Fetal büyüme kısıtlılığı ile komplike olan gebeliklerde antenatal kortikosteroid uygulamasının umbilikal arter Doppler velosimetrisi üzerine etkisi
Year 2024,
Volume: 7 Issue: 3, 245 - 251, 27.10.2024
Sevda Zamanova
,
Sunullah Soysal
,
Merve Demir
Abstract
Amaç: Fetal büyüme kısıtlılığı (FBK) ile komplike olan gebeliklerde antenatal kortikosteroid uygulamasının umbilikal arter (UA) Doppler ölçümleri üzerine etkisini incelemek.
Yöntem: Bu kesitsel çalışma, erken doğum olasılığı nedeniyle antenatal kortikosteroid tedavisi planlanan 149 gebe kadın ile gerçekleştirildi. FBK ile komplike olan ve FBK ile komplike olmayan gebe gruplarında, antenatal kortikosteroid uygulamasından önceki ve son doz kortikosteroid uygulamasından 24 ve 48 saat sonraki UA Doppler ölçümleri (PI, S/D oranı, RI) değerlendirildi ve birbirleriyle karşılaştırıldı.
Bulgular: FBK olan ve olmayan her grupta, antenatal kortikosteroid tedavisinden 24 ve 48 saat sonra UA Doppler parametrelerinde istatistiksel olarak anlamlı bir değişiklik gözlenmedi. FBK olan ve olmayan iki grubun prekortikosteroid UA Doppler parametreleri (PI, S/D oranı, RI) arasında anlamlı fark bulunmazken, son tedavi dozundan 24 saat sonra bu parametrelerin değerleri FBK ile komplike olan grupta komplike olmayan gruba göre istatistiksel olarak yüksekti. Ancak son tedavi dozundan 48 saat sonra iki grup arasında UA Doppler parametrelerinde istatistiksel fark gözlenmedi.
Sonuç: Antenatal kortikosteroid, FBK durumunda UA Doppler parametrelerini kalıcı olarak etkilememektedir. Doğum öncesi kortikosteroidin ilk dozundan sonra 72 saat boyunca fetüsün yakından izlenmesi, FBK ile komplike olan gebe kadınlarda faydalı olabilir.
Ethical Statement
Bu kesitsel çalışma, 02.02.2018 tarihinde, 09.2018.161 protokol koduyla, Marmara Üniversitesi Klinik Araştırmalar Etik Kurulu tarafından onaylandı.
Supporting Institution
Yazarlar bu çalışmanın herhangi bir finansal destek almadığını beyan etmişlerdir.
References
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- Krishna U, Bhalerao S. Placental insufficiency and fetal growth restriction. J Obstet Gynaecol India. 2011;61(5):505-511. doi:10.1007/s13224-011-0092-x
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- Berkley E, Chauhan SP, Abuhamad A. Doppler assessment of the fetus with intrauterine growth restriction. Am J Obstet Gynecol. 2012;206(4):300–338. doi:10.1016/j.ajog.2012.01.022
- Aditya I, Tat V, Sawana A, Mohamed A, Tuffner R, Mondal T. Use of Doppler velocimetry in diagnosis and prognosis of intrauterine growth restriction (IUGR): A Review. J Neonatal Perinatal Med. 2016;9(2):117-126. doi:10.3233/NPM-16915132
- Nnamani AO, Ibewuike CU, Okere PC, Obikili EN. Comparative analysis of umbilical artery doppler indices of normal and suspected IUGR fetuses in the third trimester. Niger J Clin Pract. 2021;24(12):1793-1799. doi:10.4103/njcp.njcp_46_18
- Acharya G, Wilsgaard T, Berntsen GK, Maltau JM, Kiserud T. Reference ranges for serial measurements of umbilical artery Doppler indices in the second half of pregnancy. Am J Obstet Gynecol. 2005;192(3):937-344. doi:10.1016/j.ajog.2004.09.019
- Srikumar S, Debnath J, Ravikumar R, Bandhu HC, Maurya VK. Doppler indices of the umbilical and fetal middle cerebral artery at 18-40 weeks of normal gestation: A pilot study. Med J Armed Forces India. 2017;73(3):232-241. doi:10.1016/j.mjafi.2016.12.008
- Khanduri S, Parashari UC, Bashir S, Bhadury S, Bansal A. Comparison of diagnostic efficacy of umbilical artery and middle cerebral artery waveform with color Doppler study for detection of intrauterine growth restriction. J Obstet Gynaecol India. 2013;63(4):249-255. doi:10.1007/s13224-012-0326-6
- 1McGoldrick E, Stewart F, Parker R, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2020;12(12):CD004454. doi:10.1002/14651858.CD004454.pub4
- 1Vidaeff AC, Blackwell SC. Potential risks and benefits of antenatal corticosteroid therapy prior to preterm birth in pregnancies complicated by severe fetal growth restriction. Obstet Gynecol Clin North Am. 2011;38(2):205-214. doi:10.1016/j.ogc.2011.02.011
- 1Rotmensch S, Liberati M, Celentano C et al. The effect of betamethasone on fetal biophysical activities and Doppler velocimetry of umbilical and middle cerebral arteries. Acta Obstet Gynecol Scand. 1999;78(9):768-773.
- Mulder EJ, Derks JB, Zonneveld MF, Bruinse HW, Visser GH. Transient reduction in fetal activity and heart rate variation after maternal betamethasone administration. Early Hum Dev. 1994;36(1):49-60. doi:10.1016/0378-3782(94)90032-9
- Derks JB, Giussani DA, Jenkins SL et al. A comparative study of cardiovascular, endocrine and behavioural effects of betamethasone and dexamethasone administration to fetal sheep. J Physiol. 1997;499(Pt 1):217-226. doi:10.1113/jphysiol.1997.sp021922.
- Schwab M, Roedel M, Anwar MA et al. Effects of betamethasone administration to the fetal sheep in late gestation on fetal cerebral blood flow. J Physiol. 2000;528(Pt 3):619-632. doi:10.1111/j.1469-7793.2000.00619.x.
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- Senat MV, Ville Y. Effect of steroids on arterial Doppler in intrauterine growth retardation fetuses. Fetal Diagn Ther. 2000;15(1):36-40. doi:10.1159/000020972
- Niroomanesh S, Shojaei K, Moghadam SF, Mohammadi N, Rahimi Z, RezaeiKeyhanaei K. Effect of prenatal betamethasone on fetal, uteroplacental, and maternal blood flow velocity in pregnancies complicated by fetal growth restriction. Int J Gynaecol Obstet. 2015;130(3):270-273. doi:10.1016/j.ijgo.2015.04.043
- Nozaki AM, Francisco RP, Fonseca ES, Miyadahira S, Zugaib M. Fetal hemodynamic changes following maternal betamethasone administration in pregnancies with fetal growth restriction and absent end-diastolic flow in the umbilical artery. Acta Obstet Gynecol Scand. 2009;88(3):350-354. doi:10.1080/00016340902730334
- Raghuraman N, Porcelli B, Temming LA et al. Clinical implications of umbilical artery Doppler changes after betamethasone administration. J Matern Fetal Neonatal Med. 2020;33(1):42-48. doi:10.1080/14767058.2018.1484095
- Simchen MJ, Alkazaleh F, Adamson SL et al. The fetal cardiovascular response to antenatal steroids in severe early-onset intrauterine growth restriction. Am J Obstet Gynecol. 2004;190(2):296-304. doi:10.1016/j.ajog.2003.08.011
- Robertson MC, Murila F, Tong S, Baker LS, Yu VY, Wallace EM. Predicting perinatal outcome through changes in umbilical artery Doppler studies after antenatal corticosteroids in the growth-restricted fetus. Obstet Gynecol. 2009;113(3):636-640. doi:10.1097/AOG.0b013e318197bf4d
- Miller SL, Chai M, Loose J et al. The effects of maternal betamethasone administration on the intrauterine growth-restricted fetus. Endocrinology. 2007;148(3):1288-1295. doi:10.1210/en.2006-1058
The effect of antenatal corticosteroid administration on umbilical artery Doppler velocimetry in pregnancies complicated with fetal growth restriction
Year 2024,
Volume: 7 Issue: 3, 245 - 251, 27.10.2024
Sevda Zamanova
,
Sunullah Soysal
,
Merve Demir
Abstract
Objective: To examine the effect of antenatal corticosteroid administration on umbilical artery (UA) Doppler measurements in pregnancies complicated with fetal growth restriction (FGR).
Methods: This cross-sectional study was conducted with 149 pregnant women scheduled for antenatal corticosteroid therapy because of the possibility of preterm birth. UA Doppler measurements (PI, S/D ratio, RI) before antenatal corticosteroid administration and 24 and 48 hours after the last dose of corticosteroid administration were evaluated and compared with each other in pregnant groups complicated with FGR and uncomplicated with FGR.
Results: No statistically significant change was observed in UA Doppler parameters 24 and 48 hours after antenatal corticosteroid treatment in each group with and without FGR. While there was no significant difference between the precorticosteroid UA Doppler parameters (PI, S/D ratio, RI) of the two groups with and without FGR, the values of these parameters 24 hours after the last dose of treatment were statistically higher in the group complicated with FGR than in the uncomplicated group. However, no statistical difference was observed in UA Doppler parameters between the two groups 48 hours after the last dose of treatment.
Conclusion: Antenatal corticosteroid does not permanently affect UA Doppler parameters in the case of FGR. Close monitoring of the fetus for 72 hours after the first dose of antenatal corticosteroid may be helpful in pregnant women complicated by FGR.
Ethical Statement
This cross-sectional study was approved by Marmara University Clinical Research Ethics Committee on 02.02.2018 with protocol code 09.2018.161.
Supporting Institution
The authors declared that this study received no financial support
References
- Uquillas KR, Grubbs BH, Prosper AE, Chmait RH, Grant EG, Walker DK. Doppler US in the Evaluation of Fetal Growth and Perinatal Health. Radiographics. 2017;37(6):1831-1838. doi:10.1148/rg.2017170020
- Krishna U, Bhalerao S. Placental insufficiency and fetal growth restriction. J Obstet Gynaecol India. 2011;61(5):505-511. doi:10.1007/s13224-011-0092-x
- American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 204: fetal growth restriction. Obstet Gynecol. 2019;133(2):e97–e109. doi:10.1097/AOG.0000000000003070
- Berkley E, Chauhan SP, Abuhamad A. Doppler assessment of the fetus with intrauterine growth restriction. Am J Obstet Gynecol. 2012;206(4):300–338. doi:10.1016/j.ajog.2012.01.022
- Aditya I, Tat V, Sawana A, Mohamed A, Tuffner R, Mondal T. Use of Doppler velocimetry in diagnosis and prognosis of intrauterine growth restriction (IUGR): A Review. J Neonatal Perinatal Med. 2016;9(2):117-126. doi:10.3233/NPM-16915132
- Nnamani AO, Ibewuike CU, Okere PC, Obikili EN. Comparative analysis of umbilical artery doppler indices of normal and suspected IUGR fetuses in the third trimester. Niger J Clin Pract. 2021;24(12):1793-1799. doi:10.4103/njcp.njcp_46_18
- Acharya G, Wilsgaard T, Berntsen GK, Maltau JM, Kiserud T. Reference ranges for serial measurements of umbilical artery Doppler indices in the second half of pregnancy. Am J Obstet Gynecol. 2005;192(3):937-344. doi:10.1016/j.ajog.2004.09.019
- Srikumar S, Debnath J, Ravikumar R, Bandhu HC, Maurya VK. Doppler indices of the umbilical and fetal middle cerebral artery at 18-40 weeks of normal gestation: A pilot study. Med J Armed Forces India. 2017;73(3):232-241. doi:10.1016/j.mjafi.2016.12.008
- Khanduri S, Parashari UC, Bashir S, Bhadury S, Bansal A. Comparison of diagnostic efficacy of umbilical artery and middle cerebral artery waveform with color Doppler study for detection of intrauterine growth restriction. J Obstet Gynaecol India. 2013;63(4):249-255. doi:10.1007/s13224-012-0326-6
- 1McGoldrick E, Stewart F, Parker R, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2020;12(12):CD004454. doi:10.1002/14651858.CD004454.pub4
- 1Vidaeff AC, Blackwell SC. Potential risks and benefits of antenatal corticosteroid therapy prior to preterm birth in pregnancies complicated by severe fetal growth restriction. Obstet Gynecol Clin North Am. 2011;38(2):205-214. doi:10.1016/j.ogc.2011.02.011
- 1Rotmensch S, Liberati M, Celentano C et al. The effect of betamethasone on fetal biophysical activities and Doppler velocimetry of umbilical and middle cerebral arteries. Acta Obstet Gynecol Scand. 1999;78(9):768-773.
- Mulder EJ, Derks JB, Zonneveld MF, Bruinse HW, Visser GH. Transient reduction in fetal activity and heart rate variation after maternal betamethasone administration. Early Hum Dev. 1994;36(1):49-60. doi:10.1016/0378-3782(94)90032-9
- Derks JB, Giussani DA, Jenkins SL et al. A comparative study of cardiovascular, endocrine and behavioural effects of betamethasone and dexamethasone administration to fetal sheep. J Physiol. 1997;499(Pt 1):217-226. doi:10.1113/jphysiol.1997.sp021922.
- Schwab M, Roedel M, Anwar MA et al. Effects of betamethasone administration to the fetal sheep in late gestation on fetal cerebral blood flow. J Physiol. 2000;528(Pt 3):619-632. doi:10.1111/j.1469-7793.2000.00619.x.
- Bennet L, Kozuma S, McGarrigle HH, Hanson MA. Temporal changes in fetal cardiovascular, behavioural, metabolic and endocrine responses to maternally administered dexamethasone in the late gestation fetal sheep. Br J Obstet Gynaecol. 1999;106(4):331-339. doi:10.1111/j.1471-0528.1999.tb08270.x.
- Wijnberger LD, Bilardo CM, Hecher K, Stigter RH, Visser GH. Effect of antenatal glucocorticoid therapy on arterial and venous blood flow velocity waveforms in severely growth-restricted fetuses. Ultrasound Obstet Gynecol. 2004;23(6):584-589. doi:10.1002/uog.1052.
- Senat MV, Ville Y. Effect of steroids on arterial Doppler in intrauterine growth retardation fetuses. Fetal Diagn Ther. 2000;15(1):36-40. doi:10.1159/000020972
- Niroomanesh S, Shojaei K, Moghadam SF, Mohammadi N, Rahimi Z, RezaeiKeyhanaei K. Effect of prenatal betamethasone on fetal, uteroplacental, and maternal blood flow velocity in pregnancies complicated by fetal growth restriction. Int J Gynaecol Obstet. 2015;130(3):270-273. doi:10.1016/j.ijgo.2015.04.043
- Nozaki AM, Francisco RP, Fonseca ES, Miyadahira S, Zugaib M. Fetal hemodynamic changes following maternal betamethasone administration in pregnancies with fetal growth restriction and absent end-diastolic flow in the umbilical artery. Acta Obstet Gynecol Scand. 2009;88(3):350-354. doi:10.1080/00016340902730334
- Raghuraman N, Porcelli B, Temming LA et al. Clinical implications of umbilical artery Doppler changes after betamethasone administration. J Matern Fetal Neonatal Med. 2020;33(1):42-48. doi:10.1080/14767058.2018.1484095
- Simchen MJ, Alkazaleh F, Adamson SL et al. The fetal cardiovascular response to antenatal steroids in severe early-onset intrauterine growth restriction. Am J Obstet Gynecol. 2004;190(2):296-304. doi:10.1016/j.ajog.2003.08.011
- Robertson MC, Murila F, Tong S, Baker LS, Yu VY, Wallace EM. Predicting perinatal outcome through changes in umbilical artery Doppler studies after antenatal corticosteroids in the growth-restricted fetus. Obstet Gynecol. 2009;113(3):636-640. doi:10.1097/AOG.0b013e318197bf4d
- Miller SL, Chai M, Loose J et al. The effects of maternal betamethasone administration on the intrauterine growth-restricted fetus. Endocrinology. 2007;148(3):1288-1295. doi:10.1210/en.2006-1058