American Journal of Obstetrics and Gynecology
Meeting paperSMFM paperCardiac dysfunction and cell damage across clinical stages of severity in growth-restricted fetuses
Section snippets
Study populations
Eligible cases were singleton pregnancies that were selected from women who attended the Maternal-Fetal Medicine Department at Hospital Clinic and at Harris Birthright Research Centre for Fetal Medicine. The study protocol was approved by the Ethics Committee at each participating institution, and patients provided written informed consent.
IUGR was defined as an estimated fetal weight below the 10th percentile according to local reference curves18 together with a Doppler pulsatility index in
Characteristics of the study populations
Clinical and perinatal data are shown in TABLE 1, TABLE 2. IUGR fetuses from severity stages 2 and 3 showed lower 5-minute Apgar scores and umbilical artery pH values and higher rates of adverse perinatal outcome, compared with AGA fetuses.
Fetal echocardiography
A total of 62, 65, and 47 ultrasound explorations were performed in IUGR-stages 1, 2, and 3, respectively. Values of echocardiographic parameters in term AGA and in IUGR fetuses are shown in Figure 1. Mod-MPI was significantly higher in stage 1 and showed a
Comment
This study documents the evolution of cardiac dysfunction and cell damage in fetal growth restriction in relation with Doppler stages of severity that are used widely in clinical practice. It provides evidence that subclinical cardiac dysfunction is an early and progressive event in severe IUGR. Echocardiographic parameters and cord blood levels of BNP indicate that cardiac dysfunction increased progressively across the stages of fetal compromise. Advanced fetal Doppler deterioration was
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Cite this article as: Crispi F, Hernandez-Andrade E, Pelsers MMAL, et al. Cardiac dysfunction and cell damage across clinical stages of severity in growth-restricted fetuses. Am J Obstet Gynecol 2008;199:254.e1-254.e8.
Supported by grants from the Fondo the Investigación Sanitaria (PI0600347); Cerebra Foundation for the Brain Injured Child, Carmarthen, Wales, UK; Thrasher Research Fund (Salt Lake City, UT); and the Medical Research Council (grants G0601295 and G0700288 [A.A.; E.G.]).