Saemundur Gudmundsson

Umbilical Artery and Uteroplacental Blood Flow Velocity Waveforms in Normal Pregnancy — A Cross‐Sectional Study

Umbilical and arcuate artery blood flow velocity waveforms (FVW) were recorded in 125 normal singleton pregnancies from 20 to 42 weeks of gestation. The FVW were analysed for pulsatility index (PI), peak systolic velocity/minimum diastolic velocity ratio (S/D ratio), rising slope (RS) and descending slope (DS). Both in the umbilical and arcuate arteries, values for all variables declined with advancing gestation, indicating decreasing placental vascular resistance. The umbilical artery PI was unaffected by the fetal heart rate, but the arcuate artery PI was negatively correlated to the maternal heart rate (r = −0.40). The arcuate artery PI decreased by 0.00394 with each beat per minute increase in maternal heart rate. Normal limits (mean ± 2 SD) were established for umbilical artery PI corrected for gestational age, and arcuate artery Pi corrected for gestational age and maternal heart rate.

Frequency of anal sphincter rupture at delivery in Sweden and Finland ‐ result of difference in manual help to the baby's head

BACKGROUNDnAnal sphincter rupture is a serious complication of vaginal delivery and almost half the affected women have persistent defecatory symptoms despite adequate primary repair. During the past decade, the incidence of anal sphincter ruptures has been increasing in Sweden and is currently estimated to occur in 2.5% of vaginal deliveries. The aim of the study was to report the frequency of anal sphincter ruptures in two university hospitals in two Scandinavian countries, Malmö in Sweden and Turku in Finland, and analyze the potential determinants.nnnMETHODSnRetrospective analysis of a population of 30,933 deliveries (26,541 vaginal) during the years 1990 to 1994.nnnRESULTSnThe incidence of anal sphincter ruptures in Malmö, Sweden was 2.69%, and in Turku, Finland 0.36%. There were no significant population differences for the known risk factors (fetal weight, nulliparity or fetal head circumference). However, there is a difference in manual support given to the perineum and to the babys head when crowning through the vaginal introitus between Malmö and Turku. The proportion of operative vaginal deliveries and abnormal presentations was significantly higher in Turku reflected in the lower Apgar score at 5 minutes and longer duration of second phase of labor. When high risk deliveries (operative vaginal delivery, abnormal presentation and newborns over 4,000 g) were excluded, the risk for anal sphincter ruptures was estimated to be 13 times higher in Malmö than in Turku.nnnCONCLUSIONSnThe difference in the incidence of anal sphincter rupture between Malmö, Sweden and Turku, Finland may be due to the difference in manual control of the babys head when crowning.

Uterine and umbilical artery Doppler are comparable in predicting perinatal outcome of growth-restricted fetuses

Objectiveu2002 To compare umbilical and uterine artery Doppler in predicting outcome of pregnancies suspected of fetal growth restriction (FGR).

Uterine artery color Doppler assisted veloeimetry and perinatal outcome

Background. Previously, we have found uterine artery blood veloeimetry performed with Doppler ultrasound without vessel visualization to be a poor predictor of perinatal outcome. The aim of this study was to ascertain whether the combination of color Doppler imaging with the method would improve its predictive value.

Umbilical and uteroplacental blood flow velocity waveforms in pregnancies with fetal growth retardation

A 2 MHZ pulsed Doppler ultrasound was used to record blood flow velocity waveforms (FVW) in the umbilical and arcuate arteries of 129 singleton pregnancies where intra-uterine growth retardation (IUGR) was suspected at routine ultrasound screening in the 32nd week of gestation. All patients were examined once a fortnight, between 32nd week and delivery, the results presented being from the final examination before delivery. The FVW were characterized by the pulsatility index (PI). Sixty-six of the 129 newborns were growth-retarded at delivery (birthweight less than or equal to mean--2SD of the general population). Of the IUGR cases, 56% had an abnormal PI (greater than or equal to mean + 2SD of normals) in the umbilical artery and 47% in the arcuate artery. Significant relationships were found between abnormal umbilical artery PI and both IUGR (p less than 0.001) and operative delivery for fetal distress (ODFD) (p less than 0.001). No such relationship was found between abnormal PI in the arcuate artery and either IUGR or ODFD. Four placenta waveform classes (PWC), reflecting the FVW on either side of the placenta, are presented and compared with the outcome of pregnancy. The data show the umbilical artery FVW to be a good predictor of IUGR and intra-uterine fetal distress, whereas the arcuate artery FVW appears to have low predictive value for the above conditions.

Middle cerebral artery velocimetry as a predictor of hypoxemia in fetuses with increased resistance to blood flow in the umbilical artery

About half of all fetuses with increased resistance to blood flow, but with still detectable diastolic blood velocity in the umbilical artery (UA), show signs of imminent asphyxia during labour indicating a need for operative delivery. Fetal brain-sparing during hypoxia is characterized by an increase in diastolic and mean blood flow velocity in the middle cerebral artery (MCA). The aim of this study was to assess whether MCA blood velocity in pregnancies with increased resistance to blood flow in the feto-placental circulation could predict the development of fetal asphyxia during labour. Fifty pregnant women with signs of increased feto-placental vascular resistance between 31 and 42 weeks of gestation were studied serially by Doppler ultrasound and the last examination was correlated to perinatal outcome. The MCA pulsatility index (PI), cerebroplacental PI ratio and mean MCA blood velocity were calculated and correlated to fetal outcome. Fetal brain-sparing was defined as MCA PI < mean -2 S.D., cerebroplacental PI ratio < 1.08 and mean MCA blood velocity >mean + 2 S.D. No significant association was found between signs of fetal brain-sparing and the perinatal outcome. Among fetuses with signs of increased resistance to flow in the umbilical artery, velocimetry of the middle cerebral artery did not identify those that would not withstand the strain of labour.

Increased uterine artery vascular impedance is related to adverse outcome of pregnancy but is present in only one-third of late third-trimester pre-eclamptic women.

Signs of increased uterine artery vascular impedance in mid‐gestation are strongly related to pre‐eclampsia later in pregnancy. Whether this is true for the late third trimester is, however, unclear. The aim of the present study was to analyze the frequency of increased uterine artery vascular impedance in the third trimester, and its relationship to abnormal umbilical artery Doppler and adverse outcome of pregnancy.

New score indicating placental vascular resistance.

Background.u2002 Umbilical artery Doppler velocimetry is a routine method for fetal surveillance in high‐risk pregnancy. Uterine artery Doppler seems to give comparable information, but it can be difficult to interpret as there are two arteries, which might show notching and/or increased pulsatility index (PI) as signs of increased vascular impedance. Combining the information on vascular resistance on both sides in a new score might simplify and improve evaluation of placental circulation.

Correlation of birth injury with maternal height and birthweight

Backgroundu2003 Infant or maternal injury during vaginal delivery is a constant threat to all involved, but difficult to predict.

Can women with intrapartum rupture of anal sphincter still suffer after-effects two decades later?

Background. Recent research has revealed that women who suffer anal sphincter rupture (ASR) during delivery can experience persisting complaints some time afterwards. Examinations have been made some years postpartum, but it would be of interest to know if women with anal sphincer rupture might still have complaints attributable to the tear, two decades later.