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Middle cerebral artery peak velocity and fetal anemia
SPO Abstracts
V o l u m e 176, N u m b e r 1, Part 2 A m J O b s t e t Gynecol
$151
523
MATERNAL RENAL ARTERY B L O O D FLOW VELOCIMETRY I N NORMALAND PREECLAMPTIC PREGNANCIES M. Kublickas, 3L O. Lunell, H. Nisell, M. Westgr~n. Department of Ob/Gyn, Karolinska Institute, Huddinge University Hospital, S-141 86 Huddinge, Sweden. OBJECTIVE: The aim of the study was to investigate the effect of normal and preeclamptic pregnancy on the maternal renal artei3~ Doppler blood flow velocity indices. STUDY DESIGN: The study consisted of 30 normal pregnant women and 43 women with mild (n=28) and severe (n = 15) preeclampsia in the third trimester. Blood flow velocity in the segmental renal arteries t-ore the right kidney was analysed by pulsed and color Doppler. T h e pulsatility index (PI) was used for the Doppler waveform analysis. RESULTS: In the preeclamptic wonmn renal artery PI (i.00 -+ 0.16 in mild and 0.94 • 0.14 in severe preeclampsia) was significantly lower as compared to normal pregnant women (PI = 1.15 • 0.18) ; P < 0.01. Renal artery PI did not differ between mild and severe preeclampsia. There was a significant negative relationship between renal artery PI and mean arterial pressure in preeclamptic group (r = - 0 . 3 2 , P < 0.05). CONCLUSION: The present results demonstrate that the nmchauism of renal aumregulation in preeclampsia might be altered, leaving glomerulus unprotected from increased blood pressure. It seems that the concept of renal vasoconstriction in preeclampsia might be disputed and needs further investigation.
525
CLINICAL APPLICATIONS O F ABSENT DIASTOLIC FLOW IN MULTIPLE GESTATIONS. A. Webb,* .4. Rijhsinghani, D. Peleg.* Dept. Ob/Gyn, Univ. of Iowa, Iowa City, IA. OBJECTIVE: Our aim was to study the implications of Absent Diastolic Flow (ADF) in multiple gestations. STUDY DESIGN: A cohort of 11 muhiple gestations where one fetus was diagnosed with ADF were followed closely by frequent ~ltxasound examinations, cord doppler studies and fetal heart rate testing. The pregnancies were allowed to continue on outpatient basis until the time the fetal testing showed abnormalities. RESULTS: t 0 / I 1 were twin gestations and I was triplet. 16/23 fetuses were delivered alive. In 8/11 pregnancies oligohydramnios was diagnosed in the ADF fetuses close to time of the ~d)F diagnosis. The median gestational age at which the ADF was diagnosed was 23.l wks in pregnancies that did not experience an IUFD and the gestational age at delivery was 33.7 wks. Chromosmnal analysis was performed in 8/11 patients. One was diagnosed with trisomy 21. Seven fetuses (5 pregnancies) died in utero. In 3 / 7 where one fetus died, the ADF and growth retardation was documented at 22 & 23 wks in the 2 twin gestations and 28 wks in the triplet gestation. In these 3 cases we anticipated IUFD but did not intervene in the interest of the remaining fetuses. O n e patient delivered the twins at 23 wks and the remaining patient experienced rupture of the dividing membrane, and documented IUFD of both twins 10 days later. The twin gestation with T21 was terminated. CONCLUSION: In multiple gestations where one fetus is diagnosed with ADF the pregnancy can continue for an average of 10 additional wks. These patients can be managed on outpatient basis with frequent uhrasounds and fetal monitoring when they reach a viable gestation.
524
JUGULAR VENOUS B L O O D FLOW I N FETUSES WITH SINGLE NUCHAL UMBILICAL CORD B: Petrikovsk2, B. Gross, 1:2 Schneider, lq Mandel. Division of Maternal Fetal Medicine, North Shore Univ. Hospital, Manhasset, NY OBJECTIVE: To assess the jugular blood flow in fetuses with single umbilical cord detected prenatally. STUDY DESIGN: Twenty four fetuses between 20 and 42 weeks gestation with sonographically detected single nuchal cords comprised the study group. O n e hundred and six fetuses matched for gestational age without nuchal cords served as controls. Color and pulsed Doppler assessment of the jugular vein was performed. The following parameters were analyzed: peak systolic velocity (S), peak early diastolic velocity (D), S / D ratio, time averaged m a x i m u m velocity (Talnx) forward flow. RESULTS:
526
MIDDLE CEREBRAL ARTERY PEAK VELOCITY AND FETAL ANEMIA M.~ Johnson, W B. Krame~; L. Alger, (2 Mueller ~, C.P. Weiner. Center for Advanced Fetal Care, University of Maryland School of Medicine, Baldmore, MD. OBJECTIVE: Fetal anemia increases blood velocity. Marl et al suggeste d that the measurement of the fetal middle cerebral artery peak velocity (MCAPV) as a noninvasive test for fetal anemia (Uhrasound Obstet Gyne 5: 400) with an elevation being abnormal. STUDY DESIGN: The MCAPV was measured prior to 165 cordocenteses/intravascular transfusions (IVF) in 82 fetuses at the University of Iowa Fetal Diagnosis and Treatment Unit. 39 O f these fetuses underwent 116 procedures solely for the diagnosis and treatment of hemolytic disease (HD)~ The fetal HCT and MCAPV were normalized for gestational age; anemia was defined as <2SD below control (Am J Obstet Gynecol 1991; 165:546) and an elevation of the MCAPV 2SDs above control. 70/165 samples (42%) revealed anemia. Data analyses included 2• table and regression analysis. RESULTS: There was a significant relationship between both the actual and normalized H C T and the normalized MCAPV ( r = - 0 . 5 9 and -0.61, respectively, p<0.0001). Further, fetuses wid/ an elevated MCAPV had significandy lower HCTs (20% vs 34%, p<0.001). Unfortunately, a MCAPV 2SDs above the mean failed to identify the majority of aneinic fetuses.
Jugular flow parameters S (cm/sec) D (cm/sec) S/D Tainx forward
nuchal cord present 33 21 1.6 23
-+ 19 _+ 13 • 0.3 • 15
nuchal cord abse~t 27 + 16 NS* 17-+ 10NS* 1.7 -+ 0.4 NS* 17 • 1 NS*
flow (Cln/sec) NS*--Non-significant. CONCLUSIONS: The presence of a nuchal cord was not associated with alterations in the jugular flow parameters. Single nuchal cord does not affect blood outflow froin the fetal head as j u d g e d by jugular venous flow patterns.
All cases HD only
Sensitivity
Specificity
PPV
NPV
17 18
100 100
100 100
65 52
CONCLUSIONS: An elevated MCAPV in the setting of H D is strongly consistent with fetal anemia. But because of its very low sensitivity, a normal MCAPV cannot replace invasive testing.
V o l u m e 176, N u m b e r 1, Part 2 A m J O b s t e t Gynecol
$151
523
MATERNAL RENAL ARTERY B L O O D FLOW VELOCIMETRY I N NORMALAND PREECLAMPTIC PREGNANCIES M. Kublickas, 3L O. Lunell, H. Nisell, M. Westgr~n. Department of Ob/Gyn, Karolinska Institute, Huddinge University Hospital, S-141 86 Huddinge, Sweden. OBJECTIVE: The aim of the study was to investigate the effect of normal and preeclamptic pregnancy on the maternal renal artei3~ Doppler blood flow velocity indices. STUDY DESIGN: The study consisted of 30 normal pregnant women and 43 women with mild (n=28) and severe (n = 15) preeclampsia in the third trimester. Blood flow velocity in the segmental renal arteries t-ore the right kidney was analysed by pulsed and color Doppler. T h e pulsatility index (PI) was used for the Doppler waveform analysis. RESULTS: In the preeclamptic wonmn renal artery PI (i.00 -+ 0.16 in mild and 0.94 • 0.14 in severe preeclampsia) was significantly lower as compared to normal pregnant women (PI = 1.15 • 0.18) ; P < 0.01. Renal artery PI did not differ between mild and severe preeclampsia. There was a significant negative relationship between renal artery PI and mean arterial pressure in preeclamptic group (r = - 0 . 3 2 , P < 0.05). CONCLUSION: The present results demonstrate that the nmchauism of renal aumregulation in preeclampsia might be altered, leaving glomerulus unprotected from increased blood pressure. It seems that the concept of renal vasoconstriction in preeclampsia might be disputed and needs further investigation.
525
CLINICAL APPLICATIONS O F ABSENT DIASTOLIC FLOW IN MULTIPLE GESTATIONS. A. Webb,* .4. Rijhsinghani, D. Peleg.* Dept. Ob/Gyn, Univ. of Iowa, Iowa City, IA. OBJECTIVE: Our aim was to study the implications of Absent Diastolic Flow (ADF) in multiple gestations. STUDY DESIGN: A cohort of 11 muhiple gestations where one fetus was diagnosed with ADF were followed closely by frequent ~ltxasound examinations, cord doppler studies and fetal heart rate testing. The pregnancies were allowed to continue on outpatient basis until the time the fetal testing showed abnormalities. RESULTS: t 0 / I 1 were twin gestations and I was triplet. 16/23 fetuses were delivered alive. In 8/11 pregnancies oligohydramnios was diagnosed in the ADF fetuses close to time of the ~d)F diagnosis. The median gestational age at which the ADF was diagnosed was 23.l wks in pregnancies that did not experience an IUFD and the gestational age at delivery was 33.7 wks. Chromosmnal analysis was performed in 8/11 patients. One was diagnosed with trisomy 21. Seven fetuses (5 pregnancies) died in utero. In 3 / 7 where one fetus died, the ADF and growth retardation was documented at 22 & 23 wks in the 2 twin gestations and 28 wks in the triplet gestation. In these 3 cases we anticipated IUFD but did not intervene in the interest of the remaining fetuses. O n e patient delivered the twins at 23 wks and the remaining patient experienced rupture of the dividing membrane, and documented IUFD of both twins 10 days later. The twin gestation with T21 was terminated. CONCLUSION: In multiple gestations where one fetus is diagnosed with ADF the pregnancy can continue for an average of 10 additional wks. These patients can be managed on outpatient basis with frequent uhrasounds and fetal monitoring when they reach a viable gestation.
524
JUGULAR VENOUS B L O O D FLOW I N FETUSES WITH SINGLE NUCHAL UMBILICAL CORD B: Petrikovsk2, B. Gross, 1:2 Schneider, lq Mandel. Division of Maternal Fetal Medicine, North Shore Univ. Hospital, Manhasset, NY OBJECTIVE: To assess the jugular blood flow in fetuses with single umbilical cord detected prenatally. STUDY DESIGN: Twenty four fetuses between 20 and 42 weeks gestation with sonographically detected single nuchal cords comprised the study group. O n e hundred and six fetuses matched for gestational age without nuchal cords served as controls. Color and pulsed Doppler assessment of the jugular vein was performed. The following parameters were analyzed: peak systolic velocity (S), peak early diastolic velocity (D), S / D ratio, time averaged m a x i m u m velocity (Talnx) forward flow. RESULTS:
526
MIDDLE CEREBRAL ARTERY PEAK VELOCITY AND FETAL ANEMIA M.~ Johnson, W B. Krame~; L. Alger, (2 Mueller ~, C.P. Weiner. Center for Advanced Fetal Care, University of Maryland School of Medicine, Baldmore, MD. OBJECTIVE: Fetal anemia increases blood velocity. Marl et al suggeste d that the measurement of the fetal middle cerebral artery peak velocity (MCAPV) as a noninvasive test for fetal anemia (Uhrasound Obstet Gyne 5: 400) with an elevation being abnormal. STUDY DESIGN: The MCAPV was measured prior to 165 cordocenteses/intravascular transfusions (IVF) in 82 fetuses at the University of Iowa Fetal Diagnosis and Treatment Unit. 39 O f these fetuses underwent 116 procedures solely for the diagnosis and treatment of hemolytic disease (HD)~ The fetal HCT and MCAPV were normalized for gestational age; anemia was defined as <2SD below control (Am J Obstet Gynecol 1991; 165:546) and an elevation of the MCAPV 2SDs above control. 70/165 samples (42%) revealed anemia. Data analyses included 2• table and regression analysis. RESULTS: There was a significant relationship between both the actual and normalized H C T and the normalized MCAPV ( r = - 0 . 5 9 and -0.61, respectively, p<0.0001). Further, fetuses wid/ an elevated MCAPV had significandy lower HCTs (20% vs 34%, p<0.001). Unfortunately, a MCAPV 2SDs above the mean failed to identify the majority of aneinic fetuses.
Jugular flow parameters S (cm/sec) D (cm/sec) S/D Tainx forward
nuchal cord present 33 21 1.6 23
-+ 19 _+ 13 • 0.3 • 15
nuchal cord abse~t 27 + 16 NS* 17-+ 10NS* 1.7 -+ 0.4 NS* 17 • 1 NS*
flow (Cln/sec) NS*--Non-significant. CONCLUSIONS: The presence of a nuchal cord was not associated with alterations in the jugular flow parameters. Single nuchal cord does not affect blood outflow froin the fetal head as j u d g e d by jugular venous flow patterns.
All cases HD only
Sensitivity
Specificity
PPV
NPV
17 18
100 100
100 100
65 52
CONCLUSIONS: An elevated MCAPV in the setting of H D is strongly consistent with fetal anemia. But because of its very low sensitivity, a normal MCAPV cannot replace invasive testing.