Cerebroplacental and Uterine Doppler Indices in Pregnancies Complicated by Congenital Heart Disease of the Fetus

Graupner, O; Koch, Jessica; Enzensberger, C; Götte, M; Wolter, A; Müller, V; Kawecki, A; Herrmann, Jens; Axt-Fliedner, R

doi:10.1055/a-0900-4021

Cited by 7 publications

(5 citation statements)

References 38 publications

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“…Especially, from 37 weeks of gestation onwards FGR fetuses are at increased risk of being undetected prenatally with the consecutive risk of adverse perinatal outcome [4]. Although sonography is part of the daily obstetrical routine, screening for compromised fetuses at term still remains a major challenge within various collectives of fetuses [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Amniotic-Umbilical-to-Cerebral Ratio – A Novel Ratio Combining Doppler Parameters and Amniotic Fluid Volume to Predict Adverse Perinatal Outcome in SGA Fetuses At Term

et al. 2020

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Purpose Introduction of a novel ratio – the amniotic-umbilical-to-cerebral ratio (AUCR) – to predict adverse perinatal outcome in SGA fetuses at term and comparison of its predictive accuracy with established parameters. Materials and Methods This retrospective cohort study included 165 singleton pregnancies with SGA fetuses (birth weight < 10th percentile) at term. Cases with planned vaginal delivery and documented pulsatility indices (PI) of the umbilical artery (UA), middle cerebral artery (MCA), and single deepest pocket (SDP) were included. CPR was calculated as the ratio between MCA PI and UA PI, UCR as the ratio between UA PI and MCA PI. AUCR was defined as follows: SDP/(UA PI/MCA PI). Adverse perinatal outcomes were defined as operative intervention (OI), OI due to fetal distress, admission to the neonatal intensive care unit (NICU), and composite adverse perinatal outcome (CAPO). Associations between Doppler parameters and these outcomes were estimated using regression analyses. Results OI was statistically significantly associated with UCR, SDP, and AUCR, whereas no association was observed for UA PI, MCA PI, and CPR. Fetuses requiring OI due to fetal distress revealed a significantly higher UA PI and UCR as well as a lower MCA PI, CPR, and AUCR. With regard to NICU admission and CAPO, a significantly higher UA PI and lower CPR were found. Furthermore, a significant association was shown for SDP, UCR, and AUCR. AUCR achieved the best area under the curve for all outcome parameters. Conclusion AUCR leads to an improvement in the prediction of unfavorable outcome in SGA fetuses at term. Furthermore, results of our study show that UCR might be superior to CPR.

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Section: Introductionmentioning

confidence: 99%

Amniotic-Umbilical-to-Cerebral Ratio – A Novel Ratio Combining Doppler Parameters and Amniotic Fluid Volume to Predict Adverse Perinatal Outcome in SGA Fetuses At Term

et al. 2020

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“…Our findings also showed that uterine artery PI and umbilical artery PI could independently predict the incidence of heart disorders in IUGR/SGA fetuses. Graupner et al Showed that congenital heart disease is associated with changes in Doppler patterns, especially with increased uterine artery PI (Graupner, Koch, Enzensberger, Götte, Wolter, Müller, Kawecki, Herrmann, & Axt-Fliedner, 2019). Abnormal uterine artery Doppler suggests impaired placentation and poor placental function.…”

Section: Discussionmentioning

confidence: 99%

The Relationship between Abnormal Echocardiography Findings in Fetus with Small Gestational Age

Shojaei¹,

Saadati²,

Zarei³

2020

JMBR

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Background: Intrauterine growth restriction (IUGR), refers to a condition in which the fetus does not grow well according to its genetic potential. Development of the cardiovascular system and impairing fetal developmental planning ultimately caused long-term cardiovascular morbidity. In the present study, the incidence of cardiac abnormalities in fetuses affected by IUGR as well as factors related to the occurrence of these abnormalities were evaluated. Material and Methods: In this descriptive-analytical study, pregnant women referred to the Imam Khomeini Hospital in Ahvaz during February 2018 to January 2020 were recruited. Complete clinical information was recorded using a questionnaire. The recorded information included age, birth weight, gestational age, weight and BMI and comorbidities. Then, echocardiographic data; structural abnormalities including septal condition, valves and outflow of large arteries, and the presence of mass or oxygen in the heart and pulmonary arteries, EF and HR, were extracted from the medical records. Results: In the present study, 152 patients were studied. The mean age of patients was 28.2 ranged from 17- to 40year. Fetal echocardiography showed that nearly 60% of fetuses had heart abnormalities. The most common disease was ventricular septal defect (VSD) (n = 21,13.8%), followed by atrial septal defec(ASD) (n = 15,9.9%) and concurrent ASD and VSD was observed in of 11.2% cases (n = 17). The incidence of echocardiographic abnormalities in IUGR fetuses was significantly higher than in SGA (p = 0.0001). However, the type of IUGR did not have a significant relationship with the incidence of echocardiographic findings in terms of time of performance (Early or late). Among the Doppler ultrasound factors, uterine artery PI (p = 0.001) and umbilical artery PI (p = 0.008) were associated with fetal heart abnormalities. Conclusion: In general, the findings of this study showed that the incidence of heart disorders in IUGR fetuses is high and is related to the severity of fetal growth restriction. Cardiac abnormalities are more common in IUGR fetuses than in SGA. Our results have also shown that the umbilical artery PI and uterine artery PI can be used as predictive factors in diagnosing fetal heart abnormalities. Our findings suggest an evaluation of echocardiography in IUGR fetuses.

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“…However, Doppler measures have shown limited effectiveness in distinguishing abnormal placental function in CHD compared to healthy controls. 9,80,81 Furthermore, Doppler measurements of placental function have demonstrated poor predictability regarding fetal biometric and neurodevelopmental outcomes. 82,83 Associations between fetal Doppler measures of placental function and fetal outcomes also appear to vary with gestational age, indicating a an evolution of abnormal placental function in CHD.…”

Section: Abnormal In Vivo Placental Functionmentioning

confidence: 99%

“…Fetal Doppler, commonly employed in clinical practice, is used to infer placental function through secondary measurements of the umbilical artery and fetal hemodynamics (cerebroplacental ratio). However, Doppler measures have shown limited effectiveness in distinguishing abnormal placental function in CHD compared to healthy controls 9,80,81 . Furthermore, Doppler measurements of placental function have demonstrated poor predictability regarding fetal biometric and neurodevelopmental outcomes 82,83 .…”

Section: Clinical Insights Into a Placental Origin Of Chdmentioning

confidence: 99%

Interdependence of placenta and fetal cardiac development

Leon,

Bitar,

Rajagopalan

et al. 2024

Prenatal Diagnosis

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The placenta and fetal heart undergo development concurrently during early pregnancy, and, while human studies have reported associations between placental abnormalities and congenital heart disease (CHD), the nature of this relationship remains incompletely understood. Evidence from animal studies suggests a plausible cause and effect connection between placental abnormalities and fetal CHD. Biomechanical models demonstrate the influence of mechanical forces on cardiac development, whereas genetic models highlight the role of confined placental mutations that can cause some forms of CHD. Similar definitive studies in humans are lacking; however, placental pathologies such as maternal and fetal vascular malperfusion and chronic deciduitis are frequently observed in pregnancies complicated by CHD. Moreover, maternal conditions such as diabetes and pre‐eclampsia, which affect placental function, are associated with increased risk of CHD in offspring. Bridging the gap between animal models and human studies is crucial to understanding how placental abnormalities may contribute to human fetal CHD. The next steps will require new methodologies and multidisciplinary approaches combining innovative imaging modalities, comprehensive genomic testing, and histopathology. These studies may eventually lead to preventative strategies for some forms of CHD by targeting placental influences on fetal heart development.

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Cerebroplacental and Uterine Doppler Indices in Pregnancies Complicated by Congenital Heart Disease of the Fetus

Cited by 7 publications

References 38 publications

Amniotic-Umbilical-to-Cerebral Ratio – A Novel Ratio Combining Doppler Parameters and Amniotic Fluid Volume to Predict Adverse Perinatal Outcome in SGA Fetuses At Term

Amniotic-Umbilical-to-Cerebral Ratio – A Novel Ratio Combining Doppler Parameters and Amniotic Fluid Volume to Predict Adverse Perinatal Outcome in SGA Fetuses At Term

The Relationship between Abnormal Echocardiography Findings in Fetus with Small Gestational Age

Interdependence of placenta and fetal cardiac development

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