Uterine and umbilical artery Doppler are comparable in predicting perinatal outcome of growth‐restricted fetuses

Abstract

Objective To compare umbilical and uterine artery Doppler in predicting outcome of pregnancies suspected of fetal growth restriction (FGR).Design A prospective study included 353 singleton pregnancies complicated by an FGR fetus.Setting University Hospital setting.Sample Pregnancies suspected of FGR diagnosed by ultrasound fetal biometry during a 5-year period.Main outcome measure Perinatal outcome in relation to uterine and umbilical artery Doppler.Methods The women underwent Doppler examination of the umbilical and uterine arteries. Results from the uterine, but not the umbilical artery, were blind to the woman and managing obstetrician. The Doppler results were related to perinatal outcomes including small for gestational age newborns, caesarean delivery, premature delivery (<37 weeks of gestation) and admission of the newborn to a neonatal intensive care unit.Results Abnormal uterine artery Doppler velocimetry was seen in 120 (33.4%) pregnancies and abnormal umbilical artery Doppler in 102 (28.4%). There was a statistically significant correlation between abnormal Doppler of both the umbilical and uterine arteries and adverse outcome of pregnancy. The two vessels were comparable in predicting adverse outcome. Women with normal umbilical artery Doppler (251) were analysed separately. Abnormal uterine artery Doppler, seen in 61 (24.3%) of those women, showed a statistically significant correlation for adverse outcome of pregnancy.Conclusions Doppler examinations of the uterine and/or the umbilical arteries seem to be comparable as predictors of outcome in pregnancies complicated by FGR. Including uterine artery Doppler in the surveillance of growth-restricted fetuses might detect a group of pregnancies at high risk, even though the umbilical artery Doppler was normal.

Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term

“…Some studies have suggested that the predictive value of third trimester uterine artery Doppler is comparable to that of umbilical artery Doppler when predicting adverse pregnancy outcomes in late onset FGR [45][46][47]. More recent findings suggest that third trimester uterine artery Doppler was significantly associated with the risk of stillbirth and perinatal death [48].…”

Alterations in maternal and fetal heart functions accompany failed spiral arterial remodeling in pregnant mice

“…In women, these changes are attributed to an almost doubling of uterine arterial diameter accompanied by alternations in collagen and elastin. 1 Increasing uterine arterial flow, used with other tests to identify human fetuses at increased risk for adverse outcome, 28,29 is thought to reflect defective SA modification and increased downstream resistance. 30 Our data in Rag2 −/− / Il2rg −/− support this interpretation and expand it to show that altered maternal and fetal cardiac functions accompany and may precede the gd10-16 gains in uterine arterial flow velocity.…”

Early onset fetal growth restriction

“…According to Baschat et al in-early onset FGR the nutritional and vascular restriction in placental function is limited with umbilical artery AREDV, and particularly reversed end-diastolic velocity is an independent risk factor for adverse motor and cognitive development [54]. Later in life no differences were reported in the rates of severe disability and individual domain scores between the two delivery arms in the GRIT study [86,98] and results were comparable to other preterm cohorts without FGR [54]. Recently published data concerning short term survival of severe growth restricted fetuses across gestation at diagnosis and delivery are reported in Tables 2, 3 …”

“…Uterine artery Doppler may predict poor outcome in FGR but does not provide information sufficiently sophisticated to be considered effective in the management of the FGR fetuses [89,[96][97][98].…”