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Published in: Cardiovascular Ultrasound 1/2014

Open Access 01-12-2014 | Research

Foetal aortic flow velocity waveforms in healthy and hypertensive pregnant women

Authors: Luís Guedes-Martins, Ana Cunha, Joaquim Saraiva, Ana Rita-Gaio, Ana S Cerdeira, Filipe Macedo, Henrique Almeida

Published in: Cardiovascular Ultrasound | Issue 1/2014

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Abstract

Background

The foetal aortic Doppler frequency spectrum is influenced by cardiac output and contractility of the foetal heart as well as vascular compliance, blood viscosity and impedance of the arterial vascular system. The present study aimed at comparing Doppler flow pulsatility (PI) and resistance (RI) indexes of foetal proximal descending aorta (AoF) in the first, second and third trimesters of pregnancy, in low risk women and in those with chronic arterial hypertension, who had normal pregnancy outcomes.

Methods

A longitudinal and prospective study was carried out in 101 singleton pregnancies (71 low-risk pregnancies and 30 with essential hypertension). Multivariate regression had to be considered due to the experiment’s nature: two different indexes were read on the same set of individuals, once at each trimester of the pregnancy [1st (11–14 weeks), 2nd (19–22 weeks) and 3rd (28–32 weeks) trimesters]. The response variable was denoted as index d, in a subject with hypertensive status h (hypertensive or normotensive), at continuous time t.

Results

In both groups, AoF-PI and AoF-RI showed a small, but significant increase from the first to the second (1.850 ± 0.339 vs 2.110 ± 0.242 for PI, and 0.829 ± 0.068 vs 0.857 ± 0.038 for RI; p < 0.001) and the first to the third (1.850 ± 0.339 vs 2.163 ± 0.282 for PI, and 0.829 ± 0.068 vs 0.864 ± 0.037 for RI; p < 0.001) trimesters of pregnancy. The global model showed that while AoF-RI trends were converging as time progressed, the AoF-PI values exhibited a divergent trend (p < 0.05).

Conclusions

Chronic stable hypertension in pregnancies with normal outcome, evidences an upward regular trend of foetal descending aorta pulsatility index that is similar to the normotensive condition.
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Literature
1.
go back to reference Alfirevic Z, Neilson JP: Doppler ultrasonography in high-risk pregnancies: systematic review with meta-analysis. Am J Obstet Gynecol. 1995, 172: 1379-1387. 10.1016/0002-9378(95)90466-2.CrossRefPubMed Alfirevic Z, Neilson JP: Doppler ultrasonography in high-risk pregnancies: systematic review with meta-analysis. Am J Obstet Gynecol. 1995, 172: 1379-1387. 10.1016/0002-9378(95)90466-2.CrossRefPubMed
2.
go back to reference Struijk PC, Mathews VJ, Loupas T, Stewart PA, Clark EB, Steegers EA, Wladimiroff JW: Blood pressure estimation in the human fetal descending aorta. Ultrasound Obstet Gynecol. 2008, 32: 673-681. 10.1002/uog.6137.CrossRefPubMed Struijk PC, Mathews VJ, Loupas T, Stewart PA, Clark EB, Steegers EA, Wladimiroff JW: Blood pressure estimation in the human fetal descending aorta. Ultrasound Obstet Gynecol. 2008, 32: 673-681. 10.1002/uog.6137.CrossRefPubMed
3.
go back to reference Bahlmann F, Wellek S, Reinhardt I, Krummenauer F, Merz E, Welter C: Reference values of fetal aortic flow velocity waveforms and associated intra-observer reliability in normal pregnancies. Ultrasound Obstet Gynecol. 2001, 17: 42-49. 10.1046/j.1469-0705.2001.00306.x.CrossRefPubMed Bahlmann F, Wellek S, Reinhardt I, Krummenauer F, Merz E, Welter C: Reference values of fetal aortic flow velocity waveforms and associated intra-observer reliability in normal pregnancies. Ultrasound Obstet Gynecol. 2001, 17: 42-49. 10.1046/j.1469-0705.2001.00306.x.CrossRefPubMed
4.
go back to reference Campbell S, Bewley S, Cohen-Overbrook T: Investigation of the uteroplacental circulation by Doppler ultrasound. Semin Perinatol. 1987, 11: 362-368.PubMed Campbell S, Bewley S, Cohen-Overbrook T: Investigation of the uteroplacental circulation by Doppler ultrasound. Semin Perinatol. 1987, 11: 362-368.PubMed
5.
go back to reference Gómez O, Martínez JM, Figueras F, Del Río M, Borobio V, Puerto B, Coll O, Cararach V, Vanrell JA: Uterine artery Doppler at 11–14 weeks of gestation to screen for hypertensive disorders and associated complications in an unselected population. Ultrasound Obstet Gynecol. 2005, 26: 490-494. 10.1002/uog.1976.CrossRefPubMed Gómez O, Martínez JM, Figueras F, Del Río M, Borobio V, Puerto B, Coll O, Cararach V, Vanrell JA: Uterine artery Doppler at 11–14 weeks of gestation to screen for hypertensive disorders and associated complications in an unselected population. Ultrasound Obstet Gynecol. 2005, 26: 490-494. 10.1002/uog.1976.CrossRefPubMed
6.
go back to reference Papageorghiou AT, Yu CK, Erasmus IE, Cuckle HS, Nicolaides KH: Assessment of risk for the development of pre-eclampsia by maternal characteristics and uterine artery Doppler. BJOG. 2005, 112: 703-709. 10.1111/j.1471-0528.2005.00519.x.CrossRefPubMed Papageorghiou AT, Yu CK, Erasmus IE, Cuckle HS, Nicolaides KH: Assessment of risk for the development of pre-eclampsia by maternal characteristics and uterine artery Doppler. BJOG. 2005, 112: 703-709. 10.1111/j.1471-0528.2005.00519.x.CrossRefPubMed
7.
go back to reference Baschat AA: The fetal circulation and essential organs – a new twist to an old tale. Ultrasound Obstet Gynecol. 2006, 27: 349-354. 10.1002/uog.2762.CrossRefPubMed Baschat AA: The fetal circulation and essential organs – a new twist to an old tale. Ultrasound Obstet Gynecol. 2006, 27: 349-354. 10.1002/uog.2762.CrossRefPubMed
8.
go back to reference Gómez O, Figueras F, Martínez JM, del Río M, Palacio M, Eixarch E, Puerto B, Coll O, Cararach V, Vanrell JA: Sequential changes in uterine artery blood flow pattern between the first and second trimesters of gestation in relation to pregnancy outcome. Ultrasound Obstet Gynecol. 2006, 28: 802-808. 10.1002/uog.2814.CrossRefPubMed Gómez O, Figueras F, Martínez JM, del Río M, Palacio M, Eixarch E, Puerto B, Coll O, Cararach V, Vanrell JA: Sequential changes in uterine artery blood flow pattern between the first and second trimesters of gestation in relation to pregnancy outcome. Ultrasound Obstet Gynecol. 2006, 28: 802-808. 10.1002/uog.2814.CrossRefPubMed
9.
go back to reference Makikallio K, Jouppila P, Rasanen J: Retrograde aortic isthmus net blood flow and human fetal cardiac function in placental insufficiency. Ultrasound Obstet Gynecol. 2003, 22: 351-357. 10.1002/uog.232.CrossRefPubMed Makikallio K, Jouppila P, Rasanen J: Retrograde aortic isthmus net blood flow and human fetal cardiac function in placental insufficiency. Ultrasound Obstet Gynecol. 2003, 22: 351-357. 10.1002/uog.232.CrossRefPubMed
10.
go back to reference Fouron JC, Gosselin J, Raboisson MJ, Lamoureux J, Tison CA, Fouron C, Hudon L: The relationship between an aortic isthmus blood flow velocity index and the postnatal neurodevelopmental status of fetuses with placental circulatory insufficiency. Am J Obstet Gynecol. 2005, 192: 497-503. 10.1016/j.ajog.2004.08.026.CrossRefPubMed Fouron JC, Gosselin J, Raboisson MJ, Lamoureux J, Tison CA, Fouron C, Hudon L: The relationship between an aortic isthmus blood flow velocity index and the postnatal neurodevelopmental status of fetuses with placental circulatory insufficiency. Am J Obstet Gynecol. 2005, 192: 497-503. 10.1016/j.ajog.2004.08.026.CrossRefPubMed
11.
go back to reference Nicolaides KH, Bilardo CM, Campbell S: Prediction of fetal anemia by measurement of the mean blood velocity in the fetal aorta. Am J Obstet Gynecol. 1990, 162: 209-212. 10.1016/0002-9378(90)90852-X.CrossRefPubMed Nicolaides KH, Bilardo CM, Campbell S: Prediction of fetal anemia by measurement of the mean blood velocity in the fetal aorta. Am J Obstet Gynecol. 1990, 162: 209-212. 10.1016/0002-9378(90)90852-X.CrossRefPubMed
12.
go back to reference Ferrazzi E, Bellotti M, Marconi A, Flisi L, Barbera A, Pardi G: Peak velocity of the outflow tract of the aorta: correlation with acid base status and oxygenation of the growth retarded fetus. Obstet Gynecol. 1995, 85: 663-668. 10.1016/0029-7844(95)00021-I.CrossRefPubMed Ferrazzi E, Bellotti M, Marconi A, Flisi L, Barbera A, Pardi G: Peak velocity of the outflow tract of the aorta: correlation with acid base status and oxygenation of the growth retarded fetus. Obstet Gynecol. 1995, 85: 663-668. 10.1016/0029-7844(95)00021-I.CrossRefPubMed
13.
go back to reference Jouppila P, Kirkinen P: Increased vascular resistance in the descending aorta of the human fetus in hypoxia. Br J Obstet Gynaecol. 1984, 91: 853-856. 10.1111/j.1471-0528.1984.tb03696.x.CrossRefPubMed Jouppila P, Kirkinen P: Increased vascular resistance in the descending aorta of the human fetus in hypoxia. Br J Obstet Gynaecol. 1984, 91: 853-856. 10.1111/j.1471-0528.1984.tb03696.x.CrossRefPubMed
14.
go back to reference Tonge HM, Wladimiroff JW, Noordam MJ, van Kooten C: Blood flow velocity waveforms in the descending fetal aorta: comparison between normal and growth-retarded pregnancies. Obstet Gynecol. 1986, 67: 851-855. 10.1097/00006250-198606000-00022.CrossRefPubMed Tonge HM, Wladimiroff JW, Noordam MJ, van Kooten C: Blood flow velocity waveforms in the descending fetal aorta: comparison between normal and growth-retarded pregnancies. Obstet Gynecol. 1986, 67: 851-855. 10.1097/00006250-198606000-00022.CrossRefPubMed
15.
go back to reference Laurin J, Lingman G, Marsal K, Persson PH: Fetal blood flow in pregnancies complicated by intrauterine growth retardation. Obstet Gynecol. 1987, 69: 895-902.PubMed Laurin J, Lingman G, Marsal K, Persson PH: Fetal blood flow in pregnancies complicated by intrauterine growth retardation. Obstet Gynecol. 1987, 69: 895-902.PubMed
16.
go back to reference Votino C, Cos T, Strizek B, Dessy H, Jani JC: First trimester fetal echocardiography: where are we now?. Minerva Ginecol. 2012, 64: 375-386.PubMed Votino C, Cos T, Strizek B, Dessy H, Jani JC: First trimester fetal echocardiography: where are we now?. Minerva Ginecol. 2012, 64: 375-386.PubMed
17.
go back to reference Bude RO, Rubin JM: Relationship between the resistive index and vascular compliance and resistance. Radiology. 1999, 211: 411-417. 10.1148/radiology.211.2.r99ma48411.CrossRefPubMed Bude RO, Rubin JM: Relationship between the resistive index and vascular compliance and resistance. Radiology. 1999, 211: 411-417. 10.1148/radiology.211.2.r99ma48411.CrossRefPubMed
18.
go back to reference Del Río M, Martínez JM, Figueras F, López M, Palacio M, Gómez O, Coll O, Puerto B: Reference ranges for Doppler parameters of the fetal aortic isthmus during the second half of pregnancy. Ultrasound Obstet Gynecol. 2006, 28: 71-76. 10.1002/uog.2827.CrossRefPubMed Del Río M, Martínez JM, Figueras F, López M, Palacio M, Gómez O, Coll O, Puerto B: Reference ranges for Doppler parameters of the fetal aortic isthmus during the second half of pregnancy. Ultrasound Obstet Gynecol. 2006, 28: 71-76. 10.1002/uog.2827.CrossRefPubMed
19.
go back to reference Macdonald-Wallis C, Lawlor DA, Fraser A, May M, Nelson SM, Tilling K: Blood pressure change in normotensive, gestational hypertensive, preeclamptic, and essential hypertensive pregnancies. Hypertension. 2012, 59: 1241-1248. 10.1161/HYPERTENSIONAHA.111.187039.CrossRefPubMedPubMedCentral Macdonald-Wallis C, Lawlor DA, Fraser A, May M, Nelson SM, Tilling K: Blood pressure change in normotensive, gestational hypertensive, preeclamptic, and essential hypertensive pregnancies. Hypertension. 2012, 59: 1241-1248. 10.1161/HYPERTENSIONAHA.111.187039.CrossRefPubMedPubMedCentral
20.
go back to reference Zetterström K, Lindeberg S, Haglund B, Hanson U: The association of maternal chronic hypertension with perinatal death in male and female offspring: a record linkage study of 866,188 women. BJOG. 2008, 115: 1436-1442. 10.1111/j.1471-0528.2008.01844.x.CrossRefPubMed Zetterström K, Lindeberg S, Haglund B, Hanson U: The association of maternal chronic hypertension with perinatal death in male and female offspring: a record linkage study of 866,188 women. BJOG. 2008, 115: 1436-1442. 10.1111/j.1471-0528.2008.01844.x.CrossRefPubMed
21.
go back to reference Ramsey PS, Ramin KD, Ramin SM: Cardiac disease in pregnancy. Am J Perinatol. 2001, 18: 245-266. 10.1055/s-2001-16991.CrossRefPubMed Ramsey PS, Ramin KD, Ramin SM: Cardiac disease in pregnancy. Am J Perinatol. 2001, 18: 245-266. 10.1055/s-2001-16991.CrossRefPubMed
22.
go back to reference Gilbert RD, Pearce WJ, Longo LD: Fetal cardiac and cerebrovascular acclimatization responses to high altitude, long-term hypoxia. High Alt Med Biol. 2003, 4: 203-213. 10.1089/152702903322022802.CrossRefPubMed Gilbert RD, Pearce WJ, Longo LD: Fetal cardiac and cerebrovascular acclimatization responses to high altitude, long-term hypoxia. High Alt Med Biol. 2003, 4: 203-213. 10.1089/152702903322022802.CrossRefPubMed
23.
go back to reference Moore LG, Shriver M, Bemis L, Hickler B, Wilson M, Brutsaert T, Parra E, Vargas E: Maternal adaptation to high-altitude pregnancy: an experiment of nature–a review. Placenta. 2004, 25 (Suppl A): 60-71.CrossRef Moore LG, Shriver M, Bemis L, Hickler B, Wilson M, Brutsaert T, Parra E, Vargas E: Maternal adaptation to high-altitude pregnancy: an experiment of nature–a review. Placenta. 2004, 25 (Suppl A): 60-71.CrossRef
24.
26.
go back to reference National Collaborating Centre for Women’s and Children’s Health (UK): Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy. London: RCOG Press, 2010 National Collaborating Centre for Women’s and Children’s Health (UK): Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy. London: RCOG Press, 2010
27.
go back to reference Romundstad PR, Magnussen EB, Smith GD, Vatten LJ: Hypertension in pregnancy and later cardiovascular risk: common antecedents?. Circulation. 2010, 122: 579-584. 10.1161/CIRCULATIONAHA.110.943407.CrossRefPubMed Romundstad PR, Magnussen EB, Smith GD, Vatten LJ: Hypertension in pregnancy and later cardiovascular risk: common antecedents?. Circulation. 2010, 122: 579-584. 10.1161/CIRCULATIONAHA.110.943407.CrossRefPubMed
28.
go back to reference Snijders RJ, Nicolaides KH: Fetal biometry at 14–40 weeks’ gestation. Ultrasound Obstet Gynecol. 1994, 4: 34-48. 10.1046/j.1469-0705.1994.04010034.x.CrossRefPubMed Snijders RJ, Nicolaides KH: Fetal biometry at 14–40 weeks’ gestation. Ultrasound Obstet Gynecol. 1994, 4: 34-48. 10.1046/j.1469-0705.1994.04010034.x.CrossRefPubMed
29.
go back to reference Yudkin PL, Aboualfa M, Eyre JA, Redman CW, Wilkinson AR: New birthweight and head circumference centiles for gestational ages 24 to 42 weeks. Early Hum Dev. 1987, 15: 45-52. 10.1016/0378-3782(87)90099-5.CrossRefPubMed Yudkin PL, Aboualfa M, Eyre JA, Redman CW, Wilkinson AR: New birthweight and head circumference centiles for gestational ages 24 to 42 weeks. Early Hum Dev. 1987, 15: 45-52. 10.1016/0378-3782(87)90099-5.CrossRefPubMed
31.
go back to reference Sibai BM, Lindheimer M, Hauth J, Caritis S, VanDorsten P, Klebanoff M, MacPherson C, Landon M, Miodovnik M, Paul R, Meis P, Dombrowski M: Risk factors for preeclampsia, abruptio placentae, and adverse neonatal outcomes among women with chronic hypertension. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med. 1998, 339: 667-671. 10.1056/NEJM199809033391004.CrossRefPubMed Sibai BM, Lindheimer M, Hauth J, Caritis S, VanDorsten P, Klebanoff M, MacPherson C, Landon M, Miodovnik M, Paul R, Meis P, Dombrowski M: Risk factors for preeclampsia, abruptio placentae, and adverse neonatal outcomes among women with chronic hypertension. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med. 1998, 339: 667-671. 10.1056/NEJM199809033391004.CrossRefPubMed
32.
go back to reference Lecarpentier E, Tsatsaris V, Goffinet F, Cabrol D, Sibai B, Haddad B: Risk factors of superimposed preeclampsia in women with essential chronic hypertension treated before pregnancy. PLoS One. 2013, 8: e62140-10.1371/journal.pone.0062140.CrossRefPubMedPubMedCentral Lecarpentier E, Tsatsaris V, Goffinet F, Cabrol D, Sibai B, Haddad B: Risk factors of superimposed preeclampsia in women with essential chronic hypertension treated before pregnancy. PLoS One. 2013, 8: e62140-10.1371/journal.pone.0062140.CrossRefPubMedPubMedCentral
33.
go back to reference Low JA: The current status of maternal and fetal blood flow velocimetry. Am J Obstet Gynecol. 1991, 164: 1049-1063. 10.1016/0002-9378(91)90585-F.CrossRefPubMed Low JA: The current status of maternal and fetal blood flow velocimetry. Am J Obstet Gynecol. 1991, 164: 1049-1063. 10.1016/0002-9378(91)90585-F.CrossRefPubMed
34.
go back to reference Bland JM, Altman DG: Applying the right statistics: analyses of measurement studies. Ultrasound Obstet Gynecol. 2003, 22: 85-93.CrossRefPubMed Bland JM, Altman DG: Applying the right statistics: analyses of measurement studies. Ultrasound Obstet Gynecol. 2003, 22: 85-93.CrossRefPubMed
35.
go back to reference Walter SD, Eliasziw M, Donner A: Sample size and optimal designs for reliability studies. Stat Med. 1998, 17: 101-110. 10.1002/(SICI)1097-0258(19980115)17:1<101::AID-SIM727>3.0.CO;2-E.CrossRefPubMed Walter SD, Eliasziw M, Donner A: Sample size and optimal designs for reliability studies. Stat Med. 1998, 17: 101-110. 10.1002/(SICI)1097-0258(19980115)17:1<101::AID-SIM727>3.0.CO;2-E.CrossRefPubMed
36.
go back to reference Pardi G, Ferrari MM, Iorio F, Acocella F, Boero V, Berlanda N, Monaco A, Reato C, Santoro F, Cetin I: The effect of maternal hypothermic cardiopulmonary bypass on fetal lamb temperature, hemodynamics, oxygenation, and acid–base balance. J Thorac Cardiovasc Surg. 2004, 127: 1728-1734. 10.1016/j.jtcvs.2003.08.036.CrossRefPubMed Pardi G, Ferrari MM, Iorio F, Acocella F, Boero V, Berlanda N, Monaco A, Reato C, Santoro F, Cetin I: The effect of maternal hypothermic cardiopulmonary bypass on fetal lamb temperature, hemodynamics, oxygenation, and acid–base balance. J Thorac Cardiovasc Surg. 2004, 127: 1728-1734. 10.1016/j.jtcvs.2003.08.036.CrossRefPubMed
37.
go back to reference Leach L, Mann GE: Consequences of fetal programming for cardiovascular disease in adulthood. Microcirculation. 2011, 18: 253-255. 10.1111/j.1549-8719.2011.00097.x.CrossRefPubMed Leach L, Mann GE: Consequences of fetal programming for cardiovascular disease in adulthood. Microcirculation. 2011, 18: 253-255. 10.1111/j.1549-8719.2011.00097.x.CrossRefPubMed
38.
go back to reference Gómez O, Figueras F, Fernández S, Bennasar M, Martínez JM, Puerto B, Gratacós E: Reference ranges for uterine artery mean pulsatility index at 11–41 weeks of gestation. Ultrasound Obstet Gynecol. 2008, 32: 128-132. 10.1002/uog.5315.CrossRefPubMed Gómez O, Figueras F, Fernández S, Bennasar M, Martínez JM, Puerto B, Gratacós E: Reference ranges for uterine artery mean pulsatility index at 11–41 weeks of gestation. Ultrasound Obstet Gynecol. 2008, 32: 128-132. 10.1002/uog.5315.CrossRefPubMed
Metadata
Title
Foetal aortic flow velocity waveforms in healthy and hypertensive pregnant women
Authors
Luís Guedes-Martins
Ana Cunha
Joaquim Saraiva
Ana Rita-Gaio
Ana S Cerdeira
Filipe Macedo
Henrique Almeida
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Cardiovascular Ultrasound / Issue 1/2014
Electronic ISSN: 1476-7120
DOI
https://doi.org/10.1186/1476-7120-12-1

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