Fetal hemodynamic changes following maternal betamethasone administration in pregnancies with fetal growth restriction and absent end-diastolic flow in the umbilical artery.
OBJECTIVE
To examine the effects of betamethasone administration on umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV) Doppler flow.


METHODS
Longitudinal prospective study.


METHODS
Fetal Surveillance Unit, Department of Obstetrics and Gynecology, University of São Paulo, São Paulo, Brazil.


METHODS
Thirty-two singleton pregnancies complicated by fetal growth restriction with absent end-diastolic flow in the UA.


METHODS
Pulsatility index (PI) of the UA, MCA and DV was measured from 26 to 34 weeks prior to and within 24 or 48 hours after starting betamethasone treatment course. Analysis of variance for repeated measures was used to determine the changes in the fetal hemodynamic Doppler flow following maternal corticosteroid administration.


METHODS
Improvement of UA-PI within 24 hours and DV-PIV (venous pulsatility) within 48 hours from the first betamethasone dose.


RESULTS
Mean gestational age at delivery was 29.3 (+/-1.8) weeks and birthweight was 806.6 (+/-228.2) g. A reduction in the UA-PI was observed in 29 (90.6%) cases, with return of end-diastolic flow in 22 (68.7%). The mean UA-PI were 2.84 (+/-0.52) before corticosteroid administration, 2.07 (+/-0.56) within 24 hours and 2.42 (+/-0.75) after 48 hours, with a significant difference along the evaluations (p<0.001). No significant changes in the MCA Doppler were observed. DV-PIV decreased from 1.06 (+/-0.23) prior corticosteroids administration to 0.73 (+/-0.16) within 24 hours and 0.70 (+/-0.19) after 48 hours (p<0.001).


CONCLUSIONS
There was reduction in the umbilical artery and in the DV pulsatility indices within 24 hours from betamethasone administration that was maintained up to 48 hours.
Nozaki
Alexandre M
AM
Fetal Surveillance Unit, Department of Obstetrics and Gynecology, University of São Paulo, São Paulo, Brazil. alexandrenozaki@globo.com
Francisco
Rossana P V
RP
Fonseca
Eduardo S V B
ES
Miyadahira
Seizo
S
Zugaib
Marcelo
M
D001623:Betamethasone / Q000494:pharmacology* / Q000627:therapeutic use; D001783:Blood Flow Velocity; D005260:Female; D005317:Fetal Growth Retardation / Q000503:physiopathology*; D005318:Fetal Heart / Q000000981:diagnostic imaging / Q000187:drug effects / Q000502:physiology; D005333:Fetus / Q000098:blood supply; D005865:Gestational Age; D005938:Glucocorticoids / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D008137:Longitudinal Studies; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000187:drug effects / Q000502:physiology; D011247:Pregnancy; D011673:Pulsatile Flow; D012039:Regional Blood Flow / Q000187:drug effects; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000502:physiology
D005938:Glucocorticoids; D001623:Betamethasone