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Published on: June 29, 2013
Association of Amniotic Fluid Volume and Fetal Cardiac and Cerebrovascular Parameters in Fetal Growth Restriction
Lauren Sayres1, Roopjit K Sahi1, Heather Straub1
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, USA.
Insights
Oligohydramnios is rare in fetal growth restriction (FGR) but indicates significant cardiac and brain issues. This study highlights the importance of monitoring amniotic fluid volume in FGR pregnancies.
Area of Science:
- Perinatal Medicine
- Fetal Cardiology
- Maternal-Fetal Medicine
Background:
- Fetal growth restriction (FGR) is a major cause of perinatal morbidity and mortality.
- Oligohydramnios, a condition of low amniotic fluid, is often associated with FGR but its prevalence and impact on fetal well-being require further investigation.
- Assessing fetal cardiac function and brain sparing is crucial in managing FGR.
Purpose of the Study:
- To determine the prevalence of oligohydramnios and reduced amniotic fluid in a cohort of fetuses with FGR.
- To investigate the association between oligohydramnios and fetal cardiac dysfunction and brain sparing in FGR.
- To characterize the cardiac phenotype in FGR fetuses with oligohydramnios.
Main Methods:
- Retrospective analysis of ultrasound data from FGR pregnancies in maternal-fetal medicine clinics.
- Oligohydramnios defined as maximum vertical pocket (MVP) <2 cm; reduced fluid as MVP 2-3 cm.
- Assessment of Doppler values and cardiac parameters in a comprehensive cohort of FGR fetuses.
Main Results:
- Oligohydramnios prevalence was low (0.8% clinical cohort, 2.3% comprehensive cohort).
- Reduced fluid prevalence was 8% (clinical) and 11.1% (comprehensive).
- FGR fetuses with oligohydramnios exhibited a high rate of cardiac abnormalities, including small and round hearts, and Doppler abnormalities.
Conclusions:
- Oligohydramnios is uncommon in FGR but signifies a higher risk of fetal cardiac and cerebral abnormalities.
- The presence of oligohydramnios in FGR warrants close monitoring for signs of brain sparing and cardiac dysfunction.
- Oligohydramnios in FGR is linked to a distinct cardiac phenotype, suggesting significant underlying pathophysiology.
Objectives:
To investigate the prevalence of oligohydramnios, brain sparing, and cardiac dysfunction among a cohort of fetal growth restriction (FGR).
Methods:
To assess the prevalence of oligohydramnios amongst a large sample of FGR fetuses, we screened a database of ultrasounds of FGR pregnancies from our maternal-fetal medicine clinics (clinical cohort) for diminished amniotic fluid volume. Using a threshold of a maximum vertical pocket (MVP) of <2 cm for "oligohydramnios," and 2 to 3 cm as a "reduced fluid" group, trends of Doppler values and cardiac parameters were assessed from pregnancies in an ongoing research study (comprehensive cohort).
Results:
In the clinical cohort, oligohydramnios was identified in only 2/229 (0.8%) and reduced fluid in 19/229 (8%). In the comprehensive cohort, oligohydramnios was seen in 3/126 (2.3%) and reduced fluid in 14/126 (11.1%). A high rate of cardiac and Doppler abnormalities were observed in the oligohydramnios group of the comprehensive cohort. The patients with oligohydramnios had a distinctly different cardiac phenotype with small (2/3 with cardiac area <5th%) (P = 0.01) and round (3/3 with global sphericity index <5th%) (P = 0.02) hearts.
Conclusion:
Oligohydramnios, when present with FGR, is accompanied by high rates of cerebral and cardiovascular abnormalities.
