Qualitative venous Doppler flow waveform analysis in preterm intrauterine growth-restricted fetuses with ARED flow in the umbilical artery - Correlation with short-term outcome

A. Schwarze, U. Gembruch, M. Krapp, A. Katalinic, U. Germer, R. Axt-Fliedner*

*Corresponding author for this work
53 Citations (Scopus)

Abstract

Objective: The aim of this retrospective study was to examine the significance of severe Doppler waveform abnormalities in the ductus venosus (DV) and the umbilical vein (UV) for the prediction of adverse outcomes in very preterm growth-restricted fetuses with absent or reversed end-diastolic flow in the umbilical artery (UA) at 24-34 weeks of gestation. Methods: Seventy-four fetuses with intrauterine growth restriction (IUGR) and absent or reversed end-diastolic (ARED) flow in the UA at 24-34 weeks of gestation, which were delivered before 34 weeks' gestation, were examined. Absent or reversed flow during atrial contraction (a-wave) in the DV and pulsatile flow in the UV were examined to predict severe perinatal outcomes (stillbirth, neonatal death, perinatal death, acidemia, 5 min Apgar < 7, intraventricular hemorrhage and elevated nucleated red blood cell counts at delivery). Results: Twelve (16.2%) perinatal deaths, of which eight were stillbirths (10.8%), and two (2.7%) neonatal deaths occurred among 74 fetuses. Logistic regression analysis confirmed that abnormal DV Doppler waveforms (R 2 = 0.57, P < 0.001) together with gestational age at delivery (R 2 = 0.57, P < 0.001) showed the strongest association with perinatal death, whereas only gestational age was significantly related to neonatal death (R 2 = 0.67, P < 0.05). Abnormal DV Doppler waveforms (R 2 = 0.86, P < 0.001) and gestational age (R 2 = 0.49, P < 0.05) were strongly associated with adverse outcome (including stillbirth, perinatal death or neonatal death). Abnormal venous Doppler flow patterns performed better in the prediction of fetal or perinatal demise than did ARED flow or brain sparing. Conclusion: Abnormal venous Doppler waveforms in preterm IUGR fetuses with ARED flow are strongly related to adverse fetal and perinatal outcomes before 32 weeks of gestation. The possible benefit of prolonging these pregnancies can only be evaluated in a prospective randomized study.

Original languageEnglish
JournalUltrasound in Obstetrics and Gynecology
Volume25
Issue number6
Pages (from-to)573-579
Number of pages7
ISSN0960-7692
DOIs
Publication statusPublished - 01.06.2005

Fingerprint

Dive into the research topics of 'Qualitative venous Doppler flow waveform analysis in preterm intrauterine growth-restricted fetuses with ARED flow in the umbilical artery - Correlation with short-term outcome'. Together they form a unique fingerprint.

Cite this