Coronary artery blood flow visualization signifies hemodynamic deterioration in growth-restricted fetuses

Ahmet Baschat, U. Gembruch, L. Gortner, I. Reiss, C. P. Weiner, C. R. Harman

Research output: Contribution to journalArticle

Abstract

Objective. To determine the relationship between fetal coronary blood flow (CBF) visualization in intrauterine growth restriction (IUGR), longitudinal changes in arterial and venous flow velocity waveforms and perinatal outcome. Methods. A total of 48 IUGR fetuses (abdominal circumference below the 5th percentile for gestational age) with absent or reversed umbilical artery (UA) end-diastolic velocity (AREDV) were examined longitudinally by echocardiography attempting CBF visualization at each examination. Doppler evaluation of the middle cerebral artery, inferior vena cava (IVC), ductus venosus (DV) and umbilical vein (UV) was performed at each examination. Doppler measurements were correct for gestational age by conversion into Z-scores (Δ-indices). Doppler results and outcome from fetuses in which CBF was visualized (group 1, n = 20) and those in which CBF was never visualized (group 2, n = 28) were compared. Outcome parameters analyzed included Apgar scores, cord arterial blood gases, perinatal mortality, respiratory distress, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis and postpartum circulatory failure requiring pressor support. Results. There was no difference in Doppler indices between groups at study entry. CBF visualization coincides with a significant increase of UA-, IVC- and DV Δ-indices. The greatest rate of change was observed for indices in the ductus venosus which occurred in the 24 h preceding CBF visualization. Group 1 fetuses required earlier delivery (median 27 + 4, vs. median 30 + 0), had lower birth-weight (682 ± 305 g vs. 936 ± 416 g), lower cord pH (7.21 ± 0.1 vs. 7.27 ± 0.06) and cord pO2 (13 ± 4.5 vs. 24.1 ± 13.5 mmHg) compared to group 2 (all values P <0.05). Mortality was similar (group 1 = 6/20, 30%; group 2 = 6/28, 21.4%). Conclusions. In IUGR, fetuses with AREDV and centralization are at high risk for hypoxemia, acidemia and adverse outcome. CBF visualization coincides with deteriorating venous flows. Operator dependence of CBF visualization and the strong association with abnormal venous flow stresses the importance of venous Doppler surveillance in these fetuses.

Original languageEnglish (US)
Pages (from-to)425-431
Number of pages7
JournalUltrasound in Obstetrics and Gynecology
Volume16
Issue number5
DOIs
StatePublished - 2000
Externally publishedYes

Fingerprint

hemodynamics
flow visualization
fetuses
blood flow
arteries
deterioration
Coronary Vessels
Fetus
Hemodynamics
Growth
Umbilical Arteries
constrictions
Inferior Vena Cava
mortality
Fetal Blood
Gestational Age
vasoconstrictor drugs
hypoxemia
examination
Bronchopulmonary Dysplasia

Keywords

  • Coronary blood flow
  • Doppler
  • Fetal growth restriction
  • Hypoxia

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology
  • Reproductive Medicine
  • Acoustics and Ultrasonics

Cite this

Coronary artery blood flow visualization signifies hemodynamic deterioration in growth-restricted fetuses. / Baschat, Ahmet; Gembruch, U.; Gortner, L.; Reiss, I.; Weiner, C. P.; Harman, C. R.

In: Ultrasound in Obstetrics and Gynecology, Vol. 16, No. 5, 2000, p. 425-431.

Research output: Contribution to journalArticle

Baschat, Ahmet ; Gembruch, U. ; Gortner, L. ; Reiss, I. ; Weiner, C. P. ; Harman, C. R. / Coronary artery blood flow visualization signifies hemodynamic deterioration in growth-restricted fetuses. In: Ultrasound in Obstetrics and Gynecology. 2000 ; Vol. 16, No. 5. pp. 425-431.
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abstract = "Objective. To determine the relationship between fetal coronary blood flow (CBF) visualization in intrauterine growth restriction (IUGR), longitudinal changes in arterial and venous flow velocity waveforms and perinatal outcome. Methods. A total of 48 IUGR fetuses (abdominal circumference below the 5th percentile for gestational age) with absent or reversed umbilical artery (UA) end-diastolic velocity (AREDV) were examined longitudinally by echocardiography attempting CBF visualization at each examination. Doppler evaluation of the middle cerebral artery, inferior vena cava (IVC), ductus venosus (DV) and umbilical vein (UV) was performed at each examination. Doppler measurements were correct for gestational age by conversion into Z-scores (Δ-indices). Doppler results and outcome from fetuses in which CBF was visualized (group 1, n = 20) and those in which CBF was never visualized (group 2, n = 28) were compared. Outcome parameters analyzed included Apgar scores, cord arterial blood gases, perinatal mortality, respiratory distress, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis and postpartum circulatory failure requiring pressor support. Results. There was no difference in Doppler indices between groups at study entry. CBF visualization coincides with a significant increase of UA-, IVC- and DV Δ-indices. The greatest rate of change was observed for indices in the ductus venosus which occurred in the 24 h preceding CBF visualization. Group 1 fetuses required earlier delivery (median 27 + 4, vs. median 30 + 0), had lower birth-weight (682 ± 305 g vs. 936 ± 416 g), lower cord pH (7.21 ± 0.1 vs. 7.27 ± 0.06) and cord pO2 (13 ± 4.5 vs. 24.1 ± 13.5 mmHg) compared to group 2 (all values P <0.05). Mortality was similar (group 1 = 6/20, 30{\%}; group 2 = 6/28, 21.4{\%}). Conclusions. In IUGR, fetuses with AREDV and centralization are at high risk for hypoxemia, acidemia and adverse outcome. CBF visualization coincides with deteriorating venous flows. Operator dependence of CBF visualization and the strong association with abnormal venous flow stresses the importance of venous Doppler surveillance in these fetuses.",
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AU - Baschat, Ahmet

AU - Gembruch, U.

AU - Gortner, L.

AU - Reiss, I.

AU - Weiner, C. P.

AU - Harman, C. R.

PY - 2000

Y1 - 2000

N2 - Objective. To determine the relationship between fetal coronary blood flow (CBF) visualization in intrauterine growth restriction (IUGR), longitudinal changes in arterial and venous flow velocity waveforms and perinatal outcome. Methods. A total of 48 IUGR fetuses (abdominal circumference below the 5th percentile for gestational age) with absent or reversed umbilical artery (UA) end-diastolic velocity (AREDV) were examined longitudinally by echocardiography attempting CBF visualization at each examination. Doppler evaluation of the middle cerebral artery, inferior vena cava (IVC), ductus venosus (DV) and umbilical vein (UV) was performed at each examination. Doppler measurements were correct for gestational age by conversion into Z-scores (Δ-indices). Doppler results and outcome from fetuses in which CBF was visualized (group 1, n = 20) and those in which CBF was never visualized (group 2, n = 28) were compared. Outcome parameters analyzed included Apgar scores, cord arterial blood gases, perinatal mortality, respiratory distress, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis and postpartum circulatory failure requiring pressor support. Results. There was no difference in Doppler indices between groups at study entry. CBF visualization coincides with a significant increase of UA-, IVC- and DV Δ-indices. The greatest rate of change was observed for indices in the ductus venosus which occurred in the 24 h preceding CBF visualization. Group 1 fetuses required earlier delivery (median 27 + 4, vs. median 30 + 0), had lower birth-weight (682 ± 305 g vs. 936 ± 416 g), lower cord pH (7.21 ± 0.1 vs. 7.27 ± 0.06) and cord pO2 (13 ± 4.5 vs. 24.1 ± 13.5 mmHg) compared to group 2 (all values P <0.05). Mortality was similar (group 1 = 6/20, 30%; group 2 = 6/28, 21.4%). Conclusions. In IUGR, fetuses with AREDV and centralization are at high risk for hypoxemia, acidemia and adverse outcome. CBF visualization coincides with deteriorating venous flows. Operator dependence of CBF visualization and the strong association with abnormal venous flow stresses the importance of venous Doppler surveillance in these fetuses.

AB - Objective. To determine the relationship between fetal coronary blood flow (CBF) visualization in intrauterine growth restriction (IUGR), longitudinal changes in arterial and venous flow velocity waveforms and perinatal outcome. Methods. A total of 48 IUGR fetuses (abdominal circumference below the 5th percentile for gestational age) with absent or reversed umbilical artery (UA) end-diastolic velocity (AREDV) were examined longitudinally by echocardiography attempting CBF visualization at each examination. Doppler evaluation of the middle cerebral artery, inferior vena cava (IVC), ductus venosus (DV) and umbilical vein (UV) was performed at each examination. Doppler measurements were correct for gestational age by conversion into Z-scores (Δ-indices). Doppler results and outcome from fetuses in which CBF was visualized (group 1, n = 20) and those in which CBF was never visualized (group 2, n = 28) were compared. Outcome parameters analyzed included Apgar scores, cord arterial blood gases, perinatal mortality, respiratory distress, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis and postpartum circulatory failure requiring pressor support. Results. There was no difference in Doppler indices between groups at study entry. CBF visualization coincides with a significant increase of UA-, IVC- and DV Δ-indices. The greatest rate of change was observed for indices in the ductus venosus which occurred in the 24 h preceding CBF visualization. Group 1 fetuses required earlier delivery (median 27 + 4, vs. median 30 + 0), had lower birth-weight (682 ± 305 g vs. 936 ± 416 g), lower cord pH (7.21 ± 0.1 vs. 7.27 ± 0.06) and cord pO2 (13 ± 4.5 vs. 24.1 ± 13.5 mmHg) compared to group 2 (all values P <0.05). Mortality was similar (group 1 = 6/20, 30%; group 2 = 6/28, 21.4%). Conclusions. In IUGR, fetuses with AREDV and centralization are at high risk for hypoxemia, acidemia and adverse outcome. CBF visualization coincides with deteriorating venous flows. Operator dependence of CBF visualization and the strong association with abnormal venous flow stresses the importance of venous Doppler surveillance in these fetuses.

KW - Coronary blood flow

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KW - Fetal growth restriction

KW - Hypoxia

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