title: Influence of parity on fetal hemodynamics and amniotic fluid volume at term.
abstract: OBJECTIVE
  Pregnancy complications, particularly those associated with placental dysfunction, occur more frequently in nulliparous than in parous women. This difference may be a consequence of improved trophoblastic invasion and, as a result, improved placental function following previous pregnancy. Placental dysfunction in cases of fetal growth restriction may be identified by ultrasound assessment of fetoplacental hemodynamics and amniotic fluid volume. In this prospective observational study, we investigated whether differences in these measures of placental function exist between nulliparous and parous women, prior to active labor.
  
  
  METHODS
  Over a 2-year period, 456 nulliparous and 152 parous women with uncomplicated singleton pregnancies were recruited to this prospective observational study. Each participant underwent an ultrasound assessment prior to active labor, during which fetal biometry, umbilical artery, middle cerebral artery and umbilical venous Dopplers, as well as amniotic fluid volume, were assessed. All cases were followed up within 48 h of delivery. Ultrasound parameters and intrapartum outcomes were then compared between the nulliparous and parous groups.
  
  
  RESULTS
  Compared with nulliparous women, parous women had significantly higher fetal middle cerebral artery pulsatility index, cerebroplacental ratio and amniotic fluid volume. In nulliparous women, middle cerebral artery flow rate was also significantly higher and represented a greater percentage of umbilical venous flow than was observed in parous women.
  
  
  CONCLUSIONS
  Prior to the active phase of labor, ultrasound parameters indicative of placental function differ significantly between nulliparous and parous pregnancy, even amongst an uncomplicated, low-risk cohort.
authors.affiliation: Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, London, UK; Institute for Reproductive and Developmental Biology, Imperial College London, London, UK.
authors.forename: T
authors.initials: T
authors.lastname: Prior
authors.forename: E
authors.initials: E
authors.lastname: Mullins
authors.forename: P
authors.initials: P
authors.lastname: Bennett
authors.forename: S
authors.initials: S
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D000653:Amniotic Fluid / Q000000981:diagnostic imaging / Q000502:physiology*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000502:physiology*; D010298:Parity / Q000502:physiology*; D010920:Placenta / Q000502:physiology*; D011247:Pregnancy; D011446:Prospective Studies; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging / Q000502:physiology*; D014471:Umbilical Veins / Q000000981:diagnostic imaging / Q000502:physiology*; D055815:Young Adult
keywords: fetal Doppler; hemodynamics; parity; ultrasound