Physiological adaptation of the growth-restricted fetus

Publication date: Available online 24 February 2018 Source:Best Practice & Research Clinical Obstetrics & Gynaecology Author(s): Karel Maršál The growth-restricted fetus in utero is exposed to a hostile environment and suffers of undernutrition and hypoxia. In order to cope with the stress the fetus changes its physiological functions. These adaptive changes aid intrauterine survival, however, they can lead to permanent functional and structural changes that can contribute to development of serious chronic diseases later in life. Epigenetic mechanisms are an important part of the pathophysiological processes behind this “developmental origin of adult diseases”. The dominant cardiovascular adaptive change is the redistribution of blood flow in hypoxic fetuses with preferential supply of fetal brain, myocardium and adrenal glands. The proportion of blood from the umbilical vein to the ductus venosus and foramen ovale increases, and so does the cardiac output of left heart ventricle. The increased perfusion of fetal brain can be followed with Doppler ultrasound as increased diastolic velocities and decreased pulsatility index in the middle cerebral artery.
Source: Best Practice and Research Clinical Obstetrics and Gynaecology - Category: OBGYN Source Type: research