Peter Malcus

Early intervention in management of very preterm growth-restricted fetuses: 2-year outcome of infants delivered on fetal indication before 30 gestational weeks

To describe the outcome of growth‐restricted fetuses with absent or reversed end‐diastolic flow (ARED) in the umbilical artery delivered on fetal indication before 30 gestational weeks.

Screening for Down syndrome based on maternal age or fetal nuchal translucency: a randomized controlled trial in 39,572 pregnancies.

Nuchal translucency (NT) screening increases antenatal detection of Down syndrome (DS) compared to maternal age‐based screening. We wanted to determine if a change in policy for prenatal diagnosis would result in fewer babies born with DS.

Effect of maternal betamethasone on fetal and uteroplacental blood flow velocity waveforms

To investigate the effects of antenatal betamethasone on fetal and uteroplacental hemodynamics.

Preeclampsia: Haemostatic Status and the Short‐Term Effects of Methyldopa and Isradipine Therapy

Objective: To determine the haemostatic status in preeclampsia and to investigate the effects of short‐term use of anti‐hypertensive drugs, methyldopa and isradipine.

Lactate and acid–base balance at delivery in relation to cardiotocography and T/QRS ratios in the second stage of labour

OBJECTIVE To compare foetal electrocardiogram (T/QRS ratio) and cardiotocography (CTG) during the second stage of labour with lactate and acid-base balance in cord artery blood at delivery. DESIGN Forty-six parturients delivered at the National University of Singapore were monitored during the second stage of labour with T/QRS ratios and CTG. At delivery blood from a segment of clamped cord was sampled for lactate and acid-base balance analyses. The Spearman Rank correlation, the Mann Whitney U-test and the Kruskal Wallis ANOVA were used when appropriate. RESULTS Maternal pushing time was significantly correlated to lactate (R = 0.51; P = 0.0003), pH (R = -0.38; P = 0.009) and base deficit (R = 0.33; P = 0.026), but not to T/QRS ratio (R = 0.002; P = 0.99). No significant correlation between lactate and T/QRS ratios (R = 0.06; P = 0.70) or type of CTG pattern was found (P = 0.10), though there were significant differences in pH (P = 0.029) and T/QRS ratios (P = 0.037) between groups with different FHR abnormalities. CONCLUSION Lactate increases progressively with maternal pushing time. No significant correlation was found between lactate and the T/QRS ratio. Lack of correlation is likely to be due to poor sensitivity of foetal ECG at this level of foetal stress, though the influence from transplacentally transferred maternal lactate cannot be excluded.

Waveform Pattern Recognition – A New Semiquantitative Method for Analysis of Fetal Aortic and Umbilical Artery Blood Flow Velocity Recorded by Doppler Ultrasound

A semiquantitative computerized waveform pattern recognition system for analysis of the fetal descending aortic and umbilical artery Doppler flow velocity waveforms is presented. Based on empirically and manually selected clinical recordings from both vessels, 11 computerized and normalized standard curves for the aorta (type curves A to K), and 10 curves for the umbilical artery (type curves a to j) were constructed. The best match between the normalized waveform and the standard curve was based on either the degree of absent diastolic flow or, in cases with positive diastolic flow, on the calculation of the least square sum of the difference. The pattern recognition was tested against conventional waveform indices and our older semiquantitative Blood Flow Class (BFC) system in 472 clinical consecutive Doppler recordings. A good correlation was found. This new relatively simple computer-based method for waveform analysis is now prospectively applied in clinical studies.

Doppler blood flow changes and placental morphology in pregnancies with third trimester hemorrhage

Combined real‐time ultrasound and pulsed Doppler ultrasound examinations were performed in 67 patients with third trimester hemorrhage and other symptoms related to placental abruption, starting from the onset of symptoms to delivery. In 52 of the cases, placental morphology was investigated by light microscopy. Thirteen patients were ultimately given the diagnosis abruptio placentae. None of the morphological placental changes considered had any statistical relationship to placental abruption. Patients with placental centrocotyledon hemorrhages and infarction more often had abnormal umbilical artery flow velocity waveforms at the onset of symptoms, and more frequent abnormal arcuate artery flow velocity waveforms were found among those with placental infarction alone. Abnormal flow velocity waveforms in the umbilical and arcuate arteries were associated with placental abruption, both at the onset of symptoms and at the final examination before delivery. The results indicate an increased risk for placental abruption if the arcuate and/or umbilical artery flow velocity waveforms are abnormal in patients with third trimester hemorrhage.

Fetal breathing recorded by actocardiogram and real - time ultrasonography a comparison

Background. The aim of the study is to evaluate the ability of fetal actocardiogram to assess fetal breathing movements.

632 Cardiac Evaluation of Neonates with Impaired Intrauterine Growth

Background and aims. We investigated the relationship between the cardiac function and coronary flow in neonates with impaired intrauterine growth. Methods. Fetal growth was assessed by fetometry and Doppler velocimetry of the umbilical artery blood flow. Impaired fetal growth was defined as an estimated fetal weight less than mean -2SD from the normal gestational age related fetal weight. Cardiac function and left anterior descending artery (LAD) flow parameters were measured by transthoracic Doppler echocardiography in 14 newborns at one week of age when the ductus arteriosus was closed. Gestational age- and age-matched healthy newborns, appropriate for gestational age (N=15) served as controls. Results. The mean pulsatility index was 0.97 and the mean birth weight 2.2 (range 2.1 to 2.4) kg. The left ventricular shortening fraction was normal 39±4.3%. Aortic velocity time integral/minute as a measure of systolic LV function correlated to LAD PFVd, r=0.54, p< 0.0001. LAD peak flow velocity in diastole (PFVd) correlated to left ventricular mass (r=0.46, p=0.0001). The mean LAD diameter was 0.99±0.09 mm. Impaired intrauterine growth was associated with an increase of PFVd (mean 34.5±4, controls 19±6 mm/s, p=0.0001) and coronary flow (7.3±2, and 4.8±2 ml/min respectively, p=0.04). LAD velocity time integral per minute correlated to mitral peak E-wave (r=0.74, p< 0.01). Conclusions. Basal coronary flow and peak flow velocity appear to be significantly increased in these neonates with intrauterine growth impairment, which leads to decreased coronary flow reserve. LAD flow parameters were linearly related to LV systolic and diastolic functions and to LV mass.

OP14.12: Outcome after active delivery before 30 gestational weeks of pregnancies complicated by fetal growth restriction and ARED flow.

n 320 207 79 51 GA (m±sd) 38.8 ± 1.6 39.1 ± 1.69 38.43 ± 3.25 35.28 ± 3.32 < 0.05 NW (m±sd) 3165 ± 578 2449.06 ± 324.1 2321.58 ± 505.19 1693.96 ± 562.3 <0.05 OD (%) 19 18.4 32.9 49.0 < 0.05 APG < 7 (%) 0.4 1.9 1.3 2.0 NS UApH < 7.15 (%) 11.5 16.7 14.9 16.7 NS NC (%) 6 23.9 29.1 76.5 < 0.05 INT (%) 0.4 2.4 5.1 11.8 < 0.05 SNMB (%) 2.1 1.9 5.1 11.8 < 0.05 NMT (%) 0 0.5 1.3 0 NS OUTCOME (%) 18 37.7 44.0 82.4 < 0.05 ASQ  n 97 107 31 18 ASQ  Communication (centile) 61.3 ± 25.1 67.16 ± 21.54 56.41 ± 30.73 57.11 ± 31.6 <0.05 ASQ  Gross motor (centile) 55.3 ± 21.5 53.64 ± 22.91 50.96 ± 24.67 48.00 ± 26.53 NS ASQ  Fine motor (centile) 43.7 ± 26.6 43.43 ± 28.72 47.67 ± 29.79 49.88 ± 26.0 NS ASQ  Problem solving (centile) 39.0 ± 26.8 46.57 ± 28.42 40.67 ± 27.02 46.33 ± 30.51 NS ASQ  Person-Social (centil) 57.0 ± 26.2 43.95 ± 27.73 36.09 ± 29.0 42.83 ± 28.13 NS