Kontext: Dosud se toho ví málo o možné spojitosti mezi cévním zásobením štítné žlázy a aterosklerotickou zátěží koronárních tepen u pacientů s podezřením na ischemickou chorobu srdeční. Cíle: Posoudit možnou spojitost mezi dopplerovskými parametry horní štítné tepny a markery aterosklerózy koronárních tepen včetně závažnosti stenózy, kalcifikace koronárních tepen (cAc) a rozsahu plátu zjištěného koronarografickým vyšetřením pacientů s podezřením na ischemickou chorobu srdeční (ichS) metodou multidetektorové výpočetní tomografie (MDct). Pacienti a metody: Do této průřezové studie bylo zařazeno 100 pacientů s bolestí na hrudi, u nichž byla pro vyloučení okluzivní ischemické choroby srdeční provedena koronarografie MDct. Všichni zařazení pacienti byli z klinického hlediska eutyreoidní, bez klinických známek hypotyreózy nebo hypertyreózy. u zařazených pacientů byla pro stanovení cévních parametrů včetně indexu rezistence (ri), maximální rychlosti proudění krve v systole (PSV), rychlosti proudění krve na konci diastoly (eDV) a indexu pulsatility (pulsatility index, Pi) sonograficky vyšetřena horní štítná tepna. Výsledky: Byla nalezena statisticky významná spojitost mezi sníženými hodnotami PSV (16 cm/s vs. 15 cm/s; p = 0,03) a cAc ≥ 400, a to i po další adjustaci na rizikové faktory koronárních příhod (or [ci] = 0,3 [0,1–0,8]; p = 0,03). Pacienti s významnou koronární stenózou (≥ 50%) vykazovali vyšší hodnoty ri (0,58 vs. 0,54; p = 0,04) než jedinci bez významné koronární stenózy (< 50%). Po adjustaci na jiné rizikové faktory koronárních příhod však již tato spojitost nepřetrvávala. nebyla pozorována spojitost mezi parametry vyšetření štítné žlázy dopplerovským ultrazvukem včetně PSV, eDV, ri a Pi na jedné straně, a přítomností koronárních plátů na straně druhé. Závěr: hodnoty PSV a ri v horní štítné tepně vykazovaly statisticky významnou spojitost se zátěží cAc a s významnou koronární stenózou. tyto výsledky mohou naznačovat možné spojení mezi parametry rezistence cév štítné žlázy a zátěží aterosklerózou koronárních tepen.

Background: Little is known about the potential association between thyroid vascular parameters and coronary atherosclerotic burden in patients with suspected coronary artery disease. Objectives: To assess the potential association between superior thyroid artery Doppler parameters and coronary atherosclerotic markers, including stenosis severity, coronary artery calcification (CAC), and plaque assessed by multi-detector CT (MDCT) coronary angiography among patients with suspected coronary artery disease (CAD). Patients and methods: This cross-sectional study included 100 patients with chest pain who underwent MDCT coronary angiography to exclude the presence of occlusive coronary artery disease. All of the enrolled patients were clinically euthyroid, with no clinical features of hypothyroidism or hyperthyroidism. The superior thyroid artery in enrolled patients was examined using ultrasound to assess vascular parameters, including resistive index (RI), peak systolic velocity (PSV), end-diastolic velocity (EDV), and pulsatility index (PI). Results: There was a significant association between decreased PSV values (16 cm/s vs. 15 cm/s, p = 0.03) and CAC ≥400, even after further adjustment for coronary risk factors (OR (CI) = 0.3 (0.1-0.8. p = 0.03). Patients with significant coronary stenosis severity ≥50% had higher RI values (0.58 vs. 0.54, p = 0.04) than those with a non-significant coronary stenosis <50%. However, this association did not persist after adjustment for other coronary risk factors. No significant association was observed between thyroid Doppler parameters, including PSV, EDV, RI, and PI, and coronary plaque presence. Conclusion: PSV and RI of the superior thyroid artery showed a significant association with CAC burden and significant coronary stenosis. These results may suggest a possible link between thyroid vascular resistance parameters and coronary atherosclerosis burden.

• MeSH
• Atherosclerosis * diagnostic imaging   pathology   MeSH
• Computed Tomography Angiography MeSH
• Coronary Vessels diagnostic imaging   pathology   MeSH
• Coronary Stenosis diagnostic imaging   pathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Multidetector Computed Tomography MeSH
• Cross-Sectional Studies MeSH
• Heart Disease Risk Factors MeSH
• Statistics as Topic MeSH
• Thyroid Gland * diagnostic imaging   blood supply   pathology   MeSH
• Ultrasonography, Doppler MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Clinical Study MeSH

OBJECTIVES: To analyze the prevalence and severity of fetal aortic regurgitation (AR) after undergoing successful fetal aortic valvuloplasty (FAV) and to evaluate its effects on fetal circulation and left ventricular (LV) growth. METHODS: This was a retrospective review of all fetuses with critical aortic stenosis who underwent successful FAV at our center between 2010 and 2024 for whom postnatal echocardiograms were available in digital format. Fetal and postnatal echocardiographic examinations were analyzed for ventricular and valvular dimensions and characteristics, and Z-scores were calculated for middle cerebral artery (MCA) pulsatility index (PI), umbilical artery (UA) PI and cerebroplacental ratio. AR severity was classified into no/mild AR or significant (moderate/severe) AR. The balloon-to-aortic valve ratio (BVR) was calculated as the ratio between the maximum actual balloon diameter and the aortic valve (AV) annulus diameter. The primary endpoints of this study were the prevalence, severity and risk factors for fetal AR following successful FAV. RESULTS: Ninety-nine fetuses who underwent successful FAV were included. Immediate post-FAV echocardiograms showed that 87% of fetuses developed some degree of AR, including 45% of all fetuses with significant AR. BVR was significantly higher in fetuses with significant AR compared to those with no/mild AR (mean, 1.09 (95% CI, 1.06-1.12) vs 1.02 (95% CI, 0.99-1.04); P < 0.001). In a subgroup of 66/99 fetuses with available postnatal echocardiograms, the prevalence of AR decreased significantly from 86% before birth to 58% after birth (P < 0.001), with the proportion of fetuses with significant AR reducing from 47% before birth to 17% after birth (P < 0.001). In the overall cohort of fetuses, AV maximum velocity (Vmax) increased significantly from post-FAV to after birth (mean, 1.93 (95% CI, 1.75-2.11) m/s vs 3.21 (95% CI, 2.89-3.55) m/s; P < 0.001), regardless of AR severity, but Vmax after birth was lower in the significant-AR group compared with the no/mild-AR group (mean, 2.85 m/s vs 3.55 m/s; P = 0.020). Fetuses with significant AR exhibited higher relative LV length increases from immediately post-FAV to after birth than did those with no/mild AR (25% (95% CI, 16-33%) vs 14% (95% CI, 6-21%); P = 0.044), although there was no significant difference in mean LV length Z-score after birth between the two groups. FAV led to significant short-term increases in MCA-PI and UA-PI Z-scores, with greater increases observed in fetuses with significant AR. CONCLUSIONS: FAV is associated with a high prevalence of fetal AR, which lessens in severity over the course of gestation. Significant fetal AR had the largest association with greater BVR and had significant impact on fetal hemodynamics. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

• MeSH
• Aortic Valve diagnostic imaging   embryology   MeSH
• Aortic Valve Insufficiency * diagnostic imaging   epidemiology   physiopathology   MeSH
• Aortic Valve Stenosis diagnostic imaging   embryology   epidemiology   physiopathology   MeSH
• Balloon Valvuloplasty * MeSH
• Adult MeSH
• Echocardiography methods   MeSH
• Fetal Heart diagnostic imaging   physiopathology   MeSH
• Gestational Age MeSH
• Humans MeSH
• Fetal Diseases epidemiology   diagnostic imaging   MeSH
• Infant, Newborn MeSH
• Prevalence MeSH
• Retrospective Studies MeSH
• Risk Factors MeSH
• Severity of Illness Index MeSH
• Pregnancy MeSH
• Ultrasonography, Prenatal * MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: Patients with transposition of the great arteries (TGA) and systemic right ventricle often confront significant adverse cardiac events. The prognostic significance of invasive hemodynamic parameters in this context remains uncertain. Our hypothesis is that the aortic pulsatility index and hemodynamic profiling utilizing invasive measures provide prognostic insights for patients with TGA and a systemic right ventricle. METHODS: This retrospective multicenter cohort study encompasses adults with TGA and a systemic right ventricle who underwent cardiac catheterization. Data collection, spanning from 1994 to 2020, encompasses clinical and hemodynamic parameters, including measured and calculated values such as pulmonary capillary wedge pressure, aortic pulsatility index, and cardiac index. Pulmonary capillary wedge pressure and cardiac index values were used to establish 4 distinct hemodynamic profiles. A pulmonary capillary wedge pressure of ≥15 mm Hg indicated congestion, termed wet, while a cardiac index <2.2 L/min per m2 signified inadequate perfusion, labeled cold. The primary outcome comprised a composite of all-cause death, heart transplantation, or the requirement for mechanical circulatory support. RESULTS: Of 1721 patients with TGA, 242 individuals with available invasive hemodynamic data were included. The median follow-up duration after cardiac catheterization was 11.4 (interquartile range, 7.5-15.9) years, with a mean age of 38.5±10.8 years at the time of cardiac catheterization. Among hemodynamic parameters, an aortic pulsatility index <1.5 emerged as a robust predictor of the primary outcome, with adjusted hazard ratios of 5.90 (95% CI, 3.01-11.62; P<0.001). Among the identified 4 hemodynamic profiles, the cold/wet profile was associated with the highest risk for the primary outcome, with an adjusted hazard ratio of 3.83 (95% CI, 1.63-9.02; P<0.001). CONCLUSIONS: A low aortic pulsatility index (<1.5) and the cold/wet hemodynamic profile are linked with an elevated risk of adverse long-term cardiac outcomes in patients with TGA and systemic right ventricle.

• MeSH
• Adult MeSH
• Ventricular Function, Right physiology   MeSH
• Hemodynamics * physiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Pulmonary Wedge Pressure physiology   MeSH
• Prognosis MeSH
• Retrospective Studies MeSH
• Cardiac Catheterization * MeSH
• Heart Ventricles * physiopathology   diagnostic imaging   MeSH
• Transposition of Great Vessels * physiopathology   surgery   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH

PURPOSE: To assess the longitudinal variation of the ratio of umbilical and cerebral artery pulsatility index (UCR) in late preterm fetal growth restriction (FGR). MATERIALS AND METHODS: A prospective European multicenter observational study included women with a singleton pregnancy, 32+ 0-36+ 6, at risk of FGR (estimated fetal weight [EFW] or abdominal circumference [AC] < 10th percentile, abnormal arterial Doppler or fall in AC from 20-week scan of > 40 percentile points). The primary outcome was a composite of abnormal condition at birth or major neonatal morbidity. UCR was categorized as normal (< 0.9) or abnormal (≥ 0.9). UCR was assessed by gestational age at measurement interval to delivery, and by individual linear regression coefficient in women with two or more measurements. RESULTS: 856 women had 2770 measurements; 696 (81 %) had more than one measurement (median 3 (IQR 2-4). At inclusion, 63 (7 %) a UCR ≥ 0.9. These delivered earlier and had a lower birth weight and higher incidence of adverse outcome (30 % vs. 9 %, relative risk 3.2; 95 %CI 2.1-5.0) than women with a normal UCR at inclusion. Repeated measurements after an abnormal UCR at inclusion were abnormal again in 67 % (95 %CI 55-80), but after a normal UCR the chance of finding an abnormal UCR was 6 % (95 %CI 5-7 %). The risk of composite adverse outcome was similar using the first or subsequent UCR values. CONCLUSION: An abnormal UCR is likely to be abnormal again at a later measurement, while after a normal UCR the chance of an abnormal UCR is 5-7 % when repeated weekly. Repeated measurements do not predict outcome better than the first measurement, most likely due to the most compromised fetuses being delivered after an abnormal UCR.

• MeSH
• Umbilical Arteries diagnostic imaging   MeSH
• Gestational Age MeSH
• Fetal Weight MeSH
• Infant, Small for Gestational Age MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Premature Birth * MeSH
• Prospective Studies MeSH
• Fetal Growth Retardation * MeSH
• Pregnancy MeSH
• Ultrasonography, Doppler MeSH
• Ultrasonography, Prenatal MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Observational Study MeSH

Cieľ: Porovnať zmeny v cirkulácii v dolnom segmentne maternice pomocou trojdimenzionálneho power Dopplerovho ultrazvuku (3DPD) u pacientok po cisárskom reze (SC) a po nekomplikovanom vaginálnom pôrode (VAG). Materiál/metódy: Ultrazvukové vyšetrenie podstúpilo 60 pacientok po SC a 60 pacientok po vaginálnom pôrode, ktoré boli hospitalizované na Gynekologicko-pôrodníckej klinike, Jesseniovej lekárskej fakulty v Martine, Univerzity Komenského v Bratislave a Univerzitnej nemocnici v Martine od novembra 2021 do februára 2023. Pomocou 3DPD zobrazenia bol získaný vopred daný objem, a to 15 cm 3 . Ultrazvukový softvér VOCAL (Virtual Organ Computer-aided Analysis) následne automaticky kalkuloval 3 vaskulárne indexy: index vaskularizácie (VI), index prietoku (FI) a kombináciu oboch spomenutých indexov (VFI). Následne bol vyšetrený index pulzatility (PI) v oboch uterinných artériách (UtA). Všetky merania boli realizované 48 hodín po pôrode. Výsledky: V tejto pilotnej štúdii sme pozorovali signifikantné rozdiely vo všetkých troch vaskulárnych indexoch medzi skupinou pacientok po SC a po vaginálnom pôrode s p ˂ 0,001. V skupine pacientok po vaginálom pôrode sme zaznamenali inverznú koreláciu medzi vaskulárnymi indexami a hodnotami PI v UtA s p ˂ 0,001. Podobný výsledok sme však v skupine pacientok po SC nepozorovali. Záver: V súčasnosti predstavujú cirkulačné zmeny maternice v puerpériu stále pomerne málo preštudovanú problematiku. Naše výsledky dokázali signifikantné rozdiely vo vaskulárnych indexoch medzi oboma skupinami. V budúcnosti by mohla táto metodika slúžiť na monitorovanie hojenia jazvy alebo jej výslednej kvality zhojenia. Podľa súčasného prehľadu literatúry doteraz nebola publikovaná žiadna podobná štúdia.

Objective: To evaluate circulation of the lower uterine segment (LUS) using three-dimensional power Doppler ultrasound (3DPD) in patients after Cesarean section (CS) and uncomplicated vaginal delivery (VD). Study design: We evaluated 60 patients after CS and 60 patients after uncomplicated VD by ultrasound admitted at the Department of Gynecology and Obstetrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital Martin, Slovakia, from November 2021 to February 2023. A spherical volume of 15 cc was captured for each patient with a 3D transabdominal probe. We used an ultrasound software program Virtual Organ Computer-aided Analysis (VOCAL) to calculate three vascular indices – vascularization index (VI), flow index (FI), and vascularization-flow index (VFI). We also assessed Doppler indices in the uterine arteries (UtA). The measurements were taken 48 hours postpartum. Results: There was a significant difference in all three vascular indices between the studied and controlled group with a p-value ˂ 0.001. We observed a significant inverse correlation between vascular indices and pulsatility index (PI) in UtA in the VD group, but we found no such correlation in the CS group. Conclusion: Although it is still not well understood, 3DPD can be a suitable ultrasound method to study postpartum uterine circulation. Our results proved significant differences in vascularization and perfusion in LUS in patients after CS vs. VD. Therefore, 3DPD may be useful in the ultrasound assessment of healing areas after CS. To the best of our knowledge, this is the first study analyzing vascular indices in LUS during puerperium in patients both after VD and CS.

BACKGROUND: Criteria for diagnosis of fetal growth restriction differ widely according to national and international guidelines, and further heterogeneity arises from the use of different biometric and Doppler reference charts, making the diagnosis of fetal growth restriction highly variable. OBJECTIVE: This study aimed to compare fetal growth restriction definitions between Delphi consensus and Society for Maternal-Fetal Medicine definitions, using different standards/charts for fetal biometry and different reference ranges for Doppler velocimetry parameters. STUDY DESIGN: From the TRUFFLE 2 feasibility study (856 women with singleton pregnancy at 32+0 to 36+6 weeks of gestation and at risk of fetal growth restriction), we selected 564 women with available mid-pregnancy biometry. For the comparison, we used standards/charts for estimated fetal weight and abdominal circumference from Hadlock, INTERGROWTH-21st, and GROW and Chitty. Percentiles for umbilical artery pulsatility index and its ratios with middle cerebral artery pulsatility index were calculated using Arduini and Ebbing reference charts. Sensitivity and specificity for low birthweight and adverse perinatal outcome were evaluated. RESULTS: Different combinations of definitions and reference charts identified substantially different proportions of fetuses within our population as having fetal growth restriction, varying from 38% (with Delphi consensus definition, INTERGROWTH-21st biometric standards, and Arduini Doppler reference ranges) to 93% (with Society for Maternal-Fetal Medicine definition and Hadlock biometric standards). None of the different combinations tested appeared effective, with relative risk for birthweight <10th percentile between 1.4 and 2.1. Birthweight <10th percentile was observed most frequently when selection was made with the GROW/Chitty charts, slightly less with the Hadlock standard, and least frequently with the INTERGROWTH-21st standard. Using the Ebbing Doppler reference ranges resulted in a far higher proportion identified as having fetal growth restriction compared with the Arduini Doppler reference ranges, whereas Delphi consensus definition with Ebbing Doppler reference ranges produced similar results to those of the Society for Maternal-Fetal Medicine definition. Application of Delphi consensus definition with Arduini Doppler reference ranges was significantly associated with adverse perinatal outcome, with any biometric standards/charts. The Society for Maternal-Fetal Medicine definition could not accurately detect adverse perinatal outcome irrespective of estimated fetal weight standard/chart used. CONCLUSION: Different combinations of fetal growth restriction definitions, biometry standards/charts, and Doppler reference ranges identify different proportions of fetuses with fetal growth restriction. The difference in adverse perinatal outcome may be modest, but can have a significant impact in terms of rate of intervention.

• MeSH
• Fetal Weight * MeSH
• Humans MeSH
• Birth Weight MeSH
• Fetal Growth Retardation * diagnosis   MeSH
• Pregnancy MeSH
• Ultrasonography, Doppler MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

OBJECTIVES: Fabry disease (FD) is a rare X-linked lysosomal storage disorder with variable phenotypes, including neurological symptoms. These can be influenced by vascular impairment. Extracranial and transcranial vascular sonography is an effective and noninvasive method for measuring arterial structures and blood flow. The study aims to investigate cerebrovascular phenotype characteristics in FD patients compared to controls using neurosonology. METHODS: This is a single-center, cross-sectional study of 130 subjects-65 patients (38 females), with genetically confirmed FD, and 65 sex- and age-matched controls. Using ultrasonography, we measured structural and hemodynamic parameters, including distal common carotid artery intima-media thickness, inner vertebral artery diameter, resting blood flow velocity, pulsatility index, and cerebral vasoreactivity (CVR) in the middle cerebral artery. To assess differences between FD and controls and to identify factors influencing investigated outcomes, unadjusted and adjusted regression analyses were performed. RESULTS: In comparison to sex- and age-matched controls, FD patients displayed significantly increased carotid artery intima-media thickness (observed FD 0.69 ± 0.13 mm versus controls 0.63 ± 0.12 mm; Padj = .0014), vertebral artery diameter (observed FD 3.59 ± 0.35 mm versus controls 3.38 ± 0.33 mm; Padj = .0002), middle cerebral artery pulsatility index (observed FD 0.98 ± 0.19 versus controls 0.87 ± 0.11; Padj < .0001), and significantly decreased CVR (observed FD 1.21 ± 0.49 versus controls 1.35 ± 0.38; Padj = .0409), when adjusted by age, BMI, and sex. Additionally, FD patients had significantly more variable CVR (0.48 ± 0.25 versus 0.21 ± 0.14; Padj < .0001). CONCLUSIONS: Our results suggest the presence of multiple vascular abnormalities and changes in hemodynamic parameters of cerebral arteries in patients with FD.

• MeSH
• Fabry Disease * diagnostic imaging   MeSH
• Hemodynamics physiology   MeSH
• Carotid Intima-Media Thickness MeSH
• Humans MeSH
• Cerebrovascular Circulation physiology   MeSH
• Cross-Sectional Studies MeSH
• Blood Flow Velocity physiology   MeSH
• Ultrasonography, Doppler, Transcranial methods   MeSH
• Ultrasonography MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

INTRODUCTION: Multisystem inflammatory syndrome in children (MIS-C) is a new clinical entity that has emerged in the context of the COVID-19 pandemic. Despite the less severe course of the disease, varying degrees of cardiovascular events may occur in MIS-C; however, data on vascular changes occurring in MIS-C are still lacking. Endothelial dysfunction (ED) is thought to be one of the key risk factors contributing to MIS-C. BACKGROUND: We conducted a prospective observational study. We investigated possible manifestations of cardiac and endothelial involvement in MIS-C after the treatment of the acute stage and potential predictive biomarkers in patients with MIS-C. METHODS: Twenty-seven consecutive pediatric subjects (≥9 years), at least three months post-treated MIS-C of varying severity, in a stable condition, and twenty-three age- and sex-matched healthy individuals (HI), were enrolled. A combined non-invasive diagnostic approach was used to assess endothelial function as well as markers of organ damage using cardiac examination and measurement of the reactive hyperemia index (RHI), by recording the post- to pre-occlusion pulsatile volume changes and biomarkers related to ED and cardiac disease. RESULTS: MIS-C patients exhibited a significantly lower RHI (indicative of more severe ED) than those in HI (1.32 vs. 1.80; p = 0.001). The cutoff of RHI ≤ 1.4 was independently associated with a higher cardiovascular risk. Age and biomarkers significantly correlated with RHI, while serum cystatin C (Cys C) levels were independently associated with a diminished RHI, suggesting Cys C as a surrogate marker of ED in MIS-C. CONCLUSIONS: Patients after MIS-C display evidence of ED, as shown by a diminished RHI and altered endothelial biomarkers. Cys C was identified as an independent indicator for the development of cardiovascular disease. The combination of these factors has the potential to better predict the cardiovascular consequences of MIS-C. Our study suggests that ED may be implicated in the pathophysiology of this disease.

• Publication type
• Journal Article MeSH

PURPOSE: The aim of the study was to obtain the values of oxygen saturation in retinal vessels and ophthalmic blood flow parameters in a healthy Caucasian population and assess whether the oximetry parameters are affected by the flow rate or the vascular resistance. METHODS: The spectrophotometric retinal oximetry and colour Doppler imaging (CDI) of retinal vessels were successfully performed with 52 healthy subjects (average age 29.7 ± 5.6 years). The retinal oximeter simultaneously measures the wavelength difference of haemoglobin oxygen saturation in retinal arterioles and venules. The arteriolar and venular saturation in both eyes was measured. The peak systolic (PSV) end diastolic (EDV) velocities, resistive (RI) and pulsatility (PI) indices were obtained for both eyes using CDI in the ophthalmic artery. A paired t-test and two sample t-tests were used for statistical analyses. The correlation was assessed using the Pearson coefficient correlation. RESULTS: The mean oxygen saturation level was 96.9 ± 3.0% for the retinal arterioles and 65.0 ± 5.1% for the retinal venules. The A-V difference was 31.8 ± 4.6%. The mean of the measured haemodynamic parameters was PSV 46.6 ± 9.4 cm/s, EDV 12.0 ± 3.5 cm/s, PI 1.68 ± 0.38 and RI 0.74 ± 0.05. No significant difference in oxygen saturation and haemodynamic parameters was found between the left and the right eyes or the dominant and non-dominant eye. The oximetry and ultrasound values were sex independent. The Pearson correlation coefficient demonstrated a significant yet weak negative correlation between A-V difference and RI (r = -0.321, p = 0.020). CONCLUSIONS: A negative correlation between A-V difference and resistance index was observed, suggesting that reduced oxygen consumption may reflect the increased vascular tone of the ophthalmic vessels, which is likely determined by autoregulatory mechanisms.

• MeSH
• Retinal Artery * diagnostic imaging   physiology   MeSH
• Ophthalmic Artery * MeSH
• Adult MeSH
• Hemodynamics MeSH
• Hemoglobins MeSH
• Oxygen MeSH
• Humans MeSH
• Young Adult MeSH
• Oximetry methods   MeSH
• Retina MeSH
• Blood Flow Velocity MeSH
• Oxygen Saturation MeSH
• Healthy Volunteers MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Young Adult MeSH
• Publication type
• Journal Article MeSH

INTRODUCTION: Following the detection of fetal growth restriction, there is no consensus about the criteria that should trigger delivery in the late preterm period. The consequences of inappropriate early or late delivery are potentially important yet practice varies widely around the world, with abnormal findings from fetal heart rate monitoring invariably leading to delivery. Indices derived from fetal cerebral Doppler examination may guide such decisions although there are few studies in this area. We propose a randomised, controlled trial to establish the optimum method of timing delivery between 32 weeks and 36 weeks 6 days of gestation. We hypothesise that delivery on evidence of cerebral blood flow redistribution reduces a composite of perinatal poor outcome, death and short-term hypoxia-related morbidity, with no worsening of neurodevelopmental outcome at 2 years. METHODS AND ANALYSIS: Women with non-anomalous singleton pregnancies 32+0 to 36+6 weeks of gestation in whom the estimated fetal weight or abdominal circumference is <10th percentile or has decreased by 50 percentiles since 18-32 weeks will be included for observational data collection. Participants will be randomised if cerebral blood flow redistribution is identified, based on umbilical to middle cerebral artery pulsatility index ratio values. Computerised cardiotocography (cCTG) must show normal fetal heart rate short term variation (≥4.5 msec) and absence of decelerations at randomisation. Randomisation will be 1:1 to immediate delivery or delayed delivery (based on cCTG abnormalities or other worsening fetal condition). The primary outcome is poor condition at birth and/or fetal or neonatal death and/or major neonatal morbidity, the secondary non-inferiority outcome is 2-year infant general health and neurodevelopmental outcome based on the Parent Report of Children's Abilities-Revised questionnaire. ETHICS AND DISSEMINATION: The Study Coordination Centre has obtained approval from London-Riverside Research Ethics Committee (REC) and Health Regulatory Authority (HRA). Publication will be in line with NIHR Open Access policy. TRIAL REGISTRATION NUMBER: Main sponsor: Imperial College London, Reference: 19QC5491. Funders: NIHR HTA, Reference: 127 976. Study coordination centre: Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS with Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University. IRAS Project ID: 266 400. REC reference: 20/LO/0031. ISRCTN registry: 76 016 200.

• MeSH
• Child MeSH
• Fetal Weight MeSH
• Cardiotocography MeSH
• Infant MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Premature Birth * MeSH
• Randomized Controlled Trials as Topic MeSH
• Fetal Growth Retardation MeSH
• Heart Rate, Fetal physiology   MeSH
• Pregnancy MeSH
• Ultrasonography, Prenatal * MeSH
• Check Tag
• Child MeSH
• Infant MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Clinical Trial Protocol MeSH