Acute centralization of blood flow in compromised human fetuses evoked by uterine contractions.

Hui Li, Saemundur Gudmundsson, Per Olofsson

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Abstract

Background: During fetal hypoxia blood is redistributed to the brain ('brain-sparing'). Sequential changes of the cerebral and placental circulation in parallel in comparisons between basal conditions and acute hypoxic stress have not yet been thoroughly studied in human fetuses. Aim: To explore acute fetal middle cerebral artery (MCA) circulatory changes relative to umbilical artery (UA) blood flow in a clinical experimental model with hypoxic stress provoked by uterine contractions during an oxytocin challenge test (OCT). Study design: Prospective comparative between imminently compromised (OCT positive) and un-compromised (OCT negative) fetuses. Subjects and methods: 82 term pregnancies suspected of intrauterine growth restriction were exposed to simultaneous electronic fetal heart rate monitoring and Doppler recordings of pulsatility index (PI) in the UA and MCA during basal conditions and during uterine contractions and relaxations at an OCT. Outcome measures: Sequential changes of UA and MCA PI, OCT positive vs. negative cases. Nonparametric statistics with a P < 0.05 considered significant. Results: The UA PI was significantly higher in OCT positive cases (N=10) compared with OCT negative cases (N=72) during uterine contractions and relaxations, but not during basal measurements. During contractions and relaxations the MCA PI decreased significantly in both groups (brain-sparing), but significantly more in OCT positive cases. Conclusions: During acute hypoxic stress, changes towards a centralization of blood flow to the brain develop in imminently compromised (OCT positive) fetuses at an expense of the umbilicoplacental. blood flow, and the brain-sparing flow is more pronounced than in uncompromised (OCT negative) fetuses.
Original languageEnglish
Pages (from-to)747-752
JournalEarly Human Development
Volume82
Issue number11
DOIs
Publication statusPublished - 2006

Bibliographical note

The information about affiliations in this record was updated in December 2015.
The record was previously connected to the following departments: Research Unit for Urogynaecology and Reproductive Pharmacology (013242710), Pediatrics/Urology/Gynecology/Endocrinology (013240400)

Subject classification (UKÄ)

  • Obstetrics, Gynecology and Reproductive Medicine
  • Clinical Medicine

Free keywords

  • index
  • pulsatility
  • pregnancy
  • cerebral
  • middle cerebral artery
  • umbilical
  • Doppler

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