The Disappearing Brain-Sparing Effect in Early-Onset Fetal Growth Restriction Fetuses Revisited

Yeniel, Ahmet Özgür; Ergenoğlu, Ahmet Mete; Sanhal, Cem Yaşar; Akdemir, Ali; Akercan, Fuat; Kazandı, Mert; Sağol, Sermet

doi:10.1159/000355933

Cited by 4 publications

(5 citation statements)

References 37 publications

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“…The results of the current study are in agreement with the findings of Herraiz et al, though the method of assessment differed between the studies (sFlt-1 vs Doppler). Moreover, contrary to the findings of Yeniel et al 48 , we could not replicate a benefit of longitudinal assessment of MCA-PI.…”

Section: Interpretation Of Study Findings and Comparison With Publishcontrasting

confidence: 99%

“…Moreover, similar positive findings have been reported for conditional centiles of EFW, though these findings are contested in more recent studies 11,31,46 . The relationship of longitudinal changes with perinatal outcome in early-onset FGR is sparsely reported [47][48][49] . Some have suggested worse outcome in early-onset growth-restricted fetuses with resolution of cerebral redistribution 48 .…”

Section: Interpretation Of Study Findings and Comparison With Publishmentioning

confidence: 99%

“…The relationship of longitudinal changes with perinatal outcome in early-onset FGR is sparsely reported [47][48][49] . Some have suggested worse outcome in early-onset growth-restricted fetuses with resolution of cerebral redistribution 48 . Blood levels of soluble fms-like tyrosine kinase-1 (sFlt-1) are correlated with the development of early-onset FGR and abnormal Doppler parameters 50,51 .…”

Section: Interpretation Of Study Findings and Comparison With Publishmentioning

confidence: 99%

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Longitudinal change in cerebroplacental ratio in small‐for‐gestational‐age fetuses and risk of stillbirth

Kalafat

Öztürk

Sivanathan

et al. 2019

Ultrasound in Obstet & Gyne

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Objective To investigate whether assessment of longitudinal change in Doppler variables in small‐for‐gestational‐age (SGA) fetuses improves the prediction of those at risk of stillbirth. Methods This was a longitudinal study of two cohorts of singleton pregnancies, which included SGA and appropriate‐for‐gestational‐age (AGA) fetuses, respectively. The inclusion criteria for the SGA cohort were singleton pregnancy at ≥ 20 weeks' gestation, classified as SGA (estimated fetal weight < 10th centile). The AGA cohort consisted of singleton pregnancies deemed at high risk of being SGA, which were followed up longitudinally but remained AGA. Fetal middle cerebral artery (MCA) pulsatility index (PI) and umbilical artery (UA)‐PI were measured longitudinally and cerebroplacental ratio (CPR) was calculated, and values were converted to multiples of the median. The last two measurements prior to delivery were included in the analysis. Longitudinal models for Doppler variables were developed using linear‐mixed models and their accuracy in the prediction of stillbirth was tested using generalized linear models. A Bayesian framework was employed to compare the accuracy of longitudinal and standard (last‐scan measurement) models. Results In total, 1549 AGA and 941 SGA pregnancies were included in the analysis. There were 30 (3.2%) and no stillbirth cases in the SGA and AGA groups, respectively. Change in MCA‐PI, UA‐PI and CPR with advancing gestation was significantly different between liveborn AGA and SGA fetuses, with a less pronounced difference with advancing gestation. Using the last measurement, the best models for the prediction of stillbirth in SGA pregnancies were those based on CPR (accuracy, 75.0%; 95% CI, 72.6–77.2%) and UA‐PI (accuracy, 71.0%; 95% CI, 68.6–73.4%). The posterior probability of the standard CPR model having a higher accuracy compared with the UA‐PI model was 97.2% (magnitude of change (MC), 3.9%; 95% credible interval (CrI), 0.5–7.3%). The accuracies of the standard, compared with the longitudinal, models for UA‐PI (71.0% vs 72.8%), MCA‐PI (64.6% vs 63.8%) and CPR (75.0% vs 74.9%) in the prediction of stillbirth were not significantly different. The posterior probabilities for improvement in accuracy using longitudinal, compared with standard, assessment were 50.1% (MC, < 0.1%; 95% CrI, −3.3 to 3.3%), 35.2% (MC, −0.1%; 95% CrI, −4.5 to 2.8%) and 82.2% (MC, 1.9%; 95% CrI, −1.5 to 5.3%) for CPR, MCA‐PI and UA‐PI models, respectively. Therefore, change in Doppler parameters did not improve the accuracy of the prediction of stillbirth, compared with that of the last‐scan measurement. Conclusion Longitudinal assessment of Doppler parameters was not useful in improving the detection of stillbirth in SGA pregnancies, as compared with a single‐point assessment. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Interpretation Of Study Findings and Comparison With Publishcontrasting

confidence: 99%

Section: Interpretation Of Study Findings and Comparison With Publishmentioning

confidence: 99%

Section: Interpretation Of Study Findings and Comparison With Publishmentioning

confidence: 99%

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Longitudinal change in cerebroplacental ratio in small‐for‐gestational‐age fetuses and risk of stillbirth

Kalafat

Öztürk

Sivanathan

et al. 2019

Ultrasound in Obstet & Gyne

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“…Ultimately, brain sparing can only be sustained for so long, as shown by the recovery of low pulsatility index in the MCA that subsequently returned to normal levels (‘disappeared’) in the presence of sustained hypoxia. The outcomes for fetuses with disappearing changes in pulsatility within the MCA were very poor and included significantly greater deficits in body weight, longer duration of care in hospital and increased mortality (Yeniel et al., 2014 ).…”

Section: Brainstem‐mediated Responses To Chronic Hypoxaemia: Brain Sp...mentioning

confidence: 99%

Does fetal growth restriction induce neuropathology within the developing brainstem?

Ahmadzadeh,

Polglase,

Stojanovska

et al. 2023

The Journal of Physiology

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Fetal growth restriction (FGR) is a complex obstetric issue describing a fetus that does not reach its genetic growth potential. The primary cause of FGR is placental dysfunction resulting in chronic fetal hypoxaemia, which in turn causes altered neurological, cardiovascular and respiratory development, some of which may be pathophysiological, particularly for neonatal life. The brainstem is the critical site of cardiovascular, respiratory and autonomic control, but there is little information describing how chronic hypoxaemia and the resulting FGR may affect brainstem neurodevelopment. This review provides an overview of the brainstem‐specific consequences of acute and chronic hypoxia, and what is known in FGR. In addition, we discuss how brainstem structural alterations may impair functional control of the cardiovascular and respiratory systems. Finally, we highlight the clinical and translational findings of the potential roles of the brainstem in maintaining cardiorespiratory adaptation in the transition from fetal to neonatal life under normal conditions and in response to the pathological environment that arises during development in growth‐restricted infants. This review emphasises the crucial role that the brainstem plays in mediating cardiovascular and respiratory responses during fetal and neonatal life. We assess whether chronic fetal hypoxaemia might alter structure and function of the brainstem, but this also serves to highlight knowledge gaps regarding FGR and brainstem development. image

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“…При I степени отмечаются отличие показателей фетометрии от нормативных и соответствие их показателям, которые характерны для беременности меньшего срока на 2 нед (34,2%), при II степени -меньшего срока на 3-4 нед (56,6%), при III -меньшего срока более чем на 4 нед (9,2%). Степень тяжести внутриутробной задержки роста коррелирует со степенью тяжести фетоплацентарной недостаточности и неблагоприятными перинатальными исходами [3,[7][8][9].…”

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Electrocardiography of the fetus as an optimal way to evaluate its condition

Chukanova¹,

Башмакова²,

Tsyvyan³

2018

Ross. vestn. akush.-ginekol.

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With scientific and technical progress in reproductology, the choice of the safest and most informative ways to evaluate fetal condition becomes relevant. Auscultation has been and continues to remain to be one of the earliest and simplest ways to evaluate fetal condition. But, unfortunately, this technique is unobjective and does not have the ability to record the findings; moreover, it has a high error factor. In view of this, objective biophysical studies, such as ultrasonography, electrocardiography, and cardiotocography, are gaining wide acceptance. Electrocardiography of the fetus becomes more relevant when the latter develops complications during early pregnancy. This technique allows fetal status to be evaluated at 20 weeks' gestation. At the same time, in the presence of the already existing disorders, this method provides a way of preparing the fetus for delivery and allows 24-hour fetal monitoring. Of course, the use of only one method does not give a comprehensive picture of fetal condition; therefore the use of all techniques allows evaluation of the condition of the fetus and, in case of its pathology, to decide on delivery time and method.

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The Disappearing Brain-Sparing Effect in Early-Onset Fetal Growth Restriction Fetuses Revisited

Cited by 4 publications

References 37 publications

Longitudinal change in cerebroplacental ratio in small‐for‐gestational‐age fetuses and risk of stillbirth

Longitudinal change in cerebroplacental ratio in small‐for‐gestational‐age fetuses and risk of stillbirth

Does fetal growth restriction induce neuropathology within the developing brainstem?

Electrocardiography of the fetus as an optimal way to evaluate its condition

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