Early-onset Intrauterine Growth Restriction Research Articles

Atypical hemodynamic pattern in fetuses with hypercoiled umbilical cord and growth restriction

Objectives: To describe fetal and uterine hemodynamics in intrauterine growth restriction (IUGR) fetuses with hypercoiled umbilical cord. Methods: 102 pregnant women with IUGR fetuses were enrolled in the study. In these cases, hemodynamic indices and Doppler waveform profiles were evaluated. Results: In seven of the enrolled cases of IUGR, we found an anomalous umbilical coiling. They showed normal impedance to flow in utero-placental district and abnormal venous umbilical cord pulsatility with flow velocity higher than the umbilical artery. The ductus venosus showed a reduction of the forward flow and/or a reverse flow during atrial contractions. Two of these seven patients had early onset IUGR and a particular deteriorating hemodynamic profile with “brain sparing”, severe reverse flow in the ductus venosus, increased reverse flow in the inferior vena cava during atrial contraction and absent flow during the diastole in the umbilical arteries. Five patients had late onset of IUGR and three of these did not demonstrate these worsening hemodynamic alterations until term. Conclusions: In patients with fetal IUGR and hypercoiling without signs of placental insufficiency, we observed an “atypical” feto-maternal hemodynamic pattern. These IUGR fetuses with hypercoiling and fetal venous system hemodynamic alteration can be at high hypoxic risk.

A Role for Nrf2 in Redox Signalling of the Invasive Extravillous Trophoblast in Severe Early Onset IUGR Associated with Preeclampsia

BackgroundPreeclampsia (PE) is characterized by increased lipid oxidation and diminished antioxidant capacity, while intrauterine growth restriction (IUGR) is characterized by impaired invasion of the extravillous trophoblast. Vascular endothelial growth factor (VEGF) has been reported to be altered in preeclampsia. A relationship between VEGF and nuclear factor erythroid 2-related factor-2 (Nrf2) has been shown in vitro, where VEGF prevents oxidative damage via activation of the Nrf2 pathway. In this study the expression of Nrf2, VEGF and 4-hydroxynonenal (4-HNE), was determined in interstitial and endovascular/intramural extravillous trophoblast (EVT) in normal pregnancies and those complicated by severe early onset IUGR associated with preeclampsia IUGR/PE.Materials and MethodsFull-thickness uterine tissues derived from caesarean hysterectomies performed in 5 healthy normotensive women delivering term infants and 6 women with severe early onset IUGR with preeclampsia (29–34 weeks gestation) were analyzed. Interstitial and endovascular extravillous trophoblast were quantified after immunohistochemical staining of paraffin sections using antibodies against Nrf2, 4-HNE, VEGF, and cytokeratin 7.ResultsUterine tissues from women suffering from severe early onset IUGR/PE were characterized by reduced invasion of extravillous trophoblast into the endometrial and myometrial segments of spiral arteries in the placental bed. Extravillous trophoblast showed an increased cytoplasmic expression of Nrf2 and 4-HNE in IUGR/PE cases. The increased expression of Nrf2 in cases of IUGR/PE was associated with decreased expression of VEGF in these cells compared to controls.ConclusionOur data suggests that besides villous cytotrophoblast, also the extravillous trophoblast is a source of Nrf2-dependent genes. VEGF deficiency may cause higher oxidative stress in extravillous trophoblast in cases with IUGR/PE. The resulting reduced basal defence against oxidative stress and the higher vulnerability to oxidative damage may play a role in the limited trophoblast invasion into spiral arteries in cases suffering from severe early onset IUGR/PE.

P08.14: Results of perinatal care of fetuses with early onset intrauterine growth restriction and signs of blood flow redistribution in our institute

P08.14: Results of perinatal care of fetuses with early onset intrauterine growth restriction and signs of blood flow redistribution in our institute

Risk of Perinatal Death in Early-Onset Intrauterine Growth Restriction according to Gestational Age and Cardiovascular Doppler Indices: A Multicenter Study

Objective: To assess the value of gestational age and cardiovascular Doppler indices in predicting perinatal mortality in a multicenter cohort of early-onset intrauterine growth-restricted (IUGR) fetuses. Methods: A multicenter prospective cohort study including 157 early-onset (<34 weeks) IUGR cases with abnormal umbilical artery (UA) Doppler was conducted. Cardiovascular assessment included the ductus venosus (DV), the aortic isthmus flow index (IFI), and the myocardial performance index (MPI). Isolated and combined values to predict the risk of perinatal death were evaluated by logistic regression and by decision tree analysis, where the gestational age at delivery, UA, and middle cerebral artery (MCA) were also included as covariates. Results: Perinatal mortality was 17% (27/157). All parameters were significantly associated with perinatal death, with individual odds ratios (OR) of 25.2 for gestational age below 28 weeks, 12.1 for absent/reversed DV atrial flow, 5.3 for MCA pulsatility index <5th centile, 4.6 for UA absent/reversed diastolic end-flow, 1.8 for IFI <5th centile, and 1.6 for MPI >95th centile. Decision tree analysis identified gestational age at birth as the best predictor of death (<26 weeks, 93% mortality; 26–28 weeks, 29% mortality, and >28 weeks, 3% mortality). Between 26 and 28 weeks, DV atrial flow allowed further stratification between high (60%) and low risk (18%) of mortality. Conclusions: Gestational age largely determines the risk of perinatal mortality in early-onset IUGR before 26 weeks and later than 28 weeks of gestation. The DV may improve clinical management by stratifying the probability of death between 26 and 28 weeks of gestation.

First-trimester ultrasound volumetry: measurement techniques and potential application in the prediction of pregnancy complications

First-trimester prediction of intrauterine growth restriction (IUGR), preeclampsia (PE), birthweight, aneuploidy, miscarriage, complications in multiple pregnancies and homozygous α0-thalassemia is a challenging and emerging field. Placenta volumes (PV) and embryo volume/fetal volume ratios are correlated with crown–rump length (CRL) or gestational age. Measurement of PV or placental quotient (PV/CRL ratio) is an early method to identify impaired trophoblast invasion and predict subsequent development of IUGR or PE. In early-onset IUGR caused by triploidy, or trisomy 13 or 18, a larger deficit in fetal volume than CRL is observed. Fetal and placental volume measurements may be applied to predict other conditions such as aneuploidy, miscarriage or stillbirth. Standardization of the 3D volumetric methodology is needed to improve reproducibility of measurement. Further studies are required to determine the use of first-trimester volumetry alone or in combination with Doppler ultrasound and other parameters t...

PP015. Differential expression of Nrf2 and VEGF in human placental beds from normal and pregnancies complicated with preeclampsia and IUGR

Impaired trophoblast invasion into the uteroplacental arteries is accompanied with an evidence of oxidative stress in the extravillous trophoblast in preeclampsia complicated with IUGR. Preeclampsia is characterised by increased lipid oxidation and diminished antioxidant capacity; recently, we have shown that PE is associated with an increased expression of the nuclear factor erythroid 2-related factor 2 (Nrf2) in villous cytotrophoblast. A possible relationship between the vascular endothelial growth factor (VEGF) and Nrf2 was established in vitro and the activation of Nrf2 pathway could lead to upregulation of VEGF synthesis through the induction of Nrf2-dependent Heme oxygenase-1 (HO-1). In this study the expression of Nrf2 and VEGF was determined in the interstitial and intramural extravillous trophoblast in normal pregnancies and those complicated by preeclampsia and intra-uterine growth restriction (IUGR). Full-thickness uterine tissues were obtained from caesarean hysterectomies performed in 5 healthy normotensive women delivering term infants and from 5 women with severe early-onset preeclampsia and IUGR (29-34 week's gestation). The interstitial and intramural trophoblasts were studied by immunohistochemical analysis of paraffin sections stained with anti VEGF and anti Nrf2. Cases suffering from preeclampsia with IUGR were characterised by reduced invasion of extravillous trophoblast into uteroplacental arteries in the endometrial and myometrial segments. In addition, these cells showed an increased expression of Nrf2 in the pathological sections. The overexpression of Nrf2 in cases with preeclampsia was associated with restricted expression of VEGF in these cells compared to controls. Our data suggest that besides villous cytotrophoblast, also the extravillous trophoblast is a source of Nrf2-dependent genes. VEGF deficiency may cause higher oxidative stress in extravillous trophoblast in cases with preeclampsia with IUGR. The resulting reduced basal defence against oxidative stress and the higher vulnerability to oxidative damage may play a role in the limited trophoblast invasion into uteroplacental arteries in cases suffering from early onset preeclampsia and IUGR.

The double life of MULE in preeclamptic and IUGR placentae

The E3 ubiquitin ligase MULE (Mcl-1 Ubiquitin Ligases E3) targets myeloid cell leukemia factor 1 (Mcl-1) and tumor suppressor p53 for proteasomal degradation. Although Mcl-1 and p53 have been implicated in trophoblast cell death in preeclampsia (PE) and intrauterine growth restriction (IUGR), the mechanisms regulating their expression in the human placenta remains elusive. Herein, we investigated MULE's involvement in regulating Mcl-1 and p53 degradation during normal and abnormal (PE, IUGR) placental development. MULE expression peaked at 5–7 weeks of gestation, when oxygen tension is low and inversely correlated with that of Mcl-1 and p53. MULE efficiently bound to Mcl-1 and p53 and regulated their ubiquitination during placental development. Exposure of first trimester villous explants to 3% O2 resulted in elevated MULE expression compared with 20% O2. Low-oxygen-induced MULE expression in JEG3 choriocarcinoma cells was abolished by hypoxia-inducible factor (HIF)-1α siRNA. MULE was overexpressed in both PE and IUGR placentae. In PE, MULE preferentially targeted p53 for degradation, allowing accumulation of pro-apoptotic Mcl-1 isoforms. In IUGR, however, MULE targeted pro-survival Mcl-1, allowing p53 to accumulate and exert its apoptotic function. These data demonstrate that oxygen regulates Mcl-1 and p53 stability during placentation via HIF-1-controlled MULE expression. The different preferential targets of MULE in PE and IUGR placentae classify early-onset PE and IUGR as distinct molecular pathologies.

Fetal renal artery (RA) volume blood flow is altered in early-onset intra-uterine growth restriction (IUGR) and has a non-linear relationship with AFI

IntroductionIUGR is associated with oligohydramnios. We investigated fetal RA parameters in normal and IUGR pregnancies and their correlation with amniotic fluid index (AFI).MethodWomen booking at Queen Charlotte's & Chelsea Hospital...

Fetal circulatory redistribution in normal and intra-uterine growth restriction (IUGR) pregnancies by volume blood flow (VBF)

IntroductionA number of studies have reported that ‘sparing’ or redistribution occurs in various vascular beds in IUGR. We took a global approach to assessing this redistribution using VBF.MethodWomen booking at...

405: Prediction of neonatal respiratory function in fetuses with isolated congenital diaphragmatic hernia (CDH) in the FETO era

in fetuses with isolated congenital diaphragmatic hernia (CDH) in the FETO era Jan Deprest, Elisa Done, Paul Lewi, Tim Van Mieghem, Inga Sandaite, Leonardo Gucciardo, Roland Devlieger, Karel Allegaert, Filip Claus University Hospitals Leuven, Division of Woman and Child, Leuven, Belgium, University Hospitals Leuven, Medical Imaging, Leuven, Belgium, University Hospitals Leuven, Neonatology, Leuven, Belgium OBJECTIVE: To correlate prenatal lung hypoplasia indicators and early postnatal lung function as evaluated by oxygenation index (OI) and alveolar arterial oxygen gradient (A-a DO2) in fetuses with isolated Congenital Diaphragmatic Hernia (iCDH). STUDY DESIGN: Prospective single centre study on 40 fetuses with iCDH either expectantly managed (13) or undergoing tracheal occlusion (TO;27) for severe lung hypoplasia. Prenatal predictors included Observed/Expected Lung-Head Ratio (O/E LHR), fetal pulmonary artery reactivity to maternal O2 administration ( PI), Observed/Expected Total Fetal Lung Volume (O/E TFLV) and Liver-to-Thorax ratio (LiTR), measured in the late second and third trimester. In TO cases this was prior to balloon placement and after its removal. Postnatal outcome measures included the best OI and A-a DO2 value in the first 24h of life. Other postnatal outcome variables were survival at discharge and the occurrence of neonatal pulmonary hypertension that did not respond to iNO (severe PHT). RESULTS: 33/40 (82%) were left CDH. Median GA at first evaluation was 27.2 wks (26-29.6) and 34.3 wks (30.1-37) at the second (median interval between two exams: 7 wks (2.4-10)). GA at delivery was 36.0 (30-39.4) wks. 22 (55%) cases (initial median O/E LHR 24%) survived till discharge, 54% of these had undergone TO. All prenatal predictors assessed at 28 wks are significantly related to the best OI and A-a DO2. At 34 wks, PI and the LiTR are predictive of early postnatal respiratory function. The occurrence of severe PHT was best predicted by PI and LiTR. O/E LHR, PI and LiTR at both time points are predictive of neonatal survival, while O/E TFLV was significantly related to postnatal outcome only at the early time point. (Figure: significant bivariate relations; linear or logistic regression R2 values along the line) CONCLUSION: In CDH fetuses prenatal lung size assessment and vascular reactivity measurement are significantly related to early postnatal respiratory function. PHT is significantly related to fetal O2 reactivity as well as liver herniation, but not to lung size measurements. 406 Fetal growth restriction from placental insufficiency is not associated with an inflammatory markers response in umbilical cord blood Line Leduc, Emeline Maisonneuve, Edgard Delvin, Emile Levy, Emilie Grenier, Annie Ouellet, Lucie Morin, Johanne Dube, Maurice Bouity-Voubou, Jean-Marie Moutquin, Jean-Claude Fouron, Stephanie Klam Universite de Montreal and Research Center, CHU Sainte-Justine, Obstetrics and Gynecology, Montreal, QC, Canada, Universite de Montreal and Research Center, CHU Sainte-Justine, Biochemistry, Montreal, QC, Canada, Universite de Montreal and Research Center, CHU Sainte-Justine, Nutrition, Montreal, QC, Canada, Universite de Sherbrooke, Obstetrics and Gynecology, Sherbrooke, QC, Canada, Universite de Montreal and Research Center, CHU Sainte-Justine, Research Center, Montreal, QC, Canada, Universite de Sherbrooke, Research Center, Sherbrooke, QC, Canada, Universite de Montreal and Research Center, CHU Sainte-Justine, Cardiology, Montreal, QC, Canada, Jewish General Hospital, Obstetrics and Gynecology, Montreal, QC, Canada OBJECTIVE: Intrauterine growth restriction (IUGR) has increased risks of cardiovascular disease (CVD). Prenatal exposure to conditions associated with inflammation may predispose to CVD. Our objective was to document 1) whether inflammatory biomarkers (interleukin-6, tumor necrosis factor, serum amyloid A, soluble intercellular vascular cell adhesion molecule and circulating C-reactive protein) are increased in the umbilical cord from IUGR neonates with abnormal Doppler and 2) to assess whether these vary with the severity of IUGR and vascular disease. STUDY DESIGN: This prospective cohort study, involving 3 tertiary care centers, consists of consecutively recruited pregnant women carrying twins. We chose the twin pregnancy model because both fetuses share the same maternal environment thereby avoiding potential confounding factors when comparing inflammation biomarkers. We analysed only twin pairs with one co-twin with IUGR defined as fetal growth 10th percentile. Blood samples were taken at birth from the umbilical vein. Intra-pair comparisons on the biomarkers were performed in using the Student paired t-test for normal distribution and Wilcoxon test for non-parametric distribution. We also verified whether there was a link between early onset IUGR (in the second trimester), severe IUGR ( 5th percentile) and IUGR in presence of reverse diastolic flow, verified by umbilical Doppler. RESULTS: Of the 68 twin pregnancies, 48 were dichorionic-diamniotic and 20 monochorionic twins. We observed no increase in cord blood levels of inflammation markers in growth restricted neonates when compared to their normal twin. Furthermore there was no increase of inflammation markers when we compared fetuses with severe IUGR, early IUGR or IUGR with abnormal umbilical Doppler and their normal counterpart. CONCLUSION: IUGR is not associated with significant differences in cord blood inflammation biomarkers between normal and IUGR twins.(CIHR grant #158179) www.AJOG.org Doppler Assessment, Fetus, Prematurity Poster Session III

Sequence of changes in myocardial performance index in relation to aortic isthmus and ductus venosus Doppler in fetuses with early‐onset intrauterine growth restriction

To explore the sequence of changes in myocardial performance index (MPI) and aortic isthmus (AoI) and ductus venosus (DV) flow in fetuses with early-onset intrauterine growth restriction (IUGR). MPI and AoI and DV pulsatility indices (PI) were evaluated every 1-7 days in a cohort of IUGR fetuses with abnormal umbilical artery Doppler PI (> 95(th) percentile) delivered before 34 weeks' gestation. The longitudinal changes were analyzed in the last 30 days before delivery by multilevel and survival analysis. A total of 430 scans were performed on 115 IUGR fetuses. MPI, AoI-PI and DV-PI showed increases with the progression of fetal deterioration throughout the follow-up study period, but the rates of progression were different. On average, MPI, AoI-PI and DV-PI crossed the 95(th) percentile at 26 days, 12 days and 5 days before delivery, respectively. At the last examination before delivery, the proportion of increased MPI (70.4%) was significantly higher than that of abnormal AoI-PI (55.7%; P < 0.01) and DV-PI (47.8%; P < 0.01). In early-onset IUGR, MPI and AoI and DV Doppler indices all increase but at different rates, which could provide the basis for further research on their use for improving in-utero monitoring and prediction of long-term outcome.

Utility of Head/Abdomen Circumference Ratio in the Evaluation of Severe Early-Onset Intrauterine Growth Restriction

ObjectiveTo determine whether the predominant phenotype of intrauterine growth restriction (IUGR) is symmetric or asymmetric in severe, early-onset disease due to placental insufficiency. MethodsWe conducted a retrospective chart review of high-risk pregnant women with severe, early-onset IUGR who were delivering at < 33+0 weeks’ gestation at Mount Sinai Hospital from 2001 to 2010. Ultrasound images were reviewed for fetal biometry, amniotic fluid volume, and uterine and umbilical Doppler flow studies within seven days of delivery, and the frequency of head circumference/abdominal circumference ratio ≥ 95th percentile for gestation was determined. ResultsSixty-two of 107 pregnancies (58%) with early-onset IUGR had an elevated HC/AC ratio (≥95th percentile), which was more than 10-fold greater than the expected proportion (P < 0.001). High rates of severe preeclampsia (53%), abnormal amniotic fluid (70%), and abnormal uterine artery Doppler studies (78%) indicated placental insufficiency. ConclusionFetuses with severe placental IUGR in the second trimester are more likely to have an asymmetric phenotype. This is in contrast to the current belief that asymmetric IUGR is confined to third trimester IUGR.

First trimester screening for intra‐uterine growth restriction and early‐onset pre‐eclampsia

To assess first trimester placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A) as screening markers for early-onset pre-eclampsia (PE) and intra-uterine growth restriction (IUGR). PlGF concentration was retrospectively measured in first trimester serum specimens of 23 cases of early-onset PE (<34 weeks), 26 cases of IUGR (birth weight < 5th centile) and 5 controls per case. Levels were adjusted for gestational age (GA), ethnicity and smoking to obtain multiples of the expected median (MoM). Logistic regression was used to assess PlGF, PAPP-A and maternal characteristics as potential predictors of early-onset PE and IUGR. PlGF MoM levels were significantly lower in the early-onset PE group (P < 0.0001) compared with controls, but not in the IUGR group. PAPP-A MoM levels were significantly lower in the IUGR group (P < 0.01) compared with controls but not in the early-onset PE group. PlGF significantly improved the ability of systolic blood pressure at the first prenatal visit to predict early-onset PE [achieving a receiver-operating characteristics curve with area under the curve (AUC) of 0.8]. Combining systolic blood pressure at the first prenatal visit and PlGF did not significantly improve the predictive ability compared with PlGF alone (AUC = 0.83). Serum PlGF is an acceptable marker in first trimester screening for early-onset PE, but a poor marker in screening for IUGR. Screening performance of serum PAPP-A is poor for both early-onset PE and IUGR.

Placental Dysfunction and Fetal Programming: The Importance of Placental Size, Shape, Histopathology, and Molecular Composition

Normal function of the placenta is pivotal for optimal fetal growth and development. Fetal programming commonly is associated with placental dysfunction that predisposes to obstetric complications and suboptimal fetal outcomes. We consider several clinical phenotypes for placental dysfunction that likely predispose to fetal programming. Some of these reflect abnormal development of the chorioallantoic placenta in size, shape, or histopathology. Others result when exogenous stressors in the maternal environment combine with maladaptation of the placental response to yield small placentas with limited reserve, as typical of early-onset intrauterine growth restriction and preeclampsia. Still others reflect epigenetic changes, including altered expression of imprinted genes, altered enzymatic activity, or altered efficiencies in nutrient transport. Although the human placenta is a transient organ that persists only 9 months, the effects of this organ on the offspring remain for a lifetime.

Tissue Doppler echocardiographic markers of cardiac dysfunction in small-for-gestational age fetuses

The objective of the study was to evaluate echocardiographic markers of cardiac dysfunction in small-for-gestational age (SGA) fetuses with normal umbilical artery Doppler. Cardiac function was evaluated in 58 SGA (mean gestational age, 38 weeks) and 58 gestational-age matched normally grown fetuses by conventional echocardiography (peak early [E] and late [A] ratios and myocardial performance index [MPI]), and tissue Doppler imaging (TDI) (annular peak velocities and MPI'). With conventional echocardiography, SGA fetuses had a nonsignificant trend to increased E/A ratios and left MPI compared with controls. TDI demonstrated that SGA fetuses had significantly lower right E' and A' peak velocities and higher MPI' values. These findings further support that a proportion of SGA fetuses have true late-onset intrauterine growth restriction, which is associated with subclinical cardiac dysfunction, as previously described for early-onset intrauterine growth restriction.

Sildenafil citrate therapy for severe early-onset intrauterine growth restriction

Sildenafil citrate therapy for severe early-onset intrauterine growth restriction. BJOG 2011;118:624-628. Currently, there is no effective therapy for severe early-onset intrauterine growth restriction (IUGR). Sildenafil citrate vasodilates the myometrial arteries isolated from women with IUGR-complicated pregnancies. Women were offered Sildenafil (25 mg three times daily until delivery) if their pregnancy was complicated by early-onset IUGR [abdominal circumference (AC)< 5th percentile] and either the gestational age was <25(+0) weeks or an estimate of the fetal weight was <600 g (excluding known fetal anomaly/syndrome and/or planned termination). Sildenafil treatment was associated with increased fetal AC growth [odds ratio, 12.9; 95% confidence interval (CI), 1.3, 126; compared with institutional Sildenafil-naive early-onset IUGR controls]. Randomised controlled trial data are required to determine whether Sildenafil improves perinatal outcomes for early-onset IUGR-complicated pregnancies.

Editor’s Choice

Editor’s Choice

434: Sildenafil citrate therapy for early-onset severe intrauterine growth restriction

434: Sildenafil citrate therapy for early-onset severe intrauterine growth restriction

Subsequent Pregnancy Outcome after First Pregnancy with Normotensive Early-Onset Intrauterine Growth Restriction at

Objective. The aim of this study was to evaluate maternal and fetal outcome of the subsequent pregnancy of primiparous women with a history of early-onset intrauterine growth restriction (IUGR), prompting delivery before 34 weeks of gestation, without concomitant maternal hypertensive disease. Design. Retrospective cohort study. Setting. Tertiary center in the Netherlands. Population. Women with a normotensive first pregnancy complicated by early-onset severe IUGR, prompting delivery before 34 weeks of gestation. Methods. Reproductive follow-up data were recorded for 22 women with a normotensive first pregnancy complicated by early-onset severe IUGR before 34 weeks, referred to the University Medical Centre Utrecht, the Netherlands, between 1993 and 2005. Main Outcome Measures. Main outcome measures were recurrent IUGR, perinatal mortality, preterm delivery, preeclampsia (PE), pregnancy-induced hypertension, and other major obstetric complications, for example placental abruption. Results. Mean gestational age at delivery was 29.4 weeks for the index pregnancy compared to 36.4 weeks for the next pregnancy. IUGR recurred in six pregnancies (27.3%). Four subsequent pregnancies were complicated by hypertensive disorders. Perinatal mortality was 72.7% in the index pregnancy, compared to 13.6% in the second pregnancy. Overall, 11 women (54.5%) had an uneventful pregnancy. Conclusion. Women with first pregnancy early-onset IUGR, without concomitant maternal hypertensive disease, frequently develop severe perinatal complications in their subsequent pregnancy.

Usefulness of myocardial tissue Doppler vs conventional echocardiography in the evaluation of cardiac dysfunction in early-onset intrauterine growth restriction

To evaluate cardiac function by tissue Doppler imaging vs conventional echocardiography in intrauterine growth restriction. A prospective study in 25 intrauterine growth restriction, and in 50 normally grown fetuses between 24 and 34 weeks. Conventional echocardiography (E/A ratios, outflow tract velocities and myocardial performance index), and tissue Doppler (myocardial peak velocities, E'/A' ratios and myocardial performance index') measurements were performed. With conventional echocardiography, intrauterine growth restriction fetuses showed an increase in left myocardial performance index but similar values of E/A ratios, outflow tract velocities and right myocardial performance index as compared with controls. Tissue Doppler imaging demonstrated that intrauterine growth restriction fetuses had significantly lower systolic and diastolic myocardial velocities in mitral and tricuspid annulus, higher mitral E'/A' ratio and higher mitral, tricuspid and septal myocardial performance index' values. Tissue Doppler imaging demonstrated the presence of both systolic and diastolic cardiac dysfunction in intrauterine growth restriction. Tissue Doppler imaging may constitute a more sensitive tool than conventional echocardiography to evaluate cardiac dysfunction in intrauterine growth restriction.