Myocardial performance index for evaluation of fetal cardiac function in pregnant women with velamentous cord insertion

Abstract

Objective To determine whether there are any changes in fetal cardiac function in pregnant women with velamentous cord insertion by using the myocardial performance index and whether there are any influence on perinatal outcome. Methods Seventy singleton pregnant women diagnosed with velamentous cord insertion at 28-40 weeks of gestation were recruited to the study from January 2016 to December 2018. They were matched with 89 healthy women with normal pregnancies. Using Doppler echocardiography, the modified myocardial performance index (Mod-MPI) and ratios of E wave/A wave peak velocities (E/A) were determined. The Doppler indices of ductus venosus and umbilical and middle cerebral arteries were also determined in both groups. Adverse perinatal outcome was defined as fetal distress, admission to neonatal intensive care unit, neonatal asphyxia, and respiratory acidosis. Results The Mod-MPI (t=4.593, P 0.05 for all). Receiver operating characteristic analysis revealed>0.45 as the optimal cut-off level for MPI in perinatal adverse outcome prediction (sensitivity: 83.3%; specificity: 38.1%; area under the curve: 0.690; 95% confidence interval: 0.580-0.799). Conclusions Fetuses of pregnant women with velamentous cord insertion have significantly impaired cardiac function. There is an association between the MPI elevation and adverse perinatal outcome. The Mod-MPI has the potential to provide a theoretical basis for monitoring intrauterine environment. Key words: Velamentous cord insertion; Fetal cardiac function; Myocardial performance index