dr. farzad afzali,pregnancy doppler
TRANSCRIPT
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Presented by:
Dr. Farzad AfzaliKasra medical imaging center
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An early stage in fetal adaptation to
hypoxemia
increased blood flow in DV to protect the brain,heart, and adrenals
central redistribution of blood flow
( brain-sparing reflex)
reduced flow to the peripheral and placentalcirculations
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Under physiologic conditions, 60 to 70
percent of umbilical venous blood in the
human fetus is distributed to the liver and the
remainder to the heart.
With chronic hypoxemia, this proportion may
be modulated so that a larger proportion of
umbilical venous blood can bypass the liver to
reach the heart
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The middle cerebral artery (MCA) in the fetal brain
Normally high-impedance
Most accessible to U/S imaging
More than 80% of cerebral blood
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Average of both MCAs must be calculated for more
precise result.
Compression of the fetal head causes increasing arterial
resistance.( false negative of IUGR)
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The best predictor for fetal acidemia
is PI of thoracic aorta.
The best predictor of fetal hypoxia is
PI of MCA.
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The damage that obliterate small muscular arteries in
placental tertiary stem villi
absent flow or even reversed flow, suggestive more
than 70% damage of placenta.
commonly associated with severe IUGR and
oligohydramnios
Waveforms obtained from the placental end of cord
show more end-diastolic flow, thus lower RI & PI,than waveforms obtained from the abdominal cord
insertion. (No significance on clinical practice)
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Velocimetry of uterine artey should be obtained
after the vessel crosses the hypo gastric artery and
vein, at the uterus-cervical junction, before it
divides to cervical and uterine branches.
The best predictor of PIH is notch in the uterine
artery & RI>61.5 % after 22 w of gestation.
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Venous indices reflect : ventricular function
Fetal hypoxia
Myocardial lactic acidosis
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DV a wave decrease
Reverse EDF UA -- Reverse a wave DV
Pulsatile UV
Constriction of cerebral circulation
Death within 96 hours
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At the level of AC measuring, ductus venosus canbe identified as it branches from hepatic vein.
It has high speed flow with biphasic waveform.
The first phase corresponding ventricular systole,the second phase to early diastole and nadir to theatrial kick.
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Umbilical vein displays pulsatility in first trimester
but this disappears with advancing gestation in the
pregnancy unaffected by FGR
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1530021&dopt=Abstracthttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1530021&dopt=Abstract -
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In clinical practice, it is necessary to carry out serial
Doppler investigations to estimate the duration of
fetal blood flow redistribution.
The onset of abnormal venous Doppler resultsindicates deterioration in the fetal condition and
iatrogenic delivery should be considered
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Preterm growth restricted fetuses with elevated
umbilical artery Doppler resistance have an overall
perinatal mortality rate of 5 6percent .This rate increases to 5percent when end-diastolic
velocity is absent.
and rises to 38 8percent when venous Doppler indicesbecome abnormal (predominantly due to an increase in
the rate of stillbirth).
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