<scp>OP</scp>25.04: Indirect assessment of central blood flow dynamics and cerebral oxygenation in fetuses with placental circulatory insufficiency

Jurjević, Rajka Lulić; Fouron, Jean‐Claude; Gendron, Roxanne; Audibert, François; Bujold, Emmanuel; Dubé, Johanne; Jaeggi, Edgar; Klam, Stephanie; Mayer, Catherine

doi:10.1002/uog.13879

Cited by 2 publications

(3 citation statements)

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“…One study found that the ISI was significantly lower in 62 IUGR fetuses compared to controls until 32 weeks' gestation. It also found that the systolic nadir of the AoI became retrograde at 26 weeks in IUGR fetuses compared to 31 weeks in their normal population [56]; yet the established ISI normal range study found that the systolic nadir appeared at 28 weeks' gestation in a normal population [14]. The other abstract on 113 IUGR fetuses also found statistically different systolic nadir values when comparing IUGR fetuses with balanced haemodynamic status to those with poor circulatory status (CPR <1, or absent or reversed A wave in the DV profile) [57].…”

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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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

View full text Add to dashboard Cite

show abstract

“…Only two studies have been presented that monitor the Ao ISI in IUGR fetuses. In 2014, Lulic Jurjevic et al 19 presented the data on 62 IUGR fetuses. They observed that in the IUGR group, systolic nadir became retrograde earlier, at 26 weeks rather than 31 weeks of gestation.…”

Section: Discussionmentioning

confidence: 99%

“…This might be explained by the cerebral redistribution resulting from a lowered vascular resistance leading to systolic retrograde flow through the isthmus.Only two studies have been presented that monitor the Ao ISI in IUGR fetuses. In 2014, Lulic Jurjevic et al19 presented the data on 62 IUGR fetuses. They observed that in the IUGR group,…”

mentioning

confidence: 99%

Aortic isthmus Doppler in normal and small‐for‐gestational‐age fetuses and its association with prediction of adverse perinatal outcome

Sharma

Swami

Dadhwal

et al. 2021

Intl J Gynecology & Obste

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Objective To establish reference ranges for aortic isthmus Doppler indices in appropriate‐for‐gestational‐age (AGA) fetusesand to evaluate its association with perinatal outcome in small‐for‐gestational‐age (SGA) fetuses. Methods Prospective cohort observational study in which 30 pregnant women with SGA fetuses and 60 women with AGA fetuses were recruited from the prenatal clinic of the hospital. The AGA group was eventually followed from 24 weeks by 4‐weekly Doppler assessment, and the SGA group was examined as per institutional protocol. We analyzed the data using STATA version 14.0 statistical software. Continuous variables were examined for normality assumption using the Kolmogorov‐Smirnov test. To develop a nomogram for appropriate gestational age, we adopted a mixed linear model analysis. For each of the variables Ao pulsatility index (PI), Ao peak systolic velocity (PSV), Ao systolic nadir (Ns), and Ao isthmic systolic index (ISI) mean predicted values, 3rd centile and 97th centile were calculated based on the parameter estimation of mixed model. Observed data for each of the variables in the SGA group were plotted in the nomogram developed for the AGA group to show the trend of SGA data in comparison to AGA data. Results The total number of observations made on 60 AGA and 30 SGA fetuses were 240 and 67, respectively. Nomograms for the 3rd and 97th centiles were derived for Ao PI, Ao PSV, Ao Ns, and Ao ISI. Mean Ao PI values were significantly higher in SGA group (2.37 vs 2.22; P < .05); mean Ao PSV was significantly lower in the SGA group (67.1 vs 76.3; P < .05), but mean Ao Ns and mean Ao ISI values were significantly higher in the SGA group (–5.24 vs 2.0 and –0.04 vs –0.01; P < .05). Conclusions Aortic Doppler assessment seems to provide beneficial information for monitoring small fetuses. Ao PI and Ao ISI, which were raised in fetuses with SGA, can be used in prognosis.

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OP25.04: Indirect assessment of central blood flow dynamics and cerebral oxygenation in fetuses with placental circulatory insufficiency

Cited by 2 publications

References 0 publications

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

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

Aortic isthmus Doppler in normal and small‐for‐gestational‐age fetuses and its association with prediction of adverse perinatal outcome

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