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Cardiac function monitoring of fetuses with growth restriction
Francesc Figueras1, Bienvenido Puerto, Josep M Martinez
1Obstetrics and Gynecology Department, Hospital Clinic, Institut Dexeus, Bonanova 67, 08017, Barcelona, Spain. frafig@iudexeus.uab.es
Insights
In intrauterine growth restriction, umbilical artery pulsatility index abnormalities appear first. Cardiac function deteriorates progressively, with right-sided and diastolic measures declining before left-sided and systolic ones.
Area of Science:
- Cardiology
- Fetal Medicine
- Obstetrics
Background:
- Intrauterine growth restriction (IUGR) poses significant risks to fetal well-being.
- Understanding the temporal sequence of cardiac dysfunction in IUGR is crucial for timely intervention.
Purpose of the Study:
- To delineate the chronological order of cardiac function changes in fetuses with IUGR.
- To identify the earliest indicators of cardiac compromise in growth-restricted fetuses.
Main Methods:
- Prospective longitudinal study of 22 singleton pregnancies with IUGR fetuses.
- Serial assessment of fetal Doppler indices, ventricular function (shortening fraction), and atrioventricular flow (E/A ratio).
- Logistic regression and Mann-Whitney U-test used for temporal analysis and trend evaluation.
Main Results:
- Umbilical artery pulsatility index abnormality was the earliest observed change.
- Progressive deterioration followed in middle cerebral artery, right-sided diastolic and systolic indices, and finally left cardiac indices.
- Right-sided and diastolic cardiac function showed earlier decline than left-sided and systolic function.
Conclusions:
- A distinct temporal sequence of cardiac function deterioration exists in IUGR fetuses.
- Right ventricular and diastolic function are more vulnerable and decline earlier than left ventricular and systolic function in IUGR.
- These findings aid in monitoring and managing fetuses with intrauterine growth restriction.
Objective:
To describe the time sequence of changes in cardiac function in intrauterine growth restriction.
Study Design:
This was a prospective longitudinal study on 22 singleton pregnancies with growth-restricted fetuses. Pulsatility indices of fetal arterial and venous Doppler waveforms, systolic peak velocity in the aorta and pulmonary artery, right and left ventricular shortening fraction and atrioventricular flow E/A ratio were assessed at each monitoring session. Logistic regression was used for modeling the probability of abnormality of a variable in relation to the time interval before delivery. Trends over time were analyzed by Mann-Withney U-test.
Results:
Umbilical artery pulsatility index was the first variable to become abnormal, followed by the middle cerebral artery, right diastolic indices (right E/A, ductus venosus), right systolic indices and, finally, both diastolic and systolic left cardiac indices.
Conclusion:
We have found an earlier and more pronounced right than left and diastolic than systolic fetal cardiac function deterioration in growth restricted fetuses monitored longitudinally.