{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T03:00:29Z","timestamp":1781319629902,"version":"3.54.1"},"reference-count":26,"publisher":"Walter de Gruyter GmbH","issue":"5","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_jpm-2025-0660_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine gestational age-specific reference ranges and develop a Z-score equation for the fetal ductal pulsatility index (PI), between 24 and 33\u00a0+\u00a06\u00a0weeks of gestation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2025-0660_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective cross-sectional study conducted from 2023 to 2024, 226 singleton fetuses between 24 and 33\u00a0+\u00a06\u00a0weeks were enrolled. The ductus arteriosus (DA) was assessed in the longitudinal plane of the fetus using color Doppler to confirm its course and flow direction, and pulsed Doppler sampling was placed at the proximal DA with an insonation angle &lt;15\u00b0. Three consecutive measurements of PI were recorded and averaged. Z-scores were derived from predicted means and standard deviations and reference percentiles (5th, 50th, and 95th) were computed for gestational age groups using quantile regression. Intraobserver reproducibility was evaluated in 30 randomly selected cases with an interval\u00a0\u22652\u00a0weeks using the intraclass correlation coefficient (ICC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2025-0660_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean gestational age was 28.2\u00a0\u00b1\u00a03.1\u00a0weeks. The ductal PI showed a mean of 2.4\u00a0\u00b1\u00a00.26 with normal distribution (p=0.2525). The Z-score equation for PI was successfully derived Z-score = (Measured PI\u00a0\u2212 2.4)\/0.26. Reference ranges for PI were: 24\u201327\u00a0weeks (5th=2.0; 50th=2.4; 95th=2.7), 28\u201331\u00a0weeks (5th=2.1; 50th=2.5; 95th=2.9), and 32\u201334\u00a0weeks (5th=2.2; 50th=2.4; 95th=2.5). Intraobserver reproducibility for PI was excellent (ICC &gt;0.90).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2025-0660_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We established gestational age-specific reference ranges and a Z-score equation for the ductal PI in normal fetuses between 24 and 33\u00a0+\u00a06\u00a0weeks. These findings provide a standardized tool for fetal cardiologists to identify subtle ductal flow abnormalities and support perinatal risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/jpm-2025-0660","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T21:12:39Z","timestamp":1777497159000},"page":"922-928","source":"Crossref","is-referenced-by-count":0,"title":["Development of a Z-score for the ductal flow pulsatility index in normal fetuses using two-dimensional Doppler echocardiography"],"prefix":"10.1515","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3990-865X","authenticated-orcid":false,"given":"Luciane Alves","family":"da Rocha Amorim","sequence":"first","affiliation":[{"name":"University Hospital Get\u00falio Vargas of the Federal University of Amazonas (HUGV-UFAM), Brazilian Company of Hospital Services (EBSERH) , Manaus , AM , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2766-2534","authenticated-orcid":false,"given":"Julia Castro","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"University Hospital Get\u00falio Vargas of the Federal University of Amazonas (HUGV-UFAM), Brazilian Company of Hospital Services (EBSERH) , Manaus , AM , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9268-1450","authenticated-orcid":false,"given":"Paulo","family":"Zielinsky","sequence":"additional","affiliation":[{"name":"Fetal Cardiology Unit, Institute of Cardiology of Rio Grande do Sul , Porto Alegre , RS Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2942-6182","authenticated-orcid":false,"given":"Antonio","family":"Braga","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics , School of Medicine, Federal University of Rio de Janeiro , Rio de Janeiro , RJ , Brazil"},{"name":"Department of Maternal and Child Health , School of Medicine, Fluminense Federal University , Niter\u00f3i , RJ , Brazil"},{"name":"Postgraduate Program in Applied Health Sciences, University of Vassouras , Vassouras , RJ , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6694-6569","authenticated-orcid":false,"given":"Gustavo Yano","family":"Callado","sequence":"additional","affiliation":[{"name":"Albert Einstein Israelite College of Health Sciences (FICSAE), Albert Einstein Israelite Hospital , S\u00e3o Paulo , SP , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2350-6587","authenticated-orcid":false,"given":"Pedro Teixeira","family":"Castro","sequence":"additional","affiliation":[{"name":"Department of Fetal Medicine , Biodesign Laboratory DASA\/PUC , Rio de Janeiro , RJ , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6145-2532","authenticated-orcid":false,"given":"Edward","family":"Araujo J\u00fanior","sequence":"additional","affiliation":[{"name":"Department of Obstetrics , Paulista School of Medicine, Federal University of S\u00e3o Paulo (EPM-UNIFESP) , S\u00e3o Paulo , SP , Brazil"},{"name":"Discipline of Woman Health, Municipal University of S\u00e3o Caetano do Sul (USCS) , S\u00e3o Caetano do Sul , SP , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"2026061302442414810_j_jpm-2025-0660_ref_001","doi-asserted-by":"crossref","unstructured":"Rudolph, AM. 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