Skip to main content
Top
Published in: Archives of Gynecology and Obstetrics 5/2014

01-05-2014 | Maternal-Fetal Medicine

Advanced dynamic Doppler flow of the pulmonary artery in a normal population: reference values from 18 to 41 weeks of gestation calculated by automatic Doppler waveform analysis

Authors: M. Fittschen, I. Reinhard, S. Wellek, S. Friedrichs, F. Bahlmann

Published in: Archives of Gynecology and Obstetrics | Issue 5/2014

Login to get access

Abstract

Objective

The aim of the present cross-sectional prospective study was to establish Doppler reference ranges for blood flow velocity waveforms (V max, V mean and V min) and resistance indices (PI, RI) of the fetal pulmonary arteries using the new pulsed-wave color advanced dynamic flow (ADF) Doppler technique.

Method

Data were collected in 206 low-risk pregnancies at 18–41 weeks of gestation. The measurements were obtained in the proximal pulmonary artery near the first bifurcation in the absence of fetal body or breathing movements.

Results

The pulsatility index (PI) in the pulmonary artery showed mean increases of 2.43–3.59 between gestational weeks 18 and 42. A similar pattern was observed for the resistance index (RI) with increases of 0.79–0.90. Increases in systolic (V max), mean (V mean) and end diastolic (V min) blood flow velocities of 36.0–63.3, 10.8–19.9 and 5.71–7.53 cm/s, respectively, were noted during the observation interval.

Conclusions

The ranges for blood flow velocities and impedance indices in the fetal pulmonary artery calculated by the authors may serve as reference values to help distinguish a normal patient population from patients carrying fetuses at high risk for neonatal lung disease in antenatal examinations.
Literature
1.
go back to reference Achiron R, Heggesh J, Mashiach S, Lipitz S, Rotstein Z (1998) Peripheral right pulmonary artery blod flow velocimetry: Doppler sonographic study of normal and abnormal fetuses. J Ultrasound Med 17:687–692PubMed Achiron R, Heggesh J, Mashiach S, Lipitz S, Rotstein Z (1998) Peripheral right pulmonary artery blod flow velocimetry: Doppler sonographic study of normal and abnormal fetuses. J Ultrasound Med 17:687–692PubMed
2.
3.
go back to reference Altman DG, Chitty LS (1993) Design and analysis of studies to derive charts of fetal size. Ultrasound Obstet Gynecol 3:378–384PubMedCrossRef Altman DG, Chitty LS (1993) Design and analysis of studies to derive charts of fetal size. Ultrasound Obstet Gynecol 3:378–384PubMedCrossRef
4.
go back to reference Bahlmann F, Merz E, Weber G, Wellek S, Engelhardt O (1997) Transvaginal sonographic biometry in early pregnancy—a growth model. Ultraschall in Med 18:196–204CrossRef Bahlmann F, Merz E, Weber G, Wellek S, Engelhardt O (1997) Transvaginal sonographic biometry in early pregnancy—a growth model. Ultraschall in Med 18:196–204CrossRef
5.
go back to reference Bahlmann F, Wellek S, Reinhardt I, Merz E, Steiner E, Welter C (2000) Reference values of ductus venosus flow velocities and calculated waveform indices. Prenat Diagn 20:623–634PubMedCrossRef Bahlmann F, Wellek S, Reinhardt I, Merz E, Steiner E, Welter C (2000) Reference values of ductus venosus flow velocities and calculated waveform indices. Prenat Diagn 20:623–634PubMedCrossRef
6.
go back to reference Chaoui R, Taddei F, Rizzo G, Bast C, Lenz F, Bollmann R (1998) Doppler echocardiography of the main stems of the pulmonary arteries in the normal human fetus. Ultrasound Obstet Gynecol 11:173–179PubMedCrossRef Chaoui R, Taddei F, Rizzo G, Bast C, Lenz F, Bollmann R (1998) Doppler echocardiography of the main stems of the pulmonary arteries in the normal human fetus. Ultrasound Obstet Gynecol 11:173–179PubMedCrossRef
7.
go back to reference Chaoui R, Kalache K, Tennstedt C, Lenz F, Vogel M (1999) Pulmonary arterial Doppler velocimetry in fetuses with lung hypoplasia. Eur J Obstet Gynecol Reprod Biol 84:179–185PubMedCrossRef Chaoui R, Kalache K, Tennstedt C, Lenz F, Vogel M (1999) Pulmonary arterial Doppler velocimetry in fetuses with lung hypoplasia. Eur J Obstet Gynecol Reprod Biol 84:179–185PubMedCrossRef
8.
go back to reference Fuke S, Kanzaki T, Mu J, Wasada K, Takemura M, Mitsuda N, Murata Y (2003) Antenatal prediction of pulmonary hypoplasia by acceleration time/ejection time ratio of fetal pulmonary arteries by Doppler blood flow velocimetry. Am J Obstet Gynecol 188:228–233PubMedCrossRef Fuke S, Kanzaki T, Mu J, Wasada K, Takemura M, Mitsuda N, Murata Y (2003) Antenatal prediction of pulmonary hypoplasia by acceleration time/ejection time ratio of fetal pulmonary arteries by Doppler blood flow velocimetry. Am J Obstet Gynecol 188:228–233PubMedCrossRef
9.
go back to reference Heling KS, Chaoui R, Bollmann R (2004) Advanced dynamic flow—a new method of vascular imaging in prenatal medicine. A pilot study of its applicability. Ultraschall Med 25(4):280–284PubMedCrossRef Heling KS, Chaoui R, Bollmann R (2004) Advanced dynamic flow—a new method of vascular imaging in prenatal medicine. A pilot study of its applicability. Ultraschall Med 25(4):280–284PubMedCrossRef
10.
go back to reference Laudy JA, Gaillard JL, vd Anker JN, Tibboel D, Wladimiroff JW (1996) Doppler ultrasound imaging: a new technique to detect lung hypoplasia before birth? Ultrasound Obstet Gynecol 7:189–192PubMedCrossRef Laudy JA, Gaillard JL, vd Anker JN, Tibboel D, Wladimiroff JW (1996) Doppler ultrasound imaging: a new technique to detect lung hypoplasia before birth? Ultrasound Obstet Gynecol 7:189–192PubMedCrossRef
11.
go back to reference Laudy JA, de Ridder MA, Wladimiroff JW (1997) Doppler velocimetry in branch pulmonary arteries of normal human fetuses during the second half of gestation. Pediatr Res 41:897–901PubMedCrossRef Laudy JA, de Ridder MA, Wladimiroff JW (1997) Doppler velocimetry in branch pulmonary arteries of normal human fetuses during the second half of gestation. Pediatr Res 41:897–901PubMedCrossRef
12.
go back to reference Laudy JA, de Ridder MA, Wladimiroff JW (2000) Human fetal pulmonary artery velocimetry: repeatability and normal values with emphasis on middle and distal pulmonary vessels. Ultrasound Obstet Gynecol 15:479–486PubMedCrossRef Laudy JA, de Ridder MA, Wladimiroff JW (2000) Human fetal pulmonary artery velocimetry: repeatability and normal values with emphasis on middle and distal pulmonary vessels. Ultrasound Obstet Gynecol 15:479–486PubMedCrossRef
13.
go back to reference Laudy JA, Wladimiroff JW (2000) The fetal lung 1: developmental aspects. Ultrasound Obstet Gynecol 16:284–290PubMedCrossRef Laudy JA, Wladimiroff JW (2000) The fetal lung 1: developmental aspects. Ultrasound Obstet Gynecol 16:284–290PubMedCrossRef
14.
go back to reference Laudy JA, Wladimiroff JW (2000) The fetal lung 2: pulmonary hypoplasia. Ultrasound Obstet Gynecol 16:482–494PubMedCrossRef Laudy JA, Wladimiroff JW (2000) The fetal lung 2: pulmonary hypoplasia. Ultrasound Obstet Gynecol 16:482–494PubMedCrossRef
15.
go back to reference Laudy JA, Tibboel D, Robben SG, de Krijger RR, de Ridder MA, Wladimiroff JW (2002) Prenatal prediction of pulmonary hypoplasia: clinical, biometric, and Doppler velocity correlates. Pediatrics 109:250–258PubMedCrossRef Laudy JA, Tibboel D, Robben SG, de Krijger RR, de Ridder MA, Wladimiroff JW (2002) Prenatal prediction of pulmonary hypoplasia: clinical, biometric, and Doppler velocity correlates. Pediatrics 109:250–258PubMedCrossRef
16.
go back to reference Levin DL, Rudolph AM, Heymann MA, Phibbs RH (1976) Morphological development oft he pulmonary vascular bed in fetal lambs. Circulation 53:144–151PubMedCrossRef Levin DL, Rudolph AM, Heymann MA, Phibbs RH (1976) Morphological development oft he pulmonary vascular bed in fetal lambs. Circulation 53:144–151PubMedCrossRef
17.
go back to reference Merz E, Wellek S (1996) Normal fetal development profiles—a model to obtain standard development graphs for the head and abdominal parameters and the long limb bones. Ultraschall in Med 17:153–162CrossRef Merz E, Wellek S (1996) Normal fetal development profiles—a model to obtain standard development graphs for the head and abdominal parameters and the long limb bones. Ultraschall in Med 17:153–162CrossRef
18.
go back to reference Mitchell JM, Roberts AB, Lee A (1998) Doppler waveforms from the pulmonary arterial system in normal fetuses and those with pulmonary hypoplasia. Ultrasound Obstet Gynecol 11:167–172PubMedCrossRef Mitchell JM, Roberts AB, Lee A (1998) Doppler waveforms from the pulmonary arterial system in normal fetuses and those with pulmonary hypoplasia. Ultrasound Obstet Gynecol 11:167–172PubMedCrossRef
19.
go back to reference Rasanen J, Huhta JC, Weiner S, Wood DC, Ludomirski A (1996) Fetal branch pulmonary arterial vascular impedance during the second half of pregnancy. Am J Obstet Gynecol 174:1441–1449PubMedCrossRef Rasanen J, Huhta JC, Weiner S, Wood DC, Ludomirski A (1996) Fetal branch pulmonary arterial vascular impedance during the second half of pregnancy. Am J Obstet Gynecol 174:1441–1449PubMedCrossRef
20.
go back to reference Rasanen J, Wood DC, Weiner S, Ludomirski A, Huhta JC (1996) Role of the pulmonary circulation in the distribution of human fetal cardiac output during the second half of pregnancy. Circulation 94:1068–1073PubMedCrossRef Rasanen J, Wood DC, Weiner S, Ludomirski A, Huhta JC (1996) Role of the pulmonary circulation in the distribution of human fetal cardiac output during the second half of pregnancy. Circulation 94:1068–1073PubMedCrossRef
21.
go back to reference Rizzo G, Capponi A, Chaoui R, Taddei F, Arduini D, Romanini C (1996) Blood flow velocity waveforms from peripheral pulmonary arteries in normally grown and growth-retarded fetuses. Ultrasound Obstet Gynecol 8:87–92PubMedCrossRef Rizzo G, Capponi A, Chaoui R, Taddei F, Arduini D, Romanini C (1996) Blood flow velocity waveforms from peripheral pulmonary arteries in normally grown and growth-retarded fetuses. Ultrasound Obstet Gynecol 8:87–92PubMedCrossRef
22.
go back to reference Rizzo G, Capponi A, Angelini E, Mazzoleni A, Romanini C (2000) Blood flow velocity waveforms from fetal peripheral pulmonary arteries in pregnancies with preterm premature rupture of the membranes: relationship with pulmonary hypoplasia. Ultrasound Obstet Gynecol 15:98–103PubMedCrossRef Rizzo G, Capponi A, Angelini E, Mazzoleni A, Romanini C (2000) Blood flow velocity waveforms from fetal peripheral pulmonary arteries in pregnancies with preterm premature rupture of the membranes: relationship with pulmonary hypoplasia. Ultrasound Obstet Gynecol 15:98–103PubMedCrossRef
23.
go back to reference Royston P, Wright EM (1998) How to construct ‘normal ranges’ for fetal variables. Ultrasound Obstet Gynecol 11:30–38PubMedCrossRef Royston P, Wright EM (1998) How to construct ‘normal ranges’ for fetal variables. Ultrasound Obstet Gynecol 11:30–38PubMedCrossRef
24.
go back to reference Taddei F, Chaoui R, Lenz F, Bast C, Kalache K, Heling KS, Bollmann R (1997) Doppler Assessment of the fetal right and left pulmonary arteries in relation to fetal position and gestational age. Ultraschall in Med 18:14–18CrossRef Taddei F, Chaoui R, Lenz F, Bast C, Kalache K, Heling KS, Bollmann R (1997) Doppler Assessment of the fetal right and left pulmonary arteries in relation to fetal position and gestational age. Ultraschall in Med 18:14–18CrossRef
25.
go back to reference Wellek S, Merz E (1995) Age related reference ranges for growth parameters. Meth Infom Med 4:523–528 Wellek S, Merz E (1995) Age related reference ranges for growth parameters. Meth Infom Med 4:523–528
26.
go back to reference Yoshimura S, Masuzaki H, Miura K, Muta K, Gotoh H, Ishimaru T (1999) Diagnosis of fetal pulmonary hypoplasia by measurement of blood flow velocity waveforms of pulmonary arteries with Doppler ultrasonography. Am J Obstet Gynecol 180:441–446PubMedCrossRef Yoshimura S, Masuzaki H, Miura K, Muta K, Gotoh H, Ishimaru T (1999) Diagnosis of fetal pulmonary hypoplasia by measurement of blood flow velocity waveforms of pulmonary arteries with Doppler ultrasonography. Am J Obstet Gynecol 180:441–446PubMedCrossRef
Metadata
Title
Advanced dynamic Doppler flow of the pulmonary artery in a normal population: reference values from 18 to 41 weeks of gestation calculated by automatic Doppler waveform analysis
Authors
M. Fittschen
I. Reinhard
S. Wellek
S. Friedrichs
F. Bahlmann
Publication date
01-05-2014
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 5/2014
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-013-3071-x

Other articles of this Issue 5/2014

Archives of Gynecology and Obstetrics 5/2014 Go to the issue

General Gynecology

Ovarian hydatid disease