Fetal cardiac dysfunction in preterm premature rupture of membranes

Romero, Roberto; Espinoza, Jimmy; Gonçalves, L. F.; Gomez, Ricardo; Medina, Lorena; Silva, M; Chaiworapongsa, Tinnakorn; Yoon, Byungun; Ghezzi, Fabio; Lee, W; Treadwell, Marjorie C.; Berry, S M; Maymon, Eli; Mazor, Moshe; DeVore, G R

doi:10.1080/jmf.16.3.146.157

Cited by 94 publications

(51 citation statements)

References 54 publications

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“…In uncontrolled diabetic pregnant women, Wong et al [24] also reported a reduction in the E/A ratios, mainly in the right ventricle, reflecting early fetal cardiac adaptation. In fetuses with premature rupture of membranes and microbial invasion of the amniotic cavity, Romero et al [25] showed an increment in E/A velocities and ratios in both cardiac ventricles, also indicating early cardiac dysfunction in these fetuses.…”

Section: Clinical Implications Of the E/a Ratios And Outflow Tractsmentioning

confidence: 99%

Evaluation of Conventional Doppler Fetal Cardiac Function Parameters: E/A Ratios, Outflow Tracts, and Myocardial Performance Index

et al. 2012

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Structural evaluation of the fetal heart is well established. Functional evaluation using pulsed-wave Doppler may also be performed. E/A ratios express the relationship between the maximal velocities of the E and A waveforms of ventricular filling. In normal fetuses, E/A ratios are usually <1 but show a constant increment during gestation, mainly related to the increment of the E wave. In intrauterine growth restriction (IUGR) fetuses, E/A ratios are lower compared to values in normally grown fetuses at the same gestational age. Cardiac outflows provide information on the time-velocity integral that, combined with the vessel area, allows calculation of the left and right cardiac outputs. In normal fetuses there is a predominance of the right ventricle (55–60%) in contributing to the combined cardiac output. In IUGR fetuses this predominance shifts to the left ventricle in order to increase the flow to the upper part of the fetal body and brain. The myocardial performance index (MPI) also provides information on systolic and diastolic cardiac function. The MPI is an early and consistent marker of cardiac dysfunction which becomes altered in early stages of chronic hypoxia or in cases with cardiac overload such as in twin-to-twin transfusion syndrome.

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Section: Clinical Implications Of the E/a Ratios And Outflow Tractsmentioning

confidence: 99%

Evaluation of Conventional Doppler Fetal Cardiac Function Parameters: E/A Ratios, Outflow Tracts, and Myocardial Performance Index

et al. 2012

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“…Preterm rupture of membranes, particularly in cases with intra-amniotic infection, is associated with changes in fetal cardiac function consistent with increased left ventricular compliance and systolic dysfunction measured as an increased E/A ratio [131,132], shorter ejection time [133], and ventricular strain [132]. …”

Section: Research and Clinical Applications Of Fetal Cardiac Functionmentioning

confidence: 99%

Fetal Cardiac Function: Technical Considerations and Potential Research and Clinical Applications

2012

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Fetal echocardiography was initially used to detect structural anomalies but has more recently also been proposed to assess fetal cardiac function. This review summarizes technical issues and limitations in fetal cardiac function evaluation, as well as its potential research and clinical applications. Functional echocardiography has been demonstrated to select high-risk populations and to be associated with outcome in several fetal conditions including intrauterine growth restriction, twin-to-twin transfusion syndrome, maternal diabetes, and congenital diaphragmatic hernia. Fetal heart evaluation is challenging due to the smallness and high heart rate of the fetus and restricted access to the fetus far from the transducer. Due to these limitations and differences in cardiac function which are related to fetal maturation, cardiovascular parameters should be validated in the fetus and used with caution. Despite these precautions, in expert hands and with appropriate ultrasound equipment, evaluation of cardiac function is feasible in most fetuses. Functional fetal echocardiography is a promising tool that may soon be incorporated into clinical practice. Research is warranted to further refine the contribution of fetal cardiac assessment to the diagnosis, monitoring, or prediction of outcomes in various fetal conditions.

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“…This condition has been operationally defined as an elevation in fetal plasma IL-6 concentration, and is a risk factor for spontaneous preterm labour, neonatal morbidity and mortality, as well as multisystemic involvement (cardiac dysfunction [419,420], adrenal stress response [421], neurologic injury [422][423][424][425][426][427][428][429][430][431][432][433][434][435][436][437][438], as well as lung disease [128,[439][440][441][442][443][444][445]) (Figure 3). The relevance of this is that the identification of the patient with intra-amniotic inflammation has become a priority to select a patient in whom tocolysis would be futile, and who may benefit from antimicrobial and anti-inflammatory agents.…”

Section: Inflammation As a Mechanism For Term And Preterm Parturitionmentioning

confidence: 99%

The preterm parturition syndrome and its implications for understanding the biology, risk assessment, diagnosis, treatment and prevention of preterm birth

Gotsch

Romero²,

Erez

et al. 2009

The Journal of Maternal-Fetal & Neonatal Medicine

117

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Fetal cardiac dysfunction in preterm premature rupture of membranes

Cited by 94 publications

References 54 publications

Evaluation of Conventional Doppler Fetal Cardiac Function Parameters: E/A Ratios, Outflow Tracts, and Myocardial Performance Index

Evaluation of Conventional Doppler Fetal Cardiac Function Parameters: E/A Ratios, Outflow Tracts, and Myocardial Performance Index

Fetal Cardiac Function: Technical Considerations and Potential Research and Clinical Applications

The preterm parturition syndrome and its implications for understanding the biology, risk assessment, diagnosis, treatment and prevention of preterm birth

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