Related Experiment Videos
Coronary artery blood flow visualization signifies hemodynamic deterioration in growth-restricted fetuses
A A Baschat1, U Gembruch, L Gortner
1Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, 405 West Redwood Street, 4th floor, Baltimore, MD 21201, USA.
Insights
In intrauterine growth restriction (IUGR) with absent or reversed umbilical artery flow, visualizing fetal coronary blood flow (CBF) indicates worsening venous Doppler indices and poorer outcomes. This highlights the importance of venous Doppler surveillance in high-risk IUGR fetuses.
Area of Science:
- Perinatal Medicine
- Fetal Cardiology
- Doppler Ultrasound
Background:
- Intrauterine growth restriction (IUGR) with absent or reversed umbilical artery end-diastolic velocity (AREDV) signifies severe fetal compromise.
- Fetal coronary blood flow (CBF) visualization is a potential marker, but its relationship with venous Doppler changes and perinatal outcomes in IUGR requires clarification.
Purpose of the Study:
- To investigate the association between fetal coronary blood flow (CBF) visualization in IUGR fetuses with AREDV.
- To analyze longitudinal changes in fetal arterial and venous Doppler indices.
- To correlate these findings with perinatal outcomes.
Main Methods:
- Longitudinal echocardiographic assessment of 48 IUGR fetuses with AREDV, attempting CBF visualization.
- Doppler evaluation of middle cerebral artery, inferior vena cava (IVC), ductus venosus (DV), and umbilical vein (UV), with measurements converted to Z-scores (delta-indices).
- Comparison of outcomes between fetuses with visualized CBF (group 1) and those without (group 2).
Main Results:
- No significant Doppler differences between groups at study entry.
- CBF visualization coincided with significant increases in umbilical artery (UA), IVC, and DV delta-indices, particularly in the 24 hours preceding visualization.
- Group 1 fetuses (CBF visualized) required earlier delivery, had lower birthweight, and poorer cord blood gas values compared to group 2.
Conclusions:
- In IUGR fetuses with AREDV, CBF visualization is linked to deteriorating venous flows and increased risk of hypoxemia, acidemia, and adverse perinatal outcomes.
- The findings underscore the importance of venous Doppler surveillance in managing these high-risk fetuses.
- Operator dependence of CBF visualization necessitates standardized protocols and emphasizes the critical role of venous Doppler assessment.
Objective:
To determine the relationship between fetal coronary blood flow (CBF) visualization in intrauterine growth restriction (IUGR), longitudinal changes in arterial and venous flow velocity waveforms and perinatal outcome.
Methods:
A total of 48 IUGR fetuses (abdominal circumference below the 5th percentile for gestational age) with absent or reversed umbilical artery (UA) end-diastolic velocity (AREDV) were examined longitudinally by echocardiography attempting CBF visualization at each examination. Doppler evaluation of the middle cerebral artery, inferior vena cava (IVC), ductus venosus (DV) and umbilical vein (UV) was performed at each examination. Doppler measurements were correct for gestational age by conversion into Z-scores (delta-indices). Doppler results and outcome from fetuses in which CBF was visualized (group 1, n = 20) and those in which CBF was never visualized (group 2, n = 28) were compared. Outcome parameters analyzed included Apgar scores, cord arterial blood gases, perinatal mortality, respiratory distress, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis and postpartum circulatory failure requiring pressor support.
Results:
There was no difference in Doppler indices between groups at study entry. CBF visualization coincides with a significant increase of UA-, IVC- and DV delta-indices. The greatest rate of change was observed for indices in the ductus venosus which occurred in the 24 h preceding CBF visualization. Group 1 fetuses required earlier delivery (median 27 + 4, vs. median 30 + 0), had lower birthweight (682 +/- 305 g vs. 936 +/- 416 g), lower cord pH (7.21 +/- 0.1 vs. 7.27 +/- 0.06) and cord pO2 (13 +/- 4.5 vs. 24.1 +/- 13.5 mmHg) compared to group 2 (all values P < 0.05). Mortality was similar (group 1 = 6/20, 30%; group 2 = 6/28, 21.4%).
Conclusions:
In IUGR, fetuses with AREDV and centralization are at high risk for hypoxemia, acidemia and adverse outcome. CBF visualization coincides with deteriorating venous flows. Operator dependence of CBF visualization and the strong association with abnormal venous flow stresses the importance of venous Doppler surveillance in these fetuses.