Aug 28, 2011 - Purpose: To investigate the usefulness of pulsed Tissue Doppler as a new tool for surveillance of diabetic pregnancies. Material & Methods: We ...
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Ultrasound in Medicine and Biology
investigated whether ONSD measurements correlated with noninvasive and invasive ICP measurements in brain-injured adults. Material & Methods: We examined 106 brain-injured patients and 67 control subjects without intracranial pathology. Brain-injured patients were evaluated clinically (Glasgow coma scale, GCS) and using a semiquantitative (I–VI) neuroimaging scale (Marshall Scale, MS), and were divided into those with moderate (MS 5 I and GCS.8, n 5 35) and severe (MS 5 II–VI and GCS#8, n 5 71) brain injury. During Hospitalization, patients with severe brain injury underwent three measurements of the ONSD and noninvasive ICP (eICP), using optic nerve sonography and transcranial Doppler sonography, respectively. Upon admission, 32 severely brain-injured patients additionally underwent invasive ICP measurement. Results: In severely brain-injured patients, the ONSD correlated with the MS (r 5 0.76–0.82) and the eICP (r 5 0.53–0.80) in all three evaluations (P,0.001), whereas ONSD and eICP were significantly increased (6.260.7mm and 27.566.9mmHg, P,0.0001) as compared with moderately brain-injured patients (4.260.9mm and 12.263.7mmHg) and controls (3.560.8mm and 9.963.7mmHg). Invasive ICP measurements also correlated with ONSD measurements (r 5 0.68, P 5 0.002). The best cut-off ONSD value for predicting elevated ICP was 5.7 mm (sensitivity 5 74.1%, specificity 5 100%). Conclusion: ONSD measurements correlate with noninvasive and invasive ICP measurements, and with neuroimaging findings in braininjured adults. Optic nerve sonography could alert clinicians to the presence of elevated ICP, whenever invasive ICP evaluation is contraindicated and/or is unavailable.
Sun, Aug 28, 2011 Hall D SS 15 10:30-12:00 Obstetrics and Prenatal Medicine SS 15.03 Pulsed Tissue Doppler in the Surveillance of Diabetic Pregnancies: Prenatal Changes of Fetal Cardiac Time Intervals and Postnatal Outcome J. Ritgen,1 P. Kozlowski,2 R. Stressig1 1 Prenatal Medicine and Genetics, Praenatal.de, Cologne/DE, 2 Praenatal.de, Duesseldorf/DE Purpose: To investigate the usefulness of pulsed Tissue Doppler as a new tool for surveillance of diabetic pregnancies. Material & Methods: We investigated 274 pregnancies between 14 and 39 weeks of gestation. 59 Pregnancies were complicated by either impaired glucose tolerance, preexistent diabetes or gestational diabetes; 38 were insulin-dependent. Pulsed Tissue Doppler measurements were performed in the right subvalvular ventricular myocardium and measured cardiac time intervals were used to calculate TD-Tei Index. Postnatal outcome measures were GA at birth and birth weight. Measurments of TD-Tei were not used as an indication for labor induction. Results: The Tissue Doppler-derived Tei index values were 0,60 + /0,09 (SD) in the control group and 0,73 + /- 0,13 in the diabetic group. Mean birth weights at delivery in the diabetic group were high: 3402 + /563g compared with an expected mean birth weight of 3270 + /- 382g (calculated from regional and gender-specific percentile charts, Voigt 2006). TD-Tei did not significantly correlate with birth weight but with gestational age at delivery (pearson R -0,344). Conclusion: Maternal diabetes causes fetal macrosomia as well as growth restriction. Hence fetal growth measurements may not always suffice in the surveillance of these high-risk pregnancies. TD-Tei index
Volume 37, Number 8S, 2011 can aid as an additional component in the assessment of diabetic pregnancies. SS 15.04 The Role of Preterm Placental Calcification in High-Risk Pregnancy as a Predictor of Poor Uteroplacental Flow and Adverse Pregnancy Outcome K. Chen,1 L. Chen2 1 Obs/gyn, Buddhist Tzu-Chi General Hospital, Taipei Branch, Taipei/TW, 2MacKay Memorial Hospital, Taipei City/TW Purpose: To clarify the role of preterm Grade III placental calcification in high-risk (hypertension, diabetes, placenta previa, or severe anemia) pregnant women as a predictor of poor uteroplacental flow (absent or reverse end-diastolic velocity; AREDV) and adverse pregnancy outcome. Material & Methods: In this prospective cohort study, participants were classified into three groups: Group A (n 5 776), a low-risk group without antenatal complication; Group B (n 5 42), a high-risk group with preterm (28-36 weeks) placental calcification, and Group C (n 5 71), a high-risk control group without preterm (,36 weeks) placental calcification. Logistic regression analyses was used with adjusting maternal age, body mass index, economic status, marital status, type of delivery, and parity. Results: The risks of AREDV (OR:4.32; 95%CI:1.25–14.94), adverse maternal outcome including postpartum hemorrhage (OR:3.98; 95% CI:1.20–13.20), placental abruption (OR:4.80; 95%CI:1.19–19.35) and maternal transfer to ICU (OR:3.83; 95%CI:1.10–13.33), and adverse fetal outcome, including preterm birth (OR:3.86; 95% CI:1.32–11.29), low birth weight (OR:2.99; 95%CI:1.11–8.03), low Apgar score (OR:5.14; 95%CI:1.64–16.08), and neonatal death (OR:4.52; 95%CI:1.15–17.73) were greater in Group B than those in Group C. In contrast, the risks of AREDV and adverse pregnancy outcome were significantly lower in Group A than those in Group C, except postpartum hemorrhage (OR:0.53; 95%CI:0.19–1.46). Conclusion: The presence of preterm placental calcification in high-risk pregnant women is a predictor of poor uteroplacental flow and adverse pregnancy outcome, requiring closer surveillance for maternal and fetal well-being. SS 15.05 Umbilical Artery Doppler Velocimetry in a Sheep Model of Fetal Growth Restriction D. Carr,1 R. Aitken,2 J. Milne,2 A. David,1 J. Wallace2 1 Maternal and Fetal Medicine, UCL Institute for Women’s Health, London/UK, 2Early Life Nutrition Group, Rowett Institute of Nutrition and Health, Aberdeen/UK Purpose: Overnourishing adolescent sheep dams results in placental and fetal growth restriction. We aimed to evaluate changes in the umbilical arterial (UA) Doppler waveform in relation to altered fetal growth velocity in these compromised pregnancies. Material & Methods: Singleton pregnancies of known gestational age were established in 36 adolescent ewe-lambs using embryo transfer. Dams were offered a control diet (n 5 12) or overnourished (n 5 24), resulting in normal and compromised fetal growth trajectories, respectively. Ultrasonographic fetal biometry and UA Doppler indices were measured weekly between mid-gestation and necropsy at 131.0 6 0.30 days (term 5 145days). Results: At 83.160.16days there were no significant differences in fetal biometry, but UA resistance index and systolic:diastolic ratio were already higher in overnourished ewes (p 5 0.022). Differences in UA pulsatility index reached significance at 98.0 6 0.07days (p # 0.001). Values of all three Doppler indices progressively fell throughout gestation but remained different between groups (p 5 0.001–0.032). Relative
Abstracts to controls, fetal abdominal circumference, renal volume and femur/ tibia lengths were decreased from 104.660.13days (p 5 0.001–0.023) in overnourished ewes whilst biparietal diameter was not reduced until 111.860.09days (p 5 0.015), indicating an asymmetric pattern of growth. At necropsy fetal weight was lower in overnourished versus control groups (41106168g vs. 51336136g, p 5 0.001). Relative brain weight was increased (11.1g/kg vs.9.1g/kg, p 5 0.001) commensurate with fetal brain sparing. Conclusion: Changes in UA Doppler indices precede slowing of the fetal growth trajectory in overnourished adolescent sheep dams. This may reflect altered vascularity in the downstream fetal placental compartment.
SS 15.06 3D Power Doppler Placenta Bed Perfusion as Predictor for Pregnancy Complications S. Wintner, E. Hafner, M. Metzenbauer, I. Stuempflen, K. Philipp Geburtshilfliche und Gynaekologische Abteilung, Sozialmedizinisches Zentrum Ost - Donauspital, Vienna/AT Purpose: To investigate the number of vessels in the deciduomyometrium given by the 3D Power Doppler vascularity index (MVI) as a screening method to detect risk pregnancies in a low-risk population. Material & Methods: Women (n 5 3068) with singleton pregnancies were prospectively enrolled during a period of 3 years. At 11-14 weeks (gw) first trimester screening measurement of the placental volume (PV), examination of both uterine arteries and calculation of the pulsatility indices (PI) and 3D Power Doppler measurement of the MVI were carried out. At 20-22gw fetal anomaly scan uterine artery PIs were measured and finally pregnancy outcome data were collected. Results: 2505 women were left for evaluation. Six outcome groups were distinguished by the severity of maternal and neonatal problems (IUGR, preterm, PIH, PE, severe cases). MVI differs highly significant in nulliparous and multiparous (p 5 0.0000). At a 10% false-positive rate 58.8% of severe cases and 33.3% with uncomplicated PE could be detected at 12gw using the MVI. Conclusion: A reduced vascularization in the deciduomyometrial layer gives valuable information on a woman’s risk for pregnancy problems, particularly PE. MVI exceeds other screening parameters in sensitivity, especially for PE. Vascularization is better in multiparous women. The possibility of early investigation at 12gw is beneficial, as this moment still might allow therapeutic intervention. SS 15.07 Speckle Tracking for the Assessment of Fetal Cardiac Radial and Longitudinal Strain R. Schmitz,1 K. Hammer,1 A. Fruscalzo,2 L. Kiesel,3 J. Steinhard3 1 Obstetrics and Gynecology, University of M€unster, M€unster/DE, 2 Gynecology and Obstetrics, Mathias-Spital, Rheine/DE, 3University of M€ unster, M€ unster/DE Purpose: To evaluate speckle tracking as a modern tool based on grayscale image tracking for the assessment of fetal cardiac deformation. To evaluate the correlation of strain measurements by speckle tracking in radial and longitudinal axis. Material & Methods: In 20 fetuses video sequences were prospectively stored in transversal and apical four-chamber view. Longitudinal and radial strain of the left (LV) and right ventricular myocardium (RV) was calculated by off-line Speckle Tracking Software (Toshiba Medical Systems, Europe). Results: The assessment of strain was possible in all cases. The longitudinal strain of the LV in the transversal view correlates with the radial strain in the apical view (p,0.01). In the RV and for radial strain of the LV there was no correlation found.
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Conclusion: Two-dimensional strain measurements by speckle tracking in radial and longitudinal axis have several limitations. The reliability of calculation depends on the image quality and the software tracking technique.
SS 15.08 Ductus Venosus Streaming and Left Heart Hypoplasia R. Stressig,1 U. Gembruch,2 T. Kohl3 1 Praenatal-medizin und Genetik, Praenatal.de, K€oln/DE, 2Abteilung f€ur Geburtshilfe und Pr€anatalmedizin, Universit€atsklinikum Bonn, Bonn/DE, 3German Center for Fetal Surgery, University of Giessen, Giessen/DE Purpose: Preferential left heart underdevelopment in human fetuses with diaphragmatic hernia is almost uniformly associated with preferential streaming of the ductus venosus toward the right side of the heart. The purpose of our study was to examine whether this flow anomaly might also be present in fetuses with isolated hypoplasia of left-sided cardiovascular structures. Material & Methods: We studied 32 fetuses with left heart hypoplasia as defined by gestational-age related Z-scores by echocardiography. Apart from defining cardiovascular morphology as detailed as possible, particular focus was put on the presence or absence of preferential streaming of the ductus venosus and inferior caval vein toward the right side of the heart. Results: Eight of 32 fetuses with hypoplasia of one or more left-sided cardiovascular structures exhibited preferential streaming of the ductus venosus toward the right side of the heart. In all eight fetuses, this finding was associated with additional cardiovascular anomalies like aortic valve stenosis, ventricular septal defect, left superior caval vein-to-coronary sinus, pulmonary vein stenosis and/or aortic arch hypoplasia. Conclusion: As in human fetuses with left diaphragmatic hernia, preferential ductus venosus streaming toward the right side of the heart can be found in a subgroup of fetuses with isolated hypoplasia of left-sided cardiovascular structures. SS 15.09 Spatial Angle-Corrected Fetal Volume Flow Measurement (SAFM) T. M. Scholbach,1 J. Stolle,2 J. Scholbach3 1 Pediatrics, Chemnitz Clinics, Chemnitz/DE, 2Obstetrics, Chemnitz Clinics, Chemnitz/DE, 3Mathematisches Institut, Westf€alische Wilhelms-Universit€at M€unster, M€unster/DE Purpose: Fetal perfusion measurement is an important factor in describing the actual state of a fetus. Attempts to derive reliable flow volume data from 2D images failed so far. Therefore, we developed a novel method of three-dimensional flow volume measurements. Material & Methods: A spatial angle correction of umbilical venous flow velocity combined with a pixel-wise measurement of vessel area (PixelFlux-method) irrespective of its shape was applied to three-dimensional color Doppler sonograms. 206 singleton pregnancies including 25 fetuses with intrauterine growth restriction (IUGR) were investigated. Flow volumes were correlated to fetal weight and age. Results: SAFM demonstrated a significant correlation to fetal age and weight. IUGR-fetuses showed a significant reduction of volume perfusion. Conclusion: SAFM might become a tool to describe the actual state of a fetus in terms of blood supply and could offer a new perspective of fetal pathophysiology. The new method overcomes principal drawbacks of existing methods by using for the first time all relevant information necessary for true spatially angle-corrected flow velocity calculation and pixel-wise vessel area calculation. It has the potential to identify IUGR fetuses. In future, more extended investigations are needed to
