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
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
Doppler
fd
q
f0
f0
fd
q
v = flow velocity
q
PSV
EDV
Normal Values for the Umbilical Artery
PL
AI
FL
PVC
Figueraz et al, JPM 2007
Khare et al, Acta Obstet Gynecol 2006
Khare et al, Acta Obstet Gynecol 2006
Preeclampsia
Rischio di Morbosita’ e Mortalita’ perinatale
Condizioni Materne
Condizioni Fetali
Insufficienza placentare
Causes
Matermal
Idiopathic
Fetal
Placental
Cosmi E, Obstet Gynecol 2005
Antenetal testing performed in all fetuses
from preeclamptic women




Doppler velocimetry twice weekly
fetal growth every 2 weeks
daily NST
Biophysical profile twice weekly
Preeclamptic IUGR fetuses
Temporal sequence of antenatal
testing is shorter
Cosmi E et al, Am J Obst Ginecol, 2007;SMFM, Dallas 2008
Cosmi et al, Obstet Gynecol 2005, Cosmi et al,SMFM 2008
UA PI
MCA PI
UA AEDF
UA RDF • IVH
• NEC
DV ARF • RDS
FETAL WEIGHT • RDS
• Neonatal Death
GESTATIONAL AGE
• IVH
• NEC
• PVL
• Neonatal Death
• Fetal Death
• Fetal Death
ABNORMAL NST OR BPP
Cosmi E et al, Ultrasoud Obstet Gynecol 2006
Neonatal weight and neonatal outcome
DV ADF or RF vs neonatal mortality
NO DV ARF
70
63
60
50
40
30
16
20
10
0
35
32
ALIVE
34
DEATH
30
25
20
15
10
DV ARF
5
OR = 4,18
0
ALIVE
DEATH
P<0.05
UA RF vs Neonatal mortality
60
NO UA RDF
56
50
40
30
19
20
10
0
40
39
35
AlIVE
DEATH
31
30
25
20
UA RDF
15
10
5
0
ALIVE
DEATH
OR = 2,34
P<0.05
100
Neonatal survival
Intact survival until discharge
90
80
70
Percent
60
50
40
30
20
10
0
24
25
26
27
28
29
Gestational week
30
31
32