the last recording within 48 hours before the first dose of betamethasone (baseline value) and for 10 days after were evaluated. Multilevel analysis was performed to analyze the longitudinal course of the umbilico-cerebral ratio (UC ratio), the ductus venosus pulsatility index (DVPIV) and CTG-STV. Results We included 115 fetuses. A significant increase from baseline in CTG-STV was found on day + 1 (p = 0.019) but no difference thereafter. The DVPIV was not significantly different from baseline in any of the 10 days following the first dose of betamethasone (p = 0.167). Multilevel analysis revealed that, over 10 days, the time elapsed from antenatal administration of betamethasone was significantly associated with a decrease in CTG-STV (p = 0.045) and an increase in the DVPIV (p = 0.001) and UC ratio (p Conclusion Although steroid administration in early FGR has a minimal effect on increasing CTG-STV one day afterwards, the effects on Doppler parameters were extremely slight with regression coefficients of small magnitude suggesting no clinical significance, and were most likely related to the deterioration with time in FGR. Hence, arterial and venous Doppler assessment of Fetal health remains informative following antenatal steroid administration to accelerate Fetal lung maturation.
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uterine and Fetal placental Doppler indices are associated with maternal cardiovascular function
American Journal of Obstetrics and Gynecology, 2019Co-Authors: J Tay, Dino A Giussani, Caroline J Shaw, Giulia Masini, Carmel M Mceniery, Ian B Wilkinson, Phillip R Bennett, C LeesAbstract:Background The mechanism underlying Fetal-placental Doppler index changes in preeclampsia and/or Fetal growth restriction are unknown, although both are associated with maternal cardiovascular dysfunction. Objective We sought to investigate whether there was a relationship between maternal cardiac output and vascular resistance and fetoplacental Doppler findings in healthy and complicated pregnancy. Study Design Women with healthy pregnancies (n=62), preeclamptic pregnancies (n=13), preeclamptic pregnancies with Fetal growth restriction (n=15), or Fetal growth restricted pregnancies (n=17) from 24–40 weeks gestation were included. All of them underwent measurement of cardiac output with the use of an inert gas rebreathing technique and derivation of peripheral vascular resistance. Uterine and Fetal Doppler indices were recorded; the latter were z scored to account for gestation. Associations were determined by polynomial regression analyses. Results Mean uterine artery pulsatility index was higher in Fetal growth restriction (1.37; P=.026) and preeclampsia+Fetal growth restriction (1.63; P=.001) but not preeclampsia (0.92; P=1) compared with control subjects (0.8). There was a negative relationship between uterine pulsatility index and cardiac output (r2=0.101; P=.025) and umbilical pulsatility index z score and cardiac output (r2=0.078; P=.0015), and there were positive associations between uterine pulsatility index and peripheral vascular resistance (r2=0.150; P=.003) and umbilical pulsatility index z score and peripheral vascular resistance (r2= 0.145; P=.001). There was no significant relationship between cardiac output and peripheral vascular resistance with cerebral Doppler indices. Conclusion Uterine artery Doppler change is abnormally elevated in Fetal growth restriction with and without preeclampsia, but not in preeclampsia, which may explain the limited sensitivity of uterine artery Doppler changes for all these complications when considered in aggregate. Furthermore, impedance within fetoplacental arterial vessels is at least, in part, associated with maternal cardiovascular function. This relationship may have important implications for Fetal surveillance and would inform therapeutic options in those pathologic pregnancy conditions currently, and perhaps erroneously, attributed purely to placental maldevelopment. Uterine and Fetal placental Doppler indices are associated significantly with maternal cardiovascular function. The classic description of uterine and Fetal Doppler changes being initiated by placental maldevelopment is a less plausible explanation for the pathogenesis of the conditions than that relating to maternal cardiovascular changes.
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defining the relationship between Fetal Doppler indices abdominal circumference and growth rate in severe Fetal growth restriction using functional linear discriminant analysis
Journal of the Royal Society Interface, 2013Co-Authors: Alon Jonathan Talmor, Dino A Giussani, C Lees, Anneleen Daemen, Edile M Murdoch, H Missfelderlobos, Dirk Timmerman, T BourneAbstract:The relationship between Doppler measurements, size and growth rate in Fetal growth restriction has not been defined. We used functional linear discriminant analysis (FLDA) to investigate these parameters taking account of the difficulties inherent in exploring relationships between repeated observations from a small number of cases. In 40 fetuses with severe growth restriction, serial abdominal circumference (AC), umbilical, middle cerebral artery (MCA) and ductus venosus Doppler pulsatility index measurements were recorded. In 11 singleton fetuses with normal growth, umbilical artery pulsatility index only was measured. Data were expressed as z-scores in relation to gestation and analysed longitudinally using FLDA. In severe growth restriction, the Spearman correlation coefficients between umbilical artery pulsatility index and AC z-score, MCA pulsatility index and AC z-score and ductus venosus pulsatility index z-score and AC z-score were, respectively: −0.36, p = 4.4 × 10−7; 0.70, p = 1.1 × 10−17 and −0.50, p = 8.1 × 10−4. No relationship was seen between Doppler parameters and growth rate. There was no relationship between umbilical artery pulsatility index and AC nor growth rate in normally grown fetuses. In severe Fetal growth restriction, Doppler changes are related to absolute Fetal AC size, not growth rate.