Fetal cerebrovascular response to maternal hyperoxygenation
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A cross-sectional study of fetuses with complex CHD compared to controls without CHD. CHD cases were grouped according to physiology; left sided obstructive lesion (LSOL), right sided obstructive lesion (RSOL) or dextro-transposition of the great arteries (d-TGA). Subjects underwent MH testing during the third trimester fetal echocardiogram. The pulsatility index (PI) was calculated for the fetal middle cerebral artery (MCA), umbilical artery (UA) and branch pulmonary artery (PA). The change in PI from baseline to during MH was compared between each CHD group and controls.

Sixty pregnant women were enrolled (CHD, n = 43; control, n = 17). In the CHD group, there were 27 fetuses with LSOL, seven with RSOL and nine with d-TGA. Mean gestational age was 33.9 (95% CI, 33.6–34.2) weeks. At baseline, MCAPI Z-score was lowest in the LSOL group (1.8 (95% CI, 2.4 to 1.2)) compared with the control group ( 0.8 (95%CI, 1.3 to 0.3)) (P=0.01). In response to MH, MCA PI Z-score increased significantly in the control and d-TGA groups but did not change significantly in the LSOL and RSOL groups. The change in MCA PI Z-score was significantly higher in the control group than in the LSOL group (0.9 (95% CI, 0.42–1.4) vs 0.12 (95% CI, 0.21 to 0.45); P=0.03). This difference was more pronounced in the LSOL subgroup with retrograde aortic arch flow. Branch PA PI decreased significantly in response to MH in all groups, with no difference in the change from baseline to MH between the groups, while UA PI was unchanged during MH compared with at baseline.

The fetal cerebrovascular response to MH varies based on the underlying CHD diagnosis, suggesting that cardiovascular physiology may influence the autoregulatory capacity of the fetal brain. Further studies are needed to determine the clinical implications of these findings on long-term neurodevelopment in these at risk children.

Read more : https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.22024?af=R
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