Cardiovascular Hemodynamic Changes After Antenatal Corticosteroids in Growth Restricted and Appropriate for Gestational Age Fetuses

Abstract

Purpose To investigate hemodynamic effects after antenatal corticosteroids (ACS) administration in appropriate for gestational age (AGA) and early growth restricted (GR) fetuses by measurement of Doppler cardiovascular function parameters.

Materials and Methods Prospective cohort study. AGA and GR singleton pregnancies receiving ACS for fetal lung maturation between 24 + 0–33 + 6 weeks were enrolled. Feto-placental vascular hemodynamics were studied by: umbilical artery (UA) pulsatility index (PI), middle cerebral artery (MCA) PI, renal artery (RenA) PI. Cardiac function was evaluated by ductus venosus (DV) PI and by echocardiographic parameters: E to A wave ratios (E/A) and mitral and tricuspid annular plane systolic excursion (MAPSE and TAPSE) for diastolic function, left and right myocardial performance index (MPI) for overall (diastolic and systolic) function. A single operator performed all the measurements at 3 different time points (E): E0 before or within 4 hours of ACS administration (baseline examination), E1 24–48 hours after the first dose and E2 7 days after the second dose of ACS. The values were expressed as z-scores. Pairwise comparisons with paired t-test were performed to compare measurements before and after exposure to ACS.

Results 25 AGA and 20 GR fetuses (mean gestational age: 31 + 1 and 30 + 6, respectively) were included in the analysis. In the AGA group ACS administration was associated with a significant reduction in UA PI. In the GR fetuses ACS temporarily (E0-E1) restored UA-end diastolic flow (EDF) in 6 of 9 fetuses with A/R-EDF (“Return of EDF phenomenon”) and produced a significant increase (worsening) in right MPI (both in E1-E2 and in E0-E2).

Conclusion ACS administration is associated with UA vasodilation in both AGA and GR fetuses and with an increase in right MPI in the latter group. This suggests a worsening in cardiac function in GR fetuses.

Zusammenfassung

Ziel Untersuchung der hämodynamischen Effekte nach Verabreichung von antenatalen Kortikosteroiden (ACS) in bei zeitgerecht entwickelten AGA-Feten („appropriate for gestational age“) und bei Feten mit früher intrauteriner Wachstumsretardierung (GR) durch Messung von kardiovaskulären Funktionsparametern in der Dopplersonografie.

Material und Methoden In die prospektive Kohortenstudie wurden AGA- und GR-Einlings-Schwangerschaften von SSW 24 + 0 bis 33 + 6 eingeschlossen, die ACS für die fetale Lungenreifung erhielten. Die Untersuchung der fetoplazentaren vaskulären Hämodynamik erfolgte durch: Pulsatilitätsindindizes (PI) der A. umbilicalis (UA), der A. cerebri media (MCA) und der Nierenarterie (RenA). Die Herzfunktion wurde durch den PI des Ductus venosus (DV) und durch echokardiografische Parameter ausgewertet: Ratio von E- zu A-Welle (E/A) und die „Mitral and Tricuspid Annular Plane Systolic Excursion“ (MAPSE und TAPSE) für die diastolische Funktion, linker und rechter „Myocard Performance Index“ (MPI) für die Gesamtfunktion (diastolisch und systolisch). Ein einzelner Untersucher führte alle Messungen zu drei verschiedenen Zeitpunkten (E) durch: E0 vor oder innerhalb von 4 Stunden nach ACS-Gabe (Basisuntersuchung), E1 24–48 Stunden nach der ersten Dosis und E2 sieben Tage nach der zweiten ACS-Dosis. Die Werte wurden als Z-Scores angegeben. Paarweise Vergleiche erfolgten mittels gepaarten t-Test, um Messungen vor und nach ACS-Exposition zu vergleichen.

Ergebnisse 25 AGA- und 20 GR-Feten (mittlere SSW 31 + 1 bzw. 30 + 6) wurden in die Analyse einbezogen. In der AGA-Gruppe war die ACS-Gabe mit einer signifikanten Reduktion des UA PI assoziiert. Bei GR-Feten stellte ACS bei 6 von 9 Feten mit A/R-EDF („Return of EDF-Phänomen“) den UA-end diastolischen Fluss vorübergehend (E0-E1) wieder her (EDF) und führte zu einer signifikanten Erhöhung (Verschlechterung) des rechten MPI (sowohl bei E1-E2 als auch bei E0-E2).

Schlussfolgerung Eine ACS-Gabe ist sowohl bei AGA- als auch bei GR-Feten mit einer UA-Vasodilatation assoziiert, und bei Letzteren auch mit einem Anstieg des rechten MPI. Dies deutet auf eine Verschlechterung der Herzfunktion bei GR-Feten hin.

Key words

obstetrics - doppler - antenatal corticosteroids - fetal growth restriction

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