Relationship between ultrasound parameters of the umbilical and middle cerebral arteries and intrauterine fetal distress

BACKGROUND By comprehensively analyzing the blood flow parameters of the umbilical and middle cerebral arteries,doctors can more accurately identify fetal intrauterine distress,as well as assess its severity,so that timely interventions can be implemented to safeguard the health and safety of the fetus.AIM To identify the relationship between ultrasound parameters of the umbilical and middle cerebral arteries and intrauterine distress.METHODS Clinical data of pregnant women admitted between January 2021 and January 2023 were collected and divided into the observation and control groups(n=50 each),according to the presence or absence of intrauterine distress.The ultrasound hemodynamic parameters of the uterine artery(UtA),fetal middle cerebral artery(MCA),and umbilical artery(UmA)were compared with neonatal outcomes and occurrence of intrauterine distress in the two groups.RESULTS Comparison of ultrasonic hemodynamic parameters,resistance index(RI),pulsatility index(PI),and systolic maximal blood flow velocity of UmA compared to diastolic blood flow velocity(S/D),revealed higher values of fetal MCA,PI,and S/D of UmA in pregnant women with UtA compared to controls(P<0.05),while there was no difference between the two groups in terms of RI(P<0.05)The incidence of a neonatal Apgar score of 8-10 points was lower in the observation group(66.7%)than in the control group(90.0%),and neonatal weight(2675.5±27.6 g)was lower than in the control group(3117.5±31.2 g).Further,cesarean section rate was higher in the observation group(70.0%)than in the control group(11.7%),and preterm labor rate was higher in the observation group(40.0%)than in the control group(10.0%).The incidence of fetal distress,neonatal growth restriction and neonatal asphyxia were also higher in the observation group(all P<0.05).CONCLUSION Fetal MCA,UmA,and maternal UtA hemodynamic abnormalities all develop in pregnant women with intrauterine distress during late pregnancy,which suggests that clinical attention should be paid to them,and monitoring should be strengthened to provide guidance for clinical intervention.

Ultrasound blood flow characteristics changes in fetal umbilical artery thrombosis:A retrospective analysis

BACKGROUND Umbilical artery thrombosis(UAT)is extremely uncommon and leads to adverse perinatal outcomes.Hypercoagulation of blood in pregnant women is suspected to be an important risk for UAT.Ultrasound is an effective way to detect thrombosis.The mother can monitor her own fetal health using ultrasound,which enables her to take preventative action in case of emergency.AIM To investigate ultrasonic blood signal after UAT in the umbilical artery,and evaluate the relationship between hypercoagulability and UAT.METHODS We described a case of a newly formed UAT with markedly altered ultrasonic indices of umbilical artery blood flow,and retrospectively studied it with 18 UAT patients confirmed by histopathology from October 2019 and March 2023 in Xiamen Women and Children's Hospital.Patients’information was collected from medical archives,including maternal clinical data,neonatal outcomes,pathological findings and ultrasonic indices of umbilical artery blood flow,such as systolic-diastolic duration ratio(S/D),resistance index(RI),pulsatility index(PI)and peak systolic velocity(PSV).Ultrasound and coagulation indices were analyzed with matched samples t-test and Wilcoxon rank sum test using the statistical packages in R(version 4.2.1)including car(version 3.1-0)and stats(version 4.2.1),and visualized by ggplot2 package(version 3.3.6).RESULTS A patient with normal findings in second and third-trimester routine ultrasound scan developed UAT with severe changes in ultrasonic indices of umbilical artery blood flow(within 2.5th of reference ranges)in a short period of time.Statistical analysis of umbilical artery blood flow ultrasound indices for 19 patients with UAT showed that the decrease in S/D,RI,and PI and increase of PSV during the disease process was greater than that of non-UAT.All 18 patients delivered in our hospital showed characteristic manifestations of UAT on histological examination after delivery,most of which(16/18)showed umbilical cord abnormalities,with 15 umbilical cord torsion and 1 pseudoknot.Coagulation parameters were not significantly changed in UAT patients compared with normal pregnancy women.CONCLUSION Significant changes in ultrasound indicators after UAT were demonstrated.PSV can play important roles in the diagnosis of UAT.Hypercoagulability alone is not sufficient for the occurrence of UAT.

Shengmai Suppressed Vascular Tension in Umbilical Arteries and Veins of Human and Sheep

Objective—The umbilical cord is a critical pathway between mothers and fetuses, and regulations of umbilical vessel tension are important for fetal growth. Shengmai is an herbal medicine being used in treatments of cardiovascular diseases. However, effects of Shengmai on human blood vessels and related pharmacological mechanisms are unclear. Methods—This study investigated the effects of related mechanisms of Shengmai and its key compounds on human and sheep umbilical arteries and veins using organ bath systems. Key Findings—Shengmai significantly suppressed phenylephrine-stimulated vasoconstriction in umbilical arteries and veins. NG-Nitro-L-arginine Methyl Estercould not change the Shengmai-suppressed vasoconstriction in human and sheep umbilical vessels. Among four key compounds of Shengmai, Ginsenoside Re, Ginsenoside Rb1, Ginsenoside Rg1, and Schisandrin, only Ginsenoside Re showed the significant effect similar to Shengmai’s in the umbilical vessels. In Ca2+-free solution, Ginsenoside Re did not affect vasoconstriction. In addition, caffeine- or phenylephrine-stimulated vasoconstriction were not changed by Ginsenoside Re. Either charybdotoxin or glibenclamide could inhibit Ginsenoside Re-caused inhibition of the stimulated vasoconstriction in both human and sheep umbilical vessels, where 4-aminopyridine did not show the similar inhibitory effect. Conclusion—The results provide new information on Shengmai’s effects and underlying mechanisms in umbilical vessels. Importantly, the information gained offers interesting potential for developing new drugs acting on umbilical cords for fetal medicine.

Dissecting molecular mechanisms underlying ferroptosis in human umbilical cord mesenchymal stem cells:Role of cystathionineγ-lyase/hydrogen sulfide pathway

BACKGROUND Ferroptosis can induce low retention and engraftment after mesenchymal stem cell(MSC)delivery,which is considered a major challenge to the effectiveness of MSC-based pulmonary arterial hypertension(PAH)therapy.Interestingly,the cystathionineγ-lyase(CSE)/hydrogen sulfide(H_(2)S)pathway may contribute to mediating ferroptosis.However,the influence of the CSE/H_(2)S pathway on ferroptosis in human umbilical cord MSCs(HUCMSCs)remains unclear.AIM To clarify whether the effect of HUCMSCs on vascular remodelling in PAH mice is affected by CSE/H_(2)S pathway-mediated ferroptosis,and to investigate the functions of the CSE/H_(2)S pathway in ferroptosis in HUCMSCs and the underlying mechanisms.METHODS Erastin and ferrostatin-1(Fer-1)were used to induce and inhibit ferroptosis,respectively.HUCMSCs were transfected with a vector to overexpress or inhibit expression of CSE.A PAH mouse model was established using 4-wk-old male BALB/c nude mice under hypoxic conditions,and pulmonary pressure and vascular remodelling were measured.The survival of HUCMSCs after delivery was observed by in vivo bioluminescence imaging.Cell viability,iron accumulation,reactive oxygen species production,cystine uptake,and lipid peroxidation in HUCMSCs were tested.Ferroptosis-related proteins and S-sulfhydrated Kelchlike ECH-associating protein 1(Keap1)were detected by western blot analysis.RESULTS In vivo,CSE overexpression improved cell survival after erastin-treated HUCMSC delivery in mice with hypoxiainduced PAH.In vitro,CSE overexpression improved H_(2)S production and ferroptosis-related indexes,such as cell viability,iron level,reactive oxygen species production,cystine uptake,lipid peroxidation,mitochondrial membrane density,and ferroptosis-related protein expression,in erastin-treated HUCMSCs.In contrast,in vivo,CSE inhibition decreased cell survival after Fer-1-treated HUCMSC delivery and aggravated vascular remodelling in PAH mice.In vitro,CSE inhibition decreased H_(2)S levels and restored ferroptosis in Fer-1-treated HUCMSCs.Interestingly,upregulation of the CSE/H_(2)S pathway induced Keap1 S-sulfhydration,which contributed to the inhibition of ferroptosis.CONCLUSION Regulation of the CSE/H_(2)S pathway in HUCMSCs contributes to the inhibition of ferroptosis and improves the suppressive effect on vascular remodelling in mice with hypoxia-induced PAH.Moreover,the protective effect of the CSE/H_(2)S pathway against ferroptosis in HUCMSCs is mediated via S-sulfhydrated Keap1/nuclear factor erythroid 2-related factor 2 signalling.The present study may provide a novel therapeutic avenue for improving the protective capacity of transplanted MSCs in PAH.

Neonatal necrotizing enterocolitis caused by umbilical arterial catheter-associated abdominal aortic embolism:A case report

BACKGROUND Reports of necrotizing enterocolitis(NEC)caused by umbilical arterial catheter(UAC)-associated abdominal aortic embolism in neonates are rare.Herein,we report the case of an extremely low birth weight(ELBW)infant with NEC caused by UAC-associated abdominal aortic embolism.CASE SUMMARY A female infant,aged 21 min and weighing 830 g at 28+6 wk of gestational age,was referred to our hospital because of premature birth and shallow breathing.The patient was diagnosed with ELBW,neonatal respiratory distress syndrome,neonatal intrauterine infection,and neonatal asphyxia.Umbilical arterial and venous catheters were inserted on the day after birth and were removed 9 d later,according to the doctor’s plan.Within 48 h after extubation,the patient’s manifestations included poor responsiveness,heart rate range of 175-185/min,and currant jelly stool.Therefore,we considered a diagnosis of NEC.To determine the cause,we used B-mode ultrasound,which revealed a partial abdominal aortic embolism(2 cm×0.3 cm)and abdominal effusion.The patient was treated with nil per os,gastrointestinal decompression,anti-infective therapy,blood transfusion,and low-molecular-weight heparin sodium q12h for anticoagulant therapy(from May 20 to June 1,the dosage of low-molecular-weight heparin sodium was adjusted according to the anti-Xa activity during treatment).On the 67th day after admission,the patient fully recovered and was discharged.CONCLUSION The abdominal aortic thrombosis in this patient was considered to be catheter related,which requires immediate treatment once diagnosed.The choice of treatment should be determined according to the location of the thrombus and the patient’s condition.

正常足月顺产新生儿脐带动、静脉血pH值的相关性研究

目的探讨正常足月顺产新生儿脐静脉血pH值能否取代脐动脉血pH值来评估新生儿健康状况,及其影响因素。方法选取2020年1—12月符合纳入标准的150例产妇及新生儿为研究对象,用GEM Premier 3000进行血气分析,采用配对t检验,进行线性相关分析及回归分析。结果脐带动、静脉血平均pH值分别为(7.278±0.073)和(7.352±0.061),二者差异有统计学意义(P<0.001);脐带动、静血pH值在统计学上高度相关(r=0.782,P<0.05);脐带动、静脉血pH值、第二产程时长、产次、新生儿性别和需要吸氧分娩差异有统计学意义(P<0.05)。结论脐带动、静脉血pH值有显著差异,但是二者也显著相关;对于正常足月顺产新生儿,可以采集脐静脉血代替脐动脉血进行血气分析。

Viscoelastic evaluation of fetal umbilical vein for reconstruction of middle cerebral artery

The transplantation of artificial blood vessels with 〈 6 mm inner diameter as substitutes for human arterioles or veins has not achieved satisfactory results. Umbilical vein has been substituted for ar- tery in vascular transplantation, but it remains unclear whether the stress relaxation and creep be- tween these vessels are consistent. In this study, we used the fetal umbilical vein and middle cere- bral artery from adult male cadavers to make specimens 15 mm in length, 0.196-0.268 mm in tu- nica media thickness, and 2.82-2.96 mm in outer diameter. The results demonstrated that the stress decrease at 7 200 seconds was similar between the middle cerebral artery and fetal umbilical vein specimens, regardless of initial stress of 18.7 kPa or 22.5 kPa. However, the strain increase at 7 200 seconds of fetal umbilical veins was larger than that of middle cerebral arteries. Moreover, the stress relaxation experiment showed that the stress decrease at 7 200 seconds of the fetal umbilical vein and middle cerebral artery specimens under 22.5 kPa initial stress was less than the decrease in these specimens under 18.7 kPa initial stress. These results indicate that the fetal umbilical vein has appropriate stress relaxation and creep properties for transplantation. These properties are advantageous for vascular reconstruction, indicating that the fetal umbilical vein can be transplanted to repair middle cerebral artery injury.

Pulsed Umbilical Artery Doppler Ultrasound Findings in Management of High-Risk Term Pregnant Women during Labour

Purpose: Intrapartum Doppler velocimetry is a non-invasive investigation method. This method is useful for evaluating the pathophysiological mechanisms underlying changes in fetal heart rate. This study aimed to determine the usefulness of Doppler ultrasound findings during labor in high-risk women on determining the mode of delivery and outcome of the newborn. Methods: A cross-sectional study was conducted from January 1, 2015 to December 31, 2015 on 100 high-risk pregnant women during labor. The study was performed in the Maternity Teaching Hospital in Erbil City, Kurdistan Region, Iraq. Results: The majority of women (77%) had a normal end-diastolic blood flow pattern through the umbilical artery. A total of 76.9% of those with abnormal Doppler results had a Cesarean delivery compared with only 9.5% of those with normal Doppler results (p p p = 0.07) and fifth minutes (p = 0.01). Conclusions: Abnormal umbilical artery Doppler ultrasound findings in high-risk pregnancies for women in labor are associated with increased rates of emergency cesarean sections and a poor outcome of the newborn.

Fetal umbilical vein transplantation for the repair of middle cerebral artery injury

It is necessary to investigate the longitudinal tensile mechanical characteristics of the middle cere- bral artery and the fetal umbilical vein prior to applying fetal umbilical vein transplantation for repair of injured middle cerebral artery. Fifteen fresh fetal umbilical vein specimens and 15 normal human fresh cadaver middle cerebral artery specimens were collected for longitudinal tensile testing at the speed of 0.5 mm/min and at normal human temperature. The results showed that under 16.0 kPa physiological stress, the strain value of fetal umbilical vein specimens was larger, while the maximal stress and elastic modulus values were less than those of middle cerebral artery specimens. Our findings indicate that fetal umbilical vein has good elastic properties and the stress-strain curve of the fetal umbilical vein is similar to that of the middle cerebral artery. Fetal umbilical vein transplan- tation can, therefore, potentially repair the injured middle cerebral artery.

Correlation between ductus venosus spectrum and right ventricular diastolic function in isolated single-umbilical-artery foetus and normal foetus in third trimester

BACKGROUND Single umbilical artery(SUA)is the most common umbilical cord malformation in prenatal diagnosis.The presence of an SUA can cause blood circulation disorder in the foetus and functional changes of the foetal heart,affecting foetal circulation.The right ventricular diastolic functions in foetuses with isolated SUA and in normal foetuses in the third trimester were evaluated using the spectral Doppler of blood flow in the foetal ductus venosus(DV).AIM To evaluate the right ventricular diastolic functions in foetuses with isolated SUA and in normal foetuses in the third trimester.METHODS Colour Doppler was used to measure the spectrum of foetal DV and tricuspid orifice in 34 foetuses with isolated SUA aged 28-39 wk and in age-matched healthy controls.The DV flow velocities and velocity ratios were measured.The early passive/late active(E/A)ratio at the tricuspid orifice and tissue Doppler Tei index of the foetal right ventricular in the two groups were also measured.RESULTS During the third trimester,the isolated SUA group showed a lower‘a’-wave peak velocity in the DV than the control group(P<0.05).The correlations between the velocity ratios and E/A ratio at the tricuspid orifice in the two groups were analysed,and the correlation between the ventricular late diastolic velocity/ventricular diastolic peak flow velocity and E/A ratios was the best(R^2of the isolated SUA group:0.520;R2 of the control group:0.358).The correlations between the velocity ratios and tissue Doppler Tei index of foetal right ventricular in the two groups were analysed,and the correlation between the pulsatility index for veins(PIV)and tissue Doppler Tei index ratios was the best(R2 of the isolated SUA group:0.865;R2 of the control group:0.627).CONCLUSION In the isolated SUA group,the atrial systolic peak velocity‘a’decreased,and this finding might be related to the changes in foetal cardiac functions.The ratio of ventricular late diastolic velocity to ventricular diastolic peak flow velocity was closely related to the E/A ratio at the tricuspid valve and can be used to identify changes in the right ventricular diastolic functions of isolated SUA and healthy foetuses.PIV was closely related to the tissue Doppler Tei index of the foetal right ventricular and can be used to identify the right ventricular overall functions of isolated SUA and healthy foetuses.

Study of the mechanisms regulating human umbilical artery contractility

We studied the involvement of different types of Ca2+ channels, cyclic nucleotides and different kinases in the regulation of human umbilical artery (HUA) contractility. The elucidation of the precise mechanisms regulating the contractility of this artery could be very important to reveal potential therapeutic targets to treat HUA disorders such as preeclampsia. The relevancy of different types of Ca2+ channels on the regulation of HUA tonus was analyzed. Among the different Ca2+ channel inhibitors used, only the L-type calcium channels (LTCC) inhibition induced relaxation of HUA in Ca2+ containing medium. The inhibition of T-type calcium channels (TTCC) or TRP channels did not significantly affect HUA contractility. In presence of Ca2+, the intracellular increase of a cyclic nucleotide (cAMP or cGMP) induces relaxation of HUA, which was almost complete in histamine-con- tracted HUA, and lower effect was observed in arteries contracted by KCl and serotonin (5-HT). Inhibition of PKA and PKG weakly reduced the relaxations induced by the increase of cAMP and cGMP respectively, suggesting that the relaxation induced by these nucleotides is not totally mediated by the activation of their respective kinases and that other mechanisms are involved. In calcium containing solution, PP2A inhibition produces relaxation of contracted HUA. In KCl contracted arteries, the OA and nifedipine relaxant effects are similar and not additive, suggesting that PP2A could activate LTCC. Besides, the increase of cyclic nucleotides significantly increased the OA effect, suggesting that the effect of PP2A inhibition is independent of the cyclic nucleotide pathways. The contractions induced by KCl, histamine and 5-HT in presence of Ca2+ were not significantly affected by ROCK, ERK1/2 or p38MAPK inhibitors. In absence of extracellular Ca2+, histamine and 5-HT elicited contractions of HUA characterized by two components, a rapid phasic contractile component followed by a decrease of the contraction until a tonic component. However, KCl elicited sustained contractions of HUA in absence of extracellular Ca2+. As in presence of calcium, the ERK1/2 and p38MAPK inhibitors did not influence the contractions induced by KCl, histamine or 5-HT in absence of extracellular Ca2+. However, in these conditions, ROCK inhibition significantly relaxed the contractions induced by KCl and reduced the phasic and tonic components of the contraction elicited either by histamine or 5-HT. Our results show that calcium-dependent contractions of HUA depend on Ca2+ entry by LTCC, and these chan- nels seems to be positive regulated by PP2A. Cyclic nucleotides mediate HUA vasodilatation but their dependent kinases are not the unique responsible of this effect. HUA is able to contract independently of Ca2+ influx by activating the ROCK pathway and/or due to intracellular Ca2+ release.

Umbilical Catheter Complications in Newborns during Prone Position: A Pilot Study

Introduction: It is not known whether prone position of newborns with umbilical catheters increases the complication risk. Purpose: Analysing complications of umbilical catheters in newborns during prone positioning and analysing if local complications as a wet or red rim increase severe complications. Subjects: Newborns (

Apgar评分、脐动脉血pH值和乳酸联合应用于新生儿窒息诊断的价值

目的研究联合应用Apgar评分、脐动脉血pH值与乳酸诊断新生儿窒息的效果.方法选取2020年4月至2022年3月广州市番禺区妇幼保健院收治的100例新生儿窒息患儿为研究组,同期在本院分娩的200例正常新生儿为对照组,比较2组1 min Apgar评分、脐动脉血pH值及乳酸水平,并分析各单项指标及不同指标联合诊断新生儿窒息的准确率、灵敏度和特异度.结果研究组1 min Apgar评分、脐动脉血pH值和乳酸水平均高于对照组(均P<0.001).各单项指标中,1 min Apgar评分诊断准确率高于脐动脉血pH值和乳酸(均P<0.01)、灵敏度高于脐动脉血pH值(P<0.05)、特异度高于乳酸(P<0.01);联合指标中,1 min Apgar评分+脐动脉血pH值诊断准确率、灵敏度和特异度分别为80.67%、81.00%和80.50%,1 min Apgar评分+乳酸诊断准确率、灵敏度和特异度分别为80.00%、84.00%和78.00%,1 min Apgar评分+脐动脉血pH值+乳酸诊断准确率、灵敏度和特异度分别为95.00%、100.00%和92.50%,1 min Apgar评分+脐动脉血pH值+乳酸的诊断准确率、灵敏度和特异度高于1 min Apgar评分+脐动脉血pH值和1 min Apgar评分+乳酸(均P<0.001).结论在应用1 min Apgar评分与脐动脉血pH值的基础上联合乳酸检测能够提高新生儿窒息的诊断效果.

Human umbilical artery smooth muscle exhibits a 2-APBsensitive capacitative contractile response evoked by vasoactive substances and expresses mRNAs for STIM, Orai and TRPC channels

After depletion of intracellular Ca^(2+)stores the capacitative response triggers an extracellular Ca^(2+)influx through store-operated channels(SOCs)which refills these stores.Our objective was to explore if human umbilical artery smooth muscle presented this response and if it was involved in the mechanism of serotonin-and histamine-induced contractions.Intracellular Ca^(2+)depletion by a Ca^(2+)-free extracellular solution followed by Ca^(2+)readdition produced a contraction in artery rings which was inhibited by the blocker of Orai and TRPC channels 2-aminoethoxydiphenyl borate(2-APB),suggesting a capacitative response.In presence of 2-APB the magnitude of a second paired contraction by serotonin or histamine was significantly less than a first one,likely because 2-APB inhibited store refilling by capacitative Ca^(2+)entry.2-APB inhibition of sarcoplasmic reticulum Ca^(2+)release was excluded because this blocker did not affect serotonin force development in a Ca^(2+)-free solution.The PCR technique showed the presence of mRNAs for STIM proteins(1 and 2),for Orai proteins(1,2 and 3)and for TRPC channels(subtypes 1,3,4 and 6)in the smooth muscle of the human umbilical artery.Hence,this artery presents a capacitative contractile response triggered by stimulation with physiological vasoconstrictors and expresses mRNAs for proteins and channels previously identified as SOCs.

Hemodynamic changes in arterial flow velocities throughout the first six months of pregnancy in buffalo heifers by Doppler ultrasonography

Objective: To assess blood flow parameters as well as Doppler indices at the first six months of pregnancy in buffalo heifers. Methods: A total of 15 healthy, cycling, buffalo heifers were examined twice per month. Examination of Doppler ultrasonography started from the first month till the sixth months of pregnancy. All animals were subjected to transrectal Doppler ultrasonography to assess ovarian and uterine blood flow. Resistance index, pulsatility index, peak systolic velocity, end diastolic velocity, and blood flow rate were measured of both ipsilateral and contralateral to the fetus side. Results: The resistance index was positively correlated with the pulsatility index (r=0.62, P<0.01) but negatively correlated with all other parameters. For both ovarian and uterine arteries ipsilateral and contralateral to the fetus, there was a reduction in the resistance index, with a significant increase (P<0.01) in peak systolic and end diastolic velocities in both ovarian and uterine arteries. The peak systolic and end diastolic velocities of the ipsilateral ovarian and uterine arteries increased linearly till the six months of pregnancy with increased growth demands of the fetus. The same for the uterine branch of the ovarian artery was done in the middle uterine artery and umbilical artery ipsilateral to the fetus side. Conclusions: This study provides reference data of the hemodynamic changes in both ovarian and uterine arteries that could be a valuable tool to evaluate all hemodynamic changes in the developing placenta/fetus. Transrectal Doppler ultrasonography proves to be a useful non-invasive method to assess utero-ovarian blood flow during pregnancy.

Vazoactive Effects of Oxidative Stress Elicited by Hydrogen Peroxide in the Human Umbilical Artery: An <i>in Vitro</i>Study

The vasoactive effects of oxidative stress induced by hydrogen peroxide (H2O2) on human umbilical artery strips as well as the possible mechanisms involved are studied. Contraction responses to cumulative H2O2 (10–7 M-3 × 10–2 M) in endothelium intact and denuded umbilical arteries and responses to cumulative H2O2 after incubation with L-NAME (10–4 M) (n = 8), indomethacin (10–5 M) (n = 8) and verapamil (10–6) (n = 8) were recorded. Responses elicited with cumulative H2O2 in Ca2+ free extracellular medium and the responses to cumulative Ca2+ (10–4 M-2 × 10–3 M) after H2O2 (10–3 M) induced contraction were also studied. The Emax for each experiment was calculated. p 2O2 elicited contraction was greater in endothelium denuded artery strips compared to endothelium intact strips (p 2O2 (p 2+ free extracellular medium caused decreases in cumulative H2O2 elicited contractions and cumulative Ca2+ caused concentration dependent increases in the contraction caused by a single bolus of H2O2 (p 2O2 causes concentration-dependent constriction in human umbilical arteries. The presence of the endothelium and NOS enzyme activation influences the H2O2 responses. Removal of the endothelium increases the H2O2 elicited contractions more than incubation with L-NAME suggesting beside NO, other endothelial vasodilators are also involved in vascular tonus of the umbilical arteries. Both intracellular and extracellular Ca2+ ions and constrictor cyclooxygenase metabolites play a role in the contractile responses elicited by H2O2 in human umbilical arteries.

Umbilical artery doppler flow patterns in high-risk pregnancy and foetal outcome in Mulago hospital

Objective: To demonstrate the flow patterns and factors associated with adverse foetal outcome in high-risk pregnancy at Mulago Hospital using Doppler ultrasound of the foetal umbilical artery. Design: Cross-sectional descriptive study. Setting: Mulago National Referral Hospital, Kampala Uganda. Study Subjects: One hundred and ninety-two patients in a 4-month period (December 2008-April 2009). Results: Maternal age was 16 to 41 years. Twenty-one foetuses had abnormal flow patterns (12 had reduced end-diastolic flow, 8 had AEDF and 1 had RF). Prematurity was associated with abnormal flow patterns. 11 out of 12 foetuses with reduced end-diastolic flow survived. Of the foetuses with AEDF, 3 survived but were admitted to the neonatal special care unit while 5 died. One foetus had RF and was a stillbirth. Eighteen foetuses were delivered after an obstetric intervention. Conclusions: 1) The prevalence of abnormal flow patterns is 10.9%. 2) Abnormal flow patterns, low biophysical profile score, premature delivery, low birth weight and low Apgar score are related to adverse foetal outcome. 3) A low biophysical profile score is related to AEDF/RF. 4) Foetuses of low parity mothers are more likely to have abnormal flow patterns. Recommendation: Umbilical artery Doppler Biophysical profile scores should be done in high-risk pregnancy.

Colour Doppler Study of Umbilical Artery in Antenatal Women with Severe Preeclampsia and Foetal Outcome

Hypertensive disorders are the most common medical complications of pregnancy (7.15%). Doppler analysis of umbilical artery S/D ratio PI and RI, absent or reversal of EDV were evaluated and follow up results studied in severe preeclampsia women between 26 to 40 weeks. Doppler analysis of Uterine Artery and Middle Cerebral Artery is also studied. Doppler study guides in decision making and follows up in severe preeclampsia and guides in reducing perinatal morbidity and mortality. Period of Study: This is a prospective randomised study conducted at Niloufer Hospital for Women and Children Red Hills Hyderabad from September 2011 to June 2014. Material and Methods: 100 pregnant women with severe preeclampsia who attended Antenatal Out-Patient Department and got admitted in Emergency ward underwent Umbilical artery velocimetry by means of a Colour doppler vision (6000 Toshiba corp Tokyo Japan) using 3.5_5 MHZ Trasabdominal traducer. Results: Total number of 100 women were studied. In this 60 women had foetuses with abnormal umbilical artery flow velocimetry and 40 had normal umbilical artery flow velocimetry. The average birth weight and diagnosis to delivery interval were lower in foetuses with abnormal umbilical artery doppler. Admission to neonatal intensive care unit is high. The APGAR score at 1 minute is <7 in 20 women with abnormal umbilical artery doppler compared to 17 women with normal umbilical artery doppler. Compared to 32 women with normal umbilical artery doppler, the APGAR score is more than 7 in 31 women with abnormal umbilical artery Doppler. P = 0.639647 and chi-square statistic = 0.2192, the result is statistically not significant at p-value < 0.05, implying that APGAR scores are not dependent on doppler findings alone. Conclusion: Doppler study guides obstetrician to assess the physiological status of the foetus and it helps in identifying the changes in the foetal circulation. This study suggests that doppler assessment of foe to placental circulation including umbilical artery is a better prognostic indicator in severe PE and helps in timely intervention. The foetuses with normal artery flow velocimetry area at a lower risk of having poor APGAR score than those with abnormal velocimetry and NICU admissions are less with normal umbilical artery flow velocimetry. The average birth weight of neonates with abnormal umbilical artery was lower compared to neonates with normal umbilical artery velocimetry.

Predicting obstetric outcomes of advanced maternal age through determination of hemodynamics of uterine artery, umbilical artery and fetal cerebral middle artery

Objective: The purpose of this study was to investigate the relationship between pregnancy outcome in older pregnant women and the uterine artery and fetal hemodynamic parameters in the third trimester. Methods: Randomized selection of 100 patients in our hospital delivery and late pregnancy monitoring of uterine artery and fetal hemodynamics in patients. (1) There were compared and analyzed the hemodynamic parameters (PSV, EDV, RI, PI, S/D) of the uterine artery, umbilical artery and fetal middle cerebral artery in the third trimester between 36 elderly patients with normal pregnancy outcome (≥35 years old, observation group) and 32 patients with normal age of normal pregnancy (<35 years old, control group). (2) There were compared and analyzed the hemodynamic parameters of the uterine artery, umbilical artery and fetal middle cerebral artery in the third trimester between 32 elderly patients with abnormal pregnancy outcome and 36 elderly patients with normal pregnancy outcome. Results: (1) Normal pregnancy outcomes in different age groups, the hemodynamic parameters of uterine artery, umbilical artery and fetal middle cerebral artery were not significantly different. (2) The high age group had different pregnancy outcomes,Fetal middle cerebral artery PI was statistically significant, there was no significant difference in Uterine artery and umbilical artery of the hemodynamic parameters. Conclusion: Color Doppler ultrasonography to evaluate the PI value of fetal middle cerebral artery in older pregnant women has a certain reference value to judge whether there is hypoxia and distress and neonatal prognosis in the fetus, and to provide some reference information for clinicians to predict the pregnancy outcome of the older pregnant women.

Study on the uterine artery and fetal umbilical artery hemodynamics in patients with HDP

Objective:To explore the uterine artery and fetal umbilical artery hemodynamic change in patients with HDP.Methods:A total of 80 patients with HDP who came to our hospital from July, 2015 to July, 2016 for pregnancy examination were included in the study and served as the observation group, while 80 healthy pregnant women who came for pregnancy examination in the same period were served as the control group. The pregnant women in the two groups were performed with sequential color Doppler ultrasound at gestation 30-40 weeks. The two-dimensional ultrasound apparatus was used to detect the uterine artery and umbilical artery. PI, RI, and S/D were recorded. The fetal BPD, head girth, femur length, and abdominal girth were measured. ELISA was used to detect 8-iso-PGF2α. The immunoturbidimetry was used to detect Cys-C and CRP.Results:The uterine artery PI, RI, and S/D in the observation group were significantly higher than those in the control group. The umbilical artery PI, RI, and S/D in the observation group were significantly higher than those in the control group. The fetal BPD, head girth, femur length, and abdominal girth in the observation group were significantly less than those in the control group. 8-iso-PGF2α, Cys C, and CRP levels in the observation group were significantly higher than those in the control group.Conclusions:The uterine artery and umbilical artery blood flow resistance in patients with HDP are significantly elevated, which can severely affect the placental blood perfusion and fetal growth and development, while the color Doppler ultrasound can provide a non-invasive diagnosis for fetal distress in uterus.