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Fetal cardiac function in late‐onset intrauterine growth restriction vs small‐for‐gestational age, as defined by estimated fetal weight, cerebroplacental ratio and uterine artery Doppler
Author(s) -
PérezCruz M.,
CruzLemini M.,
Fernández M. T.,
Parra J. A.,
Bartrons J.,
GómezRoig M. D.,
Crispi F.,
Gratacós E.
Publication year - 2015
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.14930
Subject(s) - medicine , intrauterine growth restriction , small for gestational age , fetus , gestational age , population , obstetrics , birth weight , fetal echocardiography , cardiac function curve , cardiology , pregnancy , prenatal diagnosis , heart failure , genetics , environmental health , biology
ABSTRACT Objective Among late‐onset small fetuses, a combination of estimated fetal weight ( EFW ), cerebroplacental ratio ( CPR ) and mean uterine artery ( UtA ) pulsatility index ( PI ) can predict a subgroup of fetuses with poor perinatal outcome; however, the association of these criteria with fetal cardiac structure and function is unknown. Our aim was to determine the presence and severity of signs indicating cardiac dysfunction in small fetuses, classified as intrauterine growth‐restricted ( IUGR ) or small‐for‐gestational age ( SGA ), according to EFW , CPR and UtA‐PI . Methods A cohort of 209 late‐onset small fetuses that were delivered > 34 weeks of gestation was divided in two categories: SGA ( n = 59) if EFW was between the 3 rd and 9 th centiles with normal CPR and UtA‐PI ; and IUGR ( n = 150) if EFW was < 3 rd centile, or < 10 th centile with a CPR < 5 th centile and/or UtA‐PI > 95 th centile. The small population was compared with 150 appropriately grown fetuses (controls). Fetal cardiac morphometry and function were assessed by echocardiography using two‐dimensional M‐mode, conventional and tissue Doppler. Results Compared with controls, both IUGR and SGA fetuses showed larger and more globular hearts (mean left sphericity index ± SD : controls, 1.8 ± 0.3; SGA , 1.5 ± 0.2; and IUGR , 1.6 ± 0.3; P < 0.01) and showed signs of systolic and diastolic dysfunction, including decreased tricuspid annular plane systolic excursion (mean ± SD : controls, 8.2 ± 1.1; SGA , 7.4 ± 1.2; and IUGR , 6.9 ± 1.1; P < 0.001) and increased left myocardial performance index (mean ± SD : controls, 0.45 ± 0.14; SGA , 0.51 ± 0.08; and IUGR , 0.57 ± 0.1; P < 0.001). Conclusions Despite a perinatal outcome comparable to that of normal fetuses, the population of so‐defined SGA fetuses showed signs of prenatal cardiac dysfunction. This supports the concept that at least a proportion of them are not ‘constitutionally small’ and that further research is needed. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.