Effects of Cordocentesis on Inferior Vena cava Velocity Waveforms: Differences between Normally Grown and Growth-Retarded Fetuses

Abstract

The objective of this study was to analyze the effects of cordocentesis on velocity waveforms recorded from the inferior vena cava and to evaluate differences, if any, in the hemodynamic response between normally grown and growth-retarded fetuses. Twenty-five normally grown fetuses and 20 growth-retarded fetuses were considered for this study. This latter group was characterized by abnormal Doppler indices in the umbilical artery and the middle cerebral artery suggestive of uteroplacental insufficiency as the causative factor of the impaired growth. Flow velocity waveforms were measured from the inferior vena cava immediately before and after cordocentesis and the % reverse flow during atrial contraction calculated. In normally grown fetuses the % reverse flow values did not vary significantly after cordocentesis, while in growth-retarded fetuses this index increased significantly after the procedure (p < 0.001). Furthermore, the amplitude of this increase was inversely related to pH levels in umbilical vein (p = 0.004). In conclusion, in growth-retarded fetuses cordocentesis induces an increase of % reverse flow in the inferior vena cava, while no modifications occur in normally grown fetuses. This suggests the presence in growth-retarded fetuses of an impaired cardiac adaptive mechanism to cordocentesis that may explain the higher incidence of complications occurring in such fetuses.

Effect of cordocentesis on fetal myocardial performance

“…Currently, assessment of fetal cardiac function with Tei index has been evaluated in various conditions such as after laser therapy in twin‐to‐twin transfusion syndrome, fetuses with hemoglobin Bart's disease and fetuses with severe growth‐restriction . Although some studies have reported the effect of cordocentesis on cardiotocography and inferior vena cava waveform, to date, the effect of cordocentesis on fetal Tei index had not been evaluated.…”