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Doppler, Cardiotocography, and Biophysical Profile Changes in Growth-Restricted Fetuses

From the Departments of ¹Gynecological Science and Human Reproduction, Section of Maternal Fetal Medicine, University of Padua School of Medicine, Padova, Italy; ²Obstetrics and Gynecology, La Sapienza, University of Rome, Rome, Italy; ³Obstetrics and Gynecology, University of Sassari, Sassari, Italy; and ⁴Obstetrics and Gynecology, Wayne State University, Detroit, Michigan.

OBJECTIVE: To assess from diagnosis to delivery the Doppler studies of the umbilical artery, middle cerebral artery, umbilical vein, ductus venosus, and amniotic fluid index of fetuses with idiopathic growth restriction.

METHODS: A total of 145 singleton growth-restricted fetuses with abnormal umbilical artery pulsatility indexes were studied. Cesarean delivery was performed because of abnormal biophysical profile or nonreassuring fetal heart rate pattern.

RESULTS: There were 4 fetal and 50 neonatal deaths. Two growth-restricted groups were identified: Group A (n = 44) included fetuses in whom all measures became abnormal preceding an abnormal biophysical profile or nonreassuring nonstress test. Group B (n = 101) included fetuses in whom 1 or more measures were normal at the time of cesarean delivery. There was no statistically significant difference in perinatal morbidity and mortality between the 2 groups. Neonatal death was increased in fetuses with umbilical artery reversed flow (odds ratio 2.34, 95% confidence interval 1.16–4.73; P < .05) and ductus venosus reversed flow (odds ratio 4.18, 95% confidence interval 2.01–8.69; P < .05). A significant correlation was also found between low birth weight and adverse perinatal outcome.

CONCLUSION: In fetuses with idiopathic growth restriction, 1) low birth weight, 2) umbilical artery reversed flow, and 3) ductus venosus absent or reversed flow are associated with an increased perinatal morbidity and mortality.

LEVEL OF EVIDENCE: II-2

This article has been cited by other articles:

				G. Mari, F. Hanif, K. Drennan, and M. Kruger Staging of Intrauterine Growth-Restricted Fetuses J. Ultrasound Med., November 1, 2007; 26(11): 1469 - 1477. [Abstract] [Full Text] [PDF]

				G. Mari, F. Hanif, M. C. Treadwell, and M. Kruger Gestational Age at Delivery and Doppler Waveforms in Very Preterm Intrauterine Growth-Restricted Fetuses as Predictors of Perinatal Mortality J. Ultrasound Med., May 1, 2007; 26(5): 555 - 559. [Abstract] [Full Text] [PDF]