Yonsei Med J.  2009 Feb;50(1):39-44. 10.3349/ymj.2009.50.1.39.

Umbilical Artery Doppler Study as a Predictive Marker of Perinatal Outcome in Preterm Small for Gestational Age Infants

Affiliations
  • 1Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea. kimhs7@ajou.ac.kr

Abstract

PURPOSE: To evaluate the merit of umbilical artery Doppler study as a predictive marker of perinatal outcome in preterm small for gestational age (SGA) infants.
MATERIALS AND METHODS
A total of 218 patients at 27 - 36 weeks of gestational age (GA) who received antenatal umbilical artery Doppler velocimetry and delivered singleton infants with SGA. The ratio of peak-systolic to end-diastolic blood flow velocities (S/D) in the umbilical artery was measured in each patient. The patients were divided into 3 groups: the normal group with S/D ratios of less than 95th percentile (n = 134), elevated S/D ratio group of 95th or more percentile (n = 41), and those with absent/reversed end diastolic flow (n = 43). Maternal characteristics and neonatal outcomes of these groups were comparatively analyzed.
RESULTS
The gestational age (GA) at the time of diagnosis of SGA, the mean GA at delivery, and the mean birth weight showed statistically significant difference among three groups (p < 0.001). Also, poor perinatal outcome was significantly increased in infants with abnormal S/D ratio (13.4% vs. 31.7% vs. 67.4%, p < 0.001). Multivariate logistic regression analysis revealed umbilical artery Doppler study as a significant independent factor for prediction of poor perinatal outcome (odds ratio: 3.7, 95% confidence interval 1.4 - 9.5, p = 0.007).
CONCLUSION
Antenatal umbilical artery Doppler velocimetry is shown as a significantly efficient marker in predicting perinatal outcome in preterm SGA infants.

Keyword

Preterm small for gestational age infant; umbilical artery Doppler velocimetry; perinatal outcome

MeSH Terms

Blood Flow Velocity
Female
Humans
Infant, Newborn
*Infant, Small for Gestational Age
Multivariate Analysis
Predictive Value of Tests
Pregnancy
*Pregnancy Outcome
Retrospective Studies
Ultrasonography, Doppler/*methods
Ultrasonography, Prenatal/*methods
Umbilical Arteries/*ultrasonography

Reference

1. Garite TJ, Clark R, Thorp JA. Intrauterine growth restriction increases morbidity and mortality among premature neonates. Am J Obstet Gynecol. 2004. 191:481–487.
Article
2. Barker DJ, Gluckman PD, Godfrey KM, Harding JE, Owens JA, Robinson JS. Fetal nutrition and cardiovascular disease in adult life. Lancet. 1993. 341:938–941.
Article
3. Neilson JP, Alfirevic Z. Doppler ultrasound for fetal assessment in high risk pregnancies. Cochrane Database Syst Rev. 2000. (2):CD000073.
4. Gagnon R, Van den Hof M. Diagnostic Imaging Committee, Executive and Council of the Society of Obstetricians and Gynaecologists of Canada. The use of fetal Doppler in obstetrics. J Obstet Gynaecol Can. 2003. 25:601–614. quiz 615-6.
5. Giles WB, Trudinger BJ, Baird PJ. Fetal umbilical artery flow velocity waveforms and placental resistance: pathological correlation. Br J Obstet Gynaecol. 1985. 92:31–38.
6. Morrow RJ, Adamson SL, Bull SB, Ritchie JW. Effect of placental embolization on the umbilical arterial velocity waveform in fetal sheep. Am J Obstet Gynecol. 1989. 161:1055–1060.
7. Soregaroli M, Bonera R, Danti L, Dinolfo D, Taddei F, Valcamonico A, et al. Prognostic role of umbilical artery Doppler velocimetry in growth-restricted fetuses. J Matern Fetal Neonatal Med. 2002. 11:199–203.
Article
8. Brar HS, Platt LD. Reverse end-diastolic flow velocity on umbilical artery velocimetry in high-risk pregnancies: an ominous finding with adverse pregnancy outcome. Am J Obstet Gynecol. 1988. 159:559–561.
Article
9. Karsdorp VH, van Vugt JM, van Geijn HP, Kostense PJ, Arduini D, Montenegro N, et al. Clinical significance of absent or reversed end diastolic velocity waveforms in umbilical artery. Lancet. 1994. 344:1664–1668.
Article
10. Valcamonico A, Danti L, Frusca T, Soregaroli M, Zucca S, Abrami F, et al. Absent end-diastolic velocity in umbilical artery: risk of neonatal morbidity and brain damage. Am J Obstet Gynecol. 1994. 170:796–801.
Article
11. Zelop CM, Richardson DK, Heffner LJ. Outcomes of severely abnormal umbilical artery doppler velocimetry in structurally normal singleton fetuses. Obstet Gynecol. 1996. 87:434–438.
Article
12. Wienerroither H, Steiner H, Tomaselli J, Lobendanz M, Thun-Hohenstein L. Intrauterine blood flow and long-term intellectual, neurologic, and social development. Obstet Gynecol. 2001. 97:449–453.
Article
13. Piper JM, Xenakis EM, McFarland M, Elliott BD, Berkus MD, Langer O. Do growth-retarded premature infants have different rates of perinatal morbidity and mortality than appropriately grown premature infants? Obstet Gynecol. 1996. 87:169–174.
Article
14. Kristensen S, Salihu HM, Keith LG, Kirby RS, Fowler KB, Pass MA. SGA subtypes and mortality risk among singleton births. Early Hum Dev. 2007. 83:99–105.
Article
15. Gilbert WM, Danielsen B. Pregnancy outcomes associated with intrauterine growth restriction. Am J Obstet Gynecol. 2003. 188:1596–1599. discussion 1599-601.
Article
16. Gortner L, van Husen M, Thyen U, Gembruch U, Friedrich HJ, Landmann E. Outcome in preterm small for gestational age infants compared to appropriate for gestational age preterms at the age of 2 years: a prospective study. Eur J Obstet Gynecol Reprod Biol. 2003. 110 Suppl 1:S93–S97.
Article
17. Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol. 1996. 87:163–168.
Article
18. Seyam YS, Al-Mahmeid MS, Al-Tamimi HK. Umbilical artery Doppler flow velocimetry in intrauterine growth restriction and its relation to perinatal outcome. Int J Gynaecol Obstet. 2002. 77:131–137.
Article
19. Berkowitz GS, Mehalek KE, Chitkara U, Rosenberg J, Cogswell C, Berkowitz RL. Doppler umbilical velocimetry in the prediction of adverse outcome in pregnancies at risk for intrauterine growth retardation. Obstet Gynecol. 1988. 71:742–746.
Article
20. Gaziano EP, Knox H, Ferrera B, Brandt DG, Calvin SE, Knox GE. Is it time to reassess the risk for the growth-retarded fetus with normal Doppler velocimetry of the umbilical artery? Am J Obstet Gynecol. 1994. 170:1734–1741. discussion 1741-3.
Article
21. Malhotra N, Chanana C, Kumar S, Roy K, Sharma JB. Comparison of perinatal outcome of growth-restricted fetuses with normal and abnormal umbilical artery Doppler waveforms. Indian J Med Sci. 2006. 60:311–317.
Article
22. Burke G, Stuart B, Crowley P, Scanaill SN, Drumm J. Is intrauterine growth retardation with normal umbilical artery blood flow a benign condition? BMJ. 1990. 300:1044–1045.
Article
23. Nienhuis SJ, Vles JS, Gerver WJ, Hoogland HJ. Doppler ultrasonography in suspected intrauterine growth retardation: a randomized clinical trial. Ultrasound Obstet Gynecol. 1997. 9:6–13.
Article
24. Ott WJ. Intrauterine growth restriction and Doppler ultrasonography. J Ultrasound Med. 2000. 19:661–665. quiz 667.
Article
25. Baschat AA, Weiner CP. Umbilical artery doppler screening for detection of the small fetus in need of antepartum surveillance. Am J Obstet Gynecol. 2000. 182(1 Pt 1):154–158.
Article
26. McCowan LM, Harding JE, Roberts AB, Barker SE, Ford C, Stewart AW. A pilot randomized controlled trial of two regimens of fetal surveillance for small-for-gestational-age fetuses with normal results of umbilical artery doppler velocimetry. Am J Obstet Gynecol. 2000. 182(1 Pt 1):81–86.
Article
27. McCowan LM, Harding JE, Stewart AW. Umbilical artery Doppler studies in small for gestational age babies reflect disease severity. BJOG. 2000. 107:916–925.
Article
28. Figueras F, Eixarch E, Meler E, Iraola A, Figueras J, Puerto B, et al. Small-for-gestational-age fetuses with normal umbilical artery Doppler have suboptimal perinatal and neurodevelopmental outcome. Eur J Obstet Gynecol Reprod Biol. 2008. 136:34–38.
Article
29. Baschat AA, Galan HL, Bhide A, Berg C, Kush ML, Oepkes D, et al. Doppler and biophysical assessment in growth restricted fetuses: distribution of test results. Ultrasound Obstet Gynecol. 2006. 27:41–47.
Article
30. Spinillo A, Montanari L, Bergante C, Gaia G, Chiara A, Fazzi E. Prognostic value of umbilical artery Doppler studies in unselected preterm deliveries. Obstet Gynecol. 2005. 105:613–620.
Article
Full Text Links
  • YMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr