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WS12‐07Fetal venous and arterial circulation in hypoxic IUGR. From adaptation to decompensation
Author(s) -
Ville Y.
Publication year - 2000
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 - 10.1046/j.1469-0705.2000.00009-1-74.x
Subject(s) - ductus venosus , medicine , cardiology , fetus , fetal distress , decompensation , cerebral blood flow , umbilical artery , middle cerebral artery , cerebral arteries , fetal circulation , anesthesia , ischemia , pregnancy , genetics , placenta , biology
Objective To evaluate the changes in flow velocity waveforms in the mid‐cerebral artery and in the transverse cerebral sinus in growth restricted fetuses and to correlate these changes between them and with (1) flow velocity waveforms in the ductus venosus and (2) changes in computerized analysis of fetal cardiotocogram. Design Fetuses between 22 and 37 weeks' gestation with an estimated fetal weight below the 5th centile were included in this prospective longitudinal study. Doppler measurements in the umbilical artery, descending aorta, middle cerebral artery, transverse cerebral sinus and ductus venosus were recorded. Fetal heart rate was analyzed by a computer system according to the Dawes‐Redman criteria. Results Blood flow within the midcerebral artery and that in the cerebral transverse sinus follow a mirror image distribution. Arterial redistribution is already present when alteration in the venous cerebral circulation develops. We measured a significant correlation between pulsatility index in the transverse cerebral sinus and in the ductus venosus over the study period and at delivery. There was a negative correlation between these indices and short and long‐term variability of the fetal heart rate. There was a parallel increase in pulsatility in the ductus venosus and the transverse cerebral sinus. These changes were inversely correlated with fetal heart rate variability and preceded fetal distress. Conclusion Cerebral venous blood flow in IUGR fetuses may be a useful additional investigation to (1) understand better the mechanism of cerebral redistribution in hypoxemic IUGR and (2) to discriminate between fetal adaptation and fetal decompensation in chronic hypoxemia.