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Changes in regional fetal cerebral blood flow perfusion in relation to hemodynamic deterioration in severely growth-restricted fetuses

Hernandez-Andrade, E. ; Figueroa-Diesel, H. ; Jansson, Tomas LU ; Rangel-Nava, H. and Gratacos, E. (2008) In Ultrasound in Obstetrics & Gynecology 32(1). p.71-76
Abstract
Objectives To study regional cerebral blood perfusion with power Doppler ultrasound (PDU) imaging in appropriate-for-gestational age (AGA) fetuses and those with intrauterine growth restriction (IUGR) at different hemodynamic stages of fetal deterioration. Methods Brain blood perfusion was studied with PDU imaging, and the fractional moving blood volume (FMB V) was estimated in 56 growth-restricted and 56 AGA matched fetuses at 26-32 weeks of gestation. Fetuses with IUGR were classified according to progressi. on of hemodynamic deterioration as follows: Group 1, abnormal umbilical artery (UA) pulsatility index (PI) (mean > 2 SD, n = 13); Group 2, abnormal UA-PI and middle cerebral artery (MCA) PI (mean < 2 SD, n = IS); Group 3,... (More)
Objectives To study regional cerebral blood perfusion with power Doppler ultrasound (PDU) imaging in appropriate-for-gestational age (AGA) fetuses and those with intrauterine growth restriction (IUGR) at different hemodynamic stages of fetal deterioration. Methods Brain blood perfusion was studied with PDU imaging, and the fractional moving blood volume (FMB V) was estimated in 56 growth-restricted and 56 AGA matched fetuses at 26-32 weeks of gestation. Fetuses with IUGR were classified according to progressi. on of hemodynamic deterioration as follows: Group 1, abnormal umbilical artery (UA) pulsatility index (PI) (mean > 2 SD, n = 13); Group 2, abnormal UA-PI and middle cerebral artery (MCA) PI (mean < 2 SD, n = IS); Group 3, abnormal UA-PI, MCA-PI and ductus venosus (D V) PI (mean > 2 SD) but atrial (a-wave) flow present (n = 16); and Group 4, absent or reversed DV atrial flow (n = 12). FMBV was calculated in the complete mid-sagittal, frontal, basal ganglia and cerebellar regions. Results In all growth-restricted fetuses, FMBV was significantly increased in all regions. Fetuses in Group 1 showed considerable increments in FMBV values in the frontal, complete mid-sagittal and cerebellar regions, and a mild increase in the basal ganglia. From Groups 2 to 4, there was a steady reduction (compared with Group 1) in frontal FMBV values (F = 3.25, P = 0.027) together with a significant increment in the basal ganglia values (F = 11.61, P < 0.001). A trend for increasing FMBV values was also observed in the cerebellum, whereas a decreasing trend was noted in the complete mid-sagittal area. Conclusions Brain perfusion in growth-restricted fetuses shows clear regional variations, which change with progression of hemodynamic deterioration. After an initial and early increase in the frontal area, progression of fetal deterioration was rapidly associated with a pronounced decrease in frontal perfusion, together with an increase towards the basal ganglia. Copyright (c) 2008 ISUOG. Published by John Wiley & Sons, Ltd. (Less)
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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
volume, fractional moving blood, fetal hypoxia, blood perfusion, fetal brain, intrauterine growth restriction, power Doppler
in
Ultrasound in Obstetrics & Gynecology
volume
32
issue
1
pages
71 - 76
publisher
John Wiley & Sons Inc.
external identifiers
  • wos:000258009500013
  • scopus:54849405348
  • pmid:18570240
ISSN
1469-0705
DOI
10.1002/uog.5377
language
English
LU publication?
yes
id
fb7c7e8e-1761-4618-9abe-6a4be0c348ff (old id 1253559)
date added to LUP
2016-04-01 13:44:25
date last changed
2025-03-15 00:09:23
@article{fb7c7e8e-1761-4618-9abe-6a4be0c348ff,
  abstract     = {{Objectives To study regional cerebral blood perfusion with power Doppler ultrasound (PDU) imaging in appropriate-for-gestational age (AGA) fetuses and those with intrauterine growth restriction (IUGR) at different hemodynamic stages of fetal deterioration. Methods Brain blood perfusion was studied with PDU imaging, and the fractional moving blood volume (FMB V) was estimated in 56 growth-restricted and 56 AGA matched fetuses at 26-32 weeks of gestation. Fetuses with IUGR were classified according to progressi. on of hemodynamic deterioration as follows: Group 1, abnormal umbilical artery (UA) pulsatility index (PI) (mean &gt; 2 SD, n = 13); Group 2, abnormal UA-PI and middle cerebral artery (MCA) PI (mean &lt; 2 SD, n = IS); Group 3, abnormal UA-PI, MCA-PI and ductus venosus (D V) PI (mean &gt; 2 SD) but atrial (a-wave) flow present (n = 16); and Group 4, absent or reversed DV atrial flow (n = 12). FMBV was calculated in the complete mid-sagittal, frontal, basal ganglia and cerebellar regions. Results In all growth-restricted fetuses, FMBV was significantly increased in all regions. Fetuses in Group 1 showed considerable increments in FMBV values in the frontal, complete mid-sagittal and cerebellar regions, and a mild increase in the basal ganglia. From Groups 2 to 4, there was a steady reduction (compared with Group 1) in frontal FMBV values (F = 3.25, P = 0.027) together with a significant increment in the basal ganglia values (F = 11.61, P &lt; 0.001). A trend for increasing FMBV values was also observed in the cerebellum, whereas a decreasing trend was noted in the complete mid-sagittal area. Conclusions Brain perfusion in growth-restricted fetuses shows clear regional variations, which change with progression of hemodynamic deterioration. After an initial and early increase in the frontal area, progression of fetal deterioration was rapidly associated with a pronounced decrease in frontal perfusion, together with an increase towards the basal ganglia. Copyright (c) 2008 ISUOG. Published by John Wiley &amp; Sons, Ltd.}},
  author       = {{Hernandez-Andrade, E. and Figueroa-Diesel, H. and Jansson, Tomas and Rangel-Nava, H. and Gratacos, E.}},
  issn         = {{1469-0705}},
  keywords     = {{volume; fractional moving blood; fetal hypoxia; blood perfusion; fetal brain; intrauterine growth restriction; power Doppler}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{71--76}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Ultrasound in Obstetrics & Gynecology}},
  title        = {{Changes in regional fetal cerebral blood flow perfusion in relation to hemodynamic deterioration in severely growth-restricted fetuses}},
  url          = {{http://dx.doi.org/10.1002/uog.5377}},
  doi          = {{10.1002/uog.5377}},
  volume       = {{32}},
  year         = {{2008}},
}