The clinical impact of absent or reversed end-diastolic velocity in the umbilical artery before the 34th week of pregnancy

Rhee, Yun Ee; Hong, Dal Soo

Abstract

OBJECTIVE
To investigate the clinical impact of absent or reversed end-diastolic (ARED) umbilical artery flow detected before the 34th week of pregnancy in high-risk pregnancies.
METHODS
Fifty-eight singleton pregnant women with high-risk factors were included in this retrospective study. Based on the umbilical artery Doppler finding, pregnant women were divided into 3 groups: group 1 (12 subjects) with normal Doppler systolic/diastolic (S/D) ratios; group 2 (30 subjects) with significant abnormal umbilical artery S/D ratios, and group 3 (16 subjects) with ARED flow in the umbilical artery between the 25+0 and 33+6 gestational weeks. Incidence of intrauterine growth retardation (IUGR) and pregnancy-induced hypertension, detection week, diagnosis-to-delivery interval, birth weight and gestational ages at delivery, Apgar scores, emergency cesarean section, neonatal intensive care unit (NICU) admission, admission-to-discharge interval, perinatal mortality (PNM) and morbidity, and neonatal morbidity were registered. Perinatal outcomes were assessed. The data was analyzed using the Mann-Whitney U-test and X-square test. A significant difference was considered present if p was<0.05.
RESULTS
The PNM in group 3 in the study was 25% (4/16). Sixteen had ARED flow. Our study shows that fetuses with ARED flow tend to be more severely growth-retarded. Our results also show ARED flow to be associated with poor perinatal outcome. There was a higher incidence of cesarean section for fetal distress, neonatal intensive care unit admission, and lower Apgar scores. Birth weight and gestational age at delivery were lower. The diagnosis-to-delivery interval was shorter. The admission-to-discharge interval was longer.
CONCLUSION
An early ARED finding before the 34th week in the umbilical artery is a very serious sign of likely fetal compromise. The perinatal mortality and morbidity rate were high, and there was evidence of acute or chronic hypoxia in most fetuses. It is an indication that extremely careful surveillance should be followed but not necessarily an indication for an emergency delivery.