RESUMEN
Objective: Potassium channels have an important role in the vascular adaptation during pregnancy and a reduction in the expression of adenosine triphosphate-sensitive potassium channels (Katp) has been linked to preeclampsia. Activation of Katp induces vasodilation; however, no previous study has been conducted to evaluate the effects of the inhibition of these channels in the contractility of preeclamptic arteries. Glibenclamide is an oral antihyperglycemic agent that inhibits Katp and has been widely used in vascular studies. Methods: To investigate the effects of the inhibition of Katp, umbilical arteries of preeclamptic women and women with healthy pregnancies were assessed by vascular contractility experiments, in the presence or absence of glibenclamide. The umbilical arteries were challenged with cumulative concentrations of potassium chloride (KCl) and serotonin. Results: There were no differences between the groups concerning the maternal age and gestational age of the patients. The percentage of smokers, caucasians and primiparae per group was also similar. On the other hand, blood pressure parameters were elevated in the preeclamptic group. In addition, the preeclamptic group presented a significantly higher body mass index. The newborns of both groups presented similar APGAR scores and weights. Conclusion: In the presence of glibenclamide, there was an increase in the KCl-induced contractions only in vessels from the PE group, showing a possible involvement of these channels in the disorder.
Asunto(s)
Gliburida , Preeclampsia , Arterias Umbilicales , Humanos , Femenino , Embarazo , Preeclampsia/fisiopatología , Arterias Umbilicales/fisiopatología , Adulto , Gliburida/farmacología , Vasoconstricción/efectos de los fármacos , Adulto Joven , Canales KATP/metabolismo , Cloruro de Potasio/farmacologíaRESUMEN
OBJECTIVE: To evaluate the association between Doppler patterns in fetuses with Down syndrome (DS) and their placental histopathologic findings. METHODS: A retrospective cross-sectional study was performed by collecting data from medical records of singleton pregnancies between January 2014 and January 2022, whose fetuses had a confirmed diagnosis of DS either prenatally or postnatally. Placental histopathology, maternal characteristics, and prenatal ultrasound (biometric parameters and umbilical artery [UA] Doppler) were evaluated. RESULTS: Of 69 eligible pregnant women, 61 met the inclusion and exclusion criteria. In the sample, 15 fetuses had an estimated fetal weight < 10th percentile for gestational age (GA) and were considered small for gestational age (SGA). Thirty-eight fetuses had increased resistance on the UA Doppler. Histologic changes were detected in 100% of the placentas, the most common being delayed villous maturation, alterations associated with poor fetal vascular perfusion, and villous dysmorphism. More than 50% of the placentas showed alterations related to placental insufficiency. We did not observe a statistically significant association between UA Doppler examination and placental alterations. All placentas analyzed in the SGA subgroup showed findings compatible with placental insufficiency. CONCLUSION: We found no statistically significant association between placental histopathologic findings and UA Doppler abnormalities in fetuses with DS. The placental alterations identified were delayed villous maturation, alterations associated with poor fetal vascular perfusion, and villous dysmorphism.
Asunto(s)
Síndrome de Down , Placenta , Ultrasonografía Prenatal , Humanos , Femenino , Síndrome de Down/diagnóstico por imagen , Síndrome de Down/complicaciones , Síndrome de Down/fisiopatología , Embarazo , Estudios Transversales , Estudios Retrospectivos , Ultrasonografía Prenatal/métodos , Adulto , Placenta/diagnóstico por imagen , Placenta/patología , Placenta/irrigación sanguínea , Hemodinámica/fisiología , Ultrasonografía Doppler/métodos , Arterias Umbilicales/diagnóstico por imagen , Arterias Umbilicales/fisiopatología , Feto/diagnóstico por imagenRESUMEN
OBJECTIVE: To compare Doppler ultrasonographic measurements of the fetal middle cerebral artery peak systolic velocity (MCA PSV) among women with or without gestational diabetes mellitus (GDM). METHODS: A cross-sectional study was conducted among pregnant women who presented for prenatal care at a single hospital in Brazil between September 11, 2015, and January 6, 2017. Patients were stratified into a group with GDM and a control group without GDM. One Doppler ultrasonographic assessment was performed per participant. This measurement was made after diagnosis but before the start of treatment among women in the GDM group. Fetal ultrasonographic and biometric variables assessed included MCA PSV, MCA pulsatility index, umbilical artery pulsatility index, the MCA-to-umbilical artery ratio, abdominal circumference, and weight. RESULTS: The study included 238 women: 115 in the GDM group and 123 in the control group. The median MCA PSV was 1.02 in the GDM group and 1.08 in the control group (P=0.036). No statistically significant between-group differences were found for the other fetal ultrasonographic variables or for the fetal biometric variables assessed. None of the maternal or fetal parameters assessed displayed a linear correlation with MCA PSV. CONCLUSION: Doppler ultrasonographic measurements of MCA PSV were lowered among the fetuses of women diagnosed with GDM.
Asunto(s)
Diabetes Gestacional/fisiopatología , Arteria Cerebral Media/diagnóstico por imagen , Arterias Umbilicales/diagnóstico por imagen , Adulto , Velocidad del Flujo Sanguíneo , Brasil , Estudios de Casos y Controles , Estudios Transversales , Femenino , Feto/irrigación sanguínea , Humanos , Arteria Cerebral Media/embriología , Arteria Cerebral Media/fisiopatología , Embarazo , Atención Prenatal , Ultrasonografía Doppler , Ultrasonografía Prenatal , Arterias Umbilicales/irrigación sanguínea , Arterias Umbilicales/fisiopatologíaRESUMEN
OBJECTIVE: The objective of the study was to establish the risk of fetal death in early-onset growth-restricted fetuses with absent or reversed end-diastolic velocities in the umbilical artery or ductus venosus. DATA SOURCES: A systematic search was performed to identify relevant studies published in English, Spanish, French, Italian, or German using the databases PubMed, ISI Web of Science, and SCOPUS, without publication time restrictions. STUDY ELIGIBILITY CRITERIA: The study criteria included observational cohort studies and randomized controlled trials of early-onset growth-restricted fetuses (diagnosed before 34 weeks of gestation), with information on the rate of fetal death occurring before 34 weeks of gestation and absent or reversed end-diastolic velocities in the umbilical artery and/or ductus venosus. STUDY APPRAISAL AND SYNTHESIS METHODS: For quality assessment, 2 reviewers independently assessed the risk of bias using the Newcastle-Ottawa Scale for observational studies and the Cochrane Collaboration's tool for randomized trials. For the meta-analysis, odds ratio for both fixed and random-effects models (weighting by inverse of variance) were used. Heterogeneity between studies was assessed using tau2, χ2 (Cochrane Q), and I2 statistics. Publication bias was assessed by a funnel plot for meta-analyses and quantified by the Egger method. RESULTS: A total of 31 studies were included in this meta-analysis. The odds ratios for fetal death (random-effects models) were 3.59 (95% confidence interval, 2.3-5.6), 7.27 (95% confidence interval, 4.6-11.4), and 11.6 (95% confidence interval, 6.3-19.7) for growth-restricted fetuses with umbilical artery absent end-diastolic velocities, umbilical artery reversed end-diastolic velocities, and ductus venosus absent or reversed end-diastolic velocities, respectively. There was no substantial heterogeneity among studies for any of the analyses. CONCLUSION: Early-onset growth-restricted fetuses with either umbilical artery or ductus venosus absent or reserved end-diastolic velocities are at a substantially increased risk for fetal death.
Asunto(s)
Muerte Fetal , Retardo del Crecimiento Fetal/epidemiología , Arterias Umbilicales/fisiopatología , Venas Umbilicales/fisiopatología , Velocidad del Flujo Sanguíneo , Diástole , Femenino , Retardo del Crecimiento Fetal/fisiopatología , Edad Gestacional , Humanos , Embarazo , Riesgo , Ultrasonografía Prenatal , Arterias Umbilicales/diagnóstico por imagen , Venas Umbilicales/diagnóstico por imagenRESUMEN
PURPOSE:: To evaluate the effects of enoxaparin and unfractionated heparin (UFH) administered in prophylactic and therapeutic doses on fetal vessels in healthy pregnant Wistar rats, according to Doppler velocimetry measurements. METHODS:: Fifty animals were assigned to one of five groups: controls (saline), prophylactic and therapeutic enoxaparin (1 and 2 mg/kg/day, respectively), and prophylactic and therapeutic UFH (72 and 400 UI/kg/day, respectively). Uterine horns were examined by ultrasound for identification of live fetuses. A sample of these fetuses underwent Doppler velocimetry. Spectral curves, peak systolic velocity (PSV), pulsatility index (PI), and resistance index (RI) of the middle cerebral artery, ductus venosus, and umbilical artery were investigated. Differences were considered statistically significant when p<0.05. RESULTS:: No significant differences in PSV, PI, or RI values were observed among the groups. CONCLUSION:: Doppler velocimetry measurements revealed no significant effects of enoxaparin or unfractionated heparin on fetal vessels in pregnant Wistar rats.
Asunto(s)
Anticoagulantes/farmacología , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Enoxaparina/farmacología , Feto/irrigación sanguínea , Heparina/farmacología , Arteria Cerebral Media/efectos de los fármacos , Arterias Umbilicales/efectos de los fármacos , Arteria Uterina/efectos de los fármacos , Animales , Ecocardiografía Doppler de Pulso/métodos , Femenino , Arteria Cerebral Media/fisiopatología , Modelos Animales , Embarazo , Ratas Wistar , Ultrasonografía Prenatal/métodos , Arterias Umbilicales/fisiopatología , Arteria Uterina/fisiopatología , Aumento de Peso/efectos de los fármacosRESUMEN
Abstract Purpose: To evaluate the effects of enoxaparin and unfractionated heparin (UFH) administered in prophylactic and therapeutic doses on fetal vessels in healthy pregnant Wistar rats, according to Doppler velocimetry measurements. Methods: Fifty animals were assigned to one of five groups: controls (saline), prophylactic and therapeutic enoxaparin (1 and 2 mg/kg/day, respectively), and prophylactic and therapeutic UFH (72 and 400 UI/kg/day, respectively). Uterine horns were examined by ultrasound for identification of live fetuses. A sample of these fetuses underwent Doppler velocimetry. Spectral curves, peak systolic velocity (PSV), pulsatility index (PI), and resistance index (RI) of the middle cerebral artery, ductus venosus, and umbilical artery were investigated. Differences were considered statistically significant when p<0.05. Results: No significant differences in PSV, PI, or RI values were observed among the groups. Conclusion: Doppler velocimetry measurements revealed no significant effects of enoxaparin or unfractionated heparin on fetal vessels in pregnant Wistar rats.
Asunto(s)
Animales , Femenino , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Heparina/farmacología , Enoxaparina/farmacología , Arteria Cerebral Media/efectos de los fármacos , Feto/irrigación sanguínea , Anticoagulantes/farmacología , Arterias Umbilicales/fisiopatología , Embarazo , Aumento de Peso/efectos de los fármacos , Ultrasonografía Prenatal/métodos , Ratas Wistar , Ecocardiografía Doppler de Pulso/métodos , Arteria Cerebral Media/fisiopatología , Modelos Animales , Arteria Uterina/fisiopatologíaRESUMEN
Objective: to evaluate neonatal morbidity and mortality in monochorionic- -diamniotic (MCDA) twin pregnancies complicated by selective intrauterine growth restriction (sIUGR) and non-selective intrauterine growth resctriction (nsIUGR). Methods: neonatal morbidity parameters and mortality were analyzed in 34 twins with IUGR (< 10th percentile on twins’ growth charts): 18 with sIUGR and 16 with nsIUGR. The sIUGR group was made up of 18 pregnancies in which growth was restricted in only one fetus (n = 18). The nsIUGR group was composed of 8 pregnancies in which both fetuses presented restricted growth (n = 16). Cases of twin-to-twin transfusion syndrome and fetal malformation were not included in the study. Results: the MCDA twin pregnancies with sIUGR had a higher rate of orotracheal intubation (p = 0.001) and mechanical ventilation (p = 0.0006), as well as longer than average fasting time (p = 0.014) compared to those in which the fetuses had nsIUGR. A higher incidence was also observed of types II and III umbilical artery Doppler velocimetry patterns in the sIUGR cases (p = 0.002). There was no significant difference between the two groups as to mortality during pregnancy and the neonatal period (p = 0.09). Conclusion: in MCDA twin pregnancies, sIUGR presents more severe umbilical artery Doppler velocimetry abnormalities and worse morbidity than nsIUGR. .
Objetivo: avaliar a morbidade e mortalidade neonatal em gestações monocoriônicas e diamnióticas (MCDA) acometidas pela restrição de crescimento fetal seletiva (RCFS) e não seletiva (RCFNS). Métodos: os parâmetros de morbidade e mortalidade neonatais foram avaliados em 34 gêmeos com RCF (abaixo do percentil 10 de uma curva de crescimento para gêgêmeos): 18 com RCFS e 16 com RCFNS. O grupo com RCFS teve origem em 18 gestações, em que somente um feto apresentava RCF. O grupo com RCFNS teve origem em 8 gestações em que ambos os fetos apresentavam RCF. Foram excluídos deste estudo casos da síndrome da transfusão feto-fetal e malformações fetais. Resultados: os gêmeos de gestações MCDA com RCFS apresentaram maior frequência de entubação orotraqueal (p=0,001), ventilação mecânica (p=0,0006) e maior tempo em jejum durante internação (p=0,014), quando comparados aos gêmeos de gestações MCDA com RCFNS. No grupo com RCFS, também foram observados maior frequência de tipos II e III de dopplervelocimetria de artéria umbilical (p=0,002). Não houve diferença significativa entre os grupos quanto à mortalidade neonatal (p=0,09). Conclusão: em gestações gemelares MCDA, a RCFS representa maior frequência de alterações severas na velocimetria Doppler da artéria umbilical e piores resultados na morbidade neonatal. .
Asunto(s)
Femenino , Humanos , Recién Nacido , Masculino , Embarazo , Retardo del Crecimiento Fetal , Mortalidad Perinatal , Gemelos Monocigóticos/estadística & datos numéricos , Arterias Umbilicales , Brasil/epidemiología , Estudios de Cohortes , Ayuno , Retardo del Crecimiento Fetal/epidemiología , Retardo del Crecimiento Fetal/mortalidad , Retardo del Crecimiento Fetal , Estudios de Seguimiento , Intubación Intratraqueal , Flujometría por Láser-Doppler/métodos , Tiempo de Internación , Morbilidad , Embarazo Gemelar , Respiración Artificial , Estudios Retrospectivos , Arterias Umbilicales/fisiopatología , Arterias UmbilicalesRESUMEN
Objetivo: Estudiar los resultados perinatales de fetos diagnosticados con flujo umbilical ausente en diástole en el Hospital Universitario de Canarias, España. Métodos: Estudio retrospectivo de gestantes con Doppler fetal umbilical con flujo diastólico ausente entre 2004 y 2011, excluyendo embarazos gemelares. Las variables estudiadas fueron: edad y enfermedades maternas, edad gestacional al diagnóstico y parto, vía de parto, Apgar y estado del recién nacido. Resultados: Se recogieron 57 casos. Hubo un 43 por ciento de gestantes hipertensas y 19 por ciento de diabéticas. La edad gestacional media al diagnóstico fue de 30+4 semanas. En el 89% de los casos se observó redistribución del flujo y en el 21 por ciento el Doppler umbilical fue reverso. El 28 por ciento se acompañó de oligoamnios y en el 26 por ciento el peso fetal estimado inferior al percentil 3. Hubo 3 muertes fetales. En el 80 por ciento de los casos la vía de parto fue por cesárea. La supervivencia fue del 83 por ciento con una tasa de mortalidad perinatal del 17 por ciento. En el seguimiento entre 1 y 6 años encontramos un 35 por ciento de niños sin secuelas. Conclusiones: En nuestra serie, el Doppler con flujo umbilical ausente en diástole se relaciona con alto riesgo de morbimortalidad perinatal. El 65 por ciento de los niños tendrán secuelas de algún tipo en el seguimiento entre 1 a 6 años. El momento óptimo para la extracción fetal debe ser individualizado y resuelto junto con el consejo pediátrico y participación de los padres.
Objective: To determine the perinatal outcome in fetal growth restriction were umbilical artery Doppler end diastolic flow was absent. Methods: A retrospective study performed at the Canary Islands University Hospital. All consecutive cases between 2004 and 2011 were included. We excluded twin pregnancies. Data was abstracted for maternal age, gestational age at diagnosis and delivery, mode of delivery, Apgar and perinatal adverse outcomes. Results: Fifty seven patients were included. Forty three percent had a pregnancy complicated by hypertension and 19 percent diabetes. Mean gestational age at diagnosis was 30+4 weeks. We found 89 percent and 21 percent absent umbilical artery end diastolic flow and reverse flow respectively. Oligohydramnios was seen in 28 percent of the cases. Fetal weight was below the third percentile in 26 percent of the cases. Fetal demise occurred in 3 cases. Mode of delivery was cesarean section in 80 percent of the cases. We found a rate of 17 percent perinatal mortality. At 1 to 6 years follow up 35 percent of the children had no sequelae. Conclusion: Absent end diastolic umbilical flow is associated with a high risk of perinatal mortality. Up to 65 percent of the children will show some type of sequelae. The optimal gestational date for fetal extraction should be individualized after multidisciplinary counseling.
Asunto(s)
Humanos , Adulto , Femenino , Arterias Umbilicales/fisiopatología , Feto/irrigación sanguínea , Retardo del Crecimiento Fetal/fisiopatología , Mortalidad Fetal , Resultado del Embarazo , Diagnóstico Prenatal , Flujo Pulsátil , Flujo Sanguíneo Regional , Estudios Retrospectivos , Ultrasonografía DopplerRESUMEN
OBJECTIVE: To elucidate the association between Doppler parameters and histological signs of placental underperfusion in late-onset small-for-gestational-age (SGA) babies. METHODS: Umbilical, fetal middle cerebral and uterine artery pulsatility indices and umbilical vein blood flow (UVBF), which had been recorded within 7 days prior to delivery, were analyzed from a cohort of SGA singleton pregnancies delivered after 34 weeks' gestation and confirmed as having a birth weight < 10(th) percentile by local standards. In each case, the placenta was histologically evaluated for signs of placental underperfusion using a hierarchical and standardized classification system. The independent association of the Doppler parameters with placental underperfusion was evaluated using logistic regression and decision tree analysis. RESULTS: In 51 cases (53.7%), there were 61 placental histological findings indicative of placental underperfusion. These cases had a significantly higher incidence of Cesarean section for non-reassuring fetal status (52.1% vs 11.9%; P < 0.001) and neonatal metabolic acidosis at birth (21.6% vs 0%; P = 0.001). Significant and independent contributions to the presence of placental underperfusion lesions were provided by increased mean UtA pulsatility index (PI) (P = 0.018; odds ratio (OR) 2 (95% CI, 1.1-3.7)) and decreased UVBF normalized to estimated fetal weight (P = 0.027; OR 0.97 (95% CI, 0.95-0.99)). The combination of both parameters revealed three groups with differing risks for placental underperfusion: normalized UVBF > 82 mL/min/kg (risk 31.3%), normalized UVBF ≤ 82 mL/min/kg and mean UtA-PI ≤ 95(th) percentile (risk 65.5%), and normalized UVBF ≤ 82 mL/min/kg and UtA-PI > 95(th) percentile (risk 94.4%). CONCLUSIONS: In late-onset SGA pregnancies, uterine Doppler and UVBF are surrogates for placental underperfusion. These findings facilitate phenotypic profiling of cases of fetal growth restriction among the general population of late-onset SGA babies.
Asunto(s)
Retardo del Crecimiento Fetal/patología , Hipoxia-Isquemia Encefálica/patología , Placenta/patología , Insuficiencia Placentaria/fisiopatología , Ultrasonografía Doppler en Color , Arterias Umbilicales/fisiopatología , Arteria Uterina/fisiopatología , Peso al Nacer , Femenino , Humanos , Hipoxia-Isquemia Encefálica/diagnóstico por imagen , Recién Nacido , Recién Nacido Pequeño para la Edad Gestacional , Masculino , Circulación Placentaria , Embarazo , Estudios Prospectivos , Ultrasonografía Prenatal , Arterias Umbilicales/diagnóstico por imagen , Arteria Uterina/diagnóstico por imagenRESUMEN
Through their control of cell membrane potential, potassium (K(+)) channels are among the best known regulators of vascular tone. This article discusses the expression and function of K(+) channels in human umbilical artery smooth muscle cells (HUASMCs). We review the bibliographic reports and also present single-channel data recorded in freshly isolated cells. Electrophysiological properties of big conductance, voltage- and Ca(2+)-sensitive K(+) channel and voltage-dependent K(+) channels are clearly established in this vessel, where they are involved in contractile state regulation. Their role in the maintenance of membrane potential is an important control mechanism in the determination of the vessel diameter. Additionally, small conductance Ca(2+)-sensitive K(+) channels, 2-pore domains K(+) channels and inward rectifier K(+) channels also appear to be present in HUASMCs, while intermediate conductance Ca(2+)-sensitive K(+) channels and ATP-sensitive K(+) channels could not be identified. In both cases, additional investigation is necessary to reach conclusive evidence of their expression and/or functional role in HUASMCs. Finally, we discuss the role of K(+) channels in pregnancy-related pathologies like gestational diabetes and preeclampsia.
Asunto(s)
Músculo Liso Vascular/metabolismo , Miocitos del Músculo Liso/metabolismo , Canales de Potasio/metabolismo , Potasio/metabolismo , Vasoconstricción , Diabetes Gestacional/metabolismo , Diabetes Gestacional/fisiopatología , Femenino , Humanos , Potenciales de la Membrana , Músculo Liso Vascular/fisiopatología , Preeclampsia/metabolismo , Preeclampsia/fisiopatología , Embarazo , Transducción de Señal , Arterias Umbilicales/metabolismo , Arterias Umbilicales/fisiopatologíaRESUMEN
OBJECTIVE: to evaluate neonatal morbidity and mortality in monochorionic-diamniotic (MCDA) twin pregnancies complicated by selective intrauterine growth restriction (sIUGR) and non-selective intrauterine growth resctriction (nsIUGR). METHODS: neonatal morbidity parameters and mortality were analyzed in 34 twins with IUGR (< 10th percentile on twins' growth charts): 18 with sIUGR and 16 with nsIUGR. The sIUGR group was made up of 18 pregnancies in which growth was restricted in only one fetus (n = 18). The nsIUGR group was composed of 8 pregnancies in which both fetuses presented restricted growth (n = 16). Cases of twin-to-twin transfusion syndrome and fetal malformation were not included in the study. RESULTS: the MCDA twin pregnancies with sIUGR had a higher rate of orotracheal intubation (p = 0.001) and mechanical ventilation (p = 0.0006), as well as longer than average fasting time (p = 0.014) compared to those in which the fetuses had nsIUGR. A higher incidence was also observed of types II and III umbilical artery Doppler velocimetry patterns in the sIUGR cases (p = 0.002). There was no significant difference between the two groups as to mortality during pregnancy and the neonatal period (p = 0.09). CONCLUSION: in MCDA twin pregnancies, sIUGR presents more severe umbilical artery Doppler velocimetry abnormalities and worse morbidity than nsIUGR.
Asunto(s)
Retardo del Crecimiento Fetal , Mortalidad Perinatal , Gemelos Monocigóticos/estadística & datos numéricos , Arterias Umbilicales , Brasil/epidemiología , Estudios de Cohortes , Ayuno , Femenino , Retardo del Crecimiento Fetal/diagnóstico por imagen , Retardo del Crecimiento Fetal/epidemiología , Retardo del Crecimiento Fetal/mortalidad , Estudios de Seguimiento , Humanos , Recién Nacido , Intubación Intratraqueal , Flujometría por Láser-Doppler/métodos , Tiempo de Internación , Masculino , Morbilidad , Embarazo , Embarazo Gemelar , Respiración Artificial , Estudios Retrospectivos , Ultrasonografía , Arterias Umbilicales/diagnóstico por imagen , Arterias Umbilicales/fisiopatologíaRESUMEN
OBJECTIVE: To examine the correlation of cardiac B-type natriuretic peptide (BNP) concentrations in umbilical cord blood at birth with fetal Doppler parameters and pH at birth. STUDY DESIGN: Prospective cross-sectional study with the following inclusion criteria: women with a singleton pregnancy, placental insufficiency characterized by increased pulsatility index (PI) of the umbilical artery (UA), intact membranes, and absence of fetal abnormalities. The exclusion criteria kept out cases of newborns with postnatal diagnosis of abnormality and cases in which the blood analysis was not performed. The Doppler parameters used were the UA PI, middle cerebral artery (MCA) PI, cerebroplacental ratio (CPR), and ductus venosus (DV) PI for veins (PIV), all converted into zeta scores. Blood samples were obtained from the umbilical cord immediately after delivery to measure the pH of the UA and the BNP. RESULTS: Thirty-two pregnancies with placental insufficiency were included, 21 (65%) with positive diastolic flow and 11 (35%) with absent or reversed end diastolic flow in the UA. The concentration of BNP correlated significantly with the UA PI z-score (rho=0.43, P=0.016), the CPR z-score (rho=-0.35, P=0.048), the DV PIV z-score (rho=0.61, P<0.001), pH at birth (rho=-0.39, P=0.031), and gestational age (rho=-0.51, P=0.003). In the multiple regression analysis, antenatal parameters were included; the DV PIV z-score (P=0.008) was found to be an independent parameter correlating with BNP at birth. Correlation between BNP and the DV PIV z-score was borne out by the regression equation Log[BNP]=2.34+0.13*DV (F=18.8, P<0.001). Correlation between BNP and pH at birth was confirmed by the regression equation Log[BNP]=21.36-2.62*pH (F=7.69, P=0.01). CONCLUSION: The results suggest that fetal cardiac dysfunction identified by BNP concentrations at birth correlated independently with changes in DV PIV and correlated negatively with pH values at birth.
Asunto(s)
Sangre Fetal/química , Péptido Natriurético Encefálico/análisis , Insuficiencia Placentaria/sangre , Adulto , Estudios Transversales , Femenino , Humanos , Concentración de Iones de Hidrógeno , Recién Nacido , Flujometría por Láser-Doppler , Arteria Cerebral Media/fisiopatología , Insuficiencia Placentaria/fisiopatología , Embarazo , Estudios Prospectivos , Arterias Umbilicales/fisiopatologíaRESUMEN
PURPOSE: To evaluate the anthropometric characteristics of morbidity and mortality of premature newborns (NB) of hypertensive mothers according to the presence or absence of flow (DZ) or reverse (DR) diastolic flow in the dopplervelocimetry of the umbilical artery. METHODS: A prospective study was conducted on preterm newborns of pregnant women with hypertension between 25 and 33 weeks of gestational age, submitted to umbilical artery Doppler study during the five days before delivery. Delivery occurred at Hospital Regional da Asa Sul, Brasília - Federal District, between November 1st, 2009 and October 31st, 2010. The infants were stratified into two groups according to the results of Doppler velocimetry: Gdz/dr=absent end-diastolic velocity waveform or reversed end-diastolic velocity waveform, and Gn=normal Doppler velocimetry. Anthropometric measurements at birth, neonatal morbidity, and mortality were compared between the two groups. RESULTS: We studied 92 infants, as follows: Gdz/dr=52 infants and Gn=40 infants. In Gdz/dr, the incidence of infants small for gestational age was significantly greater, with a relative risk of 2.5 (95%CI 1.7 - 3.7). In Gdz/dr, infants remained on mechanical ventilation for a longer time: median 2 (0â28) and Gn median 0.5 (0â25) p=0.03. The need for oxygen at 28 days was higher in G dz/dr comparing to Gn (33 versus 10%; p=0.01). Neonatal mortality was higher in Gdz/dr compared to Gn (36 versus 10%; p=0.03; relative risk of 1.6; 95%CI 1.2â2.2). Logistic regression showed that, with each 100 grams lower birth weight, the chance of death increased 6.7 times in G dz/dr (95%CI 2.0 - 11.3; p<0.01). CONCLUSION: In preterm infants of mothers with hypertensive changes in Doppler velocimetry of the umbilical artery, intrauterine growth restriction and neonatal prognosis are often worse, with a high risk of death related to birth weight.
Asunto(s)
Hipertensión Inducida en el Embarazo/fisiopatología , Hipertensión/fisiopatología , Flujo Sanguíneo Regional , Arterias Umbilicales/fisiopatología , Adulto , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Embarazo , Resultado del Embarazo , Estudios ProspectivosRESUMEN
OBJETIVO: Avaliar as características antropométricas, a morbidade e mortalidade de recém-nascidos (RN) prematuros nascidos vivos de mães hipertensas em função da presença ou não de diástole zero (DZ) ou reversa (DR) na doplervelocimetria arterial umbilical. MÉTODOS: Estudo prospectivo, envolvendo RN prematuros nascidos vivos de gestantes hipertensas, com idade gestacional entre 25 e 33 semanas, submetidas à doplervelocimetria da artéria umbilical nos 5 dias que antecederam o parto, realizado no Hospital do Distrito Federal, entre 1º de novembro de 2009 e 31 de outubro de 2010. Os RN foram estratificados em dois grupos, conforme o resultado da doplervelocimetria da artéria umbilical: Gdz/dr=presença de diástole zero (DZ) ou diástole reversa (DR) e Gn=doplervelocimetria normal. Medidas antropométricas ao nascimento, morbidades e mortalidade neonatal foram comparadas entre os dois grupos. RESULTADOS: Foram incluídos 92 RN, assim distribuídos: Gdz/dr=52 RN e Gn=40 RN. No Gdz/dr a incidência de RN pequenos para idade gestacional foi significativamente maior, com risco relativo de 2,5 (IC95% 1,7‒3,7). No grupo Gdz/dr os RN permaneceram mais tempo em ventilação mecânica mediana 2 (0‒28) e no Gn mediana 0,5 (0‒25), p=0,03. A necessidade de oxigênio aos 28 dias de vida foi maior no Gdz/dr do que no Gn (33 versus10%; p=0,01). A mortalidade neonatal foi maior em Gdz/dr do que em Gn (36 versus 10%; p=0,03; com risco relativo de 1,6; IC95% 1,2 - 2,2). Nessa amostra a regressão logística mostrou que a cada 100 gramas a menos de peso ao nascer no Gdz/dr a chance de óbito aumentou 6,7 vezes (IC95% 2,0 - 11,3; p<0,01). CONCLUSÃO: Em RN prematuros de mães hipertensas com alteração na doplervelocimetria da artéria umbilical a restrição do crescimento intrauterino é frequente e o prognóstico neonatal pior, sendo elevado o risco de óbito relacionado ao peso ao nascimento.
PURPOSE: To evaluate the anthropometric characteristics of morbidity and mortality of premature newborns (NB) of hypertensive mothers according to the presence or absence of flow (DZ) or reverse (DR) diastolic flow in the dopplervelocimetry of the umbilical artery. METHODS: A prospective study was conducted on preterm newborns of pregnant women with hypertension between 25 and 33 weeks of gestational age, submitted to umbilical artery Doppler study during the five days before delivery. Delivery occurred at Hospital Regional da Asa Sul, Brasília - Federal District, between November 1st, 2009 and October 31st, 2010. The infants were stratified into two groups according to the results of Doppler velocimetry: Gdz/dr=absent end-diastolic velocity waveform or reversed end-diastolic velocity waveform, and Gn=normal Doppler velocimetry. Anthropometric measurements at birth, neonatal morbidity, and mortality were compared between the two groups. RESULTS: We studied 92 infants, as follows: Gdz/dr=52 infants and Gn=40 infants. In Gdz/dr, the incidence of infants small for gestational age was significantly greater, with a relative risk of 2.5 (95%CI 1.7 - 3.7). In Gdz/dr, infants remained on mechanical ventilation for a longer time: median 2 (0‒28) and Gn median 0.5 (0‒25) p=0.03. The need for oxygen at 28 days was higher in G dz/dr comparing to Gn (33 versus 10%; p=0.01). Neonatal mortality was higher in Gdz/dr compared to Gn (36 versus 10%; p=0.03; relative risk of 1.6; 95%CI 1.2‒2.2). Logistic regression showed that, with each 100 grams lower birth weight, the chance of death increased 6.7 times in G dz/dr (95%CI 2.0 - 11.3; p<0.01). CONCLUSION: In preterm infants of mothers with hypertensive changes in Doppler velocimetry of the umbilical artery, intrauterine growth restriction and neonatal prognosis are often worse, with a high risk of death related to birth weight.
Asunto(s)
Adulto , Femenino , Humanos , Recién Nacido , Embarazo , Hipertensión Inducida en el Embarazo/fisiopatología , Hipertensión/fisiopatología , Flujo Sanguíneo Regional , Arterias Umbilicales/fisiopatología , Recien Nacido Prematuro , Resultado del Embarazo , Estudios ProspectivosRESUMEN
Placental vascular tone is critically influenced by nitric oxide (NO) derived from endothelial NO synthase (eNOS) activity. Placental vessels from pregnancies complicated with intrauterine growth restriction present altered NOS-dependent vasodilation. Arginase-2 competes with eNOS for l-arginine and counteracts the NOS-dependent relaxation in umbilical vessels from normal pregnancies. However there is no data regarding the contribution of arginase activity on the impaired endothelial function in IUGR placenta. We studied whether arginase-2 participates in IUGR-related placental vascular dysfunction counteracting eNOS-dependent relaxation, and the regulation of arginase-2 and eNOS expression in endothelial cells from IUGR umbilical arteries (HUAEC) and veins (HUVEC). In IUGR-derived umbilical arteries (UA) and veins (UV), and chorionic arteries (CA), NOS-dependent vasoactive response in the presence and absence of BEC (arginase inhibitor) was studied. Protein levels of eNOS (total and Ser(1177)-P-eNOS), arginase-2 and arginase activity were determined in IUGR HUAEC and HUVEC. In IUGR vessels eNOS-dependent relaxation was reduced, being improved by BEC. This effect was higher in arteries than veins, and in chorionic compared with umbilical vessels. In cultured IUGR endothelial cells, arginase-2 protein expression and activity were increased in HUVEC, without changes in HUAEC. In IUGR-derived endothelium there was a generalized reduction in the in vitro eNOS activation (Ser(1177)-P-eNOS/eNOS), and therefore a decreased eNOS/arginase activity ratio. Here we provide ex vivo and in vitro evidence for a vascular role of arginase throughout placental vasculature, negatively controlling NOS activity. This effect seems to be crucial in the pathophysiology of endothelial dysfunction present in IUGR feto-placental vessels.
Asunto(s)
Arginasa/metabolismo , Vasos Sanguíneos/fisiopatología , Células Endoteliales/metabolismo , Retardo del Crecimiento Fetal/fisiopatología , Óxido Nítrico Sintasa de Tipo III/metabolismo , Placenta/irrigación sanguínea , Arterias Umbilicales/fisiopatología , Adulto , Arginasa/fisiología , Vasos Sanguíneos/metabolismo , Vasos Sanguíneos/patología , Células Cultivadas , Células Endoteliales/patología , Células Endoteliales/fisiología , Femenino , Retardo del Crecimiento Fetal/metabolismo , Retardo del Crecimiento Fetal/patología , Células Endoteliales de la Vena Umbilical Humana/metabolismo , Células Endoteliales de la Vena Umbilical Humana/patología , Células Endoteliales de la Vena Umbilical Humana/fisiología , Humanos , Recién Nacido , Masculino , Óxido Nítrico Sintasa de Tipo III/fisiología , Placenta/metabolismo , Placenta/patología , Circulación Placentaria/fisiología , Embarazo , Arterias Umbilicales/metabolismo , Arterias Umbilicales/patologíaRESUMEN
OBJECTIVE: To assess the value of gestational age and cardiovascular Doppler indices in predicting perinatal mortality in a multicenter cohort of early-onset intrauterine growth-restricted (IUGR) fetuses. METHODS: A multicenter prospective cohort study including 157 early-onset (<34 weeks) IUGR cases with abnormal umbilical artery (UA) Doppler was conducted. Cardiovascular assessment included the ductus venosus (DV), the aortic isthmus flow index (IFI), and the myocardial performance index (MPI). Isolated and combined values to predict the risk of perinatal death were evaluated by logistic regression and by decision tree analysis, where the gestational age at delivery, UA, and middle cerebral artery (MCA) were also included as covariates. RESULTS: Perinatal mortality was 17% (27/157). All parameters were significantly associated with perinatal death, with individual odds ratios (OR) of 25.2 for gestational age below 28 weeks, 12.1 for absent/reversed DV atrial flow, 5.3 for MCA pulsatility index <5th centile, 4.6 for UA absent/reversed diastolic end-flow, 1.8 for IFI <5th centile, and 1.6 for MPI >95th centile. Decision tree analysis identified gestational age at birth as the best predictor of death (<26 weeks, 93% mortality; 26-28 weeks, 29% mortality, and >28 weeks, 3% mortality). Between 26 and 28 weeks, DV atrial flow allowed further stratification between high (60%) and low risk (18%) of mortality. CONCLUSIONS: Gestational age largely determines the risk of perinatal mortality in early-onset IUGR before 26 weeks and later than 28 weeks of gestation. The DV may improve clinical management by stratifying the probability of death between 26 and 28 weeks of gestation.
Asunto(s)
Retardo del Crecimiento Fetal/mortalidad , Retardo del Crecimiento Fetal/fisiopatología , Edad Gestacional , Arterias Umbilicales/anomalías , Arterias Umbilicales/diagnóstico por imagen , Enfermedades Vasculares/diagnóstico por imagen , Enfermedades Vasculares/etiología , Aorta/anomalías , Aorta/diagnóstico por imagen , Aorta/embriología , Aorta/fisiopatología , Bélgica/epidemiología , Chile/epidemiología , Estudios de Cohortes , Femenino , Desarrollo Fetal , Humanos , Procesamiento de Imagen Asistido por Computador , Estudios Longitudinales , Arteria Cerebral Media/anomalías , Arteria Cerebral Media/diagnóstico por imagen , Arteria Cerebral Media/embriología , Arteria Cerebral Media/fisiopatología , Embarazo , Estudios Prospectivos , Riesgo , España/epidemiología , Ultrasonografía Doppler , Ultrasonografía Prenatal , Arterias Umbilicales/embriología , Arterias Umbilicales/fisiopatología , Enfermedades Vasculares/embriología , Enfermedades Vasculares/fisiopatologíaRESUMEN
OBJECTIVES: To identify potential associations between fetal surveillance tests and acidosis at birth in pregnancies with abnormal but positive end-diastolic velocity in the umbilical artery. METHODS: A prospective case-control study [group 1: pH < 7.2; group 2: pH ≥ 7.2] including 46 fetuses with abnormal but positive end-diastolic velocity in the umbilical artery was conducted between February 2007 and March 2009. Outcome variables were evaluated by univariate analysis and compared between the two groups. Clinically relevant and statistically significant variables were analyzed by logistic regression. RESULTS: Abnormal nonstress test, presence of deceleration, and absent fetal breathing movements were statistically significant. Logistic regression analysis revealed that fetal heart rate (FHR) deceleration in the nonstress test is the only predictor of fetal acidosis at birth (p = 0.024; OR = 8.2; 95%CI: 1.2-52). CONCLUSIONS: In fetuses with positive end-diastolic flow velocity, acute variables of the antenatal surveillance tests are correlated with acidosis at birth and FHR deceleration in the nonstress test is the only predictor of fetal acidosis.
Asunto(s)
Acidosis/diagnóstico , Velocidad del Flujo Sanguíneo/fisiología , Enfermedades Fetales/diagnóstico , Tamizaje Neonatal/métodos , Parto , Flujo Pulsátil/fisiología , Arterias Umbilicales/fisiopatología , Acidosis/diagnóstico por imagen , Acidosis/fisiopatología , Adolescente , Adulto , Estudios de Casos y Controles , Diástole , Femenino , Enfermedades Fetales/diagnóstico por imagen , Enfermedades Fetales/fisiopatología , Indicadores de Salud , Humanos , Concentración de Iones de Hidrógeno , Recién Nacido , Enfermedades del Recién Nacido/diagnóstico , Enfermedades del Recién Nacido/fisiopatología , Masculino , Persona de Mediana Edad , Parto/sangre , Parto/metabolismo , Parto/fisiología , Embarazo , Pronóstico , Ultrasonografía , Arterias Umbilicales/diagnóstico por imagen , Adulto JovenRESUMEN
OBJECTIVES: To evaluate the effect of transdermal nitroglycerin on Doppler velocity waveforms of the uterine, umbilical and fetal middle cerebral arteries in patients with severe pre-eclampsia. METHODS: This was a prospective study of 30 singleton pregnancies (gestational age range: 24-31 weeks) with severe pre-eclampsia and abnormal uterine and umbilical artery Doppler waveforms. We compared maternal blood pressure as well as the resistance index (RI) and the pulsatility index (PI) of the uterine, umbilical and fetal middle cerebral arteries before and after application of a transdermal nitroglycerin patch (average dose 0.4 mg/h) for a period of 3 days. Intra-day comparisons before and after administration of nitroglycerin and a comparison between days 0 (no patch) and 3 after administration of the first dose of nitroglycerin were performed using ANOVA for paired samples. RESULTS: A significant decrease in the PI and RI of the uterine (25.3 ± 4.9% and 21.2 ± 6.2%, respectively, P < 0.001) and umbilical (23.1 ± 6.9% and 19.7 ± 6.1%, respectively, P < 0.001) arteries was noted when comparing the first day without medication against the third day with the patch. No significant change in the PI and RI of the middle cerebral artery was observed. The mean arterial blood pressure decreased from 119.5 ± 4.5 mmHg to 114.8 ± 4.4 mmHg (P < 0.05). CONCLUSION: The use of transdermal nitroglycerin in patients with severe pre-eclampsia is associated with a significant reduction in the RI and PI of the uterine and umbilical arteries, as well as of maternal blood pressure. Transdermal nitroglycerin does not affect the RI and PI of the fetal middle cerebral artery.
Asunto(s)
Velocidad del Flujo Sanguíneo/efectos de los fármacos , Arteria Cerebral Media/efectos de los fármacos , Nitroglicerina/farmacología , Insuficiencia Placentaria/tratamiento farmacológico , Preeclampsia/tratamiento farmacológico , Arterias Umbilicales/efectos de los fármacos , Resistencia Vascular/efectos de los fármacos , Adulto , Femenino , Edad Gestacional , Humanos , Arteria Cerebral Media/diagnóstico por imagen , Arteria Cerebral Media/embriología , Arteria Cerebral Media/fisiopatología , Nitroglicerina/administración & dosificación , Insuficiencia Placentaria/diagnóstico por imagen , Insuficiencia Placentaria/fisiopatología , Preeclampsia/diagnóstico por imagen , Preeclampsia/fisiopatología , Embarazo , Estudios Prospectivos , Ultrasonografía Doppler , Ultrasonografía Prenatal , Arterias Umbilicales/diagnóstico por imagen , Arterias Umbilicales/fisiopatología , Útero/irrigación sanguínea , Útero/diagnóstico por imagen , Útero/efectos de los fármacosRESUMEN
PURPOSE: To evaluate the antenatal and postnatal risk factors of neonatal death in pregnancies with absent (DZ) or reverse (DR) end-diastolic flow in the umbilical artery. METHODS: A cross-sectional retrospective study based on data from 48 medical records of singleton pregnancies with DZ or DR, and gestational age of 24 to 34 weeks, at a maternity in the Brazilian Northeast. Mean age was 27.3 (SD: 7.9) years. Twenty (41.7%) patients were primiparas. Hypertensive disorders were found in 44 (91.7%) cases. Thirty-five women (72.9%) had DZ and 13 (27.1%) had DR. Univariate analysis was firstly done (Student's t-test and Fisher's exact test) correlating the parameters with the assessed outcome (neonatal death). Variables that showed significant association were included in the logistic regression model (Wald statistics). The level of significance was set at 5%. RESULTS: The perinatal mortality rate was 64.6% (31/48). There were five stillbirths and 26 neonatal deaths. The mean gestational age at diagnosis was 27.9 (SD: 2.8) weeks. Deliveries before 24 hours after diagnosis occurred in 52.1% of the cases. Cesarean section was performed in 85.4% of the sample. The newborns weighed 975.9 g on average (SD: 457.5). Twenty-four (57.1%) presented Apgar scores below 7 in the first minute and 21.4% in the fifth minute. Gestational age at diagnosis, birth weight and Apgar of the first minute proved to be variables significantly related to neonatal death (p values were: 0.008, 0.004, and 0.020, respectively). The Odds Ratio was 6.6, 25.3 and 13.8 for neonatal death, when the diagnosis was established at the 28th week, weight was <1000 g and first minute Apgar score was <7, respectively. CONCLUSIONS: Gestational age at diagnosis, birth weight and Apgar score at the first minute were factors that could predict neonatal death in pregnancies with DV or DR determined by umbilical artery Doppler velocimetry.
Asunto(s)
Diástole , Enfermedades Fetales/mortalidad , Enfermedades del Recién Nacido/mortalidad , Flujometría por Láser-Doppler , Complicaciones Cardiovasculares del Embarazo/fisiopatología , Arterias Umbilicales/fisiopatología , Estudios Transversales , Femenino , Humanos , Recién Nacido , Valor Predictivo de las Pruebas , Embarazo , Estudios RetrospectivosRESUMEN
OBJETIVO: avaliar os fatores de risco antenatais e pós-natais para o óbito neonatal em gestações com diástole zero (DZ) ou reversa (DR) na doplervelocimetria da artéria umbilical. MÉTODOS: estudo transversal, retrospectivo, inferencial, a partir de 48 prontuários de gestações únicas com DZ ou DR, idade gestacional entre 24 e 34 semanas, em uma maternidade no Nordeste do Brasil. A média de idade foi de 27,3 anos (DP: 7,9). Vinte (41,7 por cento) eram primigestas. Síndromes hipertensivas foram observadas em 44 (91,7 por cento) casos. Trinta e cinco (72,9 por cento) apresentavam DZ e 13 (27,1 por cento) DR. Procedeu-se inicialmente à análise univariada (teste t de Student e teste Exato de Fisher), relacionando os parâmetros com o desfecho avaliado (óbito neonatal). As variáveis que apresentaram associação significativa foram incluídas no modelo de regressão logística (Estatística de Wald). O nível de significância utilizado foi de 5 por cento. RESULTADOS: a mortalidade perinatal foi de 64,6 por cento (31/48). Ocorreram cinco óbitos fetais e 26 neonatais. A média de idade gestacional no momento do diagnóstico foi de 27,9 (DP: 2,8) semanas. A resolução da gestação antes de 24 horas após o diagnóstico ocorreu em 52,1 por cento dos casos. Parto abdominal foi realizado em 85,4 por cento dos casos. Os recém-nascidos pesaram em média 975,9 g (DP: 457,5). Vinte e quatro (57,1 por cento) apresentaram Apgar menor que 7 no primeiro minuto e 21,4 por cento, no quinto. A idade gestacional no momento do diagnóstico, o peso ao nascer e o Apgar de primeiro minuto revelaram-se variáveis significativamente relacionadas com o óbito neonatal (valores de p foram, respectivamente, 0,008; 0,004 e 0,020). As razões de chance foi de 6,6; 25,3 e 13,8 para o óbito neonatal, quando o diagnóstico foi estabelecido até a 28ª semana, peso <1000 g e Apgar < 7, respectivamente. CONCLUSÕES: idade gestacional no momento do diagnóstico, peso ao nascer e Apgar de primeiro minuto foram fatores capazes de predizer o óbito neonatal em gestações com DZ ou DR na doplervelocimetria da artéria umbilical.
PURPOSE: to evaluate the antenatal and postnatal risk factors of neonatal death in pregnancies with absent (DZ) or reverse (DR) end-diastolic flow in the umbilical artery. METHODS: a cross-sectional retrospective study based on data from 48 medical records of singleton pregnancies with DZ or DR, and gestational age of 24 to 34 weeks, at a maternity in the Brazilian Northeast. Mean age was 27.3 (SD: 7.9) years. Twenty (41.7 percent) patients were primiparas. Hypertensive disorders were found in 44 (91.7 percent) cases. Thirty-five women (72.9 percent) had DZ and 13 (27.1 percent) had DR. Univariate analysis was firstly done (Student's t-test and Fisher's exact test) correlating the parameters with the assessed outcome (neonatal death). Variables that showed significant association were included in the logistic regression model (Wald statistics). The level of significance was set at 5 percent. RESULTS: The perinatal mortality rate was 64.6 percent (31/48). There were five stillbirths and 26 neonatal deaths. The mean gestational age at diagnosis was 27.9 (SD: 2.8) weeks. Deliveries before 24 hours after diagnosis occurred in 52.1 percent of the cases. Cesarean section was performed in 85.4 percent of the sample. The newborns weighed 975.9 g on average (SD: 457.5). Twenty-four (57.1 percent) presented Apgar scores below 7 in the first minute and 21.4 percent in the fifth minute. Gestational age at diagnosis, birth weight and Apgar of the first minute proved to be variables significantly related to neonatal death (p values were: 0.008, 0.004, and 0.020, respectively). The Odds Ratio was 6.6, 25.3 and 13.8 for neonatal death, when the diagnosis was established at the 28th week, weight was <1000 g and first minute Apgar score was <7, respectively. CONCLUSIONS: gestational age at diagnosis, birth weight and Apgar score at the first minute were factors that could predict neonatal death in pregnancies with DV or DR determined by umbilical artery Doppler velocimetry.