Effects of thyrotropin releasing hormone on cardiac and extracardiac flows of appropriately grown and growth-retarded fetuses.

The objective of this study was to establish the effect of thyrotropin releasing hormone on the fetal circulation of appropriately grown and growth-retarded fetuses. Doppler recordings were performed immediately before and 15 min after maternal administration of 400 micrograms of thyrotropin releasing hormone in 14 women with appropriately grown and 19 with growth-retarded fetuses. Furthermore, in six women with growth-retarded fetuses, serial recordings were performed at 2-hourly intervals for 8 h until a second thyrotropin releasing hormone dose was administered. Velocity waveforms were recorded from the outflow tracts, inferior vena cava, umbilical artery, middle cerebral artery and descending aorta, and different Doppler indices calculated. In appropriately grown fetuses, thyrotropin releasing hormone induced a significant increase of peak systolic velocity values in the aorta and pulmonary artery and an increase of Doppler-estimated cardiac output. In growth-retarded fetuses, these changes were more evident and associated with a significant decrease in reverse flow in the inferior vena cava during atrial contraction. No changes were observed in fetal heart rate or in the other fetal vessels investigated. In the growth-retarded fetuses followed longitudinally, these changes were evident for the following 8 h and were potentiated by the second thyrotropin releasing hormone administration. In conclusion, thyrotropin releasing hormone induces significant hemodynamic effects on the fetal heart that may temporarily improve the impaired cardiac function of growth-retarded fetuses.