Is it time to reassess the risk for the growth-retarded fetus with normal Doppler velocimetry of the umbilical artery?

Gaziano, Emanuel P.; Knox, Heather; Ferrera, Bruce; Brandt, Debra G.; Calvin, Steven E.; Knox, George

doi:10.1016/s0002-9378(12)91843-8

Cited by 12 publications

(8 citation statements)

References 19 publications

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“…Umbilical artery Doppler studies appear to enable the classification of small for gestational age babies into groups with varying degrees of risk to the fetus and newborn 1–4 . Those with abnormal umbilical artery Doppler studies show histological evidence of placental vascular pathology 5–7 and are at increased risk of perinatal death, iatrogenic preterm delivery and morbidity in the newborn period 1,3,8,9 . Few investigators have examined the potential confounding effects of gestational age at delivery 1,10 and/or the severity of growth restriction on perinatal outcome, in relation to umbilical artery Doppler studies 1 .…”

Section: Introductionmentioning

confidence: 99%

Umbilical artery Doppler studies in small for gestational age babies reflect disease severity

McCowan

Harding

Stewart

2000

BJOG

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Objectives To determine: 1. whether abnormal umbilical artery Doppler studies were independently associated with newborn morbidity; and 2. whether small for gestational age babies with normal umbilical artery Doppler studies had small mothers and a low rate of newborn malnutrition and morbidity.Design Prospective observational study.Setting National Women's Hospital, a tertiary referral centre, Auckland, New Zealand.Population One hundred eighty-six women and their small for gestational age babies (birthweight < loth%) who had been participants in one of two randomised controlled trials of small for gestational age pregnancies between 1993 and 1997.Methods Newborn morbidity and morphometry were compared between small for gestational age babies with normal and abnormal umbilical artery Doppler studies (resistance index > 95th%).Maternal demographic characteristics and morbidity were also compared.Results Compared with small for gestational age babies with normal umbilical artery Doppler studies (n = 109), small for gestational age babies with abnormal umbilical artery Doppler studies (n = 77) were diagnosed earlier in pregnancy as being small for gestational age (30-3 vs 32.9 weeks, P < O.OOl), were smaller in all body proportions at birth (median Z score birthweight -1.82 vs -1.70, P = 0.004, Z score length -1.86 v s -1.36, P < 0.0001, Z score head circumference -1.31 vs -0.89, P < 0.0001) and were more likely to experience newborn morbidity. When birthweight and gestation were entered into a logistic regression model, an abnormal umbilical artery Doppler study was not an independent predictor of prolonged newborn nursery admission or hypoglycaemia. Of small for gestational age babies with normal umbilical artery Doppler studies, 53 (49%) had low ponderal indices, 26/98 (26%) were hypoglycaemic and 38 (35%) required admission to the newborn nursery. There was no difference in maternal height, weight and ethnicity between the abnormal and normal umbilical artery Doppler groups.Conclusions Abnormal umbilical artery Doppler studies reflect earlier onset and more severe growth restriction and are not independently associated with newborn morbidity. Small for gestational age babies with normal Doppler studies have a high rate of newborn nursery admission and malnutrition at birth and are not all just normal small babies.

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Section: Introductionmentioning

confidence: 99%

Umbilical artery Doppler studies in small for gestational age babies reflect disease severity

McCowan

Harding

Stewart

2000

BJOG

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“…5 6 Associations have been reported between AREDFV and fetal hypoxia and acidosis, 7 neonatal acidosis, [8][9][10][11] cerebral haemorrhage, 3 12-14 hypotension, 3 respiratory distress syndrome, 9 bronchopulmonary dysplasia, 13 necrotising enterocolitis, 1 13 14 and prolonged hospitalisation. 5 12 Weiss et al reported an increased risk of neurological signs at discharge. 15 Less information is available about the later outcome of babies born after pregnancies complicated by AREDFV.…”

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confidence: 99%

Outcome at school age following antenatal detection of absent or reversed end diastolic flow velocity in the umbilical artery

Schreuder

McDonnell²,

Gaffney³

et al. 2002

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Aim: To determine whether fetal compromise, manifested by abnormalities of Doppler recordings of umbilical artery velocity waveforms in utero, is associated with neurodevelopmental or educational abnormalities at school age. Methods: A cohort of neonates born following high risk pregnancies had been previously identified for a study of the perinatal sequelae of absent (AEDFV) and reversed (REDFV) end diastolic flow velocities. Seventy six children were assessed at 5-12 years of age by a developmental paediatrician who was blinded to perinatal course and Doppler assessments. Forty children born following pregnancies with forward end diastolic flow velocities (FEDFV), were compared with 27 with AEDFV and nine with REDFV. Tests of cognitive, neurological, and sensory function were performed, and reports of behavioural and educational progress were obtained from parents and teachers. Results: There were no significant differences between FEDFV and AEDFV groups, but on tests of mental ability and neuromotor function the REDFV group had worse scores than either FEDFV or AEDFV. Comparing REDFV and FEDFV groups, the British Ability Scales general conceptual ability mean scores were 87.7 versus 101, and the Quick Neurological Screening Test mean scores were 32.8 versus 21.5. Conclusions: Absence of EDFV is well recognised as a marker of fetal compromise which is associated with acute perinatal sequelae. This study suggests it is not associated with adverse neurodevelopmental outcome. However, we found reversal of EDFV on antenatal assessment to be associated with a wide range of problems at school age, suggesting that REDFV represents intrauterine decompensation which may have adverse effects on the developing brain.

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“…Yoon et al 19 analysed outcomes in 73 women with pre-eclampsia; an abnormal umbilical artery waveform was the only variable to predict the occurrence of neonatal intraventricular hemorrhage (odds ratio 10.3). Other groups have also reported similar significant increments in the risk of developing cerebral haemorrhages, 36,17,38,41 or early onset signs of cerebral injury. Other groups have also reported similar significant increments in the risk of developing cerebral haemorrhages, 36,17,38,41 or early onset signs of cerebral injury.…”

Section: Cerebral Morbiditymentioning

confidence: 64%

“…Recent studies have shown that cerebral haemorrhages 14,[17][18][19]38,43 or some other form of cerebral injury 30,22 are apparent in between 3 to 32% of neonates delivered after the diagnosis of AEDF. Karsdorp et al 18 reported that cerebral haemorrhages occurred significantly more often in neonates with absent (21%) or reversed (43%) EDF than in controls (5%), an effect that was still present after correction for gestation.…”

Section: Cerebral Morbiditymentioning

confidence: 99%

Absent-End-Diastolic Flow Velocity in the Umbilical Artery

Bishry

Sturgiss

2003

Fet. Matern. Med. Rev.

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Fetal growth restriction (FGR) as a consequence of uteroplacental insufficiency is an important contributor to perinatal death, neonatal morbidity and long-term health problems. Progressive uteroplacental dysfunction leads to placental respiratory failure and fetal hypoxaemia, which triggers compensatory fetal haemodynamic changes including blood flow redistribution towards essential fetal organs (brain, heart and adrenal glands) at the expense of the other body systems. The duration of the compensatory phase is variable, sometimes lasting weeks, and appears not to have deleterious short-term consequences. With further disease progression, the compensatory mechanisms reach their limit and myocardial dysfunction occurs. Once the disease enters this decompensatory phase, the fetus is at high risk of multisystem organ failure and in-utero demise. There is no effective in-utero therapeutic intervention. The main aim of management is to deliver the baby when the risks of antenatal demise and irreversible end-organ dysfunction associated with further prolongation of the pregnancy are greater than the risks from delivery.

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Is it time to reassess the risk for the growth-retarded fetus with normal Doppler velocimetry of the umbilical artery?

Cited by 12 publications

References 19 publications

Umbilical artery Doppler studies in small for gestational age babies reflect disease severity

Umbilical artery Doppler studies in small for gestational age babies reflect disease severity

Outcome at school age following antenatal detection of absent or reversed end diastolic flow velocity in the umbilical artery

Absent-End-Diastolic Flow Velocity in the Umbilical Artery

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