Abstract
Objective
To evaluate the association of aortic isthmus (AoI) circulation assessed by doppler imaging in growth restricted fetuses with perinatal outcome.
Design
Prospective longitudinal observational study.
Setting
Tertiary referral center.
Population
Fetal growth restriction (FGR) (n = 38) between 24 and 36 weeks’ gestation.
Methods
Doppler examination of the aortic isthmus, umbilical artery (UA), middle cerebral artery, and ductus venosus (DV) was performed. The relationship between perinatal outcomes and antegrade (n = 25) and retrograde flow (n = 13) in the AoI and other Doppler parameters was analysed.
Results
Retrograde AoI group had higher rates of adverse perinatal outcome (92.3% vs. 72%) with 63.1% sensitivity and 87.5% specificity. Overall perinatal mortality (intrauterine death and neonatal death) was higher in the retrograde group (23%). No perinatal mortality was seen in the antegrade AoI group. Cases with absent end diastolic flow (AEDF) or reverse end diastolic flow (REDF) in the UA and retrograde flow in the AoI and normal DV flow had 40% prenatal mortality as 25% in those with abnormal DV Doppler.
Conclusion
Retrograde blood flow in the AoI is associated with adverse perinatal outcome, particularly intrauterine fetal demise, neonatal death, Respiratory Distress Syndrome (RDS) and increased duration of Neonatal Intensive Care Unit (NICU) stay. Even if DV flow is normal, adverse outcome might be suspected in fetuses with AEDF/REDF in the UA and retrograde flow in the AoI. Consequently, retrograde flow in the AoI might be considered as an additional trigger for delivering FGR fetuses at 30–34 weeks with AREDF in the UA. Larger longitudinal studies are, however, required to vaidate this.
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References
Kady S, Gardosi J. Perinatal mortality and fetal growth restriction. Best Pract Res Clin Obstet Gynaecol. 2004;18:397–410.
Jarvis S, Glinianaia SV, Torrioli MG, Platt MJ, Miceli M, Jouk PS, Johnson A, Hutton J, Hemming K, Hagberg G, Dolk H, Chalmers J. Cerebral palsy and intrauterine growth in single births: European collaborative study. Lancet. 2003;362:1106–11.
Barker DJ. Adult consequences of fetal growth restriction. Clin Obstet Gynecol. 2006;49:270–83.
Schwarze A, Gembruch U, Krapp M, Katalinic A, Germer U, Axt-Fliedner R. Qualitative venous Doppler waveform analysis in preterm intrauterine growth-restricted fetuses with ARED flow in the umbilical artery—correlation with short-term outcome. Ultrasound Obstet Gynecol. 2005;25:573–9.
Bilardo CM, Wolf H, Stigter RH, Ville Y, Baez E, Visser GH, Hecher K. Relationship between monitoring parameters and perinatal outcome in severe, early intrauterine growth restriction. Ultrasound Obstet Gynecol. 2004;23:119–25.
Fouron JC. The unrecognized physiological and clinical significance of the fetal aortic isthmus. Ultrasound Obstet Gynecol. 2003;22:441–7.
Eronen M, Kari A, Pesonen E, Kaaja R, Wallgren EI, Hallman M. Value of absent or retrograde end-diastolic flow in fetal aorta and umbilical artery as a predictor of perinatal outcome in pregnancy induces hypertension. Acta Pediatr. 1993;82:919–24.
Fouron JC, Gosselin J, Amiel-Tison C, Infante-Rivard C, Fouron C, Skoll A, Veilleux A. Correlation between prenatal velocity waveforms in the aortic isthmus and neurodevelopmental outcome between the ages of 2 and 4 years. Am J Obstet Gynecol. 2001;184:630–6.
Fouron JC, Gosselin J, Raboisson MJ, Lamoureux J, Tison CA, Fouron C, Hudon L. The relationship between an aortic isthmus blood flow velocity index and the postnatal neurodevelopmental status of fetuses with placental circulatory insufficiency. Am J Obstet Gynecol. 2005;192:497–503.
Figueras F, Benavides A, Del Rio M, Crispi F, Eixarch E, Martinez J, Hernandez-Andrade E, Gratacos E. Monitoring of fetuses with intrauterine growth restriction: longitudinal changes in ductus venosus and aortic isthmus flow. Ultrasound Obstet Gynecol. 2009;33:39–43.
Gordijn SJ, Beune IM, Thilaganathan B, Papageorghiou A, Baschat AA, Baker PN, Silver RM, Wynia K, Ganzevoort W. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol. 2016;48:333–9.
Gratacós FFE. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther. 2014;36:86–98.
Del Rio M, Martinez JM, Figueras F, Bennasar M, Olivella A, Palacio M, Coll O, Puerto B, Grataco’s E. Doppler assessment of the aortic isthmus and perinatal outcome in preterm fetuses with severe intrauterine growth restriction. Ultrasound Obstet Gynecol. 2008;31:41–7.
Hidar S, Zaafouri R, Bouguizane S, Chaïeb A, Jerbi M, Bibi M, Khaïri H. Prognostic contribution of Doppler of the fetal aortic isthmus in the management of iposterntrauterine growth retardation : Prospective longitudinal studyPrognostic value of fetal aortic isthmus Doppler waveform in growth restricted fetuses: prospective longitudinal study. J Gynecol Obstet Biol Reprod. 2004;33(8):745–52.
Cruz-Lemini M, Crispi F, Van Mieghem T, Pedraza D, Cruz-Martinez R, Acosta-Rojas R, Figueras F, Parra-Cordero M, Deprest J, Gratacos E. Risk of perinatal death in early-onset intrauterine growth restriction according to gestational age and cardiovascular Doppler indices: a multicenter study. Fetal Diagn Ther. 2012;32:116–22.
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Bansode, S.A., Balakrishnan, B., Batra, M. et al. Retrograde Flow in the Aortic Isthmus: Trigger to Deliver Growth Restricted Fetuses Between 30 and 34 Weeks of Gestation?. J. Fetal Med. 7, 267–274 (2020). https://doi.org/10.1007/s40556-020-00281-4
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DOI: https://doi.org/10.1007/s40556-020-00281-4