Evaluation of fetal circulation redistribution in pregnancies with absent or reversed diastolic flow in the umbilical artery.
OBJECTIVE
To record blood flow velocimetry in the superior mesenteric, hepatic and middle cerebral arteries for detection of circulation redistribution and prediction of perinatal outcome in fetuses with absent or reversed diastolic flow in the umbilical artery.


METHODS
The fetal superior mesenteric, hepatic and middle cerebral artery blood velocimetry was recorded in 33 pregnancies complicated by pregnancy-induced hypertension and/or intra-uterine growth retardation between 27 and 41 weeks of gestation. Uterine artery and umbilical vein velocimetries were also recorded.


RESULTS
An abnormal mesenteric artery pulsatility index (PI) was found in four cases; two newborns died due to prematurity, growth retardation and necrotizing enterocolitis. An abnormal fetal hepatic artery PI was found in 17 cases. The brain-sparing effect in the middle cerebral artery was found in 16 cases; three newborns died after delivery. Signs of redistribution in mesenteric, hepatic and middle cerebral artery velocimetry were not related to most of the perinatal outcome variables. Umbilical vein velocimetry correlated with low arterial and venous pH. All perinatal mortalities had umbilical venous pulsations.


CONCLUSIONS
Signs of visceral circulation redistribution could not predict adverse outcome. Umbilical venous pulsations were, however, seen in nearly all fetuses; this was the only variable suggesting adverse outcome in the present study of severely compromised fetuses.
Dubiel
Mariusz
M
Department of Perinatology and Gynecology, University School of Medical Sciences, ul. Lubeckiego 15 A, 60-348 Poznan, Poland. dubiel@sylaba.poznan.pl
Breborowicz
Grzegorz H
GH
Gudmundsson
Saemundur
S
D001724:Birth Weight; D001783:Blood Flow Velocity; D003971:Diastole; D005260:Female; D005317:Fetal Growth Retardation / Q000503:physiopathology*; D005333:Fetus / Q000098:blood supply*; D005865:Gestational Age; D006499:Hepatic Artery; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006973:Hypertension / Q000503:physiopathology*; D007226:Infant Mortality; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D015931:Intensive Care, Neonatal; D017538:Mesenteric Artery, Superior; D020768:Middle Cerebral Artery; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011673:Pulsatile Flow; D014469:Umbilical Arteries / Q000503:physiopathology*; D014471:Umbilical Veins / Q000503:physiopathology