The effect of maternal position on placental blood flow and fetoplacental oxygenation in late gestation fetal growth restriction: a magnetic resonance imaging study

IF 4.4 2区医学 Q1 NEUROSCIENCES Journal of Physiology-London Pub Date : 2023-07-19 DOI:10.1113/JP284269

Devanshi Jani, Alys Clark, Sophie Couper, John M. D. Thompson, Anna L. David, Andrew Melbourne, Ali Mirjalili, Anna-Maria Lydon, Peter R. Stone

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引用次数: 1

Abstract

Fetal growth restriction (FGR) and maternal supine going-to-sleep position are both risk factors for late stillbirth. This study aimed to use magnetic resonance imaging (MRI) to quantify the effect of maternal supine position on maternal-placental and fetoplacental blood flow, placental oxygen transfer and fetal oxygenation in FGR and healthy pregnancies. Twelve women with FGR and 27 women with healthy pregnancies at 34–38 weeks’ gestation underwent MRI in both left lateral and supine positions. Phase-contrast MRI and a functional MRI technique (DECIDE) were used to measure blood flow in the maternal internal iliac arteries (IIAs) and umbilical vein (UV), placental oxygen transfer (placental flux), fetal oxygen saturation (FO₂), and fetal oxygen delivery (delivery flux). The presence of FGR, compared to healthy pregnancies, was associated with a 7.8% lower FO₂ (P = 0.02), reduced placental flux, and reduced delivery flux. Maternal supine positioning caused a 3.8% reduction in FO₂ (P = 0.001), and significant reductions in total IIA flow, placental flux, UV flow and delivery flux compared to maternal left lateral position. The effect of maternal supine position on fetal oxygen delivery was independent of FGR pregnancy, meaning that supine positioning has an additive effect of reducing fetal oxygenation further in women with FGR, compared to women with appropriately grown for age pregnancies. Meanwhile, the effect of maternal supine positioning on placental oxygen transfer was not independent of the effect of FGR. Therefore, growth-restricted fetuses, which are chronically hypoxaemic, experience a relatively greater decline in oxygen transfer when mothers lie supine in late gestation compared to appropriately growing fetuses.

Key points

Fetal growth restriction (FGR) is the most common risk factor associated with stillbirth, and early recognition and timely delivery is vital to reduce this risk.
Maternal supine going-to-sleep position is found to increase the risk of late stillbirth but when combined with having a FGR pregnancy, maternal supine position leads to 15 times greater odds of stillbirth compared to supine sleeping with appropriately grown for age (AGA) pregnancies.
Using MRI, this study quantifies the chronic hypoxaemia experienced by growth-restricted fetuses due to 13.5% lower placental oxygen transfer and 26% lower fetal oxygen delivery compared to AGA fetuses.
With maternal supine positioning, there is a 23% reduction in maternal-placental blood flow and a further 14% reduction in fetal oxygen delivery for both FGR and AGA pregnancies, but this effect is proportionally greater for growth-restricted fetuses.
This knowledge emphasises the importance of avoiding supine positioning in late pregnancy, particularly for vulnerable FGR pregnancies.

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孕晚期胎儿生长受限时母体体位对胎盘血流和胎盘氧合的影响:磁共振成像研究。

胎儿生长受限(FGR)和母亲仰卧睡姿都是晚期死产的危险因素。本研究旨在利用磁共振成像技术(MRI)量化产妇仰卧位对FGR和健康妊娠中母胎盘和胎胎盘血流、胎盘氧转移和胎儿氧合的影响。12名FGR孕妇和27名孕34-38周的健康孕妇分别采用左侧侧卧位和仰卧位进行MRI检查。采用相衬MRI和功能MRI技术(DECIDE)测量产妇髂内动脉(IIAs)和脐静脉(UV)的血流量、胎盘氧转移(胎盘通量)、胎儿氧饱和度(FO2)和胎儿氧输送(分娩通量)。与健康妊娠相比，FGR的存在与FO2降低7.8% (P = 0.02)、胎盘通量减少和分娩通量减少相关。与产妇左侧卧位相比，产妇仰卧位导致FO2降低3.8% (P = 0.001)，总IIA流量、胎盘流量、UV流量和分娩流量均显著降低。母亲仰卧位对胎儿产氧的影响与FGR妊娠无关，这意味着与适龄妊娠的孕妇相比，FGR孕妇仰卧位具有进一步降低胎儿氧合的累加效应。同时，产妇仰卧位对胎盘氧转移的影响并非独立于FGR的影响。因此，与正常生长的胎儿相比，母亲在妊娠后期仰卧时，生长受限的胎儿，即慢性低氧血症，氧转移的下降相对更大。关键点:胎儿生长受限(FGR)是与死产相关的最常见危险因素，早期识别和及时分娩对于降低这种风险至关重要。发现产妇仰卧睡姿会增加晚期死产的风险，但与FGR妊娠相结合，产妇仰卧睡姿导致死产的几率比与年龄适当生长(AGA)妊娠的仰卧睡姿高15倍。使用MRI，本研究量化了生长受限胎儿所经历的慢性低氧血症，原因是与AGA胎儿相比，胎盘氧转移低13.5%，胎儿氧输送低26%。对于FGR和AGA妊娠，母亲仰卧位会减少23%的胎盘血流量和14%的胎儿氧气输送，但对于生长受限的胎儿，这种影响比例更大。这一知识强调了在妊娠后期避免仰卧位的重要性，特别是对于脆弱的FGR妊娠。

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来源期刊

Journal of Physiology-London 医学-神经科学

CiteScore

9.70

自引率

7.30%

发文量

817

审稿时长

2 months

期刊介绍： The Journal of Physiology publishes full-length original Research Papers and Techniques for Physiology, which are short papers aimed at disseminating new techniques for physiological research. Articles solicited by the Editorial Board include Perspectives, Symposium Reports and Topical Reviews, which highlight areas of special physiological interest. CrossTalk articles are short editorial-style invited articles framing a debate between experts in the field on controversial topics. Letters to the Editor and Journal Club articles are also published. All categories of papers are subjected to peer reivew. The Journal of Physiology welcomes submitted research papers in all areas of physiology. Authors should present original work that illustrates new physiological principles or mechanisms. Papers on work at the molecular level, at the level of the cell membrane, single cells, tissues or organs and on systems physiology are all acceptable. Theoretical papers and papers that use computational models to further our understanding of physiological processes will be considered if based on experimentally derived data and if the hypothesis advanced is directly amenable to experimental testing. While emphasis is on human and mammalian physiology, work on lower vertebrate or invertebrate preparations may be suitable if it furthers the understanding of the functioning of other organisms including mammals.