Noninvasive assessment of cranial blood circulation in the fetus.

The blood velocity in the common carotid artery, umbilical artery and descending aorta of 15 term fetuses with birth weights appropriate for gestational age and 20 fetuses, ultrasonically suspected of intrauterine growth retardation (IUGR), was recorded by means of a technique combining real-time linear-array ultrasonography and 2-MHz pulsed Doppler ultrasound. The waveform of the maximum blood velocity was characterized by a pulsatility index (PI) indicating peripheral vascular resistance. In the normal fetuses, the mean PI was 1.89 (+/- 0.07 SEM) in the common carotid artery, 0.93 (+/- 0.04) in the umbilical artery and 2.19 (+/- 0.06) in the descending aorta. In the IUGR fetuses, the PI was higher than in the normal fetuses in the umbilical artery (1.19 +/- 0.04; p less than 0.05) and lower in the carotid artery (1.48 +/- 0.03; p less than 0.05). The changes of the PI were even more pronounced in 10 IUGR fetuses in whom cardiotocographic signs (late decelerations) of imminent asphyxia were present. The results indicate an increase in the peripheral vascular resistance in the placental circulation and the lower body, and a decrease in the cranial vascular resistance in the growth-retarded fetuses. Furthermore, these findings suggest that in chronic and acute fetal distress, there is a redistribution of the fetal circulation favoring the brain.