Multivariable evaluation of maternal hemodynamic profile in pregnancy complicated by fetal growth restriction: prospective study

Martino, Daniela Di; Ferrazzi, E.; Garbin, M.; Fusè, F.; Izzo, Tiziana; Duvekot, Jorieke; Farina, Antonio

doi:10.1002/uog.20118

Cited by 10 publications

(17 citation statements)

References 29 publications

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“…Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) v. 22. The sample size estimation was based on a previous echocardiographic study, which reported a 10% lower maternal CO in normotensive women with FGR fetuses compared with women with appropriate‐for‐gestational‐age fetuses 27 . We calculated that the enrollment of 26 women either in the FGR and appropriate‐for‐gestational‐age group was needed to show a a 10% lower CO in the former group at 80% power and at a significance level of .05.…”

Section: Methodsmentioning

confidence: 99%

Hemodynamic findings in normotensive women with small‐for‐gestational‐age and growth‐restricted fetuses

Pasquo

Ghi

Dall’Asta

et al. 2020

Acta Obstet Gynecol Scand

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Introduction Fetal growth restriction (FGR) in most instances is a consequence of primary placental dysfunction due to inadequate trophoblastic invasion. Maternal cardiac maladaptation to pregnancy has been proposed as a possible determinant of placental insufficiency and impaired fetal growth. This study aimed to compare the maternal hemodynamic parameters between normotensive women with small‐for‐gestational‐age (SGA) and FGR fetuses and to evaluate their correlation with neonatal outcome. Material and methods An observational cohort study including singleton pregnancies referred to our tertiary care center due to fetal smallness. At the time of diagnosis, fetuses were classified as SGA or FGR according to the Delphi consensus criteria, and pregnant women underwent hemodynamic assessment using a cardiac output monitor. A group of women with singleton uncomplicated pregnancies ar ≥35 weeks of gestation were recruited as controls. Cardiac output, systemic vascular resistance, stroke volume, and heart rate were measured and compared among the three groups (controls vs FGR vs SGA). The correlation between antenatal findings and neonatal outcome was also evaluated by multivariate logistic regression analysis. Results A total of 51 women with fetal smallness were assessed at 34.8 ± 2.6 weeks. SGA and FGR were diagnosed in 22 and 29 cases, respectively. The control group included 61 women assessed at 36.5 ± 0.8 weeks of gestation. Women with FGR had a lower cardiac output Z‐score (respectively, −1.3 ± 1.2 vs −0.4 ± 0.8 vs −0.2 ± 1.0; P < .001) and a higher systemic vascular resistance Z‐score (respectively, 1.2 ± 1.2 vs 0.2 ± 1.1 vs −0.02 ± 1.2; P < .001) compared with both SGA and controls, whereas no difference in the hemodynamic parameters was found between women with SGA and controls. The incidence of neonatal intensive care unit admission did not differ between SGA and FGR fetuses (18.2% vs 41.4%; P = .13), but FGR fetuses had a longer hospitalization compared with SGA fetuses (14.2 ± 17.7 vs 4.5 ± 1.6 days; P = .02). Multivariate analysis showed that the cardiac output Z‐score at diagnosis (P = .012) and the birthweight Z‐score (P = .007) were independent predictors of the length of neonatal hospitalization. Conclusions Different maternal hemodynamic profiles characterize women with SGA or FGR fetuses. Furthermore, a negative correlation was found between the maternal cardiac output and the length of neonatal hospitalization.

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Section: Methodsmentioning

confidence: 99%

Hemodynamic findings in normotensive women with small‐for‐gestational‐age and growth‐restricted fetuses

Pasquo

Ghi

Dall’Asta

et al. 2020

Acta Obstet Gynecol Scand

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“…In an uncomplicated pregnancy, there is a positive correlation between CO change from preconception to mid-gestation and neonatal birth weight ( 18 ). During pregnancy from the first trimester onward, maternal CO is directly related to singleton birth weight ( 19 – 21 ), particularly at advanced maternal age ( 22 ), with parity ( 23 ), and multiple pregnancies ( 24 ), whereas there is an inverse relation with altitude ( 25 ) and gestational hypertensive disorders ( 26 , 27 ). Figure 1 shows the gestational trends of CO and TVR as measured by the bioimpedance technology: contrary to pregnancies eventually developing PE, the evolution is similar in FGR and uncomplicated pregnancy, however, at lower CO and higher TVR ( 10 , 11 , 28 ).…”

Section: Maternal Hemodynamics and Fetal Growthmentioning

confidence: 99%

Maternal Low Volume Circulation Relates to Normotensive and Preeclamptic Fetal Growth Restriction

Gyselaers

Lees

2022

Front. Med.

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This narrative review summarizes current evidence on the association between maternal low volume circulation and poor fetal growth. Though much work has been devoted to the study of cardiac output and peripheral vascular resistance, a low intravascular volume may explain why high vascular resistance causes hypertension in women with preeclampsia (PE) that is associated with fetal growth restriction (FGR) and, at the same time, presents with normotension in FGR itself. Normotensive women with small for gestational age babies show normal gestational blood volume expansion superimposed upon a constitutionally low intravascular volume. Early onset preeclampsia (EPE; occurring before 32 weeks) is commonly associated with FGR, and poor plasma volume expandability may already be present before conception, thus preceding gestational volume expansion. Experimentally induced low plasma volume in rodents predisposes to poor fetal growth and interventions that enhance plasma volume expansion in FGR have shown beneficial effects on intrauterine fetal condition, prolongation of gestation and birth weight. This review makes the case for elevating the maternal intravascular volume with physical exercise with or without Nitric Oxide Donors in FGR and EPE, and evaluating its role as a potential target for prevention and/or management of these conditions.

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“…Similarly, fewer than half of participants evaluated maternal hemodynamics in the presence of FGR. Pregnancies complicated by placental insufficiency are characterized by a specific maternal hemodynamic profile that appears to be more marked in the case of severe FGR 30 . Despite this emerging evidence, this evaluation is still not recommended nor it is widespread in the clinical setting.…”

Section: Discussionmentioning

confidence: 99%

“…30 Despite this emerging evidence, this evaluation is still not recommended nor it is widespread in the clinical setting. It is surprising that almost half of the participants gave a positive answer TA B L E 3…”

mentioning

confidence: 99%

Current practice in the diagnosis and management of fetal growth restriction: An international survey

Fantasia

Zamagni

Lees

et al. 2022

Acta Obstet Gynecol Scand

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Introduction:The aim of this survey was to evaluate the current practice in respect of diagnosis and management of fetal growth restriction among obstetricians in different countries.Material and methods: An e-questionnaire was sent via REDCap with "click thru" links in emails and newsletters to obstetric practitioners in different countries and settings with different levels of expertise. Clinical scenarios in early and late fetal growth restriction were given, followed by structured questions/response pairings. Results: A total of 275 participants replied to the survey with 87% of responses complete. Participants were obstetrician/gynecologists (54%; 148/275) and fetal medicine specialists (43%; 117/275), and the majority practiced in a tertiary teaching hospital (56%; 153/275). Delphi consensus criteria for fetal growth restriction diagnosis were used by 81% of participants (223/275) and 82% (225/274) included a drop in fetal growth velocity in their diagnostic criteria for late fetal growth restriction. For early fetal growth restriction, TRUFFLE criteria were used for fetal monitoring and delivery timing by 81% (223/275). For late fetal growth restriction, indices of cerebral blood flow redistribution were used by 99% (250/252), most commonly cerebroplacental ratio (54%, 134/250). Delivery timing was informed by cerebral blood flow redistribution in 72% (176/244), used from ≥32 weeks of gestation. Maternal biomarkers and hemodynamics, as additional tools in the context of early-onset fetal growth restriction (≤32 weeks of gestation), were used by 22% (51/232) and 46% (106/230), respectively. Conclusions: The diagnosis and management of fetal growth restriction are fairly homogeneous among different countries and levels of practice, particularly for early fetal growth restriction. Indices of cerebral flow distribution are widely used in the diagnosis and management of late fetal growth restriction, whereas maternal biomarkers and hemodynamics are less frequently assessed but more so in early rather than

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Multivariable evaluation of maternal hemodynamic profile in pregnancy complicated by fetal growth restriction: prospective study

Cited by 10 publications

References 29 publications

Hemodynamic findings in normotensive women with small‐for‐gestational‐age and growth‐restricted fetuses

Hemodynamic findings in normotensive women with small‐for‐gestational‐age and growth‐restricted fetuses

Maternal Low Volume Circulation Relates to Normotensive and Preeclamptic Fetal Growth Restriction

Current practice in the diagnosis and management of fetal growth restriction: An international survey

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