Blood pressure estimation in the human fetal descending aorta.
OBJECTIVE
The objectives of this study were to estimate fetal blood pressure non-invasively from two-dimensional color Doppler-derived aortic blood flow and diameter waveforms, and to compare the results with invasively derived human fetal blood pressures available from the literature.


METHODS
Aortic pressures were calculated from digitally recorded color Doppler cineloops of the fetal descending aorta by applying the Womersley model in combination with the two-element Windkessel model, assuming constant pulse wave velocity during the second half of pregnancy. The results were compared with invasively derived human fetal blood pressures obtained from the literature.


RESULTS
In 21 normal pregnancies the estimated mean aortic pressure regression line increased linearly from 28 mmHg at 20 weeks of gestation to 45 mmHg at 40 weeks of gestation. The pulse pressure based on the regression line increased linearly from 21 mmHg at 20 weeks of gestation to 29 mmHg at 40 weeks of gestation. The aortic compliance exhibited a log linear relationship with the gestational age and a statistically significant eightfold increase was observed between 20 and 40 weeks. The aortic downstream peripheral resistance exhibited an exponentially decaying relationship across the same gestational age range. Non-invasively derived aortic systolic and diastolic aortic pressures were comparable with previously reported invasively derived systolic and diastolic umbilical arterial pressures; however, the mean pressures differed significantly from those reported in the umbilical artery in a separate study. The aortic systolic pressures calculated in this study were significantly higher than invasively derived left ventricular systolic pressures that have been previously reported in the literature.


CONCLUSIONS
This study demonstrates the feasibility of estimating arterial blood pressure in the human fetus. The method described is of potential use in assessing fetal blood pressure non-invasively, particularly for studying relative changes with time.
Struijk
P C
PC
Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands. p.struijk@erasmusmc.nl
Mathews
V J
VJ
Loupas
T
T
Stewart
P A
PA
Clark
E B
EB
Steegers
E A P
EA
Wladimiroff
J W
JW
D001013:Aorta, Thoracic / Q000196:embryology / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology*; D005240:Feasibility Studies; D005333:Fetus / Q000098:blood supply*; D005865:Gestational Age; D006340:Heart Rate, Fetal / Q000502:physiology; D006801:Humans; D011673:Pulsatile Flow; D012044:Regression Analysis; D018615:Ultrasonography, Doppler, Color; D016216:Ultrasonography, Prenatal; D014655:Vascular Resistance / Q000502:physiology