Cardiac function in fetal growth restriction

Area of Science:

• Obstetrics and Gynecology
• Fetal Medicine
• Cardiology

Background:

• Fetal growth restriction (FGR) is a condition where a fetus cannot reach its full growth potential.
• FGR is classified as early (<32 weeks) or late (≥32 weeks) onset, each with distinct pathological mechanisms.
• FGR is linked to adverse short- and long-term outcomes, including neurodevelopmental delay and increased risk of infant and adult complications.

Purpose of the Study:

• To review the modifications in fetal cardiac hemodynamics in early and late-onset FGR.
• To elucidate the distinct mechanisms of cardiac hemodynamic changes in early versus late FGR.
• To highlight the impact of placental insufficiency and chronic fetal hypoxia on fetal cardiac function.

Main Methods:

• This review synthesizes existing literature on fetal cardiac hemodynamics in FGR.
• It analyzes studies focusing on cardiovascular adaptations and maladaptations in early and late FGR.
• The review discusses findings from Doppler ultrasound and other fetal assessment techniques.

Main Results:

• Early-onset FGR involves preferential cardiac output diversion to the brain and heart, with abnormal flow patterns indicating worsening hypoxia.
• Late-onset FGR is characterized by fetal heart remodeling and functional changes, primarily due to reduced umbilical vein flow.
• Both forms of FGR demonstrate significant alterations in fetal cardiac hemodynamic profiles.

Conclusions:

• Fetal growth restriction significantly impacts fetal cardiac hemodynamics, with distinct patterns observed in early and late-onset cases.
• Understanding these hemodynamic alterations is crucial for predicting outcomes and managing pregnancies complicated by FGR.
• Further research into targeted interventions based on specific hemodynamic profiles is warranted.