Arslanoğlu Tuğçe, Bilirer Kübra Kurt, Uludağ Sezin, Arslan Hale Çetin, Çetinkaya Merih, Dane Banu Kılıçoğlu, Polat İbrahim
Obstetrics and Gynecology Clinic, Department of Perinatology, University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey.
Obstetrics and Gynecology Clinic, Department of Perinatology, University of Health Sciences, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey.
BMC Pregnancy Childbirth. 2025 Sep 18;25(1):937. doi: 10.1186/s12884-025-08120-y.
Fetal growth restriction (FGR) is a major cause of perinatal morbidity and mortality. In patients with absent end-diastolic flow (AEDF) in the umbilical artery, placental insufficiency is typically severe, and adverse neonatal outcomes are common. The modified myocardial performance index (Mod-MPI) provides a noninvasive assessment of global fetal cardiac function; however, its relationship with Doppler findings and perinatal outcomes in patients with FGR remains under investigation.
This prospective observational study included 217 singleton pregnancies between 24 + 0 and 36 + 0 weeks of gestation. Among these, 103 fetuses were diagnosed with FGR and subdivided on the basis of the presence (n = 47) or absence (n = 56) of AEDF. The control group included 114 gestational age-matched fetuses with normal growth and Doppler findings. Left ventricular Mod-MPI and cardiac time intervals were measured via a standardized pulsed-wave Doppler technique on the basis of valvular motion timing. The mitral inflow E- and A-wave velocities were also recorded. Perinatal outcomes such as gestational age at delivery, birth weight, 5-minute Apgar score, and NICU admission were compared.
Although the mean Mod-MPI values were not significantly different between the groups (p = 0.38), AEDF-positive fetuses had shorter ejection times and significantly lower mitral E and A velocities (p < 0.001). These findings indicate impaired diastolic function. Compared with other groups, AEDF-positive fetuses were delivered earlier, had lower birth weights, and had higher NICU admission rates (p < 0.01).
In fetuses with FGR, the presence of AEDF is associated with early signs of cardiac dysfunction and poor perinatal outcomes. While the mean Mod-MPI may not differ markedly, its components reflect significant hemodynamic compromise. Mod-MPI may be a useful adjunct for monitoring fetal well-being in cases of severe placental insufficiency.
胎儿生长受限（FGR）是围产期发病和死亡的主要原因。在脐动脉舒张末期血流消失（AEDF）的患者中，胎盘功能不全通常很严重，不良新生儿结局很常见。改良心肌性能指数（Mod-MPI）可对胎儿整体心脏功能进行无创评估；然而，其与FGR患者多普勒检查结果及围产期结局的关系仍在研究中。
这项前瞻性观察性研究纳入了217例妊娠24⁺⁰至36⁺⁰周的单胎妊娠。其中，103例胎儿被诊断为FGR，并根据是否存在AEDF（n = 47）分为两组，无AEDF组（n = 56）。对照组包括114例生长和多普勒检查结果正常、孕周匹配的胎儿。基于瓣膜运动时间，通过标准化脉冲波多普勒技术测量左心室Mod-MPI和心脏时间间期。同时记录二尖瓣流入E波和A波速度。比较分娩孕周、出生体重、5分钟阿氏评分和新生儿重症监护病房（NICU）入住率等围产期结局。
尽管各组间平均Mod-MPI值无显著差异（p = 0.38），但AEDF阳性胎儿的射血时间较短，二尖瓣E波和A波速度显著较低（p < 0.001）。这些结果表明舒张功能受损。与其他组相比，AEDF阳性胎儿分娩更早，出生体重更低，NICU入住率更高（p < 0.01）。
在FGR胎儿中，AEDF与心脏功能障碍的早期迹象及不良围产期结局相关。虽然平均Mod-MPI可能无明显差异，但其组成部分反映了显著的血流动力学损害。Mod-MPI可能是监测严重胎盘功能不全病例中胎儿健康状况的有用辅助手段。
