Maternal oxygen administration for suspected impaired fetal growth

Say, Lale; Gülmezoglu, A Metin; Hofmeyr, G Justus

doi:10.1002/14651858.cd000137

Cited by 55 publications

(48 citation statements)

References 11 publications

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“…Since no treatment has been demonstrated to be of benefit in growth restriction [75,76,77,78,79], assessment of fetal well-being and timely delivery remain as the main management strategy. The aim behind a clinical protocol for managing FGR is to combine existing evidence on various methods for monitoring fetal well-being in order to establish the risks of fetal injury or death, and to balance them against the risks of prematurity if the fetus is delivered.…”

Section: Clinical Management Of Fetal Growth Restriction and Small-fomentioning

confidence: 99%

Update on the Diagnosis and Classification of Fetal Growth Restriction and Proposal of a Stage-Based Management Protocol

Figueras

Gratacós²

2014

Fetal Diagn Ther

600

672

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Small fetuses are defined as those with an ultrasound estimated weight below a threshold, most commonly the 10th centile. The first clinically relevant step is the distinction of ‘true' fetal growth restriction (FGR), associated with signs of abnormal fetoplacental function and poorer perinatal outcome, from constitutional small-for-gestational age, with a near-normal perinatal outcome. Nowadays such a distinction should not be based solely on umbilical artery Doppler, since this index detects only early-onset severe forms. FGR should be diagnosed in the presence of any of the factors associated with a poorer perinatal outcome, including Doppler cerebroplacental ratio, uterine artery Doppler, a growth centile below the 3rd centile, and, possibly in the near future, maternal angiogenic factors. Once the diagnosis is established, differentiating into early- and late-onset FGR is useful mainly for research purposes, because it distinguishes two clear phenotypes with differences in severity, association with preeclampsia, and the natural history of fetal deterioration. As a second clinically relevant step, management of FGR and the decision to deliver aims at an optimal balance between minimizing fetal injury or death versus the risks of iatrogenic preterm delivery. We propose a protocol that integrates current evidence to classify stages of fetal deterioration and establishes follow-up intervals and optimal delivery timings, which may facilitate decisions and reduce practice variability in this complex clinical condition.

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Section: Clinical Management Of Fetal Growth Restriction and Small-fomentioning

confidence: 99%

Update on the Diagnosis and Classification of Fetal Growth Restriction and Proposal of a Stage-Based Management Protocol

Figueras

Gratacós²

2014

Fetal Diagn Ther

600

672

View full text Add to dashboard Cite

show abstract

“…This haemodynamic compensation can cause sequential right cardiac failure, followed by left cardiac failure being observed just prior to intrauterine demise [26]. As there is no effective in utero therapy [27,28,29,30], obstetric management involves timing delivery before decompensated heart failure but preferably after sufficient fetal lung maturation to minimise neonatal complications [31]. In current clinical practice, fetal heart rate analysis, biophysical parameters, and ultrasound indices such as UA, MCA, and ductus venosus (DV) Doppler can only guide clinicians, as the usual sequence of recognised changes do not occur in all fetal demise cases [26,32,33].…”

Section: Aoi In Extracardiac Functional Pathologymentioning

confidence: 99%

The Aortic Isthmus: A Significant yet Underexplored Watershed of the Fetal Circulation

Tynan

Alphonse

Henry³

et al. 2016

Fetal Diagn Ther

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The aortic isthmus (AoI) is a unique fetal watershed with a waveform reflecting its complex haemodynamic physiology. The systolic component represents left and right ventricular systolic ejection, and the diastolic component represents comparative downstream vascular impedance between the brachiocephalic and subdiaphragmatic fetal circulations. Several indices have been devised to quantify different components of the waveform, including the pulsatility index, resistance index, isthmic flow index, and recently the isthmic systolic index. There have been promising preliminary studies applying these indices to both cardiac (congenital) and extracardiac pathologies, including intrauterine growth restriction and twin-twin transfusion syndrome. However, the waveform's multifactorial origin has proven to be challenging, and the difficulty in separating various components of the waveform could explain that AoI evaluation does not have a clear clinical utility. Further research is underway to realise the full potential of this vessel in fetal cardiac and haemodynamically compromised pathological conditions. In this review article we outline the physiological origin of this Doppler waveform, describe in detail the various published indices, summarise the published literature to date, and finally outline potential future research and hopefully clinical applications.

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“…2 However, there is limited understanding of the response of the fetal brain to maternal supplemental oxygen and as a result it is unclear whether this is of benefit either in acute or chronic hypoxic settings.…”

Section: Introductionmentioning

confidence: 99%

Absence of Po₂ change in fetal brain despite Po₂ increase in placenta in response to maternal oxygen challenge

Huen

Morris

Wright

et al. 2014

BJOG

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Objective Magnetic resonance imaging allows the noninvasive observation of PO 2 changes between air breathing and oxygen breathing through quantification of the magnetic longitudinal relaxation time T 1 . Changes in PO 2 are proportional to changes in the longitudinal relaxation rate DR 1 (where DR 1 = 1/ T 1oxygen À 1/T 1air ). Knowledge of this response could inform clinical interventions using maternal oxygen administration antenatally to treat fetal growth restriction. We present in vivo measurements of the response of the fetal-placental unit to maternal hyperoxia. Design Prospective cohort.Setting Large tertiary maternity hospital.Sample Nine women undergoing low-risk pregnancy (21-33 weeks of gestation) and five nonpregnant adults.Methods During imaging the air supply to mothers was changed from medical air (21% oxygen) to medical oxygen (100% oxygen) and T 1 was monitored over time in both the placenta and fetal brain using a periodically repeated magnetic resonance imaging sequence. To demonstrate that the method could detect a brain response, brain responses from five normal adult volunteers were measured using a similar imaging protocol.Main outcome measure Changes in T 1 following oxygen challenge.Results No significant DR 1 (P = 0.42, paired t-test) was observed in fetal brains. A significant placental DR 1 (P = 0.0002, paired t-test) of 0.02 AE 0.01/s (mean AE SD) was simultaneously observed in the same participants. In the brains of the nonpregnant adults, a significant DR 1 (P = 0.01, paired t-test) of 0.005 AE 0.002/s was observed.Conclusion Short-term maternal oxygen administration does not improve fetal brain oxygenation, in contrast to the response observed in the adult brain.

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Maternal oxygen administration for suspected impaired fetal growth

Cited by 55 publications

References 11 publications

Update on the Diagnosis and Classification of Fetal Growth Restriction and Proposal of a Stage-Based Management Protocol

Update on the Diagnosis and Classification of Fetal Growth Restriction and Proposal of a Stage-Based Management Protocol

The Aortic Isthmus: A Significant yet Underexplored Watershed of the Fetal Circulation

Absence of Po₂ change in fetal brain despite Po₂ increase in placenta in response to maternal oxygen challenge

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Maternal oxygen administration for suspected impaired fetal growth

Cited by 55 publications

References 11 publications

Update on the Diagnosis and Classification of Fetal Growth Restriction and Proposal of a Stage-Based Management Protocol

Update on the Diagnosis and Classification of Fetal Growth Restriction and Proposal of a Stage-Based Management Protocol

The Aortic Isthmus: A Significant yet Underexplored Watershed of the Fetal Circulation

Absence of Po2 change in fetal brain despite Po2 increase in placenta in response to maternal oxygen challenge

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Absence of Po₂ change in fetal brain despite Po₂ increase in placenta in response to maternal oxygen challenge