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Valensise H, Tiralongo GM, Lo Presti D, Farsetti, D, Pisani I, Gagliardi G, Novelli GP, Vasapollo B
Presented: ICMH
Published: To be published in ISUOG after the ICMH
Objective: To evaluate the haemodynamic patterns in women with fetal growth restriction (FGR) on nitric oxide (NO) donors who do not have a significant reduction of total vascular resistance (TVR).
Methods: 103 pregnant women were enrolled and underwent a non-invasive cardiovascular assessment at the time of diagnosis of fetal growth restriction. We divided our population into three groups according to the fetal ultrasonographic features and to the time of the onset in small for gestational age (SGA) (n=52), early foetal growth restriction (eFGR) (n=31) and late fetal growth restriction (lFGR) (n=20). We started treatment with transdermal nitric oxide donors and oral fluids considering clinical and haemodynamic severity. We repeated the haemodynamic assessment after 2 weeks.
Results: At the time of the enrolment, we observed a progressive worsening of cardiovascular assessment from SGA to early FGR pregnancies showing an underlying state of elevated TVR, lower cardiac output (CO) and higher potential to kinetic energy ratio (PKR). SGA fetuses showed intermediate cardiovascular values between controls and pathological FGR fetuses. After 2 weeks of treatment, we found an improvement of maternal cardiovascular conditions in SGA and late FGR groups compared to the untreated women. Despite of NO donors treatment, a subgroup of women showed a further impairment of haemodynamic values. The overall trends expressed in % variations are shown in Table 1 whereas in fig 1 we reported the effect of treatment in terms of hyper/hypodynamic circulation.
Conclusions: Our data have demonstrated the efficacy of NO donors treatment in fetuses with growth restriction, inducing a reduction in terms of afterload, an increase of preload and a hyperdynamic circulation. Moreover women with no effect or a worsening of haemodynamic conditions despite treatment might have an underlying severe endothelial impairment and cardiac dysfunction.