ABSTRACT
Background: To compare pregnancy outcomes in growth-restricted fetuses retaining normal umbilical artery doppler flow and the outcomes of pregnancies with end-diastolic velocity diminished or severely reduced/absent.Methods: In a prospective observational study, one hundred pregnant women with growth-restricted fetuses were followed with doppler velocimetry of the umbilical artery between weeks 28 and 41 of pregnancy. Outcomes were compared for the normal doppler group (55%) (Group 1), the low-end diastolic flow group (32%) (Group 2), and the group with severely reduced or absent end-diastolic velocity waveforms (13%) (Group 3).Results: Fetuses with abnormal umbilical flow velocimetry had higher incidence of oligohydramnios (82.2%). The average birth weight and gestational age at delivery were lower in the abnormal doppler group. Significantly more women with severe reduction/AEDV, 31/45 (68.8%), underwent caesarean section, with 20 of them (44.4 %) for fetal distress, compared with 17/55 (30.9%) women in the normal doppler group, with 9 of them (16.4%) for fetal distress. Also, fetuses with abnormal umbilical artery velocimetry had early delivery at less than 36 weeks of gestation (38.2% versus 65.85%), increased NICU admission (32.7% versus 80%), need for PPV (5.5% versus 40%), low Apgar score (9.1 % versus 50.2%) than those with normal doppler. All the three stillbirths in the study population were in the abnormal doppler group.Conclusions: Umbilical artery doppler velocimetry helps in differentiating fetus with pathological growth restriction at risk for perinatal complications from small and healthy fetuses.
ABSTRACT
OBJECTIVE: To investigate the clinical impact of absent or reversed end-diastolic (ARED) umbilical artery flow detected before the 34th week of pregnancy in high-risk pregnancies. METHODS: Fifty-eight singleton pregnant women with high-risk factors were included in this retrospective study. Based on the umbilical artery Doppler finding, pregnant women were divided into 3 groups: group 1 (12 subjects) with normal Doppler systolic/diastolic (S/D) ratios; group 2 (30 subjects) with significant abnormal umbilical artery S/D ratios, and group 3 (16 subjects) with ARED flow in the umbilical artery between the 25+0 and 33+6 gestational weeks. Incidence of intrauterine growth retardation (IUGR) and pregnancy-induced hypertension, detection week, diagnosis-to-delivery interval, birth weight and gestational ages at delivery, Apgar scores, emergency cesarean section, neonatal intensive care unit (NICU) admission, admission-to-discharge interval, perinatal mortality (PNM) and morbidity, and neonatal morbidity were registered. Perinatal outcomes were assessed. The data was analyzed using the Mann-Whitney U-test and X-square test. A significant difference was considered present if p was<0.05. RESULTS: The PNM in group 3 in the study was 25% (4/16). Sixteen had ARED flow. Our study shows that fetuses with ARED flow tend to be more severely growth-retarded. Our results also show ARED flow to be associated with poor perinatal outcome. There was a higher incidence of cesarean section for fetal distress, neonatal intensive care unit admission, and lower Apgar scores. Birth weight and gestational age at delivery were lower. The diagnosis-to-delivery interval was shorter. The admission-to-discharge interval was longer. CONCLUSION: An early ARED finding before the 34th week in the umbilical artery is a very serious sign of likely fetal compromise. The perinatal mortality and morbidity rate were high, and there was evidence of acute or chronic hypoxia in most fetuses. It is an indication that extremely careful surveillance should be followed but not necessarily an indication for an emergency delivery.