Cardiovascular changes and neonatal outcome in IUGR fetuses born to normotensive and preeclamptic mothers

24–28
August
2008,
Chicago,
USA
Oral
poster
abstracts
Cardiovascular
changes
and
neonatal
outcome
in
IUGR
fetuses
born
to
normotensive
and
preeclamptic
mothers
E.
Cosmi1,
E.
Funai1,
S.
Rusconi1,
MD
Piga2,
G.
Bogana1,
C.
Saccardi1,
S.
Visentin1,
V.
Berghella3,
E.
Ferrazzi4,
S.
Rigano4,
A.
Serena1
1Gynecological
Science
and
Human
Reproduction,
University
of
Padua
School
of
Medicine,
Padua,
Italy,
2Obstetrics
and
Gynecology,
University
of
Sassari,
Sassari,
Italy,,
3Obstetrics
and
Gynecology,
Thomas
Jefferson
University,
Philadelphia,
United
States,
4Department
of
Obstetrics
and
Gynecology,
University
of
Milan,
IRSCC,
Milan,
Italy
Objectives:
To
assess
the
cardiovascular
changes
in
IUGR
fetuses
with
isolated
placental
insufficiency
versus
IUGR
associated
with
preeclampsia
by
Doppler
ultrasonography,
cardiotocography
and
BPS
and
to
compare
neonatal
outcome.
Methods:
A
prospective
matched
control
multicentric
study
of
220
IUGR
fetuses
(abdominal
circumference
<5th
percentile;
increased
umbilical
artery
pulsatility
index).
Among
these,
110
fetuses
were
IUGR
from
normotensive
women
and
110
associated
to
maternal
preeclampsia.
Doppler
velocimetry
of
UA,
MCA,
DV,
evaluation
of
amniotic
fluid
index
was
performed
twice
weekly
and
cardiotocography
and
BPS
daily.
Delivery
was
performed
<32
weeks
if
there
were
signs
of
fetal
compromise
(BPS
<4
or
cardiotocographic
alterations),
or
maternal
indications
for
preeclampsia.
Perinatal
mortality
and
composite
morbidity
(5
min.
Apgar,
RDS,
BPD,
ROP,
IVH,
PVL,
and
NEC)
was
recorded
and
correlated
with
Doppler
parameters.
Results:
Among
220
IUGR
fetuses,
in
IUGR
fetuses
of
normotensive
mothers
mean
gestational
age
at
delivery
was
29.3
°æ
1.8
weeks,
and
mean
birth
weight
was
939.7
°æ
164.9gr.
In
IUGR
fetuses
associated
to
maternal
preeclampsia
mean
gestational
age
was
28.8
°æ
2
weeks,
and
mean
weight
at
birth
878.9
°æ
262.4
gr.
The
temporal
sequence
of
IUGR
fetuses
associated
to
preeclampsia
show
an
earlier
onset
of
Doppler
alterations
compared
to
IUGR
fetuses
of
normotensive
mothers.
Considering
neonatal
outcome,
in
IUGR
fetuses
of
normotensive
mothers
the
morbidity,
mortality
and
fetal
death
was
higher
compared
to
IUGR
from
preeclamptic
women.
Conclusions:
The
present
study
highlights
that
IUGR
fetuses
should
be
divided
into
two
entities:
isolated
IUGR
due
to
placental
vascular
insufficiency
and
IUGR
fetuses
associated
to
maternal
preeclampsia.
This
distinction
is
essential
to
manage
these
fetuses
since
IUGR
fetuses
without
maternal
preeclampsia
develop
cardiovascular
compromise
in
a
longer
period
of
time
compared
to
IUGR
fetuses
from
preeclamptic
women.