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 <= 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. Copyright (c) 2008 John Wiley & Sons, Ltd.