Obstet Gynecol Sci.  2017 Jul;60(4):336-342. 10.5468/ogs.2017.60.4.336.

Prediction of pregnancy complication occurrence using fetal cardiac output assessments made by ultrasonography at 20 to 24 weeks of gestation

• Lee JY
• Kim YL
• Jeong JE
• Ahn JW

• KMID: 2386274
• DOI: http://doi.org/10.5468/ogs.2017.60.4.336

Abstract

OBJECTIVE
To evaluate the importance of assessment of fetal cardiac output (CO) for the prediction of complications of pregnancy.
METHODS
We evaluated 65 fetuses and all of them had a fetal cardiac scan at 20 to 24 weeks of pregnancy. To measure CO, diameters (d) of the left right ventricle outflow tract were measured just above the valves. Each left CO (LCO) and right CO (RCO) was derived using the following equation: CO = velocity time integral ×π× d²/4 × heart rate. Pregnancy complications included gestational hypertensive disorders, fetal growth restriction (FGR) and preterm birth (PTB) caused from preterm labor or preterm premature rupture of membrane (PPROM).
RESULTS
There were 23 cases with one more pregnancy complication (FGR, 9; gestational hypertensive disorders, 8; PTB caused from PTB or PPROM, 12). The LCO was lower in complication group than in normal group (88±53 vs. 117±48 mL/min, P=0.028). The RCO to the LCO ratio (RCO/LCO) was higher in complication group (2.43±1.69 vs. 1.48±0.81, P=0.001). Regression analysis demonstrated that RCO/LCO was a significant predictor of pregnancy complication; Odds ratio was 7.76 (95% CI, 1.15 to 52.21; P=0.029). The area under the receiver-operating characteristic curve for prediction of pregnancy complications from LCO was 0.71. The diagnostic cut-off value of LCO was 80 mL/min. The area under the receiver-operating characteristic curve from RCO/LCO was 0.68 and cut-off value was 1.41.
CONCLUSION
This study demonstrated that pregnancy complications can be suspected based on fetal CO assessments at a GA of 20 to 24 weeks.

Keyword

Cardiac output; Echocardiography; Fetal growth retardation; Pre-eclampsia; Premature birth

MeSH Terms

Cardiac Output*
Echocardiography
Female
Fetal Development
Fetal Growth Retardation
Fetus
Heart Rate
Heart Ventricles
Membranes
Obstetric Labor, Premature
Odds Ratio
Pre-Eclampsia
Pregnancy Complications*
Pregnancy*
Premature Birth
Rupture
Ultrasonography*

Figure

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  Fig. 1 Ultrasonographic measurement of cardiac output using pulsed-wave Doppler. (A) The pulmonary root diameter (arrow) is used to calculate pulmonary valve area. (B) Pulsed-wave flow profile in the pulmonary root. The angle of insonation for Doppler assessment is minimized so that the flow velocity time integral can be measured directly from the spectral display. (C) The aortic root diameter (arrow) is used to calculate aortic valve area. (D) Pulsed-wave flow profile in the aortic root.

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  Fig. 2 Receiver-operating characteristics curve for the prediction of pregnancy complication according to cut-off values of left cardiac output.

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  Fig. 3 Receiver-operating characteristics curve for the prediction of pregnancy complication according to cut-off values of right cardiac output to the left cardiac output.

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