Short- and Long-Term Growth as a Function of Abnormal Doppler Flow in Growth-Restricted Fetuses

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Abstract

OBJECTIVES: To evaluate short- and long-term growth in fetuses with growth restriction (FGR) and elevated umbilical artery Doppler (UAD) systolic/diastolic (S/D) ratios.

METHODS: In this prospective observational study, two UAD waveforms were obtained from each umbilical artery weekly and were classified as normal or abnormal. Fetal growth was assessed every 3 weeks. Short-term growth was calculated from the first visit with elevated ratios until next growth assessment. Results were grouped by number of initial elevated S/D ratios (maximum, 4). Long-term growth was evaluated by change in estimated fetal weight from diagnosis of FGR to birth weight. Fetuses were grouped by average number of elevated S/D ratios and compared to a reference population of growth restricted fetuses with normal testing.

RESULTS: Of 241 fetuses evaluated, 105 demonstrated elevated S/D ratios. Short-term growth was impaired when fetuses had elevated S/D ratios. Long-term growth was affected when the average number of elevated S/D ratios was ≥1 per visit. Progressive 3 or 4 growth delay was noted as the average number of abnormal S/D ratios increased.

CONCLUSIONS: Short- and long-term fetal growth are affected by elevated UAD S/D ratios. Fetuses with more abnormal values initially and those with a higher average of elevated values over pregnancy demonstrate decreased growth.

1. Bruner JP, Levy DW, Arger PH. Doppler ultrasonography of the umbilical cord in complicated pregnancies. South Med J [Internet]. 1993 [cited 10/25/2012];86(4):418-22

2. Baschat AA, Weiner CP. Umbilical artery doppler screening for detection of the small fetus in need of antepartum surveillance. Am J Obstet Gynecol [Internet]. 2000 Jan;182(1 Pt 1):154-8

3. Baschat AA. Doppler application in the delivery timing of the preterm growth-restricted fetus: Another step in the right direction. Ultrasound Obstet Gynecol [Internet]. 2004 Feb;23(2):111-8

4. Giles W, Bisits A. Clinical use of doppler ultrasound in pregnancy: Information from six randomised trials. Fetal Diagn Ther [Internet]. 1993 Jul-Aug;8(4):247-55

5. Alfirevic Z, Neilson JP. Doppler ultrasonography in high-risk pregnancies: Systematic review with meta-analysis. Am J Obstet Gynecol [Internet]. 1995 May;172(5):1379-87.

6. Alfirevic Z, Stampalija T, Gyte GM. Fetal and umbilical doppler ultrasound in high-risk pregnancies. Cochrane Database Syst Rev [Internet]. 2013 Nov 12;11:CD007529

7. Society for Maternal-Fetal Medicine Publications Committee, Berkley E, Chauhan SP, Abuhamad A. Doppler assessment of the fetus with intrauterine growth restriction. Am J Obstet Gynecol [Internet]. 2012 Apr;206(4):300-8

8. Unterscheider J, Daly S, Geary MP, et al. Optimizing the definition of intrauterine growth restriction: The multicenter prospective PORTO study. Am J Obstet Gynecol [Internet]. 2013 Apr;208(4):290.e1,290.e6

9. Acharya G, Wilsgaard T, Berntsen GK, Maltau JM, Kiserud T. Reference ranges for serial measurements of umbilical artery doppler indices in the second half of pregnancy. Am J Obstet Gynecol [Internet]. 2005 Mar;192(3):937-44

10. Dahlke JD, Mendez-Figueroa H, Maggio L, Albright CM, Chauhan SP, Wenstrom KD. Early term versus term delivery in the management of fetal growth restriction: A comparison of two protocols. Am J Perinatol [Internet]. 2015 May;32(6):523-30

11. Wen SW, Goldenberg RL, Cutter GR, et al. Smoking, maternal age, fetal growth, and gestational age at delivery. Am J Obstet Gynecol [Internet]. 1990 Jan;162(1):53-8

12. Wang X, Zuckerman B, Pearson C, et al. Maternal cigarette smoking, metabolic gene polymorphism, and infant birth weight. JAMA [Internet]. 2002 Jan 9;287(2):195-202

13. Dolkart LA, Reimers FT, Kuonen CA. Discordant umbilical arteries: Ultrasonographic and doppler analysis. Obstet Gynecol [Internet]. 1992 Jan;79(1):59-63

14. Raio L, Ghezzi F, Di Naro E, Gomez R, Saile G, Bruhwiler H. The clinical significance of antenatal detection of discordant umbilical arteries. Obstet Gynecol [Internet]. 1998 Jan;91(1):86-91

15. Predanic M, Perni SC. Antenatal assessment of discordant umbilical arteries in singleton pregnancies. Croat Med J [Internet]. 2006 Oct;47(5):701-8

16. Predanic M, Kolli J, Yousefzadeh P, Pennisi J. Disparate blood flow patterns in parallel umbilical arteries. Obstet Gynecol [Internet]. 1998 May;91(5 Pt 1):757-60

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