Replies to This Discussion

Permalink Reply by Syed Amir Gilani on March 2, 2010 at 1:59pm

Doppler velocimetry in the evaluation of fetal hypoxia
Saemundur Gudmundsson,
Mariusz Dubiel
Citation Information. Journal of Perinatal Medicine. Volume 29, Issue 5, Pages 399–407, ISSN (Print) 0300-5577, DOI: 10.1515/JPM.2001.056, November 2001
Published Online: 01/06/2005
Abstract
Knowledge of fetal hemodynamic physiology has developed enormously during the last two decades due to Doppler ultrasound. Some of this knowledge has been utilized for routine surveillance of high-risk pregnancies. The prediction of fetal hypoxia before the development of life lasting sequel is of major importance, especially in the very premature case with absent end-diastolic blood flow in the umbilical artery before lung maturity. This review gives an overview of the present knowledge in this field.

http://www.reference-global.com/doi/abs/10.1515/JPM.2001.056

Permalink Reply by Syed Amir Gilani on March 2, 2010 at 2:03pm

Dear Dr Ibrahim,
I have just uploaded my powerpoint presentation on this topic on power point to my FTP site,please send me your personal email so that i can send FTP password.My emali is profgilani@gmail.com.
How are the things in somalia,have you brought color doppler in your hospital.
Have a nice day

Permalink Reply by Syed Amir Gilani on March 16, 2010 at 6:44am

dear friends this topic by dr ibrahim is not getting attension--it is very important--for irreversible IUGR etc,please send details.

Permalink Reply by Bashir H Samma;MD,PGD&C,SrMAIUM on April 2, 2010 at 4:36pm

I apologize to comment on this discussion rather late...the aium e-community is wide!!.

Yes, Prof Gilani is very right: It is an established finding both from the researches published, and from my personal experience that that high resistance utero-placental flow (uterine artery) and high resistance feto-placental flow (umbilical artery) are associated with IUGR and poor outcome. The suboptimal flows are associated with pregnancy-induced hypertension (PIH), a background of PCOS, antiphospholipid syndrome syndrome and hypercoagualability conditions.

Recently a lady with severe PIH not only had diastolic notching of the umbilical artery, but REVERSED diastolic flow with marked IUGR and sub-optimal fetal biophysical profile.

I have a collection of archives on the doppler observations; interested colleagues may email me at drbashirhs@gmail.com for sharing.

Talking of the umbilical cord, could someone please comment on the observation attached herewith. The obstetric details are self explanatory on the image. It appears to be a short, thick, ?semi-torsed umbilicus with whirlpool pattern in short axis, and exaggerated Wharton jelly The fetus was otherwise normal with congruent dates-biometry, and optimal biophysicals. The flow profile is unremarkable.

Attachments:

• email1.jpg, 84 KB
• email2.jpg, 77 KB
• email3.jpg, 71 KB

Permalink Reply by Syed Amir Gilani on April 4, 2010 at 4:23am

Dear Dr Bashir
Is it umbilical atrery or uterine atrery diastolic notching,for me the details you have written are great ,the images are good but i could not get few things.
1) what abt uterine artery?
2) more spectral waveforms needed to discuss.
3) the area of spectrum where there is missing umb vein waveform--did fetus moved that moment?of it is absent?
4) at which part of umb atrery the waveform it taken?
5) what was PI and S/D ratio.
6) what abt amniotic fluid quantity and appreance.


Bashir H Samma;MD,PGD&C,SrMAIUM said:

I apologize to comment on this discussion rather late...the aium e-community is wide!!.

Yes, Prof Gilani is very right: It is an established finding both from the researches published, and from my personal experience that that high resistance utero-placental flow (uterine artery) and high resistance feto-placental flow (umbilical artery) are associated with IUGR and poor outcome. The suboptimal flows are associated with pregnancy-induced hypertension (PIH), a background of PCOS, antiphospholipid syndrome syndrome and hypercoagualability conditions.

Recently a lady with severe PIH not only had diastolic notching of the umbilical artery, but REVERSED diastolic flow with marked IUGR and sub-optimal fetal biophysical profile.

I have a collection of archives on the doppler observations; interested colleagues may email me at drbashirhs@gmail.com for sharing.

Talking of the umbilical cord, could someone please comment on the observation attached herewith. The obstetric details are self explanatory on the image. It appears to be a short, thick, ?semi-torsed umbilicus with whirlpool pattern in short axis, and exaggerated Wharton jelly The fetus was otherwise normal with congruent dates-biometry, and optimal biophysicals. The flow profile is unremarkable.

Permalink Reply by Samia Aly, MD. RDMS on April 13, 2010 at 4:06pm

I got these information from an Ultrasound conference for high risk pregnancy

IUGR EVALUATION

In IUGR;there is two types of changes
-Early IUGR changes, there is biometric and arterial Doppler changes
-Late IUGR changes, there is Venous and CTG changes.

In early changes:
Decrease fetal wieght 5-10th %
.Abnormal UA Doppler. FETAL HYPOXIA
.Abnormal MCA Doppler NO FETAL ACEDEMIA
.Normal Venous Doppler NO ADVERSE EFFECTS
.Normal CTG .

These changes lead to an increase in central venous pressure --> Cardiac decompunsation --> Increase end diastolic pressure in rt. Ventricle --> ^ after load > ^ cardiac stiffness --> reverse flow in venous system--> abnormal venous Doppler --> late changes

-Late IUGR changes:
.Abnormal UA Doppler >>>>> FETAL HYPOXIA
.Abnormal MCA Doppler >>>>> FETAL ACEDEMIA
.Abnormal Venous Doppler ?? >>>> ADVERSE EFFECTS
.Abnormal CTG … late Deceleration.

IF ABNORMAL CTG / BPP >>>>>> ADVERSE EFFECTS


Syed Amir Gilani said:

dear friends this topic by dr ibrahim is not getting attension--it is very important--for irreversible IUGR etc,please send details.