Small for gestational age preterm infants and relationship of abnormal umbilical artery Doppler blood flow to perinatal mortality and neurodevelopmental outcomes (original) (raw)
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European Journal of Obstetrics & Gynecology and Reproductive Biology, 2006
Objective: Absent or reverse end-diastolic flow (Doppler II/III) in umbilical artery is correlated with poor perinatal outcome, particularly in intrauterine growth restricted (IUGR) fetuses. The optimal timing of delivery is still controversial. We studied the short-and long-term morbidity and mortality among these children associated with our defined management. Study design: Sixty-nine IUGR fetuses with umbilical Doppler II/III were divided into three groups; Group 1, severe early IUGR, no therapeutic intervention (n = 7); Group 2, fetuses with pathological biophysical profile, immediate delivery (n = 35); Group 3, fetuses for which expectant management had been decided (n = 27). Results: In Group 1, stillbirth was observed after a mean delay of 6.3 days. Group 2 delivered at an average of 31.6 weeks and two died in the neonatal period (6%). In Group 3 after a mean delay of 8 days, average gestational age at delivery was 31.7 weeks; two intra uterine and four perinatal deaths were observed (22%). Long-term follow-up revealed no sequelae in 25/31 (81%) and 15/18 (83%), and major handicap occurred in 1 (3%) and 2 patients (11%), respectively, for Groups 2 and 3. Conclusion: Fetal mortality was observed in 22% of this high risk group. After a mean period of follow-up of 5 years, 82% of infants showed no sequelae. According to our management, IUGR associated with umbilical Doppler II or III does not show any benefit from an expectant management in term of long-term morbidity.
Ultrasound in Obstetrics and Gynecology, 2010
Objective To evaluate whether anterior cerebral artery (ACA) Doppler ultrasonography is superior to middle cerebral artery (MCA) Doppler in the prediction of perinatal outcome and neonatal neurobehavior in term small-for-gestational-age (SGA) fetuses with normal umbilical artery (UA) Doppler. Methods MCA and ACA Doppler ultrasonography was performed in a cohort of SGA term fetuses with normal UA Doppler. Perinatal outcome and neonatal neurobehavioral performance were compared with a group of term appropriate-for-gestational age (AGA) infants. Neurobehavior was evaluated at 40 (± 1) weeks of corrected age with the Neonatal Behavioral Assessment Scale. Differences between the study groups were adjusted for potential confounding variables by multiple linear or logistic regression analyis. Results A total of 199 newborns (98 SGA and 101 AGA) were included. Among the SGA fetuses, 28.6 and 17% had MCA and ACA redistribution, respectively. Cases with either type of redistribution had an increased risk for adverse outcome, with no differences in predictive performance between the two parameters. SGA fetuses with MCA redistribution compared with controls had an increased risk for abnormal neurobehavioral performance in motor (36 vs. 20%; adjusted P = 0.02) and state organization (25 vs. 17.5%; adjusted P = 0.03) areas. SGA fetuses with ACA redistribution had only an increased risk for abnormal neurobehavioral performance area in state organization compared with controls (30 vs. 17.5%; adjusted P = 0.021).
Indian Journal of …, 2006
AIMS: To evaluate the role of umbilical artery Doppler in growth-restricted fetuses. MATERIALS AND METHODS: In a prospective observational study, 70 pregnant women with growth-restricted fetuses confirmed by ultrasound, were followed up with Doppler studies of the umbilical artery. The study group consisted of 35 women, where the Doppler waveform in the umbilical artery was compromised (either absent end diastolic flow [AEDF] or reversed end diastolic flow [REDF]). These were compared with an equal number of controls, where growth-restricted fetuses had normal doppler waveforms. Outcome measures were evaluated in both groups and analyzed. RESULTS: The periods of gestation at delivery were 27.2 ± 3.5 weeks in group 1 and 37 ± 3.3 weeks in-group II, respectively. Perinatal morbidity and mortality was significantly increased in the group with compromised umbilical artery blood group. Birth weight in group I was 742 ± 126 grams and in group II was 1680 ± 259 grams. This difference was statistically significant (P=0.0001). In comparison to AEDF, REDF fetuses had more morbidities. Perinatal mortality was also significantly increased in this group (P=0.001). CONCLUSION: Umbilical artery Doppler should be used in the management of growth-restricted fetuses. In those fetuses in normal Doppler, pregnancy can be prolonged. REDF is an indication for termination of pregnancy.
Indian Pediatrics, 2013
I ntrauterine growth restriction can be caused by a number of conditions but pregnancy induced hypertension and vascular disorders of the placenta are among the most common etiologies responsible for about 25-30% of IUGR [1]. Although the incidence of IUGR is about 8% in the Western world [2], the prevalence in the developing world is much higher at ~35% [3]. Although a number of different modalities are used for fetal surveillance of IUGR, umbilical Doppler flow pattern is one of the most widely used tests [4]. A number of observational studies have reported outcomes in IUGR infants with abnormal antenatal Doppler flow pattern [5-10]. However, there are few studies [11,12] from the developing world, where the global burden of the fetal growth restriction and preeclampsia is the highest [3,13]. This information is essential to devise strategies for reducing the rates of still-births/prematurity globally [14]. We hypothesized that an absent or reversed end diastolic flow in umbilical artery (AREDF) would be an independent predictor of adverse short-term and longterm infant outcomes. We report the comparison of AREDF vs. forward end-diastolic flow (FEDF) on
Long term predictive value of Doppler studies in high risk fetuses
BJOG: An International Journal of Obstetrics and Gynaecology, 1992
Objective extends beyond the perinatal period. Design Descriptive follow-up study. Setting Subjects 40 children who as high risk fetuses had had assessment of umbilical artery flow velocity waveforms. Interventions Parental history, physical examination, anthropometry, Denver developmental screening test. Outcome measures Weight, height, head circumference, neurological impairment, Denver developmental screening test
Study of abnormal umbilical artery doppler and neonatal outcome
Asian Journal of Medical Sciences, 2019
Background: Doppler provides assessment of uteroplacental and fetoplacental circulation during pregnancy. It is a sensitive tool in early detection of fetal compromise and allows needful intervention. Aims and Objective: To study the role of umbilical artery doppler in clinically suspected IUGR and its implication on neonatal outcome. Materials and Methods: A total of 104 singleton pregnancies with gestational age of more than 34 weeks who had clinical suspicion of IUGR were evaluated using obstetric ultrasound and doppler. Umbilical arteryvelocimetry with S/D >3 and RI >0.7 were considered abnormal. Newborns were classified as either small for gestational age (SGA) ie, IUGR or appropriate for gestational age (AGA). Neonatal outcome were classified as either normal or adverse events that included still birth, NICU admissions, perinatal asphyxia and/or neonatal death. Results: Out of 104 clinically suspected IUGR, 55 were born with small for gestational age. Among these SGA neo...
Neonatal outcome of abnormal versus normal antenatal Doppler in high-risk pregnancies
International Journal of Contemporary Pediatrics
Background: Umbilical Doppler flow abnormalities occur in 6% of high-risk pregnancies. Preterm infants born with abnormalities in the umbilical artery Doppler waveforms is at a risk of various complications. The objective of this study were to understand and compare the neonatal outcome of normal verses abnormal antenatal Doppler.Methods: 100 newborns each with normal antenatal Doppler and abnormal antenatal Doppler, born to women with singleton pregnancies of 28 weeks and above, were enrolled for the study after taking informed written consent from the parents. All the newborns enrolled were followed up for various neonatal outcomes and complications. Results: Majority of fetal Doppler abnormalities were seen in mothers with PIH (50% verses 21%) and Intra uterine growth restriction (59% verses 29%) which was statistically significant. Majority of babies in abnormal Doppler group were delivered by LSCS compared to normal Doppler group (72% verses 36%). Neonates in the abnormal Dopp...
The Turkish journal of pediatrics
Fetal arterial and venous Doppler is a useful tool for the monitoring of growth restricted fetuses. Our aim in this study was to compare outcomes when fetuses were grouped according to the combinations of the Doppler results and also according to each vessel Doppler. Deliveries during the period 2002-2008 were reviewed retrospectively and cases with a birth weight less than the 10th percentile were selected for the study. Cases with congenital malformations or chromosomal abnormalities were excluded. Cases were then grouped according to umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV) Doppler results. Two hundred fifty-five cases were selected for the study. The perinatal mortality rate was 9.8% (11 prenatal and 14 neonatal). In the presence of absent or reverse flow in UA, fetal death and neonatal complication rates were higher. In the fetuses having reverse or absent "a" wave, there were findings of metabolic deterioration. Absent-reverse UA en...
Umbilical Artery Doppler Indices in Small for Gestational Age Fetuses
Journal of Ultrasound in Medicine, 2009
The purpose of this study was to compare the screening efficiency of the umbilical artery systolic to diastolic ratio (S/D), pulsatility index (PI), and absent end-diastolic flow (AEDF) for adverse pregnancy outcomes and placental abnormalities in small for gestational age (SGA) fetuses. Methods. We conducted a retrospective cohort study of Doppler examinations of 161 nonanomalous SGA fetuses. The reliability of the S/D and PI were quantified by intraclass correlation coefficients. The association of the S/D, PI, and AEDF with adverse outcomes and placental abnormalities was compared by the χ 2 test. Results. There was a simple association of Doppler results with adverse outcomes, which was mitigated when controlled for gestational age. For all measures of adverse outcomes, the specificity of abnormal Doppler results exceeded the sensitivity, and the negative predictive value was greater than the positive predictive value. Comparing the S/D with the PI, there was no significant difference in the sensitivity; however, the specificity of the PI was at least 90% and exceeded that of the S/D for all outcomes. The intraclass correlation coefficients of the S/D and PI were similar, indicating no difference in reliability. Placental abnormalities were significantly more common in cases with abnormal Doppler values (positive predictive value, 94%) with no overlap in the types of placental lesions in most cases. Conclusions. As an initial screen for adverse outcomes in SGA fetuses, the umbilical artery Doppler S/D, PI, and AEDF were imprecise. However, these measures were all strongly and similarly predictive of placental abnormalities, especially lesions of maternal underperfusion and fetal vascular obstruction.