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Biomedical subjects

D Arduini

Publications and source records attributed to D Arduini.

At least 19 recordsLinked to original sources
PubMed1997

Indomethacin modifies the fetal hemodynamic response induced by percutaneous umbilical blood sampling.

OBJECTIVE: Percutaneous umbilical blood sampling induces a marked decrease of impedance to flow in the umbilical artery. Because these changes are believed to be the result of the release of prostanoids, we conducted a study to determine whether indomethacin administration before percutaneous umbilical blood sampling affects the hemodynamic response induced by this procedure. STUDY DESIGN: Percutaneous umbilical blood sampling was performed in 20 singleton pregnancies that were treated for 3 days before the procedure with indomethacin (25 mg orally 6 hours apart) as tocolytic agent and in 22 untreated pregnancies. All the procedures were uncomplicated, and sampling of the umbilical vein was confirmed by blood pressure measurement at the time of the procedure. The umbilical artery pulsatility index and the fetal heart rate were measured immediately before and after the procedure. The first and last aliquots of umbilical vein plasma obtained at the beginning and closing of the procedure were assayed for endothelin-1, 6-keto-prostaglandin F1 alpha and thromboxane B2. RESULTS: In untreated pregnancies percutaneous umbilical blood sampling induced a decrease of the umbilical artery pulsatility index (p < 0.0001) and an increase in 6-keto-prostaglandin F1 alpha (p < 0.001) and endothelin-1 levels (p = 0.001), whereas no significant changes were present in fetal heart rate and thromboxane B2 levels. In pregnancies treated with indomethacin, 6-keto-prostaglandin F1 alpha, and thromboxane B2, concentrations at the beginning of the procedure were both significantly less (p < 0.0001) than those found in untreated pregnancies. In pregnancies treated with indomethacin percutaneous umbilical blood sampling did not affect umbilical artery pulsatility index, and 6-keto-prostaglandin F1 alpha and thromboxane B2 levels did not vary during the procedure. However, endothelin-1 (p < 0.001) and fetal heart rate (p < 0.0001) increased after the procedure. CONCLUSION: Indomethacin affects the fetal hemodynamic response to percutaneous umbilical blood sampling by inhibiting the release of prostanoids and the fall in umbilical artery pulsatility index. Under this condition the fetus adapts to the procedure by increasing the heart rate.

6-Ketoprostaglandin F1 alpha↗
PubMed1997

Splenic artery velocity waveforms in small-for-gestational-age fetuses: relationship with pH and blood gases measured in umbilical blood at cordocentesis.

OBJECTIVE: Our purpose was to relate velocity waveforms from the splenic artery with pH and blood gas levels measured at cordocentesis in small-for-gestational-age fetuses and to compare the diagnostic efficiency of splenic artery waveforms with that of other fetal arterial and venous vessels in predicting acid-base status. STUDY DESIGN: Cross-sectional recordings from the splenic artery were obtained by color and pulsed Doppler techniques in 316 appropriately grown fetuses, 12 small-for-gestational-age fetuses with normal umbilical artery velocity waveforms (group 1), and 30 small-for-gestational-age fetuses with abnormal umbilical artery velocity waveforms (group 2). Measurements of splenic artery pulsatility index values in small-for-gestational-age fetuses were compared with those of appropriate-for-gestational-age fetuses. Associations of splenic artery pulsatility index with Po2, Pco2, and pH values measured at cordocentesis were examined and compared with those of umbilical artery, middle cerebral artery, and inferior vena cava. RESULTS: In appropriately grown fetuses pulsatility index values from the splenic artery decrease with advancing gestation (r = 0.51, p < 0.0001). Splenic artery pulsatility index values are lower in group 2 (p < 0.001) but not in group 1 small-for-gestational-age fetuses (p = 0.211). The amplitude of the decrease in the pulsatility index is significantly associated with fetal hypoxemia (r = 0.646, p < 0.001), acidemia (r = 0.593, p < 0.001) and hypercapnia (r = 0.577, p < 0.001). However, logistic regression demonstrates that hypoxia is better predicted by middle cerebral artery pulsatility index, whereas hypercapnia and acidosis are more closely associated with the percent of reverse flow in inferior vena cava. CONCLUSION: A decrease in the splenic artery pulsatility index occurs in small-for-gestational-age fetuses in the presence of abnormal pH and blood gas values, but a more accurate assessment of acid-base status may be obtained with the study of the middle cerebral artery and inferior vena cava.

Blood Flow Velocity↗
PubMed1997

Atrial natriuretic peptide levels in fetal blood in relation to inferior vena cava velocity waveforms.

OBJECTIVE: To determine whether blood levels of atrial natriuretic peptide in small for gestational age (SGA) fetuses are related to Doppler indices measured in arterial and venous vessels. METHODS: Atrial natriuretic peptide was assayed in fetal blood obtained at funipuncture in 42 third-trimester fetuses, of whom 11 were appropriate for gestational age (AGA) and 31 were SGA. Small for gestational age fetuses were divided into three groups according to Doppler findings in the umbilical artery and inferior vena cava: 1) normal in both vessels (n = 10); 2) abnormal in the umbilical artery but normal in the inferior vena cava (n = 10); and 3) abnormal in both vessels (n = 11). Atrial natriuretic peptide levels were related to Doppler indices and acid-base status of the fetal blood. RESULTS: Small for gestational age fetuses with abnormal waveforms in both vessels had higher atrial natriuretic peptide blood levels (median 544.8 pg/mL, range 404.2-1112.3) compared with AGA fetuses (median 316.8 pg/mL, range 159.3-470.1; P < or = .001), SGA fetuses with normal waveforms only in both vessels (median 299.8 pg/mL, range 242.6-480.5; P < or = .001), and SGA fetuses with abnormal waveforms only in the umbilical artery (median 367.6 pg/mL, range 192.7-748.9; P = .002). Blood levels of atrial natriuretic peptide were significantly related to the preload index in the inferior vena cava (p = 0.554, P < or = .001). This relation remained significant when the analysis was restricted to the SGA fetuses with abnormal waveforms in the umbilical artery and the inferior vena cava (p = 0.673, P = .03). CONCLUSIONS: Small for gestational age fetuses with abnormal velocity waveforms in the inferior vena cava have significantly higher concentrations of atrial natriuretic peptide. This may represent a compensatory mechanism in the SGA fetus for regulation of an abnormal hemodynamic condition.

Adult↗
PubMed1997

Role of antepartum computerized fetal heart rate analysis in the prediction of fetal distress during labor.

OBJECTIVE: To ascertain the diagnostic ability of a computerized fetal heart rate (FHR) analysis system in the identification of patients at risk of fetal distress in labor. STUDY DESIGN: Five-hundred and seventy-seven healthy term pregnancies were enrolled in a prospective, cross-sectional study and subdivided into two groups, with (n = 90) or without (n = 487) fetal distress in labor. Computerized FHR recordings were performed periodically and regression analysis was performed in a univariate and multivariate way to assess the ability of the last FHR recordings in the prediction of subsequent fetal distress. RESULTS: The two groups showed a significant difference in almost all of the FHR parameters studied. The multivariate analysis showed that only the FHR baseline and the percentage of small acceleration were independently and significantly related to the labor outcome. The combination of these two parameters reaches a sensitivity of 45%, specificity of 91%, positive predictive value of 48% and negative predictive value of 90%, with an overall accuracy of 84%. CONCLUSIONS: The increase in FHR baseline and in small FHR accelerations can be major factors in the prediction of subsequent fetal distress in healthy term fetuses.

Computers↗
PubMed1997

Prophylactic transabdominal amnioinfusion in oligohydramnios for preterm premature rupture of membranes: increase of amniotic fluid index during latency period.

OBJECTIVE: This study was designed to: (i) evaluate the effect of amnioinfusion on the latency period in patients with oligohydramnios for preterm premature rupture of membranes, and (ii) to investigate the relationship between changes in the amniotic fluid index and fetal heart rate short-term variability by computerized Hewlett-Packard cardiotocography, longitudinally estimated before and after prophylactic amnioinfusion. MATERIALS AND METHODS: All singleton pregnancies with prolonged premature rupture of membranes after 25 weeks of gestation and seen at the Institute of Obstetrics and Gynecology, University of Ancona (Italy), between January 1994 and June 1995 were included in the study. Transabdominal amnioinfusion with 150-350 ml warmed normal saline (25-50 ml/min) was performed at weekly intervals. Amniotic fluid volume was assessed ultrasonographically by means of the four-quadrant technique on a weekly basis before and after each amnioinfusion, as well as the short-term variability by a Hewlett-Packard computerized cardiotocographic system. RESULTS: 18 women were enrolled and underwent prophylactic transabdominal amnioinfusion at weekly intervals until delivery. Eighteen controls, who did not undergo prophylactic amnioinfusion, were recruited from our 1992-1993 series and included in the study. The median interval between premature rupture of membranes and delivery was 3.0 weeks (range 1-8 weeks), with an average delivery age of 33.0 weeks (range 27-36 weeks). The latency period was significantly longer in patients who underwent prophylactic amnioinfusion (mean +/- SD, 4.1 +/- 1.7 weeks) than in controls(1.7 +/- 1.0 weeks; p < 0.001). An increase in both the weekly amniotic fluid index (linear regression analysis r = 0.8, p = 0.03) and the weekly short-term variability (linear regression analysis r = 0.82, p = 0.02) was observed among patients who underwent prophylactic amnioinfusion. A direct relationship was observed between the amniotic fluid index and short-term variability (linear regression analysis r = 0.54, p = 0.04). The mean values of fetal movements recorded by computerized tomography during the 20 min of observation significantly increased after amnioinfusion in comparison with those before it (2.6 +/- 0.9 and 0.9 +/- 0.7 respectively; p = 0.001). CONCLUSION: The present study has shown a positive effect of prophylactic transabdominal amnioinfusion on the latency period in patients with preterm premature rupture of membranes and oligohydramnios. Among the patients who underwent amnioinfusion, an interesting improvement in fetal heart rate short-term variability was associated with the progressive increase in amniotic fluid volume, as an expression of fetal well-being.

Abdomen↗
PubMed1996

The value of fetal fibronectin in cervical and vaginal secretions and of ultrasonographic examination of the uterine cervix in predicting premature delivery for patients with preterm labor and intact membranes.

OBJECTIVE: We compared the diagnostic performances of fetal fibronectin assay of cervical and vaginal secretions and of transvaginal ultrasonographic evaluation of the uterine cervix in the prediction of preterm delivery of patients presenting with preterm labor and intact membranes. STUDY DESIGN: One hundred eight patients admitted to the hospital for preterm labor and with intact membranes underwent assay of fibronectin in the cervical and vaginal secretions and transvaginal ultrasonographic evaluation of the uterine cervix. The ultrasonographic parameters evaluated were cervical length, presence of funneling, and cervical index ([Funnel length + 1]/Cervical length). Outcome measures were occurrence of preterm delivery, defined as birth before the thirty-seventh week of gestation, and the admission-to-delivery interval. RESULTS: Forty-seven patients (43.5%) were delivered preterm. Receiver characteristic curve analysis showed that a level of fetal fibronectin in cervical secretions > or = 60 ng/ml had the highest diagnostic performance in predicting preterm delivery (sensitivity 80.9%, specificity 83.6%). Multiple stepwise logistic regression analysis indicated that the cervical index significantly improved the prediction of preterm delivery achieved by the fetal fibronectin assay. In patients with cervical secretion fibronectin levels > or = 60 ng/ml, survival analysis showed a shorter admission-to-delivery interval in the presence of an abnormal cervical index (p < or = 0.001). CONCLUSIONS: The assay of fetal fibronectin in cervical secretions is more accurate than ultrasonographic evaluation of the uterine cervix in the prediction of preterm delivery. Combined use of the fetal fibronectin assay and the cervical index improves the diagnostic efficiency and allows prediction of the admission-to-delivery interval, identifying a subgroup of patients who may require aggressive treatment.

Adult↗
PubMed1996

Interleukin-6 concentrations in cervical secretions identify microbial invasion of the amniotic cavity in patients with preterm labor and intact membranes.

OBJECTIVE: The objectives of this study were to determine whether cytokine levels in cervical secretions were increased in the presence of microbial invasion of the amniotic cavity in patients with preterm labor and intact membranes and to relate concentrations to cytokine levels in amniotic fluid, cervicovaginal microflora, and the presence of chorioamnionitis. STUDY DESIGN: Cervical secretions were sampled immediately before amniocentesis in 92 patients admitted for preterm labor with singleton pregnancies and intact membranes. Amniotic fluid was cultured and the following cytokines were measured in amniotic fluid and cervical secretions: interleukin-1 beta, interleukin-1 receptor antagonist, tumor necrosis factor-alpha, and interleukin-6. The cervicovaginal microflora and placentas (n = 42) were also analyzed. RESULTS: A total of 19.56% (18/92) of the amniotic fluid cultures had positive results. All the cytokines tested showed significantly higher levels in cervical secretions in the presence of intraamniotic infection. There were significant relationships between the concentrations of interleukin-6 and interleukin-1 receptor antagonist in amniotic fluid and cervical secretions. A concentration of interleukin-6 in cervical secretions > 410 pg/ml had a sensitivity of 66.8% and a specificity of 90.5% and a relative risk of 7.7 for intraamniotic infection, higher than the other cytokines tested. There were no relationships between the presence of bacterial vaginosis and cervicovaginal pathogens and cervical cytokine levels. In the presence of chorioamnionitis, cervical concentrations of interleukin-6 and interleukin-1 receptor antagonist were significantly increased in spite of negative amniotic fluid culture results. CONCLUSION: The measurement of interleukin-6 in cervical secretions may help to noninvasively identify intraamniotic infection among pregnancies with preterm labor and intact membranes.

Adult↗
PubMed1996

Endometrial Evaluation in Asymptomatic Postmenopausal Women by Transvaginal Sonography and Color Flow Doppler

We attempted to correlate transvaginal ultrasound endometrial assessment with histologic and hysteroscopic findings in 910 asymptomatic postmenopausal women. The women all had been postmenopausal for at least 1 year, and had no sonographically documented adnexal masses, no hormone therapy, and no history of uterine bleeding. Endometrial thickness of 5 mm and less was considered normal, and no further investigations were performed. All women with endometrial thickness 8 mm or greater were advised to undergo hysteroscopy and endometrial biopsy if necessary. When endometrial thickness was 6 to 7 mm, hysteroscopy was recommended if irregular endometrial echotexture was observed; otherwise another ultrasound examination within 3 to 6 months was suggested. We observed 83 (9.1%) asymptomatic women with endometrial thickness 8 mm or greater and 77 (8.5%) with a thickness of 6 to 7 mm, in whom a total of 89 hysteroscopies were performed. Three endometrial cancers, 8 hyperplasias, 27 endometrial polyps, and 5 submucosal myomas were detected in those with endometrial thickness of 8 mm or greater. Of the 21 women with endometrial thickness 6 to 7 mm who underwent hysteroscopy, 7 had endometrial polyps, 4 hyperplasia, and 3 submucosal myomas. Based on sensitivity and specificity analyses, an endometrial thickness of 8 or 10 mm in asymptomatic postmenopausal women seems to be an effective cut-off to select candidates for more invasive diagnostic procedures.

Journal Article↗
PubMed1996

Correlation between Ultrasonographic Findings and Laparoscopic Appearance in Patients with Laparoscopically Treated Ovarian Cysts

We performed laparoscopy in 96 women (64 age <40 yrs, 22 > 40 yrs) with a diagnosis of ovarian cyst. The size and morphology of each mass were established, and color flow Doppler characteristics were determined by ultrasonography. Laparoscopically we evaluated the external and internal surfaces and vascularization. The laparoscopic appearance confirmed the ultrasonographic findings in 85% of women.

Journal Article↗
PubMed1996

Doppler indices from inferior vena cava and ductus venosus in predicting pH and oxygen tension in umbilical blood at cordocentesis in growth-retarded fetuses.

The objective of this study was to assess the value of Doppler indices calculated from the inferior vena cava and ductus venosus in the identification of acidemia and hypoxemia as determined by pH and gas analysis of fetal blood obtained by cordocentesis in growth-retarded fetuses. Doppler measurements were performed in the inferior vena cava and ductus venosus in 209 normally grown fetuses and in 89 growth-retarded fetuses. All growth-retarded fetuses were free from structural and chromosomal abnormalities, and uteroplacental insufficiency characterized by Doppler changes in the umbilical and middle cerebral arteries was the most likely etiology of the growth defect. In this group of fetuses, Doppler recordings were performed immediately before cordocentesis. Ten different indices were calculated from venous velocity waveforms, and reference limits for gestation were constructed by the cross-sectional analysis of data from normally grown fetuses. Logistic regression and receiver operator characteristic curve analysis were performed to examine the relationship between Doppler indices and acid-base status. The pre-load index (peak velocity during atrial contraction/peak velocity during systole) in the inferior vena cava was the best explanatory variable for acidemia (chi 2 = 48.33; p < or = 0.001). Hypoxemia was predicted less well by venous indices and the best results were achieved by the S/A ratio in the ductus venosus (chi 2 = 9.46; p < or = 0.005). In conclusion, our data suggest that acidosis in growth-retarded fetuses may be non-invasively identified by Doppler measurements of the inferior vena cava and that a higher efficiency can be achieved by the use of the pre-load index.

Acidosis↗
PubMed1996

Blood flow velocity waveforms from peripheral pulmonary arteries in normally grown and growth-retarded fetuses.

The objective of this study was to describe blood flow velocity waveforms of fetal peripheral pulmonary arteries in normally grown and growth-retarded fetuses. Doppler studies were performed in 182 normally grown fetuses (gestational age 18-40 weeks) and in 61 growth-retarded fetuses (gestational age 24-36 weeks) that were free from structural and chromosomal abnormalities and whose umbilical and middle cerebral artery Doppler findings suggested uteroplacental insufficiency as the most likely etiology of the growth defect. The pulsatility index was used to quantify the velocity waveforms. Successful recordings were obtained in 90.1% of the normally grown and 93.4% of the growth-retarded fetuses. In normally grown fetuses the pulsatility index values significantly decreased with advancing gestation. In growth-retarded fetuses the pulsatility index values were significantly elevated compared to those of normal fetuses. A significant relationship was observed between the severity of hypoxia and pulsatility index values from the peripheral pulmonary arteries in 29 fetuses in which Doppler recordings were obtained immediately before cordocentesis. In conclusion, these data show that in normal fetuses the Doppler-measured impedance to flow in the peripheral pulmonary circulation decreases with advancing gestation. Impedance to flow in the lungs is elevated in the presence of growth retardation and this increase is related to the severity of fetal hypoxia.

Acid-Base Equilibrium↗
PubMed1996

Release of vasoactive agents during cordocentesis: differences between normally grown and growth-restricted fetuses.

OBJECTIVE: The purpose of this study was to evaluate whether cordocentesis is associated with the release of vasoactive substances and whether there are differences between normally grown and growth-restricted fetuses. STUDY DESIGN: 6-Keto-prostaglandin F1 alpha (the stable metabolite of prostacyclin), endothelin-1, and cyclic guanosine monophosphate were measured in fetal blood at the beginning and closing of cordocentesis in 30 normally grown fetuses and 25 growth-restricted fetuses. This latter group was characterized by abnormal Doppler index values in umbilical artery and middle cerebral artery, suggestive of chronic hypoxemia as the causative factor of the impaired growth. In six growth-restricted fetuses bradycardia occurred at the end of the procedure. Umbilical artery pulsatility index was measured by Doppler ultrasonography immediately before and after the procedure. RESULTS: The median interval between the two blood samples obtained by cordocentesis was 90 seconds (range 60 to 320 seconds). During this interval a significant rise of 6-keto-prostaglandin F1 alpha (p < or = 0.0001) and endothelin-1 (p = 0.03) was evidenced in normally grown fetuses. The increase in 6-keto-prostaglandin F1 alpha was significantly related (r = 0.52, p = 0.002) to the fall of umbilical artery pulsatility index occurring after the procedure. In growth-restricted fetuses cordocentesis induced a marked increase of endothelin-1 (p = 0.0002), which was significantly related to the severity of acidosis (r = 0.52, p = 0.018), whereas no modifications were evidenced for the other agents tested. The increase of endothelin-1 was higher in those growth-restricted fetuses showing bradycardia at the end of the procedure than in growth-restricted fetuses that did not (p = 0.04). The variations of the vasoactive substances assayed were not significantly related to the type of procedure (transamniotic or transplacental), the amount of blood aspirated during the procedure, the interval elapsing between the first and second samples, the gestational age at which the procedure was performed, and the degree of fetal smallness. CONCLUSION: Cordocentesis induces the rapid release of vasoactive substances and the effect differs between normally grown and growth-restricted fetuses. This may explain the different hemodynamic response and the higher rate of complications occurring in the latter group after cordocentesis.

6-Ketoprostaglandin F1 alpha↗
PubMed1996

The effects of fetal blood sampling and placental puncture on umbilical artery and fetal arterial vessels blood flow velocity waveforms.

This study was performed to investigate whether fetal blood sampling and/or transplacental puncture are associated with changes of blood flow velocity waveforms in umbilical artery and fetal circulation. The pulsatility index (PI) was measured from umbilical artery, thoracic descending aorta, renal artery, and middle cerebral artery immediately before and after fetal blood sampling (n = 28) or third trimester amniocentesis (n = 32). No significant changes in PI values were evidenced after amniocentesis performed either transamniotically (n = 21) or transplacentally (n = 11). Fetal blood sampling induced a significant decrease of PI values in all the vessels investigated. However, in presence of a transplacental procedure (n = 15) the amplitude of the decrease of PI in umbilical artery was significantly higher than after a transamniotic procedure (n = 13), while no differences were evidenced in the other vessels tested. These findings indicate that umbilical cord puncture at the time of fetal blood sampling is associated with a decrease in PI in umbilical artery and several peripheral arterial vessels. The isolated placental puncture does not induce Doppler-detectable hemodynamic effects, while in conjunction with cord needling, it increases the amplitude of the effects in umbilical artery.

Amniocentesis↗
PubMed1996

The effects of fetal blood sampling on ventricular filling patterns: differences between normally grown and growth-retarded fetuses.

The objective of this study was to evaluate the effect of fetal blood sampling on atrioventricular blood flow velocity waveforms. Flow velocity waveforms were measured from mitral and tricuspid valve immediately before and after fetal blood sampling in 25 normally grown and 10 growth-retarded fetuses. This latter group was characterized by abnormal Doppler indices in umbilical artery and middle cerebral artery suggestive of uteroplacental insufficiency as the causative factor of the impaired growth. The flow velocity parameters studied were peak velocity during early and active ventricular filling, time velocity integral, and fetal heart rate. Different indices were then calculated as expressions of ventricular diastolic function and cardiac output. In normally grown fetuses, both peak velocity during early diastole and time velocity integral values significantly increased after fetal blood sampling from both atrioventricular valves, whereas no significant changes were evidenced in the other parameters considered. Gestational age at the time of the procedure was positively related to the amplitude of these changes. In growth-retarded fetuses, fetal blood sampling induced a significant decrease in time velocity integral value form tricuspid valve, suggestive of a fall in right ventricle output. The amplitude of the decrease was significantly related to the severity of acidosis in umbilical vein. In conclusion, the cardiac hemodynamic response to fetal blood sampling differs between normally grown and growth-retarded fetuses. This difference may explain the higher rate of complications occurring in the latter group of fetuses after blood sampling.

Blood Flow Velocity↗
PubMed1996

Effects of cordocentesis on inferior vena cava velocity waveforms: differences between normally grown and growth-retarded fetuses.

The objective of this study was to analyze the effects of cordocentesis on velocity waveforms recorded from the inferior vena cava and to evaluate differences, if any, in the hemodynamic response between normally grown and growth-retarded fetuses. Twenty-five normally grown fetuses and 20 growth-retarded fetuses were considered for this study. This latter group was characterized by abnormal Doppler indices in the umbilical artery and the middle cerebral artery suggestive of uteroplacental insufficiency as the causative factor of the impaired growth. Flow velocity waveforms were measured from the inferior vena cava immediately before and after cordocentesis and the % reverse flow during atrial contraction calculated. In normally grown fetuses the % reverse flow values did not vary significantly after cordocentesis, while in growth-retarded fetuses this index increased significantly after the procedure (p < or = 0.001). Furthermore, the amplitude of this increase was inversely related to pH levels in umbilical vein (p = 0.004). In conclusion, in growth-retarded fetuses cordocentesis induces an increase of % reverse flow in the inferior vena cava, while no modifications occur in normally grown fetuses. This suggests the presence in growth-retarded fetuses of an impaired cardiac adaptive mechanism to cordocentesis that may explain the higher incidence of complications occurring in such fetuses.

Blood Flow Velocity↗
PubMed1996

Uterine and fetal blood flows in pregnancies complicated by preterm labor.

Flow velocity waveforms were recorded by Doppler ultrasonography from the uterine arteries, umbilical artery, thoracic descending aorta, renal artery and middle cerebral artery in fetuses of 57 pregnancies complicated by preterm labor with intact membranes. The uterine artery resistance index was significantly increased in patients with preterm labor when compared to reference limits for gestation, but no relationship was found with the time interval between Doppler recordings and delivery. The group of fetuses (n = 15) delivered within 48 h from entry to the study showed significantly reduced pulsatility index values from the middle cerebral artery when compared to fetuses delivered later or to the normal reference limits for gestation. No significant differences were found in the other vessels studied. In conclusion preterm delivery is associated with alterations in fetal cerebral waveforms and knowledge of these changes may prove useful in the evaluation of patients with preterm labor.

Adult↗