Intrauterine growth retardation is a pathology which is found in 3–10% of all pregnancies and it is associated with around 20–25% of all fetal intrauterine deaths and with long-term neurologic sequelae. It presents an increased risk of distress during labor and delivery and a greater risk of perinatal mortality. The causes of IUGR and the cardiac and venous Doppler in normal fetuses are analyzed, and the hemodynamic cardiac modifications in IUGR fetus are discussed. The fetal cardiac function in intrauterine growth retardation shows a redistribution of the fetal cardiac output, which tends to favor the left ventricle as the mechanism to compensate for the uteroplacental insufficiency. The Doppler velocity indices are modified as the fetal condition progressively deteriorates and they represent an important tool for the management of the complicated pregnancy.
International Prenatal Cardiology Collaboration Group (IPCCG) links specialists from prenatal cardiology all over the world. In this recommendation we would like to focus on the fetal/prenatal echocardiography official report. So far many recommendations focused mainly on technical aspects of the fetal heart examination.
C 12 H 22 CdN4O14, triclinic, P¯ (no. 2), a = 7.188(2) Å, b = 8.895(3) Å, c = 9.771(3) Å, α = 63.148(3)°, β = 76.750(3)°, γ = 66.225(3)°, V = 509.2(3) Å 3 , Z = 1, Rgt(F) = 0.0253, wR ref (F 2 ) = 0.0676, T = 296(2) K.
CCDC no.: 1484775The crystal structure is shown in the gure. Tables 1 and 2 contain details of the measurement method and a list of the atoms including atomic coordinates and displacement parameters.
Source of materialThe title compound was synthesized by a hydrothermal method under autogenous pressure. A mixture of CdCl 2 ·H 2 O
Objective
To measure peripheral pulmonary artery (PPA) and pulmonary vein (PV) velocity waveforms in growth restricted fetuses (IUGR) and to relate them to different Doppler indices fetal circulation and to pregnancy outcome.
Design and methods
108 IUGR fetuses from singleton pregnancies (gestational age median 28.4 range 25–32) were prospectively considered for this study. Entry criteria were an ultrasonographic extimated fetal weight < 5th centile, the absence of structural and chromosomal abnormalities, and a Pulsatility Index (PI) in umbilical artery > 95th centile of our reference limits for gestation. Velocity waveforms were recorded from the PPA and in one of the PV in proximity of the inflow in the left atrium. The PI from PPA and the Pulsatility Index for the vein from PV (PIV = [S − D]/m) were calculated. Values obtained were compared to our reference limits for gestation and related to other Doppler indices from arterial, cardiac and systemic venous circulation and to fetal outcome.
Results
In IUGR fetuses both the PI from PPA (P < 0.001) and the PIV from the PV (P < 0.001) were increased when compared to control fetuses. An inverse relationship was found between PPA and middle cerebral artery PI. Changes in PV were present when abnormal velocity waveforms are present in the systemic venous circulation. Reverse flow during atrial contraction is present in pulmonary vein in the most severely compromised fetuses and are associated with fetal distress and imminent fetal death.
Conclusions
Abnormalities in arterial and pulmonary flows are present in IUGR fetuses. Changes in arterial circulation occur at an early stage of the disease while modifications in venous flows occurs later and may be the expression of an impaired function of the left ventricle close to fetal jeopardize.
Objective
In pregnancies complicated by preterm premature rupture of the membranes (pPROM) there are essentially two causes of perinatal death: prematurity and lung hypoplasia. We used ultrasound to try to predict these complications.
Design and methods
The cervical length was measured by transvaginal ultrasound in 167 pregnancies complicated by pPROM < 32 weeks of gestation. Further in 20 pregnancies with pPROM before 24 weeks of gestation peripheral pulmonary artery (PPA) waveforms were recorded by Doppler technique at weekly interval until delivery and the Pulsatility Index (PI) calculated. Pregnancies were managed conservatively according to an Institutional management protocol. The occurrence of preterm delivery and pulmonary hypoplasia was evaluated and related to ultrasound findings.
Results
The cervical length at admission predicts the time interval elapsing between pPROM and delivery. Significant differences in PI values from PPA were present from 2 weeks onwards the pPROM between the fetuses who developed pulmonary hypoplasia and those with a normal outcome.
Conclusion
The measurement of the cervical length and of PPA velocity waveforms may help to establish the risk of developing prematurity and pulmonary hypoplasia in pregnancies complicated by pPROM.
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