Doppler velocimetry and fetal heart rate studies in nephropathic diabetics.
OBJECTIVE
Our objectives were to determine in pregnancies complicated by diabetic nephropathy (1) if impedance to flow in the uterine and umbilical arteries is normal and (2) if these fetuses are hypoxemic and acidemic and if they have decreased fetal heart rate variation and Doppler blood flow redistribution.


METHODS
In a cross-sectional study at the Harris Birthright Research Centre for Fetal Medicine, London, serial assessment of fetal heart rate variation and Doppler velocimetry of the placental and fetal circulations was undertaken in six pregnancies complicated by diabetic nephropathy. In all cases cordocentesis was performed within 24 hours before delivery for the measurement of umbilical venous blood gases.


RESULTS
Cordocentesis demonstrated these fetuses to be hypoxemic and acidemic. The fetal heart rate variation was decreased; however, impedance to flow in the uterine artery was normal, and increased impedance to flow in the umbilical artery with evidence of blood flow redistribution was observed in only one case.


CONCLUSIONS
Fetal hypoxemia and acidemia in pregnancies complicated by diabetic nephropathy is not a consequence of impaired placental perfusion, and the degree of metabolic derangement may be obscured by the apparent normal growth and failure of these fetuses to demonstrate blood flow redistribution.
Salvesen
D R
DR
Harris Birthright Research Centre for Fetal Medicine, Department of Obstetrics and Gynaecology, London, England.
Higueras
M T
MT
Brudenell
J M
JM
Drury
P L
PL
Nicolaides
K H
KH
D000328:Adult; D001783:Blood Flow Velocity; D017218:Cordocentesis; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000503:physiopathology*; D005260:Female; D005312:Fetal Blood / Q000378:metabolism; D005315:Fetal Diseases / Q000503:physiopathology; D006340:Heart Rate, Fetal / Q000502:physiology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D000860:Hypoxia / Q000503:physiopathology; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000503:physiopathology*; D012212:Rheology; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000503:physiopathology; D014599:Uterus / Q000098:blood supply; D014655:Vascular Resistance