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Fetal growth restriction is associated with prioritization of umbilical blood flow to left hepatic lobe, at the expense of the right lobe

Fetal growth restriction is associated with prioritization of umbilical blood flow to left hepatic lobe, at the expense of the right lobe
Fetal growth restriction is associated with prioritization of umbilical blood flow to left hepatic lobe, at the expense of the right lobe
Eighty to 85% of the venous perfusion to the fetal liver is from the umbilical vein, the rest from the portal vein. Umbilical venous flow to the liver is essential for intrauterine growth, and is impaired in placental insufficiency. We hypothesized that in growth-restricted fetuses portal blood flow compensates for insufficient umbilical blood flow to the liver. In 29 fetuses with fetal growth restriction (estimated fetal weight < or =5th percentile), we used ultrasound to measure blood flows in the umbilical vein, ductus venosus, left portal vein, and main portal stem. Compared with normal fetuses, both absolute and normalized total venous liver blood flows were reduced in growth-restricted fetuses, related to the degree of placental compromise and equally affecting both liver lobes. However, portal replaced umbilical flow to the right lobe, in a manner graded according to placental vascular resistance; in extreme cases, the right lobe received no umbilical perfusion. In fetal growth restriction, the liver suffers from venous hypoperfusion, and portal blood partially replaces umbilical flow to the right lobe; this will result in right liver lobe hypoxemia. This striking prioritization in nutrient delivery of left over right lobes suggests an adaptive response to poor placental perfusion that may have functional consequences
0031-3998
113-117
Kessler, Jorg
5fa012bd-0f2d-4c82-85b4-e403d121891c
Rasmussen, Svein
553e2196-bbb7-4a95-a583-792b2b5a65b9
Godfrey, Keith
0931701e-fe2c-44b5-8f0d-ec5c7477a6fd
Hanson, Mark
7cbc7c84-3dcd-4c2a-8d18-bf417b007361
Kiserud, Torvid
a7689962-989b-4f84-ae1a-dbc10b57c5f9
Kessler, Jorg
5fa012bd-0f2d-4c82-85b4-e403d121891c
Rasmussen, Svein
553e2196-bbb7-4a95-a583-792b2b5a65b9
Godfrey, Keith
0931701e-fe2c-44b5-8f0d-ec5c7477a6fd
Hanson, Mark
7cbc7c84-3dcd-4c2a-8d18-bf417b007361
Kiserud, Torvid
a7689962-989b-4f84-ae1a-dbc10b57c5f9

Kessler, Jorg, Rasmussen, Svein, Godfrey, Keith, Hanson, Mark and Kiserud, Torvid (2009) Fetal growth restriction is associated with prioritization of umbilical blood flow to left hepatic lobe, at the expense of the right lobe. Pediatric Research, 66 (1), 113-117. (doi:10.1203/PDR.0b013e3181a29077).

Record type: Article

Abstract

Eighty to 85% of the venous perfusion to the fetal liver is from the umbilical vein, the rest from the portal vein. Umbilical venous flow to the liver is essential for intrauterine growth, and is impaired in placental insufficiency. We hypothesized that in growth-restricted fetuses portal blood flow compensates for insufficient umbilical blood flow to the liver. In 29 fetuses with fetal growth restriction (estimated fetal weight < or =5th percentile), we used ultrasound to measure blood flows in the umbilical vein, ductus venosus, left portal vein, and main portal stem. Compared with normal fetuses, both absolute and normalized total venous liver blood flows were reduced in growth-restricted fetuses, related to the degree of placental compromise and equally affecting both liver lobes. However, portal replaced umbilical flow to the right lobe, in a manner graded according to placental vascular resistance; in extreme cases, the right lobe received no umbilical perfusion. In fetal growth restriction, the liver suffers from venous hypoperfusion, and portal blood partially replaces umbilical flow to the right lobe; this will result in right liver lobe hypoxemia. This striking prioritization in nutrient delivery of left over right lobes suggests an adaptive response to poor placental perfusion that may have functional consequences

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Published date: July 2009

Identifiers

Local EPrints ID: 68919
URI: http://eprints.soton.ac.uk/id/eprint/68919
ISSN: 0031-3998
PURE UUID: a3e36109-a2b5-40f5-9255-c6d6e55d067c
ORCID for Keith Godfrey: ORCID iD orcid.org/0000-0002-4643-0618

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Date deposited: 08 Oct 2009
Last modified: 14 Mar 2024 02:35

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Contributors

Author: Jorg Kessler
Author: Svein Rasmussen
Author: Keith Godfrey ORCID iD
Author: Mark Hanson
Author: Torvid Kiserud

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