Basic fetal echocardiography as part of the routine anatomy scan is very useful in showing both n... more Basic fetal echocardiography as part of the routine anatomy scan is very useful in showing both normal fetal hearts and abnormal cardiovascular physiology and anatomy. In maternal fetal and pediatric cardiology centers where fetal echo is routinely performed, over 97 % of significant anatomic and physiologic anomalies and arrhythmias can be identified. However, most fetuses with these issues are missed at the routine fetal anatomy scan for a variety of reasons. It is therefore incumbent upon those who are facile with the techniques of fetal echo to teach and promote the use of simple training methods by examples. We highly recommend the use of video clips of the fetal heart to show the anatomic and functional relationships of the veins, atria, ventricles and great arteries.
Purpose: Pulmonary hypoplasia in patients with congenital diaphragmatic hernia remains a signific... more Purpose: Pulmonary hypoplasia in patients with congenital diaphragmatic hernia remains a significant cause of morbidity and mortality. Little progress has been made in terms of predicting, in the prenatal period, which patients will develop lethal pulmonary complications from pulmonary hypolasia. In normal lungs there is an acquired vasoconstriction that occurs after 30 weeks gestation. This allows the fetal pulmonary vascular bed to respond similarly to the neonatal vascular bed in the presence of increased oxygen. By ultrasound, there is a significant increase in the fetal pulmonary blood flow (>20%), as measured by the pulsatility index, with the delivery of maternal supplemental oxygen after 30 weeks gestation compared to room air. We have previously shown, in a heterogeneous group of anomalies, that a non-reactive hyperoxygenation test predicted lethality (Am J Obstet Gynecol 2002, 187:940-5). We hypothesize that congenital diaphragmatic hernia patients with severe pulmonary...
BACKGROUND: The Myocardial Performance Index (MPI) is a Doppler derived myocardial function tool ... more BACKGROUND: The Myocardial Performance Index (MPI) is a Doppler derived myocardial function tool and can be used to evaluate systolic and diastolic function in fetuses. The objectives of this study were to investigate the MPI during labor and compare it to values in non-laboring women.METHODOLOGY: 40 women with uncomplicated, term, singleton pregnancies were recruited to this prospective observational study at Thomas Jefferson University Hospital. Controls were a retrospective cohort of women…
Progress in the fields of fetal cardiology and fetal surgery have been seen not only in singleton... more Progress in the fields of fetal cardiology and fetal surgery have been seen not only in singleton pregnancies but also in multiple pregnancies. Proper interpretation of prenatal echocardiography is critical to clinical decision making, family counseling and perinatal management for obstetricians, maternal fetal medicine specialists, neonatologists and pediatric cardiologists. Fetal echocardiography is one of the most challenging and time-consuming prenatal examinations to perform, especially in multiple gestations. Performing just the basic fetal exam in twin gestations may take an hour or more. Thus, it is not practical to perform this exam in all cases of multiple gestations. Therefore our review and recommendations are related to fetal echocardiography in twin gestation.
3D RTE images were also created for the 47 malignant tumors. Most malignant tumors 42 cases (89.4... more 3D RTE images were also created for the 47 malignant tumors. Most malignant tumors 42 cases (89.4%) exhibited Type 3. Conclusions: In 3D stereoscopic images obtained by Real-time Tissue Elastography with Real-time 3D probe, blue contrast reflects hardness distribution in the tumor. In stereoscopic images composed mainly of blue, the shape and border properties are considered useful in determining whether the tumor is benign or malignant. Sequential changes in hardness distribution, this technique may be used for evaluation of treatment and may be applied to biopsy as a puncture guide by adding hardness information of the tumor by stereoscopic images.
When started at least 2 hours after the first dose of indomethacin, dopamine induces renal and me... more When started at least 2 hours after the first dose of indomethacin, dopamine induces renal and mesenteric vasodilation without affecting cerebral hemodynamics in the >1-day-old indomethacin-treated preterm infant.
This Protocol for Evaluating the Fetal and Neonatal Heart details the indications, views, and mea... more This Protocol for Evaluating the Fetal and Neonatal Heart details the indications, views, and measurements to be obtained for both (1) the basic screening examination of the fetal heart (a necessary component of all complete fetal anatomy evaluations) and the specialty study called (2) echocardiography as applied to either the fetus or neonate, using 2D and Doppler ultrasound. While the purpose of the screening study is to detect or exclude the possibility of a cardiac abnormality, echocardiography attempts to diagnose the specific anatomic and physiologic disruption. Also emphasized is the value of a collaborative team approach to management of the fetus and its parents when a cardiovascular anomaly is present, in an effort to achieve a smoother transition from fetus to neonate across the continuum of perinatal care.
To study the effects of dopamine on renal, mesenteric, and cerebral blood flow in sick preterm ne... more To study the effects of dopamine on renal, mesenteric, and cerebral blood flow in sick preterm neonates. Study design: The pulsatility index was used to assess the dopamine-induced changes in renal, mesenteric, and cerebral blood flow by means of color Doppler ultrasonography in 23 nonhypotensive preterm neonates (birth weight: 981 ± 314 g; postnatal age: <2 days). Dopamine was given at a dose of 6.1 ± 3.0 µg/kg per minute to combat oliguria, impaired peripheral perfusion, or both. Blood flow velocity measurements were made before and during dopamine administration, with each patient serving as his or her own control subject. Results: Dopamine significantly increased blood pressure and urine output. Dopamine decreased the pulsatility index in the renal artery (2.98 ± 1.18 vs 1.68 ± 0.45; P < .05) while the pulsatility index in the superior mesenteric and medial cerebral artery was not affected. Thus renal blood flow increased while mesenteric and cerebral blood flow remained unchanged during dopamine treatment. The increase in renal blood flow was independent of the blood pressure changes. Conclusions: These findings suggest a functionally mature renal, but not mesenteric, vasodilatory dopaminergic response in the preterm neonate. The observations also indicate the lack of an effect of low-to medium-dose dopamine on cerebral hemodynamics in the nonhypotensive preterm neonate.
Background —The aims of the present study were to determine whether maternal hyperoxygenation aff... more Background —The aims of the present study were to determine whether maternal hyperoxygenation affects human fetal pulmonary circulation and whether there is a gestational age-related response in the fetal pulmonary circulation to maternal hyperoxygenation during the second half of gestation. Methods and Results —Twenty women between 20 and 26 weeks of gestation and 20 women between 31 and 36 weeks of gestation with normal singleton pregnancies were randomized to receive either 60% humidified oxygen or medical compressed air (room air) by a face mask. Fetal aortic and pulmonary valve; ductus arteriosus (DA); and right (RPA), left (LPA), and distal (DPA) pulmonary artery blood velocity waveforms were obtained by Doppler ultrasound before, during, and after maternal administration of either 60% oxygen or room air. Left and right ventricular cardiac outputs, DA volume blood flow, and RPA and LPA volume blood flows (Q P ) were calculated. Foramen ovale volume blood flow (left ventricular...
American Journal of Obstetrics and Gynecology, 2002
Several ultrasonographic signs have been described in second-trimester fetuses at high risk for D... more Several ultrasonographic signs have been described in second-trimester fetuses at high risk for Down syndrome. We examined these parameters in twin pregnancies in which one fetus was affected with Down syndrome and the other was normal. Biparietal diameter to femur length ratio was concordant (either normal or abnormal) in eight of nine sets of twins. Actual femur length to expected femur length ratio was concordant in seven of nine sets of twins. Nuchal fold thickening (6 mm or more) correctly identified five of nine affected fetuses and was not present in any of the normal fetuses. In conclusion, neither ratio was helpful in differentiating the fetus with Down syndrome from its normal co-twin. A thickened nuchal fold was the most informative parameter examined.
American Journal of Obstetrics and Gynecology, 2006
Using pulsed-wave tissue Doppler imaging (TDI), we compared right and left ventricular (RV, LV) s... more Using pulsed-wave tissue Doppler imaging (TDI), we compared right and left ventricular (RV, LV) systolic and diastolic function between fetuses with congenital heart disease (CHD) but no signs of congestive heart failure (CHF), and those with a structurally normal heart and normal function. STUDY DESIGN: We measured myocardial velocities in the RV and LV during systole and diastole in 187 fetuses (103 with CHD, 84 normal) at 18-38 weeks of gestation referred to two large perinatal cardiology services from 2005-2006 in this cross sectional retrospective study. Indices of diastolic function assessed were: peak mitral and tricuspid annular velocities (E 0 , A 0) isovolumic relaxation time (IVRT); Indices of systolic function evaluated included: peak S wave velocity (S 0), isovolumic contraction time (IVCT), and peak isovolumic velocity (IVV); and the myocardial performance index (MPI). Differences between normal and CHD fetuses were assessed by the independent two sample t-test and Mann Whitney U test. RESULTS: In the fetus with CHD but no clinical CHF, some RV indices were significantly higher compared to the normal group: MPI = 0.44 vs. 0.39 (p=0.01); IVV = 6.1 vs 4.3 cm/s (p= 0. 02); and IVRT = 50 vs 40 ms (p= 0.0003). There were no differences in LV indices. CONCLUSION: TDI detects subtle abnormalities in systolic and diastolic RV function in the fetus with CHD but no clinical signs of CHF. As with other markers of CHF in the fetus, the RV appears to manifest TDI changes before the LV. Further evaluation by TDI of the fetus with signs of heart failure may detect additional or more serious markers of diastolic or systolic dysfunction.
Pulmonary hypoplasia is a term that describes lungs that are sufficiently small enough to impede ... more Pulmonary hypoplasia is a term that describes lungs that are sufficiently small enough to impede the exchange of respiratory gases. 1 Because gas exchange does not occur in the fetal lung, it is difficult to prove that fetal lungs may be functionally hypoplastic. Pulmonary hy-poplasia may be defined as incomplete or underdevelop-ment of lung tissue that is present at autopsy and is determined by the wet lung-to-body weight ratio, by reduced alveoli count, or by reduced lung DNA content. 2 It is a diagnosis that can be made by the pathologist at the time of the autopsy with lung-to-body weight ratio, reduced radial alveolar count, or reduced lung DNA content. The incidence is reported as 11 to 14 per 10,000 live births in the general population and as 7% to 14% in autopsies of all premature infants. 3 Perinatal mortality rates approached 70% in most studies. 4 Fifteen percent to 20% of neonatal deaths can be attributed to this process. Pulmonary hypoplasia occurs when there is a disruption of normal lung growth and maturation during the critical time period. Numerous conditions can lead to thoracic compression, inhibition of fetal breathing movements , and loss of lung fluids that impede pulmonary growth during the crucial pseudoglandular and canalicu-lar phases between 6 and 26 weeks of gestation. If this is not corrected, pulmonary hypoplasia and neonatal death likely will result. Historically, attempts have been made to assess the postnatal function of the fetal pulmonary system by anatomic criteria. Recent studies have shown that fetal pulmonary vasculature reacts to maternal hyperoxygena-tion. 5,6 Our study looks to predict pulmonary function by assessing pulmonary vascular reactivity in utero. We hypothesized that fetuses with severe lung hypoplasia do not have the same reactivity to maternal hyperoxygena-tion as normal fetuses of similar gestation. We also believe that, because our test attempts to simulate physiologic factors after delivery (which do not differ despite differ-OBJECTIVE: The purpose of this study was to determine the predictive accuracy of a test for neonatal death from pulmonary hypoplasia by measuring changes in fetal pulmonary artery blood flow on room air and during maternal hyperoxygenation. STUDY DESIGN: Women who were carrying fetuses with congenital anomalies that may cause pulmonary hypoplasia were offered participation in the study as part of a comprehensive fetal echocardiogram. Each fetus at ≥30 weeks of gestation underwent Doppler measurement of the blood flow pattern in the first branch of either the right or the left pulmonary artery before and again during exposure to maternal breathing of 60% oxygen by mask. An increase in the fetal pulmonary blood flow with oxygen (a decrease of ≥20% of the pulsatility index) was considered a reactive test. A change of <20% in the flow pattern during maternal hyper-oxygenation was a nonreactive test and suggested pulmonary hypoplasia. The primary outcome for this study was neonatal death from pulmonary hypoplasia. RESULTS: Twenty-nine pregnancies met the criteria for inclusion in our study. Of the 14 fetuses who had a nonreactive hyperoxygenation test, 11 fetuses (79%) died of pulmonary hypoplasia. Of the 15 fetuses who had a reactive hyperoxygenation test, only one fetus (7%) died in the neonatal period. Sensitivity, specificity, and positive and negative predictive values were 92%, 82%, 79%, and 93%, respectively, with an odds ratio of 51 (95% CI, 4.6-560). CONCLUSION: Testing fetal pulmonary vascular reactivity with maternal hyperoxygenation is highly predic-tive of pulmonary hypoplasia. A reactive test predicted 92% of surviving infants; a nonreactive test predicted 79% of fetal deaths from pulmonary hypoplasia. (Am J Obstet Gynecol 2002;187:940-5)
Basic fetal echocardiography as part of the routine anatomy scan is very useful in showing both n... more Basic fetal echocardiography as part of the routine anatomy scan is very useful in showing both normal fetal hearts and abnormal cardiovascular physiology and anatomy. In maternal fetal and pediatric cardiology centers where fetal echo is routinely performed, over 97 % of significant anatomic and physiologic anomalies and arrhythmias can be identified. However, most fetuses with these issues are missed at the routine fetal anatomy scan for a variety of reasons. It is therefore incumbent upon those who are facile with the techniques of fetal echo to teach and promote the use of simple training methods by examples. We highly recommend the use of video clips of the fetal heart to show the anatomic and functional relationships of the veins, atria, ventricles and great arteries.
Purpose: Pulmonary hypoplasia in patients with congenital diaphragmatic hernia remains a signific... more Purpose: Pulmonary hypoplasia in patients with congenital diaphragmatic hernia remains a significant cause of morbidity and mortality. Little progress has been made in terms of predicting, in the prenatal period, which patients will develop lethal pulmonary complications from pulmonary hypolasia. In normal lungs there is an acquired vasoconstriction that occurs after 30 weeks gestation. This allows the fetal pulmonary vascular bed to respond similarly to the neonatal vascular bed in the presence of increased oxygen. By ultrasound, there is a significant increase in the fetal pulmonary blood flow (>20%), as measured by the pulsatility index, with the delivery of maternal supplemental oxygen after 30 weeks gestation compared to room air. We have previously shown, in a heterogeneous group of anomalies, that a non-reactive hyperoxygenation test predicted lethality (Am J Obstet Gynecol 2002, 187:940-5). We hypothesize that congenital diaphragmatic hernia patients with severe pulmonary...
BACKGROUND: The Myocardial Performance Index (MPI) is a Doppler derived myocardial function tool ... more BACKGROUND: The Myocardial Performance Index (MPI) is a Doppler derived myocardial function tool and can be used to evaluate systolic and diastolic function in fetuses. The objectives of this study were to investigate the MPI during labor and compare it to values in non-laboring women.METHODOLOGY: 40 women with uncomplicated, term, singleton pregnancies were recruited to this prospective observational study at Thomas Jefferson University Hospital. Controls were a retrospective cohort of women…
Progress in the fields of fetal cardiology and fetal surgery have been seen not only in singleton... more Progress in the fields of fetal cardiology and fetal surgery have been seen not only in singleton pregnancies but also in multiple pregnancies. Proper interpretation of prenatal echocardiography is critical to clinical decision making, family counseling and perinatal management for obstetricians, maternal fetal medicine specialists, neonatologists and pediatric cardiologists. Fetal echocardiography is one of the most challenging and time-consuming prenatal examinations to perform, especially in multiple gestations. Performing just the basic fetal exam in twin gestations may take an hour or more. Thus, it is not practical to perform this exam in all cases of multiple gestations. Therefore our review and recommendations are related to fetal echocardiography in twin gestation.
3D RTE images were also created for the 47 malignant tumors. Most malignant tumors 42 cases (89.4... more 3D RTE images were also created for the 47 malignant tumors. Most malignant tumors 42 cases (89.4%) exhibited Type 3. Conclusions: In 3D stereoscopic images obtained by Real-time Tissue Elastography with Real-time 3D probe, blue contrast reflects hardness distribution in the tumor. In stereoscopic images composed mainly of blue, the shape and border properties are considered useful in determining whether the tumor is benign or malignant. Sequential changes in hardness distribution, this technique may be used for evaluation of treatment and may be applied to biopsy as a puncture guide by adding hardness information of the tumor by stereoscopic images.
When started at least 2 hours after the first dose of indomethacin, dopamine induces renal and me... more When started at least 2 hours after the first dose of indomethacin, dopamine induces renal and mesenteric vasodilation without affecting cerebral hemodynamics in the >1-day-old indomethacin-treated preterm infant.
This Protocol for Evaluating the Fetal and Neonatal Heart details the indications, views, and mea... more This Protocol for Evaluating the Fetal and Neonatal Heart details the indications, views, and measurements to be obtained for both (1) the basic screening examination of the fetal heart (a necessary component of all complete fetal anatomy evaluations) and the specialty study called (2) echocardiography as applied to either the fetus or neonate, using 2D and Doppler ultrasound. While the purpose of the screening study is to detect or exclude the possibility of a cardiac abnormality, echocardiography attempts to diagnose the specific anatomic and physiologic disruption. Also emphasized is the value of a collaborative team approach to management of the fetus and its parents when a cardiovascular anomaly is present, in an effort to achieve a smoother transition from fetus to neonate across the continuum of perinatal care.
To study the effects of dopamine on renal, mesenteric, and cerebral blood flow in sick preterm ne... more To study the effects of dopamine on renal, mesenteric, and cerebral blood flow in sick preterm neonates. Study design: The pulsatility index was used to assess the dopamine-induced changes in renal, mesenteric, and cerebral blood flow by means of color Doppler ultrasonography in 23 nonhypotensive preterm neonates (birth weight: 981 ± 314 g; postnatal age: <2 days). Dopamine was given at a dose of 6.1 ± 3.0 µg/kg per minute to combat oliguria, impaired peripheral perfusion, or both. Blood flow velocity measurements were made before and during dopamine administration, with each patient serving as his or her own control subject. Results: Dopamine significantly increased blood pressure and urine output. Dopamine decreased the pulsatility index in the renal artery (2.98 ± 1.18 vs 1.68 ± 0.45; P < .05) while the pulsatility index in the superior mesenteric and medial cerebral artery was not affected. Thus renal blood flow increased while mesenteric and cerebral blood flow remained unchanged during dopamine treatment. The increase in renal blood flow was independent of the blood pressure changes. Conclusions: These findings suggest a functionally mature renal, but not mesenteric, vasodilatory dopaminergic response in the preterm neonate. The observations also indicate the lack of an effect of low-to medium-dose dopamine on cerebral hemodynamics in the nonhypotensive preterm neonate.
Background —The aims of the present study were to determine whether maternal hyperoxygenation aff... more Background —The aims of the present study were to determine whether maternal hyperoxygenation affects human fetal pulmonary circulation and whether there is a gestational age-related response in the fetal pulmonary circulation to maternal hyperoxygenation during the second half of gestation. Methods and Results —Twenty women between 20 and 26 weeks of gestation and 20 women between 31 and 36 weeks of gestation with normal singleton pregnancies were randomized to receive either 60% humidified oxygen or medical compressed air (room air) by a face mask. Fetal aortic and pulmonary valve; ductus arteriosus (DA); and right (RPA), left (LPA), and distal (DPA) pulmonary artery blood velocity waveforms were obtained by Doppler ultrasound before, during, and after maternal administration of either 60% oxygen or room air. Left and right ventricular cardiac outputs, DA volume blood flow, and RPA and LPA volume blood flows (Q P ) were calculated. Foramen ovale volume blood flow (left ventricular...
American Journal of Obstetrics and Gynecology, 2002
Several ultrasonographic signs have been described in second-trimester fetuses at high risk for D... more Several ultrasonographic signs have been described in second-trimester fetuses at high risk for Down syndrome. We examined these parameters in twin pregnancies in which one fetus was affected with Down syndrome and the other was normal. Biparietal diameter to femur length ratio was concordant (either normal or abnormal) in eight of nine sets of twins. Actual femur length to expected femur length ratio was concordant in seven of nine sets of twins. Nuchal fold thickening (6 mm or more) correctly identified five of nine affected fetuses and was not present in any of the normal fetuses. In conclusion, neither ratio was helpful in differentiating the fetus with Down syndrome from its normal co-twin. A thickened nuchal fold was the most informative parameter examined.
American Journal of Obstetrics and Gynecology, 2006
Using pulsed-wave tissue Doppler imaging (TDI), we compared right and left ventricular (RV, LV) s... more Using pulsed-wave tissue Doppler imaging (TDI), we compared right and left ventricular (RV, LV) systolic and diastolic function between fetuses with congenital heart disease (CHD) but no signs of congestive heart failure (CHF), and those with a structurally normal heart and normal function. STUDY DESIGN: We measured myocardial velocities in the RV and LV during systole and diastole in 187 fetuses (103 with CHD, 84 normal) at 18-38 weeks of gestation referred to two large perinatal cardiology services from 2005-2006 in this cross sectional retrospective study. Indices of diastolic function assessed were: peak mitral and tricuspid annular velocities (E 0 , A 0) isovolumic relaxation time (IVRT); Indices of systolic function evaluated included: peak S wave velocity (S 0), isovolumic contraction time (IVCT), and peak isovolumic velocity (IVV); and the myocardial performance index (MPI). Differences between normal and CHD fetuses were assessed by the independent two sample t-test and Mann Whitney U test. RESULTS: In the fetus with CHD but no clinical CHF, some RV indices were significantly higher compared to the normal group: MPI = 0.44 vs. 0.39 (p=0.01); IVV = 6.1 vs 4.3 cm/s (p= 0. 02); and IVRT = 50 vs 40 ms (p= 0.0003). There were no differences in LV indices. CONCLUSION: TDI detects subtle abnormalities in systolic and diastolic RV function in the fetus with CHD but no clinical signs of CHF. As with other markers of CHF in the fetus, the RV appears to manifest TDI changes before the LV. Further evaluation by TDI of the fetus with signs of heart failure may detect additional or more serious markers of diastolic or systolic dysfunction.
Pulmonary hypoplasia is a term that describes lungs that are sufficiently small enough to impede ... more Pulmonary hypoplasia is a term that describes lungs that are sufficiently small enough to impede the exchange of respiratory gases. 1 Because gas exchange does not occur in the fetal lung, it is difficult to prove that fetal lungs may be functionally hypoplastic. Pulmonary hy-poplasia may be defined as incomplete or underdevelop-ment of lung tissue that is present at autopsy and is determined by the wet lung-to-body weight ratio, by reduced alveoli count, or by reduced lung DNA content. 2 It is a diagnosis that can be made by the pathologist at the time of the autopsy with lung-to-body weight ratio, reduced radial alveolar count, or reduced lung DNA content. The incidence is reported as 11 to 14 per 10,000 live births in the general population and as 7% to 14% in autopsies of all premature infants. 3 Perinatal mortality rates approached 70% in most studies. 4 Fifteen percent to 20% of neonatal deaths can be attributed to this process. Pulmonary hypoplasia occurs when there is a disruption of normal lung growth and maturation during the critical time period. Numerous conditions can lead to thoracic compression, inhibition of fetal breathing movements , and loss of lung fluids that impede pulmonary growth during the crucial pseudoglandular and canalicu-lar phases between 6 and 26 weeks of gestation. If this is not corrected, pulmonary hypoplasia and neonatal death likely will result. Historically, attempts have been made to assess the postnatal function of the fetal pulmonary system by anatomic criteria. Recent studies have shown that fetal pulmonary vasculature reacts to maternal hyperoxygena-tion. 5,6 Our study looks to predict pulmonary function by assessing pulmonary vascular reactivity in utero. We hypothesized that fetuses with severe lung hypoplasia do not have the same reactivity to maternal hyperoxygena-tion as normal fetuses of similar gestation. We also believe that, because our test attempts to simulate physiologic factors after delivery (which do not differ despite differ-OBJECTIVE: The purpose of this study was to determine the predictive accuracy of a test for neonatal death from pulmonary hypoplasia by measuring changes in fetal pulmonary artery blood flow on room air and during maternal hyperoxygenation. STUDY DESIGN: Women who were carrying fetuses with congenital anomalies that may cause pulmonary hypoplasia were offered participation in the study as part of a comprehensive fetal echocardiogram. Each fetus at ≥30 weeks of gestation underwent Doppler measurement of the blood flow pattern in the first branch of either the right or the left pulmonary artery before and again during exposure to maternal breathing of 60% oxygen by mask. An increase in the fetal pulmonary blood flow with oxygen (a decrease of ≥20% of the pulsatility index) was considered a reactive test. A change of <20% in the flow pattern during maternal hyper-oxygenation was a nonreactive test and suggested pulmonary hypoplasia. The primary outcome for this study was neonatal death from pulmonary hypoplasia. RESULTS: Twenty-nine pregnancies met the criteria for inclusion in our study. Of the 14 fetuses who had a nonreactive hyperoxygenation test, 11 fetuses (79%) died of pulmonary hypoplasia. Of the 15 fetuses who had a reactive hyperoxygenation test, only one fetus (7%) died in the neonatal period. Sensitivity, specificity, and positive and negative predictive values were 92%, 82%, 79%, and 93%, respectively, with an odds ratio of 51 (95% CI, 4.6-560). CONCLUSION: Testing fetal pulmonary vascular reactivity with maternal hyperoxygenation is highly predic-tive of pulmonary hypoplasia. A reactive test predicted 92% of surviving infants; a nonreactive test predicted 79% of fetal deaths from pulmonary hypoplasia. (Am J Obstet Gynecol 2002;187:940-5)
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