Evaluation of Fetal Heart

Fetal Growth Restriction

Fetal heart, Echocardiography, IUGR

Evaluation of fetal cardiac functions in cases complicated with growth restriction

10% of pregnancies are, by the description, affected by the common obstetric issue known as intrauterine growth restriction (IUGR). IUGR is a significant contributor to prenatal mortality and morbidity. Cardiomyopathy is a reliable marker of the advancement of IUGR; in these babies, it begins during the early phases of fetal growth restriction and worsens as fetal impairment advances. IUGR is caused by placental dysfunction and this leads to a state of chronic hypoxia and metabolic stress and redistribution of blood flow towards vital organs, such as the brain, heart and adrenal glands. This hemodynamic compensation can itself contribute to a progressive deterioration of fetal cardiac function and myocardial remodeling. The myocardial performance index (MPI), also known as the Tei index, has emerged as a promising tool for the non-invasive evaluation of global fetal cardiac function, integrating both systolic and diastolic performance. To overcome some of the reproducibility-related limitations of the original technique, a modified version of the MPI (Mod-MPI) was introduced, which uses the opening and closing 'clicks' of the heart valves as more precise temporal landmarks. In recent years, numerous studies have investigated the role of MPI in the assessment of IUGR fetuses, and have suggested that this index may be altered early in gestation in response to chronic hypoxia and hemodynamic stress.

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