| Low cardiac output to the placenta: an early hemodynamic adaptive mechanism in intrauterine growth restriction. | |
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MedLine Citation:
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PMID: 18663767 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: A low combined cardiac output (CCO) to the placenta (placenta/CCO fraction) has been reported in growth-restricted (IUGR) fetuses, but the temporal sequence of these modifications in relation to other changes in the fetal circulation is unknown. The aim of this study was to evaluate the placenta/CCO fraction in relation to other hemodynamic changes in fetuses at risk of developing IUGR. METHODS: We studied 340 singleton nulliparous pregnancies characterized at 20-24 weeks by abnormal uterine artery pulsatility index (PI) values (> 95(th) centile). At this gestational age we measured fetal biometry and Doppler waveforms from the umbilical artery (UA), middle cerebral artery (MCA), ductus venosus (DV), umbilical vein (UV) and outflow tracts of both ventricles. The diameters of the semilunar valves and UV were measured and CCO (left cardiac + right cardiac outputs) and UV blood flow were calculated. The placenta/CCO fraction was calculated as UV flow as a percentage of CCO. RESULTS: There were 283 pregnancies with birth weight >or= 10(th) centile and normal UA-PI throughout gestation (Group A), 34 with birth weight < 10(th) centile and normal UA-PI throughout gestation (Group B) and 23 with birth weight < 10(th) centile and abnormal UA-PI developing later in gestation (Group C). At 20-24 weeks there were no differences among the three groups in fetal biometric parameters, PI values from the UA, MCA and DV, and CCO. UV flow and placenta/CCO fraction were significantly lower in Group C compared with Group A (UV flow delta value = - 1.439, P < 0.0001; placenta/CCO fraction delta value = - 1.74, P < 0.0001) but not in Group B. CONCLUSIONS: Our data suggest that, in fetuses developing IUGR secondary to placental compromise, UV flow and placental/CCO fraction are already reduced by 20-24 weeks, and that this reduction occurs earlier than do modifications in fetal size and arterial and venous PI values. |
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Authors:
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G Rizzo; A Capponi; O Cavicchioni; M Vendola; D Arduini |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology Volume: 32 ISSN: 1469-0705 ISO Abbreviation: Ultrasound Obstet Gynecol Publication Date: 2008 Aug |
Date Detail:
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Created Date: 2008-08-04 Completed Date: 2009-01-19 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9108340 Medline TA: Ultrasound Obstet Gynecol Country: England |
Other Details:
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Languages: eng Pagination: 155-9 Citation Subset: IM |
Copyright Information:
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(c) 2008 ISUOG. Published by John Wiley & Sons, Ltd. |
Affiliation:
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Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Ospedale GB Grassi Roma, Rome, Italy. giuseppe.rizzo@uniroma2.it |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Arteries / physiopathology, ultrasonography Cardiac Output, Low / ultrasonography* Female Fetal Growth Retardation / etiology* Gestational Age Heart Rate, Fetal / physiology Hemodynamics Humans Infant, Newborn Placenta / blood supply* Pregnancy Pulsatile Flow / physiology Retrospective Studies Ultrasonography, Doppler, Pulsed / methods* Ultrasonography, Prenatal / methods* Uterus / blood supply* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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