Document Detail

Foramen ovale changes in growth-restricted fetuses.
MedLine Citation:
PMID:  15287050     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: In animal experiments hypoxemia induces an increased shunting through the fetal foramen ovale (FO). Based on the hypothesis that the FO is expanded to permit more flow, the aim of this study was to determine the size of the FO in growth-restricted human fetuses. METHODS: Thirty-one women with singleton pregnancies complicated with growth-restriction (< 5th percentile) were examined at 24-39 weeks of gestation. The diameter between the FO valve and the atrial septum was determined during maximum excursion in a horizontal transverse section of the fetal heart, and the transverse diameter of the right atrium (RA) was noted. The pulsatility index (PI) was determined in the umbilical artery (UA) and absent or reversed end-diastolic flow velocity was noted. The measurements were compared with a reference population using Z-scores. RESULTS: In comparison with normally grown fetuses, the growth-restricted fetuses had a normal RA size (P = 0.08) but a smaller FO (P = 0.002), particularly when expressed as a relative size by the ratio FO/RA (P < 0.0001). This effect on the FO and FO/RA was seen mainly at < 32 weeks of gestation (P = 0.003 and P < 0.0001, respectively), and was not significant later in pregnancy. There was a tendency towards a negative relationship between relative size of the FO (FO/RA) and progressive placental compromise (overall P < 0.0001). CONCLUSIONS: Growth-restricted fetuses maintain a normally grown heart (expressed by the RA diameter) but a reduced FO diameter. The effect is seen before 32 weeks and tends to be more marked in fetuses with pronounced hemodynamic compromise of the placenta. This supports the theory that FO shunting is impaired in severely premature fetuses with placental compromise.
T Kiserud; G Chedid; S Rasmussen
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  24     ISSN:  0960-7692     ISO Abbreviation:  Ultrasound Obstet Gynecol     Publication Date:  2004 Aug 
Date Detail:
Created Date:  2004-08-02     Completed Date:  2004-09-21     Revised Date:  2005-04-08    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  England    
Other Details:
Languages:  eng     Pagination:  141-6     Citation Subset:  IM    
Copyright Information:
Copyright 2004 ISUOG
Institute of Clinical and Molecular Medicine, Division of Obstetrics & Gynecology, University of Bergen, Bergen, Norway.
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MeSH Terms
Blood Flow Velocity
Fetal Growth Retardation / pathology*,  ultrasonography
Fetal Heart / pathology,  ultrasonography
Heart Atria / pathology,  ultrasonography
Heart Septum / pathology*,  ultrasonography
Pulsatile Flow
Ultrasonography, Prenatal
Umbilical Arteries / physiopathology
Comment In:
Ultrasound Obstet Gynecol. 2005 Jan;25(1):95; author reply 95-6   [PMID:  15690556 ]

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