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Published on: June 29, 2013
Early and persistent reduction in umbilical vein blood flow in the growth-restricted fetus: a longitudinal study
S Rigano1, M Bozzo, E Ferrazzi
1Departments of Obstetrics & Gynecology at Instituto Scienze BioMediche L. Sacco, University of Milan, Italy.
Insights
Reduced umbilical vein blood flow, caused by lower umbilical vein velocity, is an early and persistent finding in fetuses with intrauterine growth restriction, continuing until delivery. This impacts fetal development throughout gestation.
Area of Science:
- Perinatology
- Fetal Medicine
- Obstetrics
Background:
- Intrauterine growth restriction (IUGR) is associated with reduced umbilical vein blood flow.
- Previous cross-sectional studies linked reduced flow to decreased umbilical vein velocity.
Purpose of the Study:
- To longitudinally assess if reduced umbilical vein velocity and blood flow in IUGR fetuses persist throughout gestation.
- To determine if these reductions are an early or late event preceding delivery.
Main Methods:
- Serial sonographic and Doppler examinations were performed on 21 IUGR fetuses from 23 to 36 weeks gestation.
- Umbilical vein diameter, velocity, and calculated blood flow (absolute and weight-specific) were measured and normalized to abdominal circumference.
- IUGR findings were compared to local reference data.
Main Results:
- IUGR fetuses demonstrated persistent reductions in umbilical vein blood flow (per abdominal circumference and weight-specific) from diagnosis.
- A consistent reduction in umbilical vein velocity was observed in IUGR fetuses.
- Umbilical vein diameter remained unchanged in IUGR fetuses compared to controls.
Conclusions:
- Reduced umbilical vein blood flow is an early indicator in IUGR fetuses.
- This diminished blood flow, driven by decreased umbilical vein velocity, persists from diagnosis until delivery.
- The findings highlight the sustained impact of reduced umbilical circulation in IUGR.
Objective:
We have previously shown, in a cross-sectional study, that the reduction in umbilical vein blood flow in intrauterine growth-restricted fetuses is due to reduced umbilical vein velocity. The purpose of this longitudinal study in intrauterine growth-restricted fetuses was to determine whether the umbilical vein velocity reduction, which, in turn, reduces blood flow, persists throughout gestation or represents a late event that precedes indicated delivery.
Study Design:
Twenty-one intrauterine growth-restricted fetuses with an abnormal umbilical artery velocimetry underwent serial sonographic and Doppler examinations from 23 to 36 weeks of gestation. Umbilical vein diameter and velocity were measured, and umbilical vein absolute (milliliters per minute) and weight-specific blood flow (milliliters per minute per kilogram) were calculated. Umbilical vein diameter, velocity, and blood flow were expressed per abdominal circumference. Intrauterine growth-restricted findings were compared to local reference data.
Results:
Intrauterine growth-restricted fetuses showed persistent reductions in umbilical vein blood flow per abdominal circumference and weight-specific blood flow (milliliters per minute per kilogram) from the time of diagnosis of intrauterine growth-restriction. Umbilical vein velocity was reduced in the intrauterine growth-restricted fetuses, although umbilical vein diameter did not change.
Conclusion:
Reduction of umbilical vein blood flow is an early finding in intrauterine growth-restricted fetuses, and it can persist for several weeks until delivery. This reduction in blood flow is due to reduced umbilical vein velocity.
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