{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T09:34:11Z","timestamp":1771493651654,"version":"3.50.1"},"reference-count":52,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,24]],"date-time":"2023-01-24T00:00:00Z","timestamp":1674518400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Corticoids are largely used for fetal interest in expected preterm deliveries. This study went further, evaluating the effect of maternal administration of dexamethasone (Dex) on the umbilical artery (UA), middle cerebral artery (MCA), and ductus venous (DV) spectrum, in growth-restricted fetuses, with the absent end-diastolic flow (AEDF) in UA, from singleton early-onset severe preeclamptic pregnancies. Supplementary, the impact on both uterine arteries (UTAs) flow was also evaluated. In 68.7% of cases, the EDF was transiently restored (trAEDF group), in the rest of 31.2% remained persistent absent (prAEDF group). UA-PI significantly decreased in the first day after Dex (day 1\/0; p &lt; 0.05), reaching its minimum during day 2 (day 2\/1; p &gt; 0.05), revealing a significant recovery to day 4 (day 4\/2; p &lt; 0.05), in both groups. The MCA-PI decreased from day 1 until day 3 in both groups, but significantly only in the trAEDF group (p = 0.030 vs. p = 0.227. The DV-PI\u2019s decrease (during day 1) and the CPR\u2019s increase (between days 0 and 2) were not significant in both groups. UTAs-PIs did not vary. The prAEDF group had a significantly increased rate of antenatal worsening Doppler and a poorer perinatal outcome compared with the trAEDF group. In conclusion, Dex transiently restored the AEDF in UA in the majority of cases, a \u201cpositive\u201d effect being a useful marker for better perinatal prognosis. UA-PI significantly decreased in all cases. The improvement in umbilical circulation probably was responsible for the short but not significant DV-PI reduction. MCA-PI decreased only in sensitive cases, probably due to an already cerebral \u201cfull\u201d vasodilation in the prAEDF group. Furthermore, the CPR\u2019s nonsignificant improvement was the result of a stronger effect of Dex on UA-PI than on MCA-PI. Finally, despite the same etiology, it was only a weak correlation between the severity of the umbilical and uterine abnormal spectrum.<\/jats:p>","DOI":"10.3390\/diagnostics13030428","type":"journal-article","created":{"date-parts":[[2023,1,25]],"date-time":"2023-01-25T03:53:18Z","timestamp":1674618798000},"page":"428","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Maternal Steroids on Fetal Doppler Indices, in Growth-Restricted Fetuses with Abnormal Umbilical Flow from Pregnancies Complicated with Early-Onset Severe Preeclampsia"],"prefix":"10.3390","volume":"13","author":[{"given":"Oana","family":"Tica","sequence":"first","affiliation":[{"name":"Department of \u201cMother and Child\u201d, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Craiova County Emergency Hospital, 200642 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrei","family":"Tica","sequence":"additional","affiliation":[{"name":"Craiova County Emergency Hospital, 200642 Craiova, Romania"},{"name":"Department of Pharmacology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doriana","family":"Cojocaru","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, \u201cNicolae Testemitanu\u201d State University of Medicine and Pharmacy Chisinau, 2004 Chisinau, Moldova"},{"name":"\u201cTimofei Mosneaga\u201d Republican Clinical Hospital, 2025 Chisinau, Moldova"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irina","family":"Tica","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, University \u201cOvidius\u201d Constanta, 900527 Constan\u021ba, Romania"},{"name":"Constanta County Emergency Hospital, 900591 Constan\u021ba, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristian","family":"Petcu","sequence":"additional","affiliation":[{"name":"Department of Biophysics, Faculty of Dental Medicine, University \u201cOvidius\u201d Constanta, 900527 Constan\u021ba, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor","family":"Cojocaru","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, \u201cNicolae Testemitanu\u201d State University of Medicine and Pharmacy Chisinau, 2004 Chisinau, Moldova"},{"name":"\u201cTimofei Mosneaga\u201d Republican Clinical Hospital, 2025 Chisinau, Moldova"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dragos","family":"Alexandru","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9000-4731","authenticated-orcid":false,"given":"Vlad","family":"Tica","sequence":"additional","affiliation":[{"name":"Constanta County Emergency Hospital, 900591 Constan\u021ba, Romania"},{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, University \u201cOvidius\u201d Constanta, 900527 Constan\u021ba, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1111\/j.1471-0528.2000.tb11617.x","article-title":"Expectant management of early onset, severe preeclampsia: Perinatal outcome","volume":"107","author":"Hall","year":"2000","journal-title":"Br. J. Obstet. Gynecol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"f6564","DOI":"10.1136\/bmj.f6564","article-title":"Pre-eclampsia rates in the United States, 1980\u20132010: Age-period-cohort analysis","volume":"347","author":"Ananth","year":"2013","journal-title":"BMJ"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1111\/aogs.13357","article-title":"Maternal deaths from hypertensive disorders: Lessons learnt","volume":"97","author":"Nyflot","year":"2018","journal-title":"Acta Obstet. Gynecol. Scan."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1093\/bmb\/ldg005","article-title":"Pre-eclampsia and the hypertensive disorders of pregnancy","volume":"67","author":"Duley","year":"2003","journal-title":"Br. Med. Bull."},{"key":"ref_5","first-page":"608","article-title":"Management and outcome of pregnancy complicated by severe pre-eclampsia of early onset","volume":"72","author":"Railton","year":"1987","journal-title":"S. Afr. Med. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1002\/pd.4412","article-title":"Stage-based approach to the management of the fetal growth restriction","volume":"34","author":"Figueras","year":"2014","journal-title":"Prenat. Diagn."},{"key":"ref_7","unstructured":"(2022, September 25). RCOG Green Top Guideline No. 31. Available online: https:\/\/www.rcog.org.uk\/en\/guidelines-research-services\/guidelines\/gtg31\/."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1111\/j.1651-2227.1993.tb12600.x","article-title":"Value of absent or retrograde end-diastolic flow in fetal aorta and umbilical artery as a predictor of perinatal outcome in pregnancy-induced hypertension","volume":"82","author":"Eronen","year":"1993","journal-title":"Acta Paediatr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"F84","DOI":"10.1136\/fn.70.2.F84","article-title":"Neonatal outcome after pregnancy complicated by abnormal velocity waveforms in the umbilical artery","volume":"70","author":"McDonnell","year":"1994","journal-title":"Arch. Dis. Child."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1002\/uog.1906","article-title":"Outcome of 60 neonates who had ARED flow prenatally compared with a matched control group of appropriate-for-gestational age preterm neonates","volume":"25","author":"Hartung","year":"2005","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_11","unstructured":"National Institute for Health and Care Excellence (2022, September 17). Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy. London: NICE, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/22220321\/."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Fedunik, S., Gaca, Z., Malinowska, O., Brunets, W., Zgliczynska, M., Wlodarczyk, M., Wojcikiewicz, A., and Ciebiera, M. (2022). The Management of Pregnancy Complicated with the Previable Preterm and Preterm Premature Rupture of the Membranes: What about a Limit of Neonatal Viability? A Review. Diagnostics, 12.","DOI":"10.3390\/diagnostics12082025"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1159\/000020972","article-title":"Effect of steroids on arterial Doppler in intrauterine growth retardation fetuses","volume":"15","author":"Senat","year":"2000","journal-title":"Fetal. Diagn. Ther."},{"key":"ref_14","first-page":"794","article-title":"Effect of antenatal corticosteroid administration on Doppler flow velocity parameters in pregnancies with absent or reverse end-diastolic flow in the umbilical artery","volume":"82","author":"Nanan","year":"2003","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1002\/uog.8879","article-title":"Effect of maternal betamethasone on fetal and uteroplacental blood flow velocity waveforms","volume":"37","author":"Thuring","year":"2011","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1515\/jpm-2015-0194","article-title":"Effect of antenatal betamethasone administration on Doppler velocimetry of fetal and uteroplacental vessels: A prospective study","volume":"44","author":"Ekin","year":"2016","journal-title":"J. Perinat. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.1016\/S0140-6736(94)90457-X","article-title":"Clinical significance of absent or reversed end diastolic velocity waveforms in umbilical artery","volume":"344","author":"Karsdorp","year":"1994","journal-title":"Lancet"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1002\/uog.1914","article-title":"Qualitative venous Doppler flow waveform analysis in preterm intrauterine growth-restricted fetuses with ARED flow in the umbilical artery\u2014correlation with short-term outcome","volume":"25","author":"Schwartze","year":"2005","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_19","unstructured":"American College of Obstetricians and Gynecologists (2022, August 21). Diagnostic Criteria of Severe Preeclampsia. Available online: www.acog.org\/~\/media\/Task%20Force%20and%20Work%20Group%20Reports\/public\/HypertensioninPregnancy.pdf."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.preghy.2014.02.001","article-title":"The classification, diagnosis and management of the hypertensive disorders of pregnancy: A revised statement from the ISSHP","volume":"4","author":"Tranquilli","year":"2014","journal-title":"Pregnancy Hypertens"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"79","DOI":"10.2147\/IBPC.S77344","article-title":"Current best practice in the management of hypertensive disorders in pregnancy","volume":"9","author":"Rosemary","year":"2016","journal-title":"Integr. Blood Press Control"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.ejogrb.2015.06.021","article-title":"Fetal growth restriction and intra-uterine growth restriction: Guidelines for clinical practice from the French College of Gynaecologists and Obstetricians","volume":"193","author":"Sentilhes","year":"2015","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1002\/uog.22134","article-title":"ISUOG Practice Guidelines: Diagnosis and management of small-for-gestational-age fetus and fetal growth restriction","volume":"56","author":"Lees","year":"2020","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1002\/uog.20157","article-title":"Fetal Medicine Foundation reference ranges for umbilical artery and middle cerebral artery pulsatility index and cerebroplacental ratio","volume":"53","author":"Ciobanu","year":"2019","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1002\/uog.3857","article-title":"Longitudinal reference ranges for ductus venosus flow velocities and waveform indices","volume":"28","author":"Kessler","year":"2006","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1002\/pd.1868","article-title":"Fetal arterial and venous Doppler pulsatility index and time averaged velocity ranges","volume":"27","author":"Lees","year":"2007","journal-title":"Prenat. Diag."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1002\/uog.8859","article-title":"Reference ranges for Doppler assessment of uterine artery resistance and pulsatility indices in dichorionic twin pregnancies","volume":"37","author":"Geipel","year":"2011","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1111\/j.1471-0528.2000.tb13269.x","article-title":"Effects of maternal dexamethasone administration on fetal Doppler flow velocity waveforms","volume":"107","author":"Chitrit","year":"2000","journal-title":"Br. J. Obstet. Gynaecol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.ejogrb.2004.09.009","article-title":"Antenatal corticosteroid therapy: A comparative study of dexamethasone and betamethasone effects on fetal Doppler flow velocity waveforms","volume":"120","author":"Urban","year":"2005","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1002\/uog.133","article-title":"Umbilical artery Doppler revisited: Pathophysiology of changes in intrauterine growth restriction revealed","volume":"21","author":"Sebire","year":"2003","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"128","DOI":"10.4038\/sljog.v34i3.4890","article-title":"Fetal growth restriction\u2014Pathophysiology, diagnosis and management of uteroplacental insufficiency before 34 weeks","volume":"34","author":"Dias","year":"2012","journal-title":"Sri. Lanka J. Obstet. Gynaecol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"F35","DOI":"10.1136\/fn.76.1.F35","article-title":"Effect of absent and diastolic flow velocity in the fetal umbilical artery on subsequent outcome","volume":"76","author":"Adiotomre","year":"1997","journal-title":"Arch. Dis. Child."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/0002-9378(94)90087-6","article-title":"An abnormal umbilical artery waveform: A strong and independent predictor of adverse perinatal outcome in patients with preeclampsia","volume":"171","author":"Yoon","year":"1994","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.ajog.2003.08.011","article-title":"The fetal cardiovascular response to antenatal steroids in severe early-onset intrauterine growth restriction","volume":"190","author":"Simchen","year":"2004","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1097\/AOG.0b013e318197bf4d","article-title":"Predicting perinatal outcome through changes in umbilical artery Doppler studies after antenatal corticosteroids in the growth-restricted fetus","volume":"113","author":"Robertson","year":"2009","journal-title":"Obstet. Gynecol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1067\/S0002-9378(03)00576-3","article-title":"The frequency and severity of placental findings in women with preeclampsia are gestational age dependent","volume":"189","author":"Moldenhauser","year":"2003","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1111\/j.1471-0528.1998.tb10158.x","article-title":"Antenatal glucocorticoid administration increases corticotrophin-releasing hormone in maternal plasma","volume":"105","author":"Korebrits","year":"1998","journal-title":"Br. J. Obstet. Gynaecol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1186\/1477-7827-10-80","article-title":"Corticotropin-releasing hormone stimulates expression of leptin, 11beta-HSD2 and syncytin-1 in primary human trophoblasts","volume":"10","author":"Fahlbusch","year":"2012","journal-title":"Reprod. Biol. Endocrinol."},{"key":"ref_39","first-page":"2888","article-title":"Corticotropin-releasing hormone-induced vasodilatation in the human fetal-placental circulation: Involvement of the nitric oxide-cyclic guanosine 3\u2032,5\u2032-monophosphate-mediated pathway","volume":"80","author":"Clifton","year":"1995","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1093\/humrep\/13.4.1070","article-title":"Maternal and fetal nitric oxide synthesis is decreased in pregnancies with small for gestational age infants","volume":"13","author":"Hata","year":"1998","journal-title":"Hum. Reprod."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"H2440","DOI":"10.1152\/ajpheart.01033.2001","article-title":"Hypoxic fetoplacental vasoconstriction in humans is mediated by potassium channel inhibition","volume":"28","author":"Hampl","year":"2002","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1080\/07853890.2021.1968030","article-title":"Dexamethasone on absent end-diastolic flow in umbilical artery, in growth restricted fetuses from early-onset preeclamptic pregnancies and the perinatal outcome","volume":"53","author":"Tica","year":"2021","journal-title":"Ann. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.7863\/jum.2005.24.9.1223","article-title":"Cerebroplacental Doppler ratio and adverse perinatal outcomes in intrauterine growth restriction: Evaluating the impact of using gestational age-specific reference values","volume":"24","author":"Odibo","year":"2005","journal-title":"J. Ultrasound Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1002\/uog.4088","article-title":"Middle cerebral artery blood flow velocities and pulsatility index and the cerebroplacental pulsatility ratio: Longitudinal reference ranges and terms for serial measurements","volume":"30","author":"Ebbing","year":"2007","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1002\/uog.13319","article-title":"Changes in fetal Doppler indices as a marker of failure to reach growth potential at term","volume":"43","author":"Khalil","year":"2014","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"285.e1","DOI":"10.1016\/j.ajog.2016.11.1008","article-title":"Evaluation of normalization of cerebro-placental ratio as a potential predictor for adverse outcome in SGA fetuses","volume":"216","author":"Monteith","year":"2017","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s40748-016-0041-x","article-title":"Early onset fetal growth restriction","volume":"3","author":"Brunelli","year":"2017","journal-title":"Matern. Health Neonatol. Perinatal."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1097\/01.AOG.0000209192.00890.3a","article-title":"Predicting pH at birth in absent or reversed end-diastolic velocity in the umbilical arteries","volume":"107","author":"Francisco","year":"2006","journal-title":"Obstet. Gynecol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1002\/uog.965","article-title":"Relationship between monitoring parameters and perinatal outcome in severe, early intrauterine growth restriction","volume":"23","author":"Bilardo","year":"2004","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_50","first-page":"586578","article-title":"Preeclampsia","volume":"2012","author":"Eiland","year":"2012","journal-title":"J. Pregnancy"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"105918","DOI":"10.1155\/2012\/105918","article-title":"A comprehensive review of hypertension in pregnancy","volume":"2012","author":"Mustafa","year":"2012","journal-title":"J. Pregnancy"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e962","DOI":"10.1016\/j.placenta.2014.07.019","article-title":"Expression of urocortin and corticotrophin-releasing hormone receptor-2 in patients with intrahepatic cholestasis of pregnancy","volume":"35","author":"Zhou","year":"2014","journal-title":"Placenta"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/3\/428\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:14:58Z","timestamp":1760120098000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/3\/428"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,24]]},"references-count":52,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["diagnostics13030428"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13030428","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,24]]}}}