Reduction in the Middle Cerebral Artery Pulsatility Index After Decompression of Polyhydramnios in Twin Gestation

Giancarlo Mari, Nathan Wasserstrum, Brian Kirshon

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Amniotic fluid decompression was performed for symptomatic polyhydramnios complicating four sets of discordant twin gestations. Doppler ultrasound waveforms of the middle cerebral artery were determined before and after the procedure in seven of the eight fetuses. After amniocentesis, the pulsatility index of the middle cerebral artery (PIMCA) was reduced in all fetuses (p <0.01). When one considers only the larger twin in each set, the magnitude of the change in PIMCA was relatively consistent among the different sets (-0.60 ö 0.14; p <0.01; range, -0.45 to -0.79). The smaller twins showed a much more variable response (-0.82 ö 0.70; range, -0.05 to -1.75). The pulsatility index of the umbilical artery (PIUA) showed no consistent trend in the five subjects in which it was determined. In principle, the cerebrovascular dilation indicated by the PIMCA measurements may in part be due to acute increases in maternal and fetal carbon dioxide tensions following relief of maternal restrictive lung dysfunction. More importantly, the acute fall in amniotic fluid pressure-the external pressure to which the fetoplacental unit is exposed-leads to pooling of blood in fetal and placental veins, and thereby reduces the effective blood volume of the fetoplacental unit. This effective hypovolemia, functionally analogous to that produced by fetal hemorrhage, elicits changes in regional vascular resistances thatfavor cerebrovascular perfusion. The impact of acute amniotic fluid decompression on the fetal circulation reflected in the marked changes in PIMCA suggests a role for monitoring to avoid large acute changes in pressure during therapeutic amniocentesis.

Original languageEnglish (US)
Pages (from-to)381-384
Number of pages4
JournalAmerican Journal of Perinatology
Volume9
DOIs
StatePublished - Jan 1 1992
Externally publishedYes

Fingerprint

Polyhydramnios
Middle Cerebral Artery
Decompression
Amniotic Fluid
Pregnancy
Amniocentesis
Pressure
Fetus
Mothers
Doppler Ultrasonography
Hypovolemia
Umbilical Arteries
Blood Volume
Fetal Blood
Carbon Dioxide
Vascular Resistance
Dilatation
Veins
Perfusion
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Reduction in the Middle Cerebral Artery Pulsatility Index After Decompression of Polyhydramnios in Twin Gestation. / Mari, Giancarlo; Wasserstrum, Nathan; Kirshon, Brian.

In: American Journal of Perinatology, Vol. 9, 01.01.1992, p. 381-384.

Research output: Contribution to journalArticle

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