FETAL CARDIAC HAEMODYNAMICS IN NORMAL AND COMPLICATED PREGNANCIES

Ismail Essop Bhorat, JS Bagratee

Abstract


Fetal monitoring in utero is essential in ensuring fetal well-being and in reducing perinatal morbidity and mortality. In the last 2 to 3 decades the monitoring of complicated pregnancies has focused on flow velocities using Doppler techniques in multiple vessels viz, umbilical artery, middle cerebral artery, ductus venosus and aortic isthmus. A new Doppler index of combined systolic and diastolic ventricular myocardial performance, the Tei index or myocardial performance index (MPI) has been proposed as a potential useful predictor of global cardiac function in adult cardiology.Tsutsumi et al and Ichizuka et al in small numbers reported using MPI to assess fetal global myocardial function and reported that the MPI increased under certain pathological conditions. These studies were however small in numbers and had methodological problems. These authors called for further larger studies using more reproducible techniques. The high risk obstetric conditions of pre-eclampsia, diabetes and intra-uterine growth restriction make up by far the vast majority of overall high risk obstetric patients. Together they are responsible for the majority of perinatal morbidity and mortality encountered. Cardiac function in these high risk conditions will be investigated using the MPI and E/A ratios. The MPI and E/A ratio may prove to be an invaluable antenatal surveillance technique available to clinicians to predict and prevent perinatal morbidity and mortality in these high risk conditions and could play a crucial role in deciding timing of delivery as changes in cardiac function may be a precursor to serious adverse events. One of the main objectives of this thesis would be to bring cardiac Doppler ie MPI and E/A ratios into mainstream of antenatal surveillance techniques and give another modality to clinicians when dealing with these complex clinical scenarios, and may revolutionise the way clinicians monitor foetuses in these conditions.