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Hemodinámica materna, biometría fetal e índices doppler en embarazos controlados por sospecha de restricción del crecimiento fetal

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Hemodinámica materna, biometría fetal e índices doppler en embarazos controlados por sospecha de restricción del crecimiento fetal. / Roberts, L. A.; Ling, H. Z.; Poon, L. C. et al.

In: Ultrasound in Obstetrics and Gynecology, Vol. 52, No. 4, 01.10.2018, p. 507-514.

Research output: Contribution to journalArticlepeer-review

Harvard

Roberts, LA, Ling, HZ, Poon, LC, Nicolaides, KH & Kametas, NA 2018, 'Hemodinámica materna, biometría fetal e índices doppler en embarazos controlados por sospecha de restricción del crecimiento fetal', Ultrasound in Obstetrics and Gynecology, vol. 52, no. 4, pp. 507-514. https://doi.org/10.1002/uog.19067

APA

Roberts, L. A., Ling, H. Z., Poon, L. C., Nicolaides, K. H., & Kametas, N. A. (2018). Hemodinámica materna, biometría fetal e índices doppler en embarazos controlados por sospecha de restricción del crecimiento fetal. Ultrasound in Obstetrics and Gynecology, 52(4), 507-514. https://doi.org/10.1002/uog.19067

Vancouver

Roberts LA, Ling HZ, Poon LC, Nicolaides KH, Kametas NA. Hemodinámica materna, biometría fetal e índices doppler en embarazos controlados por sospecha de restricción del crecimiento fetal. Ultrasound in Obstetrics and Gynecology. 2018 Oct 1;52(4):507-514. https://doi.org/10.1002/uog.19067

Author

Roberts, L. A. ; Ling, H. Z. ; Poon, L. C. et al. / Hemodinámica materna, biometría fetal e índices doppler en embarazos controlados por sospecha de restricción del crecimiento fetal. In: Ultrasound in Obstetrics and Gynecology. 2018 ; Vol. 52, No. 4. pp. 507-514.

Bibtex Download

@article{f488b71c8bf84b22a6c48462e519a073,
title = "Hemodin{\'a}mica materna, biometr{\'i}a fetal e {\'i}ndices doppler en embarazos controlados por sospecha de restricci{\'o}n del crecimiento fetal",
abstract = "Objectives To assess whether, in a cohort of patients with a small-for-gestational-age (SGA) fetus with estimated fetal weight ≤ 10th percentile, maternal hemodynamics, fetal biometry and Doppler indices at presentation can predict the subsequent development of an abnormal fetal Doppler index or delivery of a baby with birth weight < 3rd percentile. Methods This was a prospective observational cohort study conducted at a specialist clinic for the management of pregnancies with a SGA fetus at King{\textquoteright}s College Hospital, London, UK. The study population comprised 86 singleton pregnancies with a SGA fetus, presenting at a median gestational age of 32 (range, 26–35) weeks. We measured maternal cardiac function using a non-invasive transthoracic bioreactance monitor, as well as mean arterial pressure, fetal biometry, and umbilical artery (UA), fetal middle cerebral artery (MCA) and uterine artery (UtA) pulsatility indices (PI), and the deepest vertical pool of amniotic fluid. Z-scores of these variables were calculated based on reported reference ranges and the values were compared between pregnancies with evidence of an abnormal fetal Doppler index at presentation (Group 1), those that had developed an abnormal Doppler index at a subsequent visit (Group 2) and those that did not develop an abnormal Doppler index throughout pregnancy (Group 3). Abnormal fetal Doppler was defined as UA-PI > 95th percentile and/ or MCA-PI < 5th percentile. Differences in measured variables at presentation were also compared between pregnancies delivering a baby with birth weight <3rd percentile and those delivering a baby with birth weight ≥ 3rd percentile. Multivariate logistic regression analysis was used to determine significant predictors of birth weight < 3rd percentile and evolution from normal to abnormal fetal Doppler. Results In the study population, 14 (16%) cases were in Group 1, 19 (22%) in Group 2 and 53 (62%) in Group 3. Birth weight was < 3rd percentile in 39 (45%) cases and ≥ 3rd percentile in 47 (55%). There was decreased cardiac output and stroke volume and increased peripheral vascular resistance compared with a normal population, and the deviations from normal were most marked in Group 1. Pregnancies with birth weight <3rd percentile, compared with those with birth weight ≥ 3rd percentile, had greater deviations from normal in fetal biometry, maternal cardiac output, stroke volume, heart rate, peripheral vascular resistance and UtA-PI. Multivariate logistic regression analysis demonstrated that, in the prediction of birth weight < 3rd percentile, maternal hemodynamic profile provided significant improvement to the prediction provided by maternal demographics, fetal biometry, UtA-PI, UA-PI and MCA-PI (differ-ence between areas under receiver –operating characteristics curves, 0.18 (95% CI, 0.06–0.29); P = 0.002). In contrast, there was no significant independent contribution from maternal hemodynamics in the prediction of the subsequent development of abnormal fetal Doppler. Conclusions In pregnancies with a SGA fetus, there is decreased maternal cardiac output and stroke volume and increased peripheral vascular resistance, and the deviations from normal are most marked in cases of redistribution in the fetal circulation and reduced amniotic fluid volume.",
keywords = "Cardiac output, Fetal growth restriction, Hemodynamics, Pregnancy, Small-for-gestational age",
author = "Roberts, {L. A.} and Ling, {H. Z.} and Poon, {L. C.} and Nicolaides, {K. H.} and Kametas, {N. A.}",
year = "2018",
month = oct,
day = "1",
doi = "10.1002/uog.19067",
language = "Spanish",
volume = "52",
pages = "507--514",
journal = "Ultrasound in Obstetrics and Gynecology",
issn = "0960-7692",
publisher = "John Wiley and Sons Ltd",
number = "4",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Hemodinámica materna, biometría fetal e índices doppler en embarazos controlados por sospecha de restricción del crecimiento fetal

AU - Roberts, L. A.

AU - Ling, H. Z.

AU - Poon, L. C.

AU - Nicolaides, K. H.

AU - Kametas, N. A.

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Objectives To assess whether, in a cohort of patients with a small-for-gestational-age (SGA) fetus with estimated fetal weight ≤ 10th percentile, maternal hemodynamics, fetal biometry and Doppler indices at presentation can predict the subsequent development of an abnormal fetal Doppler index or delivery of a baby with birth weight < 3rd percentile. Methods This was a prospective observational cohort study conducted at a specialist clinic for the management of pregnancies with a SGA fetus at King’s College Hospital, London, UK. The study population comprised 86 singleton pregnancies with a SGA fetus, presenting at a median gestational age of 32 (range, 26–35) weeks. We measured maternal cardiac function using a non-invasive transthoracic bioreactance monitor, as well as mean arterial pressure, fetal biometry, and umbilical artery (UA), fetal middle cerebral artery (MCA) and uterine artery (UtA) pulsatility indices (PI), and the deepest vertical pool of amniotic fluid. Z-scores of these variables were calculated based on reported reference ranges and the values were compared between pregnancies with evidence of an abnormal fetal Doppler index at presentation (Group 1), those that had developed an abnormal Doppler index at a subsequent visit (Group 2) and those that did not develop an abnormal Doppler index throughout pregnancy (Group 3). Abnormal fetal Doppler was defined as UA-PI > 95th percentile and/ or MCA-PI < 5th percentile. Differences in measured variables at presentation were also compared between pregnancies delivering a baby with birth weight <3rd percentile and those delivering a baby with birth weight ≥ 3rd percentile. Multivariate logistic regression analysis was used to determine significant predictors of birth weight < 3rd percentile and evolution from normal to abnormal fetal Doppler. Results In the study population, 14 (16%) cases were in Group 1, 19 (22%) in Group 2 and 53 (62%) in Group 3. Birth weight was < 3rd percentile in 39 (45%) cases and ≥ 3rd percentile in 47 (55%). There was decreased cardiac output and stroke volume and increased peripheral vascular resistance compared with a normal population, and the deviations from normal were most marked in Group 1. Pregnancies with birth weight <3rd percentile, compared with those with birth weight ≥ 3rd percentile, had greater deviations from normal in fetal biometry, maternal cardiac output, stroke volume, heart rate, peripheral vascular resistance and UtA-PI. Multivariate logistic regression analysis demonstrated that, in the prediction of birth weight < 3rd percentile, maternal hemodynamic profile provided significant improvement to the prediction provided by maternal demographics, fetal biometry, UtA-PI, UA-PI and MCA-PI (differ-ence between areas under receiver –operating characteristics curves, 0.18 (95% CI, 0.06–0.29); P = 0.002). In contrast, there was no significant independent contribution from maternal hemodynamics in the prediction of the subsequent development of abnormal fetal Doppler. Conclusions In pregnancies with a SGA fetus, there is decreased maternal cardiac output and stroke volume and increased peripheral vascular resistance, and the deviations from normal are most marked in cases of redistribution in the fetal circulation and reduced amniotic fluid volume.

AB - Objectives To assess whether, in a cohort of patients with a small-for-gestational-age (SGA) fetus with estimated fetal weight ≤ 10th percentile, maternal hemodynamics, fetal biometry and Doppler indices at presentation can predict the subsequent development of an abnormal fetal Doppler index or delivery of a baby with birth weight < 3rd percentile. Methods This was a prospective observational cohort study conducted at a specialist clinic for the management of pregnancies with a SGA fetus at King’s College Hospital, London, UK. The study population comprised 86 singleton pregnancies with a SGA fetus, presenting at a median gestational age of 32 (range, 26–35) weeks. We measured maternal cardiac function using a non-invasive transthoracic bioreactance monitor, as well as mean arterial pressure, fetal biometry, and umbilical artery (UA), fetal middle cerebral artery (MCA) and uterine artery (UtA) pulsatility indices (PI), and the deepest vertical pool of amniotic fluid. Z-scores of these variables were calculated based on reported reference ranges and the values were compared between pregnancies with evidence of an abnormal fetal Doppler index at presentation (Group 1), those that had developed an abnormal Doppler index at a subsequent visit (Group 2) and those that did not develop an abnormal Doppler index throughout pregnancy (Group 3). Abnormal fetal Doppler was defined as UA-PI > 95th percentile and/ or MCA-PI < 5th percentile. Differences in measured variables at presentation were also compared between pregnancies delivering a baby with birth weight <3rd percentile and those delivering a baby with birth weight ≥ 3rd percentile. Multivariate logistic regression analysis was used to determine significant predictors of birth weight < 3rd percentile and evolution from normal to abnormal fetal Doppler. Results In the study population, 14 (16%) cases were in Group 1, 19 (22%) in Group 2 and 53 (62%) in Group 3. Birth weight was < 3rd percentile in 39 (45%) cases and ≥ 3rd percentile in 47 (55%). There was decreased cardiac output and stroke volume and increased peripheral vascular resistance compared with a normal population, and the deviations from normal were most marked in Group 1. Pregnancies with birth weight <3rd percentile, compared with those with birth weight ≥ 3rd percentile, had greater deviations from normal in fetal biometry, maternal cardiac output, stroke volume, heart rate, peripheral vascular resistance and UtA-PI. Multivariate logistic regression analysis demonstrated that, in the prediction of birth weight < 3rd percentile, maternal hemodynamic profile provided significant improvement to the prediction provided by maternal demographics, fetal biometry, UtA-PI, UA-PI and MCA-PI (differ-ence between areas under receiver –operating characteristics curves, 0.18 (95% CI, 0.06–0.29); P = 0.002). In contrast, there was no significant independent contribution from maternal hemodynamics in the prediction of the subsequent development of abnormal fetal Doppler. Conclusions In pregnancies with a SGA fetus, there is decreased maternal cardiac output and stroke volume and increased peripheral vascular resistance, and the deviations from normal are most marked in cases of redistribution in the fetal circulation and reduced amniotic fluid volume.

KW - Cardiac output

KW - Fetal growth restriction

KW - Hemodynamics

KW - Pregnancy

KW - Small-for-gestational age

UR - http://www.scopus.com/inward/record.url?scp=85054390786&partnerID=8YFLogxK

U2 - 10.1002/uog.19067

DO - 10.1002/uog.19067

M3 - Article

C2 - 29607557

AN - SCOPUS:85054390786

VL - 52

SP - 507

EP - 514

JO - Ultrasound in Obstetrics and Gynecology

JF - Ultrasound in Obstetrics and Gynecology

SN - 0960-7692

IS - 4

ER -

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