Fetal cerebral venous Doppler velocimetry in normal and high-risk pregnancy

OBJECTIVE

In previous pilot studies, fetal vein of Galen (GV) blood velocity has been shown to be non-pulsatile in normal pregnancies. A pulsating pattern in high-risk pregnancies has been related to adverse outcome of pregnancy. The aim of this study was to establish reference ranges for fetal cerebral venous blood flow and compare them to the recordings in high-risk pregnancies in terms of predicting adverse perinatal outcome.

METHODS

The GV, straight sinus (SS) and transverse sinus (TS) were located by color Doppler ultrasound in 189 normal pregnancies between 23 and 43 weeks of gestation. Recordings were also made in 102 pregnancies complicated by pregnancy-induced hypertension and/or intrauterine growth restriction. The following parameters were measured: peak systolic velocity, minimum diastolic velocity, time-averaged maximum velocity, pulsatility index for veins (PIV) and preload index (PLI). GV pulsations were noted. In high-risk pregnancies, Doppler measurements were correlated to pregnancy outcome, including emergency operative intervention and/or neonatal distress. Umbilical vein and umbilical, uterine and middle cerebral artery blood velocities were also recorded at the same time.

RESULTS

In normal pregnancy, pulsating venous blood velocity was observed in GV in 8% of cases, in SS in 79% of cases and in TS in 100% of cases. GV and SS maximum velocity increased with gestational age and TS-PIV showed linear decreasing values and TS-PLI showed increasing values with gestational age. In high-risk pregnancies, pulsating blood velocity in the GV was found in 59 (58%) cases and was related to adverse outcome of pregnancy including mortality. Abnormal values for TS-PIV and PLI and SS maximum velocity were found in nine, six and five cases, respectively and were only related to perinatal mortality. GV pulsations were more frequent than umbilical venous pulsations.

CONCLUSIONS

Of the fetal cerebral veins studied, the presence of pulsations in the GV seems to be the best predictor of adverse outcome of high-risk pregnancy. Pulsations in the GV are more frequent than in the umbilical vein and might therefore appear earlier during worsening fetal condition, and thus be of potential value for fetal surveillance in high-risk pregnancies.

Comparison of power Doppler and velocimetry in predicting outcome of high-risk pregnancy

OBJECTIVE

Prospectively evaluate semi-quantitative computer analysis of power Doppler (PD) signals in the placenta, tetal brain, lung, liver, kidney and spleen in high-risk pregnancies in relationship to perinatal outcome and also to compare tissue blood flow in the fetal brain and placenta with Doppler velocimetry.

METHODS

PD signals were recorded in 180 high-risk pregnancies between 27 and 41 weeks of gestation. Images from PD angiographic scans were transmitted for computer analysis of pixel intensity. Mean flow signal intensity was recorded for each organ. The PD brain/lung ratio was calculated. The PD results were plotted on reference values and related to perinatal outcome. Middle cerebral (MCA), umbilical (UA) and uterine artery (Ut. A) velocimetry was also performed.

RESULTS

High-risk pregnancies displayed lower PD signal intensity from the placenta, fetal lung, liver and kidney as compared to normals. However, the brain and spleen signals showed higher intensities suggesting increased tissue perfusion. PD signals from the fetal brain, lung, placenta and PD brain/lung ratio were correlated with perinatal outcome. The PD signal intensity from the fetal liver, kidney and spleen showed poor correlation with perinatal outcome. Fetal brain tissue blood flow showed better correlation with the outcome than MCA velocimetry. Placental tissue blood flow results were similar in predicting outcome to those obtained by means of UA and Ut. A velocimetry.

CONCLUSION

In comparison with conventional Doppler velocimetry, computer analysis of PD signals, give similar results in the prediction of adverse perinatal outcome.

[The diagnostic value of anti-CMV and anti-HPV-B19 antiviral antibodies in studies on causes of recurrent abortions]

Presence of serum anti-cytomegalovirus (CMV) and anti-parvovirus B19 (HPV-B19) antibodies was studied in 11 women within the first day after consecutive spontaneous abortion in the second trimester of pregnancy and in the control group, consisting of 15 women in the second trimester of a normal pregnancy. Most of studied women manifested presence of serum IgG class anti-CMV antibodies (IgG-anti-CMV) and levels of the antibodies proved significantly higher in women following spontaneous abortions. The patients frequently demonstrated in parallel presence of serum IgG class anti-HPV-B19 antibodies. In one patient a generalised nonimmunological hydrops fetalis was disclosed and her serum contained IgM and IgG class antibodies against CMV as well as against HPV-B19. The results suggest that in majority of the studied women the spontaneous abortion might have resulted from fetal infection due to reactivation of chronic CMV infection in the course of pregnancy.

[Ultrasound examination in presentation A for diagnosis of maxillary sinusitis in childhood]

Maxillary sinusitis is frequent in childhood. This study aimed at evaluating the value of ultra sound in presentation A in the diagnosis of maxillary sinusitis in childhood. Altogether 324 maxillary sinuses in 162 children were examined. A value of ultra sound examination was verified comparing the obtained results with the results of X-rays, considering three classifications of the latter. Besides the attempt of correlation of the results, ultra sound specificity and sensitivity were evaluated. Relatively high sensitivity and relatively low specificity of ultra sound technique were noted. It seems that ultra sound examination in presentation A may serve as a screening technique in children. Being sensitive and safe, this technique may be used in patients who require frequent examinations in persisting chronic disorders or recurrent maxillary sinusitis. However, the obtained results should be verified with X-rays because of the low specificity of ultra sound examination, especially prior to therapy of patients with unclear clinical picture of the disease.

[Evaluation of surfactant administration in neonates with respiratory distress syndrome. III. The role of intra-uterine stimulation on lung maturity]

Prenatal corticosteroids and exogenous surfactant therapy independently reduce the adds of neonatal death by about 40%. It is not clear however if babies who develop RDS despite prenatal corticosteroid therapy behave differently when later given exogenous surfactant. This paper presents an evaluation of the outcome of babies treated with Curosurf (a porcine surfactant) for RDS depending upon whether they received prenatal corticosteroids (16 babies) or not (11 babies). Although not randomised these two groups of babies appear to be similar in respect of gestational age. However, lower mortality was found in the group treated with prenatal corticosteroids (12.5% vs. 27.2%).

[Vaginal delivery after previous cesarean section]

Data concerning frequency of cesarean section as well as frequency of vaginal delivery after cesarean section in Poznań region in years 1990-1991 were presented. During last years we observed significant increase of spontaneous deliveries after cesarean section. The indications for the previous cesarean section and the outcome of the present pregnancy are discussed.

[Sinusoidal and pseudo-sinusoidal patterns in cardiotocography--differentiation and prognosis]

Examples of cardiotocograms looks like a graph of a sine function were presented. The differentiation of these various patterns was discussed. The most usefull parameters were amplitude and frequency of long-term variability and its relation to the uterine contractions and short-term variability.

[Mathematical foundation for biophysical methods in fetal monitoring. III. Magnetocardiography, phonocardiography, polycardiography, and Doppler blood flow analysis]

Magnetocardiography, phonocardiography, polycardiography and blood flow analysis based on Doppler phenomenon are described discussing the importance of these methods in fetal monitoring in pregnancy and labour.

[Mathematical foundations for biophysical methods in fetal monitoring. II. Cardiotocography]

The principles of mathematical analysis of cardiotocographic records are described, together with the methods of calculation of the baseline, oscillations, short-term and long-term variability, and cardiotocographic analysis in frequency range.

[Mathematical foundation for biophysical methods in fetal monitoring. I. Fetal electrocardiography]

The authors discuss the foundations of mathematical analysis of fetal electrocardiograms, with particular reference to the obtaining of ECG signal by indirect method, and signal processing.

[Application of computer systems in perinatology. I. Review of computer systems]

The main elements of the computer system used in medical practice are discussed. Typical application possibilities of microcomputers in perinatal medicine are described.

[Application of computer systems in perinatology. II. Organization of computer systems in intensive care of the fetus and newborn]

The main computer systems used in perinatal medicine are described, with particular reference to the systems of analysis of perinatal data, analysis of cardiotocogram, obstetric ultrasonogram, assessment of the heart function of the newborn, records of respiratory activity in newborns, and use of computers in parenteral alimentation of newborns.

Quantification of the fetal heart rate variability by spectral analysis in growth-retarded fetuses

The analysis of short-term variability of fetal heart rate in the frequency domain was performed. The fetal activity states (quiescence, trunk rotation, body movements, fetal breathing movements) were taken into account. The differences between the shapes of power spectra in physiological and growth-retarded fetuses were discussed.

A comparative study of usefulness of quantitative parameters in the description of cardiotocogram records

This study was an attempt to choose the optimized set of the features obtained from cardiotocogram records, which could explain in the best way the variability of foetal acid-base status parameters at labour. We prepared a package of the procedures in FORTRAN language which provides the possibilities for automatic detection and recognition of the long-term variability such as accelerations and decelerations and assessing some parameters connected with short-term variability (among other things oscillation bandwidth and number of baseline crossings). The acquired variables were subjected to multivariate statistical analysis to estimate the predictive power of a particular parameter. We used the described method to predict the variation of the foetal scalp blood pH and base deficit. This let us construct a set of variables which explains the maximal part of the variability of gasometric parameters. It affords possibilities for the estimation of the relative power of a particular component calculated from the cardiotocogram pattern. We obtain 41.7% of the explained variance for pH and 38.3% for base deficit.

A method for testing differences in morbidity risk for affective psychoses

A modified method for testing differences between two proportions is described and its use for testing differences in the morbidity risk for affective psychoses is discussed. The method is based upon the u test for comparisonof two proportions. An example of the application of the method to study sex differences in morbidity risk for affective psychoses in parents of probands with unipolar depression and manic-depressive psychosis presented.