1 Kolossal vannomsetning

Transkript

1 Urinary flow: 2-3% of bodyweight/day 1 Kolossal vannomsetning Urinary flow: 2-3% of bodyweight/day Nwosu et al 1993 & Moore and Cayle 199 Nwosu et al 1993 & Moore and Cayle 199 Fosterfysiologi Fosterfysiologi Torvid Kiserud Seksjon for fostermedisin og ultralyd Kvinneklinikken, Haukeland Universitetssykehus & Klinisk fosterfysiologisk forskningsgruppe Institutt for klinisk medisin, UiB Gestasjonsalder/utviklingstrinn Hemodynamikk - blodvolum - blodfordeling - responser - adaptasjon - (plastisitet) Obsterikk-kurs Oslo 216

2 Dawes G, 1968 Blodvolum og distribusjon (foster placenta) 1 % of total blood volume Fetus Placenta Gestational age Barcroft J Haugen G et al. Circulation Res. 25 Schifferli PU, Caldeyro-Barcía R; 1973 Adrenalin-konsentrasjon ved 2 minutters asfyksi. Dyreeksperiment omsatt til gestasjonsalder hos menneske 2 Fysiologi endres og tilpasses uke for uke Jensen A, 1992

3 Combined cardiac output (Normalised for fetal weight) 12 1 N = 17 Normal fetuses 8 COO/kg Kiserud T et al. Ultrasound Obstet Gynecol; 26; 28: Combined cardiac output 12 1 (Normalised for fetal weight) 12 1 Growth-restricted (N=32) Overall p=.45 PI normal PI>97.5 ARED Fraction (%) of combined cardiac output directed to the placenta N = 164 Normal fetuses COO/kg COO/kg PL/CCO-fract (%) Kiserud T et al. Ultrasound Obstet Gynecol; in press Kiserud T et al. Ultrasound Obstet Gynecol; 26; 28: Fraction (%) of combined cardiac output directed to the placenta Fraction (%) of combined cardiac output directed to the placenta 1 9 N = 164 Normal fetuses 1 9 N = 164 Normal fetuses 8 8 PL/CCO-fract (%) PL/CCO-fract (%) % 21% Kiserud T et al. Ultrasound Obstet Gynecol; 26; 28: Kiserud T et al. Ultrasound Obstet Gynecol; 26; 28:

4 PL/CCO-fract (%) /3 av CCO resirkulerer i fosterkroppen Etter 32 uker: 4/5 av CCO resirkulerer i kroppen 32% 21% N = 164 Normal fetuses Kiserud T et al. Ultrasound Obstet Gynecol; 26; 28: PL/CCO-fract (%) Fraction (%) of combined cardiac output directed to the placenta N = 32 Growth-restricted 2.5 p Z-score Overall p<.1 Kiserud T et al. Ultrasound Obstet Gynecol; 26 Sentrale blodstrømmer via dextra & via sinistra Shunting (%) Ductus venosus shunting Gynecol 2;182: Gynecol 2;182: Ductus venosus shunting (%) IUGR 11 Overall p<.1 PI normal 1 PI> ARED 8 7 Shunting (%) Kiserud T et al. Ultrasound Obstet Gynecol 26

5 Foramen ovale 21 weeks John Lind, 1953 Kiserud T: Seminars Perinat 21;25:11-2 Foramen ovale diameter Crista dividens (C.D.) seen from below, through the inferior vena cava Foramen ovale outlet area (cm^2) N = 115 Barcroft J: Research on Pre-Natal Life. Blackwell 1946 Kiserud T, Rasmussen S Ultrasound Obstet Gynecol 21;17: Oksygenmetning 65% 55%

6 Ductus arteriosus isthmus aortae Ductus arteriosus isthmus aortae 1. m/s

7 4 Hjertet: fleksibelt system; virker etter minste motstands vei Acute hypoxia Distribution Kiserud T: Seminars Perinat 21;25:11-2 Jensen A 1991 Acute hypoxia Acute hypoxia Sustained Sustained Bocking A et al. 199 Bocking A et al. 199 Acute heamorrhage (15%) Distribution 5 Acute heamorrhage (15%) Fosteret har god strategi for hypoksi Men er mye mer sårbar for hypovolemi/hypotensjon Distribution Toubas PL et al Toubas PL et al. 1981

8 Central pathways Vannskille Gynecol 2;182: Gynecol 2;182: Central pathways Central pathways Gynecol 2;182: Gynecol 2;182: Vannskille mellom portvene og umbilikalvene er et følsomt lavtrykk-system som regulerer leverutvikling 56 Central pathways (3) Watershed area: left portal vein Gynecol 2;182: J Kessler et al. Unpublished 26

9 Shunting (%) Ductus venosus shunting Shunting (%) Ductus venosus shunting Umbilical flow to the liver: 7 8% Gynecol 2;182: Gynecol 2;182: Ductus venosus shunting blocked/open Ductus venosus shunting blocked/open Tchirikov M et al. Placenta 22; 23: S153-8 Tchirikov M et al. Placenta 22; 23: S153-8 Ductus venosus shunting blocked/open Tissue proliferation Fetal liver blood flow, maternal slimness and neonatal body fat Tchirikov M et al. Placenta 22; 23: S153-8 Godfrey KM & al. PLoS One 212; 7(8): e41759

10 Fetal liver blood flow, maternal adiposity and neonatal body fat Stroke Hypertension Diabetes Adiposity Cognitive problems Osteoporosis Allergy/asthma (Cancer) Godfrey K et al. PLoSONE 213 Dept of Prenatal Medicine, Linz - Austria 7 Leveren er den metabolske hjernen Stroke Hypertension Diabetes Adiposity Cognitive ive problems Osteoporosis Allergy/asthma (Cancer) Distribution extraction Oxygen saturation