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Branch pulmonary artery Doppler parameters predict early survival–non-survival in premature rupture of membranes

Journal of Perinatology volume 40, pages 1821–1827 (2020)Cite this article

Subjects

Abstract

Background

Preterm premature rupture of membrane (pPROM) leads to high neonatal mortality due in part to severe lung hypoplasia (LH). In other causes of severe LH, fetal echo-based parameters of smaller branch pulmonary arteries (PA), shorter acceleration to ejection time ratio (AT/ET), increased peak early diastolic reverse flow (PEDRF), and higher pulsatility index (PI) are predictive of worse neonatal outcome. We sought to determine whether these parameters correlated with worse clinical outcome in pPROM.

Methods

Twenty-five pregnancies complicated by pPROM were prospectively recruited. Fetal echocardiography was used to evaluate branch PA diameters and Doppler parameters. Clinical records were reviewed. Fetal echo findings were compared between early survivors and non-survivors.

Results

Of 25 pPROM cases, 5 had early neonatal demise (≤3 days) due to respiratory insufficiency. While gestational age at pPROM, fetal echo, and at birth did not differ, amniotic fluid index (AFI) was significantly lower in early non-survivors compared to survivors (p = 0.05). No difference was observed in PA diameter, PEDRF, or PI; however, branch PA AT/ET was significantly shorter in non-survivors (right PA median 0.12 (0.11–0.16) vs. survivors 0.17 (0.14–0.21), p = 0.046 and left PA 0.12 (0.09–0.13) vs. survivors 0.16 (0.11–0.21), p = 0.042).

Conclusions

We found a significantly lower AFI and shorter fetal bilateral branch PA AT/ET to be associated with early neonatal demise following pPROM.

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Fig. 1: PA Doppler measurements.
Fig. 2: Comparison of branch PA Doppler parameters in pPROM vs. healthy controls without pPROM (a RPA, b LPA).
Fig. 3: Branch PA diameter and Doppler parameters at baseline in survivors vs. early non-survivors with pPROM (a RPA, b LPA).
Fig. 4: Distribution for AT/ET ratios throughout gestation (a RPA, b LPA).

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Acknowledgements

We want to thank to Takahisa Ogawa, MD, MPH, Harvard T.H. Chan School of Public Health, Department of Epidemiology, who helped our statistical analysis.

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Author notes

  1. Yuka Yamamoto

    Present address: Department of Obstetrics & Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan

Authors and Affiliations

  1. Fetal & Neonatal Cardiology Program, Pediatric Cardiology, Women’s & Children’s Health Research Institute & Mazankowski Heart Institute, University of Alberta, Edmonton, AB, Canada

    Yuka Yamamoto, Akiko Hirose & Lisa K. Hornberger

  2. Department of Obstetrics & Gynecology, Women’s & Children’s Health Research Institute, University of Alberta, Edmonton, AB, Canada

    Venu Jain & Lisa K. Hornberger

Authors
  1. Yuka Yamamoto
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  2. Akiko Hirose
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  4. Lisa K. Hornberger
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Contributions

AH and VJ recruited pPROM patients. YY, AH, and LKH performed the fetal echocardiograms and collected the fetal data. YY analyzed the data. YY and LKH generated the paper with input from AH and VJ.

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Correspondence to Lisa K. Hornberger.

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Yamamoto, Y., Hirose, A., Jain, V. et al. Branch pulmonary artery Doppler parameters predict early survival–non-survival in premature rupture of membranes. J Perinatol 40, 1821–1827 (2020). https://doi.org/10.1038/s41372-020-00817-6

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