Background: Fetal growth restriction (FGR), also known as intrauterine growth restriction, includes different conditions in which a fetus fails to reach its own growth potential. In recent years, more attention has been paid to changes in cardiac function in children with features of intrauterine growth retardation. Many articles describe the disorders appearing as early as in the fetus, revealing subclinical changes in the myocardium detected on echocardiographic examination.
Objective: To evaluate the cardiac functions in intrauterine growth restricted fetuses using fetal echocardiography.
Patients and methods: This were a prospective study carried out on 100 pregnant women who had singleton fetuses 28 weeks of gestation or older. It was conducted at Obstetrics and Gynecology Department at Bab Al-Sh'aaria, Al-AzharUniversityHospital during the period from June 2020 to May 2021. The subjects were divided into 2 equal groups: Group I (Patients group): women with IUGR fetuses, and Group II (Control group): disease free women.
Results: The mean of inter-ventricular septal diameter (IVST) was significantly higher in fetuses with IUGR compared to normal fetuses. It was 54.09 ± 4.05 cm in IUGR patient's groups compared to 44.38±1.87 cm in the control group. In addition, the isovolumic relaxation time (IVRT) significantly prolonged in fetuses with IUGR compared to normal fetuses. It was 37.53 ± 1.66 ms in IUGR patient's groups compared to 35.18±1.08 ms in the control group. The ejection time (ET) reduced significantly in IUGR fetuses as compared to normal control fetuses. The diastolic function across the right and left side of the heart was performed by calculating the E/A ratio across the tricuspid and the mitral valve. The average mitral E/A ratio and tricuspid E/A ratio were significantly higher in IUGR fetuses as compared to normal control fetuses. They were 0.74±0.05 and 0.77±0.06 in patients group vs 0.72±0.05 and 0.73±0.05 in control group (P=0.014 & P=0.004). Also, lower mitral annular plane systolic excursion (MAPSE), and tricuspid annular plane systolic excursion (TAPSE) were recorded in IUGR fetuses (5.14±0.38 & 6.68±0.52) compared to that detected in normal fetuses (6.1±0.6 & 7.88±0.6). The LV-MPI and RV-MPI were calculated in all fetuses in the study population. The mean LV- MPI measured 0.55±0.04 in IUGR fetuses vs. 0.45±0.02 in normal fetuses, while the mean RV- MPI measured 0.56±0.04 in IUGR fetuses vs. 0.46±0.03 in normal fetuses.
Conclusion: Cardiac function impaired in IUGR etuses, thus fetal Echo may be a useful tool in the assessment of fetus with IUGR beside to Doppler.  These data supported prenatal cardiovascular remodeling as a mechanistic pathway of increased risk later in life in cases of IUGR.