Assessment of Fetal Cardiac Function in Mild Preeclampsia

Abstract

This study investigated cardiac function in 65 fetuses of mildly preeclamptic mothers and 55 fetuses of healthy mothers at 26-40 weeks of gestation. Fetuses with intrauterine growth restriction were excluded. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. The two groups were similar in terms of maternal age, gravidity, parity, and gestational age. Peak systolic aortic and pulmonary artery velocities were significantly lower in the fetuses of the preeclamptic mothers than in the fetuses of the healthy mothers. The two groups did not differ significantly in terms of shortening fraction or with regard to mitral or tricuspid annular plane systolic excursion. Pulsed-wave Doppler-derived E/A ratios in the mitral and tricuspid valves were similar in the two groups. The deceleration time of early mitral inflow was prolonged in the fetuses of the preeclamptic mothers. The Ea, Aa, and Ea/Aa ratios in the interventricular septum, left ventricle posterior wall, and right ventricle free wall were lower in the preeclampsia group than in the control group. The E/Ea ratio was higher in the preeclampsia group than in the control group. The isovolumic relaxation time and the right and left myocardial performance indices were higher in the fetuses of the preeclamptic mothers than in the fetuses of the healthy mothers. An increased ductus venosus pulsatility index (PI) and a decreased middle cerebral artery (MCA) PI were found in the fetuses of the preeclamptic mothers. All the fetuses were asymptomatic. The results suggest that the increase in fetal cardiac afterload in mild preeclampsia may have caused early subclinical changes in fetal systolic and diastolic cardiac function. In addition, the decrease in MCA-PI may have been caused by redistribution of fetal cardiac output in favor of the left ventricle, secondary to increased placental vascular resistance.

Fetal cardiac remodeling and dysfunction is associated with both preeclampsia and fetal growth restriction

“…13 Moreover, experimental data of FGR lamb model had demonstrated high blood pressure and high vascular resistance in affected fetuses. 42 In contrast, some previous studies have evaluated fetal cardiac structure and function in PE-with and without FGR-reporting elevated myocardial performance index 43,44 and cord blood NT-proBNP and homocysteine. 45 However, the comparison among these studies is difficult, as they mostly included both FGR and non FGR cases, and a high proportion of fetuses presenting altered fetoplacental Doppler.…”

Prediction of pregnancy complication occurrence using fetal cardiac output assessments made by ultrasonography at 20 to 24 weeks of gestation

“…In our study, the mean MPI was 0.36±0.12. The MPI increases in hypervolemia and high cardiac afterload [ 8 ]. Benavides-Serralde et al [ 9 ] reported that in cases of FGR, the MPI was a reliable early marker of fetal cardiac dysfunction.…”

Zidovudine treatment in HIV-infected pregnant women is associated with fetal cardiac remodelling

“…From a pathophysiological point of view, the cause of cardiac remodelling in HIV exposed non-infected fetuses is unclear. Although fetal cardiac remodelling has been previously described in other obstetrical conditions such as small-for-gestational age fetuses, prematurity or preeclampsia [14][15][16][17] The clinical relevance of cardiac remodelling in the offspring of HIV women remains to be elucidated. Concerning childhood, previous studies suggested cardiac dysfunction and reduced ventricular cavities with controversial results on myocardial thickness in HEU children [6,7].…”