title: Umbilical vein blood volume flow rate and umbilical artery pulsatility as 'venous-arterial index' in the prediction of neonatal compromise.
abstract: OBJECTIVE
  To assess the diagnostic power of the umbilical venous-arterial index (VAI) for the prediction of poor fetal outcome.
  
  
  METHODS
  This was a retrospective, cross-sectional clinical study in which normalized umbilical vein blood volume flow rate (nUV) (mL/min/kg estimated body weight), umbilical artery pulsatility index (UAPI), the newly developed VAI (nUV/UAPI), and the uterine artery resistance index (UTRI) were determined in 85 fetuses once (17-41 gestational weeks) during pregnancy using standard ultrasound Doppler equipment. A risk score based on umbilical blood pH, 1-min Apgar score, birth weight, duration of gestation, type of respiratory support, and referral to the pediatric department was constructed, and fetuses were assigned to a control or a pathological group accordingly. Logistic regression and analysis of fitted receiver-operating characteristics curves were performed to evaluate the diagnostic power of nUV, UAPI, UTRI, and VAI.
  
  
  RESULTS
  The incidence of compromised neonates was 17.6%. The area under the receiver-operating characteristics curve was larger for VAI than for UTRI or for UAPI (P < 0.002). At a cut-off value of 100 mL/min/kg, the sensitivity of VAI to predict poor neonatal outcome was 85% with a 15% false-positive rate.
  
  
  CONCLUSIONS
  Determination of the VAI has a greater diagnostic power to predict poor fetal outcome than the pulsatility index in the umbilical artery or the resistance index in the uterine artery.
authors.affiliation: Universitätsklinikum Hamburg-Eppendorf, Klinik für Frauenheilkunde und Geburtshilfe, Abteilung für Experimentelle Gynäkologie, Hamburg, Germany. tchiriko@uke.uni-hamburg.de
authors.forename: M
authors.initials: M
authors.lastname: Tchirikov
authors.forename: C
authors.initials: C
authors.lastname: Rybakowski
authors.forename: B
authors.initials: B
authors.lastname: Hüneke
authors.forename: V
authors.initials: V
authors.lastname: Schoder
authors.forename: H J
authors.initials: HJ
authors.lastname: Schröder
mesh_terms: D001783:Blood Flow Velocity / Q000502:physiology; D001810:Blood Volume / Q000502:physiology*; D003430:Cross-Sectional Studies; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D011247:Pregnancy; D011673:Pulsatile Flow / Q000502:physiology; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler / Q000379:methods*; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014471:Umbilical Veins / Q000000981:diagnostic imaging* / Q000502:physiology