The relationship between an aortic isthmus blood flow velocity index and the postnatal neurodevelopmental status of fetuses with placental circulatory insufficiency

Sequence of changes in myocardial performance index in relation to aortic isthmus and ductus venosus Doppler in fetuses with early‐onset intrauterine growth restriction

“…During the study period a total of 430 scans were performed on 115 IUGR fetuses (median 3, range [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. The proportion of cases with two, three or more than three examinations was 43.5, 34.8 and 21.7%, respectively.…”

“…We and others have previously reported that in IUGR fetuses AoI flow becomes abnormal on average 1 week earlier than does DV flow 16,17 , which may help to explain its reported poor short-term use in the prediction of fetal death 34 . However, AoI flow has shown a strong association with neurological outcome 15 . In these respects, the steep rate of progression shown in this and previous studies 16,17 suggests an opportunity to explore the value of combining AoI flow with DV flow for the prediction of fetal neurological morbidity.…”

“…The association of increased AoI impedance with adverse perinatal and long-term neurodevelopmental outcome has been well demonstrated 14,15 . Longitudinal studies suggest that AoI abnormalities precede the occurrence of abnormal DV flow 16,17 , an observation which might open opportunities for the combined use of these two parameters.…”

Fetal Cardiac Intervention

“…Fouron 27 has investigated the importance of the aortic isthmus as a branch point in the fetal circulation and has correlated retrograde arch perfusion with impaired neurodevelopmental follow-up. 28 We have found that fetuses with HLHS and retrograde arch perfusion have a high incidence of altered cerebral blood flow with increased end-diastolic flow velocity and decreased arterial pulsatility, consistent with an autoregulatory drop in cerebrovascular resistance. 29 These findings are consistent with the altered cerebral-placental ratio of resistance that is observed in fetuses with placental insufficiency and growth retardation in which the centralization of blood flow distribution represents an effort at "headsparing."…”

Early onset fetal growth restriction

“…Retrograde flow in the AoI in growth-restricted fetuses correlates strongly with adverse perinatal outcome and neurological deficit in the infant [83,84].…”