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Master Thesis

Surveillance échographique des fœtus en situation de retard de croissance intra utérin par mesure de l'index systolique à l'isthme aortique : faisabilité, évaluation et implications

Abstract : Exploratively assess the feasibility and describe the distribution of the change in systolic index to aortic isthmus (ISI) values during pregnancy in fetuses with early vascular IUGR compared to the distribution of ISI during pregnancy in the eutrophic fetus. Methods. It was an exploratory bicentric longitudinal cohort exploratory study. From June to November 2017 and from November 2018 to June 2019, fetuses with vascular IUGR that appeared early before 32 weeks were included. Each fetus, following the usual IUGR follow-up ultrasound, benefited from a pulsed Doppler measurement of the flow at the aortic isthmus. The velocities of the systolic peak (peak) and the telesystolic nadir (nadir) were collected from the Doppler spectrum, the ISI corresponding to the nadir / peak ratio. ISI values were compared to ISI values obtained from a population of eutrophic fetuses with no structural or infectious pathology from 25 to 39 weeks. Routine ultrasound fetal monitoring assessed the cardio-circulatory state (Doppler of the umbilical artery, middle cerebral artery and Ductus Venosus) and the amount of amniotic fluidResults. 96 fetuses with vascular IUGR were included. The mean gestational age of onset of IUGR and inclusion in the study was 26.3 SA (± 3.8) and 30.3 SA (± 3.8), respectively. The mean term of birth was 34 weeks (± 4) and the mean birth weight was 1613g (± 683) with a median Audipog at 0.9th percentile (0.1-3.5). The median time from the last ISI to birth was 6 days (± 18.6). The distribution of ISI values and their evolution according to gestational age was significantly different in the group of fetuses with IUGR compared to eutrophic fetuses (p <0.001). The distribution of the values of the last ISI in the fetuses with RCIU compared to the normal values of the ISI in the fetuses eutrophic during pregnancy made it possible to identify 3 groups: the group 1 ISI percentile 97 (n = 18 or 19%). The ISI value appeared to change due to changes in the nadir velocity values while the peak values appeared to remain within the expected range for the term but this correlation was not statistically significant (p = 0.655). In group 1 ISI percentile 97 (p <0.001). Conclusion. The ISI values appear to change during pregnancy in an early vascular IUGR situation with Doppler abnormalities compared to the evolution observed in the eutrophic fetus, this being a witness to fetal hemodynamic changes.
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Alizée Berthelot. Surveillance échographique des fœtus en situation de retard de croissance intra utérin par mesure de l'index systolique à l'isthme aortique : faisabilité, évaluation et implications. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02496068⟩

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