Fetal cardiac function in late-onset intrauterine growth restriction vs small-for-gestational age, as defined by estimated fetal weight, cerebroplacental ratio and uterine artery Doppler
Por:
Pérez-Cruz M, Cruz-Lemini M, Fernández MT, Parra JA, Casas JB, Gómez-Roig MD, Crispi F and Gratacós E
Publicada:
1 oct 2015
Ahead of Print:
26 jun 2015
Categoría:
Obstetrics and Gynecology
Resumen:
Objective Among late-onset small fetuses, a combination of estimated fetal weight (EFW), cerebroplacental ratio (CPR) and mean uterine artery (UtA) pulsatility index (PI) can predict a subgroup of fetuses with poor perinatal outcome; however, the association of these criteria with fetal cardiac structure and function is unknown. Our aim was to determine the presence and severity of signs indicating cardiac dysfunction in small fetuses, classified as intrauterine growth-restricted (IUGR) or small-for-gestational age (SGA), according to EFW, CPR and UtA-PI.
Methods A cohort of 209 late-onset small fetuses that were delivered > 34 weeks of gestation was divided in two categories: SGA (n= 59) if EFW was between the 3rd and 9th centiles with normal CPR and UtA-PI; and IUGR (n= 150) if EFW was < 3rd centile, or < 10th centile with a CPR < 5th centile and/or UtA-PI > 95th centile. The small population was compared with 150 appropriately grown fetuses (controls). Fetal cardiac morphometry and function were assessed by echocardiography using two-dimensional M-mode, conventional and tissue Doppler.
Results Compared with controls, both IUGR and SGA fetuses showed larger and more globular hearts (mean left sphericity index +/- SD: controls, 1.8 +/- 0.3; SGA, 1.5 +/- 0.2; and IUGR, 1.6 +/- 0.3; P< 0.01) and showed signs of systolic and diastolic dysfunction, including decreased tricuspid annular plane systolic excursion (mean +/- SD: controls, 8.2 +/- 1.1; SGA, 7.4 +/- 1.2; and IUGR, 6.9 +/- 1.1; P< 0.001) and increased left myocardial performance index (mean +/- SD: controls, 0.45 +/- 0.14; SGA, 0.51 +/- 0.08; and IUGR, 0.57 +/- 0.1; P< 0.001).
Conclusions Despite a perinatal outcome comparable to that of normal fetuses, the population of so-defined SGA fetuses showed signs of prenatal cardiac dysfunction. This supports the concept that at least a proportion of them are not 'constitutionally small' and that further research is needed. Copyright (C) 2015 ISUOG. Published by John Wiley & Sons Ltd.
Filiaciones:
Pérez-Cruz M:
BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, Spain
Cruz-Lemini M:
BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, Spain
Fernández MT:
BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, Spain
Parra JA:
BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, Spain
Casas JB:
Department of Paediatric Cardiology, Hospital Sant Joan de Déu Barcelona, Barcelona
Gómez-Roig MD:
BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, Spain
Spanish Maternal & Child Health Network Retic SAMID, Spain
Crispi F:
BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, Spain
IDIBAPS and Center for Biomedical Research on Rare Diseases (CIBER-ER), Spain
Gratacós E:
IDIBAPS and Center for Biomedical Research on Rare Diseases (CIBER-ER), Spain
BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, Spain
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