Impaired placental perfusion and major fetal cardiac defects
Fantasia, I., Andrade, W., Syngelaki, A., Akolekar, R. and Nicolaides, K.H. 2019. Impaired placental perfusion and major fetal cardiac defects. Ultrasound in Obstetrics and Gynecology. 53 (1), pp. 68-72. https://doi.org/10.1002/uog.20149
|Authors||Fantasia, I., Andrade, W., Syngelaki, A., Akolekar, R. and Nicolaides, K.H.|
Objectives: To investigate the relationship between fetal congenital heart defects (CHD) and placental perfusion assessed by uterine artery pulsatility index (UtA-PI) in relation to development of preeclampsia (PE).
Methods: This was a prospective screening study in singleton pregnancies at 19-24 weeks’ gestation. Transvaginal ultrasound was used to measure the UtA-PI and the values were converted into multiples of the normal median (MoM). Median MoM values in pregnancies with fetuses with isolated major CHD were compared to those without CHD in relation to development of PE.
Results: The 91,407 singleton pregnancies fulfilling the entry criteria included 206 (0.23%) with isolated major fetal CHD and 91,201 without CHD. The prevalence of PE was 4.4% in those with CHD and 2.7% in those without CHD (RR 1.6, 95% CI 0.84-3.04; p=0.150); the respective values for preterm-PE, with delivery at <37 weeks’ gestation, were 2.4% and 0.7%, (RR 3.4, 95% CI 1.42-8.09; p=0.006). In the total population, the median UtA-PI MoM was significantly higher in those that developed PE compared to those without PE (1.22, IQR 0.94-1.57 vs. 1.00, IQR 0.84-1.19; p<0.0001) and in the PE group the median UtA-PI MoM was inversely related to gestational age at delivery (r=-0.458; p<0.0001). The same pattern of inverse relationship between UtA-PI MoM and gestational age at delivery with PE was observed in pregnancies with and without CHD, but in the CHD group, compared to those without CHD, UtA-PI was significantly higher both in pregnancies with and in those without
Conclusions: In both pregnancies with and without fetal CHD that develop PE impedance to flow in the uterine arteries is increased and this increase is particularly marked in those with preterm-PE. The prevalence of preterm-PE is more than 3 times higher in pregnancies with than without fetal major CHD and the prevalence of major CHD in pregnancies with preterm-PE is also more than 3 times higher than in those without PE. However, >97% of pregnancies with fetal CHD do not develop preterm-PE and >99% of pregnancies with preterm-PE are not associated with fetal CHD.
|Keywords||Congenital heart defect; Uterine artery pulsatility index; Pre-eclampsia; Ultrasound screening|
|Journal||Ultrasound in Obstetrics and Gynecology|
|Journal citation||53 (1), pp. 68-72|
|Digital Object Identifier (DOI)||https://doi.org/10.1002/uog.20149|
|Online||17 Oct 2018|
|Publication process dates|
|Accepted||10 Oct 2018|
|Deposited||03 Jun 2020|
|Accepted author manuscript|
1. Akolekar R, Zaragoza E, Poon LC, Pepes S, Nicolaides KH. Maternal serumplacental growth factor at 11 + 0to13+ 6 weeks of gestation in the prediction ofpre-eclampsia. Ultrasound Obstet Gynecol 2008; 32: 732– 739.
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