Effect of fetal breathing movements on fetal cardiac hemodynamics

Maximum flow velocity waveforms were studied at atrioventricular and outflow tract level in 12 cases during fetal breathing activity and in 12 cases during fetal apnea matched for maternal and gestational age and maternal parity. Gestational age ranged between 27 and 40 weeks (median 30 weeks). All flow velocity waveforms were obtained using a mechanical sector scanner with a pulsed Doppler system (carrier frequency 3.5 MHz). Time-averaged flow velocities were clearly different between inspiration and expiration at all four recording levels, reflecting changes in venous return as a result of fluctuations in intrathoracic pressure during fetal breathing activity. Percentage change between inspiration and expiration at outflow tract level was positively correlated with gestational age. Time-averaged flow velocity at mitral level and ascending aorta level was significantly higher during fetal breathing activity than during apnea, suggesting increased shunting of blood flow through the foramen ovale. Acceleration time at outflow tract level demonstrated very little change relative to inspiration and expiration.