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The fetal aortic pressure pulse waveform in normal and compromised pregnancy

  1. Akira Mori Research Fellow 1,
  2. Brian Trudinger Professor 1,*,
  3. Ranko Mori Research Fellow 1,
  4. Vivienne Reed Research Assistant 1,
  5. Yoshihiko Takeda Professor 2

Article first published online: 19 AUG 2005

DOI: 10.1111/j.1471-0528.1997.tb10971.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 104, Issue 11, pages 1255–1261, November 1997

Additional Information

How to Cite

Mori, A., Trudinger, B., Mori, R., Reed, V. and Takeda, Y. (1997), The fetal aortic pressure pulse waveform in normal and compromised pregnancy. BJOG: An International Journal of Obstetrics & Gynaecology, 104: 1255–1261. doi: 10.1111/j.1471-0528.1997.tb10971.x

Author Information

  1. 1

    Fetal Welfare Laboratory, Department of Obstetrics and Gynaecology, University of Sydney at Westmead Hospital, New South Wales, Australia

  2. 2

    Department of Obstetrics and Gynaecology, Maternal and Perinatal Center, Tokyo Women s Medical College, Japan

*Correspondence: Professor B. Trudinger, Department of Obstetrics and Gynaecology, Westmead Hospital, Westmead New South Wales 2145, Australia.

Publication History

  1. Issue published online: 19 AUG 2005
  2. Article first published online: 19 AUG 2005
  3. Received 9 May 1996 Returned for revision 11 October 1996 Revised version received 25 July 1997 Accepted 31 July 1997

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Objective To study the arterial pressure waveform in the descending thoracic aorta during pregnancy in both normal and compromised fetuses.

Design The pressure pulsation waveform propagated along the vascular tree, and acting laterally on the arterial wall, produces a corresponding change in the vessel diameter. The distance between diametrically opposite points of the aortic lumen was followed using a phase locked loop echo tracking system coupled to a B-mode ultrasonic imager (central frequency 3.5 MHz).

Setting Tertiary referral unit, teaching hospital.

Participants A cross-sectional study of 80 normal fetuses between 20 and 40 weeks yielded normal data. We studied 58 women with evidence of potential fetal compromise (high umbilical artery systolic: diastolic ratio).

Main outcome measures From the aortic diameter waveform we measured the maximum systolic and minimum diastolic dimension and calculated pulse amplitude. The first derivative of the aortic diameter waveform identified the incisura of aortic and pulmonary valve closure and was used to time the end of ventricular ejection and systole.

Results In normal pregnancy there was an increase in systolic and diastolic diameter and pulse amplitude with advancing gestation. Ventricular ejection time was constant. In the fetal compromised group the absolute systolic and diastolic diameters were within the normal range, but diastolic diameter per unit fetal weight was increased. There was a decrease in pulse amplitude as a percentage of diastolic diameter and an increase in the diastolic systolic diameter ratio. Fetal outcome was examined in relation to the diastolic systolic diameter ratio. Those with a high ratio (above 90th centile of normal group) exhibited significantly more adverse indices of fetal outcome.

Conclusions The fetal aortic pressure pulse waveform was represented by the vessel diameter waveform. In fetal compromise reduced pulse amplitude and increased diastolic to systolic diameter ratio suggest corresponding changes in arterial pressure pulse. We suggest these are the response of the cardiac pump to increased afterload imposed by the high umbilical placental vascular resistance.

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