A. Capponi et al., THE EFFECTS OF FETAL BLOOD-SAMPLING ON VENTRICULAR FILLING PATTERNS -DIFFERENCES BETWEEN NORMALLY GROWN AND GROWTH-RETARDED FETUSES, American journal of perinatology, 13(8), 1996, pp. 507-512
The objective of this study was to evaluate the effect of fetal blood
sampling on atrioventricular blood flow velocity waveforms. Flow veloc
ity waveforms were measured from mitral and tricuspid valve immediatel
y before and after fetal blood sampling in 25 normally grown and 10 gr
owth-retarded fetuses. This latter group was characterized by abnormal
Doppler indices in umbilical artery and middle cerebral artery sugges
tive of uteroplacental insufficiency as the causative factor of the im
paired growth. The flow velocity parameters studied were peak velocity
during early and active ventricular filling, time velocity integral,
and fetal heart rate. Different indices were then calculated as expres
sions of ventricular diastolic function and cardiac output. In normall
y grown fetuses, both peak velocity during early diastole and time vel
ocity integral values significantly increased after fetal blood sampli
ng from both atrioventricular valves, whereas no significant changes w
ere evidenced in the other parameters considered. Gestational age at t
he time of the procedure was positively related to the amplitude of th
ese changes. In growth-retarded fetuses, fetal blood sampling induced
a significant decrease in time velocity integral value from tricuspid
valve, suggestive of a fall in right ventricle output. The amplitude o
f the decrease was significantly related to the severity of acidosis i
n umbilical vein. In conclusion, the cardiac hemodynamic response to f
etal blood sampling differs between normally grown and growth-retarded
fetuses. This difference may explain the higher rate of complications
occurring in the latter group of fetuses after blood sampling.