Doppler ultrasonography of the umbilical cord in complicated pregnancies.
Ninety-two gravid women had Doppler insonation of the umbilical cord after diagnosis of various pregnancy complications. Calculations of the systolic-diastolic (S/D) ratio were plotted against a nomogram of values developed at the Hospital of the University of Pennsylvania. An S/D ratio greater than the 95th percentile for gestational age correctly predicted 58% of women who became preeclamptic and 61% of infants who were small for gestational age (SGA). Of those fetuses with an elevated S/D ratio, 42% suffered fetal distress as defined by an abnormal fetal heart rate tracing, a 1- or 5-minute Apgar score less than 5 or 7, respectively, or a cord blood pH determination less than 7.20; 60% required operative delivery; and 49% stayed in the hospital longer than 5 days or were admitted to the Neonatal Intensive Care Unit (NICU). All these values are significantly greater than those obtained in a control group of uncomplicated pregnancies or a group of women with similar pregnancies, but with normal measurements of the umbilical artery S/D ratio. Moreover, 69% of abnormally elevated umbilical artery S/D ratios were detected at or before 30 weeks' gestation. Calculation of an S/D ratio of the umbilical cord greater than the 95th percentile for gestational age is an early and sensitive predictor of poor perinatal outcome.
Bruner
J B
JB
Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia.
Levy
D W
DW
Arger
P H
PH
D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity; D016022:Case-Control Studies; D003971:Diastole; D005260:Female; D005333:Fetus / Q000098:blood supply; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008875:Middle Aged; D010927:Placental Insufficiency / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D013599:Systole; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D014470:Umbilical Cord / Q000000981:diagnostic imaging