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Objective: To describe a technique for the visualization and measurement of cerebral aqueduct diameter through a 2D sagittal median plane, and to report its aspect and measurement in fetuses with aqueductal stenosis (AS).Methods: This was a cross-sectional study of 207 morphologically normal fetuses in low-risk pregnancies between 20 and 36 weeks of gestation. The cerebral aqueduct was visualized transvaginally in a midsagittal plane, and measurements of its greatest diameter (ampulla) were taken independently by an expert and a nonexpert sonographer. In addition, the aqueduct morphology from 7 fetuses with AS and complete follow-up were compared to the reference range.Results: Aqueductal measurements were obtained in 206 of 207 normal fetuses. Aqueductal growth occurred linearly with gestational age. Our method demonstrated excellent interobserver reproducibility. Among the 7 fetuses with AS, the aqueductal lumen could not be identified in 6 and had a funneling aspect in 1.Discussion: Our study demonstrated that it is possible to visualize and measure the cerebral aqueduct directly through a 2D ultrasound median plane. In fetuses with severe ventriculomegaly, the morphology and width of this structure could represent a relevant tool in improving AS diagnosis, differentiating it from other causes of significant ventricular dilation that carry a different outcome. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relationship between umbilical artery pulsatility index and the umbilical cord pH in small-for-gestational-age fetuses. Methods: Data were collected from all pregnancies seen in our Fetal Surveillance Unit that underwent antenatal monitoring for being small-for-gestational-age beyond 24 weeks of pregnancy. A linear regression was used to analyse the effect of the umbilical artery pulsatility index (UAPI) and umbilical artery pH at birth, assessing interaction and controlling for clinically meaningful antenatal, Doppler, biophysical and perinatal variables. Results: A total of 117 pregnancies were included. According to the estimated model (which included all clinically significant confounders and statistically significant interactions), in cases with reactive cardiotography (CTG) a 1-unit increase in the UAPI resulted in a mean decrease of 0.021 (95% 0.05 to -0.005) units of umbilical artery pH at delivery. In the non-reactive CTG group a 1-unit increase in the UAPI resulted in a mean decrease of 0.02 (95% CI 0.059 to -0.019) units of umbilical artery pH at delivery. Finally, in fetuses with a pathological CTG a 1-unit increase in the UAPI resulted in a mean decrease of 0.149 (95% CI 0.107 to 0.19) units of umbilical artery pH at delivery. Conclusions: The crude effect between umbilical artery velocimetry on umbilical artery pH at birth has to be interpreted with caution, since an important part of this effect is related to other factors that confound and modify the relationship. After controlling for confounders, it was only in fetuses with pathological CTG that the effect remained statistically significant. [ABSTRACT FROM AUTHOR]

The objective was to evaluate the associations between arterial, venous and intracardiac parameters and adverse perinatal outcome in growth restricted fetuses. Fetuses beyond the 26th week of gestation with an abdominal circumference below the 5th percentile were included in this prospective study. The last Doppler measurement of the umbilical artery, middle cerebral artery, ductus venosus, outflow tract waveforms, atrioventricular flow and ventricular shortening fraction before delivery and adverse perinatal outcome were used for univariate (Fisher's exact test) and multivariate (stepwise logistic regression) statistical analysis. Adverse perinatal outcome was defined as the following: umbilical artery pH < 7.1, significant neonatal morbidity, need for admission to the neonatal intensive care unit, need for intubation at birth and perinatal mortality. A total of 108 fetuses met the inclusion criteria. The univariate analysis showed that presence of arterial redistribution; the absence or reversion of the umbilical artery end-diastolic flow; an abnormal aortic peak velocity, left shortening fraction, right shortening fraction, right atrioventricular E/A ratio and a pulsatile ductus venosus flow are associated with adverse perinatal outcome. The multivariate analysis showed that apart from arterial redistribution, absent or reversed end-diastolic umbilical artery flow and abnormal ductus venosus waveform, no other tested variable added significantly to the prediction of adverse perinatal outcome. It was concluded that fetal cardiac function indices are associated with adverse perinatal outcome. Nevertheless, no benefit was found from using them, in terms of prediction, when arterial and venous Doppler are used. [ABSTRACT FROM AUTHOR]

Objective: To describe the time sequence of changes in cardiac function in intrauterine growth restriction. Study design: This was a prospective longitudinal study on 22 singleton pregnancies with growth-restricted fetuses. Pulsatility indices of fetal arterial and venous Doppler waveforms, systolic peak velocity in the aorta and pulmonary artery, right and left ventricular shortening fraction and atrioventricular flow E/A ratio were assessed at each monitoring session. Logistic regression was used for modeling the probability of abnormality of a variable in relation to the time interval before delivery. Trends over time were analyzed by Mann–Withney U-test. Results: Umbilical artery pulsatility index was the first variable to become abnormal, followed by the middle cerebral artery, right diastolic indices (right E/A, ductus venosus), right systolic indices and, finally, both diastolic and systolic left cardiac indices. Conclusion: We have found an earlier and more pronounced right than left and diastolic than systolic fetal cardiac function deterioration in growth restricted fetuses monitored longitudinally. [Copyright &y& Elsevier]