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Kilicdag H, Parlakgumus D, Demir SC, Satar M. Effects of spontaneous first breath on placental transfusion in term neonates born by cesarean section: A randomized controlled trial. Front Pediatr 2022; 10:925656. [PMID: 36177452 PMCID: PMC9513210 DOI: 10.3389/fped.2022.925656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The role of umbilical cord management in placental transfusion in cesarean section (CS) requires clarification. The spontaneous first breath may be more important than the timing of cord clamping for placental transfusion in neonates born by CS. OBJECTIVE This study aimed to evaluate the impact of cord clamping after the first spontaneous breath on placental transfusion in neonates born by CS. METHODS We recruited women with a live singleton pregnancy at ≥37.0 weeks of gestation admitted for CS. The interventions performed, such as physiologic-based cord clamping (PBCC), intact-umbilical cord milking (I-UCM), 30-s delay in cord clamping (30-s DCC), and 60-s delay in cord clamping (60-s DCC), were noted and placed in a sealed envelope. The sealed envelope was opened immediately before delivery to perform randomization. RESULTS A total of 123 infants were eligible for evaluation. Of these, 31, 30, 32, and 30 were assigned to the PBCC, I-UCM, 30-s DCC, and 60-s DCC groups, respectively. The mean hemoglobin (Hb) and mean hematocrit (Hct) were significantly higher in the 60-s DCC group than in the PBCC group (p = 0.028 and 0.019, respectively), but no difference was noted among the I-UCM, 30-s DCC, and PBCC groups at 36 h of age. Further, no significant differences were observed in the mean Hb and mean Hct among the I-UCM, 60-s DCC, and 30-s DCC groups. Peak total serum bilirubin (TSB) levels were higher in the 60-s DCC group than in the I-UCM and PBCC groups (p = 0.017), but there was no difference between the 60-s DCC and 30-s DCC groups during the first week of life. The phototherapy requirement was higher in 60-s DCC than in IUCM and 30-sDCC (p = 0.001). CONCLUSIONS Our findings demonstrated that PBCC, 30-s DCC, and I-UCM in neonates born by CS had no significant differences from each other on placental transfusion. The Hb and Hct in the neonates were higher after 60-s DCC than after PBCC.
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Affiliation(s)
- Hasan Kilicdag
- Division of Neonatology, Department of Pediatrics, Acibadem Adana Hospital, Adana, Turkey
| | | | - Suleyman Cansun Demir
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cukurova University, Adana, Turkey
| | - Mehmet Satar
- Division of Neonatology, Department of Pediatrics, Cukurova University, Adana, Turkey
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2
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Brouwer E, Knol R, Kroushev A, Van Den Akker T, Hooper SB, Roest AA, te Pas AB. Effect of breathing on venous return during delayed cord clamping: an observational study. Arch Dis Child Fetal Neonatal Ed 2022; 107:65-69. [PMID: 34108193 PMCID: PMC8685611 DOI: 10.1136/archdischild-2020-321431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/06/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the effect of spontaneous breathing on venous return in term infants during delayed cord clamping at birth. METHODS Echocardiographic ultrasound recordings were obtained directly after birth in healthy term-born infants. A subcostal view was used to obtain an optimal view of the inferior vena cava (IVC) entering the right atrium, including both the ductus venosus (DV) and the hepatic vein (HV). Colour Doppler was used to assess flow direction and flow velocity. Recordings continued until the umbilical cord was clamped and were stored in digital format for offline analyses. RESULTS Ultrasound recordings were obtained in 15 infants, with a median (IQR) gestational age of 39.6 (39.0-40.9) weeks and a birth weight of 3560 (3195-4205) g. Flow was observed to be antegrade in the DV and HV in 98% and 82% of inspirations, respectively, with flow velocity increasing in 74% of inspirations. Retrograde flow in the DV was observed sporadically and only occurred during expiration. Collapse of the IVC occurred during 58% of inspirations and all occurred caudal to the DV inlet (100%). CONCLUSION Spontaneous breathing was associated with collapse of the IVC and increased antegrade DV and HV flow velocity during inspiration. Therefore, inspiration appears to preferentially direct blood flow from the DV into the right atrium. This indicates that inspiration could be a factor driving placental transfusion in infants.
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Affiliation(s)
- Emma Brouwer
- Neonatology, Leiden University Medical Center Willem Alexander Children's Hospital, Leiden, The Netherlands
| | - Ronny Knol
- Neonatology, Leiden University Medical Center Willem Alexander Children's Hospital, Leiden, The Netherlands,Neonatology, Erasmus MC, Rotterdam, The Netherlands
| | - Annie Kroushev
- Monash Women's, Monash Health, Clayton, Victoria, Australia
| | | | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia,Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Arno A Roest
- Pediatric Cardiology, Leiden University Medical Center Willem Alexander Children’s Hospital, Leiden, The Netherlands
| | - Arjan B te Pas
- Neonatology, Leiden University Medical Center Willem Alexander Children's Hospital, Leiden, The Netherlands
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3
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Brouwer E, te Pas AB, Polglase GR, McGillick EV, Böhringer S, Crossley KJ, Rodgers K, Blank D, Yamaoka S, Gill AW, Kluckow M, Hooper SB. Effect of spontaneous breathing on umbilical venous blood flow and placental transfusion during delayed cord clamping in preterm lambs. Arch Dis Child Fetal Neonatal Ed 2020; 105:26-32. [PMID: 31092674 PMCID: PMC6961560 DOI: 10.1136/archdischild-2018-316044] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/04/2019] [Accepted: 04/02/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION During delayed umbilical cord clamping, the factors underpinning placental transfusion remain unknown. We hypothesised that reductions in thoracic pressure during inspiration would enhance placental transfusion in spontaneously breathing preterm lambs. OBJECTIVE Investigate the effect of spontaneous breathing on umbilical venous flow and body weight in preterm lambs. METHODS Pregnant sheep were instrumented at 132-133 days gestational age to measure fetal common umbilical venous, pulmonary and cerebral blood flows as well as arterial and intrapleural (IP) pressures. At delivery, doxapram and caffeine were administered to promote breathing. Lamb body weights were measured continuously and breathing was assessed by IP pressure changes. RESULTS In 6 lambs, 491 out of 1117 breaths were analysed for change in body weight. Weight increased in 46.6% and decreased in 47.5% of breaths. An overall mean increase of 0.02±2.5 g per breath was calculated, and no net placental transfusion was observed prior to cord clamping (median difference in body weight 52.3 [-54.9-166.1] g, p=0.418). Umbilical venous (UV) flow transiently decreased with each inspiration, and in some cases ceased, before UV flow normalised during expiration. The reduction in UV flow was positively correlated with the standardised reduction in (IP) pressure, increasing by 109 mL/min for every SD reduction in IP pressure. Thus, the reduction in UV flow was closely related to inspiratory depth. CONCLUSIONS Spontaneous breathing had no net effect on body weight in preterm lambs at birth. UV blood flow decreased as inspiratory effort increased, possibly due to constriction of the inferior vena cava caused by diaphragmatic contraction, as previously observed in human fetuses.
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Affiliation(s)
| | | | - Graeme R Polglase
- The Ritchie Centre, The
Hudson Institute for Medical Research, Clayton, Victoria,
Australia,Obstetrics and Gynaecology,
Monash University, Clayton, Victoria,
Australia
| | - Erin V McGillick
- The Ritchie Centre, The
Hudson Institute for Medical Research, Clayton, Victoria,
Australia,Obstetrics and Gynaecology,
Monash University, Clayton, Victoria,
Australia
| | | | - Kelly J Crossley
- The Ritchie Centre, The
Hudson Institute for Medical Research, Clayton, Victoria,
Australia,Obstetrics and Gynaecology,
Monash University, Clayton, Victoria,
Australia
| | - Karyn Rodgers
- The Ritchie Centre, The
Hudson Institute for Medical Research, Clayton, Victoria,
Australia
| | - Douglas Blank
- Newborn Research, Royal
Women’s Hospital, Melbourne, Victoria,
Australia,The Ritchie Centre, Monash
Institute of Medical Research, Monash University, Clayton, Victoria, Australia
| | - Shigeo Yamaoka
- The Ritchie Centre, The
Hudson Institute for Medical Research, Clayton, Victoria,
Australia
| | - Andrew William Gill
- Centre for Neonatal Research and
Education, University of Western Australia,
Perth, Western
Australia, Australia
| | - Martin Kluckow
- Department of Neonatology, St
Leonards, New South Wales,
Australia
| | - Stuart B Hooper
- The Ritchie Centre, The
Hudson Institute for Medical Research, Clayton, Victoria,
Australia,Obstetrics and Gynaecology,
Monash University, Victoria, Australia
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4
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Katheria AC, Rich WD, Bava S, Lakshminrusimha S. Placental Transfusion for Asphyxiated Infants. Front Pediatr 2019; 7:473. [PMID: 31824895 PMCID: PMC6879450 DOI: 10.3389/fped.2019.00473] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/29/2019] [Indexed: 12/31/2022] Open
Abstract
The current recommendation for umbilical cord management of non-vigorous infants (limp, pale, and not breathing) who need resuscitation at birth is to immediately clamp the umbilical cord. This recommendation is due in part to insufficient evidence for delayed cord clamping (DCC) or umbilical cord milking (UCM). These methods may provide a neuroprotective mechanism that also facilitates cardiovascular transition for non-vigorous infants at birth.
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Affiliation(s)
- Anup C. Katheria
- Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, United States
| | - Wade D. Rich
- Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, United States
| | - Sunita Bava
- Independent Researcher, San Diego, CA, United States
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5
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Wohlmuth C, Bergh E, Bell C, Johnson A, Moise KJ, van Gemert MJC, van den Wijngaard JPHM, Wohlmuth-Wieser I, Averiss I, Gardiner HM. Clinical Monitoring of Sacrococcygeal Teratoma. Fetal Diagn Ther 2019; 46:333-340. [PMID: 30893693 DOI: 10.1159/000496841] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 01/09/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Sacrococcygeal teratomas (SCT) are often highly vascularized and may result in high-output cardiac failure, polyhydramnios, fetal hydrops, and demise. Delivery is guided by the SCT to fetus volume ratio (SCTratio), SCT growth rate, and cardiac output indexed for weight (CCOi). METHODS We compared measurements and outcome in 12 consecutive fetuses referred with SCT. Adverse outcomes were: fetal surgery, delivery < 32 gestational weeks or neonatal demise. Only SCTratio and CCOi were used to manage the cases. SCT vascularization index (VI%) was derived from the 3D virtual organ computer-aided analysis (VOCAL) software. The SCTModel (modified from acardiac twins) calculated a hypothetical SCT draining vein size and derived a risk line, using diameters of the superior and inferior vena cava, the azygous and umbilical veins. VI% and a model of systemic and umbilical venous volumes (SCTModel) were tested as indicators for outcome in SCT. RESULTS Fetuses were monitored from 20.1 to 36.4 gestational weeks and 5/12 had adverse outcomes: 1 had successful open fetal surgery at 23.8 weeks and delivered at term, 4 delivered at < 32 weeks with 3/4 having neonatal demise between 25 and 29 weeks. VI% was significantly higher in cases with adverse outcomes (mean 10.3 [8.9-11.6] vs. 4.4 [3.4-5.3], p < 0.0001). The additional fraction of the fetal cardiac output required to perfuse the SCT-draining vein (XSCO%) (p = 0.46), SCTratio (p = 0.08), and CCOi (p = 0.64) were not significant. All cases with adverse outcome had VI% > 8%. The SCTModel risk line predicted nonadverse outcomes well but lacked data in 2/5 cases with adverse outcomes. CONCLUSIONS VI% is a significant indicator of SCT cases with adverse outcomes and combined with SCTratio may guide timing of delivery better than current measures.
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Affiliation(s)
- Christoph Wohlmuth
- The Fetal Center, Children's Memorial Hermann Hospital and the Department of Obstetrics and Gynecology, McGovern Medical School, UTHealth, Houston, Texas, USA, .,Department of Obstetrics and Gynecology, Paracelsus Medical University Salzburg, Salzburg, Austria,
| | - Eric Bergh
- The Fetal Center, Children's Memorial Hermann Hospital and the Department of Obstetrics and Gynecology, McGovern Medical School, UTHealth, Houston, Texas, USA.,Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Cynthia Bell
- McGovern Medical School at UTHealth, Center for Clinical Research and Evidence-Based Medicine, Houston, Texas, USA
| | - Anthony Johnson
- The Fetal Center, Children's Memorial Hermann Hospital and the Department of Obstetrics and Gynecology, McGovern Medical School, UTHealth, Houston, Texas, USA
| | - Kenneth J Moise
- The Fetal Center, Children's Memorial Hermann Hospital and the Department of Obstetrics and Gynecology, McGovern Medical School, UTHealth, Houston, Texas, USA
| | - Martin J C van Gemert
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeroen P H M van den Wijngaard
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Iris Wohlmuth-Wieser
- Department of Dermatology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Ian Averiss
- The Fetal Center, Children's Memorial Hermann Hospital and the Department of Obstetrics and Gynecology, McGovern Medical School, UTHealth, Houston, Texas, USA
| | - Helena M Gardiner
- The Fetal Center, Children's Memorial Hermann Hospital and the Department of Obstetrics and Gynecology, McGovern Medical School, UTHealth, Houston, Texas, USA
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6
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Sletten J, Kiserud T, Kessler J. Effect of uterine contractions on fetal heart rate in pregnancy: a prospective observational study. Acta Obstet Gynecol Scand 2016; 95:1129-35. [DOI: 10.1111/aogs.12949] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/18/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Julie Sletten
- Department of Clinical Science; University of Bergen; Bergen Norway
| | - Torvid Kiserud
- Department of Clinical Science; University of Bergen; Bergen Norway
- Department of Obstetrics and Gynecology; Haukeland University Hospital; Bergen Norway
| | - Jörg Kessler
- Department of Clinical Science; University of Bergen; Bergen Norway
- Department of Obstetrics and Gynecology; Haukeland University Hospital; Bergen Norway
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7
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van Gemert MJ, Nikkels PG, Paarlberg KM, van den Wijngaard JP, Gardiner HM. Acardiac twin pregnancies part II: Fetal risk of chorangioma and sacrococcygeal teratoma predicted by pump/acardiac umbilical vein diameters. ACTA ACUST UNITED AC 2016; 106:733-8. [DOI: 10.1002/bdra.23531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/21/2016] [Accepted: 05/03/2016] [Indexed: 01/05/2023]
Affiliation(s)
- Martin J.C. van Gemert
- Department of Biomedical Engineering & Physics, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Peter G.J. Nikkels
- Department of Pathology, Wilhelmina Children's Hospital; University Medical Center; Utrecht The Netherlands
| | - K. Marieke Paarlberg
- Department of Obstetrics and Gynecology; Gelre Teaching Hospitals; Apeldoorn The Netherlands
| | | | - Helena M. Gardiner
- The Fetal Center at Children's Memorial Hermann Hospital, UT Health; McGovern Medical School; Houston Texas
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8
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Arias-Ortega R, Echeverría JC, Guzmán-Huerta M, Camargo-Marín L, Gaitán-González MJ, Borboa-Olivares H, Portilla-Islas E, Camal-Ugarte S, Vargas-García C, Ortiz MR, González-Camarena R. Respiratory sinus arrhythmia in growth restricted fetuses with normal Doppler hemodynamic indices. Early Hum Dev 2016; 93:17-23. [PMID: 26709133 DOI: 10.1016/j.earlhumdev.2015.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 11/09/2015] [Accepted: 11/13/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND The autonomic behavior of growth-restricted fetuses at different evolving hemodynamic stages has not been fully elicited. AIM To analyze the respiratory sinus arrhythmia (RSA) of growth-restricted fetuses that despite this severe condition show normal Doppler hemodynamics. SUBJECTS 10 growth-restricted fetuses (FGR group) with normal arterial pulsatility indices (umbilical, uterine, middle cerebral, ductus venosus and aortic isthmus), and 10 healthy fetuses (Control group), 32-37weeks of gestation. METHOD B-mode ultrasound images for visualizing fetal breathing movements (FBM) or breathing akinesis (FBA), and the simultaneous RR-interval time series from maternal abdominal ECG recordings were obtained. The root-mean-square of successive differences of RR-intervals (RMSSD) was considered as a RSA-related parameter among the instantaneous amplitude of the high-frequency component (AMPHF) and its corresponding instantaneous frequency (IFHF), both computed by using empirical mode decomposition. Mean fetal heart-periods and RSA-related parameters were assessed during episodes of FBM and FBA in 30s length windows. RESULTS FGR and Control groups presented RSA-related fluctuations during FBM and FBA. Also, both groups showed significant higher (p<0.001) values for the mean heart-period, RMSSD and AMPHF during FBM. No-significant differences (p>0.05) were found for the IFHF regardless of breathing activity (FBM vs. FBA). CONCLUSION Growth-restricted fetuses without evident hemodynamic compromise exhibit a preserved autonomic cardiovascular regulation, characterized by higher values of RSA and mean heart-period in the presence of FBM. This physiological response reflects a compensatory strategy that may contribute to preserve blood flow redistribution to vital organs.
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Affiliation(s)
- R Arias-Ortega
- Laboratorio de Investigación en Fisiología Humana (LIFH), Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana Unidad Iztapalapa (UAM-I), 09340 México D.F., México; Programa de Doctorado en Ingeniería Biomédica, División de Ciencias Básicas e Ingeniería, UAM-I, 09340 México D.F., México.
| | - J C Echeverría
- Ingeniería de Fenómenos Fisiológicos Perinatales, Departamento de Ingeniería Eléctrica, UAM-I, 09340 México D.F., México
| | - M Guzmán-Huerta
- Unidad de Investigación de Medicina Materno Fetal, del Departamento de Medicina Fetal del Instituto Nacional de Perinatología (INPer), 11000 México D.F., México
| | - L Camargo-Marín
- Unidad de Investigación de Medicina Materno Fetal, del Departamento de Medicina Fetal del Instituto Nacional de Perinatología (INPer), 11000 México D.F., México
| | - M J Gaitán-González
- Laboratorio de Investigación en Fisiología Humana (LIFH), Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana Unidad Iztapalapa (UAM-I), 09340 México D.F., México
| | - H Borboa-Olivares
- Unidad de Investigación de Medicina Materno Fetal, del Departamento de Medicina Fetal del Instituto Nacional de Perinatología (INPer), 11000 México D.F., México
| | - E Portilla-Islas
- Programa de Doctorado en Ingeniería Biomédica, División de Ciencias Básicas e Ingeniería, UAM-I, 09340 México D.F., México
| | - S Camal-Ugarte
- Centro de Investigación Materno Infantil del Grupo de Estudios al Nacimiento (CIMIGen), 09890 México D.F., México
| | - C Vargas-García
- Centro de Investigación Materno Infantil del Grupo de Estudios al Nacimiento (CIMIGen), 09890 México D.F., México
| | - M R Ortiz
- Ingeniería de Fenómenos Fisiológicos Perinatales, Departamento de Ingeniería Eléctrica, UAM-I, 09340 México D.F., México
| | - R González-Camarena
- Laboratorio de Investigación en Fisiología Humana (LIFH), Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana Unidad Iztapalapa (UAM-I), 09340 México D.F., México.
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9
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Koos BJ, Rajaee A. Fetal breathing movements and changes at birth. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 814:89-101. [PMID: 25015803 DOI: 10.1007/978-1-4939-1031-1_8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The fetus, which develops within a fluid-filled amniotic sac, relies on the placenta for respiratory gas exchange rather than the lungs. While not involved in fetal oxygenation, fetal breathing movements (FBM) nevertheless have an important role in lung growth and in development of respiratory muscles and neural regulation. FBM are regulated differently in many respects than postnatal respiration, which results from the unique intrauterine environment. Prominent distinctions of FBM include its episodic nature and apnea-sensitivity to hypoxia. The latter characteristic is the basis for using FBM in the assessment of fetuses at risk for hypoxic injury. At birth, the transition to continuous postnatal respiration involves a fall in temperature, gaseous distention of the lungs, activation of the Hering-Breuer reflexes, and functional connectivity of afferent O2 chemoreceptor activity with respiratory motoneurons and arousal centers. Importantly, exposure to drugs or adverse conditions in utero not only can change patterns of FBM but also can lead to epigenetic dysregulation in postnatal respiration. Such changes, can blunt respiratory and arousal defenses against hypoxic challenges in sleep. Thus, fetal hypoxia and/or drug exposure may in later life dispose sleeping infants, children, and adults to hypertension, diabetes mellitus, brain injury, and sudden death.
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Affiliation(s)
- Brian J Koos
- Department of Obstetrics and Gynecology, Brain Research Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA,
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10
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Abstract
Sonographic evaluation of the fetal venous system in normal and abnormal conditions has drawn increasing interest in recent years. Whereas the assessment of the fetal heart and the related arteries is standardized using well-defined planes, the fetal venous system is still lacking a systematic approach. In this article we present a novel sonographic algorithm for a systematic examination of the fetal venous system using six planes of transverse and oblique views of the fetal abdomen and chest. These planes, using two-dimensional and color Doppler, enable a targeted demonstration of the typical veins to include the umbilical vein, ductus venosus, portal veins, hepatic veins, inferior vena cava, azygos vein, pulmonary veins, coronary sinus, superior vena cava and brachiocephalic vein. We postulate that integrating such a sequential stepwise algorithm for the evaluation of the venous system into targeted fetal cardiac imaging may improve the detection of isolated and combined anomalies of the fetal systemic and pulmonary veins.
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11
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Leinan PR, Kiserud T, Hellevik LR. Human Ductus Venosus Velocity Profiles in the First Trimester. Cardiovasc Eng Technol 2013; 4:257-266. [DOI: 10.1007/s13239-013-0133-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 02/06/2013] [Indexed: 10/27/2022]
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12
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Nyberg MK, Johnsen SL, Rasmussen S, Kiserud T. Blood flow in the foetal superior vena cava and the effect of foetal breathing movements. Early Hum Dev 2012; 88:165-70. [PMID: 21958879 DOI: 10.1016/j.earlhumdev.2011.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 08/03/2011] [Accepted: 08/07/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The superior vena cava (SVC) drains venous blood from the upper foetal body, mainly the head. Data on the human foetus is scarce. Here we present reference values for the blood flow during the second half of pregnancy, and test the hypothesis that foetal breathing movements (FBM) enhance this flow. METHODS Based on a power calculation, 110 women with low-risk singleton pregnancies were recruited to a longitudinal study that included three sets of observations during the second half of pregnancy. Ultrasound was used to determine inner diameter, peak systolic blood velocity and time-average maximum velocities in the SVC during rest and respiratory activity. RESULTS During the second half of pregnancy, SVC blood flow increased from 57.8 mL/min (95% CI 51.7-64.3) to 221.5 (204.5-239.3). Based on 558 sets of observations obtained during foetal rest and FBM, we found an overall increase in diameter from 0.41 cm (0.40-0.42) to 0.46 (0.44-0.48), peak systolic velocity from 35.9 cm/s (34.9-37.0) to 62.2 (59.1-65.5), and time-averaged maximum velocity from 20.3 cm/s (19.7-20.8) to 27.3 (26.1-28.6). This resulted in an overall 90% increase in mean SVC blood flow, from 108.1 mL/min (98.8-117.9) at rest to 205.9 (183.2-230.5) during FBM. CONCLUSION The blood flow in the SVC increases during the second half of pregnancy and is substantially augmented during FBM. Since high-amplitude FBM additionally reduces flow in the inferior vena cava, the net effect is a prioritised venous drainage from the foetal head enhancing the washout of CO(2) in that area, which also contains the chemoreceptors.
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Affiliation(s)
- M K Nyberg
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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