{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T12:33:43Z","timestamp":1775738023269,"version":"3.50.1"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ultraschall Med"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background Increased pulse wave reflection in the fetal arterial\n      system, illustrated by a second systolic peak (M-sign) in middle cerebral artery (MCA) Doppler\n      waveforms, allows interpretation of fetal systemic vasoconstriction. Little is known about\n      fetal vascular regulation during fetal spina bifida (fSB) repair. Therefore, the aim of this\n      study was to analyze MCA-Doppler waveform changes before, during, and after fSB repair. Patients and Methods 31 pregnant women who underwent fSB repair were\n      included. Fetal MCA-Doppler waveforms were prospectively analyzed before, during and after\n      fSB repair, and categorized as follows: normal systolic downslope, systolic shoulder, second\n      systolic peak (M-sign), and concave systolic downslope. These MCA waveforms were related to\n      maternal and fetal characteristics, to anesthetic medication, and to umbilical artery (UA)\n      waveforms. Results Before fSB repair, all fetuses repeatedly\n      presented M-signs. After initiation of desflurane for general anesthesia, systolic shoulder\n      and the M-sign vanished in 24\/31 (78%) fetuses and 19\/31 (61%) showed transient UA ARED\n      flow. A significant association between these two Doppler findings was found (p=0.007). After\n      fSB repair, signs of increased pulse wave reflection reappeared but resolved over time (23\n      days \u00b1 20, SD) in all fetuses. Conclusion Both fSB and intrauterine\n      repair influence fetal vascular regulation. This phenomenon can be illustrated by MCA-Doppler\n      waveforms. While anesthetic agents transiently eliminated M-signs and often provoked a UA ARED\n      flow, fSB repair finally led to normalization of MCA-Doppler waveforms indicating return to\n      normal fetal vascular regulation.<\/jats:p>","DOI":"10.1055\/a-1722-2721","type":"journal-article","created":{"date-parts":[[2022,2,8]],"date-time":"2022-02-08T23:48:21Z","timestamp":1644364101000},"page":"68-74","source":"Crossref","is-referenced-by-count":7,"title":["M-Sign in Middle Cerebral Artery Doppler Waveforms: A Sign of Fetal Vasoconstriction Before and After Open Fetal Spina Bifida Repair"],"prefix":"10.1055","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1301-8608","authenticated-orcid":false,"given":"Ladina","family":"Vonzun","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland"},{"name":"University of Zurich, The Zurich Center for Fetal Diangosis and Therapy, Zurich, Switzerland"},{"name":"Faculty of Medicine, University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Gonser","sequence":"additional","affiliation":[{"name":"Obsterics and Prenatal Medicine, HELIOS HSK Wiesbaden, Wiesbaden, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ueli","family":"Moehrlen","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Children's Hospital Zurich, Zurich, Switzerland"},{"name":"University of Zurich, The Zurich Center for Fetal Diangosis and Therapy, Zurich, Switzerland"},{"name":"Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland"},{"name":"Faculty of Medicine, University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Mazzone","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Children's Hospital Zurich, Zurich, Switzerland"},{"name":"University of Zurich, The Zurich Center for Fetal Diangosis and Therapy, Zurich, Switzerland"},{"name":"Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland"},{"name":"Faculty of Medicine, University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Meuli","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Children's Hospital Zurich, Zurich, Switzerland"},{"name":"University of Zurich, The Zurich Center for Fetal Diangosis and Therapy, Zurich, Switzerland"},{"name":"Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland"},{"name":"Faculty of Medicine, University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lukas","family":"Kandler","sequence":"additional","affiliation":[{"name":"Anesthiesiology, University Hospital Zurich, Zurich, Switzerland"},{"name":"Faculty of Medicine, University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Wille","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology, Baden Cantonal Hospital, Baden, Switzerland"},{"name":"Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franziska","family":"Kraehenmann","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland"},{"name":"University of Zurich, The Zurich Center for Fetal Diangosis and Therapy, Zurich, Switzerland"},{"name":"Faculty of Medicine, University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roland","family":"Zimmermann","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland"},{"name":"University of Zurich, The Zurich Center for Fetal Diangosis and Therapy, Zurich, Switzerland"},{"name":"Faculty of Medicine, University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7691-965X","authenticated-orcid":false,"given":"Nicole","family":"Ochsenbein-K\u00f6lble","sequence":"additional","affiliation":[{"name":"University of Zurich, The Zurich Center for Fetal Diangosis and Therapy, Zurich, Switzerland"},{"name":"Faculty of Medicine, University of Zurich, Zurich, Switzerland"},{"name":"Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,2,8]]},"reference":[{"issue":"11","key":"ref1","doi-asserted-by":"publisher","first-page":"993","DOI":"10.1056\/NEJMoa1014379","article-title":"A randomized trial of prenatal versus postnatal repair of myelomeningocele","volume":"364","author":"NS 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