Medical and Health Sciences | Article | Published 2023

Aortic Isthmus Retrograde Blood Flow in Intrauterine Child as a Sign of the Terminal Stage of Placental Dysfunction: Clinical Observation

Authors:
Collection: Current Pediatrics.
DOI: https://doi.org/10.15690/vsp.v22i2.2537
Keywords: fetal growth restriction, Doppler imaging, placental dysfunction, retrograde blood flow, aorta

Abstract

Background. Aortic isthmus retrograde blood flow in intrauterine children with growth delay and centralization of blood circulation in the late stages of placental dysfunction is associated with a high risk of perinatal death. Timely diagnosis of such condition is crucial to select further obstetric tactics and delivery time. Clinical case description. Growth delay and absent end-diastolic flow in umbilical artery and no A-wave in the venous duct were diagnosed in intrauterine child (gestational age — 36 weeks) at ultrasound study. Peripheral resistance indices in middle cerebral artery in the intrauterine child were lower than peripheral resistance indices in umbilical artery. Color Doppler imaging has revealed aortic isthmus retrograde blood flow. The woman was recommended delivery due to critical circulatory disorder in the intrauterine child. Female child was delivered via Caesarean section, child’s weight — 890 g, APGAR score — 3/4. The newborn girl died due to multi-organ failure within the first day. Conclusion. Revealing the retrograde blood flow in intrauterine child in the aortic isthmus throughout the entire ventricular diastole is an unfavorable prognostic sign of the terminal stage of cerebral blood flow disturbance associated with placental dysfunction.

References

  1. Nardozza LM, Caetano AC, Zamarian AC, et al. Fetal growth restriction: current knowledge. Arch Gynecol Obstet. 2017;295(5): 1061–1077. doi: https://doi.org/10.1007/s00404-017-4341-9 2.
  2. Miller SL, Huppi PS, Mallard C. The consequences of fetal growth restriction on brain structure and neurodevelopmental outcome. J Physiol. 2016;594(4):807–823. doi: https://doi.org/10.1113/ JP271402
  3. Ахмадеев Н.Р., Терегулова Л.Е., Ульянина Е.В. и др. Ранняя и поздняя задержка роста плода. Дифференциальная диагностика, критерии неблагоприятного перинатального исхода // Дневник казанской медицинской школы. — 2019. — № 1. — С. 158–162. [Akhmadeev NR, Teregulova LE, Ulyanina EV, Akhmadeeva DG. Early and late delay fetal growth. Differential diagnostics, criteria unfavorable perinatal outcome. Dnevnik kazanskoi meditsinskoi shkoly. 2019;(1):158–162. (In Russ).]
  4. Липатов И.С., Тезиков Ю.В., Амосов М.С., Зуморина Э.М. Клинико-патогенетические варианты задержки роста плода различных сроков манифестации // Медицинский Совет. — 2021. — № 3. — С. 54–65. — doi: https://doi.org/10.21518/2079701X-2021-3-54-65 [Lipatov IS, Tezikov YuV, Amosov MS, Zumorina EM. Clinical and pathogenetic variants of fetal growth restriction with different periods of manifestation. Meditsinskiy sovet = Medical Council. 2021;(3):54–65. (In Russ). doi: https://doi.org/10.21518/2079-701X-2021-3-54-65]
  5. Fouron JC, Gosselin J, Amiel-Tison C, et al. Correlation between prenatal velocity waveforms in the aortic isthmus and neurodevelopmental outcome between the ages of 2 and 4 years. Am J Obstet Gynecol. 2001;184(4):630–636. doi: https://doi.org/ 10.1067/mob.2001.110696 6. Ropacka-Lesiak M, Świder-Musielak J, Bręborowicz GH, et al. Retrograde diastolic blood flow in the aortic isthmus is not a simple marker of abnormal fetal outcome in pregnancy complicated by IUGR — a pilot study. Ginekol Pol. 2014;85(7):509–515. doi: https://doi.org/10.17772/gp/176
  6. Ruskamp J, Fouron JC, Gosselin J, et al. Reference values for an index of fetal aortic isthmus blood flow during the second half of pregnancy. Ultrasound Obstet Gynecol. 2003;21(5):441–444. doi: https://doi.org/10.1002/uog.105
  7. Esercan A, Karakuş R, Özgü Erdinç AS. Aortic isthmus Doppler for fetal assessment. Gynecology Obstetrics and Reproductive Medicine. 2013;19(3):197–202.
  8. Fouron JC, Gosselin J, Raboisson MJ, et al. The relationship between an aortic isthmus blood flow velocity index and the postnatal neurodevelopmental status of fetuses with placental circulatory insufficiency. Am J Obstet Gynecol. 2005;192(2): 497–503. doi: https://doi.org/10.1016/j.ajog.2004.08.026
  9. Rizzo G, Capponi A, Vendola M, et al. Relationship between aortic isthmus and ductus venosus velocity waveforms in severe growth restricted fetuses. Prenat Diagn. 2008;28(11):1042–1047. doi: https://doi.org/10.1002/pd.2121
  10. Kennelly MM, Farah N, Turner MJ, Stuart B. Aortic isthmus Doppler velocimetry: role in assessment of preterm fetal growth restriction. Prenat Diagn. 2010;30(5):395–401. doi: https://doi.org/ 10.1002/pd.2474
  11. Choudhary P, Malik A, Batra A. Cerebroplacental ratio and aortic isthmus Doppler in early fetal growth restriction. J Clin Ultrasound. 2021;49(7):754–761. doi: https://doi.org/10.1002/jcu.23028
  12. Медведев М.В., Блинов А.Ю. Настало время перехода с ИР на ПИ при оценке в маточных артериях во время беременности // Пренатальная диагностика. — 2016. — Т. 15. — № 1. — С. 48–51. [Medvedev MV, Blinov AY. The time has come to move from IR on PI in assessment of uterine arteries blood flow during pregnancy. Prenatal Diagnosis. 2016;15(1) 48–51. (In Russ).]
  13. Нормурадова Н.М., Фазилов А.А., Расулова М.М. Синдром гипоплазии левых отделов сердца: трудности диагностики в пренатальном периоде // Педиатрическая фармакология. — 2021. — Т. 18. — № 5. — С. 416–422. — doi: https://doi.org/10.15690/ pf.v18i5.2331 [Normuradova NM, Fazilov АA, Rasulova MM. Hypoplastic Left Heart Syndrome: Diagnostic Difficulties in Prenatal Period. Pediatricheskaya farmakologiya — Pediatric pharmacology. 2021;18(5):416–422. (In Russ). doi: https://doi.org/10.15690/ pf.v18i5.2331]
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