Abstract
Objectives
To evaluate the role of umbilical artery Doppler in growth restricted fetuses.
Methods
In a prospective observational study, 100 pregnant women with growth restricted fetuses confirmed by ultrasound were evaluated by umbilical artery Doppler velocimetry after 28 weeks of gestation. Outcome of the pregnancy was recorded for the normal Doppler group (n=54) and abnormal Doppler group (n=46). Abnormal Doppler group consisted of low end diastolic flow group (n=29) and absent or reversed end diastolic flow (REDF) group (n=17).
Results
Fetuses with abnormal umbilical flow velocimetry had higher incidence of oligohydramnios and abnormal NST compared to the fetuses with normal umbilical flow. The average birth weight and gestational age at delivery were lower in the abnormal Doppler group. Neonates with abnormal umbilical artery velocimetry had increased incidence of caesarean delivery, low apgar scores at birth, increased NICU admissions, increased requirement of positive pressure ventilation, and higher perinatal morbidity and mortality.
Conclusion
Umbilical artery Doppler velocimetry should be used in the management of the intrauterine growth restricted fetuses, as it helps in differentiating fetus with pathological growth restriction at risk for perinatal complications from small and healthy fetuses.
Key words: perinatal outcome, intrauterine growth restriction, Doppler, umbilical artery velocimetry
Full Text
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References
- 1.Ertan A.K., He J.P., Tanriverdi H.A., et al. Comparison of perinatal outcome in fetuses with reverse or absent end diastolic flow in the umbilical artery and/or fetal descending aorta. J Perinat Med. 2003;31:307–312. doi: 10.1515/JPM.2003.043. [DOI] [PubMed] [Google Scholar]
- 2.Seyam Y.S., AI-Mahmeid M.S., AI-Tamimi H.K. Umbilical artery Doppler flow velocimetry in intrauterine growth restriction and its relation to perinatal outcome. Int J Gynaecol Obstet. 2002;77:131–137. doi: 10.1016/S0020-7292(02)00027-9. [DOI] [PubMed] [Google Scholar]
- 3.Fleischer A., Schulman H., Farmakides G., et al. Umbilical artery velocity waveforms and intrauterine growth retardation. Am J Obstet Gynecol. 1985;151:502–505. doi: 10.1016/0002-9378(85)90278-9. [DOI] [PubMed] [Google Scholar]
- 4.Malhotra N., Chanana C., Kumar S., et al. Comparison of perinatal outcome of growth restricted fetuses with normal and abnormal umbilical artery Doppler waveforms. Indian J Med Sci. 2006;60:311–317. doi: 10.4103/0019-5359.26607. [DOI] [PubMed] [Google Scholar]
- 5.Vergani P., Andreotti C., Roncaglia N., et al. Doppler predictors of adverse neonatal outcome in the growth restricted fetus at 34 weeks of gestation or beyond. Am J Obstet Gynecol. 2003;189:1007–1011. doi: 10.1067/S0002-9378(03)00836-6. [DOI] [PubMed] [Google Scholar]
- 6.McCowan L.M., Harding J.E., Stewart D.W. Umbilical artery Doppler studies in small for gestation age babies reflect disease severity. BJOG. 2000;107(7):916–925. doi: 10.1111/j.1471-0528.2000.tb11092.x. [DOI] [PubMed] [Google Scholar]
- 7.Chauhan S.P., Reynolds D., Cole J., et al. Absent or reversed end-diastolic flow in umbilical artery: outcome at a community hospital. J Miss State Med Assoc. 2005;46:163–168. [PubMed] [Google Scholar]
- 8.Sezik M., Tuncay G., Yapar E.G. Prediction of adverse neonatal outcomes in preeclampsia by absent or reversed end-diastolic flow velocity in the umbilical artery. Gynecol Obstet Invest. 2004;57:109–113. doi: 10.1159/000075675. [DOI] [PubMed] [Google Scholar]
- 9.Spinillo A., Bergante C., Gardella B., et al. Interaction between risk factors for fetal growth retardation association associated with abnormal umbilical artery Doppler studies. Acta Obstet Gynecol Scand. 2004;83:431–435. doi: 10.1111/j.0001-6349.2004.00295.x. [DOI] [PubMed] [Google Scholar]
- 10.Trudinger B.J., Cook C.M., Giles W., et al. Fetal umbilical artery velocity waveforms and subsequent neonatal outcome. Br J Obstet Gynaecol. 1991;98:378–384. doi: 10.1111/j.1471-0528.1991.tb13428.x. [DOI] [PubMed] [Google Scholar]
- 11.Madazli R. Prognostic factors for survival of growth-restricted fetuses with absent end-diastolic velocity in the umbilical artery. J Perinatal. 2002;22:286–290. doi: 10.1038/sj.jp.7210715. [DOI] [PubMed] [Google Scholar]
- 12.Brodszki J., Hernandez-Andrade E., Gudmundsson S., et al. Can the degree of retrograde diastolic flow in the abnormal umbilical artery flow velocity waveforms predict pregnancy outcome? Ultrasound Obstet Gynecol. 2002;19:229–234. doi: 10.1046/j.1469-0705.2002.00636.x. [DOI] [PubMed] [Google Scholar]
- 13.Soregaroli M., Bonera R., Danti L., et al. Prognostic role of umbilical artery Doppler velocimetry in growth-restricted fetuses. J Matern Fetal Neonatal Med. 2002;11:199–203. doi: 10.1080/jmf.11.3.199.203. [DOI] [PubMed] [Google Scholar]
- 14.Baschat A.A., Weiner C.P. Umbilical artery Doppler screening for detection of the small fetus in need of antepartum surveillance. Am J Obstet Gynecol. 2000;182:154–158. doi: 10.1016/S0002-9378(00)70505-9. [DOI] [PubMed] [Google Scholar]
- 15.Neilson J.P., Alfirevic Z. Doppler ultrasound for fetal assessment in high risk pregnancies. Cochrane Database Syst Rev. 2000;2:CD000073. doi: 10.1002/14651858.CD000073. [DOI] [PubMed] [Google Scholar]