Fetal cardiac function and ductus arteriosus during indomethacin and sulindac therapy for threatened preterm labor: A randomized study

AbstractBackgroundThe aim of this systematic review was to describe the effects of drug exposure during pregnancy on fetal cardiac function.MethodsWe searched MEDLINE, Embase, Cochrane and SCOPUS for studies assessing fetal cardiac function in drug-exposed human pregnancies. Risk of bias was assessed by the Risk Of Bias In Non-randomized Studies of Interventions (ROBIN-I) tool.ResultsWe included 32 studies on eight different drug groups. They included 51 outcome variables, which were all based on ultrasound techniques primarily assessing systolic function: pulsed wave Doppler, tissue Doppler imaging (TDI), and B- and M-mode. Overall, the risk of bias was moderate. β2 agonists increased the systolic velocity in the ductus arteriosus and the fetal heart rate. β-blockers caused unchanged or decreased systolic velocity of the pulmonary trunk. Corticosteroids increased the velocity in the ductus arteriosus. Furthermore, in growth-restricted fetuses with an increased myocardial performance index (MPI′) on the right side, corticosteroids normalized this variable. Nonsteroidal anti-inflammatory drugs (NSAIDs), but not acetylsalicylic acid, increased the flow velocities in the ductus arteriosus, decreased the shortening fraction and increased the end-diastolic ventricular diameters. Metformin and insulin normalized the diastolic strain and global longitudinal strain in diabetic pregnancies. Highly active antiretroviral therapy (HAART) exposure increased the E/A ratio on the right side, prolonged the isovolumic relaxation time (IRT) and ejection time, shortened the isovolumic contraction time (ICT), and decreased left myocardial systolic peak velocities. Chemotherapy did not cause detectable changes.ConclusionSix of the eight drug groups caused detectable changes in fetal cardiac function. However, the evidence was hampered by only a few studies for some drugs.

Download Full-text

Uterine and fetal hemodynamics and fetal cardiac function after atenolol and pindolol infusion. A randomized study

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/0301-2115(95)02197-f ◽

1995 ◽

Vol 62 (2) ◽

pp. 195-201 ◽

Cited By ~ 17

Author(s):

Juha Räsänen ◽

Pentti Jouppila

Keyword(s):

Cardiac Function ◽

Randomized Study ◽

Fetal Cardiac Function

Download Full-text

Effects of nifedipine on fetal cardiac function in preterm labor

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0160 ◽

2020 ◽

Vol 48 (7) ◽

pp. 723-727

Author(s):

Osman Yilmaz ◽

Ayhan Şule Göncü

Keyword(s):

Cardiac Function ◽

Preterm Labor ◽

Heart Function ◽

Tertiary Hospital ◽

Cardiac Effect ◽

Fetal Doppler ◽

Fetal Cardiac Function ◽

Sphericity Index ◽

Significant Difference ◽

Doppler Indices

AbstractObjectivesTo evaluate the effects of nifedipine treatment on fetal hemodynamics and cardiac function during preterm labor. This prospective study assessed several quantitative parameters of fetal cardiac circulation and function, and found no significant changes at 48 h after nifedipine treatment. These findings suggest that tocolytic nifedipine may be safe for fetuses. It supports clinicians to use nifedipine treatment for tocolysis without any cardiac effect on the fetus.MethodsA prospective cohort study was conducted at a tertiary hospital between January 2016 and October 2017. A total of 45 pregnant women who required nifedipine for preterm labor were included in this study. Fetal Doppler ultrasound was performed and fetal systolic and diastolic function was measured prior to, and 48 h after, the first nifedipine treatment. Conventional Doppler parameters were used to evaluate fetal heart function and hemodynamic changes. Tricuspid annular plane systolic excursion, mitral annular plane systolic excursion and the sphericity index were also evaluated to assess changes in fetal cardiac morphology.ResultsNo significant changes in fetal Doppler parameters were observed following nifedipine tocolysis. There was no significant difference in the fetal cardiac function parameters of both ventricles before vs. after nifedipine treatment. Tricuspid annular plane systolic excursion, mitral annular plane systolic excursion, and sphericity index values were unchanged following nifedipine treatment.ConclusionsOral administration of nifedipine did not to alter fetal cardiac function or morphology. Fetal cardiac parameters and various Doppler indices were unchanged following nifedipine treatment. Maternal nifedipine treatment does not appear to have any significant effect on fetal cardiac function.

Download Full-text

Haemodynamic examination of fetal cardiopathies assessed by fetal color-coded Doppler echocardiography – Examination of fetal cardiac function by fetal echocardiography

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/s-2008-1080762 ◽

2008 ◽

Vol 29 (S 2) ◽

Author(s):

M Katona ◽

H Orvos ◽

E Horvath ◽

A Pal

Keyword(s):

Cardiac Function ◽

Doppler Echocardiography ◽

Fetal Echocardiography ◽

Fetal Cardiac Function

Download Full-text

Possibilities of applying speckle tracking echocardiography to assess fetal myocardial function. Part 1. Methods to assess fetal cardiac function

10.21516/2413-1458-2019-18-4-297-303 ◽

2019 ◽

Author(s):

S.I. Buryakova, M.V. Medvedev

Keyword(s):

Cardiac Function ◽

Speckle Tracking ◽

Myocardial Function ◽

Speckle Tracking Echocardiography ◽

Myocardial Deformation ◽

Prenatal Period ◽

Fetal Cardiac Function ◽

Deformation Properties

The article deals with the physiology of the heart and methods to assess fetal cardiac function. The leadingedge technique to assess the myocardial deformation properties by speckle tracking echocardiography in prenatal period is presented.

Download Full-text

Anesthetic Techniques for Fetal Surgery

Anesthesiology ◽

10.1097/aln.0b013e318283c954 ◽

2013 ◽

Vol 118 (4) ◽

pp. 796-808 ◽

Cited By ~ 16

Author(s):

Pornswan Ngamprasertwong ◽

Erik C. Michelfelder ◽

Shahriar Arbabi ◽

Yun Suk Choi ◽

Christopher Statile ◽

...

Keyword(s):

Blood Flow ◽

Cardiac Function ◽

Fetal Surgery ◽

Left Ventricular ◽

High Dose ◽

Anesthetic Techniques ◽

Uterine Blood Flow ◽

Fetal Cardiac Function ◽

Significant Difference ◽

Fetal Acidosis

Abstract Background: Use of high-dose inhalational anesthesia during open fetal surgery may induce maternal–fetal hemodynamic instability and fetal myocardial depression. The authors’ preliminary human retrospective study demonstrated less fetal bradycardia and left ventricular systolic dysfunction with lower dose desflurane supplemented with propofol and remifentanil IV anesthesia (SIVA). In this animal study, the authors compare maternal–fetal effects of high-dose desflurane anesthesia (HD-DES) and SIVA. Methods: Of 26 instrumented midgestational ewes, data from 11 animals exposed to both SIVA and HD-DES in random sequences and six animals exposed to HD-DES while maternal normotension was maintained were analyzed. Maternal electroencephalography was used to guide comparable depths of anesthesia in both techniques. Hemodynamic parameters, blood gas, and fetal cardiac function from echocardiography were recorded. Results: Compared with SIVA, HD-DES resulted in significant maternal hypotension (mean arterial pressure difference, 19.53 mmHg; 95% CI, 17.6–21.4; P < 0.0001), fetal acidosis (pH 7.11 vs. 7.24 at 150 min, P < 0.001), and decreased uterine blood flow. In the HD-DES group with maternal normotension, uterine blood flow still declined and fetal acidosis persisted, with no statistically significant difference from the group exposed to HD-DES that had maternal hypotension. There was no statistically significant difference in fetal cardiac function. Conclusion: In sheep, SIVA affects maternal hemodynamics less and provides better fetal acid/base status than high-dose desflurane. Fetal echocardiography did not reflect myocardial dysfunction in this model.

Download Full-text

Optimization of Imminent Labor Prediction Systems in Women with Threatened Preterm Labor Based on Electrohysterography

Sensors ◽

10.3390/s21072496 ◽

2021 ◽

Vol 21 (7) ◽

pp. 2496

Author(s):

Gema Prats-Boluda ◽

Julio Pastor-Tronch ◽

Javier Garcia-Casado ◽

Rogelio Monfort-Ortíz ◽

Alfredo Perales Marín ◽

...

Keyword(s):

Preterm Labor ◽

Cervical Length ◽

Validation Dataset ◽

Computationally Efficient ◽

K Nearest Neighbors ◽

Predictive Values ◽

Classifier Design ◽

Input Dataset ◽

Threatened Preterm Labor ◽

Learning Machine

Preterm birth is the leading cause of death in newborns and the survivors are prone to health complications. Threatened preterm labor (TPL) is the most common cause of hospitalization in the second half of pregnancy. The current methods used in clinical practice to diagnose preterm labor, the Bishop score or cervical length, have high negative predictive values but not positive ones. In this work we analyzed the performance of computationally efficient classification algorithms, based on electrohysterographic recordings (EHG), such as random forest (RF), extreme learning machine (ELM) and K-nearest neighbors (KNN) for imminent labor (<7 days) prediction in women with TPL, using the 50th or 10th–90th percentiles of temporal, spectral and nonlinear EHG parameters with and without obstetric data inputs. Two criteria were assessed for the classifier design: F1-score and sensitivity. RFF1_2 and ELMF1_2 provided the highest F1-score values in the validation dataset, (88.17 ± 8.34% and 90.2 ± 4.43%) with the 50th percentile of EHG and obstetric inputs. ELMF1_2 outperformed RFF1_2 in sensitivity, being similar to those of ELMSens (sensitivity optimization). The 10th–90th percentiles did not provide a significant improvement over the 50th percentile. KNN performance was highly sensitive to the input dataset, with a high generalization capability.

Download Full-text