Importance of Ductus venosus Doppler Assessment for Fetal Outcome in Cases of Intrauterine Growth Restriction

Abstract

Objective: The measurement and evaluation of ductus venosus (DV) blood flow velocity waveform in high-risk pregnancies has been studied intensively in recent years in order to find a more intermediate signal of fetal compromise. Our objective was to study the fetal outcome of pregnancies with intrauterine growth retardation (IUGR) and normal pulsatility of DV compared to an IUGR group with increased DV pulsatility. Methods: The outcome of 42 fetuses before 32 weeks of gestational age without chromosomal or structural aberrations was analyzed. All fetuses showed IUGR <5th percentile based on placental insufficiency diagnosed by pathologic RI >90th percentile of both maternal uterine arteries. One group (30 fetuses; mean weight 730 g/SD 190 g; mean gestational age 197 days/SD 12 days) showed normal, the other (12 fetuses, mean weight 675 g/SD 179 g; mean gestational age 198 days/SD 12 days) reduced, but neither absent nor reverse DV flow during atrial contraction. All 42 fetuses were delivered by cesarean section because of severe variable or prolonged decelerations. We measured blood flow velocities of the DV in every fetus on an average 3.7 days (range 1–5 days) before cesarean section. Fetal outcome was determined by Apgar scores after 5 and 10 min, arterial pH and base excess; neonatal morbidity was recorded by intensive follow-up. Results: There were no significant differences of pH, umbilical artery base excess, Apgar scores and severe neonatal complications between the two groups. Conclusions: Our own data show no correlation between increased pulsatility in the DV (without absent or reverse flow during atrial contraction) and fetal outcome before 32 gestational weeks, even in cases of severe growth restriction based on placental insufficiency. Therefore in these cases reduced DV flow during atrial contraction should cautiously be interpreted regarding obstetrical decisions.

Fetal Hemodynamics and Fetal Growth Indices by Ultrasound in Late Pregnancy and Birth Weight in Gestational Diabetes Mellitus

“…Many domestic and international studies have focused on studying values of the UA or MCA for predicting preeclampsia, intrauterine growth retardation, fetal distress, and other poor outcomes of pregnancy. [141516] However, these studies have produced inconsistent results. A study of prediction of birth weight in infants born to mothers with GDM showed that serum hemoglobin levels in pregnant women with GDM were a predictive index of birth weight.…”

Survey on the Current Trends in Managing Intrauterine Growth Restriction

“…Observational studies have identified venous Doppler as the best predictor of acidemia, with OR 5.68 (95% CI 1.67-19.32) for an increased DV PI for veins, compared to OR of 2.12 (95% CI 0.66-6.83) for AEDV/REDV in the UA [34,35]. On the basis of GRIT study [6] and the findings that perinatal mortality increases from 12% in fetuses with AEDV/REDV in the UA to 39% when DV PIV is increased, it might seem reasonable to recommend delivery when the DV Doppler becomes abnormal, provided the fetus is considered viable [7,36,37,38]. Particularly reversal of the A-wave in DV results in exponentially increased risk for intrauterine fetal demise and there is a good body of evidence that delivery should be effectuated promptly [35,39,40,41].…”

Ultrasound and fetal diagnosis

“…Significant changes in STV (lower) and ductus venosus Doppler pulsatility index (higher) were present 1-0 days before birth in the group with adverse perinatal outcome (perinatal death, intracerebral hemorrhage or bronchopulmonary dysplasia), whereas only abnormalities in venous Doppler velocimetry were present 2-7 days prior to delivery. The results suggest that Doppler velocimetry of the ductus venosus is a better predictor of perinatal outcome within 2-7 days of delivery, although other investigators [95 ] have found that a high pulsatility per se (without absent or reversed flow) did not correlate with outcome in fetuses of less than 32 weeks of gestation. Further studies are under way to determine whether the use of Doppler venous velocimetry can be used to better time the delivery of growth-restricted fetuses and thereby reduce perinatal morbidity and mortality.…”