Risk of Perinatal Death in Early-Onset Intrauterine Growth Restriction according to Gestational Age and Cardiovascular Doppler Indices: A Multicenter Study

Cruz‐Lemini, M.; Crispi, F.; Mieghem, Tim Van; Pedraza, D.; Cruz‐Martínez, R.; Acosta-Rojas, Ruthy; Figueras, F.; Parra-Cordero, Mauro; Deprest, Jan; Gratacós, E.

doi:10.1159/000333001

Cited by 82 publications

(75 citation statements)

References 72 publications

(87 reference statements)

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“…On the contrary, late-onset FGR has a much weaker association with late-onset PE [35], and placental findings are generally less specific [36]. Early-onset FGR is very often associated with abnormal UA Doppler, which determines a relatively constant natural history with end-stage cardiovascular deterioration, reflected in Doppler of venous vessels [12,14,15,16,17,18,37]. In contrast, UA Doppler is often normal in late-onset FGR, possibly because placental damage is not severe enough [38] and there are no overt Doppler changes in the precordial veins [13,39].…”

Section: Discussionmentioning

confidence: 99%

“…GA at diagnosis or delivery has commonly been used to differentiate early- from late-onset FGR in research studies, since fetoplacental Doppler is not always available in large cohorts, with cut-offs ranging from 32 to 37 weeks [8,9,10,11,12,13,14,15,16,17,18,21,22,23,34,35,36,37,38]. In this study we evaluated this issue in a systematic fashion and provide evidence-based grounds to sustain the use of a cut-off of 32 weeks' gestation at diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of an Optimal Gestational Age Cut-Off for the Definition of Early- and Late-Onset Fetal Growth Restriction

et al. 2013

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Objective: The terms early- and late-onset fetal growth restriction (FGR) are commonly used to distinguish two phenotypes characterized by differences in onset, fetoplacental Doppler, association with preeclampsia (PE) and severity. We evaluated the optimal gestational age (GA) cut-off maximizing differences among these two forms. Patients and Methods: A cohort of 656 consecutive singleton pregnancies with FGR was created. We used the decision tree analysis to evaluate the GA cut-off that best discriminated perinatal mortality, association with PE and adverse perinatal outcome (fetal demise, early neonatal death, neonatal acidosis at birth, and 5-min Apgar score <7). Results: We identified 32 weeks at diagnosis as the optimal cut-off, resulting in two groups with 7.1 and 0%, p < 0.001 perinatal mortality, 35.1 and 12.1%, p < 0.001 association with PE, and 13.4 and 4.6%, p < 0.001 composite adverse perinatal outcome. Abnormal versus normal umbilical artery (UA) Doppler classified two groups with 10.6 and 0.2%, p < 0.001 perinatal mortality, 50.0 and 11.8%, p < 0.001 association with PE, and 18.2 and 4.2%, p < 0.001 composite adverse perinatal outcome. Conclusions: UA Doppler discriminated better the two forms of FGR with average early- and late-onset presentation, higher association with PE and poorer outcome. In the absence of UA information, a GA cut-off of 32 weeks at diagnosis maximizes differences between early- and late-onset FGR.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of an Optimal Gestational Age Cut-Off for the Definition of Early- and Late-Onset Fetal Growth Restriction

et al. 2013

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“…This supports the use of PSS as a potential marker of prenatal disease severity and to monitor these fetuses. Other fetal cardiovascular parameters such as ductus venosus have previously demonstrated its use in predicting poor perinatal outcome 28,29 and are already being used in clinical practice for monitoring FGR. 28 On top of its correlation with perinatal results, the presence of PSS was also associated to postnatal blood pressure values.…”

Section: Discussionmentioning

confidence: 99%

Postsystolic Shortening by Myocardial Deformation Imaging as a Sign of Cardiac Adaptation to Pressure Overload in Fetal Growth Restriction

Crispi

Bijnens

Sepulveda-Swatson

et al. 2014

Circ: Cardiovascular Imaging

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Fetal growth restriction (FGR) because of placental insufficiency affects 5% to 7% of pregnancies and represents one of the leading causes of perinatal morbidity and mortality.1 Numerous historical cohort studies 2 and animal models 3 have demonstrated that FGR has a strong association not only with metabolic but also with primary cardiovascular remodeling that lead to long-term adverse consequences in later life. The rapid cell proliferation and differentiation during fetal growth are sensitive to any of the even smallest changes damaging the environment that can lead to permanent alterations in structural and functional constitution, which may persist into the adult life. 2 The heart is a central organ in the prenatal adaptation to placental insufficiency and fetal hypoxia. Previous studies have demonstrated remodeled hearts (more globular) with signs of systolic and diastolic dysfunction and preserved ejection fraction. [4][5][6] FGR cases are associated with prenatal adverse cardiac remodeling 4,5 that persists postnatally, 6 and low birth weight was linked to increased cardiovascular mortality in adulthood.2 Chronic pressure/volume overload together with hypoxia in utero have been postulated as the potential underlying mechanistic pathway of prenatal cardiovascular remodeling in FGR. 5,6 Editorial see p 759 Clinical Perspective on p 787Although evaluation of cardiac function with echocardiography has traditionally been limited to volume-based assessment, recent developments in cardiac ultrasound allow the noninvasive measurement of cardiac deformation with direct assessment of myocardial muscle by assessing regional Background-Fetal growth restriction (FGR) is associated with global adverse cardiac remodeling in utero and increased cardiovascular mortality in adulthood. Prenatal myocardial deformation has not been evaluated in FGR to date. We aimed to evaluate prenatal cardiac remodeling comprehensively in FGR including myocardial deformation imaging. Methods and Results-Echocardiography was performed in 37 consecutive FGR (defined as birthweight <10th centile) and 37 normally grown fetuses. A comprehensive fetal echocardiography was performed including tissue Doppler and 2-dimensional-derived strain and strain rate. Postnatal blood pressure measurement at 6 months of age was also performed. FGR cases showed signs of more globular hearts with decreased longitudinal motion (left systolic annular peak velocity: controls mean 6 cm/s [SD myocardial strain and strain rate. [7][8][9] Strain is defined as change in length/thickness of a segment of myocardium relative to its resting length and is expressed as a percentage; strain rate is the velocity of this deformation.7-9 Myocardial deformation imaging has demonstrated a high sensitivity for detecting preclinical myocardial dysfunction in various pathological conditions characterized by myocardial dysfunction, despite preserved ejection fraction, such as asymptomatic carriers of hypertrophic cardiomyopathy, sarcomeric mutations, Fabry disease, or myocardial ste...

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“…In the future, MPI may be useful for screening due to its high sensitivity and relative ease of use, with an abnormal MPI serving as an indication for a complete fetal echocardiographic assessment. The information provided by the MPI and its time-period components represents early stages of cardiac adaptation associated with: increased placental vascular resistance as in growth-restricted fetuses [135,136], increased blood volume in the recipient fetus of TTTS [7,20], poorly controlled diabetic pregnant women [99,137], and altered hemodynamics in pre-eclamptic women [29]. Most IUGR fetuses show a progression of hemodynamic deterioration with an increased MPI and/or brain vasodilatation followed by changes in other fetal vascular territories [31].…”

Section: Future Research Directionsmentioning

confidence: 99%

The (Pulsed-Wave) Doppler Fetal Myocardial Performance Index: Technical Challenges, Clinical Applications and Future Research

et al. 2015

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Functional cardiovascular assessment is becoming an increasingly important tool in the study of fetal pathology. The myocardial performance index (MPI) is a parameter measuring global myocardial function. Since its introduction, several studies have proposed methods to improve its reproducibility and have constructed normative reference ranges. Fetal heart evaluation using the MPI is technically challenging, requiring specific training and expertise, and a consensus has yet to be reached on the method of delineating the time periods used to calculate the index. Despite these limitations, it has been shown to be a useful and highly sensitive parameter of dysfunction in a number of fetal pathologies. Further research is warranted into the effect of pathology on MPI, parameters of unilateral cardiac strain that utilise MPI, and automation of the MPI to encourage incorporation of the MPI as a useful tool in clinical practice.

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Risk of Perinatal Death in Early-Onset Intrauterine Growth Restriction according to Gestational Age and Cardiovascular Doppler Indices: A Multicenter Study

Cited by 82 publications

References 72 publications

Evaluation of an Optimal Gestational Age Cut-Off for the Definition of Early- and Late-Onset Fetal Growth Restriction

Evaluation of an Optimal Gestational Age Cut-Off for the Definition of Early- and Late-Onset Fetal Growth Restriction

Postsystolic Shortening by Myocardial Deformation Imaging as a Sign of Cardiac Adaptation to Pressure Overload in Fetal Growth Restriction

The (Pulsed-Wave) Doppler Fetal Myocardial Performance Index: Technical Challenges, Clinical Applications and Future Research

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