Evaluation of Fetal Breathing-Related Nasal Fluid Flow Doppler in the Third Trimester in Pregnant Women with Fetal Growth Restriction: Preliminary Observations

Abstract

Objective To investigate the fetal breathing-related nasal fluid flow Doppler waveforms as an indicator of fetal respiratory function in fetuses diagnosed with fetal growth restriction (FGR) in the third trimester.

Materials and Methods This prospective, non-interventional case-control study was conducted on 96 pregnant women, including 23 pregnant women diagnosed with FGR in the third trimester as the FGR group and 73 healthy pregnant women with fetuses appropriate for gestational age (AGA) as the control group. Fetal breathing-related nasal fluid flow Doppler was examined in the fetuses of the participants. Inspiration and expiration duration, inspiration and expiration peak velocity, total breathing duration, and number of fetal breaths per minute were calculated.

ResultsBoth groups were similar in terms of the duration of inspiration, duration of expiration, and total breathing duration (p=0.463, p=0.711, p=0.520, respectively). Peak inspiratory velocity and peak expiratory velocity were significantly lower in the FGR group than in the control group, and the number of fetal breaths per minute was similar in both groups (p=0.027, p=0.012, p=0.768, respectively). When participants were regrouped into those whose newborn was admitted to the neonatal intensive care unit (NICU) after birth and those who were not, all fetal nasal fluid flow Doppler parameters were similar in both groups.

Conclusions Although the number of participants was too small to draw a definitive conclusion, FGR appears to be associated with a decrease in peak inspiratory and expiratory velocity. The clinical significance of changes in fetal breathing-related nasal fluid flow Doppler parameters in FGR is as yet unclear, and their use in clinical follow-up and predicting unfavorable perinatal outcomes are the subjects of future research.

Keywords

fetal breath movement - fetal growth restriction - fetal nasal fluid flow Doppler

Publikationsverlauf

Eingereicht: 15. Januar 2024

Angenommen nach Revision: 03. Februar 2024

Artikel online veröffentlicht:
22. März 2024

• References

• 1 Baschat AA, Galan HL, Lee W. et al. The role of the fetal biophysical profile in the management of fetal growth restriction. Am J Obstet Gynecol 2022; 226: 475-486 DOI: 10.1016/j.ajog.2022.01.020.
• 2 Harding R, Bocking AD, Sigger JN. Influence of upper respiratory tract on liquid flow to and from fetal lungs. J Appl Physiol 1986; 61: 68-74 DOI: 10.1152/jappl.1986.61.1.68.
• 3 Koos BJ, Rajaee A. Fetal Breathing Movements and Changes at Birth. In: Zhang L, Ducsay CA, Hrsg. Advances in Fetal and Neonatal Physiology. New York, NY. Springer; New York: 2014: 89-101
• 4 Higuchi M, Hirano H, Takahashi H. et al. [Human fetal breathing movements: basic analysis and clinical relationship to fetal well-being (author’s transl)]. Acta Obstet Gynaecol Jpn 1981; 33: 597-606
• 5 Suzuki M, Saito H, Yanaihara T. Assessment of fetal nasal fluid flow by two-dimensional color Doppler ultrasonography during pregnancy. J Matern Fetal Med 1999; 8: 159-163 DOI: 10.1002/(SICI)1520-6661(199907/08)8:4<159::AID-MFM4>3.0.CO;2-O.
• 6 Zieliński R, Respondek-Liberska M, Weiner S. Assessment of nasal and oral flow of amniotic fluid in 46 non-anomalous fetuses with sonographic and echocardiographic examination. Ginekol Pol 2018; 89: 316-320 DOI: 10.5603/GP.a2018.0054.
• 7 Gordijn SJ, Beune IM, Thilaganathan B. et al. Consensus definition of fetal growth restriction: a Delphi procedure: Consensus definition of FGR. Ultrasound Obstet Gynecol 2016; 48: 333-339 DOI: 10.1002/uog.15884.
• 8 Lees CC, Stampalija T, Baschat AA. et al. ISUOG Practice Guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction. Ultrasound Obstet Gynecol 2020; 56: 298-312 DOI: 10.1002/uog.22134.
• 9 Badalian SS, Fox HE, Zimmer EZ. et al. Patterns of perinasal fluid flow and contractions of the diaphragm in the human fetus. Ultrasound Obstet Gynecol 1996; 8: 109-113 DOI: 10.1046/j.1469-0705.1996.08020109.x.
• 10 Cosmi EV, Anceschi MM, Cosmi E. et al. Ultrasonographic patterns of fetal breathing movements in normal pregnancy. Int J Gynecol Obstet 2003; 80: 285-290 DOI: 10.1016/S0020-7292(02)00384-3.
• 11 Honest H, Bachmann LM, Sengupta R. et al. Accuracy of absence of fetal breathing movements in predicting preterm birth: A systematic review. Ultrasound Obstet Gynecol 2004; 24: 94-100 DOI: 10.1002/uog.1062.
• 12 Esin S, Okuyan E, Gunakan E. et al. A novel technique for prediction of preterm birth: Fetal nasal flow Doppler. J Perinat Med 2021; 49: 319-325 DOI: 10.1515/jpm-2020-0276.
• 13 Wyse LJ, Petrikovsky BM, Schneider E. et al. Use of color Doppler to study the breathing patterns of fetuses of mothers with diabetes. J Matern Fetal Med 1996; 5: 174-181 DOI: 10.1002/(SICI)1520-6661(199607/08)5:4<174::AID-MFM3>3.0.CO;2-H.
• 14 Badalian SS, Fox HE, Baxi LV. et al. Doppler ultrasound characteristics of fetal nasal flow in pregnancies complicated by diabetes mellitus. J Matern Fetal Med 1996; 5: 206-210 DOI: 10.1002/(SICI)1520-6661(199607/08)5:4<206::AID-MFM8>3.0.CO;2-O.
• 15 Badalian SS, Fox HE, Chao CR. et al. Fetal breathing characteristics and postnatal outcome in cases of congenital diaphragmatic hernia. Am J Obstet Gynecol 1994; 171: 970-976 DOI: 10.1016/0002-9378(94)90016-7.