Time interval analysis of ductus venosus and cardiac cycles in relation with umbilical artery pH at birth in fetal growth restriction

Abstract

Background The aims of this study were to evaluate the time intervals of flow velocity waveforms (FVW) of ductus venosus (DV) and cardiac cycles, as well as the pulsatility index of DV-FVW (DV-PI), in correlation with umbilical artery (UA) pH at birth in fetal growth restriction (FGR) complicated with placental insufficiency. Methods Data were retrospectively retrieved from pregnancies complicated by FGR. FGR was defined as an estimated fetal weight below − 2.0 S.D. with an elevated UA-PI. Time interval assessments of DV-FVW were as follows: the duration of systolic wave was divided by the duration of diastolic wave and defined as DV-S/D. We also measured the following time intervals of ventricular inflow through tricuspid valve (TV) and mitral valve (MV): (iii), from the second peak of ventricular inflow caused by atrial contraction (A-wave) to the opening of atrio-ventricular valves and: (iv), from the opening of atrio-ventricular valves to the peak of A-wave. (iii)/(iv) was expressed as TV-S/D and MV-S/D, for TV and MV, respectively. The time interval data were transformed into z-scores. Results Thirty-one FGR fetuses were included in this study. Both DV-PI and DV-S/D showed significant correlation with UA-pH (r = − 0.677, p = < 0.001 and r = 0.489, p = 0.005 for DV-PI and z-score of DV-S/D, respectively) and more significances were observed in FGR ≤ 28 + 6 gestational weeks (r = − 0.819, p < 0.001 and r = 0.726, p = 0.005, for DV-PI and z-score of DV-S/D, respectively) than in FGR > 28 + 6 gestational weeks (r = − 0.634, p = 0.007 and r = 0.635, p = 0.020, for DV-PI and z-score of DV-S/D, respectively). On the other hand, TV-S/D and MV-S/D showed no significant correlation with UA-pH, although these z-scores indicated significant decreases compared with normal references. Conclusions Time interval analysis of DV-FVW might be a valuable parameter, as well as DV-PI, for the antenatal prediction of fetal acidemia in the management of FGR fetuses.

Altered Transmission of Cardiac Cycles to Ductus Venosus Blood Flow in Fetal Growth Restriction: Why Ductus Venosus Reflects Fetal Circulatory Changes More Precisely

“…The decision for delivery was made based on a non-reassuring fetal status judged by cardiotocography, and all FGR cases were delivered by cesarean section. Sixteen cases in the FGR group were included from a previous study [ 13 ]. Table 1 shows the maternal characteristics.…”

“…We previously demonstrated the systolic/diastolic time ratios of DV-FVWs and cardiac cycles, using similar methods as those in the FGR study, and the most significant decrease in systolic/diastolic ratios was observed in the DV-FVWs in severe FGR cases [ 8 ]. Furthermore, the systolic/diastolic time ratios of DV-FVWs showed a significant correlation with umbilical arterial pH at birth, as well as with the DV-PI, although the cardiac parameters did not show such a correlation [ 13 ]. These findings drove us to a further investigation in the present study; why is the fetal hemodynamic condition more discernably reflected in the time intervals of DV-FVWs than in the time-interval parameters of cardiac cycles?…”

Added value of the pulmonary vein pulsatility index and its correlation to neonatal umbilical artery pH in fetal growth restrictions: A Vietnamese matched cohort study

“…A study by Figueras et al demonstrated that in FGR cases, there was a negative correlation between UAPI and UA pH with r = -0.55 [8]. Suekane et al reported a negative correlation between the pulsatility index of the ductus venosus and UA pH (r = -0.677) [7]. In this study, we found a positive correlation between UAPI and PVPI in the FGR group (r = 0.63, 95%CI: 0.52-0.72, p < 0.0001; shown in Fig.…”

“…The Doppler indices measured from the ductus venosus, umbilical arteries, cerebro-placental, and umbilico-cerebral Doppler ratios have been shown to correlate with the well-being of fetal growth restriction, which includes umbilical artery blood pH [7][8][9]. Umbilical artery pH (UA pH) is essential for assessing adverse pregnancy outcomes since it predicts the risk that neurodevelopmental problems will manifest in childhood [10].…”

Added value of the pulmonary vein pulsatility index and its correlation to neonatal umbilical artery pH in fetal growth restrictions: a Vietnamese matched cohort study

“…The Doppler indices measured from the ductus venosus, umbilical arteries, cerebro-placental, and umbilico-cerebral Doppler ratios have been shown to correlate with the well-being of fetal growth restriction, which includes umbilical artery blood pH [ 7 – 9 ]. Umbilical artery pH (UA pH) is essential for assessing adverse pregnancy outcomes since it predicts the risk that neurodevelopmental problems will manifest in childhood [ 10 ].…”