A prospective study on the role of umbilical artery doppler velocimetry in the perinatal outcome of growth restricted fetuses

Authors

  • Sumathi R. Department of Obstetrics and Gynecology, Thoothukudi Government Medical College Hospital, Thoothukudi, Tamil Nadu, India
  • Mercy R. Rodrigo Department of Obstetrics and Gynecology, Thoothukudi Government Medical College Hospital, Thoothukudi, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20195347

Keywords:

Doppler, Intrauterine growth restriction, Perinatal outcome, Umbilical artery velocimetry

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.

References

Romero Bobrow CS, Soothill PW. Fetal growth velocity: a cautionary tale. Lancet. 1999;353:1460.

Trudinger BJ, Cook CM, Giles WB, Ng S, Fong E, Connelly A, et al. Fetal umbilical artery velocity waveforms and subsequent neonatal outcome. Br J Obstet Gynaecol. 1991;98:378-84.

Neilson JP, Alfirevic Z. Doppler ultrasound for fetal assessment in high risk pregnancies. Cochrane Database Syst Rev. 2000;CD000073.

American College of Obstetricians and Gynecologists. ACOG Committee opinion. Utility of antepartum umbilical artery Doppler velocimetry in intrauterine growth restriction. 1997:188.

Bricker L, Neilson JP. Routine doppler ultrasound in pregnancy. Cochrane Database Syst Rev. 2000; CD001450.

Goffinet F, Paris-Llado J, Nisand I, Breart G. Umbilical artery Doppler velocimetry in unselected and low-risk pregnancies: a review of randomised controlled trials. Br J Obstet Gynaecol. 1997;104:425-30.

Westergaard HB, Langhoff-Roos J, Lingman G, Marsál K, Kreiner S. A critical appraisal of the use of umbilical artery Doppler ultrasound in high-risk pregnancies: use of meta-analyses in evidence-based obstetrics. Ultrasound Obstet Gynecol. 2001;17:466-76.

Vergani P, Andreotti C, Roncaglia N, Zani G, Pozzi E, Pezzullo JC, et al. Doppler predictors of adverse neonatal outcome in the growth restricted fetus at 34 weeks' gestation or beyond. Am J Obstet Gynecol. 2003;189(4):1007-11.

Arora D, Desai SK, Sheth PN, Kania P. Significance of umbilical artery velocimetry in perinatal outcome of growth restricted fetuses. J Obstet Gynecol India. 2005;55:138-43.

Deshmukh A, Soni N, Gokhale S. Significance of umbilical artery Doppler velocimetry in the perinatal outcome of growth restricted fetuses. J Obstet Gynecol India. 2010;60:38-43.

Baschat AA, Weiner CP. Umbilical artery Doppler screening for detection of the small fetus in need of antepartum surveillance. Am J Obstet Gynecol. 2000;182:154-8.

Malcus P, van Beek E, Marsal K. Umblical artery velocimetry and non-stress test in monitoring high-risk pregnancies: a comparative longitudinal study. Ultrasound Obstet Gynecol. 1991;1:1-7.

Almstrom H, Axelsson O, Cnattingius S, Ekman G, Maesel A, Ulmsten U, et al. Comparison of umbilical artery velocimetry and cardiotocography for surveillance of small-for-gestational-age fetuses. Lancet. 1992;340:936-40.

Divon MY, Girz BA, Lieblich R, Langer O. Clinical management of the fetus with markedly diminished umbilical artery end-diastolic flow. Am J Obstet Gynecol. 1989;161:1523.

Fleischer A, Schulman H, Farmakides G. Umbilical artery velocity waveforms and intrauterine growth retardation. Am J Obstet Gynecol. 1985;151:502-5.

Shand AW, Hornbuckle J, Nathan E, Dickinson JE, French NP. Small for gestational age preterm infants and relationship of abnormal umbilical artery Doppler blood flow to perinatal mortality and neuro developmental outcomes. Aus New Zealand J Obstet Gynaecol. 2009;49:52-8.

Yoon BH, Lee CM, Kim SW. An abnormal umbilical artery waveform: a strong and independent predictor of adverse perinatal outcome in patients with preeclampsia. Am J Obstet Gynecol. 1994;171:713-21.

McCowan KME. Umbilical artery Doppler studies in small for gestational age babies reflect disease severity . Br J Obstet Gynaecol. 2000;107:916-25.

Figueras F, Eixarch E, Gratacos E, Gardosi J. Predictiveness of antenatal umbilical artery Doppler for adverse pregnancy outcome in small for- gestational-age babies according to customised birth weight centiles: population-based study. Br J Obstet Gynaecol. 2008;115:590-4.

Draper ES, Manktelow B, Field DJ, James D. Prediction of survival for preterm births by weight and gestational age: retrospective population-based study. BMJ. 1999;319:1093-7.

Wood NS, Marlow N, Costeloe K, Gibson AT, Wilkinson AR. Neurologic and developmental disability after extremely preterm birth. EPICURE Study Group. N Engl J Med. 2000;343:378-84.

Maulik D, Mundy D, Heitmann E, Maulik D. Umbilical artery Doppler in the assessment of fetal growth restriction. Clinics Perinatol. 2011;38(1):65-82.

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Published

2019-11-26

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Original Research Articles