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Zalinska A, Respondek-Liberska M, Slodki M. Maternal hyperoxygenation during pregnancy as a tool in fetal disease diagnosis and treatment. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:273-282. [PMID: 36785501 DOI: 10.1002/jcu.23347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 06/18/2023]
Abstract
Maternal hyperoxygenation (MHO) consists of giving pregnant women (60% to 100%) oxygen through a facemask and using ultrasound assess or monitor the influence on fetal cardiovascular circulation. This review discusses the findings and the utility of acute and chronic MHO in various fetal diseases.
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Affiliation(s)
- Agnieszka Zalinska
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Department of Obstetrics and Perinatology, Chair of Obstetrics, Gynecology and Oncological Gynecology, Medical University of Lodz, Lodz, Poland
| | - Maria Respondek-Liberska
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Department of Diagnosis and Prevention of Fetal Malformations, Medical University of Lodz, Lodz, Poland
| | - Maciej Slodki
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Faculty of Health Sciences, The Mazovian State University, Plock, Poland
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Wongkitikamjorn W, Wada E, Hosomichi J, Maeda H, Satrawaha S, Hong H, Yoshida KI, Ono T, Hayashi YK. Metabolic dysregulation and decreased capillarization in skeletal muscles of male adolescent offspring rats exposed to gestational intermittent hypoxia. Front Physiol 2023; 14:1067683. [PMID: 36711021 PMCID: PMC9878705 DOI: 10.3389/fphys.2023.1067683] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/03/2023] [Indexed: 01/14/2023] Open
Abstract
Gestational intermittent hypoxia (IH) is a hallmark of obstructive sleep apnea that occurs frequently during pregnancy, and effects caused by this environmental change during pregnancy may be transmitted to the offspring. In this study, we aimed to clarify the effects of IH in pregnant rats on the skeletal muscle of adolescent offspring rats. Mother rats underwent IH from gestation day 7-21, and their 5-weeks-old male offspring were analyzed. All male offspring rats were born and raised under normoxia conditions. Although no general growth retardation was observed, we found that exposure to gestational IH reduces endurance running capacity of adolescent offspring rats. Both a respiratory muscle (diaphragm; DIA) and a limb muscle (tibialis anterior; TA) showed no histological abnormalities, including fiber size and fiber type distribution. To identify the possible mechanism underlying the reduced running capacity, regulatory factors associated with energy metabolism were analyzed in different parts of skeletal muscles. Compared with rats born under conditions of gestational normoxia, gestational IH offspring rats showed significantly lower expression of genes associated with glucose and lipid metabolism, and lower protein levels of phosphorylated AMPK and AKT. Furthermore, gene expression of adiponectin receptors one and two was significantly decreased in the DIA and TA muscles. In addition, the DIA muscle from adolescent rats had significantly decreased capillary density as a result of gestational IH. However, these changes were not observed in a sucking muscle (geniohyoid) and a masticating muscle (masseter) of these rats. These results suggest that respiratory and limb muscles are vulnerable to gestational IH, which induces altered energy metabolism with decreased aerobic motor function. These changes were partially owing to the decreased expression of adiponectin receptors and decreased capillary density in adolescent offspring rats.
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Affiliation(s)
- Wirongrong Wongkitikamjorn
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan,Department of Orthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Eiji Wada
- Department of Pathophysiology, Tokyo Medical University, Tokyo, Japan
| | - Jun Hosomichi
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hideyuki Maeda
- Department of Forensic Medicine, Tokyo Medical University, Tokyo, Japan
| | - Sirichom Satrawaha
- Department of Orthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Haixin Hong
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan,Department of Stomatology, Shenzhen University General Hospital, Shenzhen, China
| | - Ken-ichi Yoshida
- Department of Forensic Medicine, Tokyo Medical University, Tokyo, Japan
| | - Takashi Ono
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yukiko K. Hayashi
- Department of Pathophysiology, Tokyo Medical University, Tokyo, Japan,*Correspondence: Yukiko K. Hayashi,
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Camacho LE, Davis MA, Kelly AC, Steffens NR, Anderson MJ, Limesand SW. Prenatal Oxygen and Glucose Therapy Normalizes Insulin Secretion and Action in Growth Restricted Fetal Sheep. Endocrinology 2022; 163:6585511. [PMID: 35560217 PMCID: PMC9113332 DOI: 10.1210/endocr/bqac053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Indexed: 11/19/2022]
Abstract
Placental insufficiency (PI) lowers fetal oxygen and glucose concentrations, which disrupts glucose-insulin homeostasis and promotes fetal growth restriction (FGR). To date, prenatal treatments for FGR have not attempted to correct the oxygen and glucose supply simultaneously. Therefore, we investigated whether a five-day correction of oxygen and glucose concentrations in PI-FGR fetuses would normalize insulin secretion and glucose metabolism. Experiments were performed in near-term FGR fetal sheep with maternal hyperthermia-induced PI. Fetal arterial oxygen tension was increased to normal levels by increasing the maternal inspired oxygen fraction and glucose was infused into FGR fetuses (FGR-OG). FGR-OG fetuses were compared to maternal air insufflated, saline-infused fetuses (FGR-AS) and control fetuses. Prior to treatment, FGR fetuses were hypoxemic and hypoglycemic and had reduced glucose-stimulated insulin secretion (GSIS). During treatment, oxygen, glucose, and insulin concentrations increased, and norepinephrine concentrations decreased in FGR-OG fetuses, whereas FGR-AS fetuses were unaffected. On treatment day 4, glucose fluxes were measured with euglycemic and hyperinsulinemic-euglycemic clamps. During both clamps, rates of glucose utilization and production were greater in FGR-AS than FGR-OG fetuses, while glucose fluxes in FGR-OG fetuses were not different than control rates. After five-days of treatment, GSIS increased in FGR-OG fetuses to control levels and their ex vivo islet GSIS was greater than FGR-AS islets. Despite normalization in fetal characteristics, GSIS, and glucose fluxes, FGR-OG and FGR-AS fetuses weighed less than controls. These findings show that sustained, simultaneous correction of oxygen and glucose normalized GSIS and whole-body glucose fluxes in PI-FGR fetuses after the onset of FGR.
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Affiliation(s)
- Leticia E Camacho
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona 85719, USA
| | - Melissa A Davis
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona 85719, USA
| | - Amy C Kelly
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona 85719, USA
| | - Nathan R Steffens
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona 85719, USA
| | - Miranda J Anderson
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona 85719, USA
| | - Sean W Limesand
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona 85719, USA
- Correspondence: Sean W. Limesand, PhD, Animal and Comparative Biomedical Sciences, The University of Arizona, 1650 E Limberlost Dr, Tucson AZ 85719, USA.
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Cadaret CN, Posont RJ, Swanson RM, Beard JK, Gibbs RL, Barnes TL, Marks-Nelson ES, Petersen JL, Yates DT. Intermittent maternofetal oxygenation during late gestation improved birthweight, neonatal growth, body symmetry, and muscle metabolism in intrauterine growth-restricted lambs. J Anim Sci 2022; 100:6453369. [PMID: 34865027 DOI: 10.1093/jas/skab358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/30/2021] [Indexed: 02/05/2023] Open
Abstract
In humans and animals, intrauterine growth restriction (IUGR) results from fetal programming responses to poor intrauterine conditions. Chronic fetal hypoxemia elevates circulating catecholamines, which reduces skeletal muscle β2 adrenoceptor content and contributes to growth and metabolic pathologies in IUGR-born offspring. Our objective was to determine whether intermittent maternofetal oxygenation during late gestation would improve neonatal growth and glucose metabolism in IUGR-born lambs. Pregnant ewes were housed at 40 °C from the 40th to 95th day of gestational age (dGA) to produce IUGR-born lambs (n = 9). A second group of IUGR-born lambs received prenatal O2 supplementation via maternal O2 insufflation (100% humidified O2, 10 L/min) for 8 h/d from dGA 130 to parturition (IUGR+O2, n = 10). Control lambs (n = 15) were from pair-fed thermoneutral ewes. All lambs were weaned at birth, hand-reared, and fitted with hindlimb catheters at day 25. Glucose-stimulated insulin secretion (GSIS) and hindlimb hyperinsulinemic-euglycemic clamp (HEC) studies were performed at days 28 and 29, respectively. At day 30, lambs were euthanized and ex vivo HEC studies were performed on isolated muscle. Without maternofetal oxygenation, IUGR lambs were 40% lighter (P < 0.05) at birth and maintained slower (P < 0.05) growth rates throughout the neonatal period compared with controls. At 30 d of age, IUGR lambs had lighter (P < 0.05) hindlimbs and flexor digitorum superficialis (FDS) muscles. IUGR+O2 lambs exhibited improved (P < 0.05) birthweight, neonatal growth, hindlimb mass, and FDS mass compared with IUGR lambs. Hindlimb insulin-stimulated glucose utilization and oxidation rates were reduced (P < 0.05) in IUGR but not IUGR+O2 lambs. Ex vivo glucose oxidation rates were less (P < 0.05) in muscle from IUGR but not IUGR+O2 lambs. Surprisingly, β2 adrenoceptor content and insulin responsiveness were reduced (P < 0.05) in muscle from IUGR and IUGR+O2 lambs compared with controls. In addition, GSIS was reduced (P < 0.05) in IUGR lambs and only modestly improved (P < 0.05) in IUGR+O2. Insufflation of O2 also increased (P < 0.05) acidosis and hypercapnia in dams, perhaps due to the use of 100% O2 rather than a gas mixture with a lesser O2 percentage. Nevertheless, these findings show that intermittent maternofetal oxygenation during late gestation improved postnatal growth and metabolic outcomes in IUGR lambs without improving muscle β2 adrenoceptor content.
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Affiliation(s)
- Caitlin N Cadaret
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE 68583
| | - Robert J Posont
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE 68583
| | - Rebecca M Swanson
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE 68583
| | - Joslyn K Beard
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE 68583
| | - Rachel L Gibbs
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE 68583
| | - Taylor L Barnes
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE 68583
| | | | - Jessica L Petersen
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE 68583
| | - Dustin T Yates
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE 68583
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Kobayashi K, Liu C, Jonas RA, Ishibashi N. The Current Status of Neuroprotection in Congenital Heart Disease. CHILDREN 2021; 8:children8121116. [PMID: 34943311 PMCID: PMC8700367 DOI: 10.3390/children8121116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022]
Abstract
Neurological deficits are a serious and common sequelae of congenital heart disease (CHD). While their underlying mechanisms have not been fully characterized, their manifestations are well-known and understood to persist through adulthood. Development of therapies to address or prevent these deficits are critical to attenuate future morbidity and improve quality of life. In this review, we aim to summarize the current status of neuroprotective therapy in CHD. Through an exploration of present research in the pre-operative, intra-operative, and post-operative phases of patient management, we will describe existing clinical and bench efforts as well as current endeavors underway within this research area.
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Affiliation(s)
- Kei Kobayashi
- Center for Neuroscience Research, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC 20010, USA; (K.K.); (C.L.); (R.A.J.)
- Children’s National Heart Institute, Children’s National Hospital, Washington, DC 20010, USA
| | - Christopher Liu
- Center for Neuroscience Research, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC 20010, USA; (K.K.); (C.L.); (R.A.J.)
- School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Richard A. Jonas
- Center for Neuroscience Research, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC 20010, USA; (K.K.); (C.L.); (R.A.J.)
- Children’s National Heart Institute, Children’s National Hospital, Washington, DC 20010, USA
- School of Medicine and Health Science, George Washington University, Washington, DC 20052, USA
| | - Nobuyuki Ishibashi
- Center for Neuroscience Research, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC 20010, USA; (K.K.); (C.L.); (R.A.J.)
- Children’s National Heart Institute, Children’s National Hospital, Washington, DC 20010, USA
- School of Medicine and Health Science, George Washington University, Washington, DC 20052, USA
- Correspondence:
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Deng Y, Jin Y, Xu R, Zeng S. Fetal Hemodynamic Response to Maternal Oxygenation in Normal and Complicated Pregnancies. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:607-613. [PMID: 32971542 DOI: 10.1055/a-1187-1459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Maternal oxygenation (MO) is widely applied in obstetrics. Scholars have conducted numerous studies on maternal hyperoxygenation and have reported many theoretical and applied achievements and a number of different points of view. The main purpose of this article is to discuss the effect of maternal oxygenation on fetal circulation during normal and complicated pregnancies and to ascertain its potential side effects and research gaps in this field. In complicated pregnancies, the fetus may benefit from oxygen therapy. However, large randomized controlled trials and longitudinal studies are necessary to support the widespread application of maternal oxygenation in this context.
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Affiliation(s)
- Yan Deng
- Department of Ultrasonography, Second Xiangya Hospital, Changsha, China
| | - Ying Jin
- Department of Ultrasonography, Second Xiangya Hospital, Changsha, China
| | - Ran Xu
- Urology, Second Xiangya Hospital, Changsha, China
| | - Shi Zeng
- Department of Ultrasonography, Second Xiangya Hospital, Changsha, China
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Hogan WJ, Moon-Grady AJ, Zhao Y, Cresalia NM, Nawaytou H, Quezada E, Brook M, McQuillen P, Peyvandi S. Fetal cerebrovascular response to maternal hyperoxygenation in congenital heart disease: effect of cardiac physiology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:769-775. [PMID: 32202689 PMCID: PMC7673795 DOI: 10.1002/uog.22024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/23/2020] [Accepted: 03/13/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Fetal cerebrovascular resistance is influenced by several factors in the setting of intact autoregulation to allow for normal cerebral blood flow and oxygenation. Maternal hyperoxygenation (MH) allows for acute alterations in fetal physiology and can be a tool to test cerebrovascular reactivity in late-gestation fetuses. In this study, we utilized MH to evaluate cerebrovascular reactivity in fetuses with specific congenital heart disease (CHD). METHODS This was a cross-sectional study of fetuses with complex CHD compared to controls without CHD. CHD cases were grouped according to physiology into: left-sided obstructive lesion (LSOL), right-sided obstructive lesion (RSOL) or dextro-transposition of the great arteries (d-TGA). Subjects underwent MH testing during the third-trimester fetal echocardiogram. The pulsatility index (PI) was calculated for the fetal middle cerebral artery (MCA), umbilical artery (UA) and branch pulmonary artery (PA). The change in PI from baseline to during MH was compared between each CHD group and controls. RESULTS Sixty pregnant women were enrolled (CHD, n = 43; control, n = 17). In the CHD group, there were 27 fetuses with LSOL, seven with RSOL and nine with d-TGA. Mean gestational age was 33.9 (95% CI, 33.6-34.2) weeks. At baseline, MCA-PI Z-score was lowest in the LSOL group (-1.8 (95% CI, -2.4 to -1.2)) compared with the control group (-0.8 (95% CI, -1.3 to -0.3)) (P = 0.01). In response to MH, MCA-PI Z-score increased significantly in the control and d-TGA groups but did not change significantly in the LSOL and RSOL groups. The change in MCA-PI Z-score was significantly higher in the control group than in the LSOL group (0.9 (95% CI, 0.42-1.4) vs 0.12 (95% CI, -0.21 to 0.45); P = 0.03). This difference was more pronounced in the LSOL subgroup with retrograde aortic arch flow. Branch PA-PI decreased significantly in response to MH in all groups, with no difference in the change from baseline to MH between the groups, while UA-PI was unchanged during MH compared with at baseline. CONCLUSIONS The fetal cerebrovascular response to MH varies based on the underlying CHD diagnosis, suggesting that cardiovascular physiology may influence the autoregulatory capacity of the fetal brain. Further studies are needed to determine the clinical implications of these findings on long-term neurodevelopment in these at-risk children. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- W J Hogan
- Division of Pediatric Cardiology, Department of Pediatrics, The University of California San Francisco, San Francisco, CA, USA
| | - A J Moon-Grady
- Division of Pediatric Cardiology, Department of Pediatrics, The University of California San Francisco, San Francisco, CA, USA
| | - Y Zhao
- Division of Pediatric Cardiology, Department of Pediatrics, The University of California San Francisco, San Francisco, CA, USA
| | - N M Cresalia
- Division of Pediatric Cardiology, Department of Pediatrics, The University of California San Francisco, San Francisco, CA, USA
| | - H Nawaytou
- Division of Pediatric Cardiology, Department of Pediatrics, The University of California San Francisco, San Francisco, CA, USA
| | - E Quezada
- Division of Pediatric Cardiology, Department of Pediatrics, The University of California San Francisco, San Francisco, CA, USA
| | - M Brook
- Division of Pediatric Cardiology, Department of Pediatrics, The University of California San Francisco, San Francisco, CA, USA
| | - P McQuillen
- Division of Critical Care, Department of Pediatrics, The University of California San Francisco, San Francisco, CA, USA
| | - S Peyvandi
- Division of Pediatric Cardiology, Department of Pediatrics, The University of California San Francisco, San Francisco, CA, USA
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McHugh A, El-Khuffash A, Franklin O, Breathnach FM. Calling into question the future of hyperoxygenation in pregnancy. Eur J Obstet Gynecol Reprod Biol 2020; 258:93-97. [PMID: 33421817 DOI: 10.1016/j.ejogrb.2020.12.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/09/2020] [Accepted: 12/28/2020] [Indexed: 01/07/2023]
Abstract
Maternal hyperoxygenation has been investigated as a potential diagnostic and therapeutic tool since the 1960s. Since then, it has been applied in many obstetric scenarios, both clinically and in the research setting. It is often administered without any determination of pre-hyperoxygenation maternal or fetal oxygen levels. Studies focussing on maternal oxygen therapy for the treatment of fetal growth restriction have been ongoing for over thirty years and there remains no clear evidence of benefit. Studies investigating the potential diagnostic or therapeutic role of maternal oxygen therapy in the setting of fetal congenital cardiac disease have reported varying success rates and some potentially worrying adverse effects. The purpose of this article is to review the effects of maternal hyperoxygenation on fetal and maternal health and to ascertain the safety of undertaking further clinical trials that employ the use of hyperoxygenation in pregnancy.
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Affiliation(s)
- Ann McHugh
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland.
| | - Afif El-Khuffash
- Department of Neonatology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - Orla Franklin
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Fionnuala M Breathnach
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
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Peyvandi S, Xu D, Wang Y, Hogan W, Moon-Grady A, Barkovich AJ, Glenn O, McQuillen P, Liu J. Fetal Cerebral Oxygenation Is Impaired in Congenital Heart Disease and Shows Variable Response to Maternal Hyperoxia. J Am Heart Assoc 2020; 10:e018777. [PMID: 33345557 PMCID: PMC7955474 DOI: 10.1161/jaha.120.018777] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Impairments in fetal oxygen delivery have been implicated in brain dysmaturation seen in congenital heart disease (CHD), suggesting a role for in utero transplacental oxygen therapy. We applied a novel imaging tool to quantify fetal cerebral oxygenation by measuring T2* decay. We compared T2* in fetuses with CHD with controls with a focus on cardiovascular physiologies (transposition or left‐sided obstruction) and described the effect of brief administration of maternal hyperoxia on T2* decay. Methods and Results This is a prospective study performed on pregnant mothers with a prenatal diagnosis of CHD compared with controls in the third trimester. Participants underwent a fetal brain magnetic resonance imaging scan including a T2* sequence before and after maternal hyperoxia. Comparisons were made between control and CHD fetuses including subgroup analyses by cardiac physiology. Forty‐four mothers (CHD=24, control=20) participated. Fetuses with CHD had lower total brain volume (238.2 mm3, 95% CI, 224.6–251.9) compared with controls (262.4 mm3, 95% CI, 245.0–279.8, P=0.04). T2* decay time was faster in CHD compared with controls (beta=−14.4, 95% CI, −23.3 to −5.6, P=0.002). The magnitude of change in T2* with maternal hyperoxia was higher in fetuses with transposition compared with controls (increase of 8.4 ms, 95% CI, 0.5–14.3, P=0.01), though between‐subject variability was noted. Conclusions Cerebral tissue oxygenation is lower in fetuses with complex CHD. There was variability in the response to maternal hyperoxia by CHD subgroup that can be tested in future larger studies. Cardiovascular physiology is critical when designing neuroprotective clinical trials in the fetus with CHD.
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Affiliation(s)
- Shabnam Peyvandi
- Department of Pediatrics Division of Cardiology University of California San Francisco San Francisco CA.,Department of Epidemiology and Biostatistics University of California San Francisco San Francisco CA
| | - Duan Xu
- Department of Radiology and Biomedical Imaging University of California San Francisco San Francisco CA
| | - Yan Wang
- Department of Radiology and Biomedical Imaging University of California San Francisco San Francisco CA
| | - Whitnee Hogan
- Department of Pediatrics Division of Cardiology University of California San Francisco San Francisco CA
| | - Anita Moon-Grady
- Department of Pediatrics Division of Cardiology University of California San Francisco San Francisco CA
| | - A James Barkovich
- Department of Radiology and Biomedical Imaging University of California San Francisco San Francisco CA
| | - Orit Glenn
- Department of Radiology and Biomedical Imaging University of California San Francisco San Francisco CA
| | - Patrick McQuillen
- Department of Pediatrics, Division of Critical Care University of California San Francisco San Francisco CA
| | - Jing Liu
- Department of Radiology and Biomedical Imaging University of California San Francisco San Francisco CA
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McHugh A, Breatnach C, Bussmann N, Franklin O, El-Khuffash A, Breathnach FM. Prenatal prediction of neonatal haemodynamic adaptation after maternal hyperoxygenation. BMC Pregnancy Childbirth 2020; 20:706. [PMID: 33213415 PMCID: PMC7678134 DOI: 10.1186/s12884-020-03403-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/06/2020] [Indexed: 11/17/2022] Open
Abstract
Abstract The reactivity of the pulmonary vascular bed to the administration of oxygen is well established in the post-natal circulation. The vasoreactivity demonstrated by the fetal pulmonary artery Doppler waveform in response to maternal hyperoxia has been investigated. We sought to investigate the relationship between the reactivity of the fetal pulmonary arteries to hyperoxia and subsequent neonatal cardiac function in the early newborn period. Methods This explorative study with convenience sampling measured pulsatility index (PI), resistance index (RI), acceleration time (AT), and ejection time (ET) from the fetal distal branch pulmonary artery (PA) at baseline and following maternal hyperoxygenation (MH). Oxygen was administered for 10 min at a rate of 12 L/min via a partial non-rebreather mask. A neonatal functional echocardiogram was performed within the first 24 h of life to assess ejection fraction (EF), left ventricular output (LVO), and neonatal pulmonary artery AT (nPAAT). This study was conducted in the Rotunda Hospital, Dublin, Ireland. Results Forty-six women with a singleton pregnancy greater than or equal to 31 weeks’ gestational age were prospectively recruited to the study. The median gestational age was 35 weeks. There was a decrease in fetal PAPI and PARI following MH and an increase in fetal PAAT, leading to an increase in PA AT:ET. Fetuses that responded to hyperoxygenation were more likely to have a higher LVO (135 ± 25 mL/kg/min vs 111 ± 21 mL/kg/min, p < 0.01) and EF (54 ± 9% vs 47 ± 7%,p = 0.03) in the early newborn period than those that did not respond to MH prenatally. These findings were not dependent on left ventricular size or mitral valve (MV) annular diameter but were related to an increased MV inflow. There was no difference in nPAAT. Conclusion These findings indicate a reduction in fetal pulmonary vascular resistance (PVR) and an increase in pulmonary blood flow and left atrial return following MH. The fetal response to hyperoxia reflected an optimal adaptation to postnatal life with rapid reduction in PVR increasing measured cardiac output. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03403-y.
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Affiliation(s)
- Ann McHugh
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland.
| | - Colm Breatnach
- Department of Neonatology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - Neidin Bussmann
- Department of Neonatology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - Orla Franklin
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Afif El-Khuffash
- Department of Neonatology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - Fionnuala M Breathnach
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
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Zeng S, Zhou J, Peng Q, Deng W, Zhou Q. Cerebral hemodynamic response to short-term maternal hyperoxygenation in fetuses with borderline small left hearts. BMC Pregnancy Childbirth 2020; 20:411. [PMID: 32680473 PMCID: PMC7368676 DOI: 10.1186/s12884-020-03103-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypoxia delays brain maturation and contributes to neurodevelopmental morbidity in fetuses with congenital heart defects (CHDs). Maternal hyperoxygenation (MH) can, in theory, promote oxygen/nutrient delivery to the fetal brain, owing to an improved heart structure/function and increased fetal oxygen content. We aimed to determine whether MH alters fetal cerebral hemodynamics in fetuses with CHD. METHODS Twenty-eight fetuses with borderline small left hearts and 28 age-matched normal fetuses were enrolled and subdivided by gestational age (GA): 23+ 0 ~ 27+ 6 weeks and 28+ 0 ~ 36+ 6 weeks. The middle cerebral artery pulsatility index (MCA-PI), vascular index (VI), flow index (FI) and vascular/flow index (VFI) were measured with baseline room air, after 10 min of MH and after 10 min of recovery for all subjects. RESULTS MCA-PI, VI, FI and VFI did not differ with MH in the normal fetuses. In fetuses with borderline small left hearts, MCA-PI increased and VI, FI and VFI significantly decreased during the 3rd trimester (from 1.44 ± 0.27, 3.19 ± 0.87, 56.91 ± 9.19, and 1.30 ± 0.33 at baseline to 1.62 ± 0.15, 2.37 ± 0.37, 45.73 ± 4.59, and 0.94 ± 0.15 during MH, respectively, P < 0.05), but this response was not apparent during mid-gestation (p > 0.05). These parameters returned to the baseline levels during the recovery phase. The change in cerebral perfusion depended on the baseline MCA-PI and increased the combined cardiac index (CCOi). CONCLUSIONS MH alters the cerebral hemodynamics of fetuses with borderline small left hearts during the third trimester. Further investigation is needed to determine whether MH may benefit brain growth and neurodevelopment in this high-risk population.
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Affiliation(s)
- Shi Zeng
- Department of Ultrasonography, The Second Xiangya Hospital, Central South University, No. 139 Middle Renming Road, Changsha, Hunan, 410011, P.R. China.
| | - Jiawei Zhou
- Department of Ultrasonography, The Second Xiangya Hospital, Central South University, No. 139 Middle Renming Road, Changsha, Hunan, 410011, P.R. China
| | - Qinghai Peng
- Department of Ultrasonography, The Second Xiangya Hospital, Central South University, No. 139 Middle Renming Road, Changsha, Hunan, 410011, P.R. China
| | - Wen Deng
- Department of Genecology & Obstetrics, The Second Xiangya Hospital, Central South University, No. 139 Middle Renming Road, Changsha, Hunan, 410011, P.R. China
| | - Qichang Zhou
- Department of Ultrasonography, The Second Xiangya Hospital, Central South University, No. 139 Middle Renming Road, Changsha, Hunan, 410011, P.R. China
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Sanapo L, Al-Shargabi T, Ahmadzia HK, Schidlow DN, Donofrio MT, Hitchings L, Khoury A, Larry Maxwell G, Baker R, Bulas DI, Gomez LM, du Plessis AJ. Fetal acute cerebral vasoreactivity to maternal hyperoxia in low-risk pregnancies: a cross-sectional study. Prenat Diagn 2020; 40:813-824. [PMID: 32274806 DOI: 10.1002/pd.5694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/03/2020] [Accepted: 03/23/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To establish whether fetal cerebral vasoreactivity (CVRO2 ), following maternal hyperoxia, is predicted by fetal cerebral and uteroplacental Doppler pulsatility indices (PI) at baseline, fetal pulmonary vasoreactivity to oxygen (PVRO2 ), gestational age (GA), or sex. METHODS Pulsatility index of middle (MCA), anterior (ACA), posterior cerebral (PCA), umbilical (UA), uterine (UtA), and branch of the pulmonary arteries (PA) were obtained, by ultrasound, before (baseline), during (hyperoxia) and after 15 minutes of maternal administration of 8 L/min of 100% oxygen, through a non-rebreathing face mask, in normal singleton pregnancies within 20 to 38 weeks' gestation. CVRO2 was defined as changes greater than zero in z score of PI of the cerebral arteries from baseline to hyperoxia. Logistic modeling was applied to identify CVRO2 predictors. RESULTS A total of 97 pregnancies were eligible. In the overall population, median z scores of PI of MCA, ACA, and PCA did not differ between study phases. Based on the logistic model, baseline z scores for cerebral PI and GA were the best predictors of CVRO2 . CONCLUSIONS In low-risk pregnancies, fetal CVRO2 to hyperoxia does not occur uniformly but depends on cerebral PI and GA at baseline. These findings may provide useful reference points when oxygen is administered in high-risk pregnancies.
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Affiliation(s)
- Laura Sanapo
- Women's Medicine Collaborative-Division of Research, The Miriam Hospital, Providence, Rhode Island, USA
| | - Tareq Al-Shargabi
- Division of Fetal and Transitional Medicine, Children's National Hospital, Washington, District of Columbia, USA
| | - Homa K Ahmadzia
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Science, Washington, District of Columbia, USA
| | - David N Schidlow
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Mary T Donofrio
- Division of Fetal and Transitional Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Division of Cardiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Laura Hitchings
- Division of Fetal and Transitional Medicine, Children's National Hospital, Washington, District of Columbia, USA
| | - Alfred Khoury
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Inova Health System, Falls Church, Virginia, USA
| | - G Larry Maxwell
- Department of Obstetrics and Gynecology, Inova Health System, Falls Church, Virginia, USA
| | - Robin Baker
- Department of Neonatology, Fairfax Neonatal Associates, Inova Children's Hospital, Falls Church, Virginia, USA
| | - Dorothy I Bulas
- Division of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Luis M Gomez
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Inova Health System, Falls Church, Virginia, USA
| | - Adre J du Plessis
- Division of Fetal and Transitional Medicine, Children's National Hospital, Washington, District of Columbia, USA
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You W, Andescavage NN, Kapse K, Donofrio MT, Jacobs M, Limperopoulos C. Hemodynamic Responses of the Placenta and Brain to Maternal Hyperoxia in Fetuses with Congenital Heart Disease by Using Blood Oxygen-Level Dependent MRI. Radiology 2019; 294:141-148. [PMID: 31687920 DOI: 10.1148/radiol.2019190751] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Impaired brain development in fetuses with congenital heart disease (CHD) may result from inadequate cerebral oxygen supply in utero. Purpose To test whether fetal cerebral oxygenation can be increased by maternal oxygen administration, effects of maternal hyperoxia on blood oxygenation of the placenta and fetal brain were examined by using blood oxygenation level-dependent (BOLD) functional MRI. Materials and Methods In this prospective study, BOLD MRI was performed in 86 fetuses (56 healthy fetuses and 30 fetuses diagnosed with CHD) between 22 and 39 weeks gestational age (GA) from May 2015 to December 2017, with the following study design: phase I, 2-minute resting state at baseline (room air); phase II, 6-minute maternal hyperoxia with 100% oxygen; and phase III, 5.6-minute return to resting state. After motion correction, the signals were averaged over the placenta and fetal brain and converted to the change in R2* (ΔR2*). Fetuses with CHD were categorized into those with a single ventricle (SV) or two ventricles (TVs) and those with aortic obstruction (AO) or non-AO. Data were analyzed by using generalized linear mixed models controlling for GA and sex. Results Placental ΔR2* increased during maternal hyperoxia in healthy fetuses and fetuses with CHD, but it was higher in SV CHD (mean ΔR2*, 1.3 sec-1 ± 0.1 [standard error; P < .01], 1.9 sec-1 ± 0.2 [P < .01], and 1.0 sec-1 ± 0.3 [P < .01], respectively, for control fetuses, fetuses with SV CHD, and fetuses with TV CHD). Placental ΔR2* during maternal hyperoxia changed with GA in healthy control fetuses and fetuses with SV or AO CHD (ΔR2* per week, 0.1 sec-1 ± 0 [P < .01], 0.2 sec-1 ± 0 [P = .01], and 0.2 sec-1 ± 0 [P = .01], respectively), but not in fetuses with CHD and TV or non-AO. Fetal brain ΔR2* was constant across all phases in healthy control fetuses and fetuses with TV CHD but increased during maternal hyperoxia in fetuses with SV or AO CHD (mean ΔR2*, 0.7 sec-1 ± 0.2 [P = .01] and 0.5 sec-1 ± 0.2 [P = .02], respectively). Conclusion Six minutes of maternal hyperoxia increased placental oxygenation in healthy fetuses and fetuses with congenital heart disease, and it selectively increased cerebral blood oxygenation in fetuses with single ventricle or aortic obstruction. © RSNA, 2019 Online supplemental material is available for this article.
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Affiliation(s)
- Wonsang You
- From the Divisions of Diagnostic Imaging & Radiology (W.Y., K.K., C.L.), Neonatology (N.N.A.), Cardiology (M.T.D.), Fetal & Transitional Medicine (M.T.D., C.L.), and Epidemiology and Biostatistics (M.J.), Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010; and Department of Pediatrics, George Washington University School of Medicine, Washington, DC (N.N.A., M.T.D., C.L.)
| | - Nickie N Andescavage
- From the Divisions of Diagnostic Imaging & Radiology (W.Y., K.K., C.L.), Neonatology (N.N.A.), Cardiology (M.T.D.), Fetal & Transitional Medicine (M.T.D., C.L.), and Epidemiology and Biostatistics (M.J.), Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010; and Department of Pediatrics, George Washington University School of Medicine, Washington, DC (N.N.A., M.T.D., C.L.)
| | - Kushal Kapse
- From the Divisions of Diagnostic Imaging & Radiology (W.Y., K.K., C.L.), Neonatology (N.N.A.), Cardiology (M.T.D.), Fetal & Transitional Medicine (M.T.D., C.L.), and Epidemiology and Biostatistics (M.J.), Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010; and Department of Pediatrics, George Washington University School of Medicine, Washington, DC (N.N.A., M.T.D., C.L.)
| | - Mary T Donofrio
- From the Divisions of Diagnostic Imaging & Radiology (W.Y., K.K., C.L.), Neonatology (N.N.A.), Cardiology (M.T.D.), Fetal & Transitional Medicine (M.T.D., C.L.), and Epidemiology and Biostatistics (M.J.), Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010; and Department of Pediatrics, George Washington University School of Medicine, Washington, DC (N.N.A., M.T.D., C.L.)
| | - Marni Jacobs
- From the Divisions of Diagnostic Imaging & Radiology (W.Y., K.K., C.L.), Neonatology (N.N.A.), Cardiology (M.T.D.), Fetal & Transitional Medicine (M.T.D., C.L.), and Epidemiology and Biostatistics (M.J.), Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010; and Department of Pediatrics, George Washington University School of Medicine, Washington, DC (N.N.A., M.T.D., C.L.)
| | - Catherine Limperopoulos
- From the Divisions of Diagnostic Imaging & Radiology (W.Y., K.K., C.L.), Neonatology (N.N.A.), Cardiology (M.T.D.), Fetal & Transitional Medicine (M.T.D., C.L.), and Epidemiology and Biostatistics (M.J.), Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010; and Department of Pediatrics, George Washington University School of Medicine, Washington, DC (N.N.A., M.T.D., C.L.)
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Chen T, Zhao M, Song J, Mu X, Jiang Y, Zhou X, Zhou X, Dai Y. The effect of maternal hyperoxygenation on placental perfusion in normal and Fetal Growth Restricted pregnancies using Intravoxel Incoherent Motion. Placenta 2019; 88:28-35. [PMID: 31606612 DOI: 10.1016/j.placenta.2019.08.078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/05/2019] [Accepted: 08/07/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the effect of maternal hyperoxygenation on placental perfusion in normal and Fetal Growth Restricted (FGR) pregnancies using Intravoxel Incoherent Motion (IVIM). METHODS Ten FGR pregnancies and twenty-five normal pregnancies underwent IVIM examinations before and after maternal hyperoxygenation (95% O2, 5% CO2) using a 1.5T MR scanner. The IVIM parameters (fp, Dt, Dp) were determined for the placentas of both groups. The IVIM parameters within and between groups and their correlations with Doppler findings were statistically analyzed. ROC analysis was performed to evaluate the diagnostic power of IVIM derived parameters. RESULTS Before maternal hyperoxygenation, the perfusion fraction fp was significantly lower in the FGR group than that in the normal group (22.88±10.29 (%) vs. 36.28±9.70 (%), p = 0.000). After maternal hyperoxygenation, fp decreased significantly in the normal group (36.28±9.70 (%) vs. 29.93±10.25 (%), p = 0.032), whereas it remained relatively stable in the FGR group (22.88±10.29 (%) vs. 24.38±13.67 (%), p = 0.508). An increase of Dt was found only for the normal group and Dp did not changed significantly after maternal hyperoxygenation. There existed a negative correlation between fppre and umbilical artery pulsatility index (PI) (r = -0.385, p < 0.05) as well as Dtpost and PI (r = -0.574, p < 0.01). The fppre displayed a best diagnostic power of all parameters with the area under curve (AUC) of 0.912. CONCLUSION The perfusion fraction, fp, is able to distinguish FGR from normal pregnancies by its value pre and by its change (or lack thereof) post maternal hyperoxygenation. IVIM may potentially help improve the diagnosis of placenta function as it relates to disease.
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Affiliation(s)
- Ting Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Meng Zhao
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Jiacheng Song
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Xihu Mu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yong Jiang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xin Zhou
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xuanyi Zhou
- United Imaging Healthcare, MR Collaboration, Shanghai, 201302, China
| | - Yongming Dai
- United Imaging Healthcare, MR Collaboration, Shanghai, 201302, China
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15
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Graupner O, Enzensberger C, Axt-Fliedner R. New Aspects in the Diagnosis and Therapy of Fetal Hypoplastic Left Heart Syndrome. Geburtshilfe Frauenheilkd 2019; 79:863-872. [PMID: 31423021 PMCID: PMC6690741 DOI: 10.1055/a-0828-7968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/29/2018] [Accepted: 12/30/2018] [Indexed: 12/26/2022] Open
Abstract
Fetal hypoplastic left heart syndrome (HLHS) is a severe congenital heart disease with a lethal prognosis without postnatal therapeutic intervention or surgery. The aim of this article is to give a brief overview of new findings in the field of prenatal diagnosis and the therapy of HLHS. As cardiac output in HLHS children depends on the right ventricle (RV), prenatal assessment of fetal RV function is of interest to predict poor functional RV status before the RV becomes the systemic ventricle. Prenatal cardiac interventions such as fetal aortic valvuloplasty and non-invasive procedures such as maternal hyperoxygenation seem to be promising treatment options but will need to be evaluated with regard to long-term outcomes. Novel approaches such as stem cell therapy or neuroprotection provide important clues about the complexity of the disease. New aspects in diagnostics and therapy of HLHS show the potential of a targeted prenatal treatment planning. This could be used to optimize parental counseling as well as pre- and postnatal management of affected children.
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Affiliation(s)
- Oliver Graupner
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Enzensberger
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital UKGM, Justus-Liebig University, Giessen, Germany
| | - Roland Axt-Fliedner
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital UKGM, Justus-Liebig University, Giessen, Germany
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16
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Szwast A, Putt M, Gaynor JW, Licht DJ, Rychik J. Cerebrovascular response to maternal hyperoxygenation in fetuses with hypoplastic left heart syndrome depends on gestational age and baseline cerebrovascular resistance. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:473-478. [PMID: 28976608 PMCID: PMC6719779 DOI: 10.1002/uog.18919] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/26/2017] [Accepted: 09/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Compared with normal fetuses, fetuses with hypoplastic left heart syndrome (HLHS) have smaller brain volumes and are at higher risk of brain injury, possibly due to diminished cerebral blood flow and oxygen content. By increasing cerebral oxygen delivery, maternal hyperoxygenation (MH) might improve brain development and reduce the risk of brain injury in these fetuses. This study investigated whether gestational age and baseline cerebrovascular resistance affect the response to MH in fetuses with HLHS. METHODS The study population comprised 43 fetuses with HLHS or HLHS variant referred for fetal echocardiography between January 2004 and September 2008. Middle cerebral artery (MCA) pulsatility index (PI), a surrogate measure of cerebrovascular resistance, was assessed between 20 and 41 weeks' gestation at baseline in room air (RA) and after 10 min of MH. Z-scores of MCA-PI were generated. A mixed-effects model was used to determine whether change in MCA-PI depends upon gestational age and baseline MCA-PI. RESULTS In RA and following MH, MCA-PI demonstrated a curvilinear relationship with gestational age in fetuses with HLHS, peaking at around 28 weeks and then falling more steeply near term. MCA-PI Z-score declined in a linear manner, such that it was 1.4 SD below that in normal fetuses at 38 weeks. Increase in MCA-PI Z-score after MH was first seen at ≥ 28 weeks. A baseline MCA-PI Z-score ≤ -0.96 was predictive of an increase in cerebrovascular resistance in response to MH. CONCLUSION In fetuses with HLHS, MCA-PI first increases in response to MH at ≥ 28 weeks' gestation. A baseline MCA-PI Z-score ≤ -0.96 predicts an increase in cerebrovascular resistance in response to MH. These results may have implications for clinical trials utilizing MH as a neuroprotective agent. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Szwast
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M Putt
- Division of Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - J W Gaynor
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - D J Licht
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - J Rychik
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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17
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Sanapo L, Pruetz JD, Słodki M, Goens MB, Moon-Grady AJ, Donofrio MT. Fetal echocardiography for planning perinatal and delivery room care of neonates with congenital heart disease. Echocardiography 2017; 34:1804-1821. [DOI: 10.1111/echo.13672] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Laura Sanapo
- Division of Fetal and Transitional Medicine; Children's National Health System; George Washington University; Washington DC USA
| | - Jay D. Pruetz
- Division of Cardiology; Children's Hospital Los Angeles; Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Maciej Słodki
- Department of Prenatal Cardiology; Polish Mother's Memorial Hospital Research Institute; Lodz Poland
- Faculty of Health Sciences; The State University of Applied Sciences; Plock Poland
| | - M. Beth Goens
- Special Delivery Service; Pediatric Cardiology; University of New Mexico; Albuquerque NM USA
| | - Anita J. Moon-Grady
- Division of Cardiology; Department of Pediatrics; UCSF Benioff Children's Hospital; San Francisco CA USA
| | - Mary T. Donofrio
- Division of Fetal and Transitional Medicine; Children's National Health System; George Washington University; Washington DC USA
- Fetal Heart Program; Division of Cardiology; Children's National Health System; Washington DC USA
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18
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Khatib N, Thaler I, Beloosesky R, Dabaja H, Ganem N, Abecassis P, Ginsberg Y, Weiner Z. The effect of maternal hyperoxygenation on fetal circulatory system in normal growth and IUGR fetuses. What we can learn from this impact. J Matern Fetal Neonatal Med 2017; 31:914-918. [DOI: 10.1080/14767058.2017.1301925] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Prior T, Kumar S. The impact of maternal hyper-oxygenation on foeto-placental blood flow. J Matern Fetal Neonatal Med 2016; 30:1563-1568. [PMID: 27405340 DOI: 10.1080/14767058.2016.1212009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Maternal hyperoxygenation has been reported to increase foetal oxygen saturation, and is frequently employed during intra-partum episodes of foetal compromise as a component of in utero resuscitation. However, there has been little investigation of its influence on foetal haemodynamics, particularly in appropriately grown foetuses. METHODS This cohort study was undertaken between July 2013 and November 2013. All participants underwent an ultrasound scan prior to active labour (<4 cm dilated), during which foetal biometry, umbilical and middle cerebral artery Dopplers were recorded. Doppler measurements were then repeated after a 20-min period (to act as a control for subsequent measurements after oxygen therapy). Women were then asked to breathe 60% oxygen through Venturi valve masks for 20 min, after which the Doppler measurements were repeated. RESULTS Twenty women were recruited to the study. No significant change in the foetal cerebro-umbilical (CU) ratio was observed following maternal oxygen therapy. The degree of change in Doppler parameters after oxygen therapy was not related to the baseline value of the Doppler parameter. CONCLUSION Maternal hyperoxygenation using 60% oxygen concentration over a 20-min period does not influence foetal umbilical or middle cerebral artery Doppler in appropriately grown foetuses. No adverse effects of maternal oxygen therapy were observed.
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Affiliation(s)
- Tomas Prior
- a Department of Surgery and Cancer , Institute of Reproduction and Developmental Biology, Imperial College London , London , UK and.,b Mater Research Institute - University of Queensland , Level 3 Aubigny Place, Raymond Terrace , South Brisbane , Queensland , Australia
| | - Sailesh Kumar
- a Department of Surgery and Cancer , Institute of Reproduction and Developmental Biology, Imperial College London , London , UK and.,b Mater Research Institute - University of Queensland , Level 3 Aubigny Place, Raymond Terrace , South Brisbane , Queensland , Australia
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Sørensen A, Sinding M, Peters DA, Petersen A, Frøkjær JB, Christiansen OB, Uldbjerg N. Placental oxygen transport estimated by the hyperoxic placental BOLD MRI response. Physiol Rep 2015; 3:3/10/e12582. [PMID: 26471757 PMCID: PMC4632952 DOI: 10.14814/phy2.12582] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Estimating placental oxygen transport capacity is highly desirable, as impaired placental function is associated with fetal growth restriction (FGR) and poor neonatal outcome. In clinical obstetrics, a noninvasive method to estimate the placental oxygen transport is not available, and the current methods focus on fetal well-being rather than on direct assessment of placental function. In this article, we aim to estimate the placental oxygen transport using the hyperoxic placental blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) response. In 21 normal pregnancies and in four cases of severe early onset FGR, placental BOLD MRI was performed in a 1.5 Tesla MRI system (TR:8000 msec, TE:50 msec, Flip angle:90). Placental histological examination was performed in the FGR cases. In normal pregnancies, the average hyperoxic placental BOLD response was 12.6 ± 5.4% (mean ± SD). In the FGR cases, the hyperoxic BOLD response was abnormal only in cases with histological signs of maternal hypoperfusion of the placenta. The hyperoxic placental BOLD response is mainly derived from an increase in the saturation of maternal venous blood. In the normal placenta, the pO2 of the umbilical vein is closely related to the pO2 of the uterine vein. Therefore, the hyperoxic placental BOLD response may reflect the placental oxygen supply to the fetus. In early onset FGR, the placental oxygen transport is reduced mainly because of the maternal hypoperfusion, and in these cases the placental BOLD response might be altered. Thus, the placental BOLD MRI might provide direct noninvasive assessment of placental oxygen transport.
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Affiliation(s)
- Anne Sørensen
- Obstetrics and Gýnecology, Aalborg University Hospital, Aalborg, Denmark
| | - Marianne Sinding
- Obstetrics and Gýnecology, Aalborg University Hospital, Aalborg, Denmark
| | - David A Peters
- Clinical Engineering, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jens B Frøkjær
- Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Ole B Christiansen
- Obstetrics and Gýnecology, Aalborg University Hospital, Aalborg, Denmark
| | - Niels Uldbjerg
- Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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22
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Channing A, Szwast A, Natarajan S, Degenhardt K, Tian Z, Rychik J. Maternal hyperoxygenation improves left heart filling in fetuses with atrial septal aneurysm causing impediment to left ventricular inflow. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:664-669. [PMID: 25296951 DOI: 10.1002/uog.14688] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/24/2014] [Accepted: 09/29/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Aneurysm of the atrial septum (AAS) with excessive excursion of septum primum into the left atrium is an uncommon and relatively benign fetal condition associated with impediment to left ventricular (LV) filling and the appearance of a slender, but apex-forming, LV on fetal echocardiography. Impediment to filling can be severe, creating the image of LV hypoplasia with retrograde aortic flow. We hypothesize that maternal hyperoxygenation alters atrial septal position, improves LV filling, and normalizes aortic flow in fetuses with AAS by increasing fetal pulmonary venous return. METHODS Fetal echocardiography was performed prior to, and at 10 min of, maternal hyperoxygenation in 12 fetuses with AAS who were referred to our center because of LV hypoplasia. Atrial septal excursion (ASE), LV and right ventricular (RV) sphericity index (SI) and direction of flow in the aortic isthmus, as determined by Doppler, were measured. RESULTS With maternal hyperoxygenation, mean ± SD ASE decreased (0.76 ± 0.17 before maternal hyperoxygenation vs 0.53 ± 0.23 after maternal hyperoxygenation; P < 0.01), consistent with increased pulmonary venous return, LV-SI increased (0.29 ± 0.06 vs 0.42 ± 0.06; P < 0.001), indicating increased LV filling, and the direction of aortic isthmus flow changed from retrograde in all cases prior to maternal hyperoxygenation to antegrade in 10 and to bidirectional in two. RV-SI remained unchanged (0.53 ± 0.13 vs 0.52 ± 0.10; P = 0.7). CONCLUSIONS In cases of AAS, short-term maternal hyperoxygenation increases fetal pulmonary venous return, substantially alters LV geometry and promotes antegrade flow in the aortic isthmus. This demonstrates proof-of-concept that maternal hyperoxygenation can improve filling of the left side of the fetal heart in AAS.
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Affiliation(s)
- A Channing
- The Fetal Heart Program, Cardiac Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - A Szwast
- The Fetal Heart Program, Cardiac Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Division of Cardiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - S Natarajan
- The Fetal Heart Program, Cardiac Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - K Degenhardt
- The Fetal Heart Program, Cardiac Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Division of Cardiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Z Tian
- The Fetal Heart Program, Cardiac Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - J Rychik
- The Fetal Heart Program, Cardiac Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Division of Cardiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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DeKoninck P, Jimenez J, Russo FM, Hodges R, Gratacós E, Deprest J. Assessment of pulmonary vascular reactivity to oxygen using fractional moving blood volume in fetuses with normal lung development and pulmonary hypoplasia in congenital diaphragmatic hernia. Prenat Diagn 2014; 34:977-81. [DOI: 10.1002/pd.4408] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 04/27/2014] [Accepted: 05/07/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Philip DeKoninck
- Fetal Medicine Unit, Department of Obstetrics and Gynecology; University Hospitals Leuven; Brussels Belgium
- Cluster Organ Systems, Department of Development and Regeneration; KU Leuven; Leuven Belgium
| | - Julio Jimenez
- Fetal Medicine Unit, Department of Obstetrics and Gynecology; University Hospitals Leuven; Brussels Belgium
- Cluster Organ Systems, Department of Development and Regeneration; KU Leuven; Leuven Belgium
| | - Francesca M. Russo
- Fetal Medicine Unit, Department of Obstetrics and Gynecology; University Hospitals Leuven; Brussels Belgium
- Cluster Organ Systems, Department of Development and Regeneration; KU Leuven; Leuven Belgium
| | - Ryan Hodges
- Fetal Medicine Unit, Department of Obstetrics and Gynecology; University Hospitals Leuven; Brussels Belgium
- Cluster Organ Systems, Department of Development and Regeneration; KU Leuven; Leuven Belgium
| | - Eduard Gratacós
- Maternal-Fetal Medicine Department; Institut Clínic de Ginecologia, Obstetrícia i Neonatologia (ICGON), Hospital Clínic; Barcelona Spain
- Institut d'Investigacions Biomèdiques Augusto Pi i Sunyer (IDIBAPS); University of Barcelona; Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER); Barcelona Spain
| | - Jan Deprest
- Fetal Medicine Unit, Department of Obstetrics and Gynecology; University Hospitals Leuven; Brussels Belgium
- Cluster Organ Systems, Department of Development and Regeneration; KU Leuven; Leuven Belgium
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Brain sparing in fetal mice: BOLD MRI and Doppler ultrasound show blood redistribution during hypoxia. J Cereb Blood Flow Metab 2014; 34:1082-8. [PMID: 24714036 PMCID: PMC4050255 DOI: 10.1038/jcbfm.2014.62] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 03/10/2014] [Accepted: 03/17/2014] [Indexed: 11/08/2022]
Abstract
Mice reproduce many features of human pregnancy and have been widely used to model disorders of pregnancy. However, it has not been known whether fetal mice reproduce the physiologic response to hypoxia known as brain sparing, where blood flow is redistributed to preserve oxygenation of the brain at the expense of other fetal organs. In the present study, blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) and Doppler ultrasound were used to determine the effect of acute hypoxia on the fetal blood flow in healthy, pregnant mice. As the maternal inspired gas mixture was varied between 100% and 8% oxygen on the timescale of minutes, the BOLD signal intensity decreased by 44±18% in the fetal liver and by 12±7% in the fetal brain. Using Doppler ultrasound measurements, mean cerebral blood velocity was observed to rise by 15±8% under hypoxic conditions relative to hyperoxia. These findings are consistent with active regulation of cerebral oxygenation and clearly show brain sparing in fetal mice.
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Huen I, Morris DM, Wright C, Sibley CP, Naish JH, Johnstone ED. Absence ofPo2change in fetal brain despitePo2increase in placenta in response to maternal oxygen challenge. BJOG 2014; 121:1588-94. [PMID: 24816043 DOI: 10.1111/1471-0528.12804] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2013] [Indexed: 12/31/2022]
Affiliation(s)
- I Huen
- Centre for Imaging Sciences, University of Manchester, Manchester, UK; The University of Manchester Biomedical Imaging Institute, University of Manchester, Manchester, UK
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Effects of supplemental oxygen on maternal and neonatal oxygenation in elective cesarean section under spinal anesthesia: a randomized controlled trial. BIOMED RESEARCH INTERNATIONAL 2014; 2014:627028. [PMID: 24696860 PMCID: PMC3950466 DOI: 10.1155/2014/627028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/15/2014] [Indexed: 11/17/2022]
Abstract
The use of supplemental oxygen in uncomplicated cesarean deliveries under spinal anesthesia has been thoroughly investigated during recent decades. The aim of this study was to determine the benefits for both mother and infant of administering supplemental, low-dose oxygen via a nasal cannula versus having no supplement (i.e., room air only). Healthy parturients at term undergoing elective cesarean section under spinal anesthesia were randomly allocated into two groups: an oxygen group (n = 170), who received 3 LPM oxygen via a nasal cannula; and a room-air group (n = 170), who were assigned to breathe room air. Maternal oxygen saturation was measured continuously by using pulse oximeter. The desaturation was determined by oxygen saturation <94% over 30 seconds. Umbilical cord gases and Apgar scores were collected followed delivery of the infant. All maternal desaturation events occurred in 12 parturients assigned to the room-air group. Most events were concurrent with hypotension. The umbilical venous partial pressure of oxygen was significantly higher in the oxygen group. The other blood gas measurements and Apgar scores were not significantly different between the two groups. Based on our findings, the use of supplemental oxygen could prevent maternal desaturation resulting from receiving sedation and intraoperative hypotension.
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Sørensen A, Peters D, Fründ E, Lingman G, Christiansen O, Uldbjerg N. Changes in human placental oxygenation during maternal hyperoxia estimated by blood oxygen level-dependent magnetic resonance imaging (BOLD MRI). ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:310-314. [PMID: 23303592 DOI: 10.1002/uog.12395] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/30/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To investigate changes in human placental oxygenation during maternal hyperoxia using non-invasive blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI). METHODS Eight healthy pregnant women with uncomplicated singleton pregnancies at gestational weeks 28-36 were examined with BOLD MRI, over two consecutive 5-min periods of different oxygenation: first normoxia (21% O2 ) and then hyperoxia (12 L O2 /min), achieved by controlling the maternal oxygen supply with a non-rebreather facial mask. Selecting three slices showing cross-sections of the central part of the placenta, we investigated total placental oxygenation by drawing regions of interest (ROIs) covering the entire placenta, and regional placental oxygenation by drawing smaller ROIs in the darker and brighter areas of the placenta. For each ROI, the difference in BOLD signal between the two episodes was determined and the percentage increase in BOLD signal during hyperoxia (ΔBOLD) was calculated. RESULTS In the BOLD image, the normoxic placenta appeared heterogeneous, with darker areas located to the fetal side and brighter areas to the maternal side. During hyperoxia, the placenta became brighter and the structure more homogeneous, and the BOLD signal of the total placenta increased (ΔBOLDtot , 15.2 ± 3.2% (mean ± SD), P < 0.0001). The increase was seen predominantly in the dark areas in the fetal part of the placenta (ΔBOLDfet , 32.1 ± 9.3%) compared with in the bright areas in the maternal part of the placenta (ΔBOLDmat , 5.4 ± 3.5%). CONCLUSION During hyperoxia, placental oxygenation was increased predominantly in the darker placental areas, which, given their anatomical location, represent the fetal circulation of the placenta. To our knowledge, this is the first study to successfully visualize changes in placental oxygenation using BOLD MRI.
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Affiliation(s)
- A Sørensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbangade, Aalborg, Denmark.
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Aimot-Macron S, Salomon LJ, Deloison B, Thiam R, Cuenod CA, Clement O, Siauve N. In vivo MRI assessment of placental and foetal oxygenation changes in a rat model of growth restriction using blood oxygen level-dependent (BOLD) magnetic resonance imaging. Eur Radiol 2013; 23:1335-42. [PMID: 23440313 DOI: 10.1007/s00330-012-2712-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 09/14/2012] [Accepted: 10/03/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate whether changes in BOLD signal intensities following hyperoxygenation are related to intrauterine growth restriction (IUGR) in a rat model. METHODS IUGR was induced in pregnant rats by ligating the left vascular uterine pedicle at day 16 of gestation. BOLD MR imaging using a balanced steady-state free-precession (balanced-SSFP) sequence on a 1.5-T system was performed on day 19. Signal intensities (SI) before and after maternal hyperoxygenation were compared in the maternal liver and in control and growth-restricted foetoplacental units (FPUs). RESULTS Maternal hyperoxygenation resulted in a significant increase in SI in all regions of interest (P < 0.05) in the 18 rats. In the control group, the SI (mean ± SD) increased by 21 % ± 15 in placentas (n = 74) and 13 % ± 8.5 in foetuses (n = 53). In the IUGR group, the increase was significantly lower: 6.5 % ± 4 in placentas (n = 36) and 7 %± 5.5 in foetuses (n = 34) (P < 0.05). CONCLUSION BOLD MRI allows non-invasive assessment of the foetoplacental response to maternal hyperoxygenation in the rat and demonstrates its alteration in an IUGR model. This imaging method may provide a useful adjunct for the early diagnosis, evaluation, and management of human IUGR. KEY POINTS • Intra-uterine growth restriction is an important cause of perinatal morbidity and mortality. • Blood oxygen level-dependent MRI non-invasively assesses foetoplacental response to maternal hyperoxygenation. • In the rat, foetoplacental response to maternal hyperoxygenation is altered in IUGR. • Functional MRI may help to assess human IUGR.
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Affiliation(s)
- S Aimot-Macron
- INSERM, U970, Paris Cardiovascular Research Center-PARCC, 56 rue Leblanc, 75015 Paris, France.
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Use of Intravoxel Incoherent Motion MR Imaging to Assess Placental Perfusion in a Murine Model of Placental Insufficiency. Invest Radiol 2013. [DOI: 10.1097/rli.0b013e318271a5f8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Sørensen A, Peters D, Simonsen C, Pedersen M, Stausbøl-Grøn B, Christiansen OB, Lingman G, Uldbjerg N. Changes in human fetal oxygenation during maternal hyperoxia as estimated by BOLD MRI. Prenat Diagn 2012; 33:141-5. [PMID: 23233459 DOI: 10.1002/pd.4025] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Changes in blood oxygen level dependent (BOLD) magnetic resonance imaging (MRI) signal are closely related to changes in fetal oxygenation. In this study, we aimed to investigate the changes in human fetal oxygenation during maternal hyperoxia by using the non-invasive BOLD MRI technique. METHOD Eight healthy pregnant women in gestational week 28 to 34 were included. With the use of a facial oxygen mask, we induced maternal hyperoxia and measured changes in the BOLD MRI signal of selected fetal organs. RESULTS In a number of fetal organs, the BOLD MRI signal increased significantly (P < 0.01) during maternal hyperoxia (mean change in % ± SEM): liver (14.3 ± 3.7%), spleen (15.2 ± 3.5%) and kidney (6.2 ± 1.8%) as well as the placenta (6.5 ± 1.6%). In the fetal brain, however, the BOLD MRI signal remained constant (0.3 ± 0.2%). CONCLUSION During maternal hyperoxia, we demonstrated an increased oxygenation in a number of human fetal organs by using the non-invasive BOLD technique. The oxygenation of the fetal brain remained constant, thus a 'reversed' brain sparing mechanism could be considered in healthy fetuses subjected to hyperoxia.
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Affiliation(s)
- Anne Sørensen
- Department of Obstetrics and Gynecology, Aalborg Hospital, Aalborg, Denmark.
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31
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DeKoninck P, Lewi P, Done E, Richter J, Gucciardo L, Mieghem TV, Deprest JA. Sonographic evaluation of vascular pulmonary reactivity following oxygen administration in fetuses with normal lung development. Prenat Diagn 2012; 32:1300-4. [DOI: 10.1002/pd.4000] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Philip DeKoninck
- Fetal Medicine Unit, Department of Obstetrics and Gynecology; University Hospitals Leuven; Leuven Belgium
| | - Paul Lewi
- Fetal Medicine Unit, Department of Obstetrics and Gynecology; University Hospitals Leuven; Leuven Belgium
| | - Elisa Done
- Fetal Medicine Unit, Department of Obstetrics and Gynecology; University Hospitals Leuven; Leuven Belgium
| | - Jute Richter
- Fetal Medicine Unit, Department of Obstetrics and Gynecology; University Hospitals Leuven; Leuven Belgium
| | - Léonardo Gucciardo
- Fetal Medicine Unit, Department of Obstetrics and Gynecology; University Hospitals Leuven; Leuven Belgium
| | - Tim Van Mieghem
- Fetal Medicine Unit, Department of Obstetrics and Gynecology; University Hospitals Leuven; Leuven Belgium
| | - Jan A. Deprest
- Fetal Medicine Unit, Department of Obstetrics and Gynecology; University Hospitals Leuven; Leuven Belgium
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Arraut AME, Frias AE, Hobbs TR, McEvoy C, Spindel ER, Rasanen J. Fetal pulmonary arterial vascular impedance reflects changes in fetal oxygenation at near-term gestation in a nonhuman primate model. Reprod Sci 2012; 20:33-8. [PMID: 22991382 DOI: 10.1177/1933719112459224] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We tested the hypothesis that fetal pulmonary arterial circulation reacts to changes in fetal oxygenation status at near-term gestation. STUDY DESIGN A total of 20 rhesus macaques underwent fetal Doppler ultrasonography at near-term gestation. Right pulmonary artery (RPA), umbilical artery (UA), ductus arteriosus (DA), and ductus venosus (DV) blood velocity waveforms were obtained, and pulsatility index (PI) values were calculated. Fetal right and left ventricular cardiac outputs were determined. Ultrasonographic data were collected during 3 maternal oxygenation states: room air (baseline), hyperoxemia, and hypoxemia. RESULTS Fetal RPA PI values increased (P < .05) during maternal hypoxemia and decreased (P < .05) during maternal hyperoxemia, compared with baseline. Maternal hyperoxemia increased (P < .05) DA PI values from baseline. Fetal cardiac outputs, UA, and DV PI values were not affected. CONCLUSIONS Our results demonstrate that at near-term gestation, fetal pulmonary arterial circulation is a dynamic vascular bed that reflects acute and short-term changes in fetal oxygenation.
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Affiliation(s)
- Amaryllis Maria Elpida Arraut
- Department of Obstetrics & Gynecology, Maternal Fetal Medicine Division, Oregon Health & Science University, Portland, OR, USA.
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Chalouhi GE, Deloison B, Siauve N, Aimot S, Balvay D, Cuenod CA, Ville Y, Clément O, Salomon LJ. Dynamic contrast-enhanced magnetic resonance imaging: definitive imaging of placental function? Semin Fetal Neonatal Med 2011; 16:22-8. [PMID: 20851065 DOI: 10.1016/j.siny.2010.09.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The placenta constitutes a complex circulatory interface between the mother and fetus, but the relationship between the maternal and fetal circulation is still very difficult to study in vivo. There is growing evidence that magnetic resonance imaging (MRI) is useful and safe during pregnancy, and MRI is increasingly used for fetal and placental anatomical imaging. MRI functional imaging is now a modern obstetric tool and has the potential to provide new insights into the physiology of the human placenta. Placental perfusion has been studied during the first pass of an MR contrast agent, by arterial spin labeling, diffusion imaging, T1 and T2 relaxation time measurement using echo-planar imaging, and by a combination of magnetization transfer with established stereological methods. The BOLD (blood oxygen level-dependent) effect offers new perspectives for functional MRI evaluation of the placenta.
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Affiliation(s)
- G E Chalouhi
- Laboratoire de Recherche en Imagerie (LRI), INSERM U970, Equipe N°2, Paris Cardiovascular Research Center - PARCC, 56 rue Leblanc, 75015 Paris, France
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Bamfo JEAK, Odibo AO. Diagnosis and management of fetal growth restriction. J Pregnancy 2011; 2011:640715. [PMID: 21547092 PMCID: PMC3087156 DOI: 10.1155/2011/640715] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 01/17/2011] [Accepted: 02/15/2011] [Indexed: 11/18/2022] Open
Abstract
Fetal growth restriction (FGR) remains a leading contributor to perinatal mortality and morbidity and metabolic syndrome in later life. Recent advances in ultrasound and Doppler have elucidated several mechanisms in the evolution of the disease. However, consistent classification and characterization regarding the severity of FGR is lacking. There is no cure, and management is reliant on a structured antenatal surveillance program with timely intervention. Hitherto, the time to deliver is an enigma. In this paper, the challenges in the diagnosis and management of FGR are discussed. The biophysical profile, Doppler, biochemical and molecular technologies that may refine management are reviewed. Finally, a model pathway for the clinical management of pregnancies complicated by FGR is presented.
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Affiliation(s)
| | - Anthony O. Odibo
- 2Division of Maternal-Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, School of Medicine, Washington University, Campus Box 8064, 4566 Scott Avenue, St. Louis, MO 63110, USA
- *Anthony O. Odibo:
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Hashima JN, Frias AE, Bernard L, Spindel ER, Hobbs TR, Rasanen J. Fetal ventricular diastolic filling characteristics in a primate model: the role of fetal heart rate and pulmonary vascular impedance. Reprod Sci 2010; 17:760-6. [PMID: 20595708 DOI: 10.1177/1933719110370490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We hypothesized that fetal ventricular diastolic filling characteristics are related to fetal heart rate (FHR) and pulmonary vascular impedance. METHODS Rhesus monkeys underwent Doppler ultrasonography at near-term gestation. Tricuspid (TV) and mitral valve (MV) blood velocity waveforms were used to calculate maximum velocity (V-max) and velocity time integral (VTI) E/A ratios (early filling/ventricular filling during atrial contraction) at baseline and during maternal hyperoxygenation. Right pulmonary artery (RPA) pulsatility indices (PIs) and FHR were measured. RESULTS Hyperoxgenation significantly decreased FHR and RPA PI. The TV V-max and the MV VTI E/A ratios increased significantly and correlated with a decrease in FHR but not with a decrease in RPA PI. The TV and MV A-wave V-max decreased during hyperoxygenation and their decrease correlated significantly with a drop in FHR. CONCLUSIONS Fetal ventricular diastolic filling characteristics are related to FHR but not to pulmonary vascular impedance.
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Affiliation(s)
- Jason N Hashima
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR 97239, USA.
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Szwast A, Tian Z, McCann M, Donaghue D, Rychik J. Vasoreactive response to maternal hyperoxygenation in the fetus with hypoplastic left heart syndrome. Circ Cardiovasc Imaging 2009; 3:172-8. [PMID: 20044513 DOI: 10.1161/circimaging.109.848432] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Cardiopulmonary interactions play an important role in the pathophysiology of hypoplastic left heart syndrome (HLHS). Pulmonary vasculopathy has been identified, especially in those with restrictive/intact atrial septum. Responsiveness of the pulmonary vasculature to maternal hyperoxygenation (MH) may provide a tool to assess the degree of pulmonary vasculopathy present before birth. METHODS AND RESULTS Doppler echocardiography was performed in 27 normal and 43 HLHS fetuses. In HLHS, sampling was repeated after 10 minutes of MH with 60% FiO(2) and after 5 minutes of recovery. Sampling was performed in the proximal, midportion, and distal branch pulmonary artery (PA). Pulsatility index (PI) was used as a measure of vascular impedance. Of the HLHS fetuses, 34 had an open interatrial septum and 9 had a restrictive/intact atrial septum. At birth, 5 fetuses underwent immediate intervention on the interatrial septum. Middle cerebral artery PI was lower in HLHS versus normal fetuses (P<0.001). There was no difference in UA, DA, or branch PA PI between normal fetuses and those with HLHS. MH led to a significant decrease in PI at each of the PA sites sampled in fetuses with an open atrial septum (P<0.001); however, there no was significant change in the PI in fetuses that required immediate intervention on the atrial septum at birth. Using a cutoff value of <10% vasoreactivity, the sensitivity of MH testing for determining need for immediate intervention at birth is 100% (0.46 to 1.0); specificity, 94% (0.78 to 0.99); positive predictive value, 71% (0.30 to 0.95); and negative predictive value, 100% (0.86 to 1.0). No untoward effects were seen with MH. CONCLUSIONS PA vasoreactivity to MH occurs in the fetus with HLHS. MH testing accurately identifies fetuses requiring urgent postnatal intervention at birth and may be used to select candidates for fetal atrial septoplasty.
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Affiliation(s)
- Anita Szwast
- The Fetal Heart Program at Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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Sørensen A, Pedersen M, Tietze A, Ottosen L, Duus L, Uldbjerg N. BOLD MRI in sheep fetuses: a non-invasive method for measuring changes in tissue oxygenation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:687-92. [PMID: 19771583 DOI: 10.1002/uog.7322] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The purpose of this descriptive study was to correlate changes in the blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) signal with direct measurements of fetal tissue oxygenation. METHODS Seven anesthetized ewes carrying singleton fetuses at 125 days' gestation (term 145 days) underwent BOLD MRI, covering the entire fetus in a multislice approach. The fetuses were subjected to normoxic, hypoxic and hyperoxic conditions by changing the O(2)/N(2)O ratio in the maternal ventilated gas supply. The partial pressure of oxygen (pO2) in the fetal liver was measured using an oxygen-sensitive optode. Maternal arterial blood samples were simultaneously withdrawn for blood gas analysis. These measurements were compared with BOLD MRI signals in the fetal liver, kidney, spleen and brain. RESULTS We demonstrated a consistent increase in the BOLD MRI signal with increasing tissue pO(2). For the fetal liver, spleen and kidney we observed a clear association between changes in maternal arterial blood pO2 and changes in BOLD MRI signal. Interestingly, we found that the BOLD signal of the fetal brain remained unchanged during hypoxic, normoxic and hyperoxic conditions. CONCLUSIONS This experimental study demonstrated that BOLD MRI is a reliable non-invasive method for measuring changes in tissue oxygenation in fetal sheep. The unchanged signal in the fetal brain during altered maternal oxygen conditions is probably explained by the brain-sparing mechanism.
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Affiliation(s)
- A Sørensen
- Department of Gynecology and Obstetrics, Institute of Clinical Medicine, Aarhus University Hospital, Skejby, Aarhus, Denmark.
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Salihagić-Kadić A, Medić M, Jugović D, Kos M, Latin V, Kusan Jukić M, Arbeille P. Fetal cerebrovascular response to chronic hypoxia—implications for the prevention of brain damage. J Matern Fetal Neonatal Med 2009; 19:387-96. [PMID: 16923693 DOI: 10.1080/14767050600637861] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Fetal hypoxia is one of the leading causes of perinatal morbidity and mortality. One of the most severe sequels of fetal hypoxic insult is the development of perinatal brain lesions resulting in a spectrum of neurological disabilities, from minor cerebral disorders to cerebral palsy. One of the most important fetal adaptive responses to hypoxia is redistribution of blood flow towards the fetal brain, known as the 'brain sparing effect'. The fetal blood flow redistribution in favor of the fetal brain can be detected and quantified by the Doppler cerebral/umbilical ratio (C/U ratio = cerebral resistance index (CRI)/umbilical resistance index (URI)). Our studies on animal models and human fetuses have demonstrated clearly that this phenomenon cannot prevent the development of perinatal brain lesions in the case of severe or prolonged hypoxia. Fetal deterioration in chronic and severe hypoxia is characterized by the disappearance of the physiological cerebral vascular variability (vasoconstriction and vasodilatation), followed by an increase in cerebral vascular resistance. However, our latest study on growth-restricted and hypoxic human fetuses has shown that perinatal brain lesions can develop even before the loss of cerebrovascular variability. The fetal exposure to hypoxia can be quantified by using a new vascular score, the hypoxia index. This parameter, which takes into account the degree as well as duration of fetal hypoxia, can be calculated by summing the daily % C/U ratio reduction from the cut-off value 1 over the period of observation. According to our results, the use of this parameter, which calculates the cumulative, relative oxygen deficit, could allow for the first time the sensitive and reliable prediction and even prevention of adverse neurological outcome in pregnancies complicated by fetal hypoxia.
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Affiliation(s)
- Aida Salihagić-Kadić
- Department of Physiology, School of Medicine, University Zagreb, Zagreb, Croatia.
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Bisazza A, Giustetto P, Rolfo A, Caniggia I, Balbis S, Guiot C, Cavalli R. Microbubble-mediated oxygen delivery to hypoxic tissues as a new therapeutic device. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2008:2067-70. [PMID: 19163102 DOI: 10.1109/iembs.2008.4649599] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chitosan-coated oxygen microbubbles of average diameter 2.5 mum, narrow size distribution and spherical shape were prepared. A core-shell structure was evidenced by fluorescence microscopy using fluorescent microbubbles. Such microbubbles can be a therapeutic device for vehiculating oxygen to hypoxic tissues, provided they show proper permeability and diffusivity properties and are non-toxic. Our study proves that oxygen is efficiently delivered both in 'in vitro' and 'in vivo' preparations, and can be conveniently metabolized reversing the cellular hypoxic response. Moreover, toxic effects were investigated in human blood and in cultured cells and no evidence for them was found.
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Affiliation(s)
- Agnese Bisazza
- Department of Drug Science and Technology, University of Torino, Italy.
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Simpson KR. Intrauterine resuscitation during labor: should maternal oxygen administration be a first-line measure? Semin Fetal Neonatal Med 2008; 13:362-7. [PMID: 18534928 DOI: 10.1016/j.siny.2008.04.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Intrauterine resuscitation techniques are often used during labor when the fetal heart rate pattern is nonreassuring. These techniques have not been well studied; common practices are based on classic studies many years old. Models of intrauterine resuscitation using one (or more) technique as a first-line intervention and adding others in a specific series or clinical algorithm based on fetal response have not been tested. Maternal oxygen therapy is often used; however, recent evidence suggests potential risks to the mother and fetus or newborn. Even small increases in maternal and fetal pO(2) as a result of maternal oxygen administration can produce oxygen free radical activity in mothers and fetuses. The potential long-term effects are unknown. Caution should be exercised when considering maternal oxygen administration as a first-line intrauterine resuscitation measure until more data are available, reserving its use after other measures have been unsuccessful in resolving the nonreassuring fetal heart rate pattern.
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Abstract
Fetal growth restriction is most commonly caused by failure of the placenta to meet the increasing demands for oxygen and substrate of the developing fetus, resulting in common fetal compensatory responses. Understanding these responses is helpful in developing a management strategy that will optimize pregnancy outcome.
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Affiliation(s)
- Mark G Neerhof
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Evanston Northwestern Healthcare, Evanston, IL 60201, USA.
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Abstract
The choice of therapy for fetal growth restriction (FGR) depends on the nature of the insult that led to the development of FGR. Many etiologic factors are either not amenable to therapy or fetal growth has not been improved by treatments that benefit the mother. Many therapeutic approaches have been used to improve fetal condition. None of the approaches have been of value in a consistent manner. We present the numerous approaches, and their rationale for their use, that have been tried to treat the growth impaired fetus. The evidence from the randomized clinical trials is summarized and their conclusions given.
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Affiliation(s)
- Reinaldo Figueroa
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Winthrop University Hospital, Mineola, New York, USA.
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Russell Z, Quintero RA, Kontopoulos EV. Intrauterine growth restriction in monochorionic twins. Semin Fetal Neonatal Med 2007; 12:439-49. [PMID: 17761462 DOI: 10.1016/j.siny.2007.06.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intrauterine growth restriction (IUGR) occurs in approximately 3-10% of singleton pregnancies, in 9.1% of all twins, and in 9.9% of monochorionic twins. Spontaneous demise of the IUGR twin may occur and may result in concomitant demise or severe neurological handicap of the other twin. Currently, monochorionic twins with selective IUGR (SIUGR) are managed expectantly. Alternatively, all adverse consequences resulting from the potential demise of the SIUGR twin could be averted by unlinking the circulations between the two fetuses. The latter can be achieved by laser photocoagulation of communicating vessels or by umbilical-cord occlusion. The purpose of this chapter is to review this important entity in obstetrics.
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Affiliation(s)
- Zoi Russell
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, 4 Columbia Drive, Suite 529, Tampa, FL 33606, USA
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Abstract
Fetal growth restriction (FGR) is challenging because of the difficulties in reaching a definitive diagnosis of the cause and planning management. FGR is associated not only with a marked increased risk in perinatal mortality and morbidity but also with long-term outcome risks. Combinations of fetal biometry, amniotic fluid volume, heart rate patterns, arterial and venous Doppler, and biophysical variables allow a comprehensive fetal evaluation of FGR. However, no evidence supports that the use of cardiotocography or the biophysical profile improves perinatal outcome. Therefore, obstetricians aim to identify fetuses with early FGR so delivery can be planned according to gestational age and severity of the condition. The balance of risks and the need for the availability of services mean that the involvement of neonatologists in FGR management is vital. In this review, the focus is on the pathophysiology and management of FGR caused by placental diseases.
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Affiliation(s)
- M Alberry
- Fetal Medicine Research Unit, University of Bristol, St Michael's Hospital, Bristol, UK
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Mondry A, Pengbo L, Loh M, Mongelli M. Z-velocity in screening for intrauterine growth restriction. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 26:634-8. [PMID: 16254884 DOI: 10.1002/uog.2598] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Ultrasound scans provide the basis for detection of intrauterine growth restriction (IUGR) but often fail to distinguish IUGR from small-for-gestational age (SGA) fetuses. This study introduces the concept of Z-velocity, calculated as changes in Z-scores over time, as an additional criterion in the diagnosis of IUGR. METHODS A computer program simulated 50 000 fetal abdominal circumference (FAC) scans based on published growth formulae. False-positive rates were calculated to determine optimal scan time and scan intervals. Using an independent simulation of 32 500 FAC scans, the two methods were compared using receiver-operating characteristics (ROC) curve analysis. RESULTS ROC showed areas under the curve of > 0.74 over the complete range of scan intervals. The positive predictive value of growth arrest as the only diagnostic criterion was, however, too low to recommend it as an exclusive or the first diagnostic criterion. CONCLUSIONS Z-velocity can be used to decide whether further investigations for growth abnormality are required in fetuses that fall below the 10(th) percentile. The gain of combined diagnostic approaches should be calculated from large databases that include the neonatal ponderal index as the gold standard.
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Affiliation(s)
- A Mondry
- Bioinformatics Institute, Singapore.
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Simchen MJ, Tesler J, Azami T, Preiss D, Fedorko L, Goldszmidz E, Fisher J, Kingdom J, Slorach C, Hornberger LK. Effects of maternal hyperoxia with and without normocapnia in uteroplacental and fetal Doppler studies. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 26:495-9. [PMID: 16180259 DOI: 10.1002/uog.1995] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE One hundred percent oxygen is given in pregnancy to improve fetal oxygenation, yet has been shown in both animal and human studies ex utero to increase cerebral vascular resistance. Adjusting end-tidal pCO2 (ET-pCO2) levels to normocapnic levels during hyperoxygenation offsets this effect in non-pregnant individuals. We aimed to evaluate the effect of maternal hyperoxygenation with and without maintaining normocapnia on the fetal and uteroplacental circulations in healthy near-term human pregnancies. METHODS Eight healthy pregnant women, serving as their own controls, sequentially breathed room air, breathed 100% oxygen, and underwent normocapnic hyperoxygenation (NH) in a three-phase experiment involving a tight-fitting facemask. Each phase lasted 10-15 min. After steady state had been reached, peak velocities and pulsatility index (PI) values were obtained from the uterine, umbilical and fetal middle cerebral arteries (MCA) by color/pulsed Doppler. In addition, maternal ventilation and ET-pCO2 were monitored. RESULTS One hundred percent oxygen induced maternal hyperventilation and hypocapnea. Uterine artery PI and peak systolic velocities were stable during 100% oxygen. In contrast, during NH uterine artery PI values decreased by 21% (P=0.04). Umbilical artery PI and peak velocities were stable during 100% oxygen; PI increased by 16% during NH (P=0.056), with no change in peak velocities. Peak MCA velocities decreased by 8% during 100% oxygen, and by 9.6% during NH, while MCA-PI decreased by 13% during 100% oxygen and by 21% during NH (P=0.06). CONCLUSIONS Maternal and fetal circulations exhibit divergent responses to 100% oxygen and NH. While no change is observed in the uteroplacental circulation on 100% oxygen, decreased resistance and increased flow velocity are evident during NH. Increased umbilical artery PI during NH with no change in absolute velocities may suggest a reduction in fetoplacental blood flow. Maintaining normocapnia during hyperoxygenation does not appear to beneficially influence the circulation of the near-term human fetus as it does in non-pregnant individuals.
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Affiliation(s)
- M J Simchen
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel.
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Littner Y, Mandel D, Mimouni FB, Dollberg S. Bone ultrasound velocity of infants born small for gestational age. J Pediatr Endocrinol Metab 2005; 18:793-7. [PMID: 16200846 DOI: 10.1515/jpem.2005.18.8.793] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Quantitative ultrasound is increasingly used to assess bone status. Bone speed of sound (SOS), a biophysical property of bone, has been used to predict bone breakability. While decreased bone mineral content and delayed epiphyseal growth have been reported in small for gestational age (SGA) infants, there are no data on bone SOS in this group of infants. OBJECTIVE To test the hypothesis that SGA infants have lower bone SOS than appropriate for gestational age (AGA) infants. METHODS Bone SOS was measured within the first 96 hours of life at the right tibial midshaft in 22 singleton SGA infants. We compared these data with data obtained in 73 AGA controls. We used the Omnisense instrument which measures axially transmitted SOS. Infants ranged in gestational age (GA) from 25 to 42 weeks and in birth weight (BW) from 500 to 2,585 g. Statistical analyses included paired t-tests between the actual value obtained in every child and the theoretical, computed average normal value for GA, BW, or knee-sole length (KSL) based on our curves for AGA singletons. A p value < 0.05 was considered significant. RESULTS Bone SOS measured in SGA infants was higher than the predicted computed average SOS of AGA singletons with significant differences in all of the parameters studied. CONCLUSIONS Contrary to our hypothesis, SGA infants have higher bone SOS than AGA controls. Since bone mineral density is reported to be low in these infants, we speculate that intrauterine growth restriction may affect bone mineral density and bone protein matrix in opposite directions.
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Affiliation(s)
- Yoav Littner
- Department of Neonatology, Lis Maternity Hospital, Sackler School of Medicine, Tel Aviv, Israel
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Abstract
Regulation of fetal growth is multifactorial and complex. Diverse factors, including intrinsic fetal conditions as well as maternal and environmental factors, can lead to intrauterine growth restriction (IUGR). The interaction of these factors governs the partitioning of nutrients and rate of fetal cellular proliferation and maturation. Although IUGR is probably a physiologic adaptive response to various stimuli, it is associated with distinct short- and long-term morbidities. Immediate morbidities include those associated with prematurity and inadequate nutrient reserve, while childhood morbidities relate to impaired maturation and disrupted organ development. Potential long-term effects of IUGR are debated and explained by the fetal programming hypothesis. In formulating a comprehensive approach to the management and follow-up of the growth-restricted fetus and infant, physicians should take into consideration the etiology, timing, and severity of IUGR. In addition, they should be cognizant of the immediate perinatal response of the growth-restricted infant as well as the childhood and long-term associated morbidities. A multi disciplinary approach is imperative, including early recognition and obstetrical management of IUGR, assessment of the growth-restricted newborn in the delivery room, possible monitoring in the neonatal intensive care unit, and appropriate pediatric follow-up. Future research is necessary to establish effective preventive, diagnostic, and therapeutic strategies for IUGR, perhaps affecting the health of future generations.
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Affiliation(s)
- Dara Brodsky
- Beth Israel Deaconess Medical Center and Children's Hospital, Harvard Medical School, Department of Newborn Medicine, Boston, MA 02215, USA.
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Sebire N, Jain V, Talbert D. Spiral artery associated restricted growth (SPAARG): a computer model of pathophysiology resulting from low intervillous pressure having fetal programming implications. PATHOPHYSIOLOGY 2004; 11:87-94. [PMID: 15364119 DOI: 10.1016/j.pathophys.2004.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2004] [Revised: 06/02/2004] [Accepted: 06/03/2004] [Indexed: 01/29/2023] Open
Abstract
Failure of adequate trophoblastic conversion of maternal spiral arteries is associated with intrauterine growth restriction (IUGR). In addition to poor oxygen delivery, raised spiral artery resistance reduces placental intervillous pressure. An iterative type computer model was formed by linking an existing model of the fetus and a new nine cotyledon placental model. Simulation of compression cuffing of the spiral arteries to progressively restrict uteroplacental flow was performed, while observing various fetal and placental variables. Water moved to the fetus in the cotyledonary core villi, and to the mother in the outer villous layers. While the fetus could match villous capillary pressure to changes in intervillous pressure, net transplacental water movement was minimal, but when spiral artery resistance was increased sufficiently to cause mean intervillous pressure to fall below that which the fetus could match, a net flow to the mother appeared. That continued until the resulting fetal blood hemoconcentration produced a sufficient increase in colloid osmotic pressure to restrict further loss. All cells within the fetal-placental unit are then required to operate in an abnormal ionic environment, which may significantly affect systems such as the renin-angiotensin set-point, with implications for post-natal homeostasis such as control of adult blood pressure. Furthermore, in vivo, cells of the feto-placental unit respond to the increased intravascular osmotic pressure by production of intracellular osmolytes in order to match intracellular and vascular/interstitial osmotic pressures. This may explain the observed effects on postnatal water balance in growth restricted infants and could also provide a possible mechanism for the association of the systemic maternal complications associated with impaired placentation and reduced intervillus flow.
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Affiliation(s)
- N.J. Sebire
- Department of Histopathology, Great Ormond Street Hospital, London, WC1N, UK
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