Role of prenatal fetal echocardiography in the assessment of intrauterine growth restriction

Abstract

Background Intrauterine growth restriction (IUGR) is a common diagnosis in obstetrics and carries an increased risk of perinatal mortality and morbidity. Identification of IUGR is crucial because proper evaluation and management can result in a favourable outcome. Cardiovascular dysfunction and remodelling is a central feature of IUGR. The aim of the study was to use the left modified myocardial performance index (MPI), assess cardiac function in foetuses with intrauterine growth restriction (IUGR) compared to healthy foetuses, and to connect the relationship between changes in MPI and perinatal outcome. A prospective study was conducted with 60 singleton foetuses between 24 and 40 weeks of gestation without foetal chromosomal abnormalities or major malformations, divided into two groups: 30 women with intrauterine growth restriction (30 women) and another 30 women with normal pregnancies (foetal growth pattern appropriate for gestational age and normal heart findings with normal sinus rhythm) who were matched for gestational age and served as the controls. Trans-abdominal ultrasound examination was done with 3.5–7-MHz curvilinear Probe (GE Medical US equipment). The umbilical arteries, middle cerebral artery, and ductus venosus all had blood flow velocity waveforms recorded. The pulsatility index (PI), cerebroplacental ratio (CPR), and Doppler velocimetry (DV) of the umbilical artery were all measured. All foetuses had their myocardial performance index assessed. Normal and abnormal umbilical artery(UA) Doppler, as well as normal and abnormal MCA Doppler, were used to examine the intrauterine growth restriction group. Foetal growth restrictions (FGR) foetuses' Mod-MPI values were compared to gestation-matched controls. The outcomes of the perinatal period were documented. Results Intrauterine growth restriction foetuses with defective umbilical arteries Doppler had a substantially higher mean left myocardial performance index (mean 0.58 SD 0.093) than healthy foetuses (mean 0.45SD 0.070) (P 0.001). When compared to the control group, IUGR foetuses with abnormal left myocardial performance index had a significantly worse perinatal outcome and higher morbidity. When compared to intrauterine growth restriction foetuses with normal MPI, intrauterine growth restriction foetuses with defective left MPI had a significantly worse perinatal outcome (whether the UA Doppler was normal or abnormal). Based on the perinatal result, the foetal myocardial performance index was linked to the severity of foetal impairment in intrauterine growth restriction foetuses. Conclusion MPI has the potential to be a useful technique for evaluating IUGR pregnancies and predicting neonatal outcome. Within the IUGR foetuses, MPI foetal echocardiographic characteristics can define a high-risk group.

Study of Doppler-derived Myocardial Performance Index in Growth-restricted Fetuses as a Predictor of Adverse Perinatal Outcome

“…Those outcomes agreed with Öcal et al (7) who studied forty females had growth-restricted fetuses and forty females had fetuses of normal weight (controls) at 29-39 gestational weeks. Also, this is in accordance with Nguyen et al (8) and Ali et al (15) . It is also, in agreement with Şimşek and Köse (4) who reported that no statistically significant variance was noted.…”

“…That was in concurrence with Eslamian et al (17) who stated that MPI was 0.4 ± 0.1 and 0.3 ± 0.1 in case and control groups, correspondingly, which was significantly variant among the both groups (P < 0.001). Also, this is in accordance with Ali et al (15) who stated that the average cardiac PI was 0.58 ± 0.02 in the group with IUGR, whereas in the control group, it was 0.44 ± 0.01. The observed outcome was highly statistically significant, with a p-value of less than 0.001.…”

“…In our research we found that no significant variance in maternal age (P value 0.377) was noted among groups. That was in agreement with Nguyen et al (8) study on two groups: control (n=97) and fetal growth restriction group (n= 73), P value 0.205, and with Ali et al (15) study on two groups: control (n equals 30) and IUGR group (n equals 30), P value 0.804. In contrast with Henry et al (16) who noted a significant variance among examined groups (FGR group n equals 52 and control group n equals 52) in maternal age with (P < 0.001).…”

“…The average AC percentile measures of fetuses in study group were substantially lesser than those of fetuses in control group: 23.2 ± 3.1 and 45.8 ± 12.0, respectively (P < 0.001). That was concurred with Ali et al (15) who reported that mean AC percentile for control and case groups was 50.62 ± 23.12 and 2.51 ± 0.73 correspondingly (P < 0.001). This is also in accordance with Eslamian et al (17) who stated that significant difference was noted among the case (n=47) and the control groups (n=47) with (P < 0.001).…”

“…Consequently, the IVRT (isovolumic relaxation time) is the main measure of MPI that shows abnormality at an early stage of dysfunction. Also, with respect to Ali et al (15) who noted that in IUGR fetuses, IVRT was longer (average 54.3 ± 3.3) and ejection time was shorter (mean 151 ± 4.47 SD) compared to control group. However, the IVCT did not exhibit any notable variances between control and IUGR groups, as indicated by a P value of 0.886.…”