الفهرس | Only 14 pages are availabe for public view |
Abstract Impaired fetal growth is associated with increased risk of perinatal mortality and morbidity, consequently postnatal adverse outcomes. The most important problem in growth-restricted fetuses is the possible risk of chronic fetal hypoxemia, which triggers a variety of adaptive mechanisms. (Figueras and Gratacós, 2014). The fetal heart has a central role in these adaptive mechanisms. Cardiac alterations in growth-restricted fetuses include predisposition to lower cardiac compliance, increased arterial stiffness, as well as increased cardiac afterload and end-diastolic ventricular filling. Assessment of the affected myocardial function and appropriate timing of labor may reduce the incidence of adverse postnatal outcomes in these patients. (Crispi et al., 2014). MPI values were increased in FGR pregnancies and appear to be related to the severity of FGR. A higher level of MPI could predict adverse outcomes. (Ali et al., 2022) In our study, we aimed to compare IUGR fetuses with AGA fetuses in terms of MPI as a marker of cardiovascular function, to evaluate the association between MPI and other parameters used for prenatal monitoring, and we planned to assess relationships between MPI values and perinatal outcome. The study included 80 cases recruited from Obstetrics and Gynecology Department, Menoufia University Hospital. Forty cases were diagnosed as IUGR fetuses and forty cases with AGA fetuses served as a control group. Summary 65 All the participants signed an informed consent about our procedure. Several factors influence the results of our study including gravidity, parity, and maternal body mass index (BMI). All the cases underwent ultrasonographic assessment: Fetal biometry measurements, gestational age, weight and AFI. As well as Doppler indices as: the pulsatility index (PI) of UA, MCA and DV were measured. All fetuses had their myocardial performance index assessed. Fetal growth restriction fetuses’ MPI values were compared to gestation-matched controls. The outcomes of the perinatal period were documented. We found that MPI was a useful parameter to evaluate IUGR pregnancies and predict neonatal outcome. Values can be affected by ultrasound machine settings as caliper placement, sample volume (SV), angle of insonation (AI), Doppler sweep velocity (DSV), wall motion filter (WMF) and Doppler gain (DG). To minimize this variability, it is recommended to use the same ultrasound equipment during patient follow-up and specific reference ranges for each ultrasound system. Conclusion 66 Conclusion Myocardial performance index (MPI) is one of the newer techniques used to evaluate cardiac function. Early stages of cardiac adaptation associated with increasing placental vascular resistance in growth restricted fetuses are represented by changes in MPI and its time components. MPI can be used in fetal assessment in cases of intrauterine fetal growth restriction because of its high sensitivity, relative ease of use, and information offered by the MPI. Myocardial performance index values are increased in IUGR fetuses and appear to be related to the severity of IUGR. A higher level of MPI could predict adverse outcomes. Clinicians should consider cardiac dysfunction in IUGR through increased MPI, this might lead to improved management and outcome of IUGR. |