Doppler flow velocimetry of the splenic artery in the human fetus: Is it a marker of chronic hypoxia?

Abuhamad, Alfred; Mari, Giancarlo; Bogdan, Donna; Evans, Arthur T.

doi:10.1016/0002-9378(95)90005-5

Cited by 51 publications

(32 citation statements)

References 20 publications

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“…All our SGA fetuses showed increased resistance in the umbilical artery, and vasodilatation in the splenic, superior mesenteric, and cerebral arteries. Although the sparing effect of the splenic, adrenal, coronary and cerebral arteries has been reported in response to chronic fetal hypoxia [19][20][21], the sparing effect of splanchic circulation has rarely been described. Mari et al [22] showed a decreased PI in the abdominal arteries of SGA fetuses, compared with AGA control fetuses.…”

Section: Discussionmentioning

confidence: 99%

Nonobstructive Dilatation of the Fetal Bowel in Twin Gestations

et al. 2003

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Objective: To assess the possible association of in-utero bowel dilatation and circulatory changes with fetal compromise. Methods: A retrospective survey of all ultrasound examinations was performed at the Chaim Sheba Medical Center (n ∼10,000) between 1995 and 1999. Cases with ultrasonographic evidence of bowel dilatation, but without evidence of obstruction, were recruited. In utero Doppler studies of umbilical, splenic, superior mesenteric arteries, and middle cerebral artery (MCA) were performed: systolic/diastolic ratio (S/D), pulsatility index (PI) and resistance index (RI) were calculated in the above arteries and compared with those of normal fetuses. Nonstress test and cord blood pH were also assessed. Neonatal medical records were procured. Results: Four fetuses, all of who were products of twin gestations, showed bowel dilatation without evidence for obstruction. Three of the four fetuses were small-for-gestation-age (SGA) and of bichorionic gestation, while one was of monochorionic twin gestation, with twin transfusion syndrome. In all three SGA fetuses, Doppler studies revealed increased peripheral resistance in the umbilical artery and adaptive peripheral vasodilatation in the fetal midcerebral, splenic and superior mesenteric arteries. In all cases, an abnormal nonstress test led to prompt delivery. Conclusions: Acute fetal bowel dilatation in a twin gestation is associated with abnormal splanchnic and gut perfusion that may lead to fetal compromise.

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Section: Discussionmentioning

confidence: 99%

Nonobstructive Dilatation of the Fetal Bowel in Twin Gestations

et al. 2003

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“…However, the same observation has been recorded in the human cerebral and splenic circulations. 15,16 A recent Doppler sonographic study by Sutton and associates 17 found that in the human fetus before 22 weeks' gestation, the peak blood velocity in the ductus arteriosus is similar to that in the main pulmonary artery, whereas peak blood flow velocity was substantially greater in the ductus of fetuses of greater than 22 weeks' gestation. This observation suggests that with advancing gestation some restriction of the ductus arteriosus occurs.…”

Section: Discussionmentioning

confidence: 99%

Peripheral right pulmonary artery blood flow velocimetry: Doppler sonographic study of normal and abnormal fetuses.

Achiron

Heggesh

Mashiach

et al. 1998

Journal of Ultrasound in Medicine

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ecent advances in ultrasound equipment have facilitated exploration of small fetal blood vessels using noninvasive Doppler sonographic technology. Although much information has been accumulated regarding physiologic and pathologic fetal blood flow in the fetal aorta and the cerebral, renal, and splenic arteries, 1 limited knowledge exists on blood flow in the human fetal lung circulation. 2-3 Recently, investigators in two studies found that the PI in the pulmonary artery of normally growing fetuses decreased significantly during the second half of pregnancy. 4,5 These results contradict those of a previous study that showed a stable high-resistance value for the pulmonary circulation during gestation. 6 Laudy and coworkers 7 showed a significant decrease in the PI of the right pulmonary artery in an abnormal case of a fetus suspected of having lung hypoplasia. Since histologic studies in hypoplastic lungs have shown increased pulmonary arterial muscularization, 8,9 it was hypothesized that these changes may lead to alter- The knowledge of fetal lung circulation in normal and abnormal human fetuses is limited. Our objectives were to assess normal values for flow velocity waveforms in the fetal pulmonic circulation and to test the hypothesis that Doppler velocimetry can predict lung hypoplasia. In a cross-sectional study, peripheral right pulmonary artery flow velocimetry was investigated prospectively in 96 healthy fetuses between 14 and 37 weeks' gestation and four fetuses with abnormalities known to induce lung hypoplasia. The pulsatility index was used to quantify the velocity waveforms. In normal fetuses the mean pulsatility index in the peripheral right pulmonary artery was low, being equivalent to that corresponding to 14 to 17 weeks' gestation (2.89; confidence interval = 2.35 to 3.42), increasing at midgestation to 3.44, with a confidence interval of 3.04 to 3.83; P < 0.01. Thereafter, during the late second and third trimesters the mean pulsatility index did not change significantly with GA, being 3.66 (confidence interval = 3.04 to 4.04) at term. In fetuses with proven lung hypoplasia, the pulsatility index measurements were within the 95% confidence limits of those for normal fetuses. In a normal pregnancy, except for the early stages, a relatively stable high vascular resistance of the fetal pulmonary circulation was found. Our preliminary data suggest that the pulsatility index of the lung circulation cannot be used as an indicator of lung hypoplasia.

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“…Doppler velocimetry of the fetal splenic artery was performed immediately before cordocentesis, following the technique described by Abuhamad et al [11] . In brief, with the patient in a semirecumbent position the fetal abdomen was imaged in an axial plane at the level of the stomach.…”

Section: Hospital Das Clinicas From Universidade Federal De Minasmentioning

confidence: 99%

“…Other fetal conditions such as intrauterine growth restriction (IUGR) and macrosomia also stimulate fetal erythropoiesis in order to compensate for fetal hypoxia [9,10] . Doppler studies of fetuses with IUGR showed that a reduction in resistance occurs in the fetal splenic artery when extramedullary erythropoiesis is present [11][12][13] .The aim of this study was to verify the influence of fetal anemia on fetal splenic artery pulsatility index (PI) and peak systolic velocity (PSV) in Rh alloimmunization. …”

mentioning

confidence: 99%

Influence of Fetal Anemia on Fetal Splenic Artery Doppler in Rh-Alloimmunized Pregnancies

Corrêa

Castro²,

Cabral³

et al. 2008

Fetal Diagn Ther

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Objective: To verify the correlation between fetal splenic artery Doppler velocimetry and fetal hemoglobin (Hb) levels in Rh alloimmunization. Methods: Splenic artery Doppler peak systolic velocity (PSV) and pulsatility index (PI) were obtained before cordocentesis in rhesus-alloimmunized fetuses. Doppler was performed before 80 cordocentesis in 36 patients between 20 and 35 weeks of gestation. Mild, moderate and severe anemia were defined as a Hb deficit of ≥2, ≥5 and ≥7 g/dl respectively. Results: Anemia was noted in 64% of the fetuses and moderate and severe anemia in 18 and 21%. Splenic artery PSV was higher in groups with moderate (p = 0.001) and severe (p < 0.000) anemia but not in the group with mild anemia (p = 0.189) when compared to non-anemic fetuses. Splenic artery PI was higher only in the severely anemic group (p = 0.001). Conclusions: The splenic artery PI and PSV are higher in fetuses with severe anemia.

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Doppler flow velocimetry of the splenic artery in the human fetus: Is it a marker of chronic hypoxia?

Cited by 51 publications

References 20 publications

Nonobstructive Dilatation of the Fetal Bowel in Twin Gestations

Nonobstructive Dilatation of the Fetal Bowel in Twin Gestations

Peripheral right pulmonary artery blood flow velocimetry: Doppler sonographic study of normal and abnormal fetuses.

Influence of Fetal Anemia on Fetal Splenic Artery Doppler in Rh-Alloimmunized Pregnancies

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