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Die etwas andere Dopplersonographie – Zeichen der Pulswellenreflexion bei Mutter und (ungeborenem) Kind

A different view on Doppler waveforms—Signs of pulse wave reflection in mother and (unborn) child

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Der Gynäkologe Aims and scope

Zusammenfassung

Hintergrund

Die Bilder einer systolischen Schulter im Dopplermuster der A. cerebri media (ACM) des Feten oder der A. uterina (A. ut.) der Mutter bei schwerer Präeklampsie (PE) sind sicher vielen Untersuchern begegnet. Bisher scheint es keine schlüssige Erklärung für diese Veränderungen zu geben.

Fragestellung

Hämodynamische Untersuchungen belegen, dass Vasokonstriktion und PW(Pulswellen)-Reflexion im systemischen Kreislauf mit dem Auftreten einer systolischen Schulter in systemischen und v. a. in zerebralen Gefäßen einhergehen. Damit stellt sich die Frage, ob diese Dopplerveränderungen bei Mutter und (ungeborenem) Kind als Folge erhöhter peripherer Vasokonstriktion interpretiert werden können.

Material und Methode

In der Hämodynamik ist das Modell der PW-Ausbreitung und -Reflexion gut etabliert. Bei schwerer PE wird damit die PW-Reflexionszeit Tr (= Transitzeit bis zur Reflexion und zurück) ermittelt und mit dem Intervall bis zur systolischen Schulter in der A. ut. verglichen. Übertragen auf den fetalen Kreislauf werden mithilfe der PW-Geschwindigkeit in der Aorta und der funktionellen Reflexionsdistanz die PW-Reflexionszeit beim Feten ermittelt und mit dem Intervall bis zur ACM-Schulter verglichen.

Ergebnisse

Die Berechnung der jeweiligen PW-Reflexionszeit Tr ergab eine gute Übereinstimmung mit den beobachteten Zeitintervallen ∆t bis zur systolischen Schulter im Dopplerbefund. Die Gabe von Vasodilatatoren führte zur Abnahme bzw. zum Verschwinden der systolischen Schulter.

Diskussion

Die Ergebnisse belegen die Validität des PW-Modells, d. h.: Die systolische Schulter im Dopplerbefund der A. ut. und der ACM kann als Zeichen der PW-Reflexion infolge peripherer Vasokonstriktion interpretiert werden. Dies ist prospektiv von Nutzen beim Monitoring der progredienten PE und in der ACM als Indikator für fetale Stressreaktionen.

Abstract

Background

The Doppler pattern of a systolic shoulder in the middle cerebral artery (MCA) of the fetus or in the uterine artery (UtA) of a mother with severe pre-eclampsia (PE) have certainly been encountered by many investigators; however, so far there seems to be no conclusive explanation for these changes.

Objective

Hemodynamic studies in the arterial system confirmed that vasoconstriction and pulse wave (PW) reflection in the systemic circulation are associated with the appearance of a systolic shoulder in systemic and especially in cerebral arteries. This raises the question whether these Doppler changes in mother and (unborn) child may be interpreted as a consequence of increased peripheral vasoconstriction.

Material and methods

In hemodynamics, the model of PW propagation and reflection is well-established. Accordingly, in severe PE the PW reflection time Tr (= transit time to reflection and return) is determined and compared with the interval to the systolic shoulder onset in the UtA. Applied to the fetal circulation, the PW reflection time is calculated using PW velocity in the fetal aorta and functional distance to reflection and compared with the interval to MCA shoulder onset.

Results

The model calculation of the respective PW reflection times Tr showed good agreement with the observed time intervals ∆t to systolic shoulder onset in the Doppler waveform for both the mother and the fetus. Furthermore, a decrease or even disappearance of the systolic shoulder was observed after administration of drugs with vasodilating effects.

Conclusion

The model results substantiate the validity of the PW model for the interpretation of this particular Doppler pattern. The systolic shoulder in the Doppler waveform of the maternal UtA and the fetal MCA can be interpreted as a sign of PW reflection due to peripheral vasoconstriction. Regarding the UtA this interpretation of the systolic shoulder may prove useful in monitoring progressive PE and in the MCA may indicate fetal stress response.

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Danksagung

für Geduld, Langmut und Unterstützung auf vielfältige Weise, an: Nicole Ochsenbein-Kölble, Ladina Vonzun, Manuela Tavares de Sousa, Kurt Hecher, Roland Zimmermann, Torvid Kiserud und Klaus Vetter, als unermüdlicher Mentor.

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  1. Pränatalmedizin und Sonographie, Steinberger Str. 29, 65187, Wiesbaden, Deutschland

    Markus Gonser

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Correspondence to Markus Gonser.

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M. Gonser gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden keine Untersuchungen an Patienten vorgenommen. Es handelt sich ausschließlich um retrospektive Auswertungen von Befunden und Daten abgeschlossener Behandlungen gemäß den Empfehlungen der jeweiligen Ethik-Kommissionen und Ärztekammern.

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R. Zimmermann, Zürich

K. Vetter, Berlin

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Gonser, M. Die etwas andere Dopplersonographie – Zeichen der Pulswellenreflexion bei Mutter und (ungeborenem) Kind. Gynäkologe 53, 821–830 (2020). https://doi.org/10.1007/s00129-020-04712-1

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