The acute effect of cordocentesis with or without fetal curarization and of intravascular transfusion upon umbilical artery waveform indices.
The systolic/end-diastolic ratio (S/D) and pulsatility and resistance indices were calculated before and after diagnostic cordocentesis in 46 fetuses, after 19 intravascular transfusions in eight fetuses, and on two occasions 45 minutes apart in eight controls. The fetus was paralyzed with pancuronium (0.3 mg/kg sonographic estimate of fetal weight) for diagnostic cordocentesis on 19 occasions (intravascularly in 17 and intramuscularly [IM] in two). Pancuronium (intravascularly in 16; IM in three) and furosemide (4 mg/kg intravenously) were administered during each transfusion. There were no significant differences between the first and second measurements for any of the three indices in the control group. Significant reductions were documented in the S/D ratio (P less than .0001), the pulsatility index (P = .043), and the resistance index (P less than .0001) after diagnostic cordocentesis. Pancuronium administration did not alter the magnitude of the decline, nor was there an association between the decline and the volume of blood removed. Significant relationships were observed between the magnitude of the decline and several respiratory blood gas measurements. As in the diagnostic cordocentesis group, there were significant reductions in each Doppler index after transfusion (S/D ratio, P = .003; pulsatility index, P = .002; resistance index, P = .0001). In addition, there was a significant relationship between gestational age and S/D ratio (r = 0.70, P = .002) in fetuses undergoing intravascular transfusion. The S/D ratio was most sensitive to changes in fetal oxygenation. We conclude that both diagnostic cordocentesis and intravascular transfusion as performed at the University of Iowa acutely lower the studied Doppler waveform indices.
Weiner
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CP
Department of Obstetrics and Gynecology, University of Iowa Medical School, Iowa City.
Anderson
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TL
D001783:Blood Flow Velocity; D001800:Blood Specimen Collection / Q000379:methods*; D001805:Blood Transfusion, Intrauterine; D005260:Female; D005312:Fetal Blood; D006801:Humans; D010197:Pancuronium; D011247:Pregnancy; D011673:Pulsatile Flow; D014465:Ultrasonics; D014469:Umbilical Arteries / Q000502:physiology*; D014655:Vascular Resistance
D010197:Pancuronium