Sequence of changes in myocardial performance index in relation to aortic isthmus and ductus venosus Doppler in fetuses with early-onset intrauterine growth restriction.

OBJECTIVE

To explore the sequence of changes in myocardial performance index (MPI) and aortic isthmus (AoI) and ductus venosus (DV) flow in fetuses with early-onset intrauterine growth restriction (IUGR).

METHODS

MPI and AoI and DV pulsatility indices (PI) were evaluated every 1-7 days in a cohort of IUGR fetuses with abnormal umbilical artery Doppler PI (> 95(th) percentile) delivered before 34 weeks' gestation. The longitudinal changes were analyzed in the last 30 days before delivery by multilevel and survival analysis.

RESULTS

A total of 430 scans were performed on 115 IUGR fetuses. MPI, AoI-PI and DV-PI showed increases with the progression of fetal deterioration throughout the follow-up study period, but the rates of progression were different. On average, MPI, AoI-PI and DV-PI crossed the 95(th) percentile at 26 days, 12 days and 5 days before delivery, respectively. At the last examination before delivery, the proportion of increased MPI (70.4%) was significantly higher than that of abnormal AoI-PI (55.7%; P < 0.01) and DV-PI (47.8%; P < 0.01).

CONCLUSION

In early-onset IUGR, MPI and AoI and DV Doppler indices all increase but at different rates, which could provide the basis for further research on their use for improving in-utero monitoring and prediction of long-term outcome.