[Middle cerebral artery fetal velocimetry: criteria for extraction in severe growth retardation].
Traditional fetal extraction criteria based on the cardiotocogram (group 1) probably occur too late to serve as extraction criteria in cases of severe growth retardation. We suggest that Doppler ultrasound of the middle cerebral artery (M.C.A.) (group 2) would be used to assess the optimal moment for fetal extraction. This method has enabled us to modify perinatal mortality from 37% to 0% (p less than 0.01). The percentage rate of cerebral hemorrhage and/or neurological sequelae was 41% (9/22) in the first group whereas no infant in group 2 or 3 (control group) had these complications. The percentage rate of neonatal complication was 67% in group 1 versus 28% in group 2 (p less than 0.01). Group 1 spent 53 days (+/- 35) in intensive neonatal care unit versus 43 days (+/- 22) for group 2. Neonatal outcome was quite similar between group 2 and the control group. Cerebral Doppler could allowed us to extract severe IUGR fetuses just before cerebral ischemia and irreversible tissue damage.
Favre
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R
Service de Gynécologie-Obstétrique, Schiltigheim, Strasbourg.
Nisand
I
I
Messer
G
G
D015148:Cardiotocography / Q000592:standards; D002536:Cerebral Arteries / Q000000981:diagnostic imaging*; D005069:Evaluation Studies as Topic; D005113:Extraction, Obstetrical / Q000592:standards*; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D016216:Ultrasonography, Prenatal / Q000592:standards*
Vélocimétrie sylvienne foetale. Critère d'extraction dans l'hypotrophie sévère.