Decreased Placental Blood Flow in Fetuses with Congenital Heart Disease is Associated with Placental Vascular Abnormalities and Impaired Fetal Growth
Presented By:
Rebecca Josowitz, MD, PhD; Deborah Ho, MD; Somya Shankar; Rebecca L. Linn, MD; Zhiyun Tian, MD; William J. Gaynor, MD; Jack Rychik, MD
Children's Hospital of Philadelphia
josowitzr@chop.eduOverview:
Introduction:
- The placenta and the fetal heart develop at similar times during human gestation
- Previous studies suggest the placenta is abnormal in fetuses with congenital heart disease (CHD), and may be due to abnormal vascular developmental pathways shared between both the developing heart and placenta
- Umbilical venous volume flow (UVVF) is a validated noninvasive method of assessing blood flow from the placenta to the fetus that can be performed routinely during fetal ultrasounds, and has been shown to reflect characteristics of the placenta rather than of the fetus
- Our group has previously demonstrated that mid-gestational UVVF is decreased in fetuses with CHD compared to normal controls
Hypothesis: Placental blood flow to fetuses with CHD, as measured by UVVF, will be decreased compared to control fetuses and will be associated with placental vascular abnormalities and impaired fetal growth
Methods:
- Single center prospective case-control study of consenting pregnant women referred to the CHOP Fetal Heart Program
- 38 cases (29 single ventricle, 8 TOF, 1 d-TGA), and 38 controls enrolled
- UVVF and combined cardiac output (CCO) measured during second trimester fetal echocardiograms (Figure 1)
- Postnatal placentas were analyzed and assigned a placental abnormality severity score (PASS) (Table 1)
- Biometrics collected for all newborns
- Statistical significance was assessed using T-tests or Fisher’s Exact Tests.
Conclusions:
- Fetuses with CHD demonstrate decreased placental blood flow in utero, higher grade placental lesions associated with FVM and CI, and decreased birth weight
- UVVF reflects characteristics of abnormal placental pathology and may be a useful marker of placental malperfusion in fetuses with CHD
- Future study looking at association of UVVF and clinical outcomes is warranted
- The placenta and the fetal heart develop at similar times during human gestation
- Previous studies suggest the placenta is abnormal in fetuses with congenital heart disease (CHD), and may be due to abnormal vascular developmental pathways shared between both the developing heart and placenta
- Umbilical venous volume flow (UVVF) is a validated noninvasive method of assessing blood flow from the placenta to the fetus that can be performed routinely during fetal ultrasounds, and has been shown to reflect characteristics of the placenta rather than of the fetus
- Our group has previously demonstrated that mid-gestational UVVF is decreased in fetuses with CHD compared to normal controls
Hypothesis: Placental blood flow to fetuses with CHD, as measured by UVVF, will be decreased compared to control fetuses and will be associated with placental vascular abnormalities and impaired fetal growth
Methods:
- Single center prospective case-control study of consenting pregnant women referred to the CHOP Fetal Heart Program
- 38 cases (29 single ventricle, 8 TOF, 1 d-TGA), and 38 controls enrolled
- UVVF and combined cardiac output (CCO) measured during second trimester fetal echocardiograms (Figure 1)
- Postnatal placentas were analyzed and assigned a placental abnormality severity score (PASS) (Table 1)
- Biometrics collected for all newborns
- Statistical significance was assessed using T-tests or Fisher’s Exact Tests.
Conclusions:
- Fetuses with CHD demonstrate decreased placental blood flow in utero, higher grade placental lesions associated with FVM and CI, and decreased birth weight
- UVVF reflects characteristics of abnormal placental pathology and may be a useful marker of placental malperfusion in fetuses with CHD
- Future study looking at association of UVVF and clinical outcomes is warranted
