3 years ago

Pre-labor fetal cardiac function and its relationship with intrapartum fetal compromise and neonatal status at term

Sailesh Kumar, Amal A. Alsolai, Larissa N. Bligh, Ristan M. Greer
Objectives To prospectively investigate the relationship between fetal cardiac function and Doppler parameters with intrapartum fetal compromise (IFC) in term appropriately grown fetuses prior to labour. Secondary outcomes were to correlate prenatal cardiac function with neonatal acid base status, intrapartum fetal heart rate abnormalities adverse neonatal outcomes. Methods This was a blinded, prospective, observational, cohort study, at the Mater Mother's Hospital, Brisbane, Australia. A cohort of 270 women with uncomplicated singleton pregnancies underwent fortnightly ultrasound from 36 weeks until delivery. Fetal cardiac output and blood flow parameters were assessed and correlated with intrapartum and neonatal outcomes. Results Two hundred and seventy women were included in the analysis, of which 18.9% had an emergency operative delivery for IFC. Fetuses that had emergency delivery for IFC showed lower mean left ventricular cardiac output (LVCO) (560 + 44 ml/min vs. 617 + 72 ml/min, p<0.001), lower mean ratio of the left to right ventricular cardiac output (LVCO/RVCO) (0.64 ± 0.11 vs. 0.55 ± 0.08, p<0.001), lower mean cerebro-placental ratio (CPR) (1.62 + 0.3 vs. 1.90 + 0.5, p<0.001), and higher mean right ventricular cardiac output (RVCO) (1026 + 176 ml/min vs. 978 + 154 ml/min, p<0.01) than those that did not. Additionally, the LVCO and CPR were lower in fetuses with adverse neonatal outcome. Conclusion Term fetuses with EFW>10th centile that develop intrapartum fetal compromise have evidence of lower left and higher right ventricular cardiac outputs which are in turn associated with poorer condition of the newborn. The fetal CPR is also positively correlated with left ventricular cardiac output.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/uog.17552

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