Original Paper Fetal Diagn Ther 2014;36:208–214 DOI: 10.1159/000358299
Received: January 7, 2013 Accepted after revision: December 27, 2013 Published online: August 13, 2014
Predicting Fetal Lung Maturity Using the Fetal Pulmonary Artery Doppler Wave Acceleration/Ejection Time Ratio Mauro H. Schenone a Jacques E. Samson a Laura Jenkins b Anju Suhag c Giancarlo Mari a a
Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, and b Department of Obstetrics and Gynecology, UT Medical Group, Inc., Memphis, Tenn., and c Thomas Jefferson University, Philadelphia, Penn., USA
Abstract Objective: To determine whether the acceleration/ejection time ratio of the fetal main pulmonary artery Doppler waveform (PATET) can accurately predict the results of fetal lung maturity testing in amniotic fluid. Methods: We prospectively studied pregnant women attending our ultrasound unit for clinically indicated fetal lung maturity testing. An ultrasound examination that included measurement of the PATET was performed before the results of the amniocentesis were reported. The results of the PATET and the surfactant/albumin ratio were compared, and a receiver operating characteristic curve was used to determine the PATET cutoff with the optimal sensitivity and specificity for predicting surfactant/albumin ratio results. p < 0.05 was considered statistically significant. Results: Forty-three patients were included in this study. The receiver operating characteristic curve demonstrated that a PATET cutoff of 0.3149 provided a specificity of 93% (95% CI 77–98%), a sensitivity of 73% (95% CI 48–89%), a negative predictive value of 87% (95% CI 70– 95%), and a positive predictive value of 85% (95% CI 58–
© 2014 S. Karger AG, Basel 1015–3837/14/0363–0208$39.50/0 E-Mail [email protected] www.karger.com/fdt
96%) for predicting immature surfactant/albumin ratio results. Conclusion: The PATET may provide a noninvasive means of determining fetal lung maturity with acceptable levels of sensitivity, specificity, and predictive values. © 2014 S. Karger AG, Basel
Introduction
A great effort has been made to predict fetal lung maturity to determine when a fetus is likely to develop neonatal complications as a result of pulmonary immaturity (e.g. respiratory distress syndrome of the newborn or death). Several methods to evaluate fetal lung maturity have been described, and the standard of care today involves performing an amniocentesis [1]. Amniocenteses carry risks and complications in approximately 0.7% of cases; such complications include preterm labor and delivery, preterm premature rupture of membranes, placental abruption, and fetomaternal hemorrhage [2]. To avoid the risks associated with amniocentesis, a noninvasive test is desirable. Based on previous studies demonstrating a correlation between advancing gestational age and fetal pulmonary artery Doppler waveform acceleration/ejecMauro H. Schenone, MD Department of Obstetrics and Gynecology University of Tennessee Health Science Center, 853 Jefferson Avenue, Room E102 Memphis, TN 38163 (USA) E-Mail mschenon @ uthsc.edu
Downloaded by: NYU Medical Center Library 128.122.253.228 - 4/28/2015 7:42:32 PM
Key Words Fetal lung maturity · Prediction · Amniotic fluid
* * Fig. 1. Appropriate views to measure the PATET. a Ductal arch view. b Right outa
tion time and between the latter and fetal lung maturity testing in amniotic fluid [3, 4], we hypothesized that this method could accurately predict lung maturity. In this study, we sought to determine whether measuring the acceleration/ejection time ratio of the fetal main pulmonary artery Doppler waveform (PATET) could accurately predict the results of fetal lung maturity testing in amniotic fluid.
Materials and Methods This study was approved by the Institutional Review Board of the University of Tennessee Health Science Center. Pregnant women attending our ultrasound unit for clinically indicated fetal lung maturity testing from April to December 2011 were studied prospectively. Patients with major fetal anomalies and those in whom the amniotic fluid was noted to be bloody or meconiumtinged were excluded. The gestational age was determined based on the last menstrual period when compatible with ultrasound dating; otherwise, ultrasound-dating criteria were used [5]. To our knowledge, none of the cases included in this study received corticosteroids for fetal maturation, but we were unable to confirm this. After obtaining informed consent, an ultrasound examination was performed within 24 h of the amniocentesis and before the investigators knew the results of the fetal lung maturity tests in amniotic fluid. During the examination, spectral Doppler ultrasound was used to obtain fetal main pulmonary artery waveforms. Additionally, the gestational age was confirmed using fetal biometry, and the amniotic fluid index, estimated fetal weight, and fetal heart rate were recorded. Using a Philips iU22 system (Philips Electronics North America Corporation, Andover, Mass., USA), which is equipped with a 5-MHz convex array sector transducer, two examiners (L.J. and M.H.S.) performed the ultrasound examination. The system’s cardiac or general obstetrical settings were used. The patients were
Predicting Fetal Lung Maturity
b
placed in the supine decubitus position with a slight inclination (
Received: January 7, 2013 Accepted after revision: December 27, 2013 Published online: August 13, 2014
Predicting Fetal Lung Maturity Using the Fetal Pulmonary Artery Doppler Wave Acceleration/Ejection Time Ratio Mauro H. Schenone a Jacques E. Samson a Laura Jenkins b Anju Suhag c Giancarlo Mari a a
Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, and b Department of Obstetrics and Gynecology, UT Medical Group, Inc., Memphis, Tenn., and c Thomas Jefferson University, Philadelphia, Penn., USA
Abstract Objective: To determine whether the acceleration/ejection time ratio of the fetal main pulmonary artery Doppler waveform (PATET) can accurately predict the results of fetal lung maturity testing in amniotic fluid. Methods: We prospectively studied pregnant women attending our ultrasound unit for clinically indicated fetal lung maturity testing. An ultrasound examination that included measurement of the PATET was performed before the results of the amniocentesis were reported. The results of the PATET and the surfactant/albumin ratio were compared, and a receiver operating characteristic curve was used to determine the PATET cutoff with the optimal sensitivity and specificity for predicting surfactant/albumin ratio results. p < 0.05 was considered statistically significant. Results: Forty-three patients were included in this study. The receiver operating characteristic curve demonstrated that a PATET cutoff of 0.3149 provided a specificity of 93% (95% CI 77–98%), a sensitivity of 73% (95% CI 48–89%), a negative predictive value of 87% (95% CI 70– 95%), and a positive predictive value of 85% (95% CI 58–
© 2014 S. Karger AG, Basel 1015–3837/14/0363–0208$39.50/0 E-Mail [email protected] www.karger.com/fdt
96%) for predicting immature surfactant/albumin ratio results. Conclusion: The PATET may provide a noninvasive means of determining fetal lung maturity with acceptable levels of sensitivity, specificity, and predictive values. © 2014 S. Karger AG, Basel
Introduction
A great effort has been made to predict fetal lung maturity to determine when a fetus is likely to develop neonatal complications as a result of pulmonary immaturity (e.g. respiratory distress syndrome of the newborn or death). Several methods to evaluate fetal lung maturity have been described, and the standard of care today involves performing an amniocentesis [1]. Amniocenteses carry risks and complications in approximately 0.7% of cases; such complications include preterm labor and delivery, preterm premature rupture of membranes, placental abruption, and fetomaternal hemorrhage [2]. To avoid the risks associated with amniocentesis, a noninvasive test is desirable. Based on previous studies demonstrating a correlation between advancing gestational age and fetal pulmonary artery Doppler waveform acceleration/ejecMauro H. Schenone, MD Department of Obstetrics and Gynecology University of Tennessee Health Science Center, 853 Jefferson Avenue, Room E102 Memphis, TN 38163 (USA) E-Mail mschenon @ uthsc.edu
Downloaded by: NYU Medical Center Library 128.122.253.228 - 4/28/2015 7:42:32 PM
Key Words Fetal lung maturity · Prediction · Amniotic fluid
* * Fig. 1. Appropriate views to measure the PATET. a Ductal arch view. b Right outa
tion time and between the latter and fetal lung maturity testing in amniotic fluid [3, 4], we hypothesized that this method could accurately predict lung maturity. In this study, we sought to determine whether measuring the acceleration/ejection time ratio of the fetal main pulmonary artery Doppler waveform (PATET) could accurately predict the results of fetal lung maturity testing in amniotic fluid.
Materials and Methods This study was approved by the Institutional Review Board of the University of Tennessee Health Science Center. Pregnant women attending our ultrasound unit for clinically indicated fetal lung maturity testing from April to December 2011 were studied prospectively. Patients with major fetal anomalies and those in whom the amniotic fluid was noted to be bloody or meconiumtinged were excluded. The gestational age was determined based on the last menstrual period when compatible with ultrasound dating; otherwise, ultrasound-dating criteria were used [5]. To our knowledge, none of the cases included in this study received corticosteroids for fetal maturation, but we were unable to confirm this. After obtaining informed consent, an ultrasound examination was performed within 24 h of the amniocentesis and before the investigators knew the results of the fetal lung maturity tests in amniotic fluid. During the examination, spectral Doppler ultrasound was used to obtain fetal main pulmonary artery waveforms. Additionally, the gestational age was confirmed using fetal biometry, and the amniotic fluid index, estimated fetal weight, and fetal heart rate were recorded. Using a Philips iU22 system (Philips Electronics North America Corporation, Andover, Mass., USA), which is equipped with a 5-MHz convex array sector transducer, two examiners (L.J. and M.H.S.) performed the ultrasound examination. The system’s cardiac or general obstetrical settings were used. The patients were
Predicting Fetal Lung Maturity
b
placed in the supine decubitus position with a slight inclination (
