Abstract
Abstract
Objective
To evaluate functional relationship between fetal circulatory response to intrauterine transfusion (IUT) as a circulatory challenge and appearance of second systolic peak (P2) in middle cerebral artery (MCA) based on hemodynamic principles.
Methods
According to the concept of pulse wave (PW) propagation and reflection in adults, PWs arrive twice at cerebral circulation, as primary wave caused by left ventricle ejection and secondary after reflection in peripheral arteries. Thus adults show a biphasic contour of systolic blood flow in cerebral arteries. Similar waveforms may appear in fetal MCA-Doppler, as a response to IUT as a circulatory challenge. This is a proof-of-principle study, applying classical hemodynamic principles to fetal circulation. Accordingly, appearance of MCA-P2 may indicate vasoconstriction with increased PW reflection and timing of P2(Δt) should agree with the additional PW travel time down to reflection and return (Tr). To test this agreement, we searched our database for IUTs performed for severe fetal anemia, and compared Δt, obtained by Doppler, with Tr, obtained by hemodynamic calculation using human fetal data. Level of agreement was assessed using Bland–Altman-Plots.
Results
We identified 21 fetuses with adequate Doppler quality for Δt evaluation. In four cases (19%) MCA-P2 was observed before the intervention, and in 17 interventions (81%) thereafter; a highly significant association between IUT and P2 appearance (p < 0.001). In these 17 interventions good agreement of P2 timing was found between Doppler assessment: Δt = 80 ± 8 ms, and hemodynamic calculation: Tr = 76 ± 4 ms.
Conclusion
P2 appearance in fetal MCA-Doppler seems to indicate PW reflection due to increased vasoconstriction after IUT. Thus hemodynamic considerations might enable Doppler monitoring of fetal vasoconstriction.
Publisher
Springer Science and Business Media LLC
Subject
Obstetrics and Gynecology,General Medicine
Reference44 articles.
1. Mari G, Moise KJ Jr, Deter RL, Carpenter RJ Jr (1990) Flow velocity waveforms of the umbilical and cerebral arteries before and after intravascular transfusion. Obstet Gynecol 75(4):584–589
2. Brace RA (1989) ovine fetal cardiovascular response to packed red blood cell transfusion. Am J Obstet Gynecol 161:1367–1374
3. Fan FC, Chen RYZ, Chluessler GB, Chien S (1980) Effects of hematocrit variations on regional hemodynamics and oxygen transport in the dog. Am Physiol Soc. 238:545–522
4. Fumia FD, Edelstone DI, Holzmann IR (1884) Blood flow and oxygen delivery to fetal organs as function of fetal hematocrit. Am J Obstet Gynecol 150:274–282
5. Gonser M, Tavares M, Klee A, Hecher K (2018) A systolic shoulder in fetal middle cerebral artery Doppler wavefroms may indicate fetal pulse wave reflection and transmission to cerebral circulation—a contribution to fetal circulatory physiology. Ultraschall in Med 39:S1–S47
Cited by
2 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献