Fetal renal artery impedance as assessed by Doppler ultrasound in pregnancies complicated by intraamniotic inflammation and preterm birth

• Published in: American journal of obstetrics and gynecology 2009-02, Vol.200 (2), p.203.e1-203.e11
• Main Authors: Azpurua, Humberto, MD, Dulay, Antonette T., MD, Buhimschi, Irina A., MD, Bahtiyar, Mert O., MD, Funai, Edmund, MD, Abdel-Razeq, Sonya S., MD, Luo, Guoyang, MD, Bhandari, Vineet, MD, Copel, Joshua A., MD, Buhimschi, Catalin S., MD
• Format: Article
• Language: English
• Subjects: Adult; Amniocentesis; amniotic fluid; Amniotic Fluid - immunology; amniotic fluid index; Biological and medical sciences; Cardiovascular system; Diseases of mother, fetus and pregnancy; erythropoietin; Female; Fetal Membranes, Premature Rupture - immunology; fetal renal artery impedance; Fetus; Gynecology. Andrology. Obstetrics; Hemodynamics; Humans; Infant, Newborn; Infant, Premature; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Obstetric Labor, Premature - immunology; Obstetrics and Gynecology; Pregnancy; Pregnancy. Fetus. Placenta; Premature Birth - immunology; Prospective Studies; pulsatility index; Renal Artery - diagnostic imaging; Renal Artery - immunology; resistance index; systolic/diastolic ratio; Ultrasonic investigative techniques; Ultrasonography, Doppler; Vascular Resistance - immunology; Young Adult
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2008.11.001

Objective The objective of the study was to evaluate the fetal renal artery impedance in the context of inflammation-associated preterm birth. Study Design We conducted a prospective Doppler assessment of the fetal renal artery impedance in 70 singleton fetuses. The study group consisted of 56 premature fetuses (median, 28.1 [interquartile range, 25.3-30.6] weeks at enrollment). Gestational age (GA) reference ranges were generated based on fetuses with uncomplicated pregnancies (n = 14). Doppler studies included renal artery pulsatility index (PI), resistance index (RI), systolic/diastolic (S/D) ratio, and presence or absence of end-diastolic blood flow. Proteomic profiling (surface-enhanced laser desorption ionization time-of-flight) was used for assessment of intraamniotic inflammation and biomarker peak corresponding to β2-microglubin. Data were interpreted in relationship to amniotic fluid index (AFI), cord blood interleukin (IL)-6 and erythropoietin (EPO) levels. The cardiovascular and metabolic profiles of the neonates were investigated in the first 24 hours of life. Results Fetuses delivered by mothers with intraamniotic inflammation had higher cord blood IL-6 but not EPO levels. Fetal inflammation did not affect either renal artery PI, RI, S/D ratio, or end-diastolic blood flow. Neonates delivered in the context of intraamniotic inflammation had higher serum blood urea nitrogen levels, which correlated significantly with AF IL-6 levels. The renal artery RI and SD ratio were inversely correlated with the AFI independent of GA, cord blood IL-6, and status of the membranes. Conclusion The fetus is capable of sustaining normal renal artery impedance despite inflammation. Resistance in the renal vascular bed affects urine output independent of inflammation.