Changes of pulsatility index from fetal vessels preceding the onset of late decelerations in growth-retarded fetuses.
Thirty-six growth-retarded fetuses selected from a population of 214 cases were studied by Doppler ultrasonography at weekly intervals for at least 4 weeks between the diagnosis of Doppler abnormalities suggestive of the existence of the brain-sparing effect (ie, ratio between umbilical artery and middle cerebral artery pulsatility indexes [PIs] above the 95th percentile of our reference limits) to the onset of antepartum late fetal heart rate (FHR) decelerations. Recordings were made from the umbilical artery, descending aorta, renal artery, internal carotid artery, and middle cerebral artery and the PIs were calculated. Statistically significant changes in PI occurred in all the vessels studied. However, different trends were found when the modifications in cerebral vessels were compared with those in fetal peripheral vascular beds and in the umbilical artery. In cerebral arteries, a nadir of vasodilatation was reached 2 weeks before the onset of antepartum late FHR decelerations, whereas significant changes in the peripheral and umbilical vessels occurred close to the onset of abnormal FHR patterns. This study demonstrates that despite a brain-sparing effect, there are further Doppler-detectable modifications in fetal circulation that differ between the cerebral and peripheral vascular beds.
Arduini
D
D
Department of Obstetrics and Gynecology, Università Cattolica S. Cuore, Rome, Italy.
Rizzo
G
G
Romanini
C
C
D002560:Cerebrovascular Circulation / Q000502:physiology; D005314:Embryonic and Fetal Development / Q000502:physiology*; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006340:Heart Rate, Fetal / Q000502:physiology*; D006801:Humans; D010927:Placental Insufficiency / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011673:Pulsatile Flow / Q000502:physiology; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000502:physiology