Sequence of cardiovascular changes in IUGR in pregnancies with and without preeclampsia.

OBJECTIVE: The aim of this study was to determine the cardiovascular changes sequence in intrauterine-growth-restricted (IUGR) fetuses using Doppler ultrasound.

METHODS: Sequential Doppler evaluations were carried out in 29 severe IUGR fetuses in pregnancies without maternal medical complications (group A) and in pregnancies complicated by preeclampsia (group B) delivered at < ort = 32 weeks. Nine fetal vessels and two cardiac valves were studied.

RESULTS: One hundred and forty three Doppler studies were performed (median: five studies; range 3-9 per patient). There were 19 fetuses in the preeclamptic group and 10 fetuses in the second group. In group A IUGR fetuses, a progressive change was observed in the parameters studied more often than in group B IUGR fetuses (P < 0.05). In six cases, an abnormal tricuspid valve (TV) followed by an abnormal mitral valve (MV) Doppler was recorded prior to the occurrence of the intrauterine-fetal demise.

CONCLUSIONS: Our data indicate that (1) in patients without preeclampsia a series of cardiovascular changes almost always occurs in severe IUGR fetuses; (2) the changes preceding intrauterine demise are right cardiac failure followed by left cardiac failure; (3) in patients with preeclampsia, the sequential Doppler changes are unpredictable and are seen in a few patients only.