Fetal cardiac dysfunction in preeclampsia: Combined Doppler ultrasonography and biochemical study.

Abstract

OBJECTIVE: The purpose of this study was to correlate Doppler ultrasonographic parameters of fetal haemodynamic compromise with neonatal umbilical artery cardiacTroponin T (cTnT) level as a biochemical marker of fetal cardiac dysfunction in pregnancies complicated by preeclampsia (PE)). PATIENTS AND METHODS: In this study, 50 pregnant women were included, recruited within two years duration, from the antenatal care clinic and the high-risk pregnancy unit of Alnoor specialist hospital, holy Makkah, KSA. Their gestational ages were ranging between 32-38 weeks and they were divided into: control group (20 women) with normal pregnancies (GI) and study group (30 women), out of them 20 with PE without any ultrasonic Doppler detection of transmitted atrial pulsations to the intra-abdominal portion of fetal umbilical vein (GII) and 10 women with PE with ultrasonic Doppler detection of transmitted atrial pulsations, to the intra-abdominal portion of fetal umbilical vein (GIII). For all cases routine ultrasound scanning, Doppler velocimetery (S/D ratio) for umbilical artery (UA) and for the intra-abdominal portion of umbilical vein was done. Maternal cubital vein and neonatal UA serum troponin-T levels was measured. RESULTS: Cardiac troponin T concentrations showed significant increase (P <0.01) in neonates who had transmitted atrial pulsations in fetal intra-abdominal part of umbilical vein, suggesting fetal myocardial cell damage, with the higher levels in fetuses with severe placental insufficiency showing absent end-diastolic or reversed flow in UA. Maternal troponin T concentrations were within normal levels, even in cases in which neonatal troponin T levels were increased, which demonstrate that the umbilical artery troponin T measured in neonates was not of maternal origin. CONCLUSION AND RECOMMENDATION: Doppler detectable transmitted atrial pulsations in the intra-abdominal part of the umbilical vein is an ominous Doppler sign for fetal outcome in cases of PE associated with placental insufficiency, indicating fetal myocardial damage and mandates prompt delivery in hospital with well-equipped neonatal intensive care unit. The optimal timing of delivery in such cases should be before the appearance of this bad prognostic sign, depending on other Doppler parameters of fetal circulation.