Umbilical Vein Blood Flow in Uncomplicated Pregnancies: Systematic Review of Available Reference Charts and Comparison with a New Cohort
Abstract
:1. Introduction
2. Materials and Methods
2.1. Systematic Review of the Available UV-Q Reference Ranges
2.1.1. Study Identification and Selection
- -
- The sampling site: (a) studies investigating UV-Q on the intra-abdominal (IA) portion of the UV; and (b) studies investigating UV-Q at the free-floating (FF) portion of the UV;
- -
- The formula used to compute the UV-Q.
2.1.2. Quality Assessment
2.2. Prospective Cohort Study on UV-Q, UV-Q/AC, and UV-Q/EFW
Statistical Analysis
3. Results
3.1. Systematic Review of the Available UV-Q Reference Ranges
3.1.1. Risk of Bias within Studies According to QUADAS Criteria
3.1.2. Description of the Included Studies
3.2. Prospective Cohort Study on UV-Q
Comparison between Reference Range Values for UV-Q and UV-Q/EFW
4. Discussion
4.1. The Main Findings of the Study
4.2. Comment
4.2.1. Methodology
4.2.2. Experimental Research
4.3. Strengths and Limitations of the Study
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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First Author, Year of Publication | Study Type | Population (N) | Gestational Age | Description of Population | Available Percentiles | Formula for Q-UV Measurement | Mean Values of Q UV (mL/min) | Mean Values of Q-UV Normalized to EFW (mL/min/kg) | |
---|---|---|---|---|---|---|---|---|---|
Free-floating portion | |||||||||
1 | DeVore et al., 2021 [28] | Prospective cross-sectional study | 240 | 20 to 40 weeks | Singleton low-risk pregnancies | Yes | 0.5 × TaMXV × π(D/2)2 × 60 | ||
2 | Flo et al., 2010 [33] | Prospective longitudinal study | 53 | 22 to 39+6 weeks | Singleton low-risk pregnancies | Yes | Two formulae used separately: (1) 0.5 × TaMXV × π(D/2)2 × 60 (2) Vwmean × π(D/2)2 × 60 | 1st formula: from 53 to 250 (22–39+6 weeks) 2nd formula: from 66 to 313 (22–39+6 weeks) | 1st formula: from 110 to 68 (22–39+6 weeks) |
3 | Boito et al., 2003 [36] | Cross-sectional matched control study | 64 | 18 to 36 weeks | 32 low-risk £ and 32 diabetic women | No | 0.06 × TaMXV × π × (D/2)2 | 100.5 (in diabetic women) versus 106.2 (in controls) | 94.2 (in diabetic women) versus 109.4 (in controls) |
4 | Boito et al., 2002 [37] | Prospective cross-sectional study | 133 | 20 to 36 weeks | 100 low-risk £ and 33 SGA | No | TaMXV × π × (D/2)2 | 33.2 (at 20 weeks) 221.0 (at 36 weeks) | 117.5 (at 20 weeks) 78.3 (at 36 weeks) |
5 | Barbera et al., 1999 [3] | Prospective cross-sectional study | 70 | 20 to 38 weeks | Singleton low-risk pregnancies | No | 0.5 × TaMXV × π × (D/2)2 × 60 | 54 (at 23 weeks) 320 (at 38 weeks) | 125 (at 23 weeks) 104 (at 38 weeks) |
6 | Sutton et al., 1990 [18] | Prospective cross-sectional study | 74 | 19 to 42 weeks | Singleton low-risk pregnancies | No | FVIUV/s × π × (D/2)2 × 60 | 105–130 | |
Intra-abdominal portion | |||||||||
7 | Rizzo et al., 2016 [40] | Prospective cross-sectional study | 852 | 14 to 40 weeks | Singleton low-risk pregnancies | No | 0.5 × TaMXV × π(D/2)2 × 60 | ||
8 | Tchirikov et al., 2009 [34] | Prospective cross-sectional study | 181 | 17 to 41 weeks | 148 low-risk and 33 with poor fetal outcome | No | TaMXV × π × (D/2)2 | 160.2 (in compromised fetuses) versus 253.3 (in controls) | 115.1 (in compromised fetuses) versus 200.3 (in controls) |
9 | Acharya et al., 2005 [35] | Prospective longitudinal study | 130 | 19 to 42 weeks | Singleton low-risk pregnancies | Yes | Two formulae used separately: (1) 0.5 × Vmax × π(D/2)2 × 60 (2) Vwmean × π(D/2)2 × 60 | 1st formula: from 27.6 to 271.1 (19–41 weeks) 2nd formula: from 27.13 to 273.4 (19–41 weeks) | 1st formula: from 74.7 to 63.2 (19–41 weeks) 2nd formula: from 73.5 to 63.3 (19–41 weeks) |
10 | Tchirikov et al., 2002 [38] | Retrospective, cross- sectional clinical study | 85 | 17 to 41 weeks | of whom 15 had poor fetal outcomes | No | iVmean × π(D/2)2 | 17 * | −2.2 ** |
11 | Kiserud et al., 2000 [41] | Prospective cross-sectional study | 197 | 18 to 41 weeks | Singleton low-risk pregnancies | No | Vwmean × π × (D/2)2 | ||
12 | Tchirikov et al., 1998 [43] | Prospective cross-sectional study | −75 (singleton) −10 (twin pregnancies) | 100 to 300 days | Singleton: −55 low-risk £ −20 FGR | No | |||
Both at free-floating and intra-abdominal portions | |||||||||
13 | Wang et al., 2021 [39] | Prospective cross-sectional study | 907 | 20 to 39 weeks | Singleton low-risk pregnancies | No | iVmean × 60 × π(D/2)2 | FL: from 32.6 to 381.9 (20–39 weeks) IA: from 31.5 to 360.1 (20–39 weeks) | |
14 | Bellotti et al., 2000 [42] | Prospective cross-sectional study | 137 | 20 to 38 weeks | Singleton low-risk pregnancies | No | 0.5 × TaMXV × π × (D/2)2 |
Population (n = 255) | |
---|---|
Maternal age (years) | 33 (29–36) |
Non-Caucasian ethnicity | 3 (1.2%) |
Maternal pre-pregnancy BMI (kg/m2) | 22 (20–24) |
Nulliparous | 122 (47.7%) |
EFW percentile | 50 (36–63) |
GA at delivery | 40+3 (39+1–40+5) |
Birthweight (g) | 3420 (3175–3645) |
Male fetuses | 133 (52.2%) |
UV-Q | UV-Q/EFW | UV-Q/AC | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
GA (Weeks) | 5th | 10th | 50th | 90th | 95th | 5th | 10th | 50th | 90th | 95th | 5th | 10th | 50th | 90th | 95th |
20 | 28 | 31 | 45 | 60 | 64 | 92 | 101 | 137 | 174 | 51 | 0.19 | 0.21 | 0.30 | 0.41 | 0.44 |
21 | 36 | 40 | 57 | 75 | 80 | 95 | 103 | 139 | 178 | 66 | 0.21 | 0.24 | 0.35 | 0.47 | 0.51 |
22 | 45 | 50 | 69 | 92 | 98 | 97 | 105 | 140 | 181 | 95 | 0.24 | 0.27 | 0.39 | 0.53 | 0.57 |
23 | 55 | 60 | 83 | 109 | 117 | 99 | 106 | 141 | 183 | 112 | 0.27 | 0.30 | 0.43 | 0.59 | 0.63 |
24 | 65 | 71 | 97 | 128 | 136 | 99 | 106 | 141 | 184 | 132 | 0.29 | 0.33 | 0.48 | 0.64 | 0.70 |
25 | 76 | 82 | 112 | 147 | 156 | 98 | 105 | 139 | 182 | 154 | 0.32 | 0.36 | 0.52 | 0.70 | 0.75 |
26 | 85 | 93 | 129 | 165 | 175 | 96 | 103 | 136 | 177 | 176 | 0.34 | 0.38 | 0.55 | 0.75 | 0.81 |
27 | 95 | 103 | 140 | 182 | 194 | 93 | 99 | 131 | 171 | 198 | 0.36 | 0.41 | 0.59 | 0.80 | 0.86 |
28 | 104 | 113 | 154 | 200 | 212 | 89 | 95 | 126 | 163 | 220 | 0.38 | 0.43 | 0.62 | 0.84 | 0.91 |
29 | 112 | 122 | 167 | 217 | 230 | 84 | 91 | 121 | 154 | 241 | 0.40 | 0.45 | 0.65 | 0.88 | 0.96 |
30 | 120 | 131 | 181 | 234 | 248 | 80 | 87 | 116 | 147 | 261 | 0.42 | 0.47 | 0.68 | 0.92 | 1.00 |
31 | 127 | 140 | 194 | 252 | 267 | 76 | 83 | 111 | 140 | 281 | 0.44 | 0.49 | 0.71 | 0.96 | 1.04 |
32 | 135 | 149 | 208 | 270 | 286 | 73 | 80 | 108 | 135 | 300 | 0.45 | 0.51 | 0.73 | 0.99 | 1.07 |
33 | 142 | 158 | 222 | 289 | 307 | 70 | 77 | 104 | 131 | 319 | 0.47 | 0.53 | 0.76 | 1.03 | 1.11 |
34 | 148 | 166 | 235 | 307 | 328 | 67 | 74 | 101 | 127 | 337 | 0.48 | 0.54 | 0.78 | 1.05 | 1.14 |
35 | 153 | 173 | 247 | 326 | 349 | 64 | 71 | 98 | 124 | 355 | 0.49 | 0.55 | 0.80 | 1.08 | 1.17 |
36 | 157 | 178 | 258 | 344 | 369 | 60 | 67 | 94 | 121 | 371 | 0.50 | 0.57 | 0.81 | 1.1 | 1.19 |
37 | 159 | 182 | 267 | 360 | 389 | 55 | 62 | 91 | 119 | 385 | 0.51 | 0.58 | 0.83 | 1.12 | 1.21 |
38 | 158 | 184 | 274 | 376 | 409 | 50 | 57 | 87 | 117 | 397 | 0.52 | 0.59 | 0.84 | 1.14 | 1.23 |
39 | 156 | 183 | 279 | 389 | 428 | 45 | 53 | 83 | 115 | 406 | 0.53 | 0.60 | 0.86 | 1.16 | 1.25 |
40 | 150 | 181 | 282 | 402 | 446 | 39 | 48 | 80 | 113 | 415 | 0.54 | 0.60 | 0.87 | 1.17 | 1.27 |
41 | 143 | 176 | 283 | 412 | 464 | 34 | 43 | 76 | 111 | 422 | 0.54 | 0.61 | 0.88 | 1.19 | 1.29 |
UV-Q | UV-Q/EFW | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
GA (Weeks) | Sutton 1990 | Bellotti 2000 | Boito 2003 | Flo 2010 | DeVore 2021 | Wang 2021 | GA (Weeks) | Sutton 1990 | Barbera 1999 | Bellotti 2000 | Flo 2010 | DeVore 2021 |
22 | −0.56 | −1.92 | −0.67 | −0.25 | −0.33 | −0.34 | 22 | 0.32 | −0.65 | −0.79 | −0.28 | −0.56 |
23 | −0.60 | −1.36 | −0.50 | −0.18 | −0.09 | 0.04 | 23 | 0.13 | −0.45 | −0.56 | −0.25 | −0.25 |
24 | −0.68 | −1.32 | −0.50 | −0.14 | −0.04 | 0.21 | 24 | 0.07 | −0.45 | −0.52 | −0.27 | −0.17 |
25 | −1.18 | −2.10 | −0.83 | −0.24 | 0.00 | 0.48 | 25 | 0.13 | −0.63 | −0.74 | −0.41 | −0.18 |
26 | −1.05 | −1.85 | −0.75 | −0.19 | 0.07 | 0.56 | 26 | 0.21 | −0.63 | −0.79 | −0.42 | −0.17 |
27 | −1.02 | −1.80 | −0.76 | −0.13 | 0.13 | 0.67 | 27 | 0.39 | −0.55 | −0.69 | −0.32 | −0.05 |
28 | −0.86 | −1.57 | −0.70 | −0.08 | 0.14 | 0.68 | 28 | 0.40 | −0.27 | −0.37 | −0.17 | 0.03 |
29 | −0.69 | −1.39 | −0.63 | −0.02 | 0.16 | 0.70 | 29 | 0.64 | −0.21 | −0.29 | −0.12 | 0.08 |
30 | −0.61 | −1.39 | −0.66 | 0.00 | 0.17 | 0.78 | 30 | 0.76 | −0.04 | −0.12 | 0.00 | 0.12 |
31 | −0.53 | −1.49 | −0.75 | 0.05 | 0.19 | 0.98 | 31 | 1.07 | 0.14 | 0.05 | 0.10 | 0.14 |
32 | −0.39 | −1.55 | −0.83 | 0.07 | 0.17 | 1.12 | 32 | 1.67 | 0.28 | 0.21 | 0.14 | 0.14 |
33 | −0.14 | −1.18 | −0.68 | 0.07 | 0.07 | 0.95 | 33 | 1.09 | 0.29 | 0.25 | 0.12 | 0.04 |
34 | 0.10 | −1.36 | −0.84 | 0.13 | 0.04 | 1.23 | 34 | 1.55 | 0.50 | 0.44 | 0.11 | 0.00 |
35 | 0.43 | −1.20 | −0.80 | 0.18 | 0.00 | 1.30 | 35 | 1.72 | 0.58 | 0.64 | 0.12 | −0.12 |
36 | 0.53 | −0.69 | −0.50 | 0.15 | −0.03 | 0.91 | 36 | 1.33 | 0.54 | 0.58 | 0.08 | −0.08 |
37 | 1.00 | −0.68 | −0.55 | 0.26 | −0.04 | 1.20 | 37 | 1.42 | 0.64 | 0.68 | 0.08 | −0.13 |
38 | 1.79 | −0.63 | −0.59 | 0.44 | −0.07 | 1.67 | 38 | 1.89 | 0.89 | 1.00 | 0.11 | −0.16 |
39 | 1.75 | −0.27 | −0.34 | 0.42 | −0.04 | 1.35 | 39 | 1.67 | 0.87 | 1.00 | 0.09 | −0.13 |
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Barbieri, M.; Zamagni, G.; Fantasia, I.; Monasta, L.; Lo Bello, L.; Quadrifoglio, M.; Ricci, G.; Maso, G.; Piccoli, M.; Di Martino, D.D.; et al. Umbilical Vein Blood Flow in Uncomplicated Pregnancies: Systematic Review of Available Reference Charts and Comparison with a New Cohort. J. Clin. Med. 2023, 12, 3132. https://doi.org/10.3390/jcm12093132
Barbieri M, Zamagni G, Fantasia I, Monasta L, Lo Bello L, Quadrifoglio M, Ricci G, Maso G, Piccoli M, Di Martino DD, et al. Umbilical Vein Blood Flow in Uncomplicated Pregnancies: Systematic Review of Available Reference Charts and Comparison with a New Cohort. Journal of Clinical Medicine. 2023; 12(9):3132. https://doi.org/10.3390/jcm12093132
Chicago/Turabian StyleBarbieri, Moira, Giulia Zamagni, Ilaria Fantasia, Lorenzo Monasta, Leila Lo Bello, Mariachiara Quadrifoglio, Giuseppe Ricci, Gianpaolo Maso, Monica Piccoli, Daniela Denis Di Martino, and et al. 2023. "Umbilical Vein Blood Flow in Uncomplicated Pregnancies: Systematic Review of Available Reference Charts and Comparison with a New Cohort" Journal of Clinical Medicine 12, no. 9: 3132. https://doi.org/10.3390/jcm12093132