{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:59:58Z","timestamp":1781650798784,"version":"3.54.5"},"reference-count":36,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001279","name":"Great Ormond Street Hospital Charity","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001279","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the combined effect of maternal general anesthesia and vasopressor support on uterine hemodynamics during the second trimester in pregnancies undergoing fetal spina bifida repair and to determine whether fetal spina bifida repair alters uteroplacental perfusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a prospective single\u2010center study conducted at the Fetal Medicine Unit of University Hospitals Leuven, Leuven, Belgium between August 2021 and April 2025. All participants underwent fetal spina bifida repair under general anesthesia with vasopressor support, titrated to maintain a mean arterial pressure\u2009\u2265\u200990% of the preoperative baseline value. Uterine artery (UtA) and umbilical artery Doppler measurements were obtained at six timepoints: (1) the day before surgery to establish preoperative baseline values; (2) immediately after epidural catheter placement, initiation of general anesthesia and intubation (at the initiation of noradrenaline); (3) 5\u2009min after initiation of general anesthesia with vasopressor support; (4) at the end of surgery, after maternal skin closure and before extubation; (5) on postoperative day 1; and (6) on postoperative day 6. The primary outcome was the change in UtA pulsatility index (PI) 5\u2009min after initiation of general anesthesia compared with the preoperative baseline value. Secondary outcomes included UtA blood flow estimated from time\u2010averaged maximum velocity and vessel diameter and fetal umbilical artery Doppler parameters. Statistical analysis included paired\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests, Wilcoxon signed\u2010rank tests and mixed\u2010effects models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 33 women undergoing fetal spina bifida repair were included, of whom 23 underwent open repair and 10 underwent fetoscopic repair. At the preoperative baseline, median UtA\u2010PI was 0.77 (interquartile range (IQR), 0.64\u20130.95), median UtA resistance index (RI) was 0.52 (IQR, 0.45\u20130.59) and median UtA blood flow was 307.5 (IQR, 209.8\u2013542.2)\u2009mL\/min. At 5\u2009min after the initiation of general anesthesia with vasopressor support, UtA\u2010PI (median, 0.87 (IQR, 0.68\u20131.04)) and UtA blood flow (median, 310.7 (IQR, 199.0\u2013421.4)\u2009mL\/min) were comparable to baseline values (both\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&gt;\u20090.05). At this timepoint, umbilical artery PI was higher than the baseline value (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.008) while fetal heart rate decreased. At the end of surgery, UtA\u2010PI (median, 1.46 (IQR, 1.04\u20132.21)) and UtA\u2010RI (median, 0.76 (IQR, 0.62\u20130.91)) were elevated compared with baseline values (both\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) and UtA blood flow was reduced (median, 182.1 (IQR, 79.8\u2013351.5)\u2009mL\/min;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.031). Elevation of UtA\u2010PI and UtA\u2010RI persisted on postoperative days 1 and 6, but umbilical artery indices generally normalized back to preoperative baseline levels. There were no significant differences in UtA or fetal Doppler parameters between surgical techniques.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>General anesthesia with vasopressor support preserved uterine perfusion and blood flow without increasing vascular resistance. During fetal spina bifida repair, UtA resistance increased and UtA blood flow decreased. These parameters did not normalize back to preoperative baseline values within 6\u2009days after surgery. In contrast, perioperative fetal Doppler changes resolved immediately postoperatively \u00a9 2026 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.70237","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T17:10:14Z","timestamp":1778519414000},"page":"815-823","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of general anesthesia with vasopressor support on uteroplacental perfusion during fetal spina bifida repair"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8372-6434","authenticated-orcid":false,"given":"S.","family":"Vergote","sequence":"first","affiliation":[{"name":"Department of Development and Regeneration KU Leuven  Leuven Belgium"},{"name":"Department of Obstetrics and Gynaecology University Hospitals Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6551-661X","authenticated-orcid":false,"given":"L.","family":"Van der Veeken","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration KU Leuven  Leuven Belgium"},{"name":"Department of Obstetrics and Gynaecology University Hospitals Leuven  Leuven Belgium"},{"name":"Department of Obstetrics and Gynaecology University Hospitals Antwerp  Antwerp Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Van den Eede","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration KU Leuven  Leuven Belgium"},{"name":"Department of Obstetrics and Gynaecology University Hospitals Leuven  Leuven Belgium"},{"name":"Department of Obstetrics and Gynaecology University Hospitals Antwerp  Antwerp Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Arai","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration KU Leuven  Leuven Belgium"},{"name":"Department of Obstetrics and Gynaecology University Hospitals Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5622-4183","authenticated-orcid":false,"given":"K.","family":"Watananirun","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration KU Leuven  Leuven Belgium"},{"name":"Department of Obstetrics and Gynaecology University Hospitals Leuven  Leuven Belgium"},{"name":"Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital Mahidol University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Brenders","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration KU Leuven  Leuven Belgium"},{"name":"Department of Obstetrics and Gynaecology University Hospitals Leuven  Leuven Belgium"},{"name":"Department of Anaesthesiology, UZ Leuven, Department of Cardiovascular Sciences Group Biomedical Sciences, KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4920-945X","authenticated-orcid":false,"given":"J.","family":"Deprest","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration KU Leuven  Leuven Belgium"},{"name":"Department of Obstetrics and Gynaecology University Hospitals Leuven  Leuven Belgium"},{"name":"Department of Women &amp; Children's Health King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1817-4749","authenticated-orcid":false,"given":"T.","family":"Bleeser","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration KU Leuven  Leuven Belgium"},{"name":"Department of Obstetrics and Gynaecology University Hospitals Leuven  Leuven Belgium"},{"name":"Department of Anaesthesiology, UZ Leuven, Department of Cardiovascular Sciences Group Biomedical Sciences, KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Collaborators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijoa.2019.01.006"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001976"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(16)32785-5"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31828ea597"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2018.04.036"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2023.e15997"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0263737"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjsopen\/zraa018"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/micc.12080"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1203\/00006450-199407001-00019"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/EA9.0000000000000003"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.14080"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijoa.2024.104287"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.4103\/1687-9090.124042"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/0959-289X(92)90016-W"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-197404000-00009"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-197411000-00010"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-67714-y"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3468(95)90013-6"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20180"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.26230"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001941"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.70021"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1014379"},{"key":"e_1_2_7_26_1","volume-title":"Standards for Basic Anesthetic Monitoring","author":"American Society of Anesthesiologists Committee on Standards and Practice Parameters","year":"2011"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(99)70106-7"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.19104"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.23698"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0044-102005"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20157"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.27579"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1159\/000548623"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aei311"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeq317"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.70237","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/uog.70237","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.70237","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:47:23Z","timestamp":1781650043000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.70237"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,11]]},"references-count":36,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1002\/uog.70237"],"URL":"https:\/\/doi.org\/10.1002\/uog.70237","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,11]]},"assertion":[{"value":"2025-12-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}