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Second systolic peak in fetal middle cerebral artery Doppler after intrauterine transfusion

OBJECTIVE: To evaluate functional relationship between fetal circulatory response to intrauterine transfusion (IUT) as a circulatory challenge and appearance of second systolic peak (P2) in middle cerebral artery (MCA) based on hemodynamic principles. METHODS: According to the concept of pulse wave...

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Autores principales: Vonzun, Ladina, Ochsenbein-Kölble, Nicole, Balsyte, Dalia, Zimmermann, Roland, Gonser, Markus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9837016/
https://www.ncbi.nlm.nih.gov/pubmed/35348831
http://dx.doi.org/10.1007/s00404-022-06517-0
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author Vonzun, Ladina
Ochsenbein-Kölble, Nicole
Balsyte, Dalia
Zimmermann, Roland
Gonser, Markus
author_facet Vonzun, Ladina
Ochsenbein-Kölble, Nicole
Balsyte, Dalia
Zimmermann, Roland
Gonser, Markus
author_sort Vonzun, Ladina
collection PubMed
description OBJECTIVE: To evaluate functional relationship between fetal circulatory response to intrauterine transfusion (IUT) as a circulatory challenge and appearance of second systolic peak (P2) in middle cerebral artery (MCA) based on hemodynamic principles. METHODS: According to the concept of pulse wave (PW) propagation and reflection in adults, PWs arrive twice at cerebral circulation, as primary wave caused by left ventricle ejection and secondary after reflection in peripheral arteries. Thus adults show a biphasic contour of systolic blood flow in cerebral arteries. Similar waveforms may appear in fetal MCA-Doppler, as a response to IUT as a circulatory challenge. This is a proof-of-principle study, applying classical hemodynamic principles to fetal circulation. Accordingly, appearance of MCA-P2 may indicate vasoconstriction with increased PW reflection and timing of P2(Δt) should agree with the additional PW travel time down to reflection and return (Tr). To test this agreement, we searched our database for IUTs performed for severe fetal anemia, and compared Δt, obtained by Doppler, with Tr, obtained by hemodynamic calculation using human fetal data. Level of agreement was assessed using Bland–Altman-Plots. RESULTS: We identified 21 fetuses with adequate Doppler quality for Δt evaluation. In four cases (19%) MCA-P2 was observed before the intervention, and in 17 interventions (81%) thereafter; a highly significant association between IUT and P2 appearance (p < 0.001). In these 17 interventions good agreement of P2 timing was found between Doppler assessment: Δt = 80 ± 8 ms, and hemodynamic calculation: Tr = 76 ± 4 ms. CONCLUSION: P2 appearance in fetal MCA-Doppler seems to indicate PW reflection due to increased vasoconstriction after IUT. Thus hemodynamic considerations might enable Doppler monitoring of fetal vasoconstriction.
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spelling pubmed-98370162023-01-14 Second systolic peak in fetal middle cerebral artery Doppler after intrauterine transfusion Vonzun, Ladina Ochsenbein-Kölble, Nicole Balsyte, Dalia Zimmermann, Roland Gonser, Markus Arch Gynecol Obstet Maternal-Fetal Medicine OBJECTIVE: To evaluate functional relationship between fetal circulatory response to intrauterine transfusion (IUT) as a circulatory challenge and appearance of second systolic peak (P2) in middle cerebral artery (MCA) based on hemodynamic principles. METHODS: According to the concept of pulse wave (PW) propagation and reflection in adults, PWs arrive twice at cerebral circulation, as primary wave caused by left ventricle ejection and secondary after reflection in peripheral arteries. Thus adults show a biphasic contour of systolic blood flow in cerebral arteries. Similar waveforms may appear in fetal MCA-Doppler, as a response to IUT as a circulatory challenge. This is a proof-of-principle study, applying classical hemodynamic principles to fetal circulation. Accordingly, appearance of MCA-P2 may indicate vasoconstriction with increased PW reflection and timing of P2(Δt) should agree with the additional PW travel time down to reflection and return (Tr). To test this agreement, we searched our database for IUTs performed for severe fetal anemia, and compared Δt, obtained by Doppler, with Tr, obtained by hemodynamic calculation using human fetal data. Level of agreement was assessed using Bland–Altman-Plots. RESULTS: We identified 21 fetuses with adequate Doppler quality for Δt evaluation. In four cases (19%) MCA-P2 was observed before the intervention, and in 17 interventions (81%) thereafter; a highly significant association between IUT and P2 appearance (p < 0.001). In these 17 interventions good agreement of P2 timing was found between Doppler assessment: Δt = 80 ± 8 ms, and hemodynamic calculation: Tr = 76 ± 4 ms. CONCLUSION: P2 appearance in fetal MCA-Doppler seems to indicate PW reflection due to increased vasoconstriction after IUT. Thus hemodynamic considerations might enable Doppler monitoring of fetal vasoconstriction. Springer Berlin Heidelberg 2022-03-29 2023 /pmc/articles/PMC9837016/ /pubmed/35348831 http://dx.doi.org/10.1007/s00404-022-06517-0 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Maternal-Fetal Medicine
Vonzun, Ladina
Ochsenbein-Kölble, Nicole
Balsyte, Dalia
Zimmermann, Roland
Gonser, Markus
Second systolic peak in fetal middle cerebral artery Doppler after intrauterine transfusion
title Second systolic peak in fetal middle cerebral artery Doppler after intrauterine transfusion
title_full Second systolic peak in fetal middle cerebral artery Doppler after intrauterine transfusion
title_fullStr Second systolic peak in fetal middle cerebral artery Doppler after intrauterine transfusion
title_full_unstemmed Second systolic peak in fetal middle cerebral artery Doppler after intrauterine transfusion
title_short Second systolic peak in fetal middle cerebral artery Doppler after intrauterine transfusion
title_sort second systolic peak in fetal middle cerebral artery doppler after intrauterine transfusion
topic Maternal-Fetal Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9837016/
https://www.ncbi.nlm.nih.gov/pubmed/35348831
http://dx.doi.org/10.1007/s00404-022-06517-0
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