Abstract：
To evaluate the maternal and fetal hemodynamic effects of treatment with a nitric oxide donor and oral fluid in pregnancies complicated by fetal growth restriction.
30 normotensive participants with early fetal growth restriction were enrolled. 15 participants were treated until delivery with transdermal glyceryl trinitrate and oral fluid intake (Treated group), and 15 comprised the untreated group. All women underwent non-invasive assessment of fetal and maternal hemodynamics and repeat evaluation 2 weeks later.
In the treated group, maternal hemodynamics improved significantly after two weeks of therapy compared to untreated participants. Fetal hemodynamics in the treated group showed an increase in umbilical vein diameter by 18.87 % (p < 0.01), in umbilical vein blood flow by 48.16 % (p < 0.01) and in umbilical vein blood flow corrected for estimated fetal weight by 30.03 % (p < 0.01). In the untreated group, the characteristics of the umbilical vein were unchanged compared to baseline. At the same time, the cerebro-placental ratio increased in the treated group, while it was reduced in the untreated group, compared to baseline values. The treated group showed a higher birthweight centile (p = 0.03) and a lower preeclampsia rate (p = 0.04) compared to the untreated group.
The combined therapeutic approach with nitric oxide donor and oral fluid intake in fetal growth restriction improves maternal hemodynamics, which becomes more hyperdynamic (volume-dominant). At the same time, in the fetal circuit, umbilical vein flow increased and fetal brain sparing improved. Although a modest sample size, there was less preeclampsia and a higher birthweight suggesting beneficial maternal and fetal characteristics of treatment.
30 normotensive participants with early fetal growth restriction were enrolled. 15 participants were treated until delivery with transdermal glyceryl trinitrate and oral fluid intake (Treated group), and 15 comprised the untreated group. All women underwent non-invasive assessment of fetal and maternal hemodynamics and repeat evaluation 2 weeks later.
In the treated group, maternal hemodynamics improved significantly after two weeks of therapy compared to untreated participants. Fetal hemodynamics in the treated group showed an increase in umbilical vein diameter by 18.87 % (p < 0.01), in umbilical vein blood flow by 48.16 % (p < 0.01) and in umbilical vein blood flow corrected for estimated fetal weight by 30.03 % (p < 0.01). In the untreated group, the characteristics of the umbilical vein were unchanged compared to baseline. At the same time, the cerebro-placental ratio increased in the treated group, while it was reduced in the untreated group, compared to baseline values. The treated group showed a higher birthweight centile (p = 0.03) and a lower preeclampsia rate (p = 0.04) compared to the untreated group.
The combined therapeutic approach with nitric oxide donor and oral fluid intake in fetal growth restriction improves maternal hemodynamics, which becomes more hyperdynamic (volume-dominant). At the same time, in the fetal circuit, umbilical vein flow increased and fetal brain sparing improved. Although a modest sample size, there was less preeclampsia and a higher birthweight suggesting beneficial maternal and fetal characteristics of treatment.
摘要：
背景：评估一氧化氮供体和口腔液治疗在合并胎儿生长受限的妊娠中对母体和胎儿的血流动力学影响。
方法：纳入30例血压正常的早期胎儿生长受限患者。15名参与者接受治疗，直到经皮三硝酸甘油酯和口服液体摄入（治疗组），和15个包括未处理组。所有妇女均接受胎儿和母体血流动力学的非侵入性评估，并在2周后重复评估。
结果：在治疗组中，与未经治疗的参与者相比,治疗2周后,母体血流动力学明显改善.治疗组胎儿血流动力学显示脐静脉直径增加18.87%(p<0.01),脐静脉血流量为48.16％（p<0.01），脐静脉血流量经估计胎儿体重校正为30.03％（p<0.01）。在未经治疗的组中，脐静脉的特征与基线相比没有变化.同时,治疗组的脑胎盘比率增加，虽然在未经治疗的组中减少了，与基线值进行比较。与未处理组相比,处理组显示出较高的出生体重百分位数(p=0.03)和较低的先兆子痫发生率(p=0.04)。
结论：一氧化氮供体和口服液体摄入联合治疗胎儿生长受限可改善母体血流动力学，变得更加超动态(体积占优势)。同时,在胎儿回路中，脐静脉流量增加，胎儿脑保留改善。虽然样本量适中，先兆子痫较少,出生体重较高,提示治疗对母体和胎儿有益.
方法：纳入30例血压正常的早期胎儿生长受限患者。15名参与者接受治疗，直到经皮三硝酸甘油酯和口服液体摄入（治疗组），和15个包括未处理组。所有妇女均接受胎儿和母体血流动力学的非侵入性评估，并在2周后重复评估。
结果：在治疗组中，与未经治疗的参与者相比,治疗2周后,母体血流动力学明显改善.治疗组胎儿血流动力学显示脐静脉直径增加18.87%(p<0.01),脐静脉血流量为48.16％（p<0.01），脐静脉血流量经估计胎儿体重校正为30.03％（p<0.01）。在未经治疗的组中，脐静脉的特征与基线相比没有变化.同时,治疗组的脑胎盘比率增加，虽然在未经治疗的组中减少了，与基线值进行比较。与未处理组相比,处理组显示出较高的出生体重百分位数(p=0.03)和较低的先兆子痫发生率(p=0.04)。
结论：一氧化氮供体和口服液体摄入联合治疗胎儿生长受限可改善母体血流动力学，变得更加超动态(体积占优势)。同时,在胎儿回路中，脐静脉流量增加，胎儿脑保留改善。虽然样本量适中，先兆子痫较少,出生体重较高,提示治疗对母体和胎儿有益.
