Left versus right intra-abdominal umbilical arteries: comparison of their Doppler waveforms.

OBJECTIVES: The purpose of this study was to compare Doppler velocimetric indices between the left and right intra-abdominal umbilical arteries in normally grown and growth-restricted fetuses. METHODS: In this cross-sectional study, Doppler indices of the intra-abdominal segment of the left and right umbilical arteries were measured lateral to the fetal bladder. Measurements, including the systolic to diastolic ratio and pulsatility index, were obtained from both anatomic locations. The Student t test was used to make comparisons. RESULTS: Differences between left and right Doppler indices were noted in 98% of patients, and these differences were greater than 20% in at least one-third. Overall, the left umbilical artery had a higher systolic to diastolic ratio (P = .025) and pulsatility index (P = .007) than the right umbilical artery. CONCLUSIONS: The laterality of the umbilical artery, whether on the left or right side of the fetus, influences important Doppler blood flow parameters.

Risk-benefit effects of tocolytic therapy.

Tocolytics are potent drugs that are used to interdict preterm labour. Although all of these agents have some side effects, if not frankly adverse effects under certain clinical situations, two of these drugs, the beta-mimetics and magnesium sulphate (MgSO(4)), have been found to have considerable potential for adverse maternal cardiovascular and respiratory effects. Furthermore, magnesium sulphate has been shown to have harmful, indeed, sometimes lethal, effects in some babies. Although less well established, NSAIDs, the most common example of which is indomethacin, also have some important adverse effects in fetuses. Within the limits of contemporary scientific knowledge, calcium channel blockers, such as nifedipine, appear to be among the more efficacious and safer drugs that are currently being used for tocolysis.

Components of the systemic fetal inflammatory response syndrome as predictors of impaired neurologic outcomes in children.

OBJECTIVE: The purpose of this study was to compare interleukin-6 and funisitis as predictors of impaired neurologic outcomes in children by performing a secondary analysis on data that were collected prospectively for another purpose. STUDY DESIGN: We examined umbilical cords for funisitis and obtained cord blood for interleukin-6 levels. A psychomotor developmental index score was determined for each child at age 18 months. RESULTS: The prevalence (46%) of elevated interleukin-6 levels (> or = 10 pg/mL) among children with low psychomotor developmental index scores (<100) was not significantly different from that of children with normal scores (47%). Among children with funisitis (n = 21), the median psychomotor developmental index score was 94; for children without funisitis (n = 92), it was 99 (P <.02). When the data were regressed for confounding, funisitis remained significant (adjusted odds ratio, 1.3; 95% CI, 1.1-1.9). Furthermore, funisitis was a more specific predictor of low psychomotor developmental index scores (P <.001), although elevated interleukin-6 levels were more sensitive. CONCLUSION: When used for the prediction of impaired neurologic outcomes in children, funisitis has better specificity and thus a better positive predictive value than does interleukin-6.