o_1977r8vv9vk1ts2ms0kd8pksa.pdf

XVIII
Contents
25 Absent End-Diastolic Velocity
in the Umbilical Artery
and Its Clinical Significance ......... 375
Dev Maulik, Reinaldo Figueroa
Incidence ....................... 376
Technical Considerations ............. 376
Absent End-Diastolic Velocity and Adverse
Perinatal Outcome ................. 377
Perinatal Mortality ............... 377
Perinatal Morbidity ............... 377
Maternal Hypertension and Absent End-
Diastolic Velocity .................. 382
Reappearance of End-Diastolic Velocity .. 382
AREDVand Other Emergent Signs of Fetal
Compromise ..................... 383
Summary ....................... 384
References .................... 384
26 Doppler Velocimetry for Fetal Surveillance:
Randomized Clinical Trials
and Implications for Practice ........ 387
Dev Maulik, Reinaldo Figueroa
Doppler Randomized Trials: A Summary .. 387
Doppler Randomized Trials: Cumulative
Summary ....................... 392
Population Characteristics .......... 392
Objective and Primary Outcome ..... 393
Doppler Sonographic Technique
and Research Design ............. 393
Management Protocol ............ 393
Doppler Randomized Trials: Meta-Analysis 393
Meta-Analysis: Brief Introduction ..... 393
Doppler Meta-Analysis ............ 395
Management of High-Risk Pregnancy: A
Proposal Based on Clinical Trials ....... 398
Conclusion ...................... 399
References .................... 399
27 Doppler Investigation
of the Fetal Inferior Vena Cava ....... 403
Yoshihide Chiba, Toru Kanzaki,
Zeev Weiner
Normal Blood Flow Pattern in Fetal IVC .. 403
Doppler Evaluation of Preload Condition
in the Fetal Vena Cava and the Umbilical
Vein ........................... 404
Preload Index .................. 404
Blood Flow Change During Fetal
Therapy ...................... 406
Blood Flow Dynamics in Fetal Central
Veins During Labor .............. 406
IVC Blood Flow at an Early Stage
of Pregnancy ................... 407
Abnormal IVC Blood Flow Patterns
with Fetal Arrhythmias .............. 407
Blood Flow Pattern of Premature
Contractions ................... 408
Bradycardic Arrhythmia ........... 408
Tachyarrhythmias ................ 408
Determination of Fetal Therapy
According to the Type of Tachycardia . 410
IVC and Umbilical Vein Blood Flow Patterns
in High-Risk Fetuses ................ 410
References .................... 411
28 Ductus Venosus .................. 413
Torvid Kiserud
Anatomy and Development .......... 413
Physiological Background ............ 414
Via Sinistra .................... 414
Umbilical Liver Perfusion .......... 415
Portal Watershed Area ............ 416
Porto-Caval Pressure Gradient ....... 416
Fetal Respiratory Force ............ 416
Postnatal Physiology ............. 416
Ultrasound Imaging and Insonation ..... 417
Normal Ductus Venosus Blood Velocity .. 418
Waveform Analysis: Indices ........... 419
Interpretation of the Waveform ........ 420
The Atrial Contraction Wave ........ 420
Systolic Wave .................. 421
Pitfalls ....................... 421
Reproducibility ................. 422
Agenesis of the Ductus Venosus ....... 423
References ...................... 423
29 Doppler Ultrasound Examination
of the Fetal Coronary Circulation ..... 429
Ahmet Alexander Baschat
Introduction ..................... 429
Embryology and Functional Anatomy
of the Coronary Circulation ........... 429
Ultrasound Examination Technique ..... 430
Ultrasound Setup ................ 430
Examination of Coronary Arteries .... 431
Examination of the Coronary Sinus ... 432
Clinical Applications in Fetuses
with Normal Cardiac Anatomy ......... 436
The ªHeart-Sparing Effectº in Fetal
Growth Restriction ............... 436
Fetal Anemia ................... 436
Ductus Arteriosus Constriction ...... 437
Other Fetal Conditions ............ 437