Perinatal outcome in growth retarded fetuses with absent or reversed end-diastolic flow in the umbilical artery
Pavel Calda, Zdenek Zizka, Blanka Zlatohlavkova, Richard Plavka, Jaroslav Zivny
Med Sci Monit 1998; 4(2): BR209-214
In an effort to define criteria of ominous fetal compromise in small for gestational age (SGA) fetuses with intrauterine growth retardation, we investigated two subgroups of 26 fetuses from singleton pregnancies with absent (AED) or reversed (RED) end-diastolic flow. The birth weight, gestational age at birth and perinatal mortality were compared to those of a group of 100 SGA fetuses with positive end-diastolic flow (PED). The mortality in the ARED (absent or reversed end-diastolic flow) group was 27%, compared with 0.8% in the PED group. In the AED group (n = 18) two newborns died (11%); the others were discharged in good condition, without sonographic signs of perinatal brain hypoxia. In the RED group (n =8), two fetuses (25%) and three newborns (38%) died, and two newborns had sonographic signs of brain damage. Only one child was discharged in good condition. There were postnatal signs of intrauterine hypoxia (laboratory changes - normoblasts and thrombocytopenia, necrotising enterocolitis and multiple organ dysfunction syndrome) in 6% of cases of the AED group, and in 100% of the RED group. There is a statistically significant difference in the outcome of AED and RED fetuses in the Pulsatility Index (p<0.01) and postnatal adaptation (p<0.01). All measures should be taken to terminate the IUGR pregnancy before reversed end-diastolic flow occurs, even if the fetus is premature, in a center with an appropriately staffed neonatal intensive care unit.
Keywords: IUGR, Doppler velocimetry, absent or reversed flow, fetal outcome