This document discusses the clinical application of Doppler ultrasound in obstetrics. It describes how Doppler of the umbilical artery is used to monitor fetal well-being and detect conditions like intrauterine growth restriction. It outlines the normal parameters assessed and how they change with gestation. Abnormal Doppler findings like absent or reversed end diastolic flow indicate placental insufficiency. Middle cerebral artery Doppler and other assessments are also described.
The document discusses Doppler ultrasound findings for a 25-year-old pregnant female with uncontrolled hypertension. Key findings include oligohydramnios, elevated head circumference to abdominal circumference ratio, and abnormal Doppler readings of the umbilical artery, middle cerebral artery, and ductus venosus indicating fetal hypoxia and intrauterine growth restriction. The summary provides an overview of the patient details and significant ultrasound findings reported in the document.
Doppler ultrasound can be used in obstetrics and gynecology in several ways. It allows assessment of blood flow in various fetal and maternal vessels. In pregnancy, Doppler is commonly used to evaluate blood flow in the umbilical artery, middle cerebral artery, uterine arteries, ductus venosus and other vessels. Abnormal flow patterns in these vessels can indicate fetal growth restriction, hypoxia, or the risk of conditions like preeclampsia. Doppler provides important information about fetal well-being and helps manage high-risk pregnancies.
USG AND DOPPLER IN DIAGNOSIS AND MANAGEMENT OF IUGRshiv lasune
This document discusses the use of ultrasound and Doppler in the diagnosis and management of intrauterine growth restriction (IUGR). It defines small for gestational age (SGA) as a fetus below the 10th percentile and describes how Doppler of the umbilical artery can help identify fetuses with IUGR, monitor disease progression, and predict outcomes. Doppler of other fetal vessels like the middle cerebral artery and ductus venosus can further evaluate the fetus and help guide management decisions. Together, Doppler studies provide both diagnostic and prognostic information useful in the care of growth restricted fetuses.
This document discusses the interpretation of various types of Doppler ultrasound during pregnancy. It describes:
1. Umbilical artery Doppler which can detect placental hypoxia and increased resistance, predicting abnormal outcomes. Abnormal readings include increased resistance index and absent/reversed end diastolic flow.
2. Middle cerebral artery Doppler which can detect fetal anemia by increased blood flow to the brain. It is also used to time delivery of growth restricted infants.
3. Ductus venosus Doppler which has moderate predictive value for growth restriction in preterm infants.
4. Uterine artery Doppler has limited use in predicting fetal growth restriction but can identify maternal causes by abnormal readings.
This document discusses color Doppler ultrasound in the evaluation of intrauterine growth restriction (IUGR). It provides details on:
1. Changes seen in the fetal circulation in IUGR, including increased placental resistance seen on umbilical artery Doppler leading to absent or reversed end diastolic flow in severe cases.
2. Brain sparing effect seen on middle cerebral artery Doppler in IUGR fetuses, shown as increased diastolic flow.
3. Changes in the ductus venosus Doppler waveform seen in IUGR, from decreased forward flow to eventual reversal, indicating worsening fetal hypoxia and myocardial dysfunction.
This document discusses umbilical and uterine artery Doppler ultrasound. It notes that umbilical artery Doppler is useful for predicting abnormal fetal outcomes, with a resistance index above 0.72 outside normal limits after 26 weeks. Absent or reversed end diastolic flow in the umbilical artery indicates fetal distress and need for monitoring or delivery. Uterine artery Doppler has limited use in predicting fetal growth restriction but can suggest maternal versus fetal causes. An abnormal uterine Doppler with decreased diastolic flow or persistence of a diastolic notch after 24 weeks can help predict preeclampsia. Fortnightly umbilical artery Doppler scans are recommended when growth is not maintained or abdominal circumference is below the third percentile.
Doppler ultrasonography is used to analyze blood flow velocity in fetal vessels. The umbilical artery, middle cerebral artery, uterine artery, ductus venosus, inferior vena cava, and umbilical vein are examined. Normal and abnormal waveforms in these vessels provide information about placental and fetal wellbeing. Abnormal waveforms can indicate issues like intrauterine growth restriction and increased risk of fetal demise. Doppler is a valuable tool for assessing fetal health through non-invasive analysis of blood flow velocities.
Doppler ultrasound uses sound waves to evaluate blood flow and was first used in 1977 to study umbilical artery flow. It measures the Doppler shift in echoes from moving blood cells to determine flow velocity. Fetal vessels commonly assessed include the umbilical artery, which provides information on placental perfusion, and the middle cerebral artery, which indicates fetal oxygenation status. Doppler ultrasound can detect signs of fetal hypoxia like increased end-diastolic flow in the MCA, and meta-analyses found it reduces perinatal deaths and inductions when used for monitoring high-risk pregnancies.
The document discusses Doppler ultrasound findings for a 25-year-old pregnant female with uncontrolled hypertension. Key findings include oligohydramnios, elevated head circumference to abdominal circumference ratio, and abnormal Doppler readings of the umbilical artery, middle cerebral artery, and ductus venosus indicating fetal hypoxia and intrauterine growth restriction. The summary provides an overview of the patient details and significant ultrasound findings reported in the document.
Doppler ultrasound can be used in obstetrics and gynecology in several ways. It allows assessment of blood flow in various fetal and maternal vessels. In pregnancy, Doppler is commonly used to evaluate blood flow in the umbilical artery, middle cerebral artery, uterine arteries, ductus venosus and other vessels. Abnormal flow patterns in these vessels can indicate fetal growth restriction, hypoxia, or the risk of conditions like preeclampsia. Doppler provides important information about fetal well-being and helps manage high-risk pregnancies.
USG AND DOPPLER IN DIAGNOSIS AND MANAGEMENT OF IUGRshiv lasune
This document discusses the use of ultrasound and Doppler in the diagnosis and management of intrauterine growth restriction (IUGR). It defines small for gestational age (SGA) as a fetus below the 10th percentile and describes how Doppler of the umbilical artery can help identify fetuses with IUGR, monitor disease progression, and predict outcomes. Doppler of other fetal vessels like the middle cerebral artery and ductus venosus can further evaluate the fetus and help guide management decisions. Together, Doppler studies provide both diagnostic and prognostic information useful in the care of growth restricted fetuses.
This document discusses the interpretation of various types of Doppler ultrasound during pregnancy. It describes:
1. Umbilical artery Doppler which can detect placental hypoxia and increased resistance, predicting abnormal outcomes. Abnormal readings include increased resistance index and absent/reversed end diastolic flow.
2. Middle cerebral artery Doppler which can detect fetal anemia by increased blood flow to the brain. It is also used to time delivery of growth restricted infants.
3. Ductus venosus Doppler which has moderate predictive value for growth restriction in preterm infants.
4. Uterine artery Doppler has limited use in predicting fetal growth restriction but can identify maternal causes by abnormal readings.
This document discusses color Doppler ultrasound in the evaluation of intrauterine growth restriction (IUGR). It provides details on:
1. Changes seen in the fetal circulation in IUGR, including increased placental resistance seen on umbilical artery Doppler leading to absent or reversed end diastolic flow in severe cases.
2. Brain sparing effect seen on middle cerebral artery Doppler in IUGR fetuses, shown as increased diastolic flow.
3. Changes in the ductus venosus Doppler waveform seen in IUGR, from decreased forward flow to eventual reversal, indicating worsening fetal hypoxia and myocardial dysfunction.
This document discusses umbilical and uterine artery Doppler ultrasound. It notes that umbilical artery Doppler is useful for predicting abnormal fetal outcomes, with a resistance index above 0.72 outside normal limits after 26 weeks. Absent or reversed end diastolic flow in the umbilical artery indicates fetal distress and need for monitoring or delivery. Uterine artery Doppler has limited use in predicting fetal growth restriction but can suggest maternal versus fetal causes. An abnormal uterine Doppler with decreased diastolic flow or persistence of a diastolic notch after 24 weeks can help predict preeclampsia. Fortnightly umbilical artery Doppler scans are recommended when growth is not maintained or abdominal circumference is below the third percentile.
Doppler ultrasonography is used to analyze blood flow velocity in fetal vessels. The umbilical artery, middle cerebral artery, uterine artery, ductus venosus, inferior vena cava, and umbilical vein are examined. Normal and abnormal waveforms in these vessels provide information about placental and fetal wellbeing. Abnormal waveforms can indicate issues like intrauterine growth restriction and increased risk of fetal demise. Doppler is a valuable tool for assessing fetal health through non-invasive analysis of blood flow velocities.
Doppler ultrasound uses sound waves to evaluate blood flow and was first used in 1977 to study umbilical artery flow. It measures the Doppler shift in echoes from moving blood cells to determine flow velocity. Fetal vessels commonly assessed include the umbilical artery, which provides information on placental perfusion, and the middle cerebral artery, which indicates fetal oxygenation status. Doppler ultrasound can detect signs of fetal hypoxia like increased end-diastolic flow in the MCA, and meta-analyses found it reduces perinatal deaths and inductions when used for monitoring high-risk pregnancies.
This document discusses color Doppler ultrasound techniques for fetal surveillance. It describes the anatomy of fetal and placental circulation and examines the uterine, umbilical and middle cerebral arteries. Waveform analysis using indices like S/D ratio, resistance index and pulsatility index is discussed. Normal and abnormal Doppler findings are presented along with their clinical significance and management. Precise techniques for imaging and interpreting various fetal blood vessels are provided.
Doppler us in the evaluation of fetal growthSumiya Arshad
This document discusses the use of Doppler ultrasound to diagnose and monitor fetal growth restriction. It outlines the current definitions of fetal growth restriction, techniques for obtaining Doppler waveforms of various fetal vessels, and what abnormal Doppler readings indicate in terms of fetal wellbeing and risk of adverse outcomes. Specifically, it describes how umbilical, middle cerebral, and ductus venosus artery Dopplers can identify fetuses with placental insufficiency and help guide management decisions.
This document provides an overview of fetal echocardiography. It discusses the equipment used, techniques for determining fetal laterality and image orientation, and how to assess the visceroatrial arrangement and cardiac position/axis. It also describes segmental analysis of the heart and various echocardiographic projections including the four chamber, five chamber, and three vessel views. Fetal echocardiography allows for diagnosis of structural heart defects and observation of cardiac physiology before birth.
This document discusses Doppler ultrasound of the umbilical artery. It begins by introducing Doppler ultrasound and its use in assessing fetal circulation. It then covers the physics of Doppler ultrasound and different Doppler modalities used such as continuous wave, pulsed wave, and color Doppler. Key aspects of Doppler waveform analysis are also outlined like peak systolic frequency and end-diastolic frequency. The document concludes by noting that abnormal Doppler readings can indicate fetal compromise and are correlated with adverse perinatal outcomes like growth restriction or preeclampsia.
This document discusses intrauterine growth restriction, fetal doppler, and macrosomia. It defines these conditions and outlines their causes, diagnostic techniques like doppler ultrasonography, and implications. Doppler uses ultrasound to measure blood flow and has been used since 1977 to study umbilical artery flow velocity. It is useful for assessing fetal well-being and risk of complications like neonatal intensive care unit admissions or brain injuries. The document also details ultrasound findings and considerations for at-risk growth-restricted or large fetuses.
Ultrasound in Obstetric Emergencies by Dr Wannanee MeennuchRathachai Kaewlai
1. The document provides guidance on using ultrasound to evaluate common emergency obstetric conditions, including vaginal bleeding and pelvic pain in the first, second, and third trimesters.
2. Key first trimester ultrasound findings discussed include yolk sac presence/size and cardiac activity for evaluating failed pregnancies. Common causes of first trimester bleeding like ectopic pregnancy, miscarriage, and molar pregnancy are reviewed.
3. Second and third trimester bleeding conditions like placenta previa, placenta accreta, placental abruption, and vasa previa are covered, along with their ultrasound identification and management.
Ultrasonography is useful for evaluating the normal ovary and detecting abnormalities. A normal ovary appears hypoechoic and contains multiple small follicles. During ovulation, a corpus luteum forms which appears as a solid or cystic structure. Polycystic ovary syndrome is diagnosed based on the number of follicles present. Ultrasonography can also detect cysts, masses, ectopic pregnancies and other ovarian pathologies. It is an important tool for assessing ovarian function and guiding fertility treatments.
This document discusses screening for chromosomal defects like Trisomy 21 during pregnancy using ultrasound measurements of fetal nuchal translucency thickness between 11-13+6 weeks. It describes how increased nuchal translucency is associated with chromosomal abnormalities and various markers that can be assessed during the first trimester ultrasound like absent nasal bone, abnormal ductus venosus flow, and certain fetal measurements. The document provides guidelines for managing pregnancies based on nuchal translucency measurements and discusses offering invasive diagnostic tests for higher risk pregnancies.
Ultrasound examination of the third trimester of pregnancyMohamed Gamal
The document summarizes a third trimester ultrasound examination performed between 28-32 weeks of gestation. A third trimester ultrasound assesses fetal growth and anatomy, amniotic fluid levels, and placental position. It measures fetal size, heart rate, and blood flow. It also checks cervical length and fetal position. The goal is to monitor fetal well-being and check for any issues like placental problems or abnormal growth. The ultrasound is performed transabdominally with a full bladder or transvaginally if needed for a clear view. It provides important information to monitor the health of the mother and fetus late in pregnancy.
The document discusses examination of the fetal heart. It describes basic screening using the four chamber view as part of routine mid-trimester scans, noting it can identify around 40% of congenital heart defects. Extended basic screening adding views of the outflow tracts increases detection rates. Detailed fetal echocardiography provides comprehensive anatomical and morphological assessment of the heart and is recommended when risk of defects is above average.
Presentation1, radiological imaging of placenta accreta.Abdellah Nazeer
1. The document discusses radiological imaging of placenta accreta, specifically focusing on ultrasound and MRI findings.
2. Key ultrasound findings that suggest placenta accreta include placental lacunae, disruption of normal color Doppler blood flow patterns in the myometrium, loss of the retroplacental clear space, and reduced myometrial thickness.
3. Important MRI findings include uterine bulging, heterogeneous placental signal intensity, and dark intraplacental bands on T2-weighted images. Visualization of direct placental invasion of the bladder is also suggestive of placenta percreta.
Accompanying slides for the Ultrasound in Obstetrics and Gynecology article 'How to measure cervical length' by K. O. Kagan and J. Sonek
You can find the full article here:
http://onlinelibrary.wiley.com/doi/10.1002/uog.14742/full
ultrasonography in obstetrics, usg in obstetrics, ultrasound in obstetrics, doppler in obstetrics, usg doppler in obstetrics, signs in ultrasound, anomaly scan, pregnancy scan, ultrasound in pregnancy,
This document discusses the role of color Doppler ultrasound in antepartum fetal surveillance. It begins by outlining the purposes of fetal surveillance, which include reducing fetal death and optimizing delivery timing. It then discusses various maternal and fetal conditions that require increased surveillance due to risks of chronic hypoxia. The document covers different methods of antepartum surveillance and provides detailed explanations of Doppler ultrasound principles, techniques like uterine and umbilical artery Doppler, and how abnormal Doppler readings can predict complications like fetal growth restriction.
This document discusses placental abnormalities that can be detected on prenatal sonography. It begins by covering embryology and normal placental development. It then discusses various placental abnormalities such as placental previa, accreta, infarction, and morphological abnormalities. It provides details on the sonographic findings, risk factors, and clinical implications of each abnormality. The conclusion emphasizes the importance of understanding placental anatomy and physiology to properly identify any abnormalities and optimize outcomes for the mother and baby.
The document provides details about performing and interpreting a fetal anatomy scan between 18-20 weeks of gestation. It describes assessing various fetal anatomical structures including the brain, skull, abdomen, lungs, heart, spine, and limbs. Key measurements and normal ranges are outlined. Common congenital anomalies that may be detected on the scan are also described for various structures. The purpose of the anatomy scan is to evaluate fetal anatomy and screen for potential fetal anomalies.
This document discusses ventriculomegaly (VM), which is the enlargement of the lateral cerebral ventricles. VM has many potential causes including infections, vascular issues, hydrocephalus, malformations, or genetic abnormalities. It can range from mild to severe. Evaluation involves detailed ultrasound exams and may include fetal MRI or maternal infection testing. Isolated mild VM carries a low risk of problems while isolated severe VM has poorer outcomes. Recurrence risks vary depending on the underlying etiology.
This document provides an overview of Doppler ultrasonography in obstetrics. It discusses the prerequisites for Doppler studies including the ultrasound machine capabilities and patient preparation. It describes the indications for Doppler including fetal growth abnormalities and maternal risk factors. It examines in detail the various fetal and maternal vessels that can be assessed by Doppler including the umbilical artery, middle cerebral artery, and uterine arteries. It outlines the normal and abnormal waveforms seen in each vessel and their clinical significance.
1) Intrauterine growth restriction (IUGR) refers to babies whose birth weight is below the 10th percentile for gestational age. It can affect preterm, term, or post-term babies.
2) The incidence of IUGR is about 3-10% in developed countries. IUGR babies have an increased risk of perinatal mortality and morbidity that progressively increases as birth weight percentile decreases.
3) IUGR can be symmetrical, affecting growth uniformly, or asymmetrical, where the head is larger than the abdomen indicating preferential shunting of nutrients to the brain. Causes include placental insufficiency, infections, and genetic/structural abnormalities.
This document discusses color Doppler ultrasound techniques for fetal surveillance. It describes the anatomy of fetal and placental circulation and examines the uterine, umbilical and middle cerebral arteries. Waveform analysis using indices like S/D ratio, resistance index and pulsatility index is discussed. Normal and abnormal Doppler findings are presented along with their clinical significance and management. Precise techniques for imaging and interpreting various fetal blood vessels are provided.
Doppler us in the evaluation of fetal growthSumiya Arshad
This document discusses the use of Doppler ultrasound to diagnose and monitor fetal growth restriction. It outlines the current definitions of fetal growth restriction, techniques for obtaining Doppler waveforms of various fetal vessels, and what abnormal Doppler readings indicate in terms of fetal wellbeing and risk of adverse outcomes. Specifically, it describes how umbilical, middle cerebral, and ductus venosus artery Dopplers can identify fetuses with placental insufficiency and help guide management decisions.
This document provides an overview of fetal echocardiography. It discusses the equipment used, techniques for determining fetal laterality and image orientation, and how to assess the visceroatrial arrangement and cardiac position/axis. It also describes segmental analysis of the heart and various echocardiographic projections including the four chamber, five chamber, and three vessel views. Fetal echocardiography allows for diagnosis of structural heart defects and observation of cardiac physiology before birth.
This document discusses Doppler ultrasound of the umbilical artery. It begins by introducing Doppler ultrasound and its use in assessing fetal circulation. It then covers the physics of Doppler ultrasound and different Doppler modalities used such as continuous wave, pulsed wave, and color Doppler. Key aspects of Doppler waveform analysis are also outlined like peak systolic frequency and end-diastolic frequency. The document concludes by noting that abnormal Doppler readings can indicate fetal compromise and are correlated with adverse perinatal outcomes like growth restriction or preeclampsia.
This document discusses intrauterine growth restriction, fetal doppler, and macrosomia. It defines these conditions and outlines their causes, diagnostic techniques like doppler ultrasonography, and implications. Doppler uses ultrasound to measure blood flow and has been used since 1977 to study umbilical artery flow velocity. It is useful for assessing fetal well-being and risk of complications like neonatal intensive care unit admissions or brain injuries. The document also details ultrasound findings and considerations for at-risk growth-restricted or large fetuses.
Ultrasound in Obstetric Emergencies by Dr Wannanee MeennuchRathachai Kaewlai
1. The document provides guidance on using ultrasound to evaluate common emergency obstetric conditions, including vaginal bleeding and pelvic pain in the first, second, and third trimesters.
2. Key first trimester ultrasound findings discussed include yolk sac presence/size and cardiac activity for evaluating failed pregnancies. Common causes of first trimester bleeding like ectopic pregnancy, miscarriage, and molar pregnancy are reviewed.
3. Second and third trimester bleeding conditions like placenta previa, placenta accreta, placental abruption, and vasa previa are covered, along with their ultrasound identification and management.
Ultrasonography is useful for evaluating the normal ovary and detecting abnormalities. A normal ovary appears hypoechoic and contains multiple small follicles. During ovulation, a corpus luteum forms which appears as a solid or cystic structure. Polycystic ovary syndrome is diagnosed based on the number of follicles present. Ultrasonography can also detect cysts, masses, ectopic pregnancies and other ovarian pathologies. It is an important tool for assessing ovarian function and guiding fertility treatments.
This document discusses screening for chromosomal defects like Trisomy 21 during pregnancy using ultrasound measurements of fetal nuchal translucency thickness between 11-13+6 weeks. It describes how increased nuchal translucency is associated with chromosomal abnormalities and various markers that can be assessed during the first trimester ultrasound like absent nasal bone, abnormal ductus venosus flow, and certain fetal measurements. The document provides guidelines for managing pregnancies based on nuchal translucency measurements and discusses offering invasive diagnostic tests for higher risk pregnancies.
Ultrasound examination of the third trimester of pregnancyMohamed Gamal
The document summarizes a third trimester ultrasound examination performed between 28-32 weeks of gestation. A third trimester ultrasound assesses fetal growth and anatomy, amniotic fluid levels, and placental position. It measures fetal size, heart rate, and blood flow. It also checks cervical length and fetal position. The goal is to monitor fetal well-being and check for any issues like placental problems or abnormal growth. The ultrasound is performed transabdominally with a full bladder or transvaginally if needed for a clear view. It provides important information to monitor the health of the mother and fetus late in pregnancy.
The document discusses examination of the fetal heart. It describes basic screening using the four chamber view as part of routine mid-trimester scans, noting it can identify around 40% of congenital heart defects. Extended basic screening adding views of the outflow tracts increases detection rates. Detailed fetal echocardiography provides comprehensive anatomical and morphological assessment of the heart and is recommended when risk of defects is above average.
Presentation1, radiological imaging of placenta accreta.Abdellah Nazeer
1. The document discusses radiological imaging of placenta accreta, specifically focusing on ultrasound and MRI findings.
2. Key ultrasound findings that suggest placenta accreta include placental lacunae, disruption of normal color Doppler blood flow patterns in the myometrium, loss of the retroplacental clear space, and reduced myometrial thickness.
3. Important MRI findings include uterine bulging, heterogeneous placental signal intensity, and dark intraplacental bands on T2-weighted images. Visualization of direct placental invasion of the bladder is also suggestive of placenta percreta.
Accompanying slides for the Ultrasound in Obstetrics and Gynecology article 'How to measure cervical length' by K. O. Kagan and J. Sonek
You can find the full article here:
http://onlinelibrary.wiley.com/doi/10.1002/uog.14742/full
ultrasonography in obstetrics, usg in obstetrics, ultrasound in obstetrics, doppler in obstetrics, usg doppler in obstetrics, signs in ultrasound, anomaly scan, pregnancy scan, ultrasound in pregnancy,
This document discusses the role of color Doppler ultrasound in antepartum fetal surveillance. It begins by outlining the purposes of fetal surveillance, which include reducing fetal death and optimizing delivery timing. It then discusses various maternal and fetal conditions that require increased surveillance due to risks of chronic hypoxia. The document covers different methods of antepartum surveillance and provides detailed explanations of Doppler ultrasound principles, techniques like uterine and umbilical artery Doppler, and how abnormal Doppler readings can predict complications like fetal growth restriction.
This document discusses placental abnormalities that can be detected on prenatal sonography. It begins by covering embryology and normal placental development. It then discusses various placental abnormalities such as placental previa, accreta, infarction, and morphological abnormalities. It provides details on the sonographic findings, risk factors, and clinical implications of each abnormality. The conclusion emphasizes the importance of understanding placental anatomy and physiology to properly identify any abnormalities and optimize outcomes for the mother and baby.
The document provides details about performing and interpreting a fetal anatomy scan between 18-20 weeks of gestation. It describes assessing various fetal anatomical structures including the brain, skull, abdomen, lungs, heart, spine, and limbs. Key measurements and normal ranges are outlined. Common congenital anomalies that may be detected on the scan are also described for various structures. The purpose of the anatomy scan is to evaluate fetal anatomy and screen for potential fetal anomalies.
This document discusses ventriculomegaly (VM), which is the enlargement of the lateral cerebral ventricles. VM has many potential causes including infections, vascular issues, hydrocephalus, malformations, or genetic abnormalities. It can range from mild to severe. Evaluation involves detailed ultrasound exams and may include fetal MRI or maternal infection testing. Isolated mild VM carries a low risk of problems while isolated severe VM has poorer outcomes. Recurrence risks vary depending on the underlying etiology.
This document provides an overview of Doppler ultrasonography in obstetrics. It discusses the prerequisites for Doppler studies including the ultrasound machine capabilities and patient preparation. It describes the indications for Doppler including fetal growth abnormalities and maternal risk factors. It examines in detail the various fetal and maternal vessels that can be assessed by Doppler including the umbilical artery, middle cerebral artery, and uterine arteries. It outlines the normal and abnormal waveforms seen in each vessel and their clinical significance.
1) Intrauterine growth restriction (IUGR) refers to babies whose birth weight is below the 10th percentile for gestational age. It can affect preterm, term, or post-term babies.
2) The incidence of IUGR is about 3-10% in developed countries. IUGR babies have an increased risk of perinatal mortality and morbidity that progressively increases as birth weight percentile decreases.
3) IUGR can be symmetrical, affecting growth uniformly, or asymmetrical, where the head is larger than the abdomen indicating preferential shunting of nutrients to the brain. Causes include placental insufficiency, infections, and genetic/structural abnormalities.
1) Intrauterine growth restriction (IUGR) refers to babies whose birth weight is below the 10th percentile for gestational age. It can affect preterm, term, or post-term babies.
2) The causes of IUGR include maternal conditions, fetal abnormalities, infections, placental dysfunction, and unknown etiologies in about 40% of cases.
3) Diagnosis involves clinical assessment, ultrasound measurements of fetal size and growth, biophysical profile testing, and Doppler studies of umbilical and uterine blood flow.
1) Fetal surveillance techniques like biophysical profile (BPP) and Doppler velocimetry help assess fetal well-being and risk of complications like intrauterine growth restriction (IUGR). Abnormal results increase rates of operative delivery, neonatal morbidity and mortality.
2) The BPP evaluates fetal movement, tone, breathing and reactivity and is interpreted based on fetal sleep cycles. Abnormal results on Doppler of the umbilical artery, middle cerebral artery, ductus venosus or uterine arteries also indicate placental insufficiency risk.
3) Despite wide individual variation, regular antenatal testing aims to predict wellness rather than just illness and time deliveries for highest chances of good outcomes
1) IUGR is caused by genetic or environmental factors that inhibit a fetus from reaching its growth potential, resulting in birth weight below the 10th percentile.
2) The leading causes of IUGR are placental insufficiency due to conditions like preeclampsia, diabetes, and chronic hypertension.
3) Diagnosis of IUGR involves assessing risk factors, ultrasound to evaluate fetal growth and dating, and Doppler ultrasound of the umbilical artery, uterine artery, middle cerebral artery, and ductus venosus to detect signs of placental insufficiency or fetal stress.
This document provides information about Prof. Narendra Malhotra, including his academic and professional qualifications, positions held, awards received, publications, lectures given, and organizations founded. It then provides an objectives and agenda for a talk on using color doppler to assess fetal growth restriction (FGR). The talk covers doppler principles, applications in evaluating the uteroplacental and fetal circulations in FGR, implications of abnormal doppler waveforms, and new applications such as in assessing fetal anemia and 3D doppler. It proposes a staging system for FGR based on doppler findings to determine timely delivery.
This document provides an overview of antepartum fetal surveillance methods. It discusses that the majority of fetal deaths occur in the antepartum period due to causes like fetal hypoxia, maternal complications, congenital malformations, and unexplained causes. The primary objective of antenatal fetal assessment is to avoid fetal death. It then describes various monitoring methods including clinical monitoring, special investigations like biochemical tests, cytogenetic tests, biophysical profiling, and Doppler ultrasound assessments of the fetus and amniotic fluid volume.
Umbilical artery doppler provides a non-invasive way to assess fetal circulation. Abnormal findings in the umbilical artery doppler such as absent or reversed end diastolic flow indicate placental insufficiency and fetal hypoxia. As the condition worsens, there is a progression from reduced to absent to reversed end diastolic flow. Along with other tests such as MCA and ductus venosus doppler, umbilical artery doppler helps predict poor fetal outcome if no interventions are made.
10.Antenatal Assesment of fetal well being (10).pptxSunilYadav42766
Fetal assessment involves various biophysical tests and Doppler ultrasound exams to evaluate fetal well-being. Biophysical tests include fetal movement counting, non-stress tests to examine heart rate patterns, and biophysical profile scoring of 5 factors. Doppler of the umbilical artery assesses blood flow and can indicate placental insufficiency. Middle cerebral artery Doppler and ductus venosus exams evaluate the fetal circulatory response. Together these non-invasive tests provide information on the fetus's health and ability to tolerate stress.
This document discusses cardiovascular diseases in pregnancy. Some key points:
- Risk factors for heart disease in pregnancy are increasing and include diabetes, hypertension, and obesity. The number of women with congenital heart disease reaching childbearing age is also rising.
- Hemodynamic changes during pregnancy place additional strain on the heart, increasing cardiac output and blood volume. These changes begin in the first trimester and peak in the second.
- Women with preexisting heart conditions like pulmonary hypertension face higher risks during pregnancy and delivery. Those with severe disease may require termination of pregnancy for safety. Close monitoring is important for women with heart conditions throughout their pregnancy.
The document summarizes Doppler ultrasound findings for a 25-year-old pregnant female with uncontrolled hypertension. Key findings included oligohydramnios, elevated head circumference to abdominal circumference ratio, and abnormal uterine and umbilical artery Doppler readings indicative of fetal hypoxia/intrauterine growth restriction. The summary discusses various Doppler measurements used to evaluate fetal well-being and placental function, including implications of abnormal readings. Middle cerebral artery Doppler was noted as useful to monitor fetal compensation for deteriorating placental function through blood flow redistribution.
The document discusses intrauterine growth restriction (IUGR), including its definition, epidemiology, etiology, pathophysiology, classification, diagnosis, management, and complications. IUGR, also known as fetal growth restriction, is diagnosed when a fetus is estimated to weigh less than the 10th percentile for gestational age based on ultrasound. Proper diagnosis involves serial fundal height measurements and ultrasound assessment of fetal size, amniotic fluid levels, and umbilical and cerebral doppler studies. Management may include monitoring, delivery timing based on test results, and treatment of any underlying maternal conditions. Complications of IUGR include stillbirth, neonatal difficulties, and long-term developmental issues.
1. Intrauterine growth restriction (IUGR) is a complication of pregnancy where the fetus does not attain its full growth potential, affecting up to 10% of pregnancies.
2. Risk factors for IUGR include maternal conditions, fetal anomalies, infections, and placental insufficiency. Abnormal umbilical artery Doppler is associated with increased risk of adverse outcomes.
3. Serial ultrasounds and Doppler studies are used to monitor fetal growth and well-being. Timing of delivery depends on gestational age and severity of IUGR.
Intrauterine growth restriction (IUGR) occurs when a fetus fails to reach its growth potential and is smaller than the 10th percentile for gestational age. IUGR is often associated with oligohydramnios, a deficiency of amniotic fluid, because decreased maternal-fetal blood flow can reduce kidney function and urine output in the fetus. The causes of IUGR include placental insufficiency, fetal abnormalities, infections, and maternal conditions like hypertension. Management involves monitoring fetal growth, well-being and lung maturity to determine the optimal time for delivery. IUGR fetuses are at risk for complications during labor so continuous fetal monitoring is important.
This document presents a case of a 23-year-old pregnant woman in her third trimester who is presenting with cessation of menses for 8.5 months and ghabrahat (anxiety) for 3 days. Her obstetric history and examination are presented. Based on her last menstrual period and ultrasound dating, her gestational age does not match. Doppler ultrasound of the umbilical and middle cerebral arteries will be performed next to investigate possible fetal growth restriction, oligohydramnios, or intrauterine fetal demise. Abnormal Doppler findings would indicate increased risk of adverse perinatal outcomes.
Imaging techniques in pregnancy mbbs final year class.pptxRajesweri Malar
Ultrasound is commonly used in pregnancy to evaluate the fetus and cervix. In the first trimester, ultrasound can confirm pregnancy and determine gestational age. It can also detect multiple pregnancies, miscarriage, ectopic pregnancy and cervical insufficiency. The second trimester ultrasound systematically examines the fetus for anomalies and measures fetal growth. Doppler ultrasound evaluates blood flow and can detect issues with the placenta or umbilical cord. The third trimester focuses on further assessing fetal growth, well-being and detecting any anomalies or complications.
This document provides an overview of intrauterine growth restriction (IUGR). It defines IUGR as fetuses with an estimated fetal weight below the 10th percentile. The prevalence of IUGR is 3-10% of pregnancies and carries high risks of perinatal mortality and morbidity. Causes of IUGR include fetal, placental and maternal factors. Diagnosis involves serial ultrasounds to monitor fetal growth and Doppler studies of blood flow. Management focuses on treating any underlying conditions, fetal monitoring, and timely delivery once the fetus is mature. Strict surveillance of at-risk newborns is also needed due to complications of IUGR.
The document provides an overview of antiphospholipid antibody syndrome (APS). It defines APS as a systemic autoimmune disease characterized by vascular thrombosis or adverse obstetric outcomes in patients with persistent antiphospholipid antibodies. The classification criteria for APS requires at least one clinical criterion (vascular thrombosis or pregnancy morbidity) and one laboratory criterion (presence of lupus anticoagulant or antiphospholipid antibodies). Common clinical manifestations of APS include venous thromboses, arterial thromboses, obstetric complications, and valvular heart disease. Treatment involves anticoagulation to prevent future thrombotic events.
Doppler in obstetric power point presentation (4)RiyadhWaheed
Doppler ultrasound is used in obstetrics to evaluate fetal growth and well-being. It assesses blood flow in the umbilical artery (placental circulation), middle cerebral artery (fetal circulation), and uterine arteries (maternal circulation). Abnormal Doppler readings include increased resistance and absent/reversed end diastolic flow in the umbilical artery, which indicate placental insufficiency and fetal growth restriction. The middle cerebral artery Doppler shows the brain-sparing effect in hypoxic fetuses. Together, Doppler ultrasound provides important information about the fetus's condition and helps time delivery.
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Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
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The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
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Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
2. UMBILICAL ARTERY
• Umbilical arterial (UA) Doppler assessment is used
in surveillance of fetal well-being in the 3RD trimester
of pregnancy. Abnormal umbilical artery Doppler is a
marker of placental insufficiency and
consequent intrauterine growth restriction (IUGR) or
suspected pre-eclampsia.
• It has been shown to reduce perinatal mortality and
morbidity in high-risk obstetric situations 5.
• As a general rule, a degree of caution should be
exercised with the routine use of Doppler in
pregnancy, due to the concerns related
to heating/thermal effects from the high intensities
3. PARAMETERS
• The commonly used parameters are:
• umbilical arterial S/D ratio (SDR): systolic velocity / diastolic velocity
• pulsatility index (PI) (Gosling index): (PSV - EDV) / TAV
• resistive index (RI) (Pourcelot index): (PSV - EDV) / PSV
• PSV: peak systolic velocity
• EDV: end-diastolic velocity
• TAV: time-averaged velocity
• The Doppler indices have been found to decline gradually with gestational age
(i.e. there is more diastolic flow as the fetus matures):
• S/D ratio mean value decreases with fetal age 8
– at 20 weeks, the 50th percentile for the S/D ratio is 4
– at 30 weeks, the 50th percentile is 2.83
– at 40 weeks, the 50th percentile is 2.18
• RI mean value decreases from 0.756 to 0.609
• PI mean value decreases from 1.270 to 0.967
• Classification of severity
• In growth-restricted fetuses and fetuses developing intrauterine distress, the
umbilical artery blood velocity waveform usually changes in a progressive manner
as below
• reduction in end-diastolic flow: increasing RI values, PI values, and S/D ratio
• absent end-diastolic flow (AEDF): RI = 1
4. RADIOGRAPHIC FEATURES
• Waveform
• The umbilical arterial waveform usually has a
"sawtooth" pattern with flow always in the forward
direction, that is towards the placenta. An abnormal
waveform shows absent or reversed diastolic flow.
Before the 15th week, the absence of diastolic flow may
be a normal finding 6.
• The 95% confidence interval limit slowly decreases for
both the resistive index (RI) and pulsatility index
(PI) through the course of gestation due to progressive
maturation of the placenta and increase in the number
of tertiary stem villi.
5. INDICATIONS
• Umbilical Doppler assessment is indicated in scenarios where there is a
risk of fetal growth restriction or poor perinatal outcome. It is also used to
stage twin-twin transfusion 7.
• Doppler ultrasound evaluation of the fetoplacental circulation is not
indicated in low-risk pregnancies 7.
• Maternal conditions
• diabetes mellitus
• chronic kidney disease
• hypertension
• prothrombotic states
• Pregnancy-related conditions
• suspected IUGR
• previous pregnancy with IUGR or fetal death in utero
• decreased fetal movement
• oligohydramnios
• polyhydramnios
• multifetal pregnancy
• . Cochrane trial[compares use of doppler with no doppler][29%
REDUCTION IN PERINATAL DEATHS
6. SINGLE UMBILICAL ARTERY
• Single umbilical artery (SUA) results when there is a congenital absence
of either the right or left umbilical artery. In the usual situation, there are
paired umbilical arteries.the absence of the left umbilical artery is much
more common (~70%).
• Epidemiology
• prevalence is ~0.4-1% of pregnancies 5,6,10.There may be an increased
incidence of twin pregnancies and maternal diabetes.
• Pathology
• The occurrence of a single umbilical artery is thought to be due to
secondary atresia or atrophy rather than primary agenesis of the
artery.The remaining single artery is often quite large and approaches
the size of the umbilical vein (which is usually larger than the artery).
• In ~65% (range 57-75%) of cases, a single umbilical artery is present in
isolation 1
•
•
•
•
•
•
•
•
•
7. ASSOCIATIONS
• When found in isolation, it is usually not of clinical significance but there is
an increased incidence of intrauterine growth restriction (IUGR) 6 (~15%).
• Recognized associations are thought to be present in ~35% (range 25-
43%) of cases:
• lesser number of coils in the umbilical cord
• umbilical arterial aneurysm
• twin reversed arterial perfusion sequence
• increased incidence of intrauterine growth restriction (IUGR)
• When found with other fetal anomalies, it can be also be associated with:
• chromosomal anomalies
– trisomy 21 (12.8% had an SUA), trisomy 18 (50% had an SUA), trisomy
13 (25% had an SUA) 11
• persistent right umbilical vein
• congenital renal anomalies
– renal agenesis: occurs usually on the side where the artery is absent 10
• sirenomelia
• velamentous insertion of the cord
• Some suggest that complex congenital and chromosomal abnormalities
are found almost exclusively when the left umbilical artery is absent
8. RADIOLOGIC FEATURES
• This is the imaging investigation of choice and an SUA is often detected
incidentally on ultrasound. High-resolution ultrasound has a sensitivity
and specificity approaching 100% 1. Sonographic features include:
• two vessels within the umbilical cord (one artery and one vein) instead of
the usual three (best seen in cross-section)
• the single artery is often larger in caliber than normal and approaches the
diameter of the accompanying vein
• examination of the fetal pelvis will demonstrate only one umbilical artery
lateral to the bladder in its course toward the umbilical cord
•
•
•
•
9.
10. ABSENT END DIASTOLIC FLOW
• in an umbilical artery Doppler assessment is a useful feature which
indicates underlying fetal vascular stress if detected in mid or late
pregnancy. It is often classified as Class II in severity in abnormal umbilical
arterial Dopplers 9.
• Pathology
• The presence of absent end-diastolic flow (AEDF) can be normal in early
pregnancy (up to 16 weeks). In mid to late pregnancy it usually occurs as
a result of placental insufficiency 7,8. Flow in the umbilical artery should be
in the forward direction in normal circumstances. If placental resistance
increases, the diastolic flow may reduce, later becoming absent and
finally reverses.
• Associations
• intra-uterine growth restriction (IUGR)
• increased risk of neonatal thrombocytopenia 6
• increased risk of necrotizing enterocolitis1
11. REVERSAL OF END DIASTOLIC FLOW
REDF velocity is often an ominous finding if detected after 16 weeks. It is
classified as Class III in severity in abnormal umbilical arterial Dopplers 6.
• Epidemiology
• The estimated incidence is at ~0.5% of all pregnancies with a much higher
rate in intrauterine growth-restricted (IUGR) fetuses.
• Pathology
• The feature is seen as a result of a significant increase in resistance to
blood flow within the placenta and often represents a "tip of the iceberg"
where there is a much larger underlying pathology.
• In a normal situation, umbilical arterial flow should always be in the
forward direction in both systole and diastole.
• However, during the first 16 weeks, a reversal in end diastolic flow can be
a normal finding due to the low resistance arcuate arteries and
intervillous spaces not yet being formed.
• Flow reversal can also be detected in the fetal aorta.
12.
13.
14.
15.
16. MCA DOPPLER
• Fetal middle cerebral arterial (MCA) Doppler assessment is an important part of
assessing fetal cardiovascular distress, fetal anemia or fetal hypoxia. In the
appropriate situation it is a very useful adjunct to umbilical artery Doppler
assessment. It is also used in the additional work up of:
• intra-uterine growth restriction (IUGR)
• twin to twin transfusion syndrome (TTTS) 5
• twin anemia polycythemia sequence (TAPS)
• Parameters used include:
• fetal MCA pulsatility index (PI)
• fetal MCA peak systolic velocity (PSV): the highest velocity should be recorded
• fetal MCA systolic/diastolic (S/D) ratio: a normal fetal MCA S/D ratio should
always be higher than the umbilical arterial S/D ratio
• cerebroplacental ratio (CPR): ratio of pulsatility index of MCA and umbilical artery
• Interpretation
• in the normal situation the fetal MCA has a high resistance flow which means
there is minimal antegrade flow in fetal diastole
• in pathological states this can turn into a low resistance flow mainly as a result of
the fetal head sparing theory
• paradoxically in some situations such as with severe cerebral edema, the flow can
revert back to a high resistance pattern when the pathology has not yet resolved -
17. FETAL MCA PSV
• The fetal middle cerebral arterial (MCA) peak
systolic velocity (PSV) is an important
parameter in fetal MCA Doppler assessment.
• Interpretation
• reliable between 18-35 weeks
• increased PSV can indicate moderate-to-severe
anemia in non-hydrops fetuses
•
•
18. MCA S/D RATIO
• Fetal MCA systolic/diastolic (S/D) ratio is an important
parameter in fetal middle cerebral arterial Doppler
assessment. It is a useful predictor of fetal
distress and intrauterine growth restriction (IUGR).
• Interpretation
• Normal
• During pregnancy the middle cerebral (and other intracranial)
arteries demonstrate high resistance waveforms, i.e. high
systolic velocity and low/absent diastolic velocity.
• A normal fetal MCA S/D ratio should always be higher than
the umbilical arterial S/D ratio.The fetal MCA S/D ratio value
will decrease as the pregnancy progresses.
• Abnormal
• A reduced S/D ratio is abnormal and implies an increased
diastolic flow in MCA. Loss of high resistance waveform is
19. MCA DOPPLER IN FETAL ANEMIA
• Uncommon but life threatening
• MC- red cell alloimm,parvo virus inf,feto maternal hemorrhage.
• MCA PSV –prim technique to detect foetal anemia
• Can be detected on basis of increase in peak velocity of systolic
blood blow in MCA
• As the hb decreases,MCA-PSV increases—can be used to
determine hb
• 100% Sensitivity,false positive rate-12%
• Doppler assessment of MCA-PSV represent an alternative to
cordocentesis for timing the need of intrauterine transfusion
• MCA-PSV>1.5 MoM represent the optimum time to perform
cordocentesis and IUT
20.
21.
22.
23.
24. FETAL DUCTUS VENOSUS DOPPLER
• It is used number of situations in fetal ultrasound:
• first-trimester screening for aneuploidic anomalies
• second and third-trimester scanning when there are concerns regarding
– intrauterine growth restriction (IUGR)
– fetal cardiac compromise
• Of all the pre-cardiac veins, the ductus venosus allows the most accurate
interpretation of fetal cardiac function as well as myocardial
hemodynamics 9.
• n Doppler ultrasound, the flow in the ductus venosus has a
characteristic triphasic waveform where in a normal physiological
situation flow should always be in the forward direction 7 (i.e. towards the
fetal heart).
• This triphasic waveform comprises of:
• S wave: corresponds to fetal ventricular systolic contraction and is the
highest peak
• D wave: corresponds to fetal early ventricular diastole and is the second
highest peak
• A wave: corresponds to fetal atrial contraction and is the lowest point in
the wave form albeit still being in the forward direction
– as above, reversal of the A wave (i.e. crossing the baseline) is always
25.
26. UMBILICAL VEIN
• Umbilical venous flow in the physiological situation comprises of a
monophasic non-pulsatile flow pattern in the umbilical vein with a mean
velocity of 10-15 cm/s. Since a normal umbilical vein supplies a continuous
forward flow of oxygenated blood to the fetal heart, the presence of
pulsatility implies a pathological state unless in the following situations:
• early in pregnancy: up to ~13 weeks gestation
– the presence of pulsatility may be higher in chromosomally abnormal
fetuses even in early pregnancy 5
• when confounded by other movement variables such as
– fetal breathing movement
– fetal hiccups 1
• Pulsations of the umbilical venous system, especially double pulsations
have been associated with increase in the perinatal mortality when
associated with the absent and reversed end-diastolic flow velocity in the
umbilical artery.
27.
28.
29. UTERINE ARTERY
• Uterine artery flow notching refers to a phenomenon observed in uterine arterial Doppler
ultrasound assessment.
• Pathology
• Associations
• The presence of notching after 22 weeks is associated with several other conditions
including adverse pregnancy outcomes.These include
• pregnancy induced hypertension (PIH)
• pre-eclampsia
• placental abruption
• intrauterine growth restriction (IUGR)
• increased maternal serum alpha fetoprotein (MSAFP)
• Radiographic features
• Doppler ultrasound
• While notching can be either systolic or diastolic, it is typically seen as a trough-like notch
between the systolic and diastolic phases.
• Significance
• The presence of notching in late pregnancy is an indicator of increased uterine vascular
resistance and impaired uterine circulation 2.
• Bilateral notching is more concerning. Unilateral notching of the uterine artery on the
ipsilateral side of the placenta, if the placenta is along one lateral wall (right or left) carries
the same significance as bilateral notching. The presence of an early diastolic notch can
however be a normal finding in a non-pregnant uterus and even in a gravid uterus, at least
up to 16 weeks, but notching typically begins to disappear in the gravid uterus by 13 weeks
with clearly established diastolic flow by 20 weeks 7.
30. UTEROPLACENTAL BLOOD FLOW
ASSESSMENT
• IT is an important part of fetal well-being assessment .
• Pathology
• In a non-gravid state and at the very start of pregnancy the flow in the
uterine artery is of high pulsatility with a high systolic flow and low
diastolic flow.A physiological early diastolic notch may be present.
• Resistance to blood flow gradually drops during gestation as a greater
trophoblastic invasion of the myometrium takes place.An abnormally
high resistance can persist in pre-eclampsia and IUGR. If resistance is low,
it has an excellent negative predictive value with a less than 1% chance of
developing either pre-eclampsia or having IUGR . A high resistance often
equates to a 70% chance of pre-eclampsia and 30% chance of IUGR.
•
•
31. PARAMETERS USED
• The parameters used in the assessment of uteroplacental blood flow include:
• RI = resistive index
• PI = pulsatility index
• presence of persistent diastolic notching
• Resistive index (RI)
• This is calculated by the following equation:
• RI = (PSV-EDV) / PSV = (peak systolic velocity - end-diastolic velocity) / peak
systolic velocity
• normal (low resistance) RI <0.55
• high resistance
– bilateral notches RI >0.55
– unilateral notches RI >0.65
• Pulsatility index (PI)
• This is calculated by the following equation:
• PI = (PSV - EDV) /TAV = (peak systolic velocity - end-diastolic velocity) / time-
averaged velocity
32. ABNORMAL PATTERNS
• persistence of a high resistance flow
throughout pregnancy
• persistence of notching throughout
pregnancy
• reversal of diastolic flow throughout
pregnancy: severe state
33.
34.
35. DOPPLER IN HYPERTENSIVE
DISEASES
• INCREASED PIWITH NOTCHING IN 2ND TRIMESTER
• INCREASED PI ALONE OR IN COMBINATIONWITH
NOTCHING-IUGR IN LOW RISK PTS
• INCREASED RIWITH/WITHOUT NOTCHING-HIGH
RISKWOMEN
• AN EARLY DIASTOLIC NOTCH IN UTERINE ARTERIES
BTW 12-14WK-DELAYEDTROPHOBLASTIC
INVASION IN HIGH RISK PT
• PERSISTENCE OF BILATERAL NOTCHINGAFTER 24TH
WK-INADEQUATETROPHOBLASTIC INVASION
• MEAN PI>95th centile-high risk for pre
eclampsia.gest.HTN,foetal growth restriction
36. • Early identification is essential for timely
commencement of preventive treatment with
low dose aspirin for pre eclampsia,foetal growth
restriction
• Acc to ASPRE[combined multimarker screening
&randomized patient treatment with aspirin for
evidence based preeclampsia prevention] study
combined screening using MAP,UtArtery
PI,PIGF,PAPP-A has detected 76.6% ofearly
preeclampsia & 38% of late preeclampsia
37.
38. VASA PREVIA
• is a rare but potentially catastrophic cause of antepartum hemorrhage.
• Pathology
• Vasa previa can be of two types:Vasa previa refers to a situation where there are
aberrant fetal vessels crossing over or in close proximity to the internal cervical os,
ahead of the fetal presenting part.These vessels are within the amniotic
membranes, without the support of the placenta. Vasa previa
• type I (present in ~ 90% of cases with vasa previa 3): abnormal fetal vessels
connect a velamentous cord insertion with the main body of the placenta
• type II
– abnormal vessels connect portions of a bilobed placenta
– placenta with a succenturiate lobe: due to this association, vasa previa needs
to be excluded in patients with variant placental morphology
• These vessels are unsupported by Wharton jelly or placental tissue and are at risk
of rupture during labor.
• Epidemiology
• Vasa previa occurs in 0.6 per 1000 pregnancies11
•
•
39. • Risk factors include:
• multiple gestations
• low lying placenta
• succenturiate lobe or bilobed placenta
• IVF pregnancy
• Clinical presentation
• Prior to rupture of the amniotic membrane during labor,
compression of the vulnerable fetal blood vessels by the
presenting part may lead to fetal heart decelerations and
bradycardia.
• However once ruptured, vasa previa will result in brisk
vaginal bleeding with rapid fetal exsanguination.
40. • DOPPLER ultrasound
• Sonographic features are considered generally specific (~90%) 2.
• The diagnosis is often made with transabdominal color Doppler sonography
demonstrating flow within vessels which are seen overlying the internal cervical
os. Non-Doppler (greyscale) images may suggest the diagnosis if there are
echogenic parallel or circular lines within the placenta near the cervix.
• Occasionally a transvaginal scan is required to better visualize aberrant vessels.
Transvaginal ultrasound has a reported sensitivity of 100% and specificity of 99-
99.8% when performed with color Doppler 12.
• Treatment and prognosis
• If recognized antenatally, vasa previa usually requires an elective cesarean section
to avoid the risk of complications during vaginal delivery.
• If recognized intrapartum, an emergency cesarean section is usually performed
•
41.
42. MONOCHORIONIC MONOAMNIOTIC
TWIN PREGNANCY
• It is a subtype of monozygotic twin pregnancy. These fetuses share a single chorionic sac, a
single amniotic sac, and, in general, a single yolk sac.
• Epidemiology
• It accounts for the minority (~5%) of monozygotic twin pregnancies and ~1-2% of all twin
pregnancies. The incidence is ~1 in 10000 of all pregnancies 2.
• Pathology
• It results from a separation of a single ovum at ~ 8-13 days following formation . By this time
a trophoblast has already formed, yielding a single placenta. These fetuses share a
single chorionic sac, a single amniotic sac, and most often a single yolk sac.The twins are
identical (and of course of the same gender).
• Radiographic features
• Ultrasound
• First trimester
• shows a twin pregnancy with a single gestational sac and a most often a single yolk sac
(which helps to differentiate from a DCDA and MCDA pregnancy)
• there is no inter-twin membrane: this differentiates from a DCDA and MCDA pregnanancy
• Second trimester
• Features noted on a second-trimester scan includes:
• specific to an MCMA pregnancy
– cord entanglement
– cord fusion
– absent inter-twin membrane
• common to both MCMA and MCDA pregnancies
43. COMPLICATIONS
• An MCMA pregnancy carries the highest level of potential complications out of all
twin pregnancies (with reported rates of overall perinatal mortality up to 70-
80% 1).These include:
• problems related to abnormal placental vascular anastomoses
– twin to twin transfusion syndrome: his particular complication only occurs in ~10-15% of
MCMA pregnancies and therefore less common than MCDA pregnancies 7
– twin embolization syndrome
– twin reversed arterial perfusion sequence
• demise of one twin: often associated with some adverse outcome to the other
twin
• placental insertion related problems
– increased incidence of velamentous cord insertion (c.f singleton pregnancy)
– increased incidence of marginal cord insertion (c.f singleton pregnancy)
• umbilical cord related complications
– umbilical cord knots
– umbilical cord thrombosis
•
44.
45.
46. MONOCHORIONIC DIAMNIOTIC
PREGNANCY
• It is a subtype of monozygotic twin pregnancy.These fetuses share a single chorionic sac but have
two amniotic sacs and two yolk sacs.
• Epidemiology
• It accounts for the vast majority (70-75%) of monozygotic twin pregnancies although only ~30% of all
twin pregnancies.The estimated incidence is at ~1:400 pregnancies 11.
• Pathology
• An MCDA pregnancy results from a separation of a single zygote at ~4-8 days (blastocyst) following
formation.These fetuses share a single chorionic sac but two yolk sacs and two amniotic sacs. By this
time a trophoblast has already formed yielding a single placenta.
• The layman term is that the twins are "identical" - in reality, they are phenotypically similar, and of course
of the same gender.
• Radiographic features
• Ultrasound
• First trimester
• shows a twin pregnancy with a single gestational sac, and almost always two separate yolk sacs 9-
10 (differentiating from an MCMA pregnancy)
• at 14-18 weeks, often a single placenta is seen: differentiating from a DCDA pregnancy
• a thin inter-twin membrane may be seen
– due to amnions abutting the placenta
– present: differentiating from an MCMA pregnancy
– but appears very thin without intervening chorion (often taken as <2 mm): differentiating from
a DCDA pregnancy
– T-sign of the intertwin membrane
• Second and third trimesters
• Findings:
• the number of placental masses, thickness of the membrane, and the presence/absence of the twin-peak
sign are still viable options for determining chorionicity
47. COMPLICATIONS
• problems related to abnormal placental vascular
anastomoses
– twin to twin transfusion syndrome: can occur in ~15 1 -
30 4 % of MCDA pregnancies
– twin embolization syndrome
– twin reversed arterial perfusion sequence:
• demise of one twin: often associated with some adverse
outcome to the other twin
• placental insertion related problems
– increased incidence of velamentous cord insertion
– increased incidence of marginal cord insertion
•
•
48. TTTS
• itis a potential complication that can occur in
a monochorionic (either MCDA or MCMA) twin pregnancy.
• This complication can occur in ~10% (range 15-25%) of monochorionic
pregnancies giving an estimated prevalence of ~1:2000 of all pregnancies.
• Marked abdominal distension has been described as a clinical feature.
• Pathology
• TTTS results from unbalanced vascular (arteriovenous and
arterioarterial) anastomoses in the placenta - that is, placental circulation is
directed predominantly towards one twin and away from the other.
• The resultant hypovolemia and hypoperfusion in one twin and hypervolemia and
hypertension in the other create a cascade of hormonal changes including the
renin-angiotensin system.This in turn leads to chronic tubulopathy and oliguria in
the hypovolemic (donor) twin with consequent oligohydramnios, and polyuria and
consequent polyhydramnios in the hypervolemic (recipient) twin.
• Staging
• The extent of the syndrome can be staged according to severity. One method
proposed by Quintero et al. is as 3:
• stage I: oligohydramnios/polyhydramnios
• stage II: bladder not visible in donor twin
• stage III: abnormal Dopplers in either twin
• stage IV: hydrops fetalis in either twin*
• stageV: in-utero demise of either twin
49. DOPPLER
• absent or reversed diastolic flow in the umbilical artery is an indication of
worsening twin-to-twin transfusion syndrome
• abnormal ductus venosus waveform pattern suggests the possibility of cardiac
diastolic dysfunction
• Treatment and prognosis
• Serial sonographic monitoring is common practice. In an uncomplicated
monochorionic twin pregnancy,TTTS screening should start from 16 weeks
gestation with assessment fetal growth, DVPs and umbilical arterial pulsatility
index (UA-PI) performed every two weeks. Detailed morphology ultrasound is
routine at 20 weeks. Additional fetal middle cerebral arterial-peak systolic
velocity (MCA-PSV) is recommended from 22 weeks.
• Untreated,TTTS generally carries a poor prognosis, with up to 90% perinatal
mortality 8. Laser coagulation of the chorionic plate is the treatment of choice and
significantly improves the prognosis for both twins - although both morbidity and
mortality remain considerably higher than in non-TTTS monochorionic
pregnancies.
• Other management options include:
• conservative management with surveillance for Quintero stage 1TTT
• serial amnioreduction, where laser treatment is not available
50.
51.
52. TAPS
• It is considered a variant of the twin to twin transfusion syndrome (TTTS).
• Epidemiology
• TAPS may occur spontaneously in up to 5% of monochorionic twins and may also develop after
incomplete laser treatment in twin-to-twin transfusion syndrome cases 2.
• Pathology
• As with twin-to-twin transfusion syndrome, the underlying mechanism is thought to be abnormal
placental vascular anastomoses, however, inTAPS the rate of transfusion is slow and therefore
results in a gradual discordance of fetal hemoglobin, without the hormonal disbalance and
subsequent liquor discordance seen inTTTS. One twin develops anemia and the other
polycythemia.
• Radiographic features
• Doppler ultrasound
• One of the features suggesting the diagnosis is a discordance in fetal middle cerebral artery peak
systolic velocity (MCA-PSV) measurements 4. In contrast to the classic twin-to-twin transfusion
syndrome, there is no amniotic fluid discordance (i.e. no-twin oligo-polyhydramnios sequence
(TOPS)) 5.
•
53.
54. TWIN EMBOLISATION SYNDROME
• It is a rare complication of a monozygotic twin pregnancy following an in utero demise of the co-twin.
• Pathology
• It was traditionally thought to result from the passage of thromboplastic material into the circulation of the surviving twin
which causes ischemic structural defects in various organs (particularly the highly vascularized organs such as the central
nervous system, gastrointestinal tract, and genitourinary system). An acute hemodynamic shift from live to dead fetus
resulting in hypoperfusion is more recently thought to play a role 3.
• Associations
• There is usually an underlying twin-twin transfusion syndrome as a causative association.
• Radiographic features
• Antenatal ultrasound
• The presence of a dead twin associated with a surviving twin with various anomalies may suggest the diagnosis. Such
anomalies include :
• CNS anomalies
• fetal ventriculomegaly
• porencephaly
• fetal cerebral atrophy
• cystic encephalomalacia 4
• microcephaly
• Non-CNS anomalies
• small bowel atresia
• fetal hydrothorax
• gastroschisis
• fetal renal cortical necrosis
• Treatment and prognosis
• While it carries a poor outcome, prenatal sonographic diagnosis may influence the antenatal neonatal management of the
surviving monozygous twin
55. TRAP
• Twin reversed arterial perfusion (TRAP) sequence is a rare complication of monochorionic
pregnancies. It develops when the following conditions are present:
• 1. lack of a well-formed heart in one of the twins (so-called acardiac twin), and
• 2. a superficial artery to artery placental anastomosis providing perfusion of the acardiac
twin by the donor (pump) twin. This can be shown on Doppler ultrasound by reversal of the
acardiac twin umbilical arterial blood (i.e. flow towards the fetus).
• Epidemiology
• It is thought to occur in ~0.5% (range 0.3-1 % 1,4)of monozygotic pregnancies with an
estimated incidence of 1:35,000 births overall 1,10.
• It can rarely occur with higher-order multifetal pregnancies 3.
• Pathology
• TRAP is considered to primarily result from an abnormal placental arterial-to-arterial
anastomosis. Venovenous anastomoses may also be present 11.
• Classically this results in one normal and one abnormal twin:
• viable twin (pump twin)
– usually normal, but 9% risk of abnormal karyotype
• non-viable twin (recipient/acardiac twin)
– this twin can have four morphological types
• acardius acephalus
• acardius anceps
56. DOPPLER FINDINGS
• REVERSAL OF FLOW ON SPECTRAL
WAVEFORM CONFIRMED BY PULSED
DOPPLER OFTHE UMBILICAL ARTERY OF
RECIPIENTTWIN
57.
58.
59.
60.
61. COMPLICATIONS
• TRAP sequence pump twin is at risk of:
• cardiac failure
• cerebral ischemic sequelae
• preterm birth
• fetal demise in utero
• The risk of adverse outcomes in the pump twin is closely related to its size ratio to
the acardiac twin.
• Treatment and prognosis
• As the acardiac twin is non-viable, the majority of efforts in management are
focused or maintaining the viability of the other donor (pump) twin.The perinatal
mortality for the pump twin can be as high as 50% 10.
• Treatment is around the surgical destruction of the inter-twin anastomosis and
includes:
• endoscopic laser coagulation/radio-frequency ablation 5
• surgical (fetoscopic) ligation of acardiac twin umbilical cord
• selective delivery of acardiac twin 7
62. IUGR
• IUGR is defined as an estimated fetal weight (EFW) /
abdominal circumference (AC) at one point in time
during pregnancy being below 3rd percentile or
EFW/AC below the 10th percentile for gestational age
with deranged Doppler parameters 14.
• An IUGR can be broadly divided into two main types:
• type I: symmetrical intrauterine growth restriction
• type II: asymmetrical intrauterine growth restriction
63. DOPPLER FEATURES
– umbilical artery Doppler assessment
• increased PI above 95th percentile
• absent/reversed diastolic flow
– umbilical venous Doppler assessment
• presence of pulsatility
– uterine arterial Doppler assessment
• increased mean uterine artery PI above 95th percentile
• presence of notching in mid to late pregnancy
• CP ratio: reduced below 5th percentile
64. • FETUSWITH GROWTH RESTRICTION
• WEEKLY DOPPLER USG OF UMBILICAL ARTERY
•
• NORMAL DELIVERY AT 38-39WKS
• ABNORMAL[ DBF]–PERFORMEDWEEKLY-
DELIVERY AT 36WKS
• ABSENT/REVERSED EDBF2-3TIMES
/WK+STEROIDTHERAPYTERMINATIONAT
34WKS[ABSENT EDBF],32WKS[REVERSED
EDBF]