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Can the degree of retrograde diastolic flow in abnormal umbilical artery flow velocity waveforms predict pregnancy outcome?

Brodszki, Jana LU ; Hernandez-Andrade, Edgar LU ; Gudmundsson, Saemundur LU ; Dubiel, M ; Mandruzzato, G P ; Laurini, R and Marsal, Karel LU (2002) In Ultrasound in Obstetrics & Gynecology 19(3). p.229-234
Abstract
OBJECTIVE: Reverse end-diastolic flow is the most pathological type of the umbilical artery flow velocity waveform. We aimed to investigate whether additional prognostic information can be obtained from umbilical artery waveforms in cases with reverse end-diastolic flow. SUBJECTS AND METHODS: Umbilical artery Doppler velocity waveforms from 44 fetuses with reverse end-diastolic flow were analyzed and the following parameters measured: the highest amplitude and the area below the maximum velocity curve of forward and reverse flow (A, B and C, D, respectively) and the duration of forward and reverse flow (Tc and Td, respectively). Ratios A/B, C/D and Tc/Td were calculated. The cut-off values for A/B, C/D and Tc/Td with the best predictive... (More)
OBJECTIVE: Reverse end-diastolic flow is the most pathological type of the umbilical artery flow velocity waveform. We aimed to investigate whether additional prognostic information can be obtained from umbilical artery waveforms in cases with reverse end-diastolic flow. SUBJECTS AND METHODS: Umbilical artery Doppler velocity waveforms from 44 fetuses with reverse end-diastolic flow were analyzed and the following parameters measured: the highest amplitude and the area below the maximum velocity curve of forward and reverse flow (A, B and C, D, respectively) and the duration of forward and reverse flow (Tc and Td, respectively). Ratios A/B, C/D and Tc/Td were calculated. The cut-off values for A/B, C/D and Tc/Td with the best predictive values for perinatal death were established with the help of receiver operating characteristics curves. The three curves were compared with each other. RESULTS: Of the three ratios, A/B and C/D had the best capacity to predict perinatal death. Both ratios had acceptable sensitivities, specificities and positive predictive values. In this regard, A/B and C/D were comparable. The cut-off values for A/B and C/D were 4.3 and 4.52, respectively. Survivors had I significantly higher A/B and C/D ratios than non-survivors (P = 0.0001 and 0.0003, respectively). Significantly more fetuses with A/B or C/D below the established cut-off values had pulsations in the venous system (P < 0.05). In fetuses with a gestational age < =210 gestational days the survival rate was significantly higher in those with A/B or C/D above the cut-off values (P = 0.03 and 0.003, respectively). CONCLUSIONS: The A/B or C/D ratio can be used for quantification of the reverse end-diastolic flow waveforms in the umbilical artery and may offer additional information to the evaluation of fetal condition. (Less)
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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Fetal Growth Retardation : mortality, Fetal Growth Retardation : physiopathology, Fetal Growth Retardation : ultrasonography, Human, Fetal Monitoring : methods, Pregnancy, Pregnancy Outcome, Probability, Prospective Studies, Sampling Studies, Sensitivity and Specificity, Statistics, Nonparametric, Survival Rate, Ultrasonography, Doppler : methods, Prenatal, Umbilical Arteries : physiopathology, Umbilical Arteries : ultrasonography, Fetal Death, Female, Diastole : physiology, Comparative Study, Blood Flow Velocity
in
Ultrasound in Obstetrics & Gynecology
volume
19
issue
3
pages
229 - 234
publisher
John Wiley & Sons Inc.
external identifiers
  • wos:000174829600004
  • pmid:11936080
  • scopus:0036227574
ISSN
1469-0705
DOI
10.1046/j.1469-0705.2002.00636.x
language
English
LU publication?
yes
id
e0147ca5-682b-40a9-b882-85856509b6c1 (old id 107409)
alternative location
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11936080&dopt=Abstract
date added to LUP
2016-04-01 15:44:31
date last changed
2022-03-30 02:46:56
@article{e0147ca5-682b-40a9-b882-85856509b6c1,
  abstract     = {{OBJECTIVE: Reverse end-diastolic flow is the most pathological type of the umbilical artery flow velocity waveform. We aimed to investigate whether additional prognostic information can be obtained from umbilical artery waveforms in cases with reverse end-diastolic flow. SUBJECTS AND METHODS: Umbilical artery Doppler velocity waveforms from 44 fetuses with reverse end-diastolic flow were analyzed and the following parameters measured: the highest amplitude and the area below the maximum velocity curve of forward and reverse flow (A, B and C, D, respectively) and the duration of forward and reverse flow (Tc and Td, respectively). Ratios A/B, C/D and Tc/Td were calculated. The cut-off values for A/B, C/D and Tc/Td with the best predictive values for perinatal death were established with the help of receiver operating characteristics curves. The three curves were compared with each other. RESULTS: Of the three ratios, A/B and C/D had the best capacity to predict perinatal death. Both ratios had acceptable sensitivities, specificities and positive predictive values. In this regard, A/B and C/D were comparable. The cut-off values for A/B and C/D were 4.3 and 4.52, respectively. Survivors had I significantly higher A/B and C/D ratios than non-survivors (P = 0.0001 and 0.0003, respectively). Significantly more fetuses with A/B or C/D below the established cut-off values had pulsations in the venous system (P &lt; 0.05). In fetuses with a gestational age &lt; =210 gestational days the survival rate was significantly higher in those with A/B or C/D above the cut-off values (P = 0.03 and 0.003, respectively). CONCLUSIONS: The A/B or C/D ratio can be used for quantification of the reverse end-diastolic flow waveforms in the umbilical artery and may offer additional information to the evaluation of fetal condition.}},
  author       = {{Brodszki, Jana and Hernandez-Andrade, Edgar and Gudmundsson, Saemundur and Dubiel, M and Mandruzzato, G P and Laurini, R and Marsal, Karel}},
  issn         = {{1469-0705}},
  keywords     = {{Fetal Growth Retardation : mortality; Fetal Growth Retardation : physiopathology; Fetal Growth Retardation : ultrasonography; Human; Fetal Monitoring : methods; Pregnancy; Pregnancy Outcome; Probability; Prospective Studies; Sampling Studies; Sensitivity and Specificity; Statistics; Nonparametric; Survival Rate; Ultrasonography; Doppler : methods; Prenatal; Umbilical Arteries : physiopathology; Umbilical Arteries : ultrasonography; Fetal Death; Female; Diastole : physiology; Comparative Study; Blood Flow Velocity}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{229--234}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Ultrasound in Obstetrics & Gynecology}},
  title        = {{Can the degree of retrograde diastolic flow in abnormal umbilical artery flow velocity waveforms predict pregnancy outcome?}},
  url          = {{http://dx.doi.org/10.1046/j.1469-0705.2002.00636.x}},
  doi          = {{10.1046/j.1469-0705.2002.00636.x}},
  volume       = {{19}},
  year         = {{2002}},
}