Is Intrauterine Growth Retardation with Normal Umbilical Artery Blood Flow a Benign Condition?

Abstract

Objective-To determine whether intrauterine growth retardation associated with normal umbilical artery blood flow is a benign condition. Design-A prospective comparative study of growth retarded fetuses with normal and abnormal umbilical artery blood flow. Setting-The fetal assessment clinic of a large maternity hospital in Ireland. Patients-179 Women with singleton pregnancies in which the fetal abdominal circumference, measured by ultrasonography, was below the fifth centile for gestation. Main outcome measures-Perinatal deaths, fetal distress requiring caesarean section, preterm delivery, cerebral irritation. Results-Of 124 fetuses with normal flow, all physically normal fetuses survived but one baby had cerebral irritation; there were six preterm deliveries and four caesarean sections for fetal distress. Among 55 women with physically normal fetuses with abnormal flow there were two midtrimester abortions, three perinatal deaths, and one case of cerebral irritation; there were 23 preterm deliveries and six caesarean sections for fetal distress in labour. Conclusions-Intrauterine growth retardation associated with normal umbilical blood flow is a different entity from that associated with abnormal flow, normal flow being largely benign and abnormal flow carrying a serious risk of adverse outcome.

Significance of Umbilical Artery Velocimetry in Perinatal Outcome of Growth Restricted Fetuses

“…It has been shown by various workers that perinatal morbidity and mortatily were significantly greater in small for gestational age babies with abnormal umbilical artery doppler studies than in those with normal studies. 1, [18][19][20] Various studies have reported on the association of abnormal umbilical artery velocity waveforms with fetal growth restriction and its prediction. 1,2,3 All infants whose birth weight is below the 10 th percentile are not exposed to pathologic process in utero but some are constitutionally small and healthy.…”

Correlation between Doppler and Perinatal Outcome in IUGR Babies

“…And we could see that IUGR with normal Doppler in umbilical artery is a benign condition 6 , and almost all of these babies had an uneventful perinatal outcome .Brain sparing effect was associated with higher perinatal complications in our study. In another study by Bacchantetal 7 Neonatal nucleated red blood cell counts in growth-restricted fetuses: relationship to arterial and venous Doppler and nucleated red cells and circulatory decompensation in IUGR were studied. Fetuses were classified into 3 groups as in previous study.…”

Ultrasound and Doppler Management of Intrauterine Growth Restriction

“…[55][56][57] There is an extensive body of evidence that those SGA fetuses with abnormal umbilical artery flow are at higher risk of adverse perinatal outcome than those with normal flow. 31,45,[55][56][57][58][59][60] Even when controlling for gestational age at delivery some series have reported a significant association between abnormal umbilical artery flow and the perinatal results. 31,55,60 In addition, the occurrence of perinatal death in the presence of a normal umbilical flow is very uncommon.…”

“…31,55,60 In addition, the occurrence of perinatal death in the presence of a normal umbilical flow is very uncommon. 55,57,61 Thus, Doppler of the umbilical artery flow could be considered a riskdiscriminator tool in the management of SGA fetuses. Evidence supports those SGA fetuses with normal Doppler benefit from a non-intensive follow-up.…”