Korean J Perinatol.  2014 Jun;25(2):91-94. 10.14734/kjp.2014.25.2.91.

Discrepancy between Non-stress Test Result and Umbilical Artery Doppler Study in a Pregnancy Complicated by Diabetes; A Case Report

• Jang JA
• Choi YJ
• Park JW
• Chun KC
• Kim YA
• Koh JW

• KMID: 2280959
• DOI: http://doi.org/10.14734/kjp.2014.25.2.91

Abstract

Pregestational diabetes is a well-known risk factor for perinatal mortality, and regarded as an important cause of stillbirth. Unfortunately, more than half of stillbirths remain unexplained. Nevertheless, there is no consensus regarding the optimal timing and content of antepartum testing in pregnancies complicated by diabetes. A 32-year-old primigravida presented with diabetes diagnosed during pregnancy. Antenatal fetal surveillance tests including nonstress test, biophysical profile, and Doppler waveforms of umbilical arteries were performed twice weekly, beginning at 32 weeks gestation. At 37(+4) weeks' gestation, a discrepancy in the surveillance test results arose when reversed end-diastolic flow in the umbilical arteries was seen, despite a reactive nonstress test. A male baby was delivered by cesarean section. The umbilical arterial pH at delivery was 7.171. Antenatal fetal surveillance in pregnancies complicated by diabetes should include evaluation of Doppler waveforms in the umbilical vessels, regardless of the presence or absence of maternal vasculopathy.

Keyword

Pregestational diabetes; Unexplained fetal demise; Antenatal fetal surveillance

MeSH Terms

Adult
Cesarean Section
Consensus
Female
Humans
Hydrogen-Ion Concentration
Male
Perinatal Mortality
Pregnancy*
Risk Factors
Stillbirth
Umbilical Arteries*

Figure

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  Fig. 1. Results of antepartum fetal surveillance at 37+4 weeks’ gestation: (A) Normal nonstress test; (B) Doppler waveforms with absent end-diastolic flow velocity in the umbilical artery.

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  Fig. 2. (A) Nonstress test result and (B) Doppler waveforms with reversed end-diastolic flow velocity in the umbilical artery six hours after the initial Doppler study.

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