Edgar Hernandez-Andrade

Cardiac dysfunction and cell damage across clinical stages of severity in growth-restricted fetuses

OBJECTIVEnThe purpose of this study was to assess cardiac function and cell damage in intrauterine growth-restricted (IUGR) fetuses across clinical Doppler stages of deterioration.nnnSTUDY DESIGNnOne hundred twenty appropriate-for-gestational-age and 81 IUGR fetuses were classified in stages 1/2/3 according umbilical artery present/absent/reversed end-diastolic blood flow, respectively. Cardiac function was assessed by modified-myocardial performance index, early-to-late diastolic filling ratios, cardiac output, and cord blood B-type natriuretic peptide; myocardial cell damage was assessed by heart fatty acid-binding protein, troponin-I, and high-sensitivity C-reactive protein.nnnRESULTSnModified-myocardial performance index, blood B-type natriuretic peptide, and early-to-late diastolic filling ratios were increased in a stage-dependent manner in IUGR fetuses, compared with appropriate-for-gestational-age fetuses. Heart fatty acid-binding protein levels were higher in IUGR fetuses at stage 3, compared with control fetuses. Cardiac output, troponin-I, and high-sensitivity C-reactive protein did not increase in IUGR fetuses at any stage.nnnCONCLUSIONnIUGR fetuses showed signs of cardiac dysfunction from early stages. Cardiac dysfunction deteriorates further with the progression of fetal compromise, together with the appearance of biochemical signs of cell damage.

Fetal middle cerebral artery peak systolic velocity in the investigation of non-immune hydrops

In some cases of non‐immune hydrops there is congenital or acquired fetal anemia. The aim of this study was to investigate the potential value of fetal middle cerebral artery peak systolic velocity (MCA‐PSV) in the assessment and management of non‐immune hydrops due to anemia.

Prediction of fetal anemia in rhesus disease by measurement of fetal middle cerebral artery peak systolic velocity

In red blood cell (RBC) isoimmunized pregnancies fetal anemia is associated with a hyperdynamic circulation. The aim of the present study was to examine further the possible value of fetal middle cerebral artery peak systolic velocity (MCA‐PSV) in the management of affected pregnancies.

Normal Reference Ranges from 11 to 41 Weeks’ Gestation of Fetal Left Modified Myocardial Performance Index by Conventional Doppler with the Use of Stringent Criteria for Delimitation of the Time Periods

Objective: To establish normal reference intervals of the fetal left modified myocardial performance index (MPI) with the use of stringent criteria for delimitation of the time periods. Study Design: A cohort of consecutive singleton fetuses was created including at least 20 fetuses for each completed week of gestation between 11 and 41 weeks. The isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), and ejection time (ET) were calculated using the clicks of the mitral and aortic valves as landmarks, and the MPI was calculated as follows: (ICT + IRT)/ET. Normal reference ranges for the MPI and its individual components were constructed by means of regression analysis of the mean and standard deviation against gestational age (GA). Results: A total of 730 fetuses were included. After a natural logarithmic transformation, a third degree cubic polynomial model (loge mean MPI = 0.0477 × GA – 0.002565 × GA2 + 0.000043 × GA3 –1.22, with GA measured in weeks) was selected to fit our data. There was a progressive increase in the mean MPI from 11 weeks (mean, 0.39; 95th centile, 0.51) to 41 weeks (mean, 0.55; 95th centile, 0.78) of gestation. While the mean ICT and IRT values increased with GA from 25 to 32 ms and from 39 to 51 ms, respectively, the ET showed an initial increase until 30 weeks and a progressive decrease thereafter. Conclusion: Normative references of left modified MPI from 11 to 41 weeks of gestation are provided, which could be useful in the assessment of cardiac function in fetuses.

Association between intrapulmonary arterial Doppler parameters and degree of lung growth as measured by lung‐to‐head ratio in fetuses with congenital diaphragmatic hernia

To describe the association between the intrapulmonary circulation and the degree of lung growth in fetuses with congenital diaphragmatic hernia (CDH).

Three‐dimensional sonographic calculation of the volume of intracranial structures in growth‐restricted and appropriate‐for‐gestational age fetuses

To evaluate the feasibility and reproducibility of volume segmentation of fetal intracranial structures using three‐dimensional (3D) ultrasound imaging, and to estimate differences in the volume of intracranial structures between intrauterine growth‐restricted (IUGR) and appropriate‐for‐gestational age (AGA) fetuses.

An experimental model of fetal growth restriction based on selective ligature of uteroplacental vessels in the pregnant rabbit.

Introduction: To describe an animal model of growth restriction based on selective ligature of uteroplacental vessels in the pregnant rabbit. Material and Methods: Two experimental protocols (+21 and +25 days of gestation) with three groups were defined: controls, mild (20–30%) and severe (40–50%) uteroplacental vessel ligature. Fetuses were delivered 120 h after the procedure by cesarean section. Biometrical measurements were carried out. Brains were obtained and glial response and cell proliferation were studied by S100β and Ki-67 immunohistochemistry. Results: Mortality rate and biometrical restriction increased across experimental groups according to the time and severity of the procedure. S100β expression was significantly higher in the severe reduction group at 25 days. Ki-67 expression was significantly higher in the mild reduction group at 21 days and in the severe reduction group at 25 days. Discussion: Selective ligature of uteroplacental vessels in the pregnant rabbit results in a gradual model of growth restriction in terms of mortality, biometrical restriction and histological brain changes.

Impact of cerebral redistribution on neurodevelopmental outcome in small‐for‐gestational‐age or growth‐restricted babies: a systematic review

To review systematically the evidence on impact of cerebral redistribution, as assessed by fetal middle cerebral artery (MCA) Doppler, on neurological outcomes in small‐for‐gestational‐age (SGA) or growth‐restricted fetuses.

Cervical strain determined by ultrasound elastography and its association with spontaneous preterm delivery

Abstract Objective: To determine if there is an association between cervical strain, evaluated using ultrasound elastography, and spontaneous preterm delivery (sPTD) <37 weeks of gestation. Methods: One hundred and eighty nine (189) women at 16–24 weeks of gestation were evaluated. Ultrasound elastography was used to estimate cervical strain in three anatomical planes: one mid-sagittal in the same plane used for cervical length measurement, and two cross sectional images: one at the level of the internal cervical os, and the other at the level of the external cervical os. In each plane, two regions of interest (endocervix and entire cervix) were examined; a total of six regions of interest were evaluated. Results: The prevalence of sPTD was 11% (21/189). Strain values from each of the six cervical regions correlated weakly with cervical length (from r=–0.24, P<0.001 to r=–0.03, P=0.69). Strain measurements obtained in a cross sectional view of the internal cervical os were significantly associated with sPTD. Women with strain values ≤25th centile in the endocervical canal (0.19) and in the entire cervix (0.14) were 80% less likely to have a sPTD than women with strain values >25th centile [endocervical: odds ratio (OR) 0.2; 95% confidence interval (CI), 0.03–0.96; entire cervix: OR 0.17; 95% CI, 0.03–0.9]. Additional adjustment for gestational age, race, smoking status, parity, maternal age, pre-pregnancy body mass index, and previous preterm delivery did not appreciably alter the magnitude or statistical significance of these associations. Strain values obtained from the external cervical os and from the sagittal view were not associated with sPTD. Conclusion: Low strain values in the internal cervical os were associated with a significantly lower risk of spontaneous preterm delivery <37 weeks of gestation.

Umbilical venous blood flow measurement: accuracy and reproducibility.

Umbilical venous blood flow could be considered a direct and physiological measurement of vascular placental function, representing the quantity of oxygen and nutrients reaching the fetus. The advent of high‐technology ultrasound and pulsed Doppler has overcome some of the limitations of early studies. Indeed, Doppler measurement of umbilical venous blood flow has been found to be accurate when compared with several gold standards for in‐vivo flow calculation. Nevertheless, small errors in volume flow components, the vessel area and the mean velocity, result in large errors in the calculation of volume flow. Therefore, technique standardization is of paramount importance. Validation studies in animal models have demonstrated accurate venous blood flow measurements by estimating the vessels cross‐sectional area from perpendicular views of longitudinal sections of free‐floating portions of the cord. On the other hand, estimation of the mean velocity from the maximum velocity, rather than using the intensity‐weighted mean velocity, is less software‐dependent and more clearly defined, yielding estimates with more predictable and systematic errors. By adhering to stringent methodological recommendations, umbilical venous blood flow calculation has moderate to good intra‐ and interobserver reproducibility. Having been found to be accurate and reproducible, further studies are required to establish the clinical value of umbilical vein flow measurement. Copyright