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de Jesus Cruz J, Bernardeco J, Rijo C, Cohen A, Serrano F. Hepatic arterial buffer response: activation in donor fetuses and the effect of laser ablation of intertwin anastomosis. J Perinat Med 2024; 52:71-75. [PMID: 37850825 DOI: 10.1515/jpm-2023-0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/12/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVES Hepatic arterial buffer response (HABR) is an important defence mechanism for maintaining liver blood flow. It is suspected that HABR is active in monochorionic diamniotic twins (MCDA) with twin-to-twin transfusion syndrome (TTTS) where donor compensates a setting of volume depletion and the recipient an overload. The present study investigates whether in TTTS, HABR is active in donor and/or recipient individually and try to determine if the activation of HABR is a direct response to TTTS. METHODS Hepatic artery (HA) peak systolic velocity (PSV) was measured in normal MCDA fetuses and TTTS. Correlation with relevant fetal Dopplers and characteristics were determined. Z-scores for HA-PSV (HAV-Z) were calculated and its association with TTTS in donors and recipients were determined as well as changes in HAV-Z after laser treatment. RESULTS In this study 118 MCDA were included, 61.9 % normal and 38.1 % TTTS. Of the TTTS 22 required laser treatment. A total of 382 scans were performed in normal group and 155 in TTTS. Our data demonstrates that in donors HAV-Z was 2.4 Z-scores higher compared to normal fetuses (β=2.429 95 % CI 1.887, 2.971; p<0.001) and after laser treatment HAV-Z reduced (β=-1.829 95 % CI -2.593, -1.064; p<0.001). There was no significant difference between recipients and normal (β=-0.092 95 % CI -0.633, 0.449; p=0.738). CONCLUSIONS HABR is active in TTTS, promoting an increased hepatic blood flow in donors. The activation is direct response to TTTS as shown by the reduction in HAV-Z after laser. This finding provides important insights into the pathophysiology of TTTS.
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Affiliation(s)
- Jader de Jesus Cruz
- Department of Fetal Medicine, Central Lisbon University Hospitals, Lisbon, Portugal
| | - Joana Bernardeco
- Department of Fetal Medicine, Central Lisbon University Hospitals, Lisbon, Portugal
| | - Claudia Rijo
- Department of Fetal Medicine, Central Lisbon University Hospitals, Lisbon, Portugal
| | - Alvaro Cohen
- Department of Fetal Medicine, Central Lisbon University Hospitals, Lisbon, Portugal
| | - Fatima Serrano
- Department of Obstetrics, Central Lisbon University Hospitals, Lisbon, Portugal
- Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisbon, Portugal
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Kivilevitch Z, Gilboa Y, Gilad N, Kassif E, Achiron R. Afferent venous perfusion of fetal liver: umbilical and portal blood-flow volumes in fetuses born small-for-gestational age. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:813-820. [PMID: 37128168 DOI: 10.1002/uog.26237] [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: 08/05/2022] [Revised: 02/25/2023] [Accepted: 04/13/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To quantify the dynamic changes in the afferent venous flow volume of the liver in low-risk pregnancies with fetuses born small-for-gestational age. METHODS This was a prospective study of low-risk singleton pregnancies with estimated fetal weight (EFW) and birth weight ≤ 10th centile attending for a routine second- or third-trimester ultrasound examination. Their umbilical and portal blood-flow volumes were compared with those of a control group of fetuses born appropriate-for-gestational age from which normal reference ranges were constructed. Absolute and Z-score differences between the groups were assessed. RESULTS In total, 133 fetuses were included in the study group and 362 in the control group. The mean umbilical blood-flow volume in the study group, both absolute and normalized per kg of EFW, was below that of the appropriate-for-gestational-age fetuses for most of the period of pregnancy studied (overall mean Z-score, -0.82 and -0.84, respectively). In contrast, the mean portal blood-flow volume, per kg of EFW, showed the opposite trend (overall mean Z-score, +0.86), reaching its maximum level (+1.43) in the late third trimester. This resulted in a steep decrease in the mean placental-to-portal-blood-flow volume ratio, from 14.4 at 24 weeks of gestation (above the 60th centile) to 4.7 at 38 weeks of gestation (15th centile), corresponding to Z-scores of +0.4 and -1.02, respectively. CONCLUSION In fetuses born small-for-gestational age, the ratio of blood-flow volume in the umbilical vein to that in the portal vein decreases consistently during pregnancy, and to a greater extent compared with those born appropriate-for-gestational age, reaching a lower nadir in the third trimester. This additional redistribution of liver perfusion affects negatively fetal growth even in low-risk pregnancy, and should be taken into account when planning delivery. We suggest considering liver venous perfusion as an ancillary tool for monitoring small-for-gestational-age pregnancies. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- Z Kivilevitch
- Maccabi Health Services, Ultrasound Unit, The Negev Medical Center, Beer Sheva, Israel
| | - Y Gilboa
- Department of Obstetrics and Gynecology, Ultrasound Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - N Gilad
- Department of Obstetrics and Gynecology, Ultrasound Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Kassif
- Department of Obstetrics and Gynecology, Ultrasound Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Achiron
- Department of Obstetrics and Gynecology, Ultrasound Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Cruz JDJ, Bernardeco J, Cohen A, Serrano F. Hepatic arterial buffer response in monochorionic diamniotic pregnancies with twin-to-twin transfusion syndrome. J Perinat Med 2022; 51:517-523. [PMID: 36279268 DOI: 10.1515/jpm-2022-0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/18/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Hepatic arterial buffer response (HABR) is an important regulatory process for hepatic blood flow. Its activity has been described in some fetal adverse conditions but in twin-to-twin transfusion syndrome (TTTS) it is unknown if such response is present. The aim of this study is to test the hypothesis that HABR operates in monochorionic diamniotic twins (MCDA) with TTTS. METHODS Hepatic artery pulsatility index (PI) and peak systolic velocity (PSV) were measured prospectively in 64 MCDA pregnancies. 43 without TTTS (group 1) and in 21 pregnancies with TTTS (group 2). We calculated ratios for PI (HAPI-ratio) and PSV (HAV-ratio) between recipient and donor in group 2 or bigger and smaller fetus in group 1 and compared groups. The association of HAV-ratio and HAPI ratio with TTTS, relation with other fetal Dopplers and reliability of measurement by a single operator were investigated. RESULTS HAV-ratio and HAPI-ratio appears to be independent from fetal Dopplers, estimated weight and gestational age. In group 2, HAV-ratio is lower than group 1 (p<0.001, 95% CI 0.443-0.643). In group 1 the mean HAV-ratio is 1.014 (±0.021) while in group 2 is 0.47 (±0.035). HAPI-ratio is lower in group 2 than in group 1 although this difference was not significant (p=0.066, 95% CI -0.007-0.231). A good reliability of measurements of hepatic artery PSV and PI was demonstrated by intraclass correlation coefficient analysis (ICC 0.971 95% CI 0.963-0.977, p<0.001 and ICC 0.694 95% CI 0.596-0.772, p<0.001, respectively). CONCLUSIONS Monochorionic pregnancies with TTTS are associated with lower HAV-ratios. This could be explained by an active HABR.
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Affiliation(s)
- Jader de Jesus Cruz
- Department of Fetal Medicine, Central Lisbon University Hospitals, Lisbon, Portugal.,Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Joana Bernardeco
- Department of Fetal Medicine, Central Lisbon University Hospitals, Lisbon, Portugal
| | - Alvaro Cohen
- Department of Fetal Medicine, Central Lisbon University Hospitals, Lisbon, Portugal
| | - Fatima Serrano
- Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisbon, Portugal.,Department of Obstetrics, Central Lisbon University Hospitals, Lisbon, Portugal
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Desoye G, Carter AM. Fetoplacental oxygen homeostasis in pregnancies with maternal diabetes mellitus and obesity. Nat Rev Endocrinol 2022; 18:593-607. [PMID: 35902735 DOI: 10.1038/s41574-022-00717-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/09/2022]
Abstract
Despite improvements in clinical management, pregnancies complicated by pre-existing diabetes mellitus, gestational diabetes mellitus or obesity carry substantial risks for parent and offspring. Some of the endocrine and metabolic changes in parent and fetus in diabetes mellitus and obesity lead to fetal oxygen deficit, mostly due to insulin-induced accelerated fetal metabolism. The human fetus deals with reduced oxygenation through a wide range of adaptive responses that act at various levels in the placenta as well as the fetus. These responses ensure adequate oxygen delivery to the fetus, increase the oxygen transport capacity of fetal blood and redistribute oxygen-rich blood to vital organs such as the brain and heart. The liver has a central role in adapting to reduced oxygenation by increasing its oxygen extraction and stimulating erythropoietin synthesis to increase haematocrit. The type of adaptive response depends on the onset and duration of hypoxia and the severity of the metabolic disturbance. In pregnancies characterized by diabetes mellitus or obesity, these adaptive systems come under additional strain owing to the increased maternal supply of glucose and resultant fetal hyperinsulinaemia, both of which stimulate oxidative metabolism. In the rare situation that the adaptive responses are overwhelmed, stillbirth can ensue.
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Affiliation(s)
- Gernot Desoye
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria.
- Center for Pregnant Women with Diabetes, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Anthony M Carter
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
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Czuba B, Tousty P, Cnota W, Borowski D, Jagielska A, Dubiel M, Fuchs A, Fraszczyk-Tousty M, Dzidek S, Kajdy A, Świercz G, Kwiatkowski S. First-Trimester Fetal Hepatic Artery Examination for Adverse Outcome Prediction. J Clin Med 2022; 11:jcm11082095. [PMID: 35456191 PMCID: PMC9026841 DOI: 10.3390/jcm11082095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/24/2022] [Accepted: 04/01/2022] [Indexed: 12/10/2022] Open
Abstract
Objective: To assess whether there are differences in first-trimester fetal hepatic artery flows depending on pregnancy outcomes. Methods: The prospective study conducted in 2012–2020 included 1841 fetuses from singleton pregnancies assessed during the routine first-trimester ultrasound examination (between 11- and 14-weeks’ gestation). Also, each fetus was examined to determine their hepatic artery flows by measuring the artery’s pulsatility index (HA-PI) and peak systolic velocity (HA-PSV). Results: The fetuses that were classified as belonging to the adverse pregnancy outcome group (those with karyotype abnormalities and congenital heart defects) were characterized by a significantly lower HA-PI and higher HA-PSV compared to normal outcome fetuses. Conclusion: Hepatic artery flow assessment proved to be a very useful tool in predicting adverse pregnancy outcomes, in particular karyotype abnormalities and congenital heart defects.
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Affiliation(s)
- Bartosz Czuba
- Department of Obstetrics and Gynecology, Medical University of Silesia, 41-703 Ruda Slaska, Poland; (B.C.); (W.C.); (A.J.)
| | - Piotr Tousty
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland; (S.D.); (S.K.)
- Correspondence: ; Tel.: +48-735-923-533
| | - Wojciech Cnota
- Department of Obstetrics and Gynecology, Medical University of Silesia, 41-703 Ruda Slaska, Poland; (B.C.); (W.C.); (A.J.)
| | - Dariusz Borowski
- Department of Perinatology, Gynecology and Gynecologic Oncology, Collegium Medicum, Nicolaus Copernicus University, 85-821 Bydgoszcz, Poland;
| | - Agnieszka Jagielska
- Department of Obstetrics and Gynecology, Medical University of Silesia, 41-703 Ruda Slaska, Poland; (B.C.); (W.C.); (A.J.)
| | - Mariusz Dubiel
- Department of Obstetrics, Gynecology and Gynecological Oncology, Jan Biziel University Hospital, Collegium Medicum, Nicolaus Copernicus University, 85-168 Bydgoszcz, Poland;
| | - Anna Fuchs
- Chair and Department of Gynecology, Obstetrics and Oncological Gynecology, Medical University of Silesia in Katowice, 40-211 Katowice, Poland;
| | - Magda Fraszczyk-Tousty
- Department of Neonatal Diseases, Pomeranian Medical University, 70-111 Szczecin, Poland;
| | - Sylwia Dzidek
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland; (S.D.); (S.K.)
| | - Anna Kajdy
- Department of Reproductive Health, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland;
| | - Grzegorz Świercz
- Clinic of Obstetrics and Gynecology, Provincial Combined Hospital in Kielce, 25-736 Kielce, Poland;
- Collegium Medicum, Jan Kochanowski University in Kielce, 25-369 Kielce, Poland
| | - Sebastian Kwiatkowski
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland; (S.D.); (S.K.)
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Abduljalil K, Pan X, Clayton R, Johnson TN, Jamei M. Fetal Physiologically Based Pharmacokinetic Models: Systems Information on Fetal Cardiac Output and Its Distribution to Different Organs during Development. Clin Pharmacokinet 2021; 60:741-757. [PMID: 33486719 DOI: 10.1007/s40262-020-00973-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Fetal circulation is unique and the parameters describing hemodynamic status during development are critical for constructing a fetal physiologically based pharmacokinetic model. To date, a comprehensive review of circulatory changes during fetal development, with a specific focus on developing these models, has not been reported. The objective of this work was to collate, analyze, and mathematically describe physiological information on fetal cardiac output and tissue blood flows during development. METHODS A comprehensive literature search was carried out to collate and evaluate the changes to fetal cardiac output and fetal tissue blood flows during growth. The collated data were assessed, integrated, and analyzed to establish continuous mathematical functions describing the average parameter changes and variability during development. RESULTS Data were available for fetal cardiac output (14 Doppler studies), blood flow through the fetal umbilical vein (15 studies), ductus venosus (6 studies), liver veins (5 studies), brain (4 studies), lungs (5 studies), and kidneys (2 studies). Fetal cardiac output is described as either an age- or weight-dependent function. The latter is preferred as it generates an individualized cardiac output that is correlated to the fetal body weight. Blood flow as a proportion of fetal cardiac output to the liver, placenta, brain, kidneys, and lungs was age varying, whilst for the adipose, bone, heart, muscle, and skin the blood flow proportions were fixed. The pattern of change (with respect to direction and pace) for each of these parameters was different. CONCLUSIONS Despite limitations in the availability of some values, the collected data provide a useful resource for fetal physiologically based pharmacokinetic modeling. Potential applications of these data include predicting xenobiotic exposure and risk assessment in the fetus following the administration of maternally dosed drugs or unintended exposure to environmental toxicants.
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Affiliation(s)
- Khaled Abduljalil
- Certara UK Limited (Simcyp Division), Level 2-Acero, 1 Concourse Way, Sheffield, S1 2BJ, UK.
| | - Xian Pan
- Certara UK Limited (Simcyp Division), Level 2-Acero, 1 Concourse Way, Sheffield, S1 2BJ, UK
| | - Ruth Clayton
- Certara UK Limited (Simcyp Division), Level 2-Acero, 1 Concourse Way, Sheffield, S1 2BJ, UK
| | - Trevor N Johnson
- Certara UK Limited (Simcyp Division), Level 2-Acero, 1 Concourse Way, Sheffield, S1 2BJ, UK
| | - Masoud Jamei
- Certara UK Limited (Simcyp Division), Level 2-Acero, 1 Concourse Way, Sheffield, S1 2BJ, UK
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7
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Hepatic arterial buffer response: pathologic evidence in non-cirrhotic human liver with extrahepatic portal vein thrombosis. Mod Pathol 2016; 29:489-99. [PMID: 26916069 DOI: 10.1038/modpathol.2016.43] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/13/2016] [Accepted: 01/22/2016] [Indexed: 02/07/2023]
Abstract
Increase in hepatic arterial flow in response to reduced portal flow (hepatic arterial buffer response) has been demonstrated experimentally and surgically. We provide pathologic evidence for hepatic arterial buffer response in non-cirrhotic patients with extrahepatic portal vein thrombosis and elucidate the histopathologic spectrum of non-cirrhotic portal vein thrombosis. Liver biopsies and resections from non-cirrhotic patients with extra-hepatic portal vein thrombosis were retrieved. Morphologic features, extent of CD34 staining, outer diameters, luminal diameters and wall thickness of hepatic arteries cut in cross-section and outer diameters of cross-sectioned paired bile ducts were compared with age- and gender-matched controls. There were 12 male and 9 female patients. Measurements of 280 and 193 arteries from patients and controls, respectively, demonstrated statistically significant (P<0.05) arterial dilatation (increase in percentage of arterial lumen to outer diameter) and arterial wall thinning in resection specimens of non-cirrhotic patients with extra-hepatic portal vein thrombosis. Subtle and/or focal dilatation of central veins, portal veins and sinusoids; focal trabecular thinning/thickening and mild ductular reaction were common findings in both the patient and control groups. Diffuse and obvious changes, and portal vein absence or attenuation were seen only in the patient group. Capillarization of sinusoids was not seen on CD34 stain. Two patients showed significant ductular reaction, one of who developed biliary strictures on follow-up. Hepatic arterial dilatation and wall thinning in non-cirrhotic patients with portal vein thrombosis provide pathologic evidence of hepatic arterial buffer response in the human liver. Obvious and diffuse sinusoidal dilatation and absence or attenuation of portal veins are highly suggestive of extrahepatic portal vein thrombosis in non-cirrhotic patients with portal hypertension. Periportal shunt vessels, hypervascular portal tracts, muscularized portal veins, large thick-walled or dilated arteries aid diagnosis but are rare findings. Normal or near-normal biopsies do not rule out portal vein thrombosis.
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Kim JH. Effects of portal hyperperfusion on partial liver grafts in the presence of hyperdynamic splanchnic circulation: hepatic regeneration versus portal hyperperfusion injury. Anesth Pain Med (Seoul) 2016. [DOI: 10.17085/apm.2016.11.2.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Jong Hae Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea
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9
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Alison M, Biran V, Tanase A, Bendavid M, Blouet M, Demené C, Sebag G, Tanter M, Baud O. Quantitative Shear-Wave Elastography of the Liver in Preterm Neonates with Intra-Uterine Growth Restriction. PLoS One 2015; 10:e0143220. [PMID: 26580807 PMCID: PMC4651533 DOI: 10.1371/journal.pone.0143220] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/01/2015] [Indexed: 12/17/2022] Open
Abstract
The feasibility and reproducibility of liver stiffness measurements using Supersonic Shear-wave Imaging (SSI) in preterm neonate have not been reported. Our aim was to determine if liver stiffness differs between intra-uterine growth restriction (IUGR) and appropriate for gestational age (AGA) preterm infants with/without cholestasis. We measured liver stiffness (in kPa) in 45 AGA and 18 IUGR preterm infants, and assessed reproducibility in 26 preterms using Intraclass Correlation Coefficients (ICC) and Bland-Altman tests. Liver stiffness values were compared between AGA and IUGR with and without cholestasis and correlated with birth weight. Measurements showed high reproducibility (ICC = 0.94–0.98 for intra-operator, 0.86 for inter-operator) with good agreement (95% limits: -1.24 to 1.24 kPa). During the first postnatal week, liver stiffness was higher in IUGR (7.50 ±1.53 kPa) than in AGA infants (5.11 ±0.80 kPa, p<0.001). After day 8, liver stiffness remained unchanged in AGA but increased progressively in IUGR infants (15.57 ±6.49 kPa after day 21). Liver stiffness was higher in IUGR neonates with cholestasis (19.35 ± 9.80 kPa) than without cholestasis (7.72 ± 1.27 kPa, p<0.001). In conclusion, quantitative liver SSI in preterms is feasible and reproducible. IUGR preterms who will develop cholestasis present high liver stiffness even at birth, before biological cholestasis occurs.
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Affiliation(s)
- Marianne Alison
- Department of Pediatric Radiology, Robert Debré Children University Hospital and Denis Diderot Paris University, APHP, 75019 Paris, France
- PremUP foundation, 75014 Paris, France
| | - Valérie Biran
- PremUP foundation, 75014 Paris, France
- Neonatal Intensive Care Unit and INSERM U1141, Robert Debré Children University Hospital and Denis Diderot Paris University, APHP, 75019 Paris, France
| | - Anca Tanase
- Department of Pediatric Radiology, Robert Debré Children University Hospital and Denis Diderot Paris University, APHP, 75019 Paris, France
- PremUP foundation, 75014 Paris, France
| | - Matthieu Bendavid
- Neonatal Intensive Care Unit and INSERM U1141, Robert Debré Children University Hospital and Denis Diderot Paris University, APHP, 75019 Paris, France
| | - Marie Blouet
- Department of Pediatric Radiology, Robert Debré Children University Hospital and Denis Diderot Paris University, APHP, 75019 Paris, France
| | - Charlie Demené
- PremUP foundation, 75014 Paris, France
- Institut Langevin, CNRS UMR 7587, INSERM U979, ESPCI ParisTech, 75005 Paris, France
| | - Guy Sebag
- Department of Pediatric Radiology, Robert Debré Children University Hospital and Denis Diderot Paris University, APHP, 75019 Paris, France
- PremUP foundation, 75014 Paris, France
| | - Mickael Tanter
- PremUP foundation, 75014 Paris, France
- Institut Langevin, CNRS UMR 7587, INSERM U979, ESPCI ParisTech, 75005 Paris, France
| | - Olivier Baud
- PremUP foundation, 75014 Paris, France
- Neonatal Intensive Care Unit and INSERM U1141, Robert Debré Children University Hospital and Denis Diderot Paris University, APHP, 75019 Paris, France
- * E-mail:
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Ahmed B, Abushama M, Khraisheh M, Dudenhausen J. Role of ultrasound in the management of diabetes in pregnancy. J Matern Fetal Neonatal Med 2014; 28:1856-63. [PMID: 25367382 DOI: 10.3109/14767058.2014.971745] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this review is to discuss the established role of ultrasound (US) in the management of pregnancy complicated by diabetes mellitus (DM), as well as new developments with regard to the use of US in this situation. We choose to explore the role of US in pregnancy complicated by DM in three areas: (1) Role of US in estimation of fetal weight. (2) Role of US in diagnosis of congenital malformation. (3) Role of US in monitoring diabetic pregnant patients.
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Affiliation(s)
- Badreldeen Ahmed
- a Weill Cornell Medical College, Fetal Medicine Centre , Doha , Qatar
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11
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Hanson MA, Gluckman PD. Early developmental conditioning of later health and disease: physiology or pathophysiology? Physiol Rev 2014; 94:1027-76. [PMID: 25287859 PMCID: PMC4187033 DOI: 10.1152/physrev.00029.2013] [Citation(s) in RCA: 698] [Impact Index Per Article: 69.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Extensive experimental animal studies and epidemiological observations have shown that environmental influences during early development affect the risk of later pathophysiological processes associated with chronic, especially noncommunicable, disease (NCD). This field is recognized as the developmental origins of health and disease (DOHaD). We discuss the extent to which DOHaD represents the result of the physiological processes of developmental plasticity, which may have potential adverse consequences in terms of NCD risk later, or whether it is the manifestation of pathophysiological processes acting in early life but only becoming apparent as disease later. We argue that the evidence suggests the former, through the operation of conditioning processes induced across the normal range of developmental environments, and we summarize current knowledge of the physiological processes involved. The adaptive pathway to later risk accords with current concepts in evolutionary developmental biology, especially those concerning parental effects. Outside the normal range, effects on development can result in nonadaptive processes, and we review their underlying mechanisms and consequences. New concepts concerning the underlying epigenetic and other mechanisms involved in both disruptive and nondisruptive pathways to disease are reviewed, including the evidence for transgenerational passage of risk from both maternal and paternal lines. These concepts have wider implications for understanding the causes and possible prevention of NCDs such as type 2 diabetes and cardiovascular disease, for broader social policy and for the increasing attention paid in public health to the lifecourse approach to NCD prevention.
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Affiliation(s)
- M A Hanson
- Academic Unit of Human Development and Health, University of Southampton, and NIHR Nutrition Biomedical Research Centre, University Hospital, Southampton, United Kingdom; and Liggins Institute and Gravida (National Centre for Growth and Development), University of Auckland, Auckland, New Zealand
| | - P D Gluckman
- Academic Unit of Human Development and Health, University of Southampton, and NIHR Nutrition Biomedical Research Centre, University Hospital, Southampton, United Kingdom; and Liggins Institute and Gravida (National Centre for Growth and Development), University of Auckland, Auckland, New Zealand
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12
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Leinan PR, Kiserud T, Hellevik LR. Human Ductus Venosus Velocity Profiles in the First Trimester. Cardiovasc Eng Technol 2013; 4:257-266. [DOI: 10.1007/s13239-013-0133-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 02/06/2013] [Indexed: 10/27/2022]
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13
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Kocylowski R, Dubiel M, Gudmundsson S, Fritzer E, Kiserud T, von Kaisenberg C. Hepatic aminotransferases of normal and IUGR fetuses in cord blood at birth. Early Hum Dev 2012; 88:461-5. [PMID: 22137247 DOI: 10.1016/j.earlhumdev.2011.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 10/31/2011] [Accepted: 11/01/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND The accepted standard for assessing the wellbeing of the newborn is the Apgar score and blood gas analysis. However, the prediction of neonatal morbidity or mortality is limited. In small-for-gestation (SGA) fetuses at 18-38 weeks of gestation, pO(2) is <5th centile both in the umbilical artery and vein in 30%. In a previous study in singleton term neonates cardiac specific enzymes (B-type natriuretic peptide, BNP and cardiac troponin T, cTnT) are increased in growth-restricted fetuses compared with normals. AIMS To test the hypothesis, that fetuses with intra uterine growth restriction (IUGR) have elevated AST (GOT) and ALT (GPT) aminotransferases as a result of hypoxic liver cell injury, and to establish references ranges. STUDY DESIGN Prospective cohort study, serum of umbilical artery (n=156) and vein (n=180), 599 normal singletons at 37(+0)-42(+0)weeks, neonates with IUGR (n=41), analysis for pH, birthweight and maternal weight, spontaneous vs cesarean section, vein vs artery and for the sex. OUTCOME MEASURES Aspartate aminotransferase (AST, GOT) and Alanine aminotransferase (ALT, GPT) were measured in normals and IUGR neonates. RESULTS Neonates with IUGR (n=41) had AST values that were not different from the reference group, but had significantly lower ALT (-1.49, 95% CI -1.98 to -1.00 vs 0.14, 95% CI -0.42-0.13), (p<0.001), (Fig. 3). CONCLUSIONS In neonates with IUGR, hypoxic hepatic injury markers in cord blood were not elevated. Rather, a substantially reduced ALT suggests a down-regulated hepatic activity.
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Affiliation(s)
- Rafal Kocylowski
- Dept. of Obstet. and Gynecol., Poznan University of Medical Sciences, Poland
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Elmstedt N, Ferm-Widlund K, Lind B, Brodin LÅ, Westgren M. Fetal cardiac muscle contractility decreases with gestational age: a color-coded tissue velocity imaging study. Cardiovasc Ultrasound 2012; 10:19. [PMID: 22571652 PMCID: PMC3403944 DOI: 10.1186/1476-7120-10-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 05/09/2012] [Indexed: 11/13/2022] Open
Abstract
Background Present data regarding how the fetal heart works and develops throughout gestation is limited. However, the possibility to analyze the myocardial velocity profile provides new possibilities to gain further knowledge in this area. Thus, the objective of this study was to evaluate human fetal myocardial characteristics and deformation properties using color-coded tissue velocity imaging (TVI). Methods TVI recordings from 55 healthy fetuses, at 18 to 42 weeks of gestation, were acquired at a frame rate of 201–273 frames/s for offline analysis using software enabling retrieval of the myocardial velocity curve and 2D anatomical information. The measurements were taken from an apical four-chamber view, and the acquired data was correlated using regression analysis. Results Left ventricular length and width increased uniformly with gestational age. Atrioventricular plane displacement and the E’/A’ ratio also increased with gestational age, while a longitudinal shortening was demonstrated. Conclusions Fetal cardiac muscle contractility decreases with gestational age. As numerous fetal- and pregnancy-associated conditions directly influence the pumping function of the fetal heart, we believe that this new insight into the physiology of the human fetal cardiovascular system could contribute to make diagnosis and risk assessment easier and more accurate.
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Affiliation(s)
- Nina Elmstedt
- Department of Medical Engineering, School of Technology and Health, Royal Institute of Technology, Stockholm, Sweden.
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Ebbing C, Rasmussen S, Kiserud T. Fetal hemodynamic development in macrosomic growth. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:303-308. [PMID: 21557374 DOI: 10.1002/uog.9046] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To determine the venous and arterial hemodynamics underlying macrosomic fetal growth. METHODS Fifty-eight healthy women who previously had given birth to a large neonate were included in a prospective longitudinal study. Of these, 29 gave birth to neonates with birth weight ≥ 90th percentile and were included in the statistical analysis. Umbilical vein blood flow and Doppler measurements of the ductus venosus, left portal vein and the hepatic, splenic, superior mesenteric, cerebral and umbilical arteries were repeated at 3-5 examinations during the second half of pregnancy and compared with the corresponding reference values. Ultrasound biometry was used to estimate fetal weight. RESULTS Umbilical blood flow increased faster in macrosomic fetuses, showed less blunting near term and was also significantly higher when normalized for estimated fetal weight (P < 0.0001). The portocaval perfusion pressure of the liver (expressed by the ductus venosus systolic blood velocity) and the left portal vein blood velocity (expressing umbilical venous distribution to the right liver lobe) were significantly higher. Systolic velocity was higher in the splenic, superior mesenteric, cerebral and umbilical arteries, while the pulsatility index was unaltered in the cerebral, hepatic, splenic and mesenteric arteries, but lower in the umbilical artery. CONCLUSIONS There is an augmented umbilical flow in macrosomic fetuses particularly near term, also when normalized for estimated fetal weight, providing increased liver perfusion, including the right liver lobe. Signs of increased vascular cross section and flow are also seen on the arterial side but not expressed in the pulsatility index of organs with prominent auto-regulation (i.e., brain, liver, spleen and gut).
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Affiliation(s)
- C Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway and Department of Clinical Medicine, University of Bergen, Norway.
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Bilardo CM, Timmerman E, De Medina PGR, Clur SA. Low-resistance hepatic artery flow in first-trimester fetuses: an ominous sign. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:438-443. [PMID: 20922779 DOI: 10.1002/uog.7766] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Low-resistance hepatic artery (HA) flow has been reported in severely growth-restricted fetuses. The same finding has been incidentally observed in first-trimester fetuses with enlarged nuchal translucency (NT). The aim of this study was to investigate HA flow in first-trimester fetuses. METHODS Crown-rump length (CRL), NT, ductus venosus (DV) pulsatility index for veins (PIV) and HA pulsatility index (PI) were measured prospectively in fetuses at increased risk on first-trimester assessment for aneuploidy and in a control group of low-risk fetuses. Outcome of pregnancy was known in all cases. Independent sample t-test was used for intergroup comparison. RESULTS NT, DV-PIV and HA-PI were measured prospectively in 59 fetuses. Thirty-four had an enlarged NT and underwent karyotyping, which was abnormal in 16 cases (trisomy 21, n = 12; trisomy 18, n = 3; 47,XXY, n = 1). Two pregnancies were terminated in view of fetal anomalies. In three other infants an abnormality was confirmed after birth (Noonan syndrome, unspecified genetic syndrome and cardiac defect). The remaining 13 fetuses with enlarged NT and the 25 with normal NT had an uneventful pregnancy outcome. HA-PI was significantly and inversely correlated with NT and DV-PIV. Mean HA-PI was significantly lower in fetuses with adverse outcome (chromosomal anomalies 1.60; chromosomally normal fetuses with adverse outcome 1.66) than in controls (2.03). CONCLUSIONS Low-resistance HA flow can be observed in first-trimester fetuses and, based on its association with adverse outcome, it can be regarded as an ominous sign.
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Affiliation(s)
- C M Bilardo
- Department of Obstetrics and Gynecology, University Medical Centre Groningen, Groningen, The Netherlands.
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Zvanca M, Gielchinsky Y, Abdeljawad F, Bilardo CM, Nicolaides KH. Hepatic artery Doppler in trisomy 21 and euploid fetuses at 11-13 weeks. Prenat Diagn 2011; 31:22-7. [DOI: 10.1002/pd.2664] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Eipel C, Abshagen K, Vollmar B. Regulation of hepatic blood flow: The hepatic arterial buffer response revisited. World J Gastroenterol 2010; 16:6046-57. [PMID: 21182219 PMCID: PMC3012579 DOI: 10.3748/wjg.v16.i48.6046] [Citation(s) in RCA: 317] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The interest in the liver dates back to ancient times when it was considered to be the seat of life processes. The liver is indeed essential to life, not only due to its complex functions in biosynthesis, metabolism and clearance, but also its dramatic role as the blood volume reservoir. Among parenchymal organs, blood flow to the liver is unique due to the dual supply from the portal vein and the hepatic artery. Knowledge of the mutual communication of both the hepatic artery and the portal vein is essential to understand hepatic physiology and pathophysiology. To distinguish the individual importance of each of these inflows in normal and abnormal states is still a challenging task and the subject of ongoing research. A central mechanism that controls and allows constancy of hepatic blood flow is the hepatic arterial buffer response. The current paper reviews the relevance of this intimate hepatic blood flow regulatory system in health and disease. We exclusively focus on the endogenous interrelationship between the hepatic arterial and portal venous inflow circuits in liver resection and transplantation, as well as inflammatory and chronic liver diseases. We do not consider the hepatic microvascular anatomy, as this has been the subject of another recent review.
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Gielchinsky Y, Zvanca M, Minekawa R, Persico N, Nicolaides KH. Liver volume in trisomy 21 and euploid fetuses at 11 to 13 weeks. Prenat Diagn 2010; 31:28-32. [DOI: 10.1002/pd.2633] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kiserud T. Diabetes in pregnancy: scanning the wrong horizon? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:266-267. [PMID: 20812306 DOI: 10.1002/uog.7758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- T Kiserud
- Department of Obstetrics & Gynecology, Haukeland University Hospital, Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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Yagel S, Kivilevitch Z, Cohen SM, Valsky DV, Messing B, Shen O, Achiron R. The fetal venous system, Part II: ultrasound evaluation of the fetus with congenital venous system malformation or developing circulatory compromise. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:93-111. [PMID: 20205158 DOI: 10.1002/uog.7622] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The human fetal venous system is well-recognized as a target for investigation in cases of circulatory compromise, and a broad spectrum of malformations affecting this system has been described. In Part I of this review, we described the normal embryology, anatomy and physiology of this system, essential to the understanding of structural anomalies and the sequential changes encountered in intrauterine growth restriction and other developmental disorders. In Part II we review the etiology and sonographic appearance of malformations of the human fetal venous system, discuss the pathophysiology of the system and describe venous Doppler investigation in the fetus with circulatory compromise.
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Affiliation(s)
- S Yagel
- Obstetrics and Gynecology Ultrasound Center, Hadassah-Hebrew University Medical Centers, Mt Scopus, Jerusalem, Israel.
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Vollmar B, Menger MD. The hepatic microcirculation: mechanistic contributions and therapeutic targets in liver injury and repair. Physiol Rev 2009; 89:1269-339. [PMID: 19789382 DOI: 10.1152/physrev.00027.2008] [Citation(s) in RCA: 352] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The complex functions of the liver in biosynthesis, metabolism, clearance, and host defense are tightly dependent on an adequate microcirculation. To guarantee hepatic homeostasis, this requires not only a sufficient nutritive perfusion and oxygen supply, but also a balanced vasomotor control and an appropriate cell-cell communication. Deteriorations of the hepatic homeostasis, as observed in ischemia/reperfusion, cold preservation and transplantation, septic organ failure, and hepatic resection-induced hyperperfusion, are associated with a high morbidity and mortality. During the last two decades, experimental studies have demonstrated that microcirculatory disorders are determinants for organ failure in these disease states. Disorders include 1) a dysregulation of the vasomotor control with a deterioration of the endothelin-nitric oxide balance, an arterial and sinusoidal constriction, and a shutdown of the microcirculation as well as 2) an overwhelming inflammatory response with microvascular leukocyte accumulation, platelet adherence, and Kupffer cell activation. Within the sequelae of events, proinflammatory mediators, such as reactive oxygen species and tumor necrosis factor-alpha, are the key players, causing the microvascular dysfunction and perfusion failure. This review covers the morphological and functional characterization of the hepatic microcirculation, the mechanistic contributions in surgical disease states, and the therapeutic targets to attenuate tissue injury and organ dysfunction. It also indicates future directions to translate the knowledge achieved from experimental studies into clinical practice. By this, the use of the recently introduced techniques to monitor the hepatic microcirculation in humans, such as near-infrared spectroscopy or orthogonal polarized spectral imaging, may allow an early initiation of treatment, which should benefit the final outcome of these critically ill patients.
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Affiliation(s)
- Brigitte Vollmar
- Institute for Experimental Surgery, University of Rostock, Rostock, Germany.
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Hellevik LR, Vierendeels J, Kiserud T, Stergiopulos N, Irgens F, Dick E, Riemslagh K, Verdonck P. An assessment of ductus venosus tapering and wave transmission from the fetal heart. Biomech Model Mechanobiol 2009; 8:509-17. [DOI: 10.1007/s10237-009-0155-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Accepted: 03/30/2009] [Indexed: 11/29/2022]
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Ebbing C, Rasmussen S, Godfrey KM, Hanson MA, Kiserud T. Fetal superior mesenteric artery: longitudinal reference ranges and evidence of regulatory link to portal liver circulation. Early Hum Dev 2009; 85:207-13. [PMID: 19013030 DOI: 10.1016/j.earlhumdev.2008.09.412] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 09/23/2008] [Accepted: 09/30/2008] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To establish longitudinal reference ranges for the fetal superior mesenteric artery (SMA) flow velocity and pulsatility index (PI(SMA)). Also to examine the hemodynamic relationship to venous liver perfusion and umbilical flow distribution in the liver, to other splanchnic arteries, and more generally to the middle cerebral and umbilical artery. METHODS Prospective longitudinal study of 161 low-risk pregnancies using Doppler recordings including the SMA, repeated on 3-5 occasions at 3-5 weekly intervals. Umbilical venous flow was estimated, blood velocity in the shunt ductus venosus represented umbilico-caval (i.e. porto-caval) pressure gradient, and left portal vein blood velocity represented umbilical distribution within the liver. The correlation between PI(SMA) and the splenic and hepatic artery PI were analysed (PI(SA) and PI(HA)), and the association to middle cerebral and umbilical artery PI (PI(MCA) and PI(UA)) assessed. RESULTS Reference ranges for the SMA for gestational weeks 21-39 were based on 589 observations. Low impedance in the SMA (i.e. low PI(SMA)) was associated with low umbilical flow and porto-caval pressure gradient (i.e. <10th centile), and high distribution of umbilical flow to the right lobe (i.e. left portal vein blood velocity >90th centile). PI(SMA) correlated weakly with PI(SA) and PI(HA) (r=0.30, 95%CI 0.22-0.37, and r=0.39, 95%CI 0.27-0.51, respectively). PI(SMA) was positively associated with PI(MCA) and PI(UA). CONCLUSION We have provided longitudinal reference ranges for fetal SMA flow velocity and PI, and shown that the SMA, which perfuses the fetal gut, is also involved in the regulation of the liver perfusion.
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Affiliation(s)
- Cathrine Ebbing
- Department of Obsterics and Gynecology, Haukeland University Hospital, N-5021 Bergen, Norway.
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Ebbing C, Rasmussen S, Godfrey KM, Hanson MA, Kiserud T. Fetal celiac and splenic artery flow velocity and pulsatility index: longitudinal reference ranges and evidence for vasodilation at a low portocaval pressure gradient. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:663-672. [PMID: 18816500 DOI: 10.1002/uog.6145] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To establish longitudinal reference ranges for the fetal celiac and splenic arteries flow velocity and pulsatility index (PI), and to determine their hemodynamic relationship to venous liver perfusion and distribution and to other essential arteries. METHODS This was a prospective longitudinal study of 161 low-risk pregnancies. Doppler recordings of the celiac and splenic arteries were made on three to five occasions at 3-5-week intervals to establish reference ranges for blood velocity and PI measurements. Peak systolic velocity in the ductus venosus, a shunt between the umbilical and inferior caval veins, was used to represent the umbilicocaval (i.e. portocaval) pressure gradient, and the left portal vein blood velocity represented the umbilical distribution to the right liver lobe. The correlations between the celiac, splenic and hepatic arteries were determined, and their association with the middle cerebral and umbilical artery PIs (MCA-PI and UA-PI) was assessed. RESULTS Longitudinal reference ranges for the fetal celiac and splenic arteries were established based on 510 and 521 observations, respectively, during gestational weeks 21-39. Terms for calculating conditional reference ranges to be used for repeat observations are provided. Celiac and splenic artery PIs were low when portocaval pressure and umbilical supply to the right lobe were low (P < 0.0001). Their peak systolic velocity and PI were correlated (r = 0.7 (95% CI, 0.6-0.8) and r = 0.5 (95% CI, 0.3-0.6), respectively), while the PI of the hepatic artery correlated weakly with those of the celiac and splenic arteries. They were positively associated with the MCA-PI and UA-PI (P < 0.0001). CONCLUSION We provide longitudinal reference ranges for the fetal celiac and splenic arteries Doppler measurements and show that they are involved in maintaining portal liver perfusion independently from the hepatic artery.
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Affiliation(s)
- C Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Norway.
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Kiserud T. Ultrasound: providing the physiological basis for fetal medicine. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:605-606. [PMID: 18816468 DOI: 10.1002/uog.6229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- T Kiserud
- Clinical Fetal Physiology Research Group, Department of Clinical Medicine, University of Bergen and Fetal Medicine Unit, Haukeland University Hospital, 5021 Bergen, Norway.
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