| Monitoring of fetuses with intrauterine growth restriction: longitudinal changes in ductus venosus and aortic isthmus flow. | |
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MedLine Citation:
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PMID: 19115231 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: To explore in growth-restricted fetuses the sequence of changes in aortic isthmus and ductus venosus blood flow in relation to other arterial Doppler parameters commonly used to evaluate fetal wellbeing. METHODS: Umbilical and middle cerebral arteries, ductus venosus and aortic isthmus were explored serially by means of pulsed Doppler in a cohort of singleton small-for-gestational age fetuses requiring delivery before 34 weeks. Longitudinal changes in the last 30 days before delivery were modeled by multilevel analysis. Individual regression lines for each variable were calculated for each fetus and from these the regression lines for the whole group were derived, in order to estimate the mean time point at which each Doppler parameter became abnormal (outside the 5th-95th centile range). A survival analysis was performed during the monitoring period, in which the endpoint was an abnormal Doppler pulsatility index. RESULTS: A total of 162 observations were performed on 46 fetuses (median, 3; range, 2-10). The median gestational age at inclusion was 28.9 (range, 23.6-33.4) weeks and delivery occurred at a median gestational age of 30.5 (range, 25.9-33.9) weeks. Six (13%) cases of perinatal mortality occurred. Umbilical and middle cerebral artery Doppler showed an almost linear deterioration throughout monitoring, becoming abnormal on average 24 days and 20 days before delivery, respectively. Aortic isthmus Doppler became abnormal on average 13 days before delivery, while ductus venosus Doppler did so within the last week before delivery. CONCLUSIONS: In preterm growth-restricted fetuses, aortic isthmus blood flow becomes abnormal on average 1 week earlier than does that in the ductus venosus. This could provide a sound basis to better define management protocols aimed to improve intact fetal survival. |
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Authors:
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F Figueras; A Benavides; M Del Rio; F Crispi; E Eixarch; J M Martinez; E Hernandez-Andrade; E Gratacós |
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: 33 ISSN: 1469-0705 ISO Abbreviation: Ultrasound Obstet Gynecol Publication Date: 2009 Jan |
Date Detail:
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Created Date: 2009-01-05 Completed Date: 2009-09-22 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: 39-43 Citation Subset: IM |
Copyright Information:
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Copyright (c) 2008 ISUOG. |
Affiliation:
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Maternal-Fetal Medicine Department, Hospital Clinic, University of Barcelona, Barcelona, Spain. ffiguera@clinic.ub.es |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aorta, Thoracic
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embryology,
physiopathology,
ultrasonography* Blood Flow Velocity / physiology Female Fetal Growth Retardation / mortality, physiopathology, ultrasonography* Fetal Monitoring Humans Kaplan-Meiers Estimate Middle Cerebral Artery / physiopathology, ultrasonography* Pregnancy Pregnancy Outcome Regional Blood Flow / physiology Ultrasonography, Doppler, Pulsed Ultrasonography, Prenatal Umbilical Veins / embryology, physiopathology, ultrasonography* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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