Fetal heart rate and umbilical artery velocity variability in fetuses with congenital cardiac defects: a preliminary study.
OBJECTIVE
To examine whether variabilities in fetal heart rate and umbilical artery flow velocity are possible markers for hemodynamic dysfunction in fetuses with a congenital heart defect.


METHODS
Doppler studies of the umbilical artery velocity waveform were performed at 20-35 weeks of gestation in 13 patients with a congenital heart defect. We determined absolute and variability values for heart rate and flow velocities from umbilical artery velocity waveforms of at least 18 s duration. We compared these findings with normal controls matched for gestational age.


RESULTS
Fetuses with a congenital heart defect displayed decreased umbilical artery peak systolic and time-averaged velocities. However, variability in peak systolic and time-averaged velocities and fetal heart rate variability were increased compared with normal controls. Absolute fetal heart rates were similar between the two groups.


CONCLUSIONS
Marked cardiovascular changes occur in the fetus with a congenital heart defect compared with the normal healthy fetus. We propose that variability in fetal heart rate and umbilical artery blood flow velocity could be additional markers for impaired homeostasis in the presence of fetal congenital heart disease.
Ursem
N T
NT
Department of Obstetrics and Gynaecology, Academic Hospital Rotterdam-Dijkzigt, Erasmus University Rotterdam, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. ursem@gyna.azr.nl
Clark
E B
EB
Pagotto
L T
LT
Wladimiroff
J W
JW
D000328:Adult; D001783:Blood Flow Velocity; D003430:Cross-Sectional Studies; D005260:Female; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000503:physiopathology*; D006340:Heart Rate, Fetal / Q000502:physiology*; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D018608:Ultrasonography, Doppler / Q000379:methods; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000502:physiology*