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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, Joachim W.

Editorial Board Member: / Bancalari, Eduardo / Milner, Anne / Genc, Mehmet R. / Chervenak, Frank A. / Chappelle, Joseph / Bergmann, Renate L. / Bernardes, J.F. / Bevilacqua, G. / Blickstein, Isaac / Cabero Roura, Luis / Carbonell-Estrany, Xavier / Carrera, Jose M. / D`Addario, Vincenzo / D'Alton, MD, Mary E. / Dimitrou, G. / Grunebaum, Amos / Hentschel, Roland / Köpcke, W. / Kawabata, Ichiro / Keirse, Marc J.N.C. / Kurjak M.D., Asim / Lee, Ben H. / Levene, Malcolm / Lockwood, Charles J. / Marsal, Karel / Makatsariya, Alexander / Nishida, Hiroshi / Ogata, Edward / Papp, Zoltán / Pejaver, Ranjan Kumar / Pooh, Ritsuko K. / Romero, Roberto / Saugstad, Ola D. / Schenker, Joseph G. / Sen, Cihat / Seri, Istvan / Vetter, Klaus / Winn, Hung N. / Young, Bruce K. / Zimmermann, Roland

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Natriuretic peptide levels in intrauterine growth-restricted fetuses with absent and reversed end-diastolic flow of the umbilical artery in relation to ductus venosus flow velocities

Franz Bahlmann
  • Department of Obstetrics and Gynecology, Bürgerhospital Frankfurt, Frankfurt, Germany
  • :
/ Frank Krummenauer
  • Institute of Medical Biometry and Epidemiology, University Witten Herdecke, Witten, Germany
/ Stephan Spahn
  • Department of Obstetrics and Gynecology, Bürgerhospital Frankfurt, Frankfurt, Germany
/ Ralph Gallinat
  • Department of Obstetrics and Gynecology, Bürgerhospital Frankfurt, Frankfurt, Germany
/ Christoph Kampmann
  • Department of Pediatrics, University Mainz, Mainz, Germany
Published Online: 2011-09-06 | DOI: https://doi.org/10.1515/jpm.2011.065


Objective: To determine if changes in natriuretic peptide levels [propeptide of atrial natriuretic peptide (proANP) and N-terminal propeptide of brain natriuretic peptide (NT-proBNP)] can be demonstrated in fetuses with serious growth restriction and Doppler ultrasonographic findings of hemodynamic compromise.

Method: Natriuretic peptides of the umbilical vein (proANP and NT-proBNP), arterial and venous blood gases, as well as lactate levels of the umbilical vein were determined in 38 appropriate for gestational age (AGA) fetuses, and 24 intrauterine growth-restricted (IUGR) fetuses with absent (zero-flow) and 17 IUGR fetuses with reversed end-diastolic flow (reverse-flow) of the umbilical artery.

Results: A continuous increase in natriuretic peptides in the presence of progressive deterioration was shown. ANP concentrations were significantly lower in the AGA group (mean 818 fmol/mL; range 508–991 fmol/mL) than the zero-flow group (mean 19,680 fmol/mL; range 13,680–25,080 fmol/mL) and the reverse-flow group (mean 33,880 fmol/mL; range 24,365–41,786 fmol/mL). Significant differences were further demonstrated in BNP concentrations of the AGA group (mean 32 fmol/L; range 25–38 fmol/L), zero-flow group (mean 1191 fmol/L; range 908–1655 fmol/L), and reverse-flow group (mean 3063 fmol/L; range 1281–4968 fmol/L). Additionally, significant differences in lactate concentrations were observed for the three groups: AGA, 2.6 mmol/L (range 2–3 mmol/L); zero-flow group, 4.1 mmol/L (range 3.3–5 mmol/L); and reverse-flow group, 7.7 mmol/L (range 5.9–13.7 mmol/L). Increased ANP levels correlated with the arterial base excess and lactate concentrations, as well as with the flow velocities in the ductus venosus during atrial contraction (a-wave), and both ductus venosus indices (Sa)/D and (Sa)/V mean. No correlations were established for BNP.

Conclusions: As components of a compensatory mechanism, natriuretic peptides exert an influence on the cardiovascular function of the fetus.

Keywords: Absent end-diastolic flow; ductus venosus; IUGR; natriuretic peptides; umbilical artery

Corresponding author: Franz Bahlmann, Dr Med Department of Obstetrics and Gynecology Bürgerhospital Nibelungenallee 37-41 D-60318 Frankfurt Germany Tel.: +49-69-1700-412 Fax: +49-69-1700-400

Received: 2010-10-12

Revised: 2011-04-27

Accepted: 2011-05-11

Published Online: 2011-09-06

Published Online: 2011-08-26

Published in Print: 2011-09-01

Citation Information: Journal of Perinatal Medicine. Volume 39, Issue 5, Pages 529–537, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/jpm.2011.065, September 2011

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