Evaluation Of Foetal Cardiac Function In Single Umbilical Artery And The Expression Of VEGF Protein In The Placenta

Objective: To investigate the changes in cardiac systolic function in foetuses with an isolated single umbilical artery(ISUA)and in normal foetuses by applying the time-space composite imaging M-mode ultrasound(STIC-M)and Doppler technology in the second and third trimesters.Ventricular diastolic functions in foetuses with ISUA and normal foetuses in the third trimester were evaluated using spectral Doppler of the blood flow in the foetal pulmonary vein(PV)and ductus venosus(DV).The umbilical cord cross-sectional area,umbilical artery and middle cerebral artery spectrum were measured to evaluate the foetal haemodynamic changes between the ISUA and control groups.Methods: A prospective study was conducted on 77 foetuses with ISUA and 77 gestational age-matched controls from 22 to 39 weeks.For gestational age grouping,the ISUA and control foetuses were divided into the second trimester group(22+0–27+6 weeks;43 foetuses)and third trimester group(28+0–39+6 weeks;34 foetuses).The foetal tricuspid annular plane systolic excursion(f-TAPSE)M-mode was applied to the tricuspid annulus,parallel to the ventricular septum,and the amplitude of the resulting wave was assessed using the spatiotemporal image correlation(STIC)M-mode in the second and third trimesters.We investigated the possible changes in the STIC M-mode indices during the course of pregnancy in both the ISUA and control groups.Virtual organ computer-aided analysis(VOCAL)was used to obtain left and right ventricular volume parameters in the second trimester.The parameters were measured including the end-diastolic volume(EDV),end-systolic volume(ESV),ventricular stroke volume(SV),ejection fraction(EF)and cardiac output(CO).VOCAL was used to obtain the left and right ventricular EDV,ESV and to calculate the SV,CO and EF.The Colour Doppler technique was used to measure the foetal aorta and pulmonary artery spectrum parameters,including peak systolic velocity(PSV),velocity time integral(VTI)and foetal heart rate,calculated left ventricular output(LCO)and right ventricular output(RCO)in the second trimester.Colour Doppler was employed to visualise the spectra of the foetal PV and DV in the third trimester.The PV flow velocities and velocity ratios were measured in the third trimester.The flow velocities included the ventricular systolic peak flow velocity ?S?,late diastolic flow velocity ?v?,early diastolic flow velocity ?D? and atrial systolic flow velocity ?a?.The velocity ratios included PIV,S/v,S/D,S/a,v/D,v/a and D/a.The E peak and A peak flow velocities at the mitral and tricuspid orifices were measured,and the E/A ratio was calculated.We measured the umbilical artery(UA)and middle cerebral artery blood flow parameters;calculated the umbilical vein(UV)area,UA area and UV area/UA area ratio;measured the umbilical arterial blood flow parameters pulsatility index(PI);and calculated the UV area,UA area and UV area/UA area ratio.The birth weight placental quality between the ISUA and control groups were analysed according to the postpartum results.Results: There were no significant differences in f-MAPSE and f-TAPSE between the second trimester ISUA foetuses and the normal foetuses(P > 0.05).In addition,there was no significant difference in f-MAPSE between the third trimester ISUA and normal foetuses(P > 0.05).Comparing the f-TAPSE between ISUA foetuses and normal foetuses in the third trimester,the difference was statistically significant(P < 0.05).There were significant correlations between gestational age(GA)and f-MAPSE among control foetuses(P < 0.01).Also,significant correlations between GA and f-TAPSE were observed(P < 0.01).STIC was combined with VOCAL to measure the systolic function of the two groups during the second trimester.There were no significant differences in LCO and RCO between the ISUA and control groups(P > 0.05).Also,the LCO and RCO were positively correlated with the GA in the ISUA and control groups(P < 0.01);the spectrum parameters of the aorta and pulmonary artery were used to measure the foetal systolic function in the two groups during the second trimester.There were no significant differences in LCO between the ISUA group and the control group(P > 0.05).There was a significant difference in RCO between the ISUA and control groups(P < 0.05).There were also significant correlations between GA and CO among ISUA and control foetuses(P < 0.01);the parameters PIV,S/v,S/D,S/a,v/D,v/a,D/a and E/A ratio did not change significantly between the ISUA and control groups(P > 0.05).The correlation between the PV spectrum PIV and mitral orifice E/A ratio was better in the two groups(R2 of 0.646 in the ISUA group and 0.579 in the control group).The correlations between the DV spectrum velocity ratios and the E/A ratio at the tricuspid orifice in the two groups were analysed,and the correlation between the v/D and E/A ratios was the best(R2 of 0.520 in the ISUA group and 0.358 in the control group).In the second and third trimesters,the ISUA group obtained a higher UA area than the control group(P < 0.01).Furthermore,the ISUA group had a lower UV area/UA area ratio than the control group(P < 0.01),and a linear positive correlation was found between GA and the UV area in both groups(P < 0.01).In the second trimester,the ISUA group had a lower foetal PI with UA than the control group(P < 0.01).In the second and third trimesters,the ISUA group had a lower foetal PI with MCA than the control group(P < 0.01).In the second and third trimesters,the ISUA group had a lower foetal PIMCA/PIUA than the control group(P < 0.01).The birth weight and placenta quality of the ISUA group were lower than those of the control group(P < 0.05).Conclusions: ISUA fetus tends to have a low mean birth weight.Through the detection of the cardiac function and haemodynamics between the ISUA and control groups,we can accurately evaluate the foetal haemodynamics and cardiac function of ISUA to provide a more accurate and an objective diagnosis and treatment basis for the clinic.Objective: To evaluate the micro-blood perfusion of ISUA and normal foetuses placenta using the three-dimensional power Doppler ultrasound(3D-PDU),qualitatively and quantitatively analyse the expression of VEGF protein in the placenta between the ISUA and control groups by SP and PCR and compare the differences between the two groups.Methods: 3D-PDU was used to detect the placental tissue blood flow parameters for 58 foetuses in the ISUA group and the 77 normal foetuses in the control group.The 3D-PDU parameters include the flow index,vascularity index(VI)and vascularity flow index(VFI);using SP and PCR methods to analyse the placental tissue VEGF protein expression for 26 foetuses in the ISUA group and 26 foetuses in the control group.Results: The VI and VFI of the control group were higher than that of the ISUA group(P < 0.05).The VEGF protein expression positivity rate in the placenta tissue of the ISUA group by SP was higher than that of the control group(?2 = 28.013,P ? 0.001).PCR was used to detect the m RNA protein of VEGF in the placenta tissues of the two groups and the VEGF m RNA protein of the ISUA group was higher than that of the control group(P ? 0.001).Conclusions: 3D-PDU can quantitatively analyse the micro-blood perfusion of the placenta,and provide an objective assessment of ISUA foetuses.By detecting the VEGF protein of ISUA foetal placental tissue,it provides an objective basis for clarifying the pathology of ISUA foetal placenta.Objective: To investigate the incidence of single umbilical artery(SUA)anomalies,and postpartum outcomes in a retrospective analysis of 781 foetuses with SUA.Methods: This retrospective analysis included 781 pregnant women carrying singleton foetuses diagnosed with SUA at the Gansu Provincial Maternal and Child-care Hospital between 2013 and 2019.Detailed clinical and ultrasound data of the foetus and maternal characteristics including postpartum outcomes were obtained.Results: In total,624(79.9%)foetuses were diagnosed with isolated SUA and 157(20.1%)foetuses had SUA in combination with other structural and/or chromosome abnormalities.The incidence of urinary system anomalies was highest,followed by the cardiovascular and digestive systems.The incidence of SUA was 59.1% on the right side and 40.9% on the left side.Foetuses with SUA and other abnormalities tended to have a lower mean birth weight(3061 g vs 3201 g,P < 0.01),but no difference in the rate of preterm delivery was noted.Conclusions: After diagnosis of SUA,structural observation of the foetus is required.The urinary,cardiovascular and digestive systems should be the focus of the observation.If relevant malformations are found,then genetic testing must be performed.With isolated SUA,dynamic monitoring of biological indicators is recommended for lower birth weight,but genetic testing is not recommended.