Venous Doppler in the Evaluation of Fetal Hydrops (original) (raw)
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Venous Doppler studies in low-output and high-output hydrops fetalis
American Journal of Obstetrics and Gynecology, 2010
The objective of the study was to compare fetal venous Doppler flow reflecting cardiac function in fetuses with hydrops fetalis between a group of congenital heart defect (low cardiac output) and a fetal anemia group (high cardiac output). STUDY DESIGN: This was a prospective cross-sectional analysis. It was conducted at the Maharaj Nakorn Chiang Mai Hospital, Tertiary center, Medical School. The study included fetuses with hydrops fetalis secondary to cardiac causes (low output group) and anemia (high output group). All fetuses underwent ultrasound examination to assess ductus venosus (DV) and umbilical vein (UV) Doppler indices. The results were related to normal reference range and were also compared between the group of high-output and the low-output group. RESULTS: Sixty-nine hydropic fetuses were available for analysis, 50 in the high-output group and 19 in the low-output group. The peak velocity index, preload index, and the pulsatility index of the DV were significantly low in the high-output group, whereas they were significantly high in the low-output group. The umbilical vein pulsations were found in 78.9% of the fetuses with low-output hydrops fetalis but only 28.0% of fetuses in the high output group (P Ͻ .001). CONCLUSION: New insights gained from this study are that hydrops caused by severe anemia because of hemoglobin Bart's is not associated with high central venous pressures as is seen in hydropic fetuses with coronary heart disease. This suggests that cardiac decompensation is not the primary mechanism of hydrops in these anemic fetuses. Additionally, umbilical vein pulsations are not a sign of cardiac failure in the anemic group.
Venous Doppler ultrasonography in the fetus with nonimmune hydrops
American Journal of Obstetrics and Gynecology, 1991
Eighteen pregnancies with non immune hydrops fetalis were referred for fetal echocardiography to rule out congenital heart disease. In 14 of these cases, pulsating blood velocities were recorded in the umbilical vein, which in a normal population had a nonpulsatile blood velocity pattern. The four cases without pulsations in the umbilical vein were found to have intrauterine viral infections. In the last 10 cases examined, the umbilical venous pulsations were found to reflect abnormal central venous pulsations during atrial systole suggesting increased fetal central venous pressure. Right ventricular shortening fraction was significantly decreased in the group with umbilical venous pulsations compared with those without (0.18 versus 0.32, p < 0.05). All the fetuses without venous pulsations survived, but only four of the 14 with pulsations survived (p < 0.05). The results suggest that blood velocity recordings in the umbilical and central veins of the fetus can give valuable clinical information with regard to the presence of fetal congestive heart failure and differentiate between this physiologic state and other causes of non immune hydrops fetalis. This may have implications for fetal diagnostic work-up and prognosis.
Blood velocity in the fetal vein of Galen and the outcome of high-risk pregnancy
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2001
Background: Pulsation in the¯ow velocity waveform in the umbilical vein is related to perinatal mortality but the¯ow velocity waveform in the fetal vein of Galen is normally even and without¯uctuation. Objectives: To establish whether blood¯ow velocity pulsations in the vein of Galen in high-risk pregnancies are related to outcome. Study Design: The vein of Galen was located by colour Doppler ultrasound in 102 pregnancies complicated by severe pregnancy-induced hypertension. The blood velocity waveform was recorded by pulsed Doppler within 2 days of delivery and the presence pulsations related to pregnancy outcome, including emergency operative intervention and neonatal distress. Umbilical artery and vein and uterine artery blood¯ow velocity waveform were also recorded at the same time. The clinicians managing the women were unaware of the venous¯ow results. Results: Pulsation were present in the vein of Galen in 68 cases and in the umbilical vein in 21. Both were signi®cantly related to adverse outcome. Pulsations in the vein of Galen were seen in all seven perinatal deaths. Conclusions: Since umbilical venous pulsation are a late sign of fetal compromise, and pulsations in the vein of Galen seem to appear earlier, thus being an intermediate sign of fetal compromise that might be of great value for fetal surveillance. #
Haemodynamic evaluation of the first trimester fetus with special emphasis on venous return
Human Reproduction Update, 2000
Knowledge of the fetal circulation is a prerequisite for understanding the physiological behaviour of the developing fetus. In this overview dealing with Colour and Power Doppler ultrasound findings in the first trimester of pregnancy and its pathophysiological background, we aim to report on the methodological aspects, normal blood flow waveform patterns, normal reference values for haemodynamic parameters and potential clinical applications for both arterial and venous flow information (umbilical artery, descending aorta, middle cerebral artery, umbilical vein, inferior vena cava, ductus venosus) and atrioventricular valves. Particular emphasis is devoted to the venous return to the heart. Alterations in venous waveforms, particularly in the ductus venosus, are correlated with the pathophysiology of some fetal diseases and are suggested as a promising tool for the screening of cardiac impairment and as an alternative method for fetal biophysical surveillance.
Middle cerebral artery peak systolic and ductus venosus velocity waveforms in the hydropic fetus
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2005
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. 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. 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 fe...
Fetal venous Doppler in pregnancies with placental dysfunction and correlation with pH at birth
Journal of Maternal-Fetal and Neonatal Medicine, 2012
To determine the correlation between ph at birth and venous Doppler parameters in pregnancies with placental dysfunction. Methods: This was a prospective cohort study of 58 pregnancies with the diagnosis of placental dysfunction between 26 and 34 weeks of gestation. Inclusion criteria were singleton pregnancies, abnormal umbilical artery (UA) Doppler, fetal growth restriction diagnosed by estimated fetal weight <10th centile for gestational age, intact membranes, and absence of fetal congenital abnormalities. The Doppler measurements were the following: UA pulsatility index (PI),
Maternal hepatic vein Doppler velocimetry during uncomplicated pregnancy and pre-eclampsia
Ultrasound in medicine & biology, 2009
Changes of Doppler velocity measurements of distinct hepatic vein (HV) Doppler wave components were evaluated during uncomplicated pregnancy (UP) as a reference to measurements in pre-eclampsia (PE). Women with UP (n = 13) were submitted to standardised duplex scanning of HV at 11 stages of pregnancy between 10 and 38 weeks. For each stage, mean +/- SD was calculated for HV A-, X-, V- and Y-peaks. Women with PE (n = 30) were evaluated once, and mean +/- SD was calculated for pregnancies <32 weeks, 32-34(+6) weeks and > or =35 weeks. PE and UP values at corresponding gestational age were compared statistically using t-test. HV A-velocity measurements changed markedly from negative values in early uncomplicated pregnancy, converting around 22-24 weeks to positive values until term. Changes throughout gestation were less prominent for HV X-, V- and Y-velocities. HV A-velocity measurements were significantly lower in PE than in UP, the difference being more pronounced at 30 weeks ...
Fetal hydropsia: challenges in etiologies
Research, Society and Development, 2021
Introduction: Fetal hydrops is defined as the presence of abnormal fluid collections in two or more extravascular fetal compartments and body cavities. There are about 150 different underlying causes known today potentially leading to this fetal alteration. Objective: To analyze the etiologies involved in the occurrence of cases of fetal hydrops. Methods: A systematic literature review was carried out using the MedLine, Pubmed and Scielo databases, from 2015 to 2021, using the expressions: "fetal, hydrop, etiologies." Discussion: Fetal hydrops is divided into immune and non-immune. Immune results from anemia secondary to erythroblastosis by alloimmunization, so when there is maternal exposure to fetal antigens, it generates an immune response that results in the production of antibodies. History of blood transfusions, previous births, trauma and a history of alloimmunization are characterized as risk factors. Thus, immunoprophylaxis with anti-D immunoglobulin is indicate...
European Journal of Ultrasound, 1995
The purpose of this retrospective work was to evaluate Doppler recorded umbilical venous volume blood flow in complicated pregnancies with abnormal umbilical venous pulsatility. During 1632 examinations abnormal pulsatility was found in 14 fetuses having normal volume flow. There were four perinatal deaths, all in pregnancies with absent blood velocity in the umbilical artery and abnormal umbilical venous pulsatility, suggesting that measurements of umbilical venous blood velocity should be included in the surveillance of pregnancies with absent diastolic blood velocity.