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Umbilical blood flow during pregnancy: evidence for decreasing placental perfusion

Authors
Journal
American Journal of Obstetrics and Gynecology
0002-9378
Publisher
Elsevier
Publication Date
Volume
196
Issue
5
Identifiers
DOI: 10.1016/j.ajog.2006.11.017
Keywords
  • Doppler Sonography
  • Fetus
  • Growth
  • Placental Weight
  • Umbilical Blood Flow
Disciplines
  • Design

Abstract

Objective The present study was designed to determine the relation of umbilical venous blood flow (UmbBF) to fetal weight (FW) at different times in late pregnancy, and to assess fetal O 2 supply near term. Study Design In 46 pregnant women, UmbBF was calculated just before delivery using the product of flow velocity and the cross section of the umbilical vein determined by pulsed Doppler technique and measuring of the diameter of the vessel, respectively. Based on the gestational age at delivery (range, 29-42 weeks), infants were divided into a preterm group (PT; ≤36 weeks, n = 13) and a full-term group (FT; >36 weeks, n = 33). Blood gas, pH, and hemoglobin analysis was performed in specimens of umbilical venous and arterial blood obtained after delivery. Results UmbBF was higher in FT infants (515 ± 125 mL/min, mean ± standard deviation) than in PT infants (423 ± 120 mL/min; P < .05). This was associated with a larger increase in umbilical vein diameter: FT 8.8 ± .7 mm, PT 8.1 ± .6 mm ( P < .01). Partial pressure of O 2 (pO 2) did not differ significantly between FT and PT; the correlation of pO 2 with gestational age showed a weak decrease ( P < .05). Hemoglobin was elevated in FT ( P < .01), whereas O 2 content remained constant in PT and FT. The ratio UmbBF/FW was considerably reduced in FT [154 ± 37 (mL/min)/kg], relative to PT [221 ± 37 (mL/min)/kg; P < .001], and was accompanied by a marked reduction of O 2 transport capacity: FT 17.6 ± 6.7 and PT 26.6 ± 9.2 (mL/min)/kg ( P < .01). Conclusion Due to the growth of the umbilical vein, UmbBF increases over the last weeks of gestation. The ratio UmbBF/FW is reduced in FT. Despite a constant O 2 content, the continuous weight-related decrease in UmbBF results in a reduction of the fetal O 2 transport capacity per unit that may contribute to an adverse intrauterine environment at the end of gestation, especially in postterm pregnancies.

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