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Lo Presti D, Tiralongo GM, Farsetti, D, Pisani I, Gagliardi G, Novelli GP, Vasapollo B, Valensise H
Presented: ICMH
Published: To be published in ISUOG after the ICMH
Objective: To identify the maternal haemodynamic condition in pregnancies affected by fetal growth restriction (FGR) and to assess the potential correlation with the fetal-maternal outcome.
Methods: 100 pregnant women underwent a non-invasive cardiovascular assessment and enrolled at the time of definition of fetal growth restriction. According to the fetal ultrasonographic features and to the gestational age at diagnosis, we collected small for gestational age (SGA) (n=50), early fetal growth restriction (eFGR) (n=32) and late fetal growth restriction (lFGR) (n=18) fetuses. Furthermore we labelled each woman only considering haemodynamic values of total vascular resistance (TVR) at the time of enrolment.
Results: We obtained a group A with low TVR (<1100 dyne-cm-sec-5) (n=58) and a group B with high TVR (>1100 dyne-cm-sec-5) (n=42). Population distribution is represented in Fig.1. Group A is composed by 66% of SGA, 17% of eFGR and 17% of lFGR whereas in group B we had 40% of SGA, 43% of eFGR and 17% lFGR. As regards the complications we noticed an elevated incidence in high TVR group. Focusing on SGA fetuses, we found 14% of incidence of complications in group B and 30% in group A.
Conclusions: We observed an overall increased risk of fetal complications in the group of women with an underlying maternal cardiovascular disorder. This impairment is expressed by a state of hypodynamic circulation with elevated TVR, a decreased preload and a poor capacity of the heart to ensure an appropriate placental perfusion. Although SGA fetuses are not defined as compromised, we have demonstrated that those with an impaired haemodynamics have worse outcome behaving like FGR fetuses. This might suggest a new definition of risk correlated to the maternal cardiovascular condition.