Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 13 , ISSUE 3 ( May-June, 2021 ) > List of Articles

RESEARCH ARTICLE

Doppler Changes in IUGR Pregnancy Following Maternal Corticosteroids: A Prospective Observational Analysis at a Tertiary Care Hospital

Neelima Choudhary, Ashima Kesri, Laxmi Goel, Vikas Chaudhary, Shubha S Trivedi

Keywords : Betamethasone, Doppler ultrasonography, IUGR-intrauterine growth restriction

Citation Information : Choudhary N, Kesri A, Goel L, Chaudhary V, Trivedi SS. Doppler Changes in IUGR Pregnancy Following Maternal Corticosteroids: A Prospective Observational Analysis at a Tertiary Care Hospital. J South Asian Feder Obs Gynae 2021; 13 (3):118-124.

DOI: 10.5005/jp-journals-10006-1899

License: CC BY-NC 4.0

Published Online: 09-09-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aims and objectives: To evaluate the impact of maternal administration of betamethsone on fetoplacental and uterine circulation in preterm pregnancies complicated with intrauterine growth restriction. Materials and methods: Prospective observational study included 77 preterm pregnant women from 26- to 34-week period of gestation with IUGR. Color Doppler blood flow study (day 0) of fetoplacental and maternal circulation including umbilical artery middle cerebral artery (MCA), ductus venosus, maternal uterine arteries of all cases was being done. After day 0 Doppler, all received two doses of 12 mg of betamethasone intramuscularly 24 hours apart. Repeat Doppler (day 2) of the above-mentioned vessels was performed between 24 hours and 48 hours of first dose of betamethasone of all cases, and various indices were recorded. Third Doppler examination (day 4) of umbilical artery and MCA was done between 72 hours and 96 hours of first dose of betamethasone administration of all women (60 cases), and then Doppler indices values on day 4 were noted. Tabulated data were analyzed statistically by using appropriate statistical tests such as paired t-test, Pearson\'s Chi-square test, and ANOVA. Results: A significant reduction in mean umbilical artery pulsatility index (PI) and S/D ratio was observed on day 2 following betamethasone administration (p <0.001), which was maintained till fourth day after first dose of betamethasone (p <0.05). A significant reduction in mean MCA PI and S/D ratio was obtained on day 2 following betamethasone administration (p <0.001) but the effect was transient and became insignificant by day 4. A significant decrease in mean ductus venosus PI was observed on day 2 following betamethasone administration (p <0.05). No significant change of maternal betamethasone administration in maternal uterine artery PI was observed (p >0.05). Conclusion: Fetoplacental circulation of pregnancies with intrauterine growth restriction showed divergent response in terms of changes in various fetoplacental Doppler indices following antenatal betamethasone administration. Clinical significance: This offers a unique model to explore the regulation of the fetoplacental vasculature. These findings are also important for fetal surveillance undertaken following corticosteroid administration to pregnant women with IUGR.


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  1. Cunningham FG, Leveno KJ, Bloom SL, et al. William's obstetrics. 23rd ed. McGraw Hill Professional; 2009. p. 842–846.
  2. Gogate S. Intrauterine growth restriction, obstetricians perspective. Int J Diab Dev Countries 2001;21(2). DOI: 10.1016.3051788.
  3. Robert D, Dalziel S. Antenatal glucocoticoids for accelerated fetal lung maturation for women at risk for preterm birth. Cochrane Database Syst Rev 2006;(3):CD004454. DOI: 10.1002/1465-1858.CD004454.pub2.
  4. Miracle X, Di Renzo GC, Stark A, et al. Guideline for the use of antenatal corticosteroids for fetal maturation. J Perinat Med 2008;36(3):191–196. DOI: 10.1515/JPM.2008.032.
  5. Kari MA, Hallman M, Eronen M, et al. Prenatal dexamethasone treatment in conjunction with rescue therapy of human surfactant: a randomized placebo-controlled multicenter study. Pediatrics 1994;93(5):730–736. DOI: 10.1016.0140-6736(98)082-4.
  6. Carlan, SJ, Parsons, M, O'Brien, WF, et al. Pharmacologic pulmonary maturation in preterm premature rupture of membranes. Am J Obstet Gynecol 1991;164:371. DOI: 10.1002/1465-1858.CD004454.
  7. Crowley P. Prophylactic corticosteroids for preterm birth. Cochrane Database Syst Rev 2000;CD000065. DOI: 10.1002/14651858.CD000065.
  8. Mulder EJH, Derks JB, Zonneveld MF, et al. Transient reduction in foetal 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.
  9. Rotenmensch 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 Gynaecol Scand 1999;78(9):768–773. DOI: 10.1016/0301-2115.367.
  10. Gudmundsson S, Marsal K. Umbilical artery and uteroplacental blood flow velocity waveform in normal pregnancy – a cross-sectional study. Acta Obstet Gynaecol Scand 1988;67(4):347–354. DOI: 10.1016.3051883.
  11. Gunnarsson GO, Marsal K. Blood flow velocity waveform in the middle cerebral, renal and femoral artery of human fetuses. Eur J Obstset Gynaecol 2006;3(3):251–259. DOI: 10.1016/0929-8266(95)00150-P.
  12. Kessler J, Rasmussen S, Hanson M, et al. Longitudinal reference range for ductus venosus flow velocity and waveform indices. Ultrasound Obstet Gynaecol 2006;28(7):890–898. DOI: 10.1002/uog.3857.
  13. Hofstaetter C, Dubiel M, Gudmundsson S, et al. Uterine artery color Doppler assisted velocimetery and perinatal outcome. Acta Obstet Gynaecol Scand 1996;75(7):612–619. DOI: 10.3109/00016349609054684.
  14. Wallace EM, Baker LS. Effects of antenatal betamethasone administration on placental vascular resistance. Lancet 1999;353(9162):1404–1407. DOI: 10.1016/S0140-6736(98)08229-4.
  15. Edward A, Baker S, Wallace M. Changes in umbilical artery flow velocity following maternal administration of betamethasone. Placenta 2003;24(1):12–16. DOI: 10.1053/plac.2002.0874.
  16. Cromi A, Raio L, Surbek D, et al. Haemodynamic effects of betamethasone on growth-restricted fetuses with absent or reversed end diastolic flow. Ultrasound Obstet Gynaecol 2007;30(4):367–455. DOI: 10.1002/uog.4360.
  17. Nozaki AM, Francisco RPV, Fonseca ESVB, et al. Fetal hemodynamic changes following maternal betamethasone administration in pregnancy with fetal growth restriction & absent end diastolic flow in umbilical artery. Acta Obstet Gynaecol 2009;88(3):350–354. DOI: 10.1080/00016340902730334.
  18. Cohlen BJ, Stigter RH, Derks JB, et al. Absence of significant hemodynamic changes in the fetus after maternal betamethasone administration. Ultrasound Obstet Gynaecol 1996:8:252–255. DOI: 10.1046/j.1469-0705.1996.08040252.x.
  19. Piazze JJ, Anceschi MM, La Torre R, et al. Effect of antenatal betamethasone therapy on maternal–fetal Doppler velocimetery. Early Hum Dev 2001;60(3):225–232. DOI: 10.1016/s0378-3782(00)00120-1.
  20. Wijnberger LDE, Bilardo CM, Hecher K, et al. Effect of antenatal glucocorticoids therapy on arterial and venous blood flow velocity waveforms in severely growth restricted fetuses. Ultrasound Obstet Gynaecol 2004;23(6):584–589. DOI: 10.1002/uog.1052.
  21. Kahler C, Schleussner E, Moller A, et al. Doppler measurement in fetoplacental vessels after maternal betamethasone administration. Fetal Diagn Ther 2004;19(1):52–57. DOI: 10.1159/000074261.
  22. Thuring A, Malcus P, Marsal K. Effect of maternal betamethasone on fetal and uteroplacental blood flow velocity waveforms. Ultrasound Obstet Gynaecol 2010;37(6):668–672. DOI: 10.1002/uog.8879.
  23. Smolin A, Mazor M, Maymon E, et al. Short term effect of betamethasone administration on MCA blood flow velocimetry on pre term intra uterine growth restricted fetuses. Ultrasound Obstet Gynaecol 2005;26:309–375.
  24. Robertson MC, Murlia F, Tong S. Predicting perinatal outcome through changes in umbilical artery Doppler study after antenatal corticosteroids in growth restricted fetus. Obstet Gynaecol 2009;13(3):636–640. DOI: 10.1097/AOG.0b013e318197bf4d. DOI: 10.1515/JPM.2007.027.
  25. Harper A, Murnaghan GA. Maternal and fetal hemodynamics in hypertensive pregnancies during maternal treatment with intravenous hydralazine or labetalol. Br J Obstet Gynaecol 1991;98(5):453–459. DOI: 10.1111/j.1471-0528.1991.tb10339.x.
  26. Clifton VL, Wallace EM, Smith R. Short term effects of glucocorticoids in the human fetal placental circulation in vitro. J Clin Endocrinol Metabol 2002;87(6):2838–2842. DOI: 10.1210/jcem.87.6.8541.
  27. Wijnberger LDE, Bilardo CM, Hecher K, et al. Effect of antenatal glucocorticoids therapy on arterial and venous blood flow velocity waveforms in severely growth restricted fetuses. Ultrasound Obstet Gynaecol 2004;23(6):584–589. DOI: 10.1002/uog.1052.
  28. Senat MV, Ville Y. Effects of steroids on antenatal Doppler in intrauterine growth retarded foetuses. Fetal Diagn Ther 2000;15(1):36–40. DOI: 10.1159/000020972.
  29. Piazze J, Anceschi MM, Cerekja A, et al. The combined effect of betamethasone and ritodrine on the middle cerebral artery in low risk third trimester pregnancies. J Perinat Med 2007;35(2):135–140. DOI: 10.1515/JPM.2007.027.
  30. Deren O, Karaer C, Onderoglu L, et al. The effect of steroid on the biophysical profile and Doppler indices of umbilical and middle cerebral arteries in healthy preterm fetuses. Eur J Obstet Gynaecol Reprod Biol 2001;99(1):72–76. DOI: 10.1016/s0301-2115(01)00367-0.
  31. Edwards A, Baker LS, Walllace EM. Changes in fetoplacental vessel flow waveforms following maternal betamethasone. Ultrasound Obstet Gynaecol 2002;20(3):240–244. DOI: 10.1046/j.1469-0705.2002.00782.x.
  32. Chitrit Y, Caubel P, Herrero R, et al. Effects of maternal dexamethasone administration on fetal Doppler flow velocity waveforms. Br J Obstet Gynaecol 2000;107(4):501–507. DOI: 10.1111/j.1471-0528.2000.tb13269.x.
  33. Simchen MJ, Alkazaleh F, Adomson SL, et al. The fetal cardiovascular response to antenatal steroids in severe early onset intra uterine growth restriction. Am J Obstet Gynaecol 2004;190(2):296–304. DOI: 10.1016/j.ajog.2003.08.011.
  34. Mulder EJH, de Heus R, Visser GHA. Antenatal corticosteroids therapy: short term effects on the fetal behaviour and haemodynamics. Semin Fetal Neonatal Med 2009;14(3):151–156. DOI: 10.1016/j.siny.2008.10.003.
  35. Korebrits C, Yu DH, Ramirez MM, et al. Antenatal glucocorticoids administration increases corticotrophin releasing hormone in maternal plasma. Br J Obstet Gynaecol 1998;105(5):556–561. DOI: 10.1111/j.1471-0528.1998.tb10158.x.
  36. Marinoni E, Korebrits C, Di Iorio R, et al. Effect of betamethasone in vivo on placental corticotropin releasing hormone in human pregnancy. Am J Obstet Gynaecol 1998;178(4):770–778. DOI: 10.1016/s0002-9378(98)70490-9.
  37. Clifton VL, Read MA, Leitch IM, et al. Corticotropin-releasing hormone-induced vasodilatation in the human fetoplacental circulation: involvement of nitric oxide-cyclic guanosine 3’,5’-monophosphate mediated pathway. J Clin Endocrinol Metab 1995;80(10):2888–2893. DOI: 10.1210/jcem.80.10.7559870.
  38. 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;499:217–226. DOI: 10.1113/jphysiol.1997.sp021922.
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