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CC BY 4.0 · Rev Bras Ginecol Obstet 2020; 42(05): 289-296
DOI: 10.1055/s-0040-1710301
Review Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Aortic Isthmus Doppler Velocimetry in Fetuses with Intrauterine Growth Restriction: A Literature Review

Dopplervelocimetria do istmo aórtico em fetos com crescimento intrauterino restrito: Uma revisão da literatura
Mariana Martins Ferraz 
1   Fetal Medicine Post Graduation, Universidade Estácio de Sá, Rio de Janeiro, RJ, Brazil
3   Clínica Perinatal, Rio de Janeiro, RJ, Brazil
,
Flávia do Vale Araújo 
1   Fetal Medicine Post Graduation, Universidade Estácio de Sá, Rio de Janeiro, RJ, Brazil
,
Paulo Roberto Nassar de Carvalho 
1   Fetal Medicine Post Graduation, Universidade Estácio de Sá, Rio de Janeiro, RJ, Brazil
2   Fetal Medicine Department, Instituto Fernandes Figueira, Rio de Janeiro, RJ, Brazil
3   Clínica Perinatal, Rio de Janeiro, RJ, Brazil
,
Renato Augusto Moreira de Sá 
2   Fetal Medicine Department, Instituto Fernandes Figueira, Rio de Janeiro, RJ, Brazil
2   Fetal Medicine Department, Instituto Fernandes Figueira, Rio de Janeiro, RJ, Brazil
› Author Affiliations
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Publication History

29 March 2019

09 March 2020

Publication Date:
29 May 2020 (online)

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ErratumRev Bras Ginecol Obstet eFirst
DOI: 10.1055/s-0040-1715592

Abstract

Intrauterine growth restriction (IUGR) is associated with poor perinatal prognosis and a higher risk of stillbirth, neonatal death, and cerebral palsy. Its detection and the evaluation of its severity by new Doppler velocimetric parameters, such as aortic isthmus (AoI), are of great relevance for obstetrical practice. The AoI is a vascular segment that represents a point of communication between the right and left fetal circulations. It is considered to be a functional arterial shunt that reflects the relationship between the systemic and cerebral impedances, and has recently been proposed as a tool to detect the status of hemodynamic balance and prognosis of IUGR in fetuses. In the present review, we noticed that in healthy fetuses, the AoI net flow is always antegrade, but in fetuses with IUGR the deterioration of placental function leads to progressive reduction in its flow until it becomes mostly retrograde; this point is associated with a drastic reduction in oxygen delivery to the brain. The more impaired the AoI flow is, the greater is the risk of impairment in the Doppler velocimetry of other vessels; and the alterations of the AoI Doppler seem to precede other indicators of severe hypoxemia. Although there seems to be an association between the presence of retrograde flow in the AoI and the risk of long-term neurologic disability, its role in the prediction of perinatal morbi-mortality remains unclear. The AoI Doppler seems to be a promising tool in the management of fetuses with IUGR, but more studies are needed to investigate its employment in clinical practice.

Resumo

O crescimento intrauterino restrito (CIUR) está associado a um prognóstico perinatal adverso, com maior risco de óbito intrauterino e neonatal, bem como de paralisia cerebral. Assim, sua detecção e a determinação de sua gravidade por novos parâmetros Dopplervelocimétricos, como o istmo aórtico (IAo), são de fundamental importância na prática obstétrica. O IAo é um segmento vascular que representa um ponto de comunicação entre os sistemas circulatórios fetais esquerdo e direito. É considerado um shunt arterial funcional, capaz de refletir a relação entre as impedâncias dos circuitos cerebral e sistêmico, e foi proposto como uma ferramenta para detecção do status do equilíbrio hemodinâmico e do prognóstico de fetos com CIUR. Na presente revisão, observou-se que, em fetos saudáveis, o fluxo predominante no IAo é sempre anterógrado; mas em fetos com CIUR a deterioração do estágio de insuficiência placentária acarreta reduções progressivas no fluxo ístmico até este apresentar sentido predominantemente retrógrado e levar a uma drástica redução no aporte de oxigênio ao sistema nervoso central. Quanto mais alterado estiver o fluxo no IAo, maior a chance de haver alteração na Dopplervelocimetria de outros vasos; e as alterações no Doppler do IAo parecem preceder outros indicadores de hipoxemia severa. Embora o fluxo retrógrado no IAo pareça se correlacionar com maior risco de alteração no desenvolvimento neurológico a longo prazo, ainda não está claro o seu papel na predição de morbimortalidade perinatal. O Doppler do IAo parece ser um parâmetro promissor no manejo do CIUR; entretanto, mais estudos são necessários para avaliar seu emprego na prática clínica.

Keywords

doppler velocimetry - doppler - aortic isthmus - intrauterine growth restriction - intrauterine growth retardation - placental insufficiency

Palavras-chave

dopplervelocimetria - doppler - istmo aórtico - crescimento intrauterino restrito - crescimento intrauterino retardo - insuficiência placentária
 

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