Human fetal cardiovascular profile score and neonatal outcome in intrauterine growth restriction

• Published in: Ultrasound in obstetrics & gynecology Vol. 31; no. 1; pp. 48 - 54
• Main Authors: Mäkikallio, K., Räsänen, J., Mäkikallio, T., Vuolteenaho, O., Huhta, J. C.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.01.2008; Wiley
• Subjects: Adult; atrial natriuretic peptide; Biological and medical sciences; Blood Flow Velocity - physiology; Cardiology. Vascular system; Cardiovascular system; Cerebral Palsy - etiology; Diseases of mother, fetus and pregnancy; Doppler; Epidemiologic Methods; Female; Fetal Growth Retardation - diagnostic imaging; Fetal Growth Retardation - mortality; Fetal Growth Retardation - physiopathology; Fetal Heart - abnormalities; Fetal Heart - diagnostic imaging; fetal heart failure; Gynecology. Andrology. Obstetrics; Heart; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Hemodynamics - physiology; Humans; Hydrops Fetalis - physiopathology; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; neonatal morbidity; neonatal mortality; Pregnancy; Pregnancy. Fetus. Placenta; Ultrasonic investigative techniques; Ultrasonography, Doppler, Pulsed - methods; Umbilical Arteries - blood supply; Umbilical Arteries - diagnostic imaging; Umbilical Veins - blood supply; Umbilical Veins - diagnostic imaging; Doppler ultrasound study; Intrauterine growth retardation; Neonatal; Prognosis; Pregnancy disorders; Cardiovascular disease; Atrial natriuretic peptide; Epidemiology; Fetal diseases; Heart disease; Evolution; Fetus; fetal heart failure; Sonography; Human; Heart failure; Gynecology; Mortality; neonatal morbidity; Obstetrics; Morbidity; Pregnancy; Score; Newborn; neonatal mortality; Circulatory system; Doppler
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.5210

Objective To determine whether low cardiovascular profile (CVP) score has prognostic value for predicting neonatal mortality and severe morbidity in human fetuses with growth restriction. Methods Seventy‐five consecutive growth‐restricted fetuses with Doppler examination of cardiovascular hemodynamics within a week prior to delivery comprised the study population. Hydrops, heart size, cardiac function and venous and arterial hemodynamics were evaluated for CVP score. The primary outcome measures were neonatal mortality and cerebral palsy. Results During the neonatal period, six of 75 neonates died and two had cerebral palsy (Group 1, n = 8). Compared with the fetuses discharged home from hospital (Group 2, n = 67), those in Group 1 were delivered at an earlier gestational age (28 (range, 24–35) weeks vs. 35 (range, 26–40) weeks, P < 0.01) and had lower CVP scores (4 (range, 2–6) vs. 9 (range, 5–10), P < 0.0001). All CVP subscale scores were lower (P < 0.01) in Group 1 than in Group 2 fetuses. Gestational age‐adjusted hazard ratios (95% CIs) for adverse neonatal outcome were highest for cardiomegaly (13.9 (1.7–114.3), P = 0.014), monophasic atrioventricular filling pattern or holosystolic tricuspid regurgitation (9.5 (2.3–38.4), P = 0.002) and atrial pulsations in the umbilical vein 7.7 (1.4–41.2), P = 0.017). Conclusions Growth‐restricted fetuses with adverse neonatal outcome have lower CVP scores than do fetuses with favorable neonatal outcome. The strongest predictors for adverse neonatal outcome in the CVP score were cardiomegaly, abnormal cardiac function with monophasic atrioventricular filling or holosystolic tricuspid regurgitation and increased systemic venous pressure. These assessments have independent prognostic power for adverse neonatal outcome even after adjustment for gestational age. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.