Naslov
Effects of chronic hypoxia on fetal cerebral circulation - implications for clinical management

Autori
Salihagić-Kadić, Aida ; Medić, Marijana ; Jugovic, Domagoj ; Kos, Milan ; Latin, Višnja ; Kušan Jukić, Marija ; Arbeille, Philippe

Izvornik
Journal of Maternal-Fetal and Neonatal Medicine (1476-7058) 19 (2006), 7; 387-396

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, stručni

Ključne riječi
fetal hypoxia; hypoxia index; cerebrovascular variability

Sažetak
Fetal hypoxia is one of the leading causes of perinatal morbidity and mortality. One of the most severe sequelae of fetal hypoxic insult is the development of perinatal brain lesions resulting in a specter of neurological disabilities, from minor cerebral disorder to cerebral palsy. One of the most important fetal adaptive responses to hypoxia is redistribution of blood flow towards the fetal brain, known as the “ brain sparing effect” . The fetal blood flow redistribution in favor of the fetal brain can be detected and quantified by the Doppler cerebral/umbilical ratio (C/U ratio= cerebral resistance index (CRI)/umbilical resistance index (URI)). Our studies on animal models and human fetuses have demonstrated clearly that this phenomenon can not prevent the development of perinatal brain lesions in case of severe and/or prolonged hypoxia. Fetal deterioration in chronic and severe hypoxia is characterized by the disappearance of the physiological cerebral vascular variability (vasoconstriction and vasodilatation), followed by an increase in cerebral vascular resistance. However, our latest study on growth restricted and hypoxic human fetuses has shown that perinatal brain lesions can develop even before the loss of cerebrovascular variability. The fetal exposure to hypoxia can be quantified by using the new vascular score, hypoxia index. This parameter, which takes into account the degree as well as duration of fetal hypoxia, can be calculated by summing the daily %C/U ratio reduction from the cut-off value 1 over the period of observation. According to our results, the use of this parameter, which calculates the cumulative, relative oxygen deficit, could allow for the first time the sensitive and reliable prediction and even prevention of adverse neurological outcome in pregnancies complicated by fetal hypoxia.

Izvorni jezik
Engleski

POVEZANOST RADA