Abstract 4369139: Characteristics and outcomes of fetuses with intrauterine ductus arteriosus constriction.
Bibliographic record
Abstract
Introduction: Fetal ductus arteriosus constriction (DAC) can cause hydrops, pulmonary arterial (PA) hypertension and even death. Maternal drug/dietary factors can cause DAC and resolve with withdrawal. Data on DAC postnatal outcomes is limited. In the current study we sought to explore the pre- and postnatal evolution and outcomes of DAC. Methods: We identified all pregnancies with structurally normal hearts and DAC in our program from 2009-2024. Those with ductal systolic velocity >1.4 m/s, diastolic velocity >0.35 m/s, pulsatility index <1.9 were included. Fetal and neonatal clinical/echo parameters were collected. Right ventricular systolic dysfunction (RVDys) was defined as fractional area change (FAC) <35%. Results: Of 41 fetuses with DAC, 17(41%) were referred for suspected fetal heart disease. Only 7 (17%) had an identifiable cause (5 drug related, 2 dietary). See Table 1 for fetal echo data. At diagnosis 2 had hydrops (1 with a non-cardiac cause) and none developed hydrops at review. The majority (9/15, 60%) with tricuspid regurgitation had gradients >1/2 estimated systemic pressure. Four of 13 (31%) with RVDys received prenatal treatment (3 digoxin, 1 oxygen). Four fetuses had complete ductal closure (DC), all idiopathic and diagnosed at > 33 weeks gestational age (GA). Of 32 with serial fetal echo, 14(43%) had resolution of DAC, including 5 with known cause, and of 6 with RVDys, 3(50%) improved when the cause was discontinued and 4 had ongoing RVDys. The fetus with hydrops due to DAC was delivered urgently on presentation at 36 weeks GA. Two of the 4 with DC required urgent preterm delivery due to RVDys and abnormal venous Dopplers. Postnatal data were available for 32(78%), all were admitted to the neonatal intensive care unit. One died from noncardiac causes. Three(9%) required invasive ventilation (including 2 with DC) and 18(56%) required CPAP. Only 2 received pulmonary vasodilators (2 nitric oxide, 1 sildenafil for <2 weeks). Of 26(81%) postnatal echoes, 21(81%) had >1/2 systemic PA pressure at 1 st echo, of whom 7(33%) normalized prior to discharge and a further 8(38%) on follow-up, with no follow up in 6(29%). Of 12 with prenatal RVDys and neonatal followup, all normalised by discharge. Five had genetic abnormalities and 9 had significant extracardiac pathologies. Conclusions: Despite a worse trajectory in cases with idiopathic DAC, postnatal outcomes are favorable in both subsets with resolved RVDys and resolved PA hypertension in infancy.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".