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Il Doppler ombelicale nelle Gravidanze complicate da Preeclampsia

Il Doppler ombelicale nelle Gravidanze complicate da Preeclampsia. Erich Cosmi MD. Department of Obstetrics, Gynecological Science and Human Reproduction Section of Maternal and Fetal Medicine University of Padua School of Medicine. Doppler studies in the fetus. MCA. UA. DV. Doppler.

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Il Doppler ombelicale nelle Gravidanze complicate da Preeclampsia

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  1. Il Doppler ombelicale nelle Gravidanze complicate da Preeclampsia Erich Cosmi MD • Department of Obstetrics, Gynecological Science and Human Reproduction • Section of Maternal and Fetal Medicine • University of Padua School of Medicine

  2. Doppler studies in the fetus MCA UA DV

  3. Doppler Doppler meta-analysis has shown the use of the umbilical artery in high risk pregnancies reduces the number of antenatal admissions (44%), inductions of labor (29%), cesarean sections for fetal distress (52%), and perinatal mortality (38%) Alfirevic Z, Neilson JP. AJOG 1995; 172:1379-87

  4. Doppler q fd f0 f0 q fd q v = flow velocity

  5. PSV EDV

  6. Normal Values for the Umbilical Artery

  7. PL AI FL PVC

  8. Figueraz et al, JPM 2007

  9. Khare et al, Acta Obstet Gynecol 2006

  10. Khare et al, Acta Obstet Gynecol 2006

  11. Preeclampsia Rischio di Morbosita’ e Mortalita’ perinatale Condizioni Materne Condizioni Fetali Insufficienza placentare

  12. Causes Matermal Fetal Placental Idiopathic Cosmi E, Obstet Gynecol 2005

  13. Antenetal testing performed in all fetuses from preeclamptic women • Doppler velocimetry twice weekly • fetal growth every 2 weeks • daily NST • Biophysical profile twice weekly

  14. Preeclamptic IUGR fetuses Temporal sequence of antenatal testing is shorter Cosmi E et al, Am J Obst Ginecol, 2007;SMFM, Dallas 2008

  15. Cosmi et al, Obstet Gynecol 2005, Cosmi et al,SMFM 2008

  16. UA PI MCA PI UA AEDF UA RDF DV ARF • IVH • NEC • RDS • IVH • NEC • PVL • Neonatal Death • Fetal Death FETAL WEIGHT • RDS • Neonatal Death GESTATIONAL AGE • Fetal Death ABNORMAL NST OR BPP Cosmi E et al, Ultrasoud Obstet Gynecol 2006

  17. Neonatal weight and neonatal outcome

  18. DV ADF or RF vs neonatal mortality OR = 4,18 P<0.05

  19. UA RF vs Neonatal mortality OR = 2,34 P<0.05

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