Differences in neonatal outcome in fetuses with absent versus reverse end-diastolic flow in umbilical artery Doppler.
OBJECTIVE
It was the aim of this study to evaluate differences in the prognosis of fetuses with absent (AED) and reverse end-diastolic (RED) flow in the umbilical artery based on neonatal outcomes.


METHODS
We performed a cross-sectional study based on the records of 143 patients attending at Assis Chateaubriand Teaching Maternity between 1 January 1999 and 31 December 2005. Patients were classified according to diagnosis as having either fetal centralization (FC), AED or RED. Obstetrical findings and perinatal outcomes were compared for the 3 groups and between AED and RED by Fisher's exact test. Perinatal outcomes were analyzed quantitatively with logistic or multinomial regression. Odds ratios were calculated for significant risk factors.


RESULTS
There was a statistically significant difference in gestational age at diagnosis, Apgar scores at 1 and 5 min, Capurro score, use of surfactant and mechanical ventilation, admission to the neonatal intensive care unit, perinatal and neonatal death. When comparing RED with AED, the odds of neonatal intensive care unit admission, mechanical ventilation, use of surfactant, neonatal mortality and perinatal mortality were 3.2, 1.4, 1.0, 5.1 and 5.3 times higher for RED. Only perinatal mortality kept statistically significant with odds of 5.2 (p = 0.043) when adjusted by gestational age (multivariate analysis).


CONCLUSIONS
The incidence of perinatal mortality was observed to increase with the severity of Doppler findings, with significant differences between the AED and RED groups.
Vasconcelos
Rodney Paiva
RP
Ceara Federal University, Fortaleza, Brazil.
Brazil Frota Aragão
José Richelmy
JR
Costa Carvalho
Francisco Herlânio
FH
Salani Mota
Rosa Maria
RM
de Lucena Feitosa
Francisco Edson
FE
Alencar Júnior
Carlos Augusto
CA
D001783:Blood Flow Velocity; D001938:Brazil; D003430:Cross-Sectional Studies; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging; D005333:Fetus / Q000098:blood supply*; D005865:Gestational Age; D006771:Hospitals, Maternity; D006801:Humans; D015994:Incidence; D007226:Infant Mortality; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D054238:Perinatal Mortality; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging; D011379:Prognosis; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000502:physiology*
D011663:Pulmonary Surfactants