2082399 Fetal Myocardial Performance Index During Progression of Labor

Abstract

Objectives: The brain sparing effect reported in fetuses with congenital heart disease (CHD) describes compensatory cerebral vasodilatation with redistribution of cerebral blood flow in the face of compromised fetal oxygenation. This protective mechanism may be insufficient to maintain normal brain growth and development. Fetuses with hypoplastic left heart (HLH) and transposition of the great arteries (TGA) have been noted to have a smaller head. As such the aim of this study was to determine whether the brain sparing effect, as reflected by the fetal BPD, is apparent in the first trimester.Methods: Retrospective study on 820 controls and 32 fetuses known to have CHD who had undergone first trimester screening for aneuploidy and structural fetal abnormalities at 2 centers in Lebanon. All scans were carried out transabdominally by 2 experienced sonologists with the fetal NT, CRL and BPD measured. Maternal age, BMI, gravidity and parity were obtained. The presence of extracardiac anomalies and aneuploidy in fetuses with CHD was recorded. Live born fetuses were evaluated by a pediatric cardiologist and the diagnosis confirmed. The BPD as a function of the fetal CRL of fetuses with CHD was plotted against the established normogram in our population with the fetuses having CHD divided into 3 groups: the group with HLH, the fetus with CoA and finally fetuses with other cardiac anomalies.Results: A total of 32 fetuses were included in the analysis: 9/32 (28.1%) with HLH, 2/32 (6.3%) with CoA and 21/32 (65.6%) with AV canal, HRH, VSD and other cardiac abnormalities. Karyotype was available on 6/32 (18.8%) fetuses and of those, 5/6 (83.3%) had trisomy 21 and 1/6 (16.6%) had an unbalanced translocation. Extracardiac abnormalities were present in 4/32 (12.5%). Of the 32 fetuses, 13 were live born (40.6%). Termination of pregnancy was carried out on 14/32 (43.8%). There was spontaneous in utero demise in 2/32 (6.3%) and 3/32 (9.4%) were lost to follow up. The fetal BPD as a function of the CRL revealed no difference between fetuses with CHD and normal fetuses.Conclusions: The brain sparing effect, exemplified by alterations in the fetal BPD, is not apparent in the first trimester.Objectives: The Myocardial Performance Index (MPI) is a Doppler derived myocardial function tool. It has been used in perinatology to evaluate systolic and diastolic dysfunction in fetuses with twin to twin transfusion syndrome and intrauterine growth restriction. The OBJECTIVES: of the study was to investigate the MPI during labor of normal term pregnancies, to establish normative values, and to evaluate change with cervical dilation.Methods: Women with uncomplicated, term, singleton pregnancies were recruited to this prospective observational study at Thomas Jefferson University Hospital. Exclusion criteria were multiples, fetal anomalies, preterm labor, non-cephalic presentation. Participants underwent an ultrasound examination by one sonographer, during which fetal left and right sided isovolumic contraction time (ICT), isovolumic relaxation ti...