Premium
F47The flow redistribution toward the brain: beneficial and adverse effects on the fetal outcome in htypertensive pregnancies
Author(s) -
Salihagic A.,
Tobal N.,
Perrotin F.,
Imily V.,
Lansac J.,
Arbeille P.
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.1469-0705.2000.00015-1-47.x
Subject(s) - medicine , fetus , cerebral hypoxia , hypoxia (environmental) , anesthesia , pregnancy , obstetrics , oxygen , chemistry , genetics , ischemia , organic chemistry , biology
Objective To predict fetal outcome (abnormal FHR to cerebral lesion) from the degree and the duration of the hypoxia. Method Pregnancies complicated with hypertension and IUGR were submitted to a daily umbilical and cerebral Doppler from first day of admission until delivery. The umbilical (URI), and cerebral (CRI) resistance indices, cerebral‐umbilical ratio (C/U = CRI/URI), and the hypoxia index (HI) were calculated. The HI expresses as the maximum C/U change between admission day and delivery day (in percentage of C/U at admission, or in percentage of C/U cut‐off limit (= 1) if C/U admission < 1) multiplied by number of days of observation. Results 68 pregnancies investigated (age: 25 ± 5 years, primipar: 35%, admission date: 30.8 ± 2.5 weeks, delivery at 33.2 ± 2.8, mean weight: 2300 ± 457g. The combination (HI > 200 and C/U < 1) was associated with abnormal FHR in 75% cases, whereas 1 or 2 of these parameter normal was associated with normal FHR in 85% cases (PPV 75% – NPV 85%). The minimal C/U and the HI during the period of observation allowed to predict abnormal FHR at delivery. On 5 pregnancies the period of hypoxia extended over 10–20 days (C/U << 1, HI >> 200), the fetuses died or were handicaped at delivery. The daily cerebral index recording showed a loss of fluctuation from one day to another, which could correspond to a deterioration of the cerebral regulation (vasoplegia). We suggest that the loss of fluctuation could be considered as the last limit before the cerebral lesion have serious chances to develop. In these 5 cases the fetal heart rate abnormalities appeared several days after this limit was passed.