{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T10:14:55Z","timestamp":1780049695616,"version":"3.53.1"},"reference-count":20,"publisher":"Georg Thieme Verlag KG","issue":"02","funder":[{"name":"The Chiang Mai University Research Fund","award":["CMU-2563"],"award-info":[{"award-number":["CMU-2563"]}]},{"DOI":"10.13039\/501100004396","name":"The Thailand Research Fund","doi-asserted-by":"crossref","award":["DPG-6280003"],"award-info":[{"award-number":["DPG-6280003"]}],"id":[{"id":"10.13039\/501100004396","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ultraschall Med"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objective\u2002To assess fetal hemodynamic changes in response to anemia in early gestation, using fetal Hb Bart\u2019s disease as a study model.<\/jats:p><jats:p>\n          Methods\u2002A prospective study was conducted on pregnancies at risk for fetal Hb Bart\u2019s disease at 12\u201314 weeks of gestation. Fetal hemodynamics were comprehensively assessed by 2D\u00a0ultrasound, Doppler velocity, and cardio-STIC just prior to the invasive procedure for diagnosis. The various hemodynamic parameters of the affected and unaffected fetuses were compared.<\/jats:p><jats:p>\n          Results\u2002Of 56 fetuses at risk, 17 had Hb Bart\u2019s disease and 39 were unaffected. The right and combined ventricular cardiac outputs (CO) were significantly higher in the affected fetuses (0.993 vs. 1.358; p\u200a&lt;\u200a0.001 and 1.010 vs. 1.236; p\u200a&lt;\u200a0.001, respectively), whereas the left CO tended to be higher but not significantly (1.027 vs. 1.113; p\u200a=\u200a0.058). Cardiac dimensions, middle-cerebral artery peak systolic velocity, Tei index, and isovolemic contraction time were significantly increased, while the global sphericity index was significantly decreased. Interestingly, cardiac preload, ventricular wall thickness, shortening fraction, isovolemic relaxation time, and fetal heart rate were unchanged. Four fetuses had hydropic changes, but all cardiac functions were normal.<\/jats:p><jats:p>\n          Conclusion\u2002Fetal anemia induces hypervolemia and increases cardiac output to meet the tissue oxygen requirement, resulting in an increase in size without hypertrophy, volume load without pressure load, and a decrease in the globular sphericity index. The heart works very well but works harder, especially systolic ventricular load. Hydrops fetalis due to anemia appears not to be caused by heart failure as previously believed but rather by volume load with high vascular permeability at least in early pregnancy.<\/jats:p>","DOI":"10.1055\/a-1499-7045","type":"journal-article","created":{"date-parts":[[2021,11,8]],"date-time":"2021-11-08T23:51:25Z","timestamp":1636415485000},"page":"e83-e90","source":"Crossref","is-referenced-by-count":3,"title":["Fetal Hemodynamic Response to Anemia in Early Gestation: Using\u00a0Hemoglobin Bart\u2019s Disease as a Study Model"],"prefix":"10.1055","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4838-175X","authenticated-orcid":false,"given":"Suchaya","family":"Luewan","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuanglada","family":"Tongprasert","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kasemsri","family":"Srisupundit","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuntharee","family":"Traisrisilp","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phudit","family":"Jatavan","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3389-6478","authenticated-orcid":false,"given":"Theera","family":"Tongsong","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,11,8]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1007\/s004390050220","article-title":"Prevalence of alpha-thalassemias in northern Thailand","volume":"98","author":"M Lemmens-Zygulska","year":"1996","journal-title":"Hum Genet"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1002\/ajmg.1320390314","article-title":"Molecular characterization of severe alpha-thalassemias causing hydrops fetalis in Taiwan","volume":"39","author":"T M Ko","year":"1991","journal-title":"Am J Med Genet"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1002\/uog.7443","article-title":"Ultrasonographic prediction of homozygous alpha(0)-thalassemia using placental thickness, fetal cardiothoracic ratio and middle cerebral artery Doppler: alone or in combination?","volume":"35","author":"K Y Leung","year":"2010","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1002\/uog.6342","article-title":"Identification of fetuses with hemoglobin Bart\u2019s disease using middle cerebral artery peak systolic velocity","volume":"33","author":"K Srisupundit","year":"2009","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"49","DOI":"10.7863\/jum.2004.23.1.49","article-title":"Sonographic markers of hemoglobin Bart disease at midpregnancy","volume":"23","author":"T Tongsong","year":"2004","journal-title":"J Ultrasound Med"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1046\/j.1469-0705.1999.13040238.x","article-title":"Nuchal translucency in fetuses affected by\u00a0homozygous alpha-thalassemia-1 at 12\u201313 weeks of gestation","volume":"13","author":"Y H Lam","year":"1999","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/S0002-9378(99)70165-1","article-title":"Prenatal ultrasonographic prediction of homozygous type 1 alpha-thalassemia at 12 to 13 weeks of gestation","volume":"180","author":"Y H Lam","year":"1999","journal-title":"Am J Obstet Gynecol"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1002\/pd.4293","article-title":"Prenatal ultrasound evaluation of fetal Hb Bart\u2019s disease among pregnancies at risk at 11 to 14 weeks of gestation","volume":"34","author":"S Sirichotiyakul","year":"2014","journal-title":"Prenat Diagn"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"e150","DOI":"10.1016\/j.ijcard.2008.12.182","article-title":"Tei index: the earliest detectable cardiac structural and functional abnormality detectable in Hb Bart\u2019s foetal edema","volume":"134","author":"G Chao","year":"2009","journal-title":"Int J Cardiol"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1055\/s-0032-1313159","article-title":"Fetal myocardial performance (Tei) index in fetal hemoglobin Bart\u2019s disease","volume":"34","author":"S Luewan","year":"2013","journal-title":"Ultraschall in Med"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1007\/s00404-014-3288-3","article-title":"Reference ranges of myocardial performance index from 12 to 40 weeks of gestation","volume":"290","author":"S Luewan","year":"2014","journal-title":"Arch Gynecol Obstet"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1016\/j.ajog.2010.06.003","article-title":"Venous Doppler studies in low-output and high-output hydrops fetalis","volume":"203","author":"T Tongsong","year":"2010","journal-title":"Am J Obstet Gynecol"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1002\/uog.8961","article-title":"Fetal cardiac dimensions at 14\u201340 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