Fetal cerebral blood flow velocities in congenital diaphragmatic hernia.
OBJECTIVE
Left ventricular cardiac output is decreased in fetuses with congenital diaphragmatic hernia (CDH). Our aim was to assess whether this alters cerebral perfusion or growth in utero.


METHODS
Fetal head circumference, biparietal diameter, lung-to-head ratio and middle cerebral artery (MCA) Doppler flow patterns were assessed by ultrasonography in 103 fetuses with prenatally diagnosed CDH. Total fetal lung volume and cerebral volume were measured using magnetic resonance imaging. Values were transformed to gestational age-independent scores (multiples of the median (MoM)) and compared with controls. Subanalyses were made according to whether the CDH was left- (n = 86) or right-sided (n = 17) and to whether it was isolated (n = 86) or associated with other anomalies (n = 17).


RESULTS
MCA flow velocity was significantly lower in fetuses with CDH than in healthy fetuses (0.79 ± 0.19 MoM; P < 0.0001) but MCA pulsatility index was unchanged (0.99 ± 0.25 MoM; P = 0.79). Cranial biometry and cerebral volume in CDH fetuses fell in the normal range. Gestational age-adjusted lung area was correlated with MCA peak systolic velocity, which was in turn correlated with brain volume.


CONCLUSIONS
Fetal cerebral blood flow velocities are decreased in CDH yet cranial and cerebral growth are conserved. Further work will be needed to address whether part of the neurologic impairment observed in long-term survivors of CDH finds its origin in the prenatal period.
Van Mieghem
T
T
Division of Woman and Child, Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium.
Sandaite
I
I
Michielsen
K
K
Gucciardo
L
L
Done
E
E
Dekoninck
P
P
Claus
F
F
Deprest
J
J
D001783:Blood Flow Velocity / Q000502:physiology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003430:Cross-Sectional Studies; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005865:Gestational Age; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000503:physiopathology*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000196:embryology / Q000503:physiopathology*; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal / Q000379:methods; D016277:Ventricular Function, Left / Q000502:physiology