Maternal cardiac function in fetal growth restriction

Abstract

Objective To assess the maternal central haemodynamics in normotensive women with pregnancies complicated by severe fetal growth restriction (FGR).Design Cross-sectional study.Setting A tertiary referral fetal medicine unit.Population The study groups comprised 107 women with normal singleton pregnancies and 20 with singleton pregnancies complicated by FGR at 25-37 weeks. In the latter group, assessment was carried out within 10 days prior to their delivery. All the women were normotensive, without any medical problems.Methods Two-dimensional and M-mode echocardiography of the left ventricle.Main outcome measures Maternal left ventricular systolic and diastolic function.Results In the FGR group, compared with the normal group, there was increased total vascular resistance (TVR), reduced systolic function characterised by lower cardiac output, stroke volume, heart rate, ejection time and septal and lateral long-axis shortening. Mean arterial pressure (MAP) was not significantly different between the groups.Conclusions Severe FGR is associated with reduced maternal systolic function and increased TVR but no change in MAP. TVR may be a useful tool in the classification and management of FGR. The findings suggest that in FGR, there is increased blood viscosity due to lack of intravascular space expansion.

Mode of Delivery and Pregnancy Outcome in Women with Congenital Heart Disease

“…With regard to the impact of maternal cardiac function in fetal growth restriction, former studies had lower birth weight and more cases of SGA be expected in women with reduced maternal systolic function [13]. Higher rates of premature birth ranging from 17.5% [14] to 26.2% [11] were reported in previous studies.…”

Maternal Cardiac Output and Fetal Doppler Predict Adverse Neonatal Outcomes in Pregnant Women With Heart Disease

“…32 To date, published literature examining the relationship between maternal cardiac output and placental blood flow has been limited to women with structurally normal hearts. 11,33 Our study focuses on cardiac output in women with preexisting heart disease, thereby expanding the existing knowledge base. Our observations support the notion that "upstream" abnormalities in maternal cardiac output can mediate "downstream" abnormalities in fetal flow patterns, and each of these factors is independently predictive of complications in offspring.…”

“…In women with structurally normal hearts, lower maternal cardiac output, determined echocardiographically, has been associated with intrauterine growth restriction. 11 Some pregnant women with obstructive left heart disease do not display the increase in transvalvular gradients on echocardiography that would be expected with advancement of pregnancy if anticipated augmentation of cardiac output by 30% to 50% were actually occurring in those women. 12,13 Furthermore, there is an established association between cardiac conditions that limit cardiac output including severe left heart valvular stenosis and cardiomyopathy, and increased frequency of neonatal complications.…”

Restricted physical activity in pregnancy reduces maternal vascular resistance and improves fetal growth

“…Normal adaptation includes plasma volume expansion and a simultaneous reduction of TVR and systemic arterial blood pressure, primarily due to the placentation process, which ensures adequate perfusion [23][24][25][26][27][28][29][30][31] . Cardiovascular changes also include a rise in heart rate, SV, CO and inotropy indices [28][29][30][31][32][33][34][35][36] . Appropriate maternal cardiovascular adaptation to pregnancy appears to be linked to normal fetal growth [28][29][30][31][32][33][34][35] .…”