Acute increase in femoral artery resistance in response to direct physical stimuli in the human fetus

Smith, Richard P., Glover, Vivette and Fisk, Nicholas M. (2003) Acute increase in femoral artery resistance in response to direct physical stimuli in the human fetus. British Journal of Obstetrics and Gynaecology, 110 10: 916-921. doi:10.1016/S1470-0328(03)02373-5


Author Smith, Richard P.
Glover, Vivette
Fisk, Nicholas M.
Title Acute increase in femoral artery resistance in response to direct physical stimuli in the human fetus
Journal name British Journal of Obstetrics and Gynaecology   Check publisher's open access policy
ISSN 1470-0328
1471-0528
Publication date 2003-10
Year available 2003
Sub-type Article (original research)
DOI 10.1016/S1470-0328(03)02373-5
Volume 110
Issue 10
Start page 916
End page 921
Total pages 6
Editor Philip Steer
Place of publication London, U.K.
Publisher Blackwell
Language eng
Subject 111402 Obstetrics and Gynaecology
1114 Paediatrics and Reproductive Medicine
Formatted abstract Objective: To determine whether fetal response to needling resembles the fetal 'brain sparing' response seen with hypoxaemia.
Design: Prospective observational study.
Setting: Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, London.
Population: Eighty-five pregnant women undergoing invasive procedures associated with fetal prenatal diagnosis and/or management.
Methods: The femoral artery and the middle cerebral artery pulsatility index were measured by Doppler ultrasonography before and after 89 invasive procedures (fetal blood sampling, transfusion, bladder or cyst aspiration, shunt insertion and amniocentesis, between 17 and 36 weeks). Cases in which the fetal body was transgressed were compared with 'control' fetuses undergoing invasive procedures which did not directly involve needling the fetus (amniocentesis and placental cord insertion procedures).
Main outcome measures: Femoral artery and middle cerebral artery pulsatility index.
Results: The femoral artery pulsatility index rose after transgression [median change (Δ) 0.73; 95% confidence interval (CI) 0.51 to 0.98]. In contrast, there was no significant change in femoral artery pulsatility index after non-transgression procedures (mean Δ 0.28; 95% CI −0.20 to 0.76). Analysis confirmed the fall in middle cerebral artery pulsatility index after transgression procedures (median Δ−0.19; 95% CI −0.07 to −0.35), but there was also a significant fall in middle cerebral artery pulsatility index after non-transgression procedures (mean Δ−0.47; 95% CI −0.23 to −0.71).
Conclusions: The human fetus mounts a peripheral haemodynamic response to invasive procedures involving transgression of the fetal body, which is consistent with the brain sparing effect. However, the change in middle cerebral artery pulsatility index in both transgression and control procedures suggests that the changes and mechanisms may be more complex than previously thought.
©RCOG 2003 BJOG: an International Journal of Obstetrics and Gynaecology

Keyword Fetal response to needling
Hypoxaemia
Cerebral artery pulsatility index
Femoral artery pulsatility index
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
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Created: Thu, 19 Mar 2009, 16:32:15 EST by Mary-Anne Marrington on behalf of Faculty Of Health Sciences