الفهرس 
1) Causes and pathogenesis of IUGROnly 14 pages are availabe for public view
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Abstract
Impaired fetal growth is associated with increased risk of perinatal
mortality and morbidity, consequently postnatal adverse outcomes. The
most important problem in growth-restricted fetuses is the possible risk of
chronic fetal hypoxemia, which triggers a variety of adaptive mechanisms.
(Figueras and Gratacós, 2014).
The fetal heart has a central role in these adaptive mechanisms.
Cardiac alterations in growth-restricted fetuses include predisposition to
lower cardiac compliance, increased arterial stiffness, as well as increased
cardiac afterload and end-diastolic ventricular filling. Assessment of the
affected myocardial function and appropriate timing of labor may reduce
the incidence of adverse postnatal outcomes in these patients. (Crispi et
al., 2014).
MPI values were increased in FGR pregnancies and appear to be
related to the severity of FGR. A higher level of MPI could predict adverse
outcomes. (Ali et al., 2022)
In our study, we aimed to compare IUGR fetuses with AGA fetuses
in terms of MPI as a marker of cardiovascular function, to evaluate the
association between MPI and other parameters used for prenatal
monitoring, and we planned to assess relationships between MPI values
and perinatal outcome.
The study included 80 cases recruited from Obstetrics and
Gynecology Department, Menoufia University Hospital.
Forty cases were diagnosed as IUGR fetuses and forty cases with
AGA fetuses served as a control group.
Summary
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All the participants signed an informed consent about our procedure.
Several factors influence the results of our study including gravidity, parity,
and maternal body mass index (BMI).
All the cases underwent ultrasonographic assessment: Fetal biometry
measurements, gestational age, weight and AFI.
As well as Doppler indices as: the pulsatility index (PI) of UA, MCA
and DV were measured.
All fetuses had their myocardial performance index assessed. Fetal
growth restriction fetuses’ MPI values were compared to gestation-matched
controls. The outcomes of the perinatal period were documented.
We found that MPI was a useful parameter to evaluate IUGR
pregnancies and predict neonatal outcome.
Values can be affected by ultrasound machine settings as caliper
placement, sample volume (SV), angle of insonation (AI), Doppler sweep
velocity (DSV), wall motion filter (WMF) and Doppler gain (DG). To
minimize this variability, it is recommended to use the same ultrasound
equipment during patient follow-up and specific reference ranges for each
ultrasound system.
Conclusion
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Conclusion
Myocardial performance index (MPI) is one of the newer techniques
used to evaluate cardiac function. Early stages of cardiac adaptation
associated with increasing placental vascular resistance in growth
restricted fetuses are represented by changes in MPI and its time
components.
MPI can be used in fetal assessment in cases of intrauterine fetal
growth restriction because of its high sensitivity, relative ease of use,
and information offered by the MPI.
Myocardial performance index values are increased in IUGR fetuses
and appear to be related to the severity of IUGR. A higher level of
MPI could predict adverse outcomes.
Clinicians should consider cardiac dysfunction in IUGR through
increased MPI, this might lead to improved management and
outcome of IUGR.