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A W Stewart - One of the best experts on this subject based on the ideXlab platform.
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A pilot randomized controlled trial of two regimens of Fetal Surveillance for small-for-gestational-age fetuses with normal results of umbilical artery doppler velocimetry.
American journal of obstetrics and gynecology, 2000Co-Authors: L M Mccowan, J E Harding, A B Roberts, S E Barker, C Ford, A W StewartAbstract:This study was undertaken to determine whether the frequency of Fetal Surveillance could be safely reduced from twice weekly to fortnightly in the case of small-for-gestational-age fetuses with normal results of umbilical artery Doppler velocimetry studies. Pregnant women between 24 and 36 weeks' gestation (n = 167) with small-for-gestational-age fetuses and normal results of umbilical artery Doppler velocimetry studies were randomly allocated to undergo twice-weekly or fortnightly Fetal Surveillance. Statistical analysis was carried out according to intention to treat. Eighty-five women were randomly assigned to undergo twice-weekly Fetal Surveillance and 82 were randomly assigned to undergo fortnightly Fetal Surveillance. Those randomly assigned to twice-weekly Surveillance were delivered 4 days earlier (264 vs 268 days; P =.04) and were more likely to have labor induced (n = 70, 82%, vs n = 54, 66%; P =.02) than those randomly assigned to fortnightly Surveillance. Fifty-four babies (23%) were admitted to the neonatal nursery, but there were no differences in neonatal morbidity between the groups. Maternal intervention (induction) was more common in the twice-weekly group. No differences in neonatal outcomes were detected. A much larger trial is required to determine the safety and potential benefits of less frequent Surveillance of small-for gestational-age fetuses with normal results of umbilical artery Doppler velocimetry studies.
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A pilot randomized controlled trial of two regimens of Fetal Surveillance for small-for-gestational-age fetuses with normal results of umbilical artery Doppler velocimetry
American Journal of Obstetrics and Gynecology, 2000Co-Authors: L M Mccowan, J E Harding, A B Roberts, C Ford, Sarah Barker, A W StewartAbstract:Abstract Objective: This study was undertaken to determine whether the frequency of Fetal Surveillance could be safely reduced from twice weekly to fortnightly in the case of small-for-gestational-age fetuses with normal results of umbilical artery Doppler velocimetry studies. Study Design: Pregnant women between 24 and 36 weeks' gestation (n = 167) with small-for-gestational-age fetuses and normal results of umbilical artery Doppler velocimetry studies were randomly allocated to undergo twice-weekly or fortnightly Fetal Surveillance. Statistical analysis was carried out according to intention to treat. Results: Eighty-five women were randomly assigned to undergo twice-weekly Fetal Surveillance and 82 were randomly assigned to undergo fortnightly Fetal Surveillance. Those randomly assigned to twice-weekly Surveillance were delivered 4 days earlier (264 vs 268 days; P = .04) and were more likely to have labor induced (n = 70, 82%, vs n=54, 66%; P = .02) than those randomly assigned to fortnightly Surveillance. Fifty-four babies (23%) were admitted to the neonatal nursery, but there were no differences in neonatal morbidity between the groups. Conclusions: Maternal intervention (induction) was more common in the twice-weekly group. No differences in neonatal outcomes were detected. A much larger trial is required to determine the safety and potential benefits of less frequent Surveillance of small-for gestational-age fetuses with normal results of umbilical artery Doppler velocimetry studies. (Am J Obstet Gynecol 2000;182:81-6.)
S Lipitz - One of the best experts on this subject based on the ideXlab platform.
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perinatal outcome of monochorionic diamniotic twins complicated by selective intrauterine growth restriction according to the umbilical artery doppler flow pattern a single center study using a strict Fetal Surveillance protocol
Ultrasound in Obstetrics & Gynecology, 2020Co-Authors: L Batsry, N Matatyahu, H Avnet, Boaz Weisz, S LipitzAbstract:OBJECTIVE To determine the perinatal outcome of monochorionic diamniotic (MCDA) twins complicated by selective intrauterine growth restriction (sIUGR) according to the umbilical artery (UA) Doppler flow pattern of the IUGR twin. METHODS A retrospective cohort study of all MCDA twin pregnancies diagnosed with sIUGR and managed at a single tertiary referral center between the years 2012-2018. Cases were classified according to the UA Doppler flow pattern of the IUGR twin: Type I (positive end-diastolic flow), Type II (persistently absent/reversed end-diastolic flow) or Type III (intermittently absent/reversed end-diastolic flow). Patients with sIUGR Type II or III were hospitalized at 26-28 weeks of gestation for increased Fetal Surveillance. Perinatal outcomes and immediate and long-term neurodevelopmental outcomes were stratified according to the UA Doppler flow pattern at the final examination. Intact survival rate was defined as the number of infants surviving without neurological impairment, divided by the total number of fetuses. A composite adverse outcome, defined as any mortality, the presence of severe brain lesions on postnatal transcranial ultrasound or severe neurological morbidity, was also assessed. RESULTS Of 88 MCDA twin pregnancies included in the study, 28 underwent selective termination by cord occlusion using radiofrequency ablation, resulting in a perinatal survival rate of 89.3% and a median gestational age (GA) at delivery of 33.8 (IQR 28.8-38.2) weeks. Expectant management was employed in 60 cases. In 26 (43.3%) cases, the classification according to the UA Doppler flow pattern had changed during gestation, resulting in 26 (43%) cases of Type I, 22 (36%) cases of Type II and 12 (20%) cases of Type III at the final examination. The perinatal survival rate of both twins with sIUGR Type I, II and III at the final examination was 100%, 82% and 75%, respectively (P=0.04). 2 cases of double Fetal death and one case of single Fetal death occurred 1-4 weeks after the Doppler pattern had changed from Type I or Type II to Type III. The median GA at delivery was 34.8 (IQR 33.1-35.7) weeks in Type I, 30.3 (IQR 28.6-32.1) weeks in Type II and 32 (IQR 31.3-32.6) weeks in Type III (P<0.01). The total intact survival rate was 100% for Type I, 77.3% for Type II and 75% for Type III (P<0.001). Multivariate analysis demonstrated that early gestational age at onset of disease [odds ratio 0.83 (95% CI 0.69-0.99); P=0.04] and the presence of type II or III vs type I at final examination [odds ratio13.16 (95% CI 1.53-113.32) ;P=0.02] were associated with preterm birth < 32 weeks. Early gestational age at onset of disease was also associated with the composite adverse outcome [0.60 (95% CI 0.36-0.99); P=0.04]. CONCLUSIONS The classification system of MCDA twins complicated by sIUGR according to the UA Doppler flow pattern of the IUGR twin at final examination is correlated with perinatal outcome. Importantly, the UA Doppler flow pattern can change during gestation, which has an impact on the risk of Fetal death. Nevertheless, under strict Fetal Surveillance, the perinatal outcome of these pregnancies is favorable. This article is protected by copyright. All rights reserved.
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Perinatal outcome of monochorionic diamniotic twins complicated by selective intrauterine growth restriction according to the umbilical artery Doppler flow pattern: a single-center study using a strict Fetal Surveillance protocol.
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2020Co-Authors: L Batsry, N Matatyahu, H Avnet, Boaz Weisz, S Lipitz, Shali Mazaki-tovi, Y. YinonAbstract:OBJECTIVE To determine the perinatal outcome of monochorionic diamniotic (MCDA) twins complicated by selective intrauterine growth restriction (sIUGR) according to the umbilical artery (UA) Doppler flow pattern of the IUGR twin. METHODS A retrospective cohort study of all MCDA twin pregnancies diagnosed with sIUGR and managed at a single tertiary referral center between the years 2012-2018. Cases were classified according to the UA Doppler flow pattern of the IUGR twin: Type I (positive end-diastolic flow), Type II (persistently absent/reversed end-diastolic flow) or Type III (intermittently absent/reversed end-diastolic flow). Patients with sIUGR Type II or III were hospitalized at 26-28 weeks of gestation for increased Fetal Surveillance. Perinatal outcomes and immediate and long-term neurodevelopmental outcomes were stratified according to the UA Doppler flow pattern at the final examination. Intact survival rate was defined as the number of infants surviving without neurological impairment, divided by the total number of fetuses. A composite adverse outcome, defined as any mortality, the presence of severe brain lesions on postnatal transcranial ultrasound or severe neurological morbidity, was also assessed. RESULTS Of 88 MCDA twin pregnancies included in the study, 28 underwent selective termination by cord occlusion using radiofrequency ablation, resulting in a perinatal survival rate of 89.3% and a median gestational age (GA) at delivery of 33.8 (IQR 28.8-38.2) weeks. Expectant management was employed in 60 cases. In 26 (43.3%) cases, the classification according to the UA Doppler flow pattern had changed during gestation, resulting in 26 (43%) cases of Type I, 22 (36%) cases of Type II and 12 (20%) cases of Type III at the final examination. The perinatal survival rate of both twins with sIUGR Type I, II and III at the final examination was 100%, 82% and 75%, respectively (P=0.04). 2 cases of double Fetal death and one case of single Fetal death occurred 1-4 weeks after the Doppler pattern had changed from Type I or Type II to Type III. The median GA at delivery was 34.8 (IQR 33.1-35.7) weeks in Type I, 30.3 (IQR 28.6-32.1) weeks in Type II and 32 (IQR 31.3-32.6) weeks in Type III (P
Dev Maulik - One of the best experts on this subject based on the ideXlab platform.
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evidence based approach to umbilical artery doppler Fetal Surveillance in high risk pregnancies an update
Clinical Obstetrics and Gynecology, 2010Co-Authors: Dev Maulik, David Mundy, Erica Heitmann, Devika MaulikAbstract:Antepartum Fetal Surveillance with Doppler ultrasound of umbilical artery has shown significant diagnostic efficacy in identifying Fetal compromise in pregnancies complicated with Fetal growth restriction and preeclampsia. Moreover, randomized clinical trials and their meta-analyses have shown its effectiveness in decreasing perinatal mortality (level I evidence). This is the only antepartum Fetal test that has shown this level of effectiveness. There is no evidence that routine Doppler in low-risk pregnancies improves the outcome. It is recommended that umbilical artery Doppler should be the standard of practice in managing high-risk pregnancies complicated with Fetal growth restriction and preeclampsia (level A recommendation). However, its use should be integrated with other current Fetal monitoring tests (levels B and C recommendation). The overall management should also be guided by additional clinical considerations such as the gestational age, Fetal and maternal status, and obstetrical conditions.
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Umbilical arterial Doppler sonography for Fetal Surveillance in pregnancies complicated by pregestational diabetes mellitus.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine the Federation of Asia and , 2002Co-Authors: Dev Maulik, Andrzej Lysikiewicz, Genevieve SicuranzaAbstract:Antepartum Fetal Surveillance constitutes an essential component of the standards of care in managing pregnancies complicated by pregestational diabetes mellitus. Fetal hyperglycemia is associated with increased oxidative metabolism, hypoxemia and increased brain and renal perfusion without any significant changes in fetoplacental perfusion. Human cordocentesis data show that Fetal hypoxemia and acidemia are associated with changes in the umbilical arterial Doppler indices in maternal diabetes mellitus complicated by Fetal growth restriction or pre-eclampsia. Consistent with this, observational studies suggest significant diagnostic efficacy of the Doppler method in diabetic pregnancies complicated by vasculopathy, and in the presence of Fetal growth restriction or hypertension. However, the relationship between abnormal umbilical arterial Doppler indices and the quality of glycemic control remains unproved. Although there are no randomized trials specifically addressing this issue, existing evidence suggests that Doppler velocimetry of the umbilical artery may be beneficial for antepartum Fetal Surveillance in diabetic pregnancies complicated by vasculopathy, Fetal growth restriction or hypertension.
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Doppler Velocimetry for Fetal Surveillance: Randomized Clinical Trials and Implications for Practice
Doppler Ultrasound in Obstetrics and Gynecology, 1Co-Authors: Dev Maulik, Reinaldo FigueroaAbstract:The development of Doppler sonography has made it feasible to assess the Fetal and uteroplacental circulations. Numerous studies have established a significant association between abnormal Doppler indices and the various pregnancy disorders and adverse perinatal outcomes. Most clinical investigations suggest that, in high-risk pregnancies, umbilical arterial Doppler indices may be efficacious for predicting perinatal problems including Fetal death. Many randomized trials on Doppler velocimetry have yielded positive results. Furthermore, systematic reviews of the trials by meta-analysis demonstrate a significant reduction in preventable Fetal deaths. The current evidence mandates that Doppler velocimetry of the umbilical artery should be an integral component of Fetal Surveillance in pregnancies complicated with Fetal growth restriction or preeclampsia. Obviously, no single testing modality should be regarded as the exclusive choice for Fetal Surveillance, as these tests reveal different aspects of Fetal pathophysiology, often in a complementary manner.
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Doppler Velocimetry for Fetal Surveillance: Adverse Perinatal Outcome and Fetal Hypoxia
Doppler Ultrasound in Obstetrics and Gynecology, 1Co-Authors: Dev Maulik, Reinaldo FigueroaAbstract:There is ample evidence that Doppler indices from the Fetal circulation can reliably predict adverse perinatal outcome in an obstetric patient population with a high prevalence of complications, such as Fetal growth restriction and hypertension. This efficacy is not evident, however, in populations with a low prevalence of pregnancy complications. It is also apparent that Fetal Doppler indices are capable of reflecting Fetal respiratory deficiency with varying degrees of efficiency. The umbilical arterial Doppler indices are more sensitive to asphyxia than to hypoxia, whereas cerebral Doppler indices demonstrate significant sensitivity to hypoxia. Compared to Fetal heart rate monitoring and the biophysical profile, umbilical artery Doppler velocimetry shows mostly similar and often superior efficacy. Furthermore, progressive Fetal deterioration manifests in sequential abnormalities of the various Fetal assessment parameters, starting with middle cerebral artery vasodilation and eventual progression to disappearance of the Fetal heart rate variability, late deceleration, and the absence or reversal of the end-diastolic velocity in the umbilical artery. Evidently, no single testing modality should be regarded as the exclusive choice for Fetal Surveillance, as these tests reveal different aspects of Fetal pathophysiology, often in a complementary manner. Clearly, more work is needed to determine the optimal integration of the various Surveillance methods for improving perinatal outcome in a cost-effective manner.
Reinaldo Figueroa - One of the best experts on this subject based on the ideXlab platform.
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Doppler Velocimetry for Fetal Surveillance: Randomized Clinical Trials and Implications for Practice
Doppler Ultrasound in Obstetrics and Gynecology, 1Co-Authors: Dev Maulik, Reinaldo FigueroaAbstract:The development of Doppler sonography has made it feasible to assess the Fetal and uteroplacental circulations. Numerous studies have established a significant association between abnormal Doppler indices and the various pregnancy disorders and adverse perinatal outcomes. Most clinical investigations suggest that, in high-risk pregnancies, umbilical arterial Doppler indices may be efficacious for predicting perinatal problems including Fetal death. Many randomized trials on Doppler velocimetry have yielded positive results. Furthermore, systematic reviews of the trials by meta-analysis demonstrate a significant reduction in preventable Fetal deaths. The current evidence mandates that Doppler velocimetry of the umbilical artery should be an integral component of Fetal Surveillance in pregnancies complicated with Fetal growth restriction or preeclampsia. Obviously, no single testing modality should be regarded as the exclusive choice for Fetal Surveillance, as these tests reveal different aspects of Fetal pathophysiology, often in a complementary manner.
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Doppler Velocimetry for Fetal Surveillance: Adverse Perinatal Outcome and Fetal Hypoxia
Doppler Ultrasound in Obstetrics and Gynecology, 1Co-Authors: Dev Maulik, Reinaldo FigueroaAbstract:There is ample evidence that Doppler indices from the Fetal circulation can reliably predict adverse perinatal outcome in an obstetric patient population with a high prevalence of complications, such as Fetal growth restriction and hypertension. This efficacy is not evident, however, in populations with a low prevalence of pregnancy complications. It is also apparent that Fetal Doppler indices are capable of reflecting Fetal respiratory deficiency with varying degrees of efficiency. The umbilical arterial Doppler indices are more sensitive to asphyxia than to hypoxia, whereas cerebral Doppler indices demonstrate significant sensitivity to hypoxia. Compared to Fetal heart rate monitoring and the biophysical profile, umbilical artery Doppler velocimetry shows mostly similar and often superior efficacy. Furthermore, progressive Fetal deterioration manifests in sequential abnormalities of the various Fetal assessment parameters, starting with middle cerebral artery vasodilation and eventual progression to disappearance of the Fetal heart rate variability, late deceleration, and the absence or reversal of the end-diastolic velocity in the umbilical artery. Evidently, no single testing modality should be regarded as the exclusive choice for Fetal Surveillance, as these tests reveal different aspects of Fetal pathophysiology, often in a complementary manner. Clearly, more work is needed to determine the optimal integration of the various Surveillance methods for improving perinatal outcome in a cost-effective manner.
L M Mccowan - One of the best experts on this subject based on the ideXlab platform.
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A pilot randomized controlled trial of two regimens of Fetal Surveillance for small-for-gestational-age fetuses with normal results of umbilical artery doppler velocimetry.
American journal of obstetrics and gynecology, 2000Co-Authors: L M Mccowan, J E Harding, A B Roberts, S E Barker, C Ford, A W StewartAbstract:This study was undertaken to determine whether the frequency of Fetal Surveillance could be safely reduced from twice weekly to fortnightly in the case of small-for-gestational-age fetuses with normal results of umbilical artery Doppler velocimetry studies. Pregnant women between 24 and 36 weeks' gestation (n = 167) with small-for-gestational-age fetuses and normal results of umbilical artery Doppler velocimetry studies were randomly allocated to undergo twice-weekly or fortnightly Fetal Surveillance. Statistical analysis was carried out according to intention to treat. Eighty-five women were randomly assigned to undergo twice-weekly Fetal Surveillance and 82 were randomly assigned to undergo fortnightly Fetal Surveillance. Those randomly assigned to twice-weekly Surveillance were delivered 4 days earlier (264 vs 268 days; P =.04) and were more likely to have labor induced (n = 70, 82%, vs n = 54, 66%; P =.02) than those randomly assigned to fortnightly Surveillance. Fifty-four babies (23%) were admitted to the neonatal nursery, but there were no differences in neonatal morbidity between the groups. Maternal intervention (induction) was more common in the twice-weekly group. No differences in neonatal outcomes were detected. A much larger trial is required to determine the safety and potential benefits of less frequent Surveillance of small-for gestational-age fetuses with normal results of umbilical artery Doppler velocimetry studies.
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A pilot randomized controlled trial of two regimens of Fetal Surveillance for small-for-gestational-age fetuses with normal results of umbilical artery Doppler velocimetry
American Journal of Obstetrics and Gynecology, 2000Co-Authors: L M Mccowan, J E Harding, A B Roberts, C Ford, Sarah Barker, A W StewartAbstract:Abstract Objective: This study was undertaken to determine whether the frequency of Fetal Surveillance could be safely reduced from twice weekly to fortnightly in the case of small-for-gestational-age fetuses with normal results of umbilical artery Doppler velocimetry studies. Study Design: Pregnant women between 24 and 36 weeks' gestation (n = 167) with small-for-gestational-age fetuses and normal results of umbilical artery Doppler velocimetry studies were randomly allocated to undergo twice-weekly or fortnightly Fetal Surveillance. Statistical analysis was carried out according to intention to treat. Results: Eighty-five women were randomly assigned to undergo twice-weekly Fetal Surveillance and 82 were randomly assigned to undergo fortnightly Fetal Surveillance. Those randomly assigned to twice-weekly Surveillance were delivered 4 days earlier (264 vs 268 days; P = .04) and were more likely to have labor induced (n = 70, 82%, vs n=54, 66%; P = .02) than those randomly assigned to fortnightly Surveillance. Fifty-four babies (23%) were admitted to the neonatal nursery, but there were no differences in neonatal morbidity between the groups. Conclusions: Maternal intervention (induction) was more common in the twice-weekly group. No differences in neonatal outcomes were detected. A much larger trial is required to determine the safety and potential benefits of less frequent Surveillance of small-for gestational-age fetuses with normal results of umbilical artery Doppler velocimetry studies. (Am J Obstet Gynecol 2000;182:81-6.)