Head growth in fetuses with isolated congenital heart defects: lack of influence of aortic arch flow and ascending aorta oxygen saturation
| Autor: | A. Kragt, Marry E.B. Rijlaarsdam, E.W. van Zwet, Eva Pajkrt, Nico A. Blom, C. L. Bax, Sally-Ann B. Clur, Fenna A. R. Jansen, C. L. van Velzen, Monique C. Haak, J.M.M. van Lith, H. R. Zuurveen |
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| Rok vydání: | 2016 |
| Předmět: |
Aortic arch
medicine.medical_specialty Hemodynamics Placental insufficiency 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Internal medicine medicine.artery medicine Radiology Nuclear Medicine and imaging Fetal head Oxygen saturation (medicine) Fetus Aorta 030219 obstetrics & reproductive medicine Radiological and Ultrasound Technology business.industry Obstetrics and Gynecology Gestational age General Medicine medicine.disease Surgery Reproductive Medicine Cardiology business |
| Zdroj: | Ultrasound in Obstetrics & Gynecology. 48:357-364 |
| ISSN: | 0960-7692 |
| DOI: | 10.1002/uog.15980 |
| Popis: | Objectives Congenital heart defects (CHDs) are reported to be associated with a smaller fetal head circumference (HC) and neurodevelopmental delay. Recent studies suggest that altered intrauterine brain hemodynamics may explain these findings. Our objectives were to evaluate the pattern of head growth in a large cohort of fetuses with various types of CHD, analyze these patterns according to the type of CHD and estimate the effect of cerebral hemodynamics with advancing gestation in the second and third trimesters. Methods Singleton fetuses with an isolated CHD were selected from three fetal medicine units (n = 436). Cases with placental insufficiency or genetic syndromes were excluded. CHD types were clustered according to the flow and oxygen saturation in the aorta. Z-scores of biometric data were constructed using growth charts of a normal population. HC at different gestational ages was evaluated and univariate and multivariate mixed regression analyses were performed to examine the patterns of prenatal HC growth. Results Fetuses with severe and less severe types of CHD demonstrated statistically significant HC growth restriction with increasing gestational age (slope of −0.017/day); however, there was no statistically significant effect of fetal hemodynamics on HC growth. Fetuses with CHD but normal brain oxygenation and normal aortic flow showed a significant decrease in HC growth (slope of −0.024/day). Only fetuses with isolated tetralogy of Fallot demonstrated a smaller HC z-score at 20 weeks of gestation (−0.67 (95% CI, −1.16 to −0.18)). Conclusions Despite the decline in head growth in fetuses with a prenatally detected isolated CHD, HC values were within the normal range, raising the question of its clinical significance. Furthermore, in contrast to other studies, this large cohort did not establish a significant correlation between aortic flow or oxygen saturation and HC growth. Factors other than altered fetal cerebral hemodynamics may contribute to HC growth restriction with increasing gestational age, such as (epi)genetic or placental factors. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. |
| Databáze: | OpenAIRE |
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