A. K. Ertan, J. P. He, H. A. Tanriverdi, J. Hendrik, H. G. Limbach, W. Schmidt
Comparison of perinatal outcome in fetuses with reverse or absent
enddiastolic flow in the umbilical artery and/or fetal descending aorta
Objectives: To examine the differences of perinatal outcome
in fetuses with absent and reversed enddiastolic
flow velocity waveforms of the umbilical artery or fetal
descending aorta.
Design: In a retrospective study, 30 pregnant women
with reversed enddiastolic flow in the umbilical artery or
fetal aorta (group I) were compared with 30 cases of absent
enddiastolic flow (group II). Patients were included
in the groups according to the last Doppler finding before
delivery. Perinatal and neonatal outcome was correlated
with antenatal Doppler flow findings.
Results: The mean gestational age at birth was 31 weeks
in both groups. Fetuses with reverse flow showed higher
perinatal (27% and 7% respectively) and overall mortality
(53.3% and 10% respectively) compared to the
absent enddiastolic flow group (p < 0.05). All the intrauterine
fetal deaths occurred in the reversed flow
group (n = 12). The rates of intrauterine growth retardation,
oligohydramnios and hypocalcemia were different
between the groups (p < 0.05). The cesarean section rate,
perinatal and neonatal complications including the incidence
of acidosis, the number of cases admitted to
neonatal intensive care unit and mean treatment time
were not different between the groups. A tendency to
higher incidence of neonatal cerebral hemorrhage in reversed
flow cases (28%) compared to absent enddiastolic
flow cases (17%) was observed, but this was not statistically
significant.
Conclusions: The present study suggests that reversed
flow should be seen as a particular clinical entity with
higher incidences of perinatal and overall mortality, and
severe intrauterine growth retardation (< 5. perc) compared
to the absent enddiastolic flow group. The optimal
timing of delivery in pregnancies complicated by highly
pathological Doppler flow findings is only to be resolved
in well-designed randomized, multicenter clinical trials.
Journal of Perinatal Medicine, Walter de Gruyter
Print ISSN: 1619-3997
Volume: 31, 07/2003
Pages: 307 - 312
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