{"id":100,"date":"2021-11-11T15:20:09","date_gmt":"2021-11-11T15:20:09","guid":{"rendered":"https:\/\/obgconnect.com\/senseclinical\/?p=100"},"modified":"2021-11-12T19:09:55","modified_gmt":"2021-11-12T19:09:55","slug":"isuog-recommendations-fetal-ultrasound-follow-up-for-women-with-established-preeclampsia","status":"publish","type":"post","link":"https:\/\/obgconnect.com\/senseclinical\/2021\/11\/11\/isuog-recommendations-fetal-ultrasound-follow-up-for-women-with-established-preeclampsia\/","title":{"rendered":"ISUOG Recommendations: Fetal Ultrasound Follow-Up for Women with Established Preeclampsia"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">SUMMARY:<\/h2>\n\n\n\n<p>The ISUOG Clinical Standards Committee has released practice guidelines reviewing the latest evidence and provides recommendations regarding the role of ultrasound in follow-up for women diagnosed with preeclampsia.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">KEY POINTS:<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li>Close fetal surveillance is warranted as deteriorating fetal status may be an indication for earlier delivery<\/li><li>Sonographic follow up of PE should include<ul><li>Fetal growth<\/li><li>Biophysical profile<\/li><li>Fetal Doppler assessments<\/li><\/ul><\/li><li>Frequency and impact of sonographic follow up has yet to be determined by large-scale clinical trials<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Role of B-mode Ultrasound<\/h3>\n\n\n\n<p><em>Ultrasound assessment should include<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Fetal growth<ul><li>Rule out impaired growth<\/li><\/ul><\/li><li>Biophysical profile<ul><li>BPP of &gt;8: Normal \u2013 manifestation of fetal wellbeing<\/li><li>BPP of 6: Inconclusive \u2013 repeat test<\/li><li>BPP of \u22644: Non-reassuring \u2013 consider delivery<\/li><\/ul><\/li><li>Amniotic fluid volume<ul><li>Ensure presence of MVP &gt;2 cm and\/or AFI &gt;5 cm<\/li><li>Evidence that MVP may result in fewer interventions (see \u2018Related ObG Topics\u2019 below)<\/li><\/ul><\/li><li>Placentation<ul><li>Thickness | Echogenicity | Uteroplacental interface<\/li><li>Severe PE may be associated with<ul><li>Placental edema and diffuse echogenicity due to edema<\/li><li>Thick placenta and reduced vascularization<\/li><li>Cystic regions (infarctions\/ hematomas)<\/li><\/ul><\/li><li>Abruption (poor sensitivity with 50 to 75% missed on ultrasound<ul><li>Hematoma (preplacental and retroperitoneal) | Subchorionic and marginal blood | Increased placental thickness and echogenicity<\/li><\/ul><\/li><\/ul><\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Role of Doppler Studies<\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li>4 major Doppler exams<ul><li>Umbilical artery (UA)<\/li><li>Fetal middle cerebral artery (MCA)<\/li><li>Fetal ductus venosus<\/li><li>Uterine arteries<\/li><\/ul><\/li><\/ul>\n\n\n\n<p><em>Especially in the presence of maternal headache, abdominal pain, bleeding and\/or reduced fetal movements consider<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>*UA<ul><li>absent or reversed end-diastolic flow is strongly associated with poor perinatal outcomes<\/li><li>Increased resistance in the uterine arteries is not a useful indicator for timing of delivery<\/li><\/ul><\/li><li>*Fetal MCA PI<ul><li>Reduced MCA-PI &lt;10th percentile (cephalization) may precede abnormal UA indices, and warrants close fetal surveillance<\/li><\/ul><\/li><li>*Cerebroplacental ratio (CPR)<ul><li>CPR: MCA PI \/ UA PI<\/li><li>CPR&lt;10th percentile may represent hemodynamic redistribution<\/li><li>Warrants close fetal surveillance<\/li><\/ul><\/li><li>Fetal ductus venosus<ul><li>Unlike the above 3 indices (marked with *), ductus venosus is not included in ultrasound recommendation list (\u2018Good Practice Points\u2019) for preeclampsia follow up<\/li><li>However, the guideline does point out that a reversed a-wave is strongly association with fetal cardiac deterioration<\/li><\/ul><\/li><\/ul>\n\n\n\n<p><strong>Note: <\/strong>ISUOG states that the above tests should also \u201cbe considered for women admitted for PE or with suspected PE, as well as for those with severe PE or HELLP syndrome\u201d as a \u2018Good Practice Point\u2019.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Impact of Medications on Ultrasound Indices<\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li>Antihypertensives<ul><li>Not associated with changes in maternal and fetal Doppler indices<\/li><\/ul><\/li><li>Antenatal steroids<ul><li>Associated with a transient decrease in vascular resistance in the UA and ductus venosus<\/li><\/ul><\/li><li>Magnesium sulfate<ul><li>Unclear<\/li><\/ul><\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Learn More &#8211; Primary Sources:<\/h2>\n\n\n\n<p><a href=\"https:\/\/www.isuog.org\/uploads\/assets\/uploaded\/14e78edc-7c46-4e3f-a13d6f563be6a9cb.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">ISUOG Practice Guidelines: role of ultrasound in screening for and follow up of pre-eclampsia<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>SUMMARY: The ISUOG Clinical Standards Committee has released practice guidelines reviewing the latest evidence and provides recommendations regarding the role of ultrasound in follow-up for women diagnosed with preeclampsia. KEY POINTS: Close fetal surveillance is warranted as deteriorating fetal status may be an indication for earlier delivery Sonographic follow up of PE should include Fetal [&hellip;]<\/p>\n","protected":false},"author":2423,"featured_media":146,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-100","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ISUOG Recommendations: Fetal Ultrasound Follow-Up for Women with Established Preeclampsia - SENSE Clinical<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/obgconnect.com\/senseclinical\/2021\/11\/11\/isuog-recommendations-fetal-ultrasound-follow-up-for-women-with-established-preeclampsia\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ISUOG Recommendations: Fetal Ultrasound Follow-Up for Women with Established Preeclampsia - SENSE Clinical\" \/>\n<meta property=\"og:description\" content=\"SUMMARY: The ISUOG Clinical Standards Committee has released practice guidelines reviewing the latest evidence and provides recommendations regarding the role of ultrasound in follow-up for women diagnosed with preeclampsia. 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