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© 2002 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 21:739-746 • 0278-4297

Fetal Flow Redistribution to the Brain in Response to Malaria Infection

Does Protection of the Fetus Against Malaria Develop Over Time?

Philippe Arbeille, MD, PhD, Gabriel Carles, PhD, Nathalie Tobal, PhD, Stéphane Herault, PhD, Monica Georgescus, MD, PhD, Frantz Bousquet, PhD and Franck Perrotin, MD

Department of Nuclear Medicine and Ultrasound, Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire Trousseau, Tours, France (P.A., N.T., S.H., M.G., F.P.); and Section of Obstetrics and Gynecology, Hôpital André Bouron, Saint-Laurent du Maroni, French Guiana (G.C., F.B.).

Address correspondence and reprint requests to Philippe Arbeille, MD, PhD, Département Médecine Nucléaire & Ultrasons, Institut National de la Santé et de la Recherche Médicale 316, Centre Hospitalier Universitaire Trousseau, 37044 Tours, France.

Objective. Malaria during pregnancy induces deterioration of placental function, resulting in transient fetal hypoxia. Our objective was to evaluate the sensitivity and specificity of fetal Doppler indices for prediction of abnormal fetal heart rate at delivery and to compare the amplitude of the fetal vascular response to malaria in 2 groups of fetuses (1994 and 1996) separated by an interval of 2 years. Methods. Every day during the crisis, the umbilical and cerebral resistance indices, the cerebral-umbilical resistance ratio, and the hypoxic index (mean percent cerebral-umbilical resistance ratio change x crisis duration) were calculated. Results. In group 2 (1996), the duration of the flow redistribution period was about 7 days (mean cerebral-umbilical resistance ratio change ± SD, 7% ± 4%; hypoxic index, 49 ± 26; premature, 35%; and abnormal fetal heart rate, 17.5%). A hypoxic index greater than 150 predicted abnormal fetal heart rate with high sensitivity and specificity (group 1, 80% and 85%; and group 2, 100% and 91%). Moreover, in group 2 (1996), the amplitude of the fetal vascular response and the rate of long-duration crisis were significantly lower than in group 1 (1994; P < .01). Nevertheless, the hypoxic index was much more predictive of fetal heart rate at delivery than the amplitude or duration (i.e., crisis duration) of the flow redistribution. Conclusions. The hypoxic index value during the crisis allowed prediction of abnormal fetal heart rate at delivery. In group 2, the absence of a long-term flow redistribution period and the smaller hemodynamic changes (lower hypoxic index) associated with a lower occurrence of abnormal fetal heart rate could be related to improvement of pregnancy management, acquired protection during the interval between the 2 studies, or both.

Key Words: Doppler sonography • fetus • hypoxia • malaria

Abbreviations: aFHR, abnormal fetal heart rate • CRI, cerebral resistance index • C/U, cerebral/umbilical resistance • FHR, fetal heart rate • HI, hypoxic index • URI, umbilical resistance index

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Copyright © 2002 by the American Institute of Ultrasound in Medicine.