[Reverse flow in fetal vessels and perinatal events].
BACKGROUND/PATIENTS: A reverse flow in the umbilical artery and/or fetal aorta is associated with a higher perinatal and neonatal mortality. 30 fetuses showed a reverse flow using pulsed wave Doppler sonography (group I). A matched-pair control group including 30 fetuses with the same gestational age as well as a normal Doppler flow pattern in the umbilical artery and/or fetal aorta was taken for comparison (group II).


RESULTS
In the group with reverse flow the rates of pregnancies with pre-eclampsia (n = 19/30, p < 0.0001), intrauterine growth retardation (n = 25/30, p < 0.0001), oligohydramnios (n = 21/30, p < 0.0001) and nicotine abuse (n = 15/30, p < 0.01) were significantly higher compared to the control group. Postnatal data showed significantly lower pH values in group I (p < 0.01). 40 % of the fetuses with reverse flow died in utero whereas in 67 % the reverse flow was accompanied by an insufficiency of the placenta (IUGR, oligohydramnios, histopathological abnormalities of the placenta). None of the fetuses in the control group died in utero. The incidence of IUGR (< 5ht percentile) was 83 % in group I but only 3 % in group II. The perinatal and overall mortality (including neonatal mortality 7 - 28 days after birth) amounted to 27 % and 53 % in group I, respectively, compared to 3 % and 0 % in the control group (p < 0.001). In addition cerebral anomalies could be found by ultrasound in 50 % of the neonates who presented a reverse flow prenatally. In 28 % of the surviving newborns an intracerebral hemorrhage (ICH) could be detected. None of the newborns of group II developed an ICH.


CONCLUSIONS
Pregnancies with a reverse flow in the umbilical artery and/or fetal aorta have to be considered as a high risk group with a poor prognosis. The reverse flow is mainly caused by chronic placental insufficiency with IUGR. With respect to the further neuromotor development the incidence and severity of cerebral lesions in affected fetuses should be considered when discussing the perinatal situation with the parents.
Universitäts-Frauenklinik und Poliklinik mit Hebammenlehranstalt, Homburg/Saar. ertan@uniklinuk-saarland.de
A K
AK
Ertan
J P
JP
He
H-J
HJ
Hendrik
M
M
Holländer
H G
HG
Limbach
W
W
Schmidt
D000328:Adult; D001011:Aorta / Q000000981:diagnostic imaging* / Q000196:embryology; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality; D005260:Female; D005313:Fetal Death / Q000000981:diagnostic imaging / Q000503:physiopathology; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000401:mortality; D005333:Fetus / Q000098:blood supply*; D006801:Humans; D007231:Infant, Newborn; D016555:Matched-Pair Analysis; D016104:Oligohydramnios / Q000000981:diagnostic imaging / Q000401:mortality; D010927:Placental Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging / Q000401:mortality; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk / Q000502:physiology*; D012307:Risk Factors; D016019:Survival Analysis; D014029:Tobacco Use Disorder / Q000000981:diagnostic imaging / Q000401:mortality; D018617:Ultrasonography, Doppler, Pulsed; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging*