title: Predictable progressive Doppler deterioration in IUGR: does it really exist?
abstract: OBJECTIVE
  An objective of the Prospective Observational Trial to Optimize Pediatric Health in IUGR (PORTO) study was to evaluate multivessel Doppler changes in a large cohort of intrauterine growth restriction (IUGR) fetuses to establish whether a predictable progressive sequence of Doppler deterioration exists and to correlate these Doppler findings with respective perinatal outcomes.
  
  
  METHODS
  More than 1100 unselected consecutive ultrasound-dated singleton pregnancies with estimated fetal weight (EFW) less than the 10th centile were recruited between January 2010 and June 2012. Eligible pregnancies were assessed by serial Doppler interrogation of umbilical (UA) and middle cerebral (MCA) arteries, ductus venosus (DV), aortic isthmus, and myocardial performance index (MPI). Intervals between Doppler changes and patterns of deterioration were recorded and correlated with respective perinatal outcomes.
  
  
  RESULTS
  Our study of 1116 nonanomalous fetuses comprised 7769 individual Doppler data points. Five hundred eleven patients (46%) had an abnormal UA, 300 (27%) had an abnormal MCA, and 129 (11%) had an abnormal DV Doppler. The classic pattern from abnormal UA to MCA to DV existed but no more frequently than any of the other potential pattern. Doppler interrogation of the UA and MCA remains the most useful and practical tool in identifying fetuses at risk of adverse perinatal outcome, capturing 88% of all adverse outcomes.
  
  
  CONCLUSIONS
  In contrast to previous reports, we have demonstrated multiple potential patterns of Doppler deterioration in this large prospective cohort of IUGR pregnancies, which calls into question the usefulness of multivessel Doppler assessment to inform frequency of surveillance and timing of delivery of IUGR fetuses. These data will be critically important for planning any future intervention trials.
authors.affiliation: Department of Obstetrics and Gynecology, Royal College of Surgeons in Ireland, Cork, Ireland. Electronic address: juliaunterscheider@rcsi.ie.
authors.forename: Julia
authors.initials: J
authors.lastname: Unterscheider
authors.forename: Sean
authors.initials: S
authors.lastname: Daly
authors.forename: Michael Patrick
authors.initials: MP
authors.lastname: Geary
authors.forename: Mairead Mary
authors.initials: MM
authors.lastname: Kennelly
authors.forename: Fionnuala Mary
authors.initials: FM
authors.lastname: McAuliffe
authors.forename: Keelin
authors.initials: K
authors.lastname: O'Donoghue
authors.forename: Alyson
authors.initials: A
authors.lastname: Hunter
authors.forename: John Joseph
authors.initials: JJ
authors.lastname: Morrison
authors.forename: Gerard
authors.initials: G
authors.lastname: Burke
authors.forename: Patrick
authors.initials: P
authors.lastname: Dicker
authors.forename: Elizabeth Catherine
authors.initials: EC
authors.lastname: Tully
authors.forename: Fergal Desmond
authors.initials: FD
authors.lastname: Malone
mesh_terms: D000328:Adult; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging*; D005323:Fetal Monitoring / Q000379:methods; D020567:Fetal Weight / Q000502:physiology*; D005333:Fetus / Q000098:blood supply*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011248:Pregnancy Complications; D011446:Prospective Studies; D011673:Pulsatile Flow; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014469:Umbilical Arteries / Q000000981:diagnostic imaging*
keywords: Doppler; intrauterine growth restriction; sequential changes; umbilical artery