Arterial and venous Doppler velocimetry in the severely growth-restricted fetus and associations with adverse perinatal outcome.
OBJECTIVE
To evaluate the association between arterial and venous Doppler waveforms and adverse perinatal outcome in severe intrauterine growth restriction.


METHODS
Fetuses between 26 and 32 weeks' gestation with ultrasonographically estimated fetal weight below the 5th centile were included in this prospective study. The last Doppler measurements of the umbilical artery, ductus venosus, umbilical vein and middle cerebral artery before delivery and adverse outcome parameters without gestational age independence were used for statistical analysis. Adverse outcome parameters were defined as the following: fetal demise or neonatal death in the first 30 days of life; 5-min Apgar score of < 7; intubation at birth; retinopathy of prematurity; respiratory distress syndrome; necrotizing enterocolitis; stay in neonatal intensive care unit of more than 60 days; intraventricular hemorrhage; periventricular leukomalacia.


RESULTS
Nineteen fetuses fulfilled the inclusion criteria. Perinatal death, low 5-min Apgar values and necrotizing enterocolitis were gestational age-independent adverse outcome parameters. Abnormal Doppler velocimetry of the ductus venosus was the only significant parameter associated with perinatal death and low 5-min Apgar scores. None of the Doppler parameters predicted necrotizing enterocolitis.


CONCLUSIONS
Our data suggest that management of severely growth-restricted fetuses may be aided by the study of ductus venosus Doppler velocimetry.
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA.
T
T
Ozcan
M
M
Sbracia
R L
RL
d'Ancona
J A
JA
Copel
G
G
Mari
D001783:Blood Flow Velocity / Q000502:physiology; D002536:Cerebral Arteries / Q000000981:diagnostic imaging; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D005333:Fetus / Q000098:blood supply*; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D011673:Pulsatile Flow / Q000502:physiology; D012016:Reference Values; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted; D015996:Survival Rate; D018615:Ultrasonography, Doppler, Color; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging; D014471:Umbilical Veins / Q000000981:diagnostic imaging