Department for Women and Child Health, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy.
Department of Obstetrics, University Medical Center Groningen, University of Groningen, Netherlands.
Ultraschall Med. 2020 Jun;41(3):292-299. doi: 10.1055/a-0654-4824. Epub 2018 Oct 26.
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.
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.
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).
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.
通过测量多普勒心血管功能参数，研究产前皮质类固醇（ACS）给药后适用于胎龄（AGA）和早期生长受限（GR）胎儿的血液动力学效应。
前瞻性队列研究。在 24+0-33+6 周期间接受 ACS 以促进胎儿肺成熟的 AGA 和 GR 单胎妊娠均被纳入本研究。通过脐动脉（UA）搏动指数（PI）、大脑中动脉（MCA）PI、肾动脉（RenA）PI 研究胎儿胎盘血管血液动力学。通过心脏功能评估：静脉导管（DV）PI 和超声心动图参数：E 波与 A 波比值（E/A）以及二尖瓣和三尖瓣环平面收缩期位移（MAPSE 和 TAPSE）舒张功能，左、右心肌性能指数（MPI）整体（舒张和收缩）功能。一位操作者在 3 个不同时间点（E）进行所有测量：E0 在 ACS 给药前或给药后 4 小时内（基线检查），E1 首次剂量后 24-48 小时，E2 ACS 第二次剂量后 7 天。将数值表示为 z 分数。采用配对 t 检验进行配对比较，以比较 ACS 暴露前后的测量值。
共纳入 25 例 AGA 和 20 例 GR 胎儿（平均孕龄：分别为 31+1 和 30+6）。在 AGA 组中，ACS 给药与 UA PI 显著降低相关。在 GR 胎儿中，ACS 在 9 例存在 UA-舒张末期血流（EDF）反转（“EDF 恢复现象”）的胎儿中暂时（E0-E1）恢复 UA-EDF，并在右侧 MPI 中产生显著增加（恶化）（E1-E2 和 E0-E2 中均如此）。
ACS 给药与 AGA 和 GR 胎儿的 UA 扩张有关，并导致后者组的右 MPI 增加。这表明 GR 胎儿的心脏功能恶化。
