Umbilical artery flow velocity waveforms in fetuses dying with congenital anomalies

Abstract

Summary. Absent or reversed diastolic component in umbilical artery (UA) flow velocity waveform was observed in eight fetuses with major malformations. Because of the uncorrectable fetal conditions or the parents' reluctance to terminate the pregnancy, no interventions were undertaken and eventually all eight fetuses died in utero. The interval between the abnormal waveform recording and fetal death was between 1 and 7 days (mean 3.6 days). In two fetuses with abnormal diastolic flow, analysis of umbilical vein blood obtained by ultrasound‐guided sampling revealed moderately severe acidosis and hypoxia (pH 7.228 and 7.241, Pco2 47.5 and 46.9 mmHg; Po2 14.6 and 14.7 mmHg, respectively). Our observation suggests that once the diastolic component of UA flow velocity waveforms becomes absent or reversed, the fetus is in a state of hypoxia and acidosis and fetal death is impending. This limited experience may help in formulating clinical management when using UA flow velocity waveforms in the monitoring of high‐risk fetuses.

Pregnancy screening by Doppler uteroplacental and umbilical artery waveforms

“…The details of these pregnancies are summarized in Table 3. Although previous reports of this finding have shown a close association with fetal and neonatal death (Hsieh et al 1988) all babies but one were born in good condition. The exception had an Apgar score of only 1 at 1 min following cord prolapse and breech extraction; the Apgar score was 7 at 5 min and the baby did well subsequently.…”

“…Forward blood flow in the umbilical artery is normally found throughout the cardiac cycle from early in the second trimester, and absence of end diastolic flow has been associated with severe fetal compromise and high perinatal mortality in pregnancies identified as being at high risk (Hsieh et al 1988;Woo et al 1987). Although this pattern was seen in two pregnancies which resulted in the birth of SGA babies (Table 3), there were no losses.…”

Impact of reverse end-diastolic flow velocity in umbilical artery on pregnancy outcome after the 28th gestational week

“…However, REDFV may be encountered in fetuses with congenital malformations or chromosomal abnormalities (16,24). Hsieh et al (25) have reported seven cases of AEDFV and one case of REDFV with chromosomal or congenital anomalies, which died within 7 days with an average of 3.6 days. Because these abnormal fetuses will die in utero or soon after delivery and the infants born before 28 weeks of gestation are often extremely small with high mortality and morbidity, we need to emphasize and discuss pregnancy outcome in singleton, normal fetuses of more than 28 gestational weeks having REDFV.…”

Plazentamorphometrie: Auffälligkeiten der Endzotten bei Fällen mit einem enddiastolischen „Reverse Flow” in der Umbilikalarterie/fetalen Aorta

“…Feten mit einem ¹Reverse Flowª in der A. umbilicalis und/oder Aorta fetalis stellen eine hochgefährdete Risikogruppe mit erhöhter Mortalität von 35 ± 100 % und erheblicher Morbidität der Neugeborenen dar [1,4,5]. Bei diesen Fällen tritt ein intrauteriner Fruchttod besonders häufig auf [4,6,7]. Auch eine gehäufte neonatale Azidoserate wird beobachtet [2,4].…”