Maternal cardiac function in fetal growth restriction JEAK Bamfo, NA Kametas, O Turan, A Khaw, KH Nicolaides Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, Denmark Hill, London, UK Correspondence: Prof. KH Nicolaides, Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, Denmark Hill, Golden Jubilee Wing, London SE5 9RS, UK. Email Kypros@fetalmedicine.com Accepted 2 March 2006. Objective To assess the maternal central haemodynamics in normotensive women with pregnancies complicated by severe fetal growth restriction (FGR). Design Cross-sectional study. Setting A tertiary referral fetal medicine unit. Population The study groups comprised 107 women with normal singleton pregnancies and 20 with singleton pregnancies complicated by FGR at 25–37 weeks. In the latter group, assessment was carried out within 10 days prior to their delivery. All the women were normotensive, without any medical problems. Methods Two-dimensional and M-mode echocardiography of the left ventricle. Main outcome measures Maternal left ventricular systolic and diastolic function. Results In the FGR group, compared with the normal group, there was increased total vascular resistance (TVR), reduced systolic function characterised by lower cardiac output, stroke volume, heart rate, ejection time and septal and lateral long-axis shortening. Mean arterial pressure (MAP) was not significantly different between the groups. Conclusions Severe FGR is associated with reduced maternal systolic function and increased TVR but no change in MAP. TVR may be a useful tool in the classification and management of FGR. The findings suggest that in FGR, there is increased blood viscosity due to lack of intravascular space expansion. Keywords Cardiac output, echocardiography, fetal growth restriction. Please cite this paper as: Bamfo J, Kametas N, Turan O, Khaw A, Nicolaides K. Maternal cardiac function in fetal growth restriction. BJOG 2006; 113:784–791. Introduction Fetal growth restriction (FGR) is a common cause of neonatal morbidity and mortality and is now increasingly recognised as a risk factor for cardiovascular and metabolic disease in later life. 1–3 Although multiple aetiologies exist, defective tropho- blastic invasion of the maternal spiral arteries is a universally accepted pathophysiological finding. 4 Normal placentation is thought to trigger a fall in systemic vascular tone and to create a state of intravascular volume depletion. This provokes an increase in plasma volume, heart rate (HR) and hence cardiac output (CO). To cope with this physiological stress, the maternal heart increases its compli- ance, its contractility and its size, thus modifying the function of the left ventricle. This reorganisation results in a 50% increase in CO and uteroplacental perfusion. 5–7 There is some evidence that impaired placentation is asso- ciated with altered maternal cardiovascular function. Bosio et al. 8 demonstrated that pregnancies complicated by pre- eclampsia are characterised by a hyperdynamic circulation, which crosses over to a low CO high peripheral resistant state at the onset of pre-eclampsia. In normotensive pregnancies with FGR, there is a contradictory evidence about maternal haemodynamics, with some studies reporting reduced CO and left ventricular (LV) diastolic function in the first and third trimesters 9–11 and others reporting no difference in LV function between normal pregnancies and those affected by FGR. 12 Accurate interpretations cannot be made from the published literature due to the small number of subjects stud- ied. Disparity may also be explained by differences in the employed echocardiographic methodologies and inconsisten- cies in the definition of FGR. Classification of FGR based on birthweight less than 10th or 5th percentile is likely to include a proportion of small-for-gestational-age (SGA) fetuses. 13 Doppler velocimetry of the fetal circulation is a useful tool in the assessment of fetal compromise and prediction of DOI: 10.1111/j.1471-0528.2006.00945.x www.blackwellpublishing.com/bjog Maternal medicine 784 ª RCOG 2006 BJOG An International Journal of Obstetrics and Gynaecology