Cardiac function in fetal growth restriction: a review

Mappa, Ilenia; Maqina, Pavjola; Bitsadze, Victoria; Khizroeva, Jamilya; Makatsarya, A.; Arduini, Domenico; Rizzo, Giuseppe

doi:10.23736/s2724-606x.21.04787-0

Cited by 6 publications

(5 citation statements)

References 65 publications

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“…Now, it has become an important means to monitor fetal blood circulation. Fetal hemodynamics abnormalities affect the fetal heart function to a certain extent [ 12 ]. The myocardial performance index (MPI), also known as the Tei index, was proposed by Tei in 1995, and modified MPI was a reliable index to assess fetal heart function under variety of pregnancy conditions including FGR [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Prenatal Prediction of Fetal Growth Restriction and Postnatal Outcomes by Ultrasound Assessment of Fetal Myocardial Performance Index and Blood Flow Spectrum

Wang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. Fetal growth restriction (FGR) affects 5% to 10% of newborns and is a major determinant of perinatal morbidity and mortality. Myocardial performance index (MPI), also known as the Tei index, is a useful, noninvasive, and Doppler-derived myocardial performance tool for fetal cardiac function evaluation. The purpose of the study is to evaluate ultrasonic prediction on FGR and postnatal outcomes using MPI and blood flow spectrum. Methods. This retrospective study included 240 pregnant women developing FGR and 240 healthy pregnant women. The blood flow spectrum of middle cerebral artery (MCA), umbilical artery (UA), and ductus venous including systolic to diastolic ratio (S/D), resistant index (RI), pulse index (PI), and peak ventricular systolic velocity/atrial contraction valley velocity (S/a) were examined using the GE Voluson E8 ultrasound system. Results. The MPI, S/D, RI, PI of UA, and S/a were all higher but S/D, RI, and PI of MCA were lower in the FGR group than those in the control group P < 0.001 . The MPI, S/D, RI, PI of UA, S/D, RI, PI of MCA, and ductus venous S/a yielded AUC of 0.813, 0.835, 0.791, 0.804, 0.789, 0.796, 0.803, and 0.784 when they were used to predict the incidence of FGR. Of note, the pregnant women with poor pregnancy outcomes exhibited higher values of MPI, S/D, RI, PI of UA, and S/a with lower scores of 1 min Apgar concomitant with lower values regarding S/D, RI, and PI of MCA than those with favorable pregnancy outcomes P < 0.001 . The MPI (r = −0.623), S/D (r = −0.660), RI (r = −0.601), PI (r = −630) of UA, and S/a (r = −0.573) shared negative correlations with 1 min Apgar scores P < 0.001 . Of note, the S/D (r = 0.562), RI (r = 0.597), and PI (r = 0.619) of MCA were positively correlated with 1 min Apgar scores P < 0.001 . It was revealed that the MPI, S/D, RI, PI of UA, S/D, RI, PI of MCA, and ductus venous S/a yielded AUC of 0.806, 0.833, 0.774, 0.788, 0.807, 0.729, 0.748, and 0.770 when they were used to predict the incidence of poor pregnancy outcomes for pregnant women developing FGR. Conclusion. Our study demonstrates good ultrasonic prediction on FGR and postnatal outcomes using MPI and blood flow spectrum.

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Section: Introductionmentioning

confidence: 99%

Prenatal Prediction of Fetal Growth Restriction and Postnatal Outcomes by Ultrasound Assessment of Fetal Myocardial Performance Index and Blood Flow Spectrum

Wang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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“…Several studies have demonstrated a role of the pressures of oxygen and carbon dioxide, presumably mediated by chemoreceptors. These stimulate the release of vasoactive substances including nitric oxide, prostanoids, catecholamines, angiotensin, and vasopressin and are acknowledged to play a role in the activation of mechanisms such as the adrenergic reflex [73, 74]. Prostanoids are among the most important vasoactive substances regulating the umbilical artery blood flow.…”

Section: Fetal Vascular Responses To Chronic Hypoxiamentioning

confidence: 99%

Mechanisms of Fetal Adaptation to Chronic Hypoxia following Placental Insufficiency: A Review

Zegarra¹,

Dall’Asta

Ghi

2022

Fetal Diagn Ther

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Placental insufficiency is associated with reduced oxygen and nutrient supply to the fetus, which may result in fetal growth restriction (FGR). In an attempt to cope with the hostile intrauterine environment, FGR fetuses respond through metabolic, endocrine, vascular, cardiac, behavioral, hematological, and immunological adaptive mechanisms. However, permanent sequelae may result from such adaptive mechanisms. In this review, we describe the mechanisms of fetal adaptation to the hostile intrauterine environment in FGR of uteroplacental origin and detail their pathophysiology and potential implications for the extrauterine life of the individual.

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“…The resulting fetal growth restriction (FGR) may be diagnosed antenatally on the basis of an ultrasound determined low estimated fetal weight (EFW) for gestational age; either <3 rd centile or <10 th centile with abnormal Doppler ultrasound indices in the uterine (UtA) and/or umbilical (UmA) arteries (3) (4, 5). Early-onset FGR, occurring before 32 weeks of gestation, carries significant risks of stillbirth, neonatal morbidity and mortality, neurodevelopmental impairment, and long-term health problems (6)(7)(8)(9)(10)(11)(12)(13). There is currently no treatment that can improve fetal growth in utero; instead, management involves monitoring the pregnancy and timing delivery to balance the risks of stillbirth and prematurity (4, [14][15][16]).…”

Section: Introductionmentioning

confidence: 99%

Ultrasound and biochemical predictors of pregnancy outcome at diagnosis of early-onset fetal growth restriction

Spencer

Maksym

Hecher

et al. 2023

Preprint

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Background: Severe early-onset fetal growth restriction (FGR) causes significant fetal and neonatal mortality and morbidity. Predicting the outcome of affected pregnancies at the time of diagnosis is difficult, preventing accurate patient counselling. We investigated the use of maternal serum protein and ultrasound measures at diagnosis to predict fetal or neonatal death and three secondary outcomes: fetal death or delivery ≤28+0 weeks; development of abnormal umbilical artery Doppler velocimetry; slow fetal growth. Methods: Women with singleton pregnancies (n=142, estimated fetal weights [EFWs] <3rd centile, <600g 20+0-26+6 weeks of gestation, no known chromosomal, genetic or major structural abnormalities), were recruited from four European centres. Maternal serum from the discovery set (n=63) was analysed for seven proteins linked to angiogenesis, 90 additional proteins associated with cardiovascular disease and five proteins identified through pooled liquid chromatography tandem mass spectrometry. Patient and clinician stakeholder priorities were used to select models tested in the validation set (n=60), with final models calculated from combined data. Results: The most discriminative model for fetal or neonatal death included EFW z-score (Hadlock 3 formula/Marsal chart), gestational age and umbilical artery Doppler category (AUC 0.91, 95%CI 0.86-0.97) but was less well calibrated than the model containing only EFW z-score (Hadlock3/Marsal). The most discriminative model for fetal death or delivery ≤28+0 weeks included maternal serum placental growth factor (PlGF) concentration and umbilical artery Doppler category (AUC 0.89, 95%CI 0.83-0.94). Conclusion: Ultrasound measurements and maternal serum PlGF concentration at diagnosis of severe early-onset FGR predict pregnancy outcomes of importance to patients and clinicians.

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Cardiac function in fetal growth restriction: a review

Cited by 6 publications

References 65 publications

Prenatal Prediction of Fetal Growth Restriction and Postnatal Outcomes by Ultrasound Assessment of Fetal Myocardial Performance Index and Blood Flow Spectrum

Prenatal Prediction of Fetal Growth Restriction and Postnatal Outcomes by Ultrasound Assessment of Fetal Myocardial Performance Index and Blood Flow Spectrum

Mechanisms of Fetal Adaptation to Chronic Hypoxia following Placental Insufficiency: A Review

Ultrasound and biochemical predictors of pregnancy outcome at diagnosis of early-onset fetal growth restriction

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