This document provides guidelines on the use of fetal Doppler in obstetrics from the Society of Obstetricians and Gynaecologists of Canada.
1. Umbilical artery Doppler should be used to assess the fetal-placental circulation in pregnancies with suspected severe placental insufficiency.
2. Reduced, absent, or reversed umbilical artery end-diastolic flow indicates the need for enhanced fetal surveillance or delivery, depending on gestational age and other factors. If delivery is delayed for fetal lung maturity, intensive surveillance is recommended until delivery for those with reversed end-diastolic flow.
3. Umbilical artery Doppler should not be used
Guía ISUOG sobre ecografía en embarazo gemelarTony Terrones
This document provides guidelines from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) on the role of ultrasound in twin pregnancies. It recommends that twin pregnancies be dated using the larger crown-rump length between 11-13 weeks of gestation. It also recommends determining chorionicity and amnionicity before 14 weeks using membrane thickness and placental mass number. Uncomplicated dichorionic twins should have scans at 11-14 weeks, 20-22 weeks, and every 4 weeks thereafter, while uncomplicated monochorionic twins should have scans every 2 weeks after 16 weeks to monitor for twin-to-twin transfusion syndrome and other complications.
This document provides guidelines for performing basic and detailed sonographic examinations of the fetal central nervous system. It outlines the structures that should be evaluated in a basic exam, including head shape, ventricles, cerebellum, cisterna magna and spine. A basic exam can be done transabdominally starting at 20 weeks and should include two standard scan planes. A detailed neurosonogram requires specific expertise and equipment to fully evaluate the brain and spine for anomalies in high risk pregnancies. Biometric measurements of the head and ventricles are also recommended as part of the evaluation.
Guía ISUOG sobre screening ecográfico de cardiopatías congénitasTony Terrones
This document provides updated guidelines for performing ultrasound screening of the fetal heart from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). The guidelines recommend that in addition to the standard four-chamber view of the heart, ultrasound practitioners should also obtain views of the outflow tracts from both ventricles. This updated recommendation aims to improve prenatal detection of congenital heart defects. The guidelines describe how to properly obtain and evaluate the four-chamber view and outflow tract views during the routine mid-gestation ultrasound examination between 18-22 weeks. Adherence to these guidelines could help maximize detection of fetal heart abnormalities.
AIUM Practice Guideline for the Performance of Fetal EchocardiographyTony Terrones
This document provides guidelines for performing fetal echocardiography from the American Institute of Ultrasound in Medicine (AIUM). It was developed collaboratively with other medical organizations. The guidelines outline qualifications for personnel, indications for fetal echocardiography examinations, specifications for what should be included in the examination, and equipment specifications. Fetal echocardiography is used to identify and characterize fetal heart anomalies before delivery when there is a valid medical reason to do so. Adherence to these guidelines aims to maximize the detection of clinically significant congenital heart disease.
Guía ISUOG: Ecografía del primer trimestreTony Terrones
This document provides guidelines for performing first trimester fetal ultrasounds from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). It recommends that routine first trimester ultrasounds should be performed between 11-13+6 weeks gestation to confirm viability, accurately date the pregnancy, determine fetal number, and assess gross anatomy. Ultrasounds should be performed by trained practitioners using appropriate equipment and following standardized examination and documentation procedures. Measurements such as crown-rump length are recommended to accurately assess gestational age. Safety considerations and limitations of first trimester ultrasounds are also discussed.
Case of CHD at 12-14 weeks, with Tricuspid regurgitation at nuchal scan.
At 8/9 weeks heart position looks like "ecttopia cordi" (sorry for absent avi. where everything can see)
This document provides guidelines for performing obstetric ultrasounds, including indications, imaging parameters, and types of examinations. It recommends using real-time ultrasound with transducers of 3-5 MHz for standard second and third trimester exams to evaluate fetal anatomy, growth, and well-being. First trimester ultrasounds should use transvaginal or transabdominal ultrasound to assess gestational age, viability, and risk of aneuploidy by measuring the nuchal translucency. Limited and specialized ultrasounds are also described for targeted evaluations.
Fetal interventions for congenital heart disease in brazilgisa_legal
In this preliminary study from Brazil, fetal cardiac interventions were performed in 21 fetuses with congenital heart defects. The interventions included aortic valvuloplasty for critical aortic stenosis, atrial septoplasty for hypoplastic left heart syndrome, and pulmonary valvuloplasty for pulmonary atresia or stenosis. The procedures had a 91% technical success rate, with one fetal death. Postnatal outcomes varied, with some patients achieving biventricular circulation and others requiring univentricular palliation or dying. This early experience demonstrated feasibility and outcomes similar to previous reports, though safety and efficacy require further study.
Guía ISUOG sobre ecografía en embarazo gemelarTony Terrones
This document provides guidelines from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) on the role of ultrasound in twin pregnancies. It recommends that twin pregnancies be dated using the larger crown-rump length between 11-13 weeks of gestation. It also recommends determining chorionicity and amnionicity before 14 weeks using membrane thickness and placental mass number. Uncomplicated dichorionic twins should have scans at 11-14 weeks, 20-22 weeks, and every 4 weeks thereafter, while uncomplicated monochorionic twins should have scans every 2 weeks after 16 weeks to monitor for twin-to-twin transfusion syndrome and other complications.
This document provides guidelines for performing basic and detailed sonographic examinations of the fetal central nervous system. It outlines the structures that should be evaluated in a basic exam, including head shape, ventricles, cerebellum, cisterna magna and spine. A basic exam can be done transabdominally starting at 20 weeks and should include two standard scan planes. A detailed neurosonogram requires specific expertise and equipment to fully evaluate the brain and spine for anomalies in high risk pregnancies. Biometric measurements of the head and ventricles are also recommended as part of the evaluation.
Guía ISUOG sobre screening ecográfico de cardiopatías congénitasTony Terrones
This document provides updated guidelines for performing ultrasound screening of the fetal heart from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). The guidelines recommend that in addition to the standard four-chamber view of the heart, ultrasound practitioners should also obtain views of the outflow tracts from both ventricles. This updated recommendation aims to improve prenatal detection of congenital heart defects. The guidelines describe how to properly obtain and evaluate the four-chamber view and outflow tract views during the routine mid-gestation ultrasound examination between 18-22 weeks. Adherence to these guidelines could help maximize detection of fetal heart abnormalities.
AIUM Practice Guideline for the Performance of Fetal EchocardiographyTony Terrones
This document provides guidelines for performing fetal echocardiography from the American Institute of Ultrasound in Medicine (AIUM). It was developed collaboratively with other medical organizations. The guidelines outline qualifications for personnel, indications for fetal echocardiography examinations, specifications for what should be included in the examination, and equipment specifications. Fetal echocardiography is used to identify and characterize fetal heart anomalies before delivery when there is a valid medical reason to do so. Adherence to these guidelines aims to maximize the detection of clinically significant congenital heart disease.
Guía ISUOG: Ecografía del primer trimestreTony Terrones
This document provides guidelines for performing first trimester fetal ultrasounds from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). It recommends that routine first trimester ultrasounds should be performed between 11-13+6 weeks gestation to confirm viability, accurately date the pregnancy, determine fetal number, and assess gross anatomy. Ultrasounds should be performed by trained practitioners using appropriate equipment and following standardized examination and documentation procedures. Measurements such as crown-rump length are recommended to accurately assess gestational age. Safety considerations and limitations of first trimester ultrasounds are also discussed.
Case of CHD at 12-14 weeks, with Tricuspid regurgitation at nuchal scan.
At 8/9 weeks heart position looks like "ecttopia cordi" (sorry for absent avi. where everything can see)
This document provides guidelines for performing obstetric ultrasounds, including indications, imaging parameters, and types of examinations. It recommends using real-time ultrasound with transducers of 3-5 MHz for standard second and third trimester exams to evaluate fetal anatomy, growth, and well-being. First trimester ultrasounds should use transvaginal or transabdominal ultrasound to assess gestational age, viability, and risk of aneuploidy by measuring the nuchal translucency. Limited and specialized ultrasounds are also described for targeted evaluations.
Fetal interventions for congenital heart disease in brazilgisa_legal
In this preliminary study from Brazil, fetal cardiac interventions were performed in 21 fetuses with congenital heart defects. The interventions included aortic valvuloplasty for critical aortic stenosis, atrial septoplasty for hypoplastic left heart syndrome, and pulmonary valvuloplasty for pulmonary atresia or stenosis. The procedures had a 91% technical success rate, with one fetal death. Postnatal outcomes varied, with some patients achieving biventricular circulation and others requiring univentricular palliation or dying. This early experience demonstrated feasibility and outcomes similar to previous reports, though safety and efficacy require further study.
The document discusses various fetal therapies and surgical interventions for treating fetal malformations. It notes that the goal of prenatal diagnosis has shifted from termination to improving fetal outcomes through medical and surgical treatment. Fetal therapies discussed include placing shunts, fetoscopic techniques like laser photocoagulation and ablation, and open fetal surgery. Conditions treated include hydrocephalus, pleural effusions, twin-twin transfusion syndrome, and obstructive uropathy. Author experiences with various fetal procedures in Indonesia are also listed. Monitoring during fetal surgery focuses on the mother and fetus' vital signs and ultrasound findings.
Vai trò của chỉ số não rốn trong đánh giá sức khỏe thai nhi ở thai AGA và SGA Võ Tá Sơn
Vai trò của chỉ số não rốn trong đánh giá sức khỏe thai nhi ở thai AGA và SGA
The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses
Value of routine ultrasound examination at 35–37 weeks’ gestation in diagnosi...Võ Tá Sơn
This study investigated the value of routine ultrasound examination at 35-37 weeks' gestation in diagnosing previously unknown fetal abnormalities. The study found:
1) Of 995 total fetal abnormalities detected, 24.8% (247) were first diagnosed at 35-37 weeks' gestation and 7.4% (74) were first diagnosed postnatally.
2) The most common abnormalities first seen at 35-37 weeks were hydronephrosis, mild ventriculomegaly, ventricular septal defect, duplex kidney, ovarian cyst, and arachnoid cyst.
3) Routine ultrasound at 35-37 weeks could potentially improve postnatal outcomes by enabling diagnosis and management planning for
Hello everyone
This presentation will give a insight into the recent advances in fetal therapy. Hope it might help you
Thanking you
Dr Ankit gupta
MD Pediatrics
Kims karad
This document discusses perinatal hydronephrosis (ANH), which refers to dilation of the renal pelvis detected on prenatal ultrasound in 1-3% of pregnancies. ANH is most commonly used to define this condition but measurements and definitions vary. Ultrasound remains the main imaging modality used, while MRI can provide additional detail. Factors like gestational age, bladder filling, and grading systems impact ANH assessment and prediction of postnatal outcomes. Counseling involves discussing differential diagnoses, natural histories, and management plans. Fetal intervention is rarely needed but may be considered to improve pulmonary and renal development in cases of late oligohydramnios or poor fetal urine markers.
invasive procedures for prenatal diagnosis ISUOG Guidelines Aboubakr Elnashar
The document discusses invasive prenatal diagnostic procedures including amniocentesis, chorionic villus sampling (CVS), and fetal blood sampling (FBS). Amniocentesis involves inserting a needle into the amniotic sac to collect fluid for testing and can be performed after 15 weeks of gestation. CVS obtains placental tissue samples between 10-12 weeks and can be done transabdominally or transcervically. FBS involves inserting a needle into the umbilical cord or fetal liver to collect blood, which is usually done after 18 weeks. All procedures carry risks of fetal loss, though the rates are generally low. Extensive counseling is recommended to discuss risks and benefits prior to any invasive prenatal
Prenatal diagnosis of congenital anomalies 3DrAhmed Badr
This document discusses various fetal anomalies that can be detected on prenatal ultrasound scans, including definitions, prevalence, diagnostic criteria, and recommendations. It covers anomalies such as thickened nuchal fold, echogenic bowel, cardiac defects, gastroschisis, exomphalos, single umbilical artery, and hydrops fetalis. Guidelines are provided on the standard assessment of fetal anatomy and soft markers for aneuploidy during the 16-20 week anatomy scan.
The limits to the number of EMBRYO TO TRANSFER. Prof Aboubakr ElnasharAboubakr Elnashar
This document presents guidelines from ASRM on the number of embryos that should be transferred during IVF treatment. It discusses the risks of high-order multiple pregnancies and aims to maximize the chance of a singleton pregnancy. The guidelines recommend elective single embryo transfer for women under 38 and restrict the number of embryos transferred based on the woman's age and prognosis. Factors like embryo quality, previous success rates, and medical risks are also considered to determine the appropriate number of embryos to transfer. The goal is to balance live birth rates with minimizing multiple gestations.
Fetal echocardiography provides several advantages for diagnosing and managing congenital heart disease:
1) It allows for counseling of parents on prognosis and treatment options, including the possibility of termination of pregnancy for major defects or chromosomal anomalies.
2) In some cases, it enables life-saving procedures to be performed on the mother or fetus before or during pregnancy.
3) It facilitates delivery planning at a specialized medical center near pediatric cardiac surgery.
This document discusses prenatal screening and diagnosis of Down syndrome. It describes various screening tests that can be done during the first and second trimester, including nuchal translucency screening between 11-13 weeks gestation and biochemical screening involving markers like beta-hCG and PAPP-A. Combining results from ultrasound markers like nuchal translucency with biochemical markers provides the most accurate risk assessment. A small percentage of high-risk cases may warrant diagnostic testing like amniocentesis or CVS. The document also discusses factors that can impact marker levels and outlines reporting recommendations.
This document provides an overview of perinatology and fetal therapy. It discusses various pharmacological and surgical fetal therapies used to treat conditions such as cardiac arrhythmias, complete atrioventricular block, congenital adrenal hyperplasia, fetal anemia, twin-twin transfusion syndrome, congenital diaphragmatic hernia, and pleural effusions. Invasive fetal therapies discussed include intrauterine blood transfusion, fetoscopy, laser coagulation of vessels, and intra-amniotic gene transfer. Fetal therapy requires a multidisciplinary team and tools such as ultrasound, MRI, and fetoscopes to properly diagnose and treat conditions in-utero.
Fetal megacystis - more than luto - Bàng quang lớn ở thai nhi LUTOVõ Tá Sơn
This study analyzed 541 pregnancies with fetal megacystis (enlarged bladder) referred to fetal medicine units in the Netherlands between 2000-2015. The study found that in 67% of cases, megacystis was isolated or accompanied only by signs of lower urinary tract obstruction. In the remaining 33% of cases, megacystis was associated with other structural abnormalities. The most common associated findings were increased nuchal translucency (22%), single umbilical artery (10%), and cardiac defects (10%). The study provides an overview of genetic syndromes, chromosomal abnormalities, and developmental disturbances that can present with fetal megacystis, in order to improve counseling and management of these complex cases
This document discusses antenatal hydronephrosis. Some key points:
- The prevalence of antenatally detected hydronephrosis ranges from 0.6-5.4% and is bilateral in 17-54% of cases. 41-88% resolves at birth or infancy, while 4-15% require intervention.
- Factors like gestational age, hydration status, and bladder distention affect measurements of the renal pelvis anteroposterior diameter (APD), which is used to diagnose and grade hydronephrosis. Threshold APD values increase with gestational age.
- Additional evaluation including assessment for lower urinary tract obstruction, renal dysplasia
Isuog practice guidelines performance of first trimester fetal ultrasound scankaleemullahabid
The document provides guidelines from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) for performing first trimester fetal ultrasound scans between 6-13 weeks gestation. It outlines recommendations for assessing viability, measuring the embryo/fetus, determining gestational age, evaluating fetal anatomy, and documenting the examination. Key recommendations include using transvaginal ultrasound when possible, measuring the crown-rump length to determine gestational age, and assessing the head, neck, spine and basic anatomy while acknowledging limitations in visualization of some structures so early.
Nearly half (47%) of fetuses diagnosed prenatally with congenital heart disease via echocardiography and who had a normal karyotype also had increased nuchal translucency, defined as 2.5mm or greater. This proportion was significantly higher than the expected 5% in the normal population. The only cardiac diagnosis with a higher proportion of increased nuchal translucency was atrioventricular septal defect, at 62%. The results support referring all fetuses with increased nuchal translucency for echocardiography regardless of other abnormalities, as increased nuchal translucency appears associated with congenital heart disease independent of karyotype.
This document provides updated guidelines for performing ultrasound screening of the fetal heart from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). The guidelines recommend that in addition to the standard four-chamber view of the heart, ultrasound practitioners should also obtain views of the outflow tracts from both ventricles. This updated recommendation aims to improve prenatal detection of congenital heart defects. The guidelines describe how to properly obtain and evaluate the four-chamber view and outflow tract views during the routine mid-gestation ultrasound examination between 18-22 weeks. Adherence to these guidelines could help maximize detection of fetal heart abnormalities.
This document discusses genetic testing, including definitions, purposes, types, and techniques. It covers several types of genetic testing such as carrier screening, preimplantation diagnosis, prenatal testing, newborn screening, and predictive adult testing. Techniques discussed include amniocentesis, chorionic villus sampling, fetal cell analysis from maternal blood, analysis of maternal serum markers, ultrasound, autopsy, and culture/microscopy. Ethical considerations around informed consent are also mentioned.
approach to evidence based antenatal Fetal survellianceDr Praman Kushwah
This document discusses evidence-based approaches to antenatal Doppler fetal surveillance. It begins by outlining the objectives and aims of fetal surveillance, including identifying fetuses at risk of hypoxia and improving perinatal outcomes. It then describes various methods of fetal surveillance, including daily fetal movement counts, non-stress tests, biophysical profiles, and Doppler velocimetry. The document discusses the indications and measurements of Doppler indices for the uterine, umbilical, and middle cerebral arteries. It reviews recent evidence showing that Doppler ultrasound in high-risk pregnancies can reduce perinatal deaths and interventions without increasing them in low-risk pregnancies. The document concludes by emphasizing that not all pregnancies require surveillance and that monitoring
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.
The document discusses various fetal therapies and surgical interventions for treating fetal malformations. It notes that the goal of prenatal diagnosis has shifted from termination to improving fetal outcomes through medical and surgical treatment. Fetal therapies discussed include placing shunts, fetoscopic techniques like laser photocoagulation and ablation, and open fetal surgery. Conditions treated include hydrocephalus, pleural effusions, twin-twin transfusion syndrome, and obstructive uropathy. Author experiences with various fetal procedures in Indonesia are also listed. Monitoring during fetal surgery focuses on the mother and fetus' vital signs and ultrasound findings.
Vai trò của chỉ số não rốn trong đánh giá sức khỏe thai nhi ở thai AGA và SGA Võ Tá Sơn
Vai trò của chỉ số não rốn trong đánh giá sức khỏe thai nhi ở thai AGA và SGA
The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses
Value of routine ultrasound examination at 35–37 weeks’ gestation in diagnosi...Võ Tá Sơn
This study investigated the value of routine ultrasound examination at 35-37 weeks' gestation in diagnosing previously unknown fetal abnormalities. The study found:
1) Of 995 total fetal abnormalities detected, 24.8% (247) were first diagnosed at 35-37 weeks' gestation and 7.4% (74) were first diagnosed postnatally.
2) The most common abnormalities first seen at 35-37 weeks were hydronephrosis, mild ventriculomegaly, ventricular septal defect, duplex kidney, ovarian cyst, and arachnoid cyst.
3) Routine ultrasound at 35-37 weeks could potentially improve postnatal outcomes by enabling diagnosis and management planning for
Hello everyone
This presentation will give a insight into the recent advances in fetal therapy. Hope it might help you
Thanking you
Dr Ankit gupta
MD Pediatrics
Kims karad
This document discusses perinatal hydronephrosis (ANH), which refers to dilation of the renal pelvis detected on prenatal ultrasound in 1-3% of pregnancies. ANH is most commonly used to define this condition but measurements and definitions vary. Ultrasound remains the main imaging modality used, while MRI can provide additional detail. Factors like gestational age, bladder filling, and grading systems impact ANH assessment and prediction of postnatal outcomes. Counseling involves discussing differential diagnoses, natural histories, and management plans. Fetal intervention is rarely needed but may be considered to improve pulmonary and renal development in cases of late oligohydramnios or poor fetal urine markers.
invasive procedures for prenatal diagnosis ISUOG Guidelines Aboubakr Elnashar
The document discusses invasive prenatal diagnostic procedures including amniocentesis, chorionic villus sampling (CVS), and fetal blood sampling (FBS). Amniocentesis involves inserting a needle into the amniotic sac to collect fluid for testing and can be performed after 15 weeks of gestation. CVS obtains placental tissue samples between 10-12 weeks and can be done transabdominally or transcervically. FBS involves inserting a needle into the umbilical cord or fetal liver to collect blood, which is usually done after 18 weeks. All procedures carry risks of fetal loss, though the rates are generally low. Extensive counseling is recommended to discuss risks and benefits prior to any invasive prenatal
Prenatal diagnosis of congenital anomalies 3DrAhmed Badr
This document discusses various fetal anomalies that can be detected on prenatal ultrasound scans, including definitions, prevalence, diagnostic criteria, and recommendations. It covers anomalies such as thickened nuchal fold, echogenic bowel, cardiac defects, gastroschisis, exomphalos, single umbilical artery, and hydrops fetalis. Guidelines are provided on the standard assessment of fetal anatomy and soft markers for aneuploidy during the 16-20 week anatomy scan.
The limits to the number of EMBRYO TO TRANSFER. Prof Aboubakr ElnasharAboubakr Elnashar
This document presents guidelines from ASRM on the number of embryos that should be transferred during IVF treatment. It discusses the risks of high-order multiple pregnancies and aims to maximize the chance of a singleton pregnancy. The guidelines recommend elective single embryo transfer for women under 38 and restrict the number of embryos transferred based on the woman's age and prognosis. Factors like embryo quality, previous success rates, and medical risks are also considered to determine the appropriate number of embryos to transfer. The goal is to balance live birth rates with minimizing multiple gestations.
Fetal echocardiography provides several advantages for diagnosing and managing congenital heart disease:
1) It allows for counseling of parents on prognosis and treatment options, including the possibility of termination of pregnancy for major defects or chromosomal anomalies.
2) In some cases, it enables life-saving procedures to be performed on the mother or fetus before or during pregnancy.
3) It facilitates delivery planning at a specialized medical center near pediatric cardiac surgery.
This document discusses prenatal screening and diagnosis of Down syndrome. It describes various screening tests that can be done during the first and second trimester, including nuchal translucency screening between 11-13 weeks gestation and biochemical screening involving markers like beta-hCG and PAPP-A. Combining results from ultrasound markers like nuchal translucency with biochemical markers provides the most accurate risk assessment. A small percentage of high-risk cases may warrant diagnostic testing like amniocentesis or CVS. The document also discusses factors that can impact marker levels and outlines reporting recommendations.
This document provides an overview of perinatology and fetal therapy. It discusses various pharmacological and surgical fetal therapies used to treat conditions such as cardiac arrhythmias, complete atrioventricular block, congenital adrenal hyperplasia, fetal anemia, twin-twin transfusion syndrome, congenital diaphragmatic hernia, and pleural effusions. Invasive fetal therapies discussed include intrauterine blood transfusion, fetoscopy, laser coagulation of vessels, and intra-amniotic gene transfer. Fetal therapy requires a multidisciplinary team and tools such as ultrasound, MRI, and fetoscopes to properly diagnose and treat conditions in-utero.
Fetal megacystis - more than luto - Bàng quang lớn ở thai nhi LUTOVõ Tá Sơn
This study analyzed 541 pregnancies with fetal megacystis (enlarged bladder) referred to fetal medicine units in the Netherlands between 2000-2015. The study found that in 67% of cases, megacystis was isolated or accompanied only by signs of lower urinary tract obstruction. In the remaining 33% of cases, megacystis was associated with other structural abnormalities. The most common associated findings were increased nuchal translucency (22%), single umbilical artery (10%), and cardiac defects (10%). The study provides an overview of genetic syndromes, chromosomal abnormalities, and developmental disturbances that can present with fetal megacystis, in order to improve counseling and management of these complex cases
This document discusses antenatal hydronephrosis. Some key points:
- The prevalence of antenatally detected hydronephrosis ranges from 0.6-5.4% and is bilateral in 17-54% of cases. 41-88% resolves at birth or infancy, while 4-15% require intervention.
- Factors like gestational age, hydration status, and bladder distention affect measurements of the renal pelvis anteroposterior diameter (APD), which is used to diagnose and grade hydronephrosis. Threshold APD values increase with gestational age.
- Additional evaluation including assessment for lower urinary tract obstruction, renal dysplasia
Isuog practice guidelines performance of first trimester fetal ultrasound scankaleemullahabid
The document provides guidelines from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) for performing first trimester fetal ultrasound scans between 6-13 weeks gestation. It outlines recommendations for assessing viability, measuring the embryo/fetus, determining gestational age, evaluating fetal anatomy, and documenting the examination. Key recommendations include using transvaginal ultrasound when possible, measuring the crown-rump length to determine gestational age, and assessing the head, neck, spine and basic anatomy while acknowledging limitations in visualization of some structures so early.
Nearly half (47%) of fetuses diagnosed prenatally with congenital heart disease via echocardiography and who had a normal karyotype also had increased nuchal translucency, defined as 2.5mm or greater. This proportion was significantly higher than the expected 5% in the normal population. The only cardiac diagnosis with a higher proportion of increased nuchal translucency was atrioventricular septal defect, at 62%. The results support referring all fetuses with increased nuchal translucency for echocardiography regardless of other abnormalities, as increased nuchal translucency appears associated with congenital heart disease independent of karyotype.
This document provides updated guidelines for performing ultrasound screening of the fetal heart from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). The guidelines recommend that in addition to the standard four-chamber view of the heart, ultrasound practitioners should also obtain views of the outflow tracts from both ventricles. This updated recommendation aims to improve prenatal detection of congenital heart defects. The guidelines describe how to properly obtain and evaluate the four-chamber view and outflow tract views during the routine mid-gestation ultrasound examination between 18-22 weeks. Adherence to these guidelines could help maximize detection of fetal heart abnormalities.
This document discusses genetic testing, including definitions, purposes, types, and techniques. It covers several types of genetic testing such as carrier screening, preimplantation diagnosis, prenatal testing, newborn screening, and predictive adult testing. Techniques discussed include amniocentesis, chorionic villus sampling, fetal cell analysis from maternal blood, analysis of maternal serum markers, ultrasound, autopsy, and culture/microscopy. Ethical considerations around informed consent are also mentioned.
approach to evidence based antenatal Fetal survellianceDr Praman Kushwah
This document discusses evidence-based approaches to antenatal Doppler fetal surveillance. It begins by outlining the objectives and aims of fetal surveillance, including identifying fetuses at risk of hypoxia and improving perinatal outcomes. It then describes various methods of fetal surveillance, including daily fetal movement counts, non-stress tests, biophysical profiles, and Doppler velocimetry. The document discusses the indications and measurements of Doppler indices for the uterine, umbilical, and middle cerebral arteries. It reviews recent evidence showing that Doppler ultrasound in high-risk pregnancies can reduce perinatal deaths and interventions without increasing them in low-risk pregnancies. The document concludes by emphasizing that not all pregnancies require surveillance and that monitoring
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 discusses antenatal hydronephrosis and its management. It begins by stating that fetal urinary tract dilation is the second most common prenatal anomaly detected. Antenatal hydronephrosis is diagnosed based on measurements of the anterior-posterior renal pelvic diameter. While most cases are transient and physiological, it can also indicate congenital anomalies of the kidney and urinary tract. Prenatal imaging using ultrasound is important to identify and monitor any urinary tract anomalies. Postnatal evaluation and management seeks to identify infants with clinically significant congenital anomalies of the kidney and urinary tract that may require treatment or surgery.
This document discusses the role of ultrasound in diagnosing and monitoring intrauterine growth restriction (IUGR). Key points include: ultrasound is used to diagnose small-for-gestational-age (SGA) babies and classify IUGR cases as symmetric or asymmetric; Doppler of the umbilical artery, uterine arteries, middle cerebral artery and ductus venosus helps assess the fetus and determine the timing of delivery; biophysical profiling and amniotic fluid volume are also monitored; management may involve delivery depending on gestational age and Doppler findings of fetal compromise.
TREATMENT GUIDELINES OF SOCIETY OF MATERNAL AND FETAL MEDICINEAboubakr Elnashar
This document outlines treatment guidelines from 2019 provided by Prof. Aboubakr Elnashar of Benha University in Egypt. It discusses recommendations from the Society for Maternal-Fetal Medicine (SMFM) on conditions such as preeclampsia, placenta accreta, twin-twin transfusion syndrome, hydrops fetalis, amniotic fluid embolism, preterm birth, and fetal anemia. The SMFM provides evidence-based guidelines on evaluating, monitoring, and managing these high-risk pregnancies and conditions.
ISUOG consensus statement: what constitutes a fetal echocardiogram?Tony Terrones
This document presents a consensus statement from an expert panel that defines what constitutes a fetal echocardiogram. A fetal echocardiogram involves a thorough examination of standard cardiac views using ultrasound and Doppler techniques to assess cardiac structure, function, connections, and blood flow. It should be performed by specialists with training in fetal cardiac imaging when indications such as increased risk of congenital heart disease or abnormal screening results are present.
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.
Antenatally detected hydronephrosis is one of the most common abnormalities detected on prenatal ultrasound. It can identify urinary tract obstructions and reflux before complications develop. The degree of hydronephrosis seen on prenatal ultrasound provides prognostic information, with mild cases often resolving and severe cases more likely to require postnatal intervention. Evaluation after birth depends on the severity and laterality of the hydronephrosis seen prenatally, with more severe or bilateral cases warranting earlier and more extensive testing like dynamic renal scintigraphy to assess kidney function and guide management.
Background: Doppler ultrasound velocimetry of uteroplacental umbilical and fetal vessels has become an established method of antenatal monitoring, Cerebroplacental and Cerebrouterine ratios have been studied to predict neonatal outcomes.
Aim of the Work: To assess if Cerebrouterine Ratio would be complementary to cerebroplacental Ratio in predicting adverse
neonatal outcome in preeclamptic pregnant women.
Fetal therapy involves both non-invasive and invasive procedures to diagnose and treat conditions affecting the unborn baby. Non-invasive procedures include administering medications to the mother that will benefit the fetus, such as steroids to promote lung maturity. Invasive procedures include intravascular transfusions to treat fetal anemia and correct blood counts, as well as fetoscopy to biopsy tissues and treat abnormalities. These invasive procedures require ultrasound guidance and careful monitoring to minimize risks to the mother and fetus. Fetal therapy is a multidisciplinary effort involving many specialists working together to diagnose and treat issues during pregnancy and improve outcomes for the unborn baby.
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
This study aimed to determine if the combined use of uterine artery Doppler velocimetry (UADV) and measurements of placental growth factor (PlGF) and soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) in maternal blood samples could identify patients at high risk of early onset and/or severe preeclampsia. The study found that abnormal UADV and plasma PlGF below 280 pg/mL were independent risk factors. Patients with abnormal UADV and low PlGF were at highest risk, with odds ratios of 43.8 for early onset preeclampsia and 37.4 for severe preeclampsia. PlGF was better than sVEGFR-1 at predicting early
This document discusses various methods for assessing fetal well-being, including the biophysical profile (BPP), modified BPP, Doppler ultrasound of the umbilical artery (UA) and middle cerebral artery (MCA), and fetal breathing movements. The BPP assigns scores based on 5 components to evaluate fetal condition. Doppler ultrasound of the UA and MCA can identify fetuses at risk, with abnormal UA Doppler indicating uteroplacental insufficiency and intrauterine growth restriction. MCA Doppler detects the brain-sparing effect in which blood is redistributed from the UA to the brain in compromised fetuses.
This document provides guidelines for antepartum fetal surveillance techniques based on the latest scientific evidence. It discusses various techniques used for antepartum fetal surveillance including maternal fetal movement assessment, contraction stress test, nonstress test, biophysical profile, and modified biophysical profile. The goal of using these techniques is to prevent fetal death by identifying fetuses that may be undergoing uterine placental compromise. A normal result from these antepartum fetal surveillance tests is highly reassuring, with false negative rates generally below 1%, however, acute catastrophic changes may still result in fetal death.
This guideline provides recommendations for the management of gestational trophoblastic disease (GTD) and gestational trophoblastic neoplasia (GTN). It covers definitions, presentation, diagnosis, evacuation methods, and follow up of molar pregnancies. The definitive diagnosis of GTD requires histological examination. Suction curettage is recommended for evacuating complete molar pregnancies, while medical evacuation may be used for partial molar pregnancies if fetal parts prevent suction curettage. Follow up beta hCG testing and treatment is important to monitor for GTN.
This study examined the effects of maternal consumption of polyphenol-rich foods during late pregnancy on fetal ductus arteriosus blood flow dynamics. Doppler ultrasound was used to compare ductal blood flow velocities and right-to-left ventricular dimensions in 102 fetuses exposed to high maternal polyphenol intake versus 41 unexposed fetuses. Exposed fetuses had higher ductal velocities and right-to-left ventricular ratios, indicating potential inhibition of prostaglandin synthesis from polyphenols and effects on ductal constriction. The findings suggest maternal polyphenol-rich food intake during late pregnancy may impact fetal ductal dynamics and warrant changes to perinatal dietary guidance.
Magnesium Prevents the Cerebral Palsy Precursor in Premature InfantsRoss Finesmith M.D.
To determine if magnesium sulfate has an effect on the development of cystic
periventricular leukomalacia in preterm infants, this retrospective case control study
was conducted. There were 23,382 infants born at three teaching hospitals in the metropolitan New York area from January 1992 to December 1994. Four hundred ninety-two infants met our entrance criteria. Criteria included a birth weight less than 750 g, survival to at least 7 days of life and at least one cranial ultrasound after 7 days of life.
Infants exposed to magnesium sulfate in utero were less likely to develop periventricular
leukomalacia. Two of 18 (11%) infants with periventricular leukomalacia were
exposed to magnesium sulfate in-utero compared to 14 of 36 controls (39%) (p =
0.035) (OR = 0.196, 95% Cl = 0.039-0.988). Pre-eclampsia as an independent factor
was not associated with a reduced risk (p = 0.251) (OR = 0.294, 95% Cl =
0.033-2.65). Preterm infants exposed to antenatal magnesium sulfate were found to
have a reduced risk of developing cystic periventricular leukomalacia.
Prediction for rashkind procedure in fetuses with d tgvbgisa_legal
This study aimed to identify prenatal echocardiographic features that predict the need for a Rashkind procedure within 24 hours of birth in fetuses with dextro-transposition of the great arteries (d-TGA). The study retrospectively analyzed 51 fetuses with d-TGA, comparing those who did (n=29) and did not (n=22) require the Rashkind procedure. While most parameters did not differ between groups, fetuses requiring the procedure had significantly higher pulmonary venous maximum velocities and were more likely to have a flattened foramen ovale valve seen on prenatal ultrasound. These findings may help predict which fetuses will need urgent postnatal intervention.
This document discusses urinary tract injuries that can occur during laparoscopic gynecological surgery. It notes that bladder injury is the most common major complication. Prevention strategies include catheterization before trocar insertion, using the lowest effective power for electrosurgery, and identifying bladder boundaries. Injuries may be recognized intraoperatively through direct visualization, cystoscopy, or instilling dye. Postoperative recognition involves symptoms like pain and hematuria. Management often involves laparoscopic repair by a gynecologist or urologist to avoid additional morbidity of laparotomy.
This study retrospectively analyzed 65 cases of unusual ectopic pregnancies out of 1000 total ectopic pregnancy cases over a 10-year period. The study found that ovarian pregnancies were associated with intrauterine device placement and pelvic inflammatory diseases. Extratubal ectopic pregnancies like those in the ovaries, cervix, and abdomen presented more serious symptoms and had higher misdiagnosis rates than tubal pregnancies. Most unusual ectopic pregnancies required surgery for treatment, though some early cervical and corneal pregnancies were treated with conservative methods like mifepristone and methotrexate or curettage.
This document discusses the role of tubal patency tests and tubal surgery in the era of assisted reproductive techniques. It reviews evidence on various tubal patency tests like laparoscopy, hysterosalpingogram, hysterosalpingo contrast sonography, and their advantages and limitations. While laparoscopy is considered the gold standard, it requires general anesthesia and carries surgical risks. Hysterosalpingogram is widely available but less accurate and exposes patients to radiation. Hysterosalpingo contrast sonography provides images without radiation but may be limited in some patients. The document concludes that in vitro fertilization has largely replaced tubal surgery as it offers better success rates and can be done on an out
This document summarizes recent advances in endocrine therapy for breast cancer. Key findings from clinical trials show that aromatase inhibitors are superior to tamoxifen for postmenopausal women, 10 years of tamoxifen is better than 5 years for premenopausal women, and combining mTOR inhibitors like everolimus with hormonal therapies improves outcomes. New trials also found fulvestrant works as well as aromatase inhibitors for first-line metastatic disease. Combining fulvestrant and exemestane was more effective than single agents. Exemestane was also found to reduce invasive breast cancers in prevention settings.
This document summarizes a study that evaluated the effects of various maternal, fetal, and technical factors on the accuracy of sonographic fetal weight estimation (SFWE). The study analyzed over 9,000 SFWEs performed within a week of delivery. It found that several maternal factors, including higher weight, height, BMI, older age, diabetes, and multiparity were associated with underestimation of fetal weight. Fetal factors like male sex were also linked to underestimation, while breech presentation slightly improved accuracy. Experience level of the sonographer had little effect. Overall, the models assessed explained less than 10% of errors, suggesting most inaccuracy comes from limitations of SFWE formulas themselves.
This study examined the effects of mechanical cervical dilation using laminaria tents for women with premature rupture of membranes (PROM) at term. The study compared outcomes between women who received laminaria tent insertion for unfavorable cervical ripening prior to 2010 (group 1) and women managed without laminaria tents after 2010 (group 2). The results found no significant differences between the groups in maternal and neonatal outcomes such as infection rates, time to delivery, Apgar scores, or umbilical cord pH levels. Mechanical cervical dilation did not increase infection risks or improve perinatal prognosis, providing no clear benefits for women with PROM at term.
This document discusses selective progesterone receptor modulators (SPRM) and their uses in gynecology. It provides background on the initial development of mifepristone as a progesterone receptor antagonist in the 1980s. More recently, ulipristal acetate, a SPRM, has been licensed for emergency contraception and as a preoperative treatment for uterine fibroids. The document outlines the mechanism of action of SPRMs as having mixed agonist and antagonist effects on progesterone receptors. It also summarizes recent clinical trials showing ulipristal acetate to be an effective alternative to gonadotropin-releasing hormone analogues for preoperative treatment of uterine fibroids, with reduced side effect profiles compared to analogues.
This study assessed satisfaction in 89 women who underwent concurrent pelvic organ prolapse (POP) repair and midurethral sling placement to treat stress urinary incontinence (SUI). At the 1-year follow-up, 72% of patients had complete cure of both POP and SUI, while 17% and 10% had persistent SUI or POP respectively. Overall, 88% reported being satisfied. Patients who achieved complete cure of both conditions had a 95% satisfaction rate, while 40% were dissatisfied if SUI was not cured and 22% if POP was not cured. The only outcome measure correlated with satisfaction was improvement in vaginal bulge symptoms. The study highlights the complex relationship between surgical outcomes and patient
1) The document discusses retinoids, which are known to be teratogenic when used during pregnancy. Isotretinoin in particular is used to treat severe acne but has significant risks of causing fetal malformations.
2) When isotretinoin is prescribed to women of childbearing age, a pregnancy prevention programme is implemented to prevent exposure during treatment and for at least one month after. However, pregnancies still occasionally occur despite these measures.
3) The main teratogenic effects of isotretinoin exposure during pregnancy include craniofacial, central nervous system, cardiovascular and thymic abnormalities in the developing fetus. Management of pregnancies with recent isotretinoin exposure involves counseling and potential
This study assessed resilience, depressed mood, and menopausal symptoms in 169 postmenopausal women aged 48-68 years. 45% of women had depressed mood and 35% had severe menopausal symptoms. Women with less resilience had higher depressed mood scores and more severe menopausal symptoms. Multiple regression identified two models: 1) Resilience scores correlated inversely with depressed mood and positively with regular exercise. 2) Depressed mood scores correlated positively with somatic and psychological menopausal symptom scores and inversely with resilience. This study suggests depressed mood and menopausal symptoms are associated with lower resilience in postmenopausal women, while exercise is linked to higher resilience.
This document discusses risk factors for early childhood obesity from a prenatal care perspective. It identifies several risk factors that occur before or immediately after birth, including maternal obesity, excessive weight gain during pregnancy, smoking during pregnancy, and bottle feeding rather than breastfeeding. The document provides evidence from multiple studies on how each of these factors increases the risk of a child being overweight or obese. It emphasizes that prenatal care provides an opportunity for healthcare providers to educate mothers on these risks and support behaviors like maintaining a healthy weight, smoking cessation, limiting weight gain during pregnancy, and breastfeeding to help decrease the likelihood of early childhood obesity.
Nerve injuries are a common complication of gynaecological surgery, occurring in 1.1-1.9% of cases. The femoral, ilioinguinal, pudendal, obturator, lateral cutaneous, iliohypogastric and genitofemoral nerves are most commonly injured during surgery due to patient mal-positioning, incorrect retractor placement, haematoma formation, or direct nerve entrapment or transection. While most neuropathies resolve with conservative management, selective serotonin reuptake inhibitors or other medications may help manage painful neuropathies.
This document discusses progress towards Millennium Development Goal 4 (MDG4) of reducing child mortality. While overall progress has been made, neonatal mortality rates have declined more slowly. Simple, low-cost interventions like kangaroo mother care, neonatal resuscitation, and breastfeeding can significantly reduce neonatal deaths. However, implementation faces barriers like lack of healthcare workers, cultural practices, financial barriers to care, and poor quality of services. Political will is needed to fully achieve MDG4 targets through strengthened health systems and addressing inequities between regions.
This document discusses litigation in the field of gynaecology. It begins by noting that obstetrics and gynaecology has a reputation as a highly litigious specialty. It then discusses some of the common reasons why doctors are sued, including accountability, the need for explanation, concern over standards of care, and compensation. The document outlines the typical stages of a medical claim and summarizes several important legal cases that have influenced medico-legal rulings. It also discusses factors that commonly lead to claims in gynaecology, such as issues with consent, sterilization procedures, and laparoscopic surgeries.
This study examined the effects of adding estradiol valerate (EV) to clomiphene citrate (CC)-stimulated cycles on endometrial thickness. Thirty women received CC for ovulation induction in two treatment cycles, with one group also receiving a placebo and the other group receiving additional EV. While CC alone slightly reduced endometrial thickness, the addition of EV significantly increased thickness compared to CC with placebo. EV especially improved endometrial thickness in women where CC caused thinning, but had little effect where thickness was normal with CC alone. Other measures of folliculogenesis and ovulation were unaffected by EV. The study concluded EV prevents CC-induced endometrial thinning without disrupting the ovulation process.
This document reviews studies that have assessed the biomechanical properties of the uterine cervix during pregnancy using various quantitative methods. It discusses how elastography techniques have been applied to measure cervical deformability but have not demonstrated an ability to predict delivery timing. Measurement of maximum cervical deformability (cervical consistency index) provided more meaningful results, showing increased compliance with gestational age. Aspiration measurements also found a progressive decrease in cervical stiffness along gestation. Cervical consistency index and aspiration measurements are promising for quantitative assessment of changing cervical biomechanics during pregnancy.
This document discusses how functional echocardiography can assess cardiac function in fetuses with non-cardiac diseases or conditions that impact the fetus. It provides details on:
1) How ultrasound can evaluate various aspects of fetal cardiac function like cardiac output, size, contractility, and diastolic function.
2) Examples of conditions that can alter fetal hemodynamics like intrauterine growth restriction (IUGR), tumors, twin-twin transfusion syndrome, and maternal diabetes. In IUGR, changes in the umbilical artery and ductus venosus occur as placental function declines.
3) Insights from evaluating these conditions, such as how IUGR fetuses develop a dominant left
This document summarizes a presentation on whether incidental findings from prenatal testing should always be reported to patients. It discusses the case for reporting all incidental findings by defining what incidental findings are and outlining the purpose and goals of prenatal diagnosis. It then applies principles of medical ethics including autonomy, beneficence, non-maleficence, and justice to argue that incidental findings of known clinical significance that are actionable should be reported. It acknowledges the difficulty of incidental findings of unknown significance but still argues they should be shared with parents so they can make informed decisions. Finally, it addresses concerns about discovering late-onset untreatable diseases and risks of anxiety, but concludes that an ethical approach is to
This document discusses the potential for noninvasive prenatal DNA testing (NIDT) to become the standard screening test for Down syndrome in all pregnant women. It presents perspectives both for and against this proposition. Those in favor argue that NIDT has higher accuracy and lower risk than current invasive screening tests, so it respects patient autonomy and informed choice better. However, others are more cautious and want more data on costs and outcomes before widely implementing NIDT as the standard of care for all pregnancies. Overall the debate centers on whether NIDT should replace current screening paradigms or be offered as an additional option based on its advantages over existing tests.
This cross-sectional study examined gestational weight gain and perinatal outcomes in 1462 pregnant women in southern India. The study found that 37.41% of women gained less than the recommended weight based on IOM guidelines, while 21.41% gained more. Less than optimal weight gain was associated with a higher risk of preterm delivery (adjusted odds ratio 3.58). However, gestational weight gain was not significantly associated with other maternal or neonatal outcomes. This suggests the IOM guidelines may not be an appropriate standard for monitoring gestational weight gain in this population.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Uso de doppler en obstetricia
1. SOGC CLINICAL PRACTICE GUIDELINES
No. 130, July 2003
THE USE OF FETAL DOPPLER IN OBSTETRICS
This guideline has been reviewed by the Diagnostic Imaging Committee and approved by
Executive and Council of the Society of Obstetricians and Gynaecologists of Canada.
PRINCIPAL AUTHORS
Robert Gagnon, MD, FRCSC, London ON
Michiel Van den Hof, MD, FRCSC, Halifax NS
DIAGNOSTIC IMAGING COMMITTEE
Michiel Van den Hof (Chair), MD, FRCSC, Halifax NS
Stephen Bly, PhD, Ottawa ON
Duncan Farquharson, MD, FRCSC,Vancouver BC
Robert Gagnon, MD, FRCSC, London ON
Barbara Lewthwaite, MN,Winnipeg MB
Lucie Morin, MD, FRCSC, Montreal QC
Shia Salem, MD, FRCP,Toronto ON (Canadian Association of Radiologists Representative)
Amanda Skoll, MD, FRCSC,Vancouver BC
Abstract 2. Depending on other clinical factors, reduced, absent, or reversed
Objective: To develop national guidelines on the use of fetal umbilical artery end-diastolic flow is an indication for enhanced
Doppler in obstetrics. fetal surveillance or delivery. If delivery is delayed to enhance
Options: Whether umbilical cord artery, umbilical cord venous, fetal lung maturity with maternal administration of glucocorti-
ductus venosus, and middle cerebral artery Doppler are use- coid, intensive fetal surveillance until delivery is suggested for
ful in assessing fetal health. those fetuses with reversed end-diastolic flow. (II-1B)
Outcome: Prediction of adverse perinatal outcome or predic- 3. Umbilical artery Doppler should not be used as a screening
tion of fetal anemia. tool in healthy pregnancies, as it has not been shown to be of
Evidence: MEDLINE search and review of bibliographies in iden- value in this group. (I-A)
tified articles. 4. Umbilical venous double pulsations, in the presence of abnor-
Values: The evidence was reviewed by the Diagnostic Imaging mal umbilical artery Doppler waveforms, necessitate a detailed
Committee and the principal authors. A quality of evidence assessment of fetal health status. (II-3B)
assessment was undertaken as outlined in the report of the 5. Measurement of the fetal middle cerebral artery Doppler peak
Canadian Task Force on the Periodic Health Examination. systolic flow velocity is a predictor of moderate or severe fetal
Benefits, harms, and costs: Intrauterine growth restriction com- anemia and can be used to avoid unnecessary invasive proce-
plicates 5% to 10% of all pregnancies and up to 30% of multi- dures in pregnancies complicated with red blood cell isoimmu-
ple pregnancies. In 60% of these pregnancies, the primary cause nization. (II-1A)
is placental insufficiency. Improvement in the identification of the 6. Since inaccurate information concerning fetal Doppler studies
fetus at risk of intrauterine demise may lead to more success- could lead to inappropriate clinical decisions, it is imperative
ful management strategies. Management of fetal red blood cell that measurements be undertaken and interpreted by expert
isoimmunization requires a prediction of fetal anemia. If invasive operators who are knowledgeable about the significance of
procedures to predict fetal anemia can be replaced with non- Doppler changes and who practise appropriate techniques.
invasive tests, fetal morbidity and mortality can be reduced. Duplex mode with pulsed Doppler and colour Doppler flow
Recommendations: mapping is the minimum required ultrasound equipment. (II-1A)
1. Umbilical artery Doppler should be available for assessment
of the fetal-placental circulation in pregnant women with sus- J Obstet Gynaecol Can 2003;25(7):601–7.
pected severe placental insufficiency. (I-A)
Key Words
Fetal Doppler, placental blood flow, placental insufficiency,
fetal growth restriction
These guidelines reflect emerging clinical and scientific advances as of the date issued and are subject to change.The information should not be construed as
dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions.They should be well doc-
umented if modified at the local level. None of the contents may be reproduced in any form without prior written permission of SOGC.
JOGC 1 JUNE 2003
2. PART I: STANDARD ANTENATAL FETAL SURVEILLANCE tance index or Pourcelot ratio, and the pulsatility index. These
indices closely correlate and they can be used interchangeably
INTRODUCTION with similar predictive values for perinatal outcome.15,16
Placental insufficiency is the primary cause of intrauterine growth Placental insufficiency can be quantified based on the reduc-
restriction in normally formed fetuses and can be identified using tion of end-diastolic Doppler flow velocity into (1) reduced end-
umbilical artery Doppler velocimetry.1-4 Umbilical artery diastolic flow velocity, (2) absent end-diastolic flow velocity, and
Doppler waveforms provide an estimate of downstream placen- (3) reversed end-diastolic flow velocity. The risk of perinatal
tal vascular resistance and placental blood flow.2 There is a strong mortality increases up to 60%, with increasing severity from
association between reduced end-diastolic umbilical artery blood reduced to reversed end-diastolic flow velocity.17-32 Therefore,
flow velocity and increased vascular resistance in the umbilical- in the presence of umbilical artery reversed end-diastolic flow
placental microcirculation.5,6 As well, abnormal umbilical artery velocity, delivery by Caesarean section may be considered if fetal
Doppler waveforms have been associated with an increased risk viability is achieved.32 This decision will be influenced by the
of fetal acidosis, as measured during cordocentesis,7 and may estimated fetal weight, gestational age, other Doppler parame-
improve the performance of the biophysical profile score in pre- ters, and other assessments of fetal health, such as fetal anatom-
dicting fetal acidemia and hypercarbia.8 The use of Doppler dur- ical and chromosomal anomalies.33 In cases of prematurity,
ing antenatal fetal surveillance has involved assessment of (1) the delivery may be delayed for 48 hours, allowing the maximum
umbilical arterial and venous flow velocity waveforms, (2) the fetal benefits of maternal administration of glucocorticoids;
fetal cerebral circulation, and (3) the fetal venous circulation, in under such circumstances, continuous fetal heart rate moni-
particular the ductus venosus. toring until delivery should be considered.34
ASSESSMENT OF PLACENTAL FUNCTION USING RECOMMENDATION
UMBILICAL ARTERY DOPPLER VELOCIMETRY 1. Umbilical artery Doppler should be available for assess-
From 7 to 16 days postconception, the yolk sac develops and ment of the fetal-placental circulation in pregnant women
early development of the primary chorionic villi takes place. with suspected severe placental insufficiency. (I-A)
Thereafter, the chorioallantoic placenta develops in stages con-
sisting of invasion of the spiral arteries by endovascular cytotro- At an early gestational age, reduced or absent umbilical
phoblast, followed by a second wave of invasion that extends artery end-diastolic flow velocity is an indication for increased
into the myometrium. The basic organization of the human fetal surveillance, but not necessarily for immediate deliv-
placenta is present by approximately day 20 of pregnancy. Fur- ery.23,35 However, closer to term, severe placental insufficien-
ther refinement of this basic structure continues until term, at cy, reflected by absent umbilical artery end-diastolic flow
which time there are approximately 50 to 60 primary fetal stem velocity, is an indication for delivery. Fetuses with absent umbil-
villi branching into several terminal or tertiary villi. The branch- ical artery end-diastolic flow velocity are more severely growth
ing of the stem villi and ensuing development of the non- restricted,2,7 are at higher risk of perinatal morbidity and mor-
branching placental microcirculation are responsible for a low tality,19 and require delivery at an earlier gestational age than
vascular resistance, the increase in placental blood flow, and the those with end-diastolic flow.21 However, when fetuses are
increase in transplacental gas exchange that characterizes human matched for gestational age and birth weight, no differences in
placentation. This low umbilical-placental vascular resistance is perinatal outcome are found in the groups with and without
also responsible for the elevated end-diastolic blood flow ve- end-diastolic flow velocity.24,36 Although absence of end-
locity in the umbilical artery seen during the third trimester in diastolic flow velocity may not affect long-term neurological
a normal pregnancy.5,9 A reduction of the branching of the stem outcome, reversal of end-diastolic flow velocity in the umbil-
villi and a reduction in the development of the nonbranching ical artery is associated with a wide range of problems at school
placental microcirculation result in fewer small arterioles in the age,37 suggesting that it represents intrauterine decompensa-
tertiary stem villi, along with a thickened fetal-maternal tion, which may have adverse effects on the developing brain.24
placental interface. This results in abnormally high umbilical-
placental vascular resistance,2,10,11 a reduction in umbilical blood RECOMMENDATION
flow,10 and chronic fetal hypoxemia.11 2. Depending on other clinical factors, reduced, absent, or
With an increase in downstream placental vascular resis- reversed umbilical artery end-diastolic flow is an indica-
tance, velocity of the end-diastolic flow in the umbilical cord tion for enhanced fetal surveillance or delivery. If delivery
artery is reduced, while the peak-systolic component is not sig- is delayed to enhance fetal lung maturity with maternal
nificantly affected.12-14 As a result, several Doppler indices have administration of glucocorticoid, intensive fetal surveil-
been used to quantify abnormalities in umbilical artery lance until delivery is suggested for those fetuses with
Doppler flow waveforms, including the A/B ratio, the resis- reversed end-diastolic flow. (II-1B)
JOGC 2 JULY 2003
3. Randomized clinical trials have demonstrated that the use tion into the fetal abdomen.42 This is particularly important for
of umbilical artery velocimetry in high-risk pregnancy (espe- studies obtained in multiple pregnancy, where cord insertion at
cially those complicated by hypertension or presumed impaired the umbilicus is relatively easy to obtain to differentiate indi-
fetal growth) is associated with a trend to a reduction in peri- vidual fetuses.43 The angle of the fetal Doppler insonation
natal deaths (OR 0.71, 95% CI 0.50–1.01).38 The use of should be kept to less than 45˚ for an optimal umbilical artery
Doppler ultrasound was also associated with fewer inductions Doppler recording. Because of the potential for variability and
of labour (OR 0.83, 95% CI 0.74–0.93) and fewer admissions inaccuracy with fetal Doppler, it is imperative that measure-
to hospital (OR 0.56, 95% CI 0.43–0.72), without reports of ments be undertaken by expert operators who are knowledge-
adverse effects.38 In high-risk pregnancies complicated with able about the significance of Doppler changes and who practise
maternal hypertension, intrauterine growth restriction, or mul- appropriate techniques. Inaccurate information concerning fetal
tiple gestation, evidence supports the use of umbilical artery Doppler studies could lead to inappropriate clinical decisions.
Doppler studies as part of antenatal assessment.38 As there is
no evidence that the use of umbilical artery Doppler has value PART II: SPECIAL CONSIDERATIONS
in low-risk pregnancies,39 it should not be used as a screening
tool in healthy pregnancies. INTRODUCTION
Although the greatest impact on perinatal clinical practice from
RECOMMENDATION Doppler research has been the use of umbilical artery Doppler
3. Umbilical artery Doppler should not be used as a screen- assessment of placental function, there have been an increasing
ing tool in healthy pregnancies, as it has not been shown number of observational studies that require special considera-
to be of value in this group. (I-A) tions. These fetal Doppler studies include assessment of the fetal
venous circulation as a marker of severe fetal hypoxia,44-51 pre-
FACTORS AFFECTING UMBILICAL diction of fetal hypoxemia using fetal middle cerebral artery,52-60
ARTERY DOPPLER VELOCIMETRY and the prediction of severe fetal anemia using fetal middle
Several factors will affect the umbilical artery Doppler wave- cerebral artery Doppler.61-64
form, independent of changes in placental vascular resistance
(Table 1). Gestational age-dependent normograms are neces- THE USE OF FETAL VENOUS
sary for accurate interpretation of umbilical cord artery DOPPLER VELOCIMETRY
velocimetry.14 No correction is necessary for fetal heart rate Blood flow velocity in the fetal systemic venous circulation
within the normal range.40,41 In order to reduce methodologi- has a pulsating pattern that reflects changes in central venous
cal variability, it is recommended that umbilical artery Doppler pressure, in particular the filling of the atria during ventricular
waveforms be measured within 5 cm of the umbilical cord inser- systole and the opening of the atrio-ventricular valves. At the
TABLE 1
FACTORS AFFECTING UMBILICAL ARTERY DOPPLER FLOW VELOCITY WAVEFORMS*
Gestational age EDFV ratio increases with advancing gestational age15
Fetal heart rate EDFV decreases with decreasing fetal heart rate13,41
Fetal breathing movements Increases variability in the measurements66
Site of measurement EDFV is higher near the umbilical cord insertion into the fetal
abdomen than near the placental insertion67
Equipment used: continuous Doppler Continuous Doppler is more a “blind technique” compared with
versus pulsed Doppler pulsed Duplex Doppler, allowing 2D real time ultrasound68
User experience Reliability increases with increasing experience69
Radius of the umbilical artery Decreasing radius (vasoconstriction) increases EDFV70
Impedance to pulsatile flow propagation Increasing vascular impedance increases EDFV70
Downstream vascular resistance within the microcirculation Increasing vascular resistance decreases EDFV70–72
Angle of the fetal Doppler insonation Best if less than 45˚73; <15˚ for MCA absolute peak systolic flow
velocity62,64
*EDFV = end diastolic flow velocity; MCA = middle cerebral artery.
JOGC 3 JULY 2003
4. end of diastole, a reduction in blood velocity occurs due to USE OF DOPPLER TO DETECT FETAL ANEMIA
atrial contraction. Blood velocities in the umbilical vein and Several noninvasive methods have been suggested to detect fetal
portal circulation are normally continuous and without fluctu- anemia. Umbilical vein maximum velocity and middle cerebral
ation.44 Umbilical venous pulsations, particularly double artery peak-systolic flow velocity (MCA-PSV) are the most
pulsations, have been associated with perinatal mortality rates promising methods.61,62 A recent systematic review indicated
of up to 16% with absent umbilical artery end-diastolic flow that studies evaluating noninvasive techniques to detect fetal
velocity, and 60% with reversed umbilical artery end-diastolic anemia were methodologically poor and lacked a standard
flow velocity.44,45 However, it is not known if Doppler assess- approach to evaluate the techniques for fetal hemoglobin pre-
ment of the fetal umbilical venous circulation improves diction.63 However, since then, it has been shown that the
perinatal outcome when compared to assessment of umbilical MCA-PSV is an accurate predictor of severe fetal anemia in
artery Doppler velocimetry alone.46-49 pregnancies complicated by red cell alloimmunization.64
Although the correlation between the fetal hemoglobin value
RECOMMENDATION and MCA-PSV becomes more accurate as the severity of ane-
4. Umbilical venous double pulsations, in the presence of mia increases, almost 70% of the cordocentesis needed, using
abnormal umbilical artery Doppler waveforms, necessi- current standard criteria for assessment of fetal hemoglobin, can
tate a detailed assessment of fetal health status. (II-3B) be avoided.62 This approach is likely to decrease the need for
cordocentesis and its potential risks.
The ductus venosus may play a role in the regulation of
venous blood flow between the inferior vena cava and the RECOMMENDATION
umbilical vein. Under normoxemic conditions, approximate- 5. Measurement of the fetal middle cerebral artery Doppler
ly 40% of the umbilical venous blood flow passes through the peak systolic flow velocity is a predictor of severe fetal
ductus venosus.50 During fetal hypoxemia, the proportion of anemia and can be used to avoid unnecessary invasive
umbilical venous flow passing through the ductus venosus procedures in pregnancies complicated with red blood
increases.52 It is not clear if this increase is the result of an cell isoimmunization. (II-1A)
increase in central venous pressure or due to vasodilatation.44
It is reported that a reduction in vascular resistance through In order to accurately measure the MCA Doppler wave-
the ductus venosus is responsible for retrograde umbilical forms, pulsed Doppler with colour Doppler flow mapping is
venous flow velocity leading to umbilical venous pulsations recommended to visualize the direction of MCA blood flow.
during atrial contraction in the presence of fetal hypoxemia.51 Since the MCA-PSV is a measurement of absolute instead of
If umbilical venous pulsations are detected in the absence of relative velocity, the angle of the fetal Doppler insonation
fetal breathing movements, careful assessment of fetal health should be kept as close as possible to 0˚ for accurate estimate
should be considered. Although available in many tertiary cen- of the absolute peak systolic flow velocity. Software-based angle
tres, further research is needed on the benefit of umbilical correction cannot be used instead of proper positioning of the
venous and ductus venosus Doppler velocimetry before it can transducer since it could lead to erroneous value and interpre-
be recommended as a standard of care to evaluate high-risk tation.
pregnancies.
RECOMMENDATION
USE OF MIDDLE CEREBRAL ARTERY 6. Since inaccurate information concerning fetal Doppler
VELOCIMETRY TO DETECT FETAL HYPOXIA studies could lead to inappropriate clinical decisions, it
The same factors that affect umbilical artery Doppler waveforms is imperative that measurements be undertaken and inter-
can also affect fetal cerebral artery Doppler waveforms.52 Fetal preted by expert operators who are knowledgeable about
behavioural states can also alter cerebral artery waveforms.53-56 the significance of Doppler changes and who practise
Of interest, an increase in pCO2 or a reduction in pO2 will appropriate techniques. Duplex mode with pulsed
cause an increase in fetal cerebral arterial Doppler end-diastolic Doppler and colour Doppler flow mapping is the mini-
flow velocity, likely related to cerebral vasodilatation.57-59 This mum required ultrasound equipment. (II-1A)
phenomenon has been described as the “brain sparing” effect.60
Although an increase in fetal cerebral end-diastolic Doppler flow EVALUATION OF EVIDENCE
velocity may reflect chronic fetal hypoxemia, there is no evi-
dence that this measurement will provide any additional ben- The quality of evidence and classification of recommendations
efit to perinatal outcome beyond the assessment of the umbilical reported in these guidelines has been described using the Eval-
circulation alone.23 uation of Evidence criteria outlined in the Report of the Cana-
dian Task Force on the Periodic Health Exam (Table 2).74
JOGC 4 JULY 2003
5. TABLE 2
QUALITY OF EVIDENCE ASSESSMENT74 CLASSIFICATION OF RECOMMENDATIONS74
The quality of evidence reported in these guidelines has been Recommendations included in these guidelines have been
described using the Evaluation of Evidence criteria outlined in adapted from the ranking method described in the
the Report of the Canadian Task Force on the Periodic Health Classification of Recommendations found in the Canadian
Exam. Task Force on the Periodic Health Exam.
I: Evidence obtained from at least one properly randomized A. There is good evidence to support the recommendation
controlled trial. that the condition be specifically considered in a periodic
II-1: Evidence from well-designed controlled trials without health examination.
randomization. B. There is fair evidence to support the recommendation that
II-2: Evidence from well-designed cohort (prospective or the condition be specifically considered in a periodic health
retrospective) or case-control studies, preferably from examination.
more than one centre or research group. C. There is poor evidence regarding the inclusion or
II-3: Evidence obtained from comparisons between times or exclusion of the condition in a periodic health examination,
places with or without the intervention. Dramatic results but recommendations may be made on other grounds.
in uncontrolled experiments (such as the results of treat- D. There is fair evidence to support the recommendation
ment with penicillin in the 1940s) could also be included that the condition not be considered in a periodic health
in this category. examination.
III: Opinions of respected authorities, based on clinical E. There is good evidence to support the recommendation
experience, descriptive studies, or reports of expert that the condition be excluded from consideration in a
committees. periodic health examination.
REFERENCES 11. Kingdom JC, Burrell SJ, Kaufmann P. Pathology and clinical implications
of abnormal umbilical artery Doppler waveforms. Ultrasound Obstet
Gynecol 1997;9:271–86.
1. Giles WB,Trudinger BJ, Cook CM. Fetal umbilical artery flow
12. Gagnon R, Challis J, Johnston L, Fraher L. Fetal endocrine responses
velocity-time waveforms in twin pregnancies. Br J Obstet Gynaecol
to chronic placental embolization in the late-gestation ovine fetus.
1985;92:490–7.
Am J Obstet Gynecol 1994;170:929–38.
2. Giles WB,Trudinger BJ, Baird PJ. Fetal umbilical artery flow velocity
13. Mansouri H, Gagnon R, Hunse C. Relationship between fetal heart rate
waveforms and placental resistance: pathological correlation. Br J
and umbilical blood flow velocity in term human fetuses during labor.
Obstet Gynaecol 1985;92:31–8.
Am J Obstet Gynecol 1989;160:1007–12.
3. Lackman F, Capewell V, Gagnon R, Richardson B. Fetal umbilical cord
14. Thompson RS,Trudinger BJ, Cook CM. Doppler ultrasound waveforms
oxygen values and birth to placental weight ratio in relation to size at
in the fetal umbilical artery: quantitative analysis technique. Ultrasound
birth. Am J Obstet Gynecol 2001;185:674–82.
Med Biol 1985;11:707–18.
4. Lackman F, Capewell V, Richardson B, daSilva O, Gagnon R.The risks
15. Thompson RS,Trudinger BJ, Cook CM. A comparison of Doppler ultra-
of spontaneous preterm delivery and perinatal mortality in relation
sound waveform indices in the umbilical artery – I. Indices derived from
to size at birth according to fetal versus neonatal growth standards.
the maximum velocity waveform. Ultrasound Med Biol 1986;12:835–44.
Am J Obstet Gynecol 2001;184:946–53.
16. Thompson RS,Trudinger BJ, Cook CM. Doppler ultrasound waveform
5. Adamson SL. Arterial pressure, vascular input impedance, and
indices: A/B ratio, pulsatility index and Pourcelot ratio. Br J Obstet
resistance as determinants of pulsatile blood flow in the umbilical
Gynaecol 1988;95:581–8.
artery. Eur J Obstet Gynecol Reprod Biol 1999;84:119–25.
17. Cook CM, Connelly AJ,Trudinger BJ. Doppler assessment of the
6. Thompson RS,Trudinger BJ. Doppler waveform pulsatility index and
umbilical circulation. Semin Ultrasound CT MR 1989;10:417–27.
resistance, pressure and flow in the umbilical placental circulation:
18. Trudinger B, Cook CM,Thompson R, Giles W, Connelly A. Low-dose
an investigation using a mathematical model. Ultrasound Med Biol
aspirin improves fetal weight in umbilical placental insufficiency. Lancet
1990;16:449–58.
1988;2:214–5.
7. Yoon BH, Syn HC, Kim SW.The efficacy of Doppler umbilical artery
19. Rochelson B, Schulman H, Farmakides G, Bracero L, Ducey J, Fleischer A,
velocimetry in identifying fetal acidosis. A comparison with fetal
et al.The significance of absent end-diastolic velocity in umbilical artery
biophysical profile. J Ultrasound Med 1992;11:1–6.
velocity waveforms. Am J Obstet Gynecol 1987;156:1213–8.
8. Yoon BH, Romero R, Roh CR, Kim SH,Ager JW, Syn HC, et al.
20. Rochelson BL, Schulman H, Fleischer A, Farmakides G, Bracero L,
Relationship between the fetal biophysical profile score, umbilical artery
Ducey J, et al.The clinical significance of Doppler umbilical artery
Doppler velocimetry, and fetal blood acid-base status determined by
velocimetry in the small for gestational age fetus. Am J Obstet
cordocentesis. Am J Obstet Gynecol 1993;169:1586–94.
Gynecol 1987;156:1223–6.
9. Trudinger BJ, Giles WB, Cook CM. Flow velocity waveforms in the
21. Ferrazzi E,Vegni C, Bellotti M, Borboni A, Della PS, Barbera A. Role of
maternal uteroplacental and fetal umbilical placental circulations.
umbilical Doppler velocimetry in the biophysical assessment of the
Am J Obstet Gynecol 1985;152:155–63.
growth-retarded fetus. Answers from neonatal morbidity and
10. Hitschold TP. Doppler flow velocity waveforms of the umbilical
mortality. J Ultrasound Med 1991;10:309–15.
arteries correlate with intravillous blood volume. Am J Obstet
22. Ferrazzi E, Bellotti M,Vegni C, Barbera A, Della PS, Ferro B, et al.
Gynecol 1998;179:540–3.
Umbilical flow waveforms versus fetal biophysical profile in hyperten-
sive pregnancies. Eur J Obstet Gynecol Reprod Biol 1989;33:199–208.
JOGC 5 JULY 2003
6. 23. Fong KW, Ohlsson A, Hannah ME, Grisaru S, Kingdom J, Cohen H, et al. 44. Hofstaetter C, Dubiel M, Gudmundsson S.Two types of umbilical
Prediction of perinatal outcome in fetuses suspected to have intra- venous pulsations and outcome of high-risk pregnancy. Early Hum
uterine growth restriction: Doppler US study of fetal cerebral, Dev 2001;61:111–7.
renal, and umbilical arteries. Radiology 1999;213:681–9. 45. Reed KL, Chaffin DG, Anderson CF. Umbilical venous Doppler velocity
24. Schreuder AM, McDonnell M, Gaffney G, Johnson A, Hope PL. pulsations and inferior vena cava pressure elevations in fetal lambs.
Outcome at school age following antenatal detection of absent or Obstet Gynecol 1996;87:617–20.
reversed end diastolic flow velocity in the umbilical artery. Arch Dis 46. Gudmundsson S. Importance of venous flow assessment for clinical
Child Fetal Neonatal Ed 2002;86:F108–14. decision-making. Eur J Obstet Gynecol Reprod Biol 1999;84:173–8.
25. Vossbeck S, de Camargo OK, Grab D, Bode H, Pohlandt F. Neonatal 47. Gudmundsson S, Gunnarsson GO, Hokegard KH, Ingemarsson J,
and neurodevelopmental outcome in infants born before 30 weeks of Kjellmer I.Venous Doppler velocimetry in relationship to central
gestation with absent or reversed end-diastolic flow velocities in the venous pressure and heart rate during hypoxia in the ovine fetus.
umbilical artery. Eur J Pediatr 2001;160:128–34. J Perinat Med 1999;27:81–90.
26. Montenegro N, Santos F,Tavares E, Matias A, Barros H, Leite LP. 48. Hofstaetter C, Gudmundsson S, Dubiel M, Marsal K. Ductus venosus
Outcome of 88 pregnancies with absent or reversed end-diastolic velocimetry in high-risk pregnancies. Eur J Obstet Gynecol Reprod
blood flow (ARED flow) in the umbilical arteries. Eur J Obstet Biol 1996;70:135–40.
Gynecol Reprod Biol 1998;79:43–6. 49. Gudmundsson S,Tulzer G, Huhta JC, Marsal K.Venous Doppler in the
27. Salafia CM, Pezzullo JC, Minior VK, Divon MY. Placental pathology of fetus with absent end-diastolic flow in the umbilical artery. Ultrasound
absent and reversed end-diastolic flow in growth-restricted fetuses. Obstet Gynecol 1996;7:262–7.
Obstet Gynecol 1997;90:830–6. 50. Kiserud T.The ductus venosus. Semin Perinatol 2001;25:11–20.
28. Karsdorp VH, van Vugt JM, van Geijn HP, Kostense PJ, Arduini D, 51. Reed KL, Chaffin DG,Anderson CF, Newman AT. Umbilical venous
Montenegro N, et al. Clinical significance of absent or reversed velocity pulsations are related to atrial contraction pressure
end diastolic velocity waveforms in umbilical artery. Lancet waveforms in fetal lambs. Obstet Gynecol 1997;89:953–6.
1994;344:1664–8. 52. Gagnon R, Lamb T, Richardson B. Cerebral circulatory responses of
29. Tannirandorn Y, Phaosavasdi S. Significance of an absent or reversed near-term ovine fetuses during sustained fetal placental embolization.
end-diastolic flow velocity in Doppler umbilical artery waveforms. Am J Physiol 1997;273:H2001–8.
J Med Assoc Thai 1994;77:81–6. 53. Wladimiroff JW. Behavioural states and cardiovascular dynamics in the
30. Wilson DC, Harper A, McClure G. Absent or reversed end diastolic human fetus; an overview. Early Hum Dev 1994;37:139–49.
flow velocity in the umbilical artery and necrotizing enterocolitis. 54. Norwitz ER, Hoyte LP, Jenkins KJ, van der Velde ME, Ratiu P,
Arch Dis Child 1991;66:1467. Rodriguez-Thompson D, et al. Separation of conjoined twins with the
31. McParland P, Steel S, Pearce JM.The clinical implications of absent or twin reversed-arterial-perfusion sequence after prenatal planning with
reversed end-diastolic frequencies in umbilical artery flow velocity three-dimensional modeling. N Engl J Med 2000;343:399–402.
waveforms. Eur J Obstet Gynecol Reprod Biol 1990;37:15–23. 55. van den Wijngaard JA, van Eyck J, Noordam MJ,Wladimiroff JW,
32. Woo JS, Liang ST, Lo RL. Significance of an absent or reversed end van Strik R.The Doppler flow velocity waveform in the fetal internal
diastolic flow in Doppler umbilical artery waveforms. J Ultrasound carotid artery with respect to fetal behavioural states. A longitudinal
Med 1987;6:291–7. study. Biol Neonate 1988;53:274–8.
33. Trudinger BJ, Cook CM. Umbilical and uterine artery flow velocity 56. Wladimiroff JW,Tonge HM, Stewart PA. Doppler ultrasound assessment
waveforms in pregnancy associated with major fetal abnormality. of cerebral blood flow in the human fetus. Br J Obstet Gynaecol
Br J Obstet Gynaecol 1985;92:666–70. 1986;93:471–5.
34. du Plessis JM, Hall DR, Norman K, Odendaal HJ. Reversed end diastolic 57. Connors G, Hunse C, Gagnon R, Richardson B, Han V, Rosenberg H.
flow velocity in viable fetuses: is there time to wait for the effect of Perinatal assessment of cerebral flow velocity wave forms in the
corticosteroids before delivery? Int J Gynaecol Obstet 2001;72:187–8. human fetus and neonate. Pediatr Res 1992;31:649–52.
35. Trudinger BJ, Cook CM, Giles WB, Ng S, Fong E, Connelly A, et al. Fetal 58. Potts P, Connors G, Gillis S, Hunse C, Richardson B.The effect of
umbilical artery velocity waveforms and subsequent neonatal outcome. carbon dioxide on Doppler flow velocity waveforms in the human
Br J Obstet Gynaecol 1991;98:378–84. fetus. J Dev Physiol 1992;17:119–23.
36. Bekedam DJ,Visser GH, van der Zee AG, Snijders RJ, Poelmann- 59. Gagnon R, Lamb T, Richardson B. Cerebral circulatory responses of
Weesjes G. Abnormal velocity waveforms of the umbilical artery in near-term ovine fetuses during sustained fetal placental embolization.
growth retarded fetuses: relationship to antepartum late heart rate Am J Physiol 1997;273:H2001–8.
decelerations and outcome. Early Hum Dev 1990;24:79–89. 60. Kopecky EA, Ryan ML, Barrett JF, Seaward PG, Ryan G, Koren G, et al.
37. Brar HS, Platt LD. Reverse end-diastolic flow velocity on umbilical Fetal response to maternally administered morphine. Am J Obstet
artery velocimetry in high-risk pregnancies: an ominous finding with Gynecol 2000;183:424–30.
adverse pregnancy outcome. Am J Obstet Gynecol 1988;159:559–61. 61. Mari G, Deter RL, Carpenter RL, Rahman F, Zimmerman R, Oepkes D,
38. Neilson JP,Alfirevic Z. Doppler ultrasound for fetal assessment in high et al.The use of ultrasonography and Doppler in the prediction of fetal
risk pregnancies. Cochrane Database Syst Rev 2000;CD000073. haemolytic anaemia: a multivariate analysis. Br J Obstet Gynaecol
39. Newnham JP, Patterson LL, James IR, Diepeveen DA, Reid SE. An evalu- 1994;101:680–4.
ation of the efficacy of Doppler flow velocity waveform analysis as a 62. Mari G, Deter RL, Carpenter RL, Rahman F, Zimmerman R, Moise KJ Jr.,
screening test in pregnancy. Am J Obstet Gynecol 1990;162:403–10. et al. Noninvasive diagnosis by Doppler ultrasonography of fetal
40. Makikallio K,Tekay A, Jouppila P.Yolk sac and umbilicoplacental hemo- anemia due to maternal re-cell alloimmunization. Collaborative
dynamics during early human embryonic development. Ultrasound Group for Doppler Assessment of the Blood Velocity in Anemic
Obstet Gynecol 1999;14:175–9. Fetuses. N Engl J Med 2000;342:9–14.
41. Yarlagadda P,Willoughby L, Maulik D. Effect of fetal heart rate on 63. Divakaran TG,Waugh J, Clark TJ, Khan KS,Whittle MJ, Kilby MD.
umbilical arterial Doppler indices. J Ultrasound Med 1989;8:215–8. Noninvasive techniques to detect fetal anemia due to red blood cell
42. Mehalek KE, Rosenberg J, Berkowitz GS, Chitkara U, Berkowitz RL. alloimmunization: a systematic review. Obstet Gynecol 2001;98:509–17.
Umbilical and uterine artery flow velocity waveforms. Effect of the 64. Mari G, Detti L, Oz U, Zimmerman R, Duerig P, Stefos T. Accurate
sampling site on Doppler ratios. J Ultrasound Med 1989;8:171–6. prediction of fetal hemoglobin by Doppler ultrasonography. Obstet
43. Joern H, Rath W. Correlation of Doppler velocimetry findings in twin Gynecol 2002;99:589–93.
pregnancies including course of pregnancy and fetal outcome. Fetal 65. Morrow RJ, Adamson SL, Lewin M, Bull SB, Ritchie JW. The influence
Diagn Ther 2000;15:160–4. of spontaneous accelerations of fetal heart rate on umbilical artery
velocity waveforms. Am J Obstet Gynecol 1989;160:995–7.
JOGC 6 JULY 2003
7. 66. Spencer JA, Price J, Lee A. Influence of fetal breathing and movements
on variability of umbilical Doppler indices using different numbers of
waveforms. J Ultrasound Med 1991;10:37–41.
67. Adamson SL, Morrow RJ, Langille BL, Bull SB, Ritchie JW. Site-dependent
effects of increases in placental vascular resistance on the umbilical
arterial velocity waveform in fetal sheep. Ultrasound Med Biol
1990;16:19–27.
68. Kurjak A, Dudenhausen JW, Hafner T, Kupesic S, Latin V, Kos M.
Intervillous circulation in all three trimesters of normal pregnancy
assessed by color Doppler. J Perinat Med 1997;25:373–80.
69. Campbell S,Vyas S, Nicolaides KH. Doppler investigation of the fetal
circulation. J Perinat Med 1991;19:21–6.
70. Surat DR, Adamson SL. Downstream determinants of pulsatility of
the mean velocity waveform in the umbilical artery as predicted by
a computer model. Ultrasound Med Biol 1996;22:707–17.
71. Gagnon R, Johnston L, Murotsuki J. Fetal placental embolization in the
late-gestation ovine fetus: alterations in umbilical blood flow and fetal
heart rate patterns. Am J Obstet Gynecol 1996;175:63–72.
72. Trudinger BJ, Stevens D, Connelly A, Hales JR, Alexander G, Bradley L,
et al. Umbilical artery flow velocity waveforms and placental resistance:
the effects of embolization of the umbilical circulation. Am J Obstet
Gynecol 1987;157:1443–8.
73. Joern H, Funk A, Goetz M, Kuehlwein H, Klein A, Fendel H.
Development of quantitative Doppler indices for uteroplacental and
fetal blood flow during the third trimester. Ultrasound Med Biol
1996;22:823–35.
74. Woolf SH, Battista RN, Angerson GM, Logan AG, Eel W. Canadian Task
Force on the Periodic Health Exam. Ottawa: Canada Communication
Group; 1994. p. xxxvii.
JOGC 7 JULY 2003