Is An Abnormal Doppler Umbilical Artery Waveform Ratio A Risk Factor for Poor Perinatal Outcome in the Non-Small for Gestational Age Fetus?

Abstract

To determine if abnormal umbilical artery velocimetry is associated with a higher rate of perinatal morbidity in pregnancies in which the outcome is not manifested by a small for gestational age (SGA) fetus, perinatal outcome was compared according to the results of Doppler umbilical artery velocimetry. Doppler study was performed in 328 singleton pregnancies with non-SGA fetuses within 7 days of delivery. The prevalence of abnormal Doppler studies was 10%. Patients with abnormal umbilical artery velocimetry had a significantly higher rate of complications, including cesarean section for fetal distress, preterm delivery, low Apgar scores, congenital anomalies, admission to the neonatal intensive care unit, and perinatal death, than patients with a normal umbilical artery velocimetry. Ten perinatal deaths were associated with major congenital anomalies. Moreover, in the absence of congenital anomalies patients with abnormal Doppler results also had a significantly higher incidence of adverse perinatal outcome compared with patients with normal umbilical artery velocimetry. Our data suggest that even the non-SGA fetus with an abnormal Doppler umbilical artery waveform ratio is at increased risk for poor perinatal outcome.

Prevalence of abnormal umbilical arterial flow on Doppler ultrasound in low-risk and unselected pregnant women: a systematic review

“…They used a low-cost, handheld, continuous flow Doppler apparatus as a routine screening tool for assessing umbilical vessel flow in 2868 unselected-risk women attending two community health centres for antenatal care. The highest prevalence was reported by Yoon et al, who reported a prevalence of AEDF or REDF of 2.13% amongst 328 unselected-risk women in South Korea [38]. The four studies (898 women) conducted in lower middle-income countries (Bangladesh, Papua New Guinea, Nigeria and Tunisia) did not report any cases of AEDF or REDF [39][40][41][42].…”

“…Similarly, in most studies, stillbirth (30 studies), early neonatal death (36 studies), perinatal death (31 studies) and neonatal death (34 studies) were not reported for the population of interest. Where these rates were reported, they were very low, except for the study by Yoon et al that reported seven cases of AEDF or REDF, 10 stillbirths and 18 perinatal deaths among 328 unselected-risk women [38].…”

“…Forty-eight of these cases were AEDF only and seven were AEDF or REDF, reported in a 1993 study in South Korea by Yoon et al [33]. These six studies reported a prevalence ranging from 0.08 to 2.13% (Table 3) [31][32][33][34][35][36][37]. They were generally larger samples (ranging from 328 to 2868 women)-four studies were in unselected-risk women and five were conducted in high-income countries.…”

Prevalence of Abnormal Umbilical Arterial Flow on Doppler Ultrasound in Low-risk and Unselected Pregnant Women: A Systematic Review

“…(36) They used a low-cost, handheld, continuous ow Doppler apparatus as a routine screening tool for assessing umbilical vessel ow in 2,868 unselected-risk women attending two community health centres for antenatal care. The highest prevalence was reported by Yoon et al, who reported a prevalence of AEDF or REDF of 2.13% amongst 328 unselected-risk women in South Korea (37). The four studies (898 women) in lower middle-income countries (Bangladesh, Papua New Guinea, Nigeria and Tunisia) which did not report any cases of AEDF…”

“…Studies with a prevalence of absent or reversed end diastolic ow greater than zero* of AEDF or REDF. Forty-eight of these cases were AEDF only and seven were AEDF or REDF, reported in a 1993 study in South Korea by Yoon et al(32) These six studies reported a prevalence ranging from 0.08-2.13%(Table 4). (30-36) They were generally larger samples (ranging from 328 to 2,868 women) -four studies were in unselected-risk women and ve were conducted in high-income countries.…”